Supportive periodontal therapy for high‐ and low‐risk patients

Aim: The validity of the risk assessment in predicting tooth loss due to periodontitis or disease progression was explored. Methods: Systemic factors, smoking status, bleeding on probing (BoP) percentage, number of residual pockets (probing pocket depth ≥6 mm), tooth loss, and alveolar bone loss in relation to age were the variables of the risk assessment. Based on an improving or deteriorating risk assessment in 2005 compared with 1999, 89 patients were divided into either a high‐ or low‐risk group. Findings were compared with the 2008 outcome. Results: Using BoP ≤ 20% as the cut‐off, the relationship between BoP and interleukin‐1 genotype status was neither significant in 2005 nor in 2008. Neither the high‐ nor low‐risk group was predictive for tooth loss. Patients displayed similar proportions of probing pocket depths ≥6 mm in 2005 and in 2008. Linear stepwise regression analysis demonstrated that only the number of supportive periodontal therapy visits explained the number of teeth lost due to periodontitis (P < 0.01). Conclusions: The categorization of patients into high‐ and low‐risk groups, according to the periodontal risk assessment model applied within a supportive periodontal therapy period of 3 years, had limitations in predicting future tooth loss.     

Experience with anti‐TNF‐α therapy for orofacial granulomatosis

J Oral Pathol Med (2011) 40 : 14–19 Background: Orofacial granulomatosis (OFG) can be challenging to treat and experience with anti‐TNF‐α therapy is limited. We report our experience with infliximab (IFX) and adalimumab (ADA) for OFG in 14 patients, the largest reported series to date. Methods: A review of patients receiving induction and maintenance IFX for OFG +/? Crohn’s disease (CD) for active oral disease failing other therapies was performed. Clinical response defined by global physician assessment, aided by oral disease activity scores, was assessed at 2 months, 1 and 2 years. ADA was considered for patients failing IFX. Adverse events were recorded. Predictors of need for anti‐TNF‐α therapy were determined by comparison with OFG patients not requiring anti‐TNF‐α from our overall OFG database (n = 207). Results: Fourteen patients (9 men) were treated with IFX [OFG only (n = 7), OFG with CD (n = 7)]. Nine patients received concomitant immunosuppression. Median duration of treatment was 18 months. Short‐term response was achieved in 10/14 (71%) patients. Eight of 14 (57%) and 4/12 (33%) patients remained responsive at 1 and 2 years, respectively. Two patients who failed IFX responded to ADA. Factors predicting need for anti‐TNF‐α therapy were oral sulcal involvement, intestinal CD and a raised C‐reactive protein (CRP). Oral sulcal involvement predicted response at 1 and 2 years. Intestinal CD did not predict response. The only significant adverse event was an IFX infusion reaction. Conclusion: IFX provided good short‐term response for most OFG patients; however, a significant proportion lost response long term. Adverse events were uncommon. Patients failing IFX may respond to ADA.     

Short‐term effects of periodontal therapy as an adjunct to anti‐lipemic treatment

Oral Diseases (2010) 16 , 648–654 Objective: This study was conducted to assess the effect of improved periodontal health following periodontal treatment on metabolic lipid control of patients on anti‐lipemic treatment. Materials and Methods: The study population consisted of 20 patients aged 34–62 years with diagnoses of hyperlipidemia and chronic periodontitis. All patients used statin to treat their elevated levels of low‐density lipoprotein cholesterol. Blood samples were obtained for measurement of serum lipids, fasting plasma glucose, and high sensitive C‐reactive protein. Periodontal parameters, including plaque index, gingival index, probing pocket depth, clinical attachment level, and percentage of bleeding on probing, were evaluated. All parameters were assessed in each subject at baseline, after 3 months as a control (at the time of periodontal treatment), and 3 months after the non‐surgical periodontal treatment that included scaling and root planning. Results: All lipid parameters decreased after the periodontal treatment, but only the decreases in total cholesterol and low‐density lipoprotein cholesterol levels reached statistical significance compared to baseline (P = 0.002 and P = 0.003, respectively). Conclusion: Improved periodontal health may influence metabolic control of hyperlipidemia and could be considered as an adjunct to the standard measures of hyperlipidemic patient care.     

