Resting salivary flow independently associated with oral malodor.

BACKGROUND: Dryness of the oral cavity is considered one cause of oral malodor. However, it is unclear which of the factors regulating the wetness of the oral cavity are involved in oral malodor development. This study investigated the effects of salivary flow and oral mucosal moisture on oral malodor. METHODS: The study population comprised 119 patients (48 men and 71 women, mean age of 50.6 ± 15.4 years) with complaint of oral malodor. After the oral malodor level had been evaluated by the organoleptic test and gas chromatography, the rates of stimulated saliva and resting saliva and the moisture levels of the tongue and buccal mucosa were measured. The plaque index, bleeding on pocket probing, probing pocket depth, and tongue coating score were also assessed. Strong oral malodor was defined as an organoleptic test score of ≥3. RESULTS: The flow rate of resting saliva in women was significantly lower than in men. The flow rate of resting saliva and the moisture levels of the tongue and buccal mucosa showed significant negative correlations with age. The flow rate of resting saliva was significantly lower in patients with strong oral malodor than in those with no or weak oral malodor. The flow rate of stimulated saliva and the moisture levels of the tongue and buccal mucosa had no relationship with strong oral malodor. Logistic regression analysis showed that a ≥5-mm probing pocket depth with bleeding on pocket probing, an increased tongue coating score, and decreased resting salivary flow were strong explanatory factors in clinical findings for oral malodor. CONCLUSION: This study suggests that the flow rate of resting saliva is a significant modulating factor for oral malodor.

VDR gene polymorphisms, interaction with smoking and risk of periodontal disease in Japanese women: the Kyushu Okinawa maternal and child health study.

Epidemiological evidence on the relationship between vitamin D receptor (VDR) polymorphisms and periodontal disease is inconsistent. We investigated associations between four VDR single-nucleotide polymorphisms (SNPs) including rs731236 (TaqI), rs7975232 (ApaI), rs1544410 (BsmI) and rs2228570 (FokI), and the risk of periodontal disease among young Japanese women. Cases included 131 women who had at least one tooth with a probing depth of 3.5 mm or deeper. Controls included 1019 women without periodontal disease. Adjustment was made for age, region of residence, education, toothbrushing frequency and use of an interdental brush. Compared with the AA genotype of SNP rs731236, the GG genotype had a significantly increased risk of periodontal disease: the adjusted OR was 3.68 (95% confidence interval: 1.06-12.78). There were no significant relationships between SNPs rs7975232, rs1544410 or rs2228570 and periodontal disease. None of the haplotypes were significantly related to periodontal disease. Compared with subjects with the AA or AG genotype of SNP rs731236 who had never smoked, those with the GG genotype who had ever smoked had a significantly increased risk of periodontal disease; nevertheless, neither multiplicative nor additive interaction was significant. The additive interaction between SNP rs7975232 and smoking was significant, although the multiplicative interaction was not statistically significant. No multiplicative or additive interactions were observed between the other SNPs and smoking. Our results indicated that VDR SNP rs731236 might be associated with periodontal disease. In addition, we present new evidence for a biological interaction between VDR SNP rs7975232 and smoking that affects periodontal disease.

Active and passive smoking and prevalence of periodontal disease in young Japanese women.

BACKGROUND AND OBJECTIVE: Studies reporting on the association between smoking and periodontal disease have mostly focused on active smoking. The purpose of this study was to examine the relationships between active smoking and exposure to second-hand smoke at home and at work and the prevalence of periodontal disease among young Japanese women. MATERIAL AND METHODS: Study subjects were 1167 postpartum women with a mean age of 31.5 years. Information on smoking and potential confounding factors was obtained through a self-administered questionnaire. Partial-mouth recording was used to determine probing pocket depth at six sites per tooth for six teeth in the mouth. Periodontal disease was defined as positive if a woman had at least one tooth with a probing pocket depth of 3.5 mm or deeper. Adjustment was made for age, region of residence, household income, education, toothbrushing frequency and use of an interdental brush. RESULTS: Compared with never smoking, ever smoking was independently positively associated with the prevalence of periodontal disease: the adjusted odds ratio was 1.56 (95% confidence interval: 1.02-2.36). There was a marginally significant positive dose-response relationship between pack-years of smoking and the prevalence of periodontal disease (p for linear trend = 0.08). No material associations were observed between second-hand smoke exposure at home or at work and periodontal disease. CONCLUSION: Our findings suggest that active smoking, but not passive smoking, might be associated with an increased prevalence of periodontal disease among young women in Japan.

