Hibitane in periodontal disease

Abstract It is generally accepted that gingivitis and periodontal disease can be prevented by means of an effective daily plaque control- Also in the treatment of periodontitis plaque control seems to be essential. The plaque-inhibiting capacity of Hibitane is well documented, and the ability of the agent to prevent gingivitis for a relatively short time has been shown. Thus Hibitane is a valuable drug in dentistry in cases when conventional plaque control is difficult or impossible for a limited period of time. The longterm effect of the drug is less known in humans. However, a few studies in selected populations indicate that the effect is preserved after continuous use for several years. Established destructive periodontitis with pocket formation and subgingival plaque seems unaffected by chlorhexidine, but healthy gingival conditions may probably be maintained by two daily applications of the agent. The indications for long-term use of Hibitane in the mouth are still not satisfactorily clarified. Such use must be regarded and controlled as experiments. Although systemic side effects seem to be rare, some embarrassing local adverse effects have been frequently reported. The staining of teeth and fillings constitutes a serious obstacle to a more generalized use of the agent in dental practice. Several modes of application of Hibitane in the mouth have been suggested. However, the pharmacodynamic properties of chlorhexidine as a plaque-inhibitor are dependent on a series of complicated chemical reactions and may in several ways be jeopardized by components of a vehicle. Therefore, reliable clinical investigations proving the effect of commercial products containing Hibitane are indispensable before advocating their use.     

Experimental gingivitis in relation to susceptibility to periodontal disease

The aim of the present study was to investigate the rate of development of experimentally-induced gingival inflammation in relation to the susceptibility to periodontal disease. By selection according to age, a younger (25-39 years) and an older (45-54 years) age group, with a comparable reduced but healthy periodontium, was selected. This equal amount of periodontal breakdown may suggest that the younger age group represented individuals with a relatively higher degree of susceptibility to periodontal disease. At the start of the experiment, each patient was instructed to abstain from oral hygiene procedures in 1 quadrant of the mouth for a period of 18 days. Results showed that all subjects developed signs of gingival inflammation. Regarding the development of redness and swelling, no differences could be assessed between the 2 age groups. However, analysis of the bleeding scores revealed that bleeding on probing developed more rapidly in the younger age group. It was concluded that those patients who have suffered from a more rapid form of periodontal disease also develop inflammation, in terms of bleeding on probing, more rapidly.     

The role of the microbiota in periodontal disease

The last decade has witnessed unparalleled advances in our understanding of the complexity of the oral microbiome and the compositional changes that occur in subgingival biofilms in the transition from health to gingivitis and to destructive periodontal disease. The traditional view, which has held sway for the last 2 decades, that disease is characterized by the outgrowth of a consortium, or consortia, of a limited number of potentially pathogenic organisms, has given way to an alternative paradigm. In this new view, the microbiological changes associated with disease represent whole-scale alterations to the overall microbial population structure and to the functional properties of the entire community. Thus, and in common with other microbially mediated diseases of the gastrointestinal tract, the normally balanced, symbiotic, and generally benign commensal microbiome of the tooth-associated biofilm undergoes dysbiosis to a potentially deleterious microbiota. Coincident with progress in defining the microbiology of these diseases, there have been equally important advances in our understanding of the inflammatory systems of the periodontal tissues, their control, and how inflammation may contribute both to the development of dysbiosis and, in a deregulated state, the destructive disease process. One can therefore speculate that the inflammatory response and the periodontal microbiome are in a bidirectional balance in oral health and a bidirectional imbalance in periodontitis. However, despite these clear insights into both sides of the host/microbe balance in periodontal disease, there remain several unresolved issues concerning the role of the microbiota in disease. These include, but are not limited to, the factors which determine progression from gingivitis to periodontitis in a proportion of the population, whether dysbiosis causes disease or results from disease, and the molecular details of the microbial stimulus responsible for driving the destructive inflammatory response. Further progress in resolving these issues may provide significant benefit to diagnosis, treatment, and prevention.     

