Natural history of periodontal disease in man

Abstract This paper describes the initiation, rate of progress of periodontal disease and consequent tooth loss in a population never exposed to any programs or incidents relative to prevention and treatment of dental diseases. The group consisted of 480 male laborers at two tea plantations in Sri Lanka. The study design and baseline data have been published. At the initial examination in 1970, the age of the participants ranged between 14 and 31 years. Subsequent examinations occurred in 1971, 1973, 1977, 1982 and 1985. Thus, the study covers the age range 14–46 years. Throughout the study, the clinical indices were scored by the same two examiners, both well-trained and experienced periodontitis. Intra-examiner reproducibility for each index was tested at baseline and repeated periodically during the study. The data for each examination were computerized and updated on an ongoing basis. At the last examination in 1985, there were 161 individuals who had participated in the first survey. This population did not perform any conventional oral hygiene measures and consequently displayed quite uniformly large aggregates of plaque, calculus and stain on their teeth. Virtually all gingival units exhibited inflammation. Based on interproximal loss of attachment and tooth mortality rates, three subpopulations were identified: (1) individuals (～8%) with rapid progression of periodontal disease (RP), those (～81%) with moderate progression (MP), and a group (～11 %) who exhibited no progression (NP) of periodontal disease beyond gingivitis. At 35 years of age, the mean loss of attachment in the RP group was ～9 mm, the MP group had ～4 mm and the NP group had less than 1 mm loss of attachment. At the age of 45 years, the mean loss of attachment in the RP group was ～13 mm and the MP group ～7 mm. The annual rate of destruction in the RP group varied between 0.1 and 1.0 mm, in the MP group between 0.05 and 0.5 mm, and in the NP group between 0.05 and 0.09 mm. Since this population was virtually caries free, essentially all missing teeth were lost due to periodontal disease. In the RP group, tooth loss already occurred at 20 years of age and increased throughout the next 25 years. At 35 years of age, 12 teeth had been lost, at 40 years of age 20 teeth were missing and at 45 all teeth were lost. In the MP groups, tooth mortality started after 30 years of age and increased throughout the decade. At 45 years of age, the mean loss of teeth in this group was 7 teeth. The NP group essentially showed no tooth loss.     

Periodontal disease in the oldest-old living in Kungsholmen, Sweden: findings from the KEOHS project

AIMS: The Kungsholmen Elders Oral Health Study evaluated the oral health status of generally healthy, community-dwelling persons aged 80 years and over living in Stockholm, Sweden. This paper reports periodontal disease findings and evaluates the distribution by sociodemographic factors. METHODS: Eligible persons were identified through the Kungsholmen Project, an ongoing, longitudinal, population-based study of older adults. A total of 121 study subjects received a periodontal examination. RESULTS: The mean pocket probing depth was 2.6 mm and the mean clinical attachment loss was 3.7 mm. Gingival bleeding was common. Over half of all study participants met the criteria used for "serious periodontitis" (SP). In the best fit adjusted odds ratio (OR) model, males were 3.1 times more likely than females to have "SP" (OR=3.1, 95% CI 1.2, 8.0), a statistically significant observation. A sub-analysis of the differences in proportion of participants with SP revealed that the difference by sex also increased by age. CONCLUSIONS: These findings document the substantial and ongoing impact of periodontal disease in a sample of generally healthy, community dwelling older adults and underscore the importance of continued periodontal disease prevention and treatment in the oldest-old.     

The association between cumulative periodontal disease and stroke history in older adults

BACKGROUND: Since the late 1980s, several studies have been conducted to investigate the relationship between periodontal disease and ischemic stroke. The purpose of this study is to investigate the relationship of periodontal disease to the self-reported history of stroke in the elderly (60 years of age and older) by examining the data of the Third National Health and Nutrition Examination Survey (NHANES III). METHODS: Data from NHANES III, a large population-based cross-sectional survey of the United States, were used for this study. Because 1,563 of the 5,123 subjects in the study were edentulous, and periodontal disease is a major cause of tooth loss, it was necessary to account for edentulousness in the statistical analysis to avoid bias. Hence, a new index called the periodontal health status (PHS) index was developed to address this problem. Two measures of PHS were developed: PHS I, based on the median percentage of sites with >/=2 mm clinical attachment loss (CAL), and PHS II, based on the median percentage of sites with >/=3 mm CAL. Multiple logistic regression analysis was used to test for the association of PHS with stroke history. Two types of a multiple logistic regression model were fit: 1) logistic regression modeling with adjustment for age and tobacco use only; and 2) logistic regression modeling with adjustment of all statistically significant confounders. RESULTS: Based on multiple logistic regression analysis of PHS with adjustment for age and tobacco use only, completely edentulous elderly adults (PHS Class 5) and partially edentulous (teeth in one arch) elderly adults with appreciable clinical attachment loss (PHS Class 4) were significantly more likely to have a history of stroke compared to dentate adults (teeth in both arches) without appreciable clinical attachment loss (PHS Class 1). When multiple logistic regression models were fit with adjustment of all significant confounders, no statistically significant association was found between PHS and stroke. CONCLUSIONS: Based on the results of this study, there is evidence of an association between cumulative periodontal disease, based on PHS, and a history of stroke. However, it is unclear whether cumulative periodontal disease is an independent risk factor for stroke or a risk marker for the disease.     