Long-term effect of xylitol gum use on mutans streptococci in adults.

Many studies have shown the effects of chewing xylitol gum on mutans streptococci (MS) over short- and long-term periods in children; however, few studies have addressed long-term periods in adults. The objective of this investigation was to examine for 6 months the effects of chewing xylitol gum on MS in saliva and plaque in 127 adults (mean age 28.0 years). The participants were assigned to three groups according to gum type, in part taking preference for flavor into account and in part at random: xylitol (XYL), maltitol (MAL) and control (CR); 33, 34 and 27 subjects in each group, respectively, completed the trial. Daily gum use of the XYL and MAL groups was 7.9 and 7.1 g, respectively. MS levels, which declined significantly in saliva (p < 0.05) and plaque (p < 0.001) in the XYL group after 6 months, exhibited a significant increase in plaque in the MAL group (p < 0.001). Differences in relative changes of MS levels in plaque during the experimental period were significant between the XYL group and the CR (p < 0.05) and MAL groups (p < 0.001). Differences in relative change of amount of plaque during the experimental period were not statistically significant between the groups. The present study demonstrated that chewing xylitol gum for 6 months continued to inhibit the growth of mutans streptococci in adults.

Apparent partial remission of breast cancer in 'high risk' patients supplemented with nutritional antioxidants, essential fatty acids and coenzyme Q10.

Thirty-two typical patients with breast cancer, aged 32-81 years and classified 'high risk' because of tumor spread to the lymph nodes in the axilla, were studied for 18 months following an Adjuvant Nutritional Intervention in Cancer protocol (ANICA protocol). The nutritional protocol was added to the surgical and therapeutic treatment of breast cancer, as required by regulations in Denmark. The added treatment was a combination of nutritional antioxidants (Vitamin C: 2850 mg, Vitamin E: 2500 iu, beta-carotene 32.5 iu, selenium 387 micrograms plus secondary vitamins and minerals), essential fatty acids (1.2 g gamma linolenic acid and 3.5 g n-3 fatty acids) and Coenzyme Q10 (90 mg per day). The ANICA protocol is based on the concept of testing the synergistic effect of those categories of nutritional supplements, including vitamin Q10, previously having shown deficiency and/or therapeutic value as single elements in diverse forms of cancer, as cancer may be synergistically related to diverse biochemical dysfunctions and vitamin deficiencies. Biochemical markers, clinical condition, tumor spread, quality of life parameters and survival were followed during the trial. Compliance was excellent. The main observations were: (1) none of the patients died during the study period. (the expected number was four.) (2) none of the patients showed signs of further distant metastases. (3) quality of life was improved (no weight loss, reduced use of pain killers). (4) six patients showed apparent partial remission.

Effect of topical application of coenzyme Q10 on adult periodontitis.

Topical application of Coenzyme Q10 (CoQ10) to the periodontal pocket was evaluated with and without subgingival mechanical debridement. Ten male patients with adult periodontitis participated and 30 periodontal pockets were selected. During the first 3 weeks, the patients did not receive any periodontal therapy except the topical application of CoQ10. After the first 3-week period, root planning and subgingival scaling were performed in all sites. CoQ10 was applied in 20 of the pockets once a week for a period of 6 weeks. Soybean oil was applied to the remaining 10 sites as a control. In the first 3-week period, significant reductions in gingival crevicular fluid flow, probing depth and attachment loss were found only at experimental sites. After mechanical subgingival debridement, significant decreases in the plaque index, gingival crevicular fluid flow, probing depth and attachment loss were found both at experimental and control sites. However, significant improvements in the modified gingival index, bleeding on probing and peptidase activity derived from periodontopathic bacteria were observed only at experimental sites. These results suggest that topical application of CoQ10 improves adult periodontitis not only as a sole treatment but also in combination with traditional nonsurgical periodontal therapy.