Distribution of periodontal disease in a Swedish adult population 1973, 1983 and 1993

Abstract. The aim of this study was to compare changes in periodontal status in a Swedish poplation over a period of 20 years. Cross-sectional studies were carried out in Jönköping County in 1973, 1983, and 1993. Individuals were randomly selected from the following age groups: 20, 30, 40, 50, 60, and 70 years. A total of 600 individuals were examined in 1973, 597 in 1983, and 584 in 1993. The number of dentate individuals was 537 in 1973, 550 in 1983, and 552 in 1993. Based on clinical data and full mouth intra-oral radiographs, all individuals were classified into 5 groups according to the severity of the periodontal disease experience. Individuals were classified as having a healthy periodontium (group 1). gingivitis without signs of alveolar bone loss (group 2), moderate alveolar bone loss not exceeding 1/3 of the normal alveolar bone height (group 3), severe alveolar bone loss ranging between 1/3 and 2/3 of the normal alveolar bone height (group 4), or alveolar bone loss exceeding 2/3 of the normal bone height and angular bony defects and/or furcation defects (group 5). During these 20 years, the number of individuals in groups 1 and 2 increased from 49%. in 1973 to 60% in 1993. In addition, there was a decrease in the number of individuals in group 3, the group with moderate periodontal bone loss. Groups 4 and 5 comprised 13% of the population and showed no change in general between 1983 and 1993. The individuals comprising these groups in 1993, however, had more teeth than those who comprised these groups in 1983; on the average, the individuals in disease group 4 had 4 more teeth and those in disease group 5, 2 more teeth per subject. ID 1973, these 2 groups were considerably smaller, probably because of wider indications for tooth extractions and fewer possibilities for periodontal care which meant that many of these individuals had become edentulous and were not placed in a group. Individuals in groups 3, 4, and 5 were subdivided according to the number of surfaces (%) with gingivitis and periodontal pockets (≥4 mm). In 1993, 20%, 42%, and 67% of the individuals m groups 3, 4, and 5 respectively were classified as diseased and in need of periodontal therapy with >20% bleeding sites and >10% sites with periodontal pockets ≥4 mm. In conclusion, an increase in the number of individuals with no marginal bone loss and a decrease in the number of individuals with moderate alveolar bone loss can be seen. The prevalence of individuals in the severe periodontal disease groups (4, 5) was unchanged during the last 10 years; however, the number of teeth per subject increased.     

犬类动物模型在牙周病研究中的应用现状

牙周病是一种常见的感染性口腔疾病,直接危害口腔健康,是造成中国成年人失牙的最重要原因。由于牙周病临床表现复杂,为进一步探讨牙周病的发病机制、病理学特点以及治疗效果和疗效的评价,单凭临床观察是远远不够的,为此,动物模型被广泛应用。近几年来犬类动物模型广泛应用于牙周病研究,本文就犬类动物模型在牙周病研究中的应用现状进行综述。     

Periodontal condition in Turkish recruits

The periodontal condition of 300 Turkish troops was investigated using the modified Ramfjord Periodontal Disease Index. In addition, the gingival condition, presence and quantity of plaque and calculus, location and depth of periodontal pockets, tooth mobility, presence and severity of wear facets, diastema magnitude and the DMFT Index were determined. The average PDI was 3.8. Nearly 98% of the recruits suffered from gingivitis, 68% of whom exhibited moderate to severe inflammation without involvement of deeper structures. Moderate plaque accumulation and heavy calculus deposits were observed. An average DMFT of 5.09 was found. Little correlation was found between the relatively low DMFT rate and the Plaque Index.     

Mouthrinses and periodontal disease

It is known that mouthwashes can influence gingivitis; however, their role in the three different kinds of periodontitis is unclear. Some solutions have demonstrated some effect on necrotising periodontitis, yet none have been shown to influence early onset periodontitis. The literature provides us with a wide range of in vitro concentrations of substances used pure or in various mixtures in mouthwashes. Although only a few solutions can be used in a curative approach, most mouthwashes represent an essential tool in prophylaxis and thus also in post-periodontal treatment (maintenance phase). However, severe qualitative differences exist between the diverse families of mouthwashes. Many studies have shown that the use of a mouthwash associated with regular tooth cleaning was more beneficial than the utilisation of mouthrinse alone.     