Minor manifestations of periodontal diseases in young adults with type 1 diabetes mellitus. Periodontal and microbiological findings

Abstract

Objective. The aim of this study was to evaluate periodontal status and microbiological conditions in young adults with insulin-dependent diabetes (IDDM) in comparison with age- and sex-matched non-diabetic controls. Materials and methods. Forty-one patients, 18–24 years of age with IDDM since childhood, were examined and the results were compared to those of a group of 41 sex- and age-matched non-diabetic controls. According to the HbA_1c %, the group of diabetic patients was divided into two groups, with good or poor metabolic control. Results. Periodontal health, expressed in probing pocket depths and marginal bone loss, was fairly good in all patients. Fifty per cent of the patients in the study and control groups displayed probing pocket depths ≥4 mm, mostly pocket depths 4 mm. These findings were also equally distributed among the patients with good and poor metabolic control. No significant differences were found between the groups regarding bleeding on probing, but in the number of sites with excessive bleeding the study group exhibited higher scores than the healthy controls. Different microbiological species were equally distributed between the groups. Conclusion. Neither periodontal nor microbiological status in young adults with IDDM differs from that of healthy controls.     

Minor manifestations of periodontal diseases in young adults with type 1 diabetes mellitus. Periodontal and microbiological findings

Abstract Objective. The aim of this study was to evaluate periodontal status and microbiological conditions in young adults with insulin-dependent diabetes (IDDM) in comparison with age- and sex-matched non-diabetic controls. Materials and methods. Forty-one patients, 18-24 years of age with IDDM since childhood, were examined and the results were compared to those of a group of 41 sex- and age-matched non-diabetic controls. According to the HbA(1c) %, the group of diabetic patients was divided into two groups, with good or poor metabolic control. Results. Periodontal health, expressed in probing pocket depths and marginal bone loss, was fairly good in all patients. Fifty per cent of the patients in the study and control groups displayed probing pocket depths ≥4 mm, mostly pocket depths 4 mm. These findings were also equally distributed among the patients with good and poor metabolic control. No significant differences were found between the groups regarding bleeding on probing, but in the number of sites with excessive bleeding the study group exhibited higher scores than the healthy controls. Different microbiological species were equally distributed between the groups. Conclusion. Neither periodontal nor microbiological status in young adults with IDDM differs from that of healthy controls.     

牙周临床治疗Ⅴ.牙周医学

对宿主易感性的认识使人们能够理解不同个体牙周炎发生、发展的差异，而另一方面，牙周疾病对许多器官系统的潜在影响日益受到关注，牙周医学的兴起开创了崭新的重要研究领域，并有着深远的临床意义。     

Periodontal health and periodontal disease in young people: global epidemiology

A review of epidemiological surveys of the periodontal conditions of young people has shown that chronic marginal gingivitis associated primarily with plaque, is global, very common and even endemic in some population groups. Data on the prevalence of transient gingival conditions associated with tooth eruption, puberty and systemic factors are lacking and therefore their contribution to the prevalence of periodontal disease is unknown. Reports of periodontitis in young people are relatively uncommon except in a few populations where it appears as an adult-type of chronic marginal periodontitis. Juvenile periodontitis and other more destructive forms of periodontitis are not common. However, problems in epidemiological methodology and clinical differential diagnosis make comparative evaluation of survey data difficult and subjective. Two epidemiological indices, the Periodontal Index and the Community Periodontal Index of Treatment Needs (CPITN) have been used for many surveys in varied population groups. They provide data which agree on the ubiquity of gingivitis, whether identified visually or by bleeding-on-probing, and the low frequency of periodontitis. Data from CPITN surveys reveal a higher prevalence of calculus (sub-gingival) associated with gingivitis in young people than previously reported. All the epidemiological data reviewed point to plaque as the primary aetiological agent in gingivitis. There is little evidence of the involvement of other factors except that host resistance/susceptibility in this age group may modify the microbial effect.     