Mitochondrial myopathy with anemia, cardiomyopathy, and lactic acidosis: a distinct late onset mitochondrial disorder.

A 40-year-old woman presented with profound muscle weakness resulting in failure to wean from a ventilator and persistent lactic acidosis after having recovered from a pneumonia complicated by adult respiratory distress syndrome, myocardial infarction, renal failure and shock. She had a 28 year history of chronic anemia and exercise intolerance. Anemia and thrombocytopenia persisted after admission. Nonobstructive hypertrophic cardiomyopathy was present. A stroke-like episode occurred. A mitochondrial myopathy with deficiencies in complexes IV and II was demonstrated, but no DNA defect has yet been found. This patient represents a distinct clinical presentation of a mitochondrial disorder characterized by late onset mitochondrial myopathy, chronic anemia, cardiomyopathy, and lactic acidosis.

Inhibition of coaggregation between Porphyromonas gingivalis and Streptococcus oralis by fibrinogen fragments.

The localization of regions of fibrinogen that inhibit coaggregation between Porphyromonas gingivalis and Streptococcus oralis was investigated. The coaggregation was inhibited by A alpha and gamma chains, but not by B beta chain. The inhibitory activity of fragment D was more potent than that of fragment E. Some cyanogen bromide-treated fragments isolated from A alpha and gamma chains including the NH2-terminal 148-207 amino acid residues of A alpha chain (A alpha 148-207) and gamma 1-78 showed inhibitory activities. A alpha 148-207 was further digested with lysyl endopeptidase. A alpha 158-176 and A alpha 192-206 which contained four and two arginine residues, respectively, retained the inhibitory activities. When the arginine residues of these two peptides were modified by phenylglyoxal, the inhibitory activities were much reduced. These findings suggest that the arginine residues of some specific regions of fibrinogen may play an important role in the inhibition of the coaggregation.

Interaction of Porphyromonas gingivalis with transferrin.

In this study, we characterized the binding of transferrin to Porphyromonas gingivalis using a classical receptor-binding assay, and examined the relationship between the binding and availability of transferrin for the growth of P. gingivalis. The binding of 125I-labeled human transferrin to P. gingivalis occurred rapidly, reversibly and specifically. Scatchard analysis yielded a Kd of 1.37 +/- 0.16 microM and an apparent number of 1.13 +/- 0.26 x 10(5) receptors per cell. The binding of transferrin was much increased when organisms were grown in iron-limited conditions. Among the species of black-pigmented anaerobic.rods, those strains of P. gingivalis which had high transferrin-binding activity exhibited unrestricted growth following the addition of transferrin to the hemin-free culture medium. On the other hand, the presence of transferrin in the culture medium did not support unrestricted growth of organisms that had low transferrin-binding activity. These results suggest that the binding of transferrin to P. gingivalis cells may be a preliminary step in iron acquisition, which allows them to survive in the healthy periodontal environment.

Effect of concentration of compounds containing iron on the growth of Porphyromonas gingivalis.

We examined the effect of the concentration of various types of iron molecules on the regulation of growth of Porphyromonas gingivalis. Bacterial growth was monitored spectrophotometrically. The hemin-depleted cells of P. gingivalis 381 were incubated in the basal medium plus test substrates such as hemoglobin, hemin, transferrin and various inorganic iron compounds. The relationship between the specific growth rate of organisms and the concentration of iron-containing compounds was determined. The value of Ks, a parameter analogous to the Michaelis-Menten constant, was estimated. P. gingivalis 381 showed a Ks value of 3.85, 4.91 and 0.0017 microM for hemin, transferrin and hemoglobin, respectively. However, the inorganic iron compounds tested did not support growth of P. gingivalis. These findings suggest that P. gingivalis utilizes hemoglobin as an iron source much more effectively than other iron-containing compounds under an iron-limited environment.