Host modulation therapy with anti‐inflammatory agents

Host modulation therapy refers to a treatment concept in which drug therapies are used as an adjunct to conventional periodontal treatment to ameliorate destructive aspects of the host inflammatory response. This strategy is not new in the treatment of periodontitis. Previously, nonsteroidal anti‐inflammatory drugs have been investigated in this regard, with evidence of reductions in alveolar bone resorption when these drugs are used for prolonged periods of time. However, the risk of significant unwanted effects precludes the use of both nonselective nonsteroidal anti‐inflammatory drugs and the selective cyclooxygenase‐2 inhibitors as adjunctive treatments for periodontitis. Currently, the only available adjunctive host response modulator that is licensed for the treatment of periodontitis is subantimicrobial dose doxycycline, which functions as an inhibitor of matrix metalloproteinases. Although clinical benefits have been shown in carefully conducted randomized controlled trials, the efficacy of subantimicrobial dose doxycycline in routine clinical practice has yet to be determined. Anti‐cytokine therapies have been developed for use in the treatment of rheumatoid arthritis, the pathogenesis of which bears many similarities to that of periodontitis; however, the significant risk of unwanted effects (as well as cost and lack of human trials in the treatment of periodontal diseases) precludes the use of any of the currently available anti‐cytokine therapies in the treatment of periodontitis. The identification of pro‐resolving lipid mediators as well as small molecule biologicals that influence inflammatory responses offers the best potential, at the present time, for the development of novel host response modulators in periodontal therapy, but much research remains to be done to confirm safety and efficacy.     

Healing of self‐inflicted thermal injury of palatal mucosa by low‐level laser therapy

Self‐inflicted injury to oral mucosa is a rare entity. These injuries can be premeditated, accidental, or can result from an abnormal habit. These uncommon gingival injuries can sometimes test the clinician's diagnostic abilities as well as treatment planning skills. In conventional treatment, removal of etiology and application of topical drugs is usually sufficient for healing. However, some cases require alternative or adjunctive wound healing methods. Low‐level laser therapy (LLLT) has been reported to be effective in pain management and improvement in wound healing through promotion, fortification, and commissioning of cellular cycle to generate productive and substitute cells. This report presents a case of 25‐year‐old female with complaints of a painful, nonhealing wound on the palate for last 6 months. She had an unusual habit of keeping burning matchsticks in her mouth. Although she had quit the habit 2 months ago after psychiatric counseling, the wound on her palate did not show any improvement in symptoms. Based on the history and clinical findings, diagnosis of chronic wound by self‐inflicted thermal injury was made. LLLT was administered on the wound every 48 hours for next 10 days. The burn wound healed completely after five applications of LLLT.     

Non‐oral,aerobic, Gram‐negative bacilli in the oral cavity of Thai HIV‐positive patients on Highly‐active anti‐retrovirus therapy medication

In the present study, we identified and evaluated the antibiotic susceptibility of 96 independent, aerobic, Gram‐negative bacillus isolates from 255 Thai HIV‐positive adults who were on Highly‐active anti‐retrovirus therapy (HAART) medication. Another 46 isolates from HIV non‐HAART individuals, vertically transmitted HIV‐positive individuals, and non‐HIV controls were included for comparison. A total of 103 strains were tested for antibiotic susceptibility using disc diffusion for screening and E‐test for minimal inhibitory concentration determination, with special attention on extended‐spectrum beta‐lactamase (ESBL) isolates. Pseudomonas aeruginosa, Pseudomonas luteola, Burkholderia cepacia, Aeromonas hydrophila, Klebsiella, and Enterobacter species were the most common bacteria. All strains were resistant against penicillin, amoxicillin, clindamycin, and metronidazole. No ESBL isolates were found.