Periodontal disease in adolescents: epidemiologic findings in Navajo Indians

A cross-sectional epidemiologic survey was conducted of 618 Navajo Indians, aged 14-19, resident in a boarding school in New Mexico. Periodontal status was assessed by clinical measurements of attachment level and gingival bleeding, and evidence of alveolar bone loss from standardized bitewing radiographs. Attachment level and gingival bleeding were measured at 24 posterior interproximal sites (six sites in each quadrant): the mesio-buccal aspect of the second molar; the disto-buccal and mesio-buccal aspects of the first molar and second premolar; and the disto-buccal aspect of the first premolar. Alveolar bone level was measured from radiographs at the corresponding approximal surfaces of the same teeth. Attachment loss was considered present when the distance from the CEJ to the base of the pocket was greater than 1 mm; bone loss was considered present when the radiographic distance from the CEJ to the alveolar crest was greater than 2 mm, and gingival bleeding was considered present if bleeding occurred immediately after gentle probing. Attachment loss was evident at one or more sites in 88.7% of the population, 45.9% of the subjects had attachment loss at eight or more sites, and 101 subjects (16.3%) had one or more sites with at least 4.0 mm of attachment loss. Bone loss was present at one or more sites in 89.2% of the population, 28.6% had eight or more affected sites, and 4.7% (29 subjects) had one or more sites with at least 2.0 mm of bone loss. Gingival bleeding was evident at one or more sites in 70.6% of the population, and 19.7% had eight or more affected sites.(ABSTRACT TRUNCATED AT 250 WORDS)     

Survey of periodontal disease among workers in Tianjin using Ramfjord''s Periodontal Disease Index (PDI)

An epidemiologic study of periodontal disease according to Ramfjord's PDI among 2284 workers was performed in Tianjin in 1982. This study included 1066 men and 1218 women, aged 18-50. The prevalence of gingivitis and periodontitis was 89.5% and 44.4%, respectively. Only 28 workers were free from periodontal disease. Gingivitis and periodontitis were highly prevalent in both sexes, but men had more severe gingivitis and periodontitis than women. The better oral hygiene of the women may account for this difference.     

Periodontal disease in HIV-positive individuals: association of periodontal indices with stages of HIV disease

BACKGROUND: Periodontal disease has been previously associated with human immunodeficiency virus (HIV) infection, and HIV infection has been considered a modifier of periodontal disease. The aim of this study was to report the prevalence and severity of periodontal disease in a population of HIV-positive individuals and to investigate the association between clinical periodontal indices and the stage of HIV disease, as expressed by CD4 cell counts. METHODS: Thirty-nine male HIV-positive patients were recruited and a medical history was taken. To evaluate periodontal disease, probing depth (PD), attachment level loss (AL), bleeding index (BI), and modified gingival index (MGI) were recorded. Associations between the above indices and CD4 counts were examined. RESULTS: Immunocompromised patients (with CD4 cell counts < 200 cells/microl) showed significantly lower BI and fewer sites with PD and AL > 4 mm compared to patients with CD4 cell counts > 200 cells/microl. When patients with CD4 counts < 500 cells/microl were considered alone, a correlation was observed between CD4 cell counts and BI (r2 = 0.1617, P = 0.0463), MGI (r2 = 0.2123, P = 0.0204), and number of sites with AL > 4 mm (r2 = 0.1469, P = 0.056). CONCLUSIONS: Severely immunocompromised HIV-positive patients showed less severe gingival inflammation than expected. Patients with CD4 cell counts > 500 cells/microl showed no association between CD4 cell count and periodontal indices.     

Periodontal repair of periapical lesions: the borderland between pulpal and periodontal disease

A series of cases demonstrating the destruction of periapical periodontal structures, without pulpal involvement has been presented. Treatment using both surgery and antibiotics resulted in extensive healing without any concommitant endodontic therapy. The results suggest that lesions affecting the apical periodontium are either periodontal or pulpal in origin. Careful diagnosis allows the maintenance of pulp vitality in cases where apical destruction has a source other than an infected pulp. The commonly held belief that lateral and accessory canals are a significant source of pulpal contamination from deep periodontal pockets has been questioned.     