Subgingival microbial profiles in refractory periodontal disease

BACKGROUND/AIM: The purpose of the present investigation was to examine subgingival microbial profiles associated with refractory periodontitis and to seek such profiles in periodontally healthy, periodontally well-maintained elder and untreated periodontitis subjects. METHODS: 36 subjects were defined as refractory on the basis of further attachment loss after scaling and root planing, surgery and systemically administered antibiotics. A total of 890 subgingival plaque samples (mean/subject=24.7) were taken from the mesial aspect of each tooth in each subject at baseline and individually processed for their content of 40 subgingival taxa using checkerboard DNA-DNA hybridization. Cluster analysis was performed on mean within subject species counts using the chord coefficient and an average unweighted linkage sort. Significant differences among clusters for individual and complexes of species were sought using the Kruskal Wallis test. The microbial profiles of the refractory subjects were compared with those of 27 periodontally healthy subjects (n plaque samples=708), 35 periodontally well-maintained elder subjects (n plaque samples=801) and 115 untreated adult periodontitis subjects (n plaque samples=2871). RESULTS: 28 of 36 refractory subjects fell into 4 clusters with >29% similarity. 10 of 40 species and 4 of 7 complexes differed significantly among clusters. Profile (Cluster) I (n=4) was characterized by high proportions of "yellow" and "green" complex species, profile II (n=3) by low total counts and high proportions of "orange" and "purple" complex species, profile III (n=9) by high total counts and counts of Actinomyces and "purple" complex species, profile IV (n=12) by high proportions of "red" and "orange" complex species. The mean profiles of each cluster were subjected to cluster analysis with microbial data from 4380 (mean 24.7) baseline subgingival plaque samples from 27 periodontally healthy, 35 treated, well-maintained elders and 115 untreated adult periodontitis subjects. 12 clusters were formed with >41% similarity. 3 of the refractory profiles were detected in 3 cluster groups. Profile II in a cluster of 1 healthy, 1 elder and 4 untreated periodontitis subjects; profile III in a cluster of 1 healthy, 2 elder and 12 periodontitis subjects; Profile IV, with 1 healthy and 5 untreated periodontitis subjects. The profile not detected in non refractory subjects was dominated by Streptococcus species. 9 clusters did not harbor refractory profiles. 11.1% of healthy, 8.6% of elder and 18.3% of periodontitis subjects were in clusters exhibiting refractory microbial profiles. CONCLUSIONS: 4 subgingival microbial profiles were detected among refractory subjects. "Refractory microbial profiles" could be detected in subjects who had not yet exhibited refractory disease.     

Prevalence and natural history of periodontal disease in prehistoric Scots (pre-900 AD)

The periodontal status of a Scottish prehistoric population was studied. No individual over the age of 10 yr had an entirely healthy periodontium. Gingivitis was the most widespread disease state in the adolescent and younger age groups. The progression towards periodontitis was at a constant rate and mirrored modern epidemiological studies. A small proportion of individuals proved to be either more susceptible or resistant to periodontal disease. There was no evidence of periodontal disease prevalence being higher than that of modern societies with access to dental treatment. Much can be learnt regarding the natural history of periodontal disease by the study of archaeological material.     