Changes in oxygen consumption in dog gingiva during induction of experimental periodontitis.

The purpose of this study was to examine changes in oxygen consumption in dog gingiva during induction of experimental periodontitis. The disease was induced in adult mongrel dogs during a 16-week period by placement of silk ligatures around selected teeth. The oxygen consumption rate of gingival tissue was determined in vivo by a non-invasive technique, tissue reflectance spectrophotometry. Changes in such clinical parameters as gingival index, plaque index, pocket depth, attachment level, and gingival crevicular fluid flow indicated acute inflammatory responses during the first three weeks after ligation, followed by the appearance of chronic inflammation during the remaining 13 weeks. The oxygen consumption rate increased during the first seven days after ligation and stayed near the maximum level for 2-7 weeks; this was followed by a gradual decrease during the final nine weeks. These results suggest that gingival oxygen consumption increases rapidly with the increase of acute inflammation responses and then decreases slightly with the gradual development of chronic inflammation. Positive correlations were observed between the oxygen consumption rate and other clinical indices. Thus, the tissue reflectance spectrophotometry is a new, useful method for objective, quantitative, and non-invasive assessment of gingival oxygen consumption.

Changes in hemoglobin concentration and oxygen saturation in human gingiva with decreasing inflammation.

The purpose of this study was to determine if functional changes in the human gingival vasculature were reversible following the resolution of gingival inflammation. Ten patients with 40 inflamed gingival sites were evaluated before and 2 weeks after the completion of treatment. We determined the hemoglobin concentration and the oxygen saturation of hemoglobin at each site by tissue reflectance spectrophotometry. With the use of treatment including motivation, oral hygiene instruction, and scaling, clinical parameters such as the gingival and plaque indices, the Periotron score, and the probing depth were altered toward a healthier state. With the resolution of gingival inflammation, the increased hemoglobin concentration and decreased oxygen saturation in the inflamed gingiva were restored to normal levels. These findings suggest that reversible changes in the local hemoglobin concentration and oxygen saturation are associated with decreasing gingival inflammation in human subjects.

Association of oxygen tension in human periodontal pockets with gingival inflammation.

The objective of this study was to investigate the association of the oxygen tension in the periodontal pockets with clinical parameters of gingival inflammation of the maxillary anterior teeth of 32 patients. The pocket oxygen tension (pO2) was measured by a polarographic method with electronic compensation for temperature change. The oxygen saturation of hemoglobin (SO2) in the gingiva was determined with tissue reflectance spectrophotometry. Gingival crevicular fluid flow (GCF) was measured with electronic impedance. No significant association was found between pocket pO2 and the modified gingival index, the plaque index, and GCE Pocket pO2 showed significant correlation with probing depth (r = -0.57, P = 0.0005). Significant correlation was observed between pocket pO2 and gingival SO2 (r = 0.69, P < 0.0001). When all variables were entered into a multiple regression model, only gingival SO2 had a significant independent effect on the pocket pO2 (P = 0.0005). These results indicate that the oxygen sufficiency in the gingiva has a significant independent influence on the pocket oxygen tension. These studies provide the basis for understanding the oxygen tension in the periodontal pocket, which likely is a major determinant of the subgingival microflora. The studies may also lead to the development of methods for diagnosing and monitoring periodontal diseases.

Pocket oxygen tension in smokers and non-smokers with periodontal disease.

