Periodontal disease in children and adolescents of Latin America

Periodontal diseases are a group of infectious diseases that mainly include gingivitis and periodontitis. Gingivitis is the most prevalent form of periodontal disease in subjects of all ages, including children and adolescents. Less frequent types of periodontal disease include aggressive periodontitis, acute necrotizing ulcerative gingivitis and various diseases of herpesviral and fungal origin. This review aimed to retrieve relevant information from Latin America on the prevalence of periodontal diseases among children and adolescents of the region. Gingivitis was detected in 35% of young Latin American subjects and showed the highest frequencies in Colombia (77%) and Bolivia (73%) and the lowest frequency in Mexico (23%). The frequency of gingivitis in subjects from other Latin American countries was between 31% and 56%. Periodontitis may affect <10% of the young population in Latin America, but the data are based on only a few studies. A more precise assessment of the distribution and severity of periodontal disease in children and adolescents of Latin America may help policy makers and dentists to institute more effective public health measures to prevent and treat the disease at an early age to avoid major damage to the permanent dentition.     

A Latin American perspective of periodontology

Periodontal diseases occur worldwide, and Latin American populations are significantly affected by different manifestations of periodontal disease. The interest in periodontics and periodontal therapy first developed in the early 1930s in the southernmost countries of Latin America, and spread, as the years went by, throughout the region. Today, periodontal research is vibrant in Latin America. The aim of this volume of Periodontology 2000 was to present an overview of the periodontal research currently being performed in different countries of Latin America. The epidemiology of periodontal diseases in adults, children and adolescents, and the pathogenesis of such diseases (including microbiological characteristics and risk factors), are discussed. The role of systemic antibiotic therapy and the effect of smoking are discussed in relation to the progression and the treatment of periodontitis. In addition, the benefit of lasers in periodontal therapy is evaluated. Latin American research groups have been active in exploring new venues of regenerative periodontal treatment, addressing the role of cementum proteins, growth factors and oral mesenchymal stem cells in tissue engineering. Finally, basic research to study cancerization is reported.     

Advances in Surveillance of Periodontitis: The Centers for Disease Control and Prevention Periodontal Disease Surveillance Project

The Centers for Disease Control and Prevention (CDC) has as one of its strategic goals to support and improve surveillance of periodontal disease. In 2003, the CDC initiated the CDC Periodontal Disease Surveillance Project in collaboration with the American Academy of Periodontology to address population‐based surveillance of periodontal disease at the local, state, and national levels. This initiative has made significant advancements toward the goal of improved surveillance, including developing valid self‐reported measures that can be obtained from interview‐based surveys to predict prevalence of periodontitis in populations. This will allow surveillance of periodontitis at the state and local levels and in countries where clinical resources for surveillance are scarce. This work has produced standard case definitions for surveillance of periodontitis that are now widely recognized and applied in population studies and research. At the national level, this initiative has evaluated the validity of previous clinical examination protocols and tested new protocols on the National Health and Nutrition Examination Survey (NHANES), recommending and supporting funding for the gold‐standard full‐mouth periodontal examination in NHANES 2009 to 2012. These examinations will generate accurate estimates of the prevalence of periodontitis in the US adult population and provide a superior dataset for surveillance and research. Also, this data will be used to generate the necessary coefficients for our self‐report questions for use in subsets of the total US population. The impact of these findings on population‐based surveillance of periodontitis and future directions of the project are discussed along with plans for dissemination and translation efforts for broader public health use.     

Periodontal microbiology in Latin America

This review article describes the microbiota associated with periodontal disease in Latin America. This vast territory includes 22 nations, which show great ethnic diversity, with large groups of White people, Black people, Mestizo people and Native people. Widespread poverty and limited access to education and health‐care services, including periodontal care, are prominent predisposing factors for destructive periodontal disease in Latin America. Black people and Mestizo people seem to have particularly severe periodontal disease and are frequently colonized by the major periodontal pathogens Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. The ‘red complex’ bacterial pathogens and A. actinomycetemcomitans predominate in chronic and aggressive periodontitis, but gram‐negative enteric rods and herpesviruses can also play important periodontopathic roles in Latin America. The key to minimizing the risk of periodontal disease is control of the pathogens, and new low‐cost periodontal treatments deserve serious consideration in Latin America.     

Role of occlusion in periodontal disease

This article deals with establishing a new link between trauma from occlusion and periodontal pockets based on the know‐how and background gradually developed. To provide a better understanding to the reader, a historical perspective is firstly presented. The main features on the controversy of the role played by trauma from occlusion on the physiologic behavior of the periodontal structures are shown, together with how deviations from the normal characteristics of this relationship itself affect the integrity of the periodontal tissues when or associated with dental biofilm in the presence or not of periodontal pockets have arisen. The literature provides evidence showing that the very first publication to establish a strong correlation between trauma from occlusion and periodontal pockets in humans was of Latin‐American origin. However, subsequently, trauma from occlusion was mostly evaluated by an American group, followed by a Scandinavian group, yet with some contributions from the Latin‐American group. Basically trauma from occlusion has been correlated with periodontal pockets in view of the fact that these would render the periodontal supporting tissues more amenable to the spread of inflammation of biofilm‐related periodontal pockets. This would facilitate the fast deepening of periodontal pockets, influencing the generation of infrabony periodontal pockets or suprabony periodontal pockets that are deeper than in areas without trauma from occlusion. The factors related to these different behaviors are discussed. Several clinical cases are presented showing evidence that corroborates the possibility of an actual interrelationship between trauma from occlusion and periodontitis. Theoretical evaluations based on recent advances of the mechanisms involving molecular modulation in physiological and altered occlusal functions, as well as on research data, and evaluations from data of clinical cases, support the assumption that trauma from occlusion and periodontitis may embrace the unique pathologic condition of the associated lesion trauma from occlusion plus periodontitis or act independently even if both co‐exist simultaneously in a particular case. The link between both conditions that was emphasized as definitively necessary in order for an associated lesion to develop is that both lesions, namely trauma from occlusion and periodontitis, occur in their destructive stage at exactly the same time. This involvement would explain why so many different data are presented in the literature and hopefully will shed some light for development of new methodologies of research. Clinical cases were selected to present a treatment philosophy on the subject.     