Frequency distribution of individuals aged 20–70 years according to severity of periodontal disease experience in 1973 and 1983

The aim of this study was to compare changes in periodontal status of a Swedish population over a 10-year period expressed as frequency distributions of individuals according to severity of periodontal disease experience. The study involved 600 randomly selected individuals evenly distributed into age groups 20, 30, 40, 50, 60 and 70 years, examined in 1973 and another randomly selected group of 597 individuals similarly age distributed and examined in 1983. Based on clinical data and full mouth intraoral radiographs all individuals were classified into 5 groups according to severity of periodontal disease experience. In 1983, 23% of the individuals were classified as having healthy periodontal tissues, group 1, compared to 8% in 1973. The changes were most pronounced in the age groups 20 and 30 years, among whom 58% and 35%, respectively, were registered as having healthy periodontium in 1983. The prevalence of individuals with gingivitis without signs of lowered periodontal bone level, group 2, was 22% in 1983 compared to 41% in 1973. In all, 49% of the dentate population in 1973 and 45% in 1983 showed no marginal alveolar bone loss. Moderate periodontal bone loss, group 3, was found in 41% of the population in 1983 compared to 47% in 1973. Among 30-, 40-, and 50-year-olds, there were more, and among 60- and 70-year-olds, fewer individuals in this group in 1983 compared to 1973. 96% of the dentate population were classified as belonging to groups 1, 2 or 3 in 1973 compared to 86% in 1983.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of oral hygiene on periodontal tissues in a town in Yugoslavia

Abstract We examined 1316 pupils, average age 16.6 years, in a small town in Serbia. The purpose of this study was to find out the effects of the oral hygiene on the condition of the periodontal tissues and the frequency of gingivitis and periodontal disease and their severity in this age group. The presence and quantity of dental plaque were registered according to the Silness & Löe Plaque Index. The amount of dental calculus was determined according to the Greene & Vermillion method. The condition of periodontal tissues was evaluated by Ramfjord's method. It was found that only 5.3% of the examined pupils had a clinically healthy periodontium. Gingivitis was discovered in 60.6%, and periodontal disease (with periodontal pockets) in 34.1% of the examined pupils. The average PDI was 1.8. We revealed great quantities of soil and hard deposits on the teeth of examined pupils. The average Plaque Index was very high (1.9).     

Diagnosis and classification of periodontal disease

Periodontal diseases have been recognized and treated for at least 5000 years. Clinicians have recognized for many years that there are apparent differences in the presentation of periodontal diseases and have attempted to classify these diseases. Systems of classifications of disease have arisen allowing clinicians to develop structures which can be used to identify diseases in relation to aetiology, pathogenesis and treatment. It allows us to organize effective treatment of our patients' diseases. Once a disease has been diagnosed and classified, the aetiology of the condition and appropriate evidence-based treatment is suggested to the clinician. Common systems of classification also allow effective communication between health care professionals using a common language. Early attempts at classification were made on the basis of the clinical characteristics of the diseases or on theories of their aetiology. These attempts were unsupported by any evidence base. As scientific knowledge expanded, conventional pathology formed the basis of classification. More recently, this has been followed by systems of classification based upon our knowledge of the various periodontal infections and the host response to them. Classification of periodontal diseases has, however, proved problematic. Over much of the last century clinicians and researchers have grappled with the problem and have assembled periodically to review or develop the classification of the various forms of periodontal disease as research has expanded our knowledge of these diseases. This has resulted in frequent revisions and changes. A classification, however, should not be regarded as a permanent structure. It must be adaptable to change and evolve with the development of new knowledge. It is expected that systems of classification will change over time. This review examines the past and present classifications of the periodontal diseases.     

Profiles of destructive periodontal disease in different populations

In this study we evaluated the traditional view that the severity of periodontal disease varies between populations in that African and Asian populations are more severely affected than other populations. Our data on periodontal destruction in two random samples of a Kenyan and a Chinese adult population were recalculated to conform with the methods of examination and data presentation utilized in each of 6 other studies of attachment loss levels in different populations. The adult Kenyan and the adult Chinese group, who had very poor oral hygiene conditions and massive gingival inflammation, had attachment loss levels which were quite similar to those in a Japanese population (31), in a Norwegian population (27) and in a New Mexico group of adults (30). Attachment losses were similar in a population of young US adults (26) aged between 35 and 60 years relative to the corresponding Kenyan and Chinese groups while young US citizens had higher and elderly US citizens had lower mean attachment levels than either Kenyans or Chinese. Higher attachment loss levels beyond the age of 27 years were reported for a population of Sri Lankan tamil tea workers (27) and across all ages in two South Pacific island populations (29). Overall, the analysis indicates that the periodontal attachment loss profiles may differ between populations, but that these differences do not conform with the traditional generalization that African and Asian populations suffer more severe periodontal breakdown than other populations.     