BACKGROUND: Smoking is associated with destructive periodontal disease. Pocket oxygen tension (pO2) is likely to be a major environmental determinant of the subgingival microflora, which is a primary etiological factor of the disease. This study aimed to compare the pocket pO2 in smokers and non-smokers with periodontal disease. METHODS: Pocket oxygen tension was compared in 27 smokers and 34 non-smokers by considering 2 confounding factors, probing depth and oxygen saturation of hemoglobin (S(O2)), in the gingiva. The pO2 was determined using oxygen microelectrode by polarographic method with an electronic compensation circuit for subgingival temperature. Gingival S(O2) was determined using tissue reflectance spectrophotometry. RESULTS: No significant difference was found in the modified gingival index and the plaque index between smokers and non-smokers. The pO2 was significantly lower in smokers (21.9+/-9.6 mmHg) than in non-smokers (33.4+/-8.4 mmHg). The difference was highly significant (P <0.0001) and was consistent when the confounding factors were considered. Correlation between the PO2 and probing depth approached statistical significance in smokers (r = -0.36, P = 0.0674) and significance in non-smokers (r = -0.41, P = 0.0174). Correlation of the PO2 to the gingival S(O2) was highly significant in non-smokers (r = 0.57, P = 0.0005), but no association was found in smokers (r = -0.08, P= 0.6975). CONCLUSIONS: These findings indicate that pO2 is lower in smokers than in non-smokers, and that the pO2 in smokers is not influenced by gingival oxygen sufficiency. The present study may provide the basis of understanding environmental factors possibly associated with microbial flora in the pockets of smokers.

Oxygen sufficiency in the gingiva of smokers and non-smokers with periodontal disease.

BACKGROUND: Epidemiological studies have demonstrated deteriorating effects of smoking on periodontal tissue. The aims of this study were to compare oxygen saturation of hemoglobin in the gingiva (GSo2) of smokers and non-smokers and to evaluate the chronic effect of smoking on gingival oxygen sufficiency. METHODS: GSo2 was determined using tissue reflectance spectrophotometry in 110 papillary gingival sites of 62 smokers and 100 sites of 60 non-smokers. RESULTS: No significant difference was found in GSo2 between smokers and non-smokers. In the model of ANOVA with covariates, age (P= 0.0048) and probing depth (P= 0.0012) had significant effects on GSo2. No significant effect was found in either smoking status (P= 0.3557) or the modified gingival index (MGI) (P= 0.3824). The interaction effect between smoking status and the MGI was highly significant (P = 0.0003) indicating that the effect of smoking status on the GSo2 should be compared at each level of the MGI score. GSo2 in healthy gingiva was significantly lower in smokers than non-smokers (P = 0.0014), while smokers showed higher GSo2 than non-smokers in moderately inflamed gingiva (P = 0.0356). The GSo2 in inflamed gingiva was significantly decreased compared with healthy gingiva in non-smokers (P = 0.0044), while smokers showed no significant difference between healthy and inflamed gingiva (P= 0.2772 to 0.8665). GSo2 in smokers was consistently and significantly lower than that of healthy gingiva of non-smokers (P = 0.0391 to 0.0004). CONCLUSIONS: Smokers exhibit possibly lower function of oxygen sufficiency in healthy gingiva and reduced ability to adapt the function in inflamed gingiva than non-smokers. This suggests that smokers have functional impairments in the gingival microcirculation.

Effect of mechanical stimulation by tooth brushing on oxygen tension in dog gingiva.

To determine oxygen tension (pO2) in gingival tissue, an oxygen micro-electrode with a membrane-coated Pt needle was inserted into the gingiva of 12 dogs. Teeth were brushed using a modified Bass technique for 10 s under 200 g pressure. pO2 increased and reached a maximum 15 min after brushing, then gradually returned to the baseline. A significant increase in pO2 persisted for approx. 1 h. These findings suggest that short-term stimulation by tooth brushing increases oxygen tension in the gingiva.

Haemoglobin concentration and oxygen saturation in dog gingiva with experimentally induced periodontitis.