Neutrophil-mediated tissue injury in periodontal disease pathogenesis: findings from localized aggressive periodontitis

Neutrophils play a major role in the host response against invading periodontopathogenic microorganisms. Localized aggressive periodontitis (LAgP) is associated with various functional abnormalities of neutrophils. Based on the recent findings, LAgP neutrophils are not "hypofunctional" or "deficient." They are "hyperfunctional," and their amplified activity is responsible for the tissue destruction in periodontal disease. Several signal transduction abnormalities are associated with elevated neutrophil function in LAgP. There is a strong correlation between defective chemotaxis and decreased intracellular Ca2+ levels; total calcium-dependent protein Kinase C (PKC) activity of neutrophils is significantly lower than healthy subjects; and there is a marked increase in diacylglycerol (DAG) accompanied by a pronounced decrease in DAG kinase activity. In a separate set of experiments on the involvement of the inducible cyclooxygenase isoform (COX-2) and the role of novel lipid mediators in the pathogenesis of periodontal disease, crevicular fluid samples from LAgP patients were found to contain prostaglandin E2 (PGE2) and 5-LO-derived products, leukotriene B4 (LTB4), and the biosynthesis interaction product, lipoxin LXA4. Neutrophils from peripheral blood of LAgP patients, but not from healthy volunteers, also generated LXA4, suggesting that this immunomodulatory molecule may have a role in periodontal disease. Lipoxin generation and its relationship to PGE2 and LTB4 can be visualized as an important marker for the pathogenesis of periodontal disease. Thus, major advances in our understanding of the role of the neutrophil in host defense against periodontal organisms have been made through studies of LAgP. LAgP is used as an example of a severe periodontal disease that is related to abnormal neutrophil function. In this model, it appears that a hyperresponsiveness of the neutrophil, due to cell priming/predisposition, results in enhanced tissue damage.     

Oral findings and periodontal status in children, adolescents and young adults suffering from renal failure

AIM: Describe the oral condition of chronic renal failure and healthy subjects, and the relationship between oral variables, chronic renal failure (CRF) conditions, and their treatment. MATERIALS AND METHODS: Four renal failure groups: chronic renal disease (n=22); undergoing dialysis (n=22); after dialysis and transplant (n=21); and after transplant (n=32), and a healthy control (n=38) were examined. Caries, enamel hypoplasia, pulp obliteration, plaque index, gingival bleeding, recession, overgrowth and index, probing depths, attachment loss, renal treatments and their relations with the oral variables were analysed. RESULTS: The renal failure groups had higher gingival index (GI) and bleeding, probing depths, attachment loss, hypoplasia and obliteration and less caries, than the control. Plaque was higher in the dialysis and pre-dialysis (PD) groups. Overgrowth was evident after transplant. The PD group showed lower GI than other renal groups. Dialysis duration and end-stage renal failure significantly correlated with gingivitis, probing depth, attachment loss and enamel hypoplasia. Immuran correlated positively with probing depth, gingival recession and attachment loss. Normiten and Nifedipine had positive correlations with gingival overgrowth. CONCLUSIONS: CRF patients are characterized by pulp obliteration, gingival and periodontal diseases. Duration of end stage renal failure and type of systemic treatment have a significant influence on the oral condition.     

Periodontal disease in HIV-infected adults in the HAART era: Clinical,immunological, and microbiological aspects

The introduction of highly active antiretroviral therapy (HAART) has decreased the incidence and prevalence of several oral manifestations such as oral candidiasis, hairy leukoplakia, and Kaposi's sarcoma in HIV-infected patients. Regarding periodontal disease the findings are not clear. This disease represents a group of chronic oral diseases characterized by infection and inflammation of the periodontal tissues. These tissues surround the teeth and provide periodontal protection (the gingival tissue) and periodontal support (periodontal ligament, root cementum, alveolar bone). Clinical, immunological, and microbiological aspects of these diseases, such as linear gingival erythema (LGE), necrotizing periodontal diseases (NPD) (necrotizing ulcerative gingivitis [NUG], necrotizing ulcerative periodontitis [NUP] and necrotizing stomatitis), and chronic periodontitis, have been widely studied in HIV-infected individuals, but without providing conclusive results. The purpose of this review was to contribute to a better overall understanding of the probable impact of HIV-infection on the characteristics of periodontal infections.