Frequency distribution of individuals aged 20–70 years according to severity of periodontal disease

Abstract This study is an analysis of the findings in an epidemiologic investigation covering a random sample of 600 individuals aged 20–70 years resident in the city of Jönköping, Sweden. The frequency distribution of individuals according to severity of periodontal disease was determined. The analysis was based on clinical registration of gingivitis, pocket depths and qualitative and quantitative changes of the alveolar bone in a full mouth intraoral survey. In the age groups 20 and 30 years, 96% and 85 % of the individuals, respectively, had healthy periodontal tissues or were grouped as having gingivitis without signs of lowering of the periodontal bone level. In the age groups 40, 50 and 70 years none of the subjects was free from signs of gingivitis/periodontitis but, as for all age groups, strikingly few cases (at most 8%) of severe destructive periodontitis were found. The need for periodontal treatment is discussed as well as the role of specific etiologic agents in the development of destructive periodontal disease.     

Comparison of profiles of key periodontal pathogens in periodontium and endodontium

Abstract – Despite the established anatomical relationship between the periodontal and pulpal tissues, bacterial migration between endodontium and periodontium is still under discussion. The objective of this study was an investigation of profiles of periodontal pathogens in pulpal and periodontal diseases affecting the same tooth by means of 16S rRNA gene directed polymerase chain reaction (PCR). 31 intact teeth with both pulp and marginal infections were investigated. The diagnosis was based on clinical and radiological examination. Samples were taken from the gingival sulcus or periodontal pocket, respectively, with sterile paper points before trepanation of the teeth. After trepanation sterile paper points and Hedstroem files were used for taking samples from the root canal. Specific PCR methods were used to detect the presence of the following pathogens: Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Eikenella corrodens, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia and Treponema denticola. In addition, quantitative competitive PCR was used to determine the total bacterial count of the samples. The investigated pathogens were proven to be present in the endondontium in all disease categories. Particularly in endodontic samples of "chronic apical periodontitis" and "chronic adult periodontitis" profiles of the periodontal pathogens were found. The results confirmed that periodontal pathogens often accompany endodontic infections and supported the idea that the periodontic-endodontic interrelationships should be considered as critical pathways which might contribute to refractory courses of endodontic or periodontal diseases.     

Influence of CPITN partial recordings on estimates of prevalence and severity of various periodontal conditions in adults

Abstract – This study compares the results of a lull mouth examination with the results of examining only the CPITN selection of 10 index teeth 17/16, 11, 26/27, 47/46, 31 and 36/37 for estimates of prevalence and severity of the conditions assessed with the CPITN, i.e. gingival bleeding, dental calculus, pockets 4–5 mm deep and pockets 6+ mm deep. The mean number of sextants recorded with bleeding or with calculus was generally overestimated when examinations were based on the CPITN selection of index teeth, whereas the mean number of sextants with pockets, whether moderate or deep, were generally underestimated. Similarly, the prevalence of pockets, whether moderate or deep, was underestimated in virtually all age groups while the prevalence of calculus was overestimated in all age groups and the prevalence of bleeding was overestimated among persons below 30 yr of age. We conclude that the partial recording approach of the CPITN methodology is reasonably well suited for identifying persons who are relatively healthy according to the hierarchy of the CPITN parameters. There is, however, a considerable risk that persons presenting with the more severe conditions, i.e. pockets, will be overlooked if only partial recordings are performed.     

Autoimmunity in periodontal disease

Periodontal disease in characterized by the loss of the normal supporting tissues of the teeth and a humoral and cellular immune response to bacterial antigen of dental plaque which accumulates at the dento-gingival junction. This review considers the evidence for the existence of an autoimmune component of the host immune response, the possible origin of such a response and the way in which such a host response may contribute to the changes observed in the periodontium in the disease.     