The index of haemoglobin concentration (Hb index) and apparent oxygen saturation (apparent SO2) were determined by a new, non-invasive method, tissue reflectance spectrophotometry. The Hb index was positively correlated with the haemoglobin concentration. The relationship between the apparent SO2 and oxygen partial pressure was a sigmoid curve resembling the haemoglobin oxygen dissociation curve. The Hb index and the apparent SO2 were monitored continuously by tissue reflectance spectrophotometry during the induction of experimental periodontitis with silk ligatures. The Hb index increased rapidly during the first 7 days after ligation and then decreased gradually during the remaining period. The apparent SO2 decreased during the first 7 days but gradually rose during the final 9 weeks. The maximum level of the deoxyhaemoglobin concentration after ligation was elevated about two times over that found before ligation, whereas the increase in oxyhaemoglobin concentration was relatively small. These results suggest that the oxygen supply to inflamed gingiva may increase to some extent, but not sufficiently to compensate for the increased oxygen consumption.

Clinical evaluation of the plaque removal efficacy of three toothbrushes.

A single-blind, randomized triple crossover study was conducted to compare the plaque removal effectiveness of three toothbrushes: Sunstar Do New Type, Reach Compact Head, and New Dental-H. Thirty-three female students were recruited from a dental school and a dental hygiene school. All subjects brushed with a control toothbrush for the first week and with each one of the three test toothbrushes in each subsequent one-week period. Plaque removal efficacy was determined by subtracting the plaque score for the test toothbrush from that of the control toothbrush. The Sunstar Do New Type toothbrush had a significantly (p<0.05) higher plaque removal efficacy than the other two toothbrushes. The differences were prominent on the distal line angle of the second molars. Differences in plaque removal efficacy between the Reach Compact Head and the New Dental-H toothbrushes were not statistically significant (p<0.05) in this study.

Plaque removal efficacy of the V-shaped toothbrush with new designs in bristle arrangement.

Experimental bristle arrangements were applied to a conventional V-shaped bristle-design toothbrush in an effort to improve plaque removal efficacy in interproximal areas. A single-blind cross-over study was performed to evaluate the plaque removal efficacy of this new bristle arrangement by comparing it to either a more conventional V-shaped toothbrush or a flat-headed toothbrush. Plaque removal efficacy was determined by assessing the percentage of plaque score reduction following a single controlled brushing. The new toothbrush bristle arrangement had a significantly higher plaque removal percentage efficacy than both the V-shaped toothbrush (59.1% vs. 48.5%; p = 0.0092) and the flat-headed toothbrush (65.3% vs. 55.3%; p = 0.0260) in interproximal areas. These differences were also consistent with whole mouth comparisons. When the subjects were asked about their preferences for the three different bristle formats used in this study, there was no significant difference of opinion found. These findings indicated a superiority of the new toothbrush to the other two, more conventional toothbrush bristle styles on plaque removal efficacy with these study subjects, but no particular preference for bristle design.

Intensive smoking-cessation intervention in the dental setting.

Smoking exerts detrimental effects on dental treatment and oral health. Our goal was to evaluate effectiveness in terms of the abstinence rate in smoking-cessation intervention delivered by dental professionals. Individuals who were willing to quit smoking were randomly assigned to either an intervention or a non-intervention group. Intensive intervention was provided, consisting of 5 counseling sessions, including an additional nicotine replacement regimen. Reported abstinence was verified by the salivary cotinine level. Thirty-three persons in the intervention and 23 in the non-intervention group started the trial. On an intent-to-treat basis, 3-, 6- and 12-month continuous abstinence rates in the intervention group were 51.5%, 39.4%, and 36.4%, respectively, while the rates in the non-intervention group were consistent at 13.0%. Adjusted odds ratios (95% confidence interval) by logistic stepwise regression analyses were 7.1 (1.8, 28.5), 8.9 (1.7, 47.2), and 6.4 (1.3, 30.7), respectively. Intensive smoking-cessation intervention in the dental setting was therefore effective.