The validity of the CPITN scoring and presentation method for measuring periodontal conditions

Abstract The CPITN is used widely in estimating periodontal treatment needs and, in many cases also to make generalizations about periodontal disease. It is therefore imperative that the heirarchical scoring method used to allocate CPITN scores is validated, and that the presentation of CPITN data reflect the true distribution of periodontal conditions. Data from one study carried out in Melbourne, Australia and one in Jakarta, Indonesia were used to compare CPITN scores on a mouth, sextant and tooth basis. Clinical periodontal components were compared with CPITN scores to establish the validity of the CPITN hierarchical scoring method. The distributions of CPITN scores varied widely on a mouth, sextant and tooth basis, and CPITN scores frequently differed from those indicated by the periodontal components. It was concluded that CPITN data should be presented not only as the % of subjects with each score, but also as the % of sextants, and. if possible, the % of tooth sites with each CPITN score. It was also concluded that there is an advantage in measuring components (calculus and bleeding) as well as CPITN in order to limit the overestimation of treatment needs, particularly for anterior teeth.     

The effect of subgingival debridement on periodontal disease parameters and the subgingival microbiota

Abstract The aim of the present investigation was to analyse the effect of subgingival scaling and root planing in subjects who prior to treatment exercised meticulous supragingival plaque control. 300 subjects were examined at baseline and after 1 and 2 years without treatment. After the year 2 examination, 62 subjects were randomly selected for therapy. They were given detailed instruction in proper self-performed toothcleaning measures and were carefully monitored during the subsequent 2 years. Following the year-4 examination, 2 quadrants, 1 maxillary and 1 mandibular in each subject, were randomly selected for additional therapy. The teeth in the selected quadrants were exposed to subgingival scaling and root planing. The subgingival therapy was repeated until a site no longer bled on gentle probing. This basic therapy was completed within a 2-month period. All subjects were re-examined after another 12-month interval. The examinations at year 4 and 5 included assessment of plaque, gingivitis, probing pocket depth and analysis of samples obtained from the subgingival microbiota at 134 selected sites. The findings from the present study demonstrated: (i) that subgingival scaling and root planing were effective in eliminating subgingival plaque and gingivitis; (ii) that professional therapy resulted in a pronounced reduction of probing depth at sites which at year 4 had a probing depth >3 mm; (iii) that in non-scaled quadrants, the extension of self-performed plaque control resulted in a continued improvement of the periodontal conditions at sites which at year 4 were < 5 mm deep.     

Validity of CPITN's assumptions of hierachical occurrence of periodontal conditions in a Kenyan population aged 15–65 years

Abstract – In order to study the validity of the hierachical principle of the CPITN we used data originating in a cross-sectional study of periodontal disease in a random sample comprising 1131 Kenyans aged 15-65 yr to determine, for each tooth present in each individual, the absence or presence of gingival bleeding, of dental calculus, of a pocket of 4–5 mm or a pocket of 6+ mm, such that each tooth had a separate recording for bleeding, calculus, pocket 4–5 mm and pocket 6+ mm. According to the hierachical principle of CPITN a tooth with pockets as the most severe finding is assumed positive also for calculus and bleeding, and a tooth with calculus as the most severe finding is assumed positive also for bleeding. Our analysis showed that calculus as the most severe finding of a tooth overestimates the occurrence of bleeding by up to 18%, depending on age of the individuals and the set of teeth examined. Pockets as the most severe finding in a tooth overestimates the occurrence of bleeding by up to 13%, and overestimates calculus by up to 54%, most pronounced in the younger age groups. The effect of these over estimations on prevalence and severity estimates was the most pronounced for the severity measures, particularly regarding the severity of bleeding, whereas prevalence estimates remained relatively unaffected. Undoubtedly, this result should be seen in the light of a very high prevalence and severity of both bleeding and calculus in this population.