Antibiotic resistance of subgingival species in chronic periodontitis patients

Ardila CM, Granada MI, Guzmán IC. Antibiotic resistance of subgingival species in chronic periodontitis patients. J Periodont Res 2010; 45: 557–563. © 2010 John Wiley & Sons A/S Background and Objective: The increasing rate of resistance of microorganisms to penicillin and other antibiotics has generated concern among health authorities in Latin America. The present investigation determined the in vitro susceptibility of Porphyromonas gingivalis, Fusobacterium nucleatum, black‐pigmented Prevotella spp. and Aggregatibacter actinomycetemcomitans to metronidazole, amoxicillin, amoxicillin/clavulanic acid, clindamycin and moxifloxacin in patients with chronic periodontitis. Material and Methods: Subgingival plaque samples from patients with periodontitis were collected and cultured on selective and nonselective culture media. The antimicrobial susceptibility of periodontopathogenic isolates was studied in chronic periodontitis patients in Colombia. Metronidazole, amoxicillin, amoxicillin/clavulanic acid, clindamycin and moxifloxacin were tested on all bacterial isolates and the percentage of resistant strains was calculated. Results: Of the 150 bacteria identified, 51 were P. gingivalis, 45 were black‐pigmented Prevotella spp., 36 were F. nucleatum and 18 were A. actinomycetemcomitans. All the isolates were sensitive to amoxicillin/clavulanic acid and to moxifloxacin, but exhibited variable susceptibility patterns to the other antimicrobial agents tested. Conclusion: The results of the present study suggest that periodontal microorganisms in patients with chronic periodontitis can be resistant to the antimicrobial agents commonly used in anti‐infective periodontal therapy. We suggest that the indiscriminate use of antimicrobials could result in the appearance of more highly antibiotic‐resistant strains of bacteria associated with periodontal diseases in our population compared with the populations of other countries.     

Socioeconomic position indicators and periodontitis: examining the evidence

Socioeconomic factors, such as education and income, are associated with disparities in the prevalence and severity of periodontal disease, and this has been recognized since the 1960s. Epidemiological reports have consistently shown that periodontal disease is inversely related to education and income after controlling for age and gender, and that differences in education and income explain most if not all of the observed disparities in periodontal disease between blacks and whites. Although race/ethnicity has been the main focus of studies on differences in periodontal diseases in the USA, periodontal disease disparities according to socioeconomic position (SEP) indicators (i.e. education, income, poverty–income ratio) remain pervasive in the USA. SEP indicators, as used in the epidemiological literature, involve use of socioeconomic measures as a proxy measure for an individual’s place, position and power in society. Thus, understanding disparities according to SEP indicators in periodontal health status may provide insight into why racial/ethnic disparities in periodontal health status persist. Here we review recent prevalence estimates of periodontitis according to SEP indicators, and critically assess the importance of SEP factors in periodontal epidemiolgy. The majority of the data available for review come from the USA. However, data from other countries are included where available. Specifically, we identify the advantages and disadvantages of the most commonly used SEP indicators in studying periodontal disease, summarize existing evidence on the association between SEP indicators and periodontitis, discuss the analytical issues associated with SEP indicators, and suggest future and alternative research directions for examining the association between SEP indicators and periodontitis.     

Periodontal disease epidemiology – learned and unlearned?

The notion of periodontal disease being the major cause of tooth loss among adults was rooted in the focal infection paradigm that dominated the first half of the 20th century. This paradigm was established largely by personal opinions, and it was not until the development of periodontal indices in the mid‐1950s that periodontal epidemiology gained momentum. Unfortunately, the indices used suffered from a number of flaws, whereby the interpretation of the research results took the form of circular reasoning. It was under this paradigm that therapeutic and preventive intervention for periodontal diseases became entirely devoted to oral hygiene, as poor oral hygiene and older age were understood to explain nearly all the variation in disease occurrence. In the early 1980s, studies appeared that contradicted the concepts of poor oral hygiene as the inevitable trigger of periodontitis and of linear and ubiquitous periodontitis progression, whereby periodontal epidemiology was led into a relatively short‐lived high‐risk era. At this time, it became evident that old scourges continue to haunt periodontology: the inability to agree in operational clinical criteria for a periodontitis diagnosis and the inability to devise both a meaningful and a useful classification of periodontal diseases based on nominalist principles. The meager outcome of the high‐risk era led researchers to resurrect the focal infection paradigm, which is now dressed up as periodontal medicine. Unfortunately, these developments have left the core of periodontology somewhat disheveled and deserted.     

Introduction to periodontal epidemiology

There is growing interest in, and appreciation of, the importance of epidemiological science in furthering our understanding of periodontal diseases. There is also interest in applying modern epidemiological methods to identify periodontal disease risk factors, prognostic factors and the long‐term outcomes of care, as well as periodontal–systemic associations. This volume combines critical reviews of selected areas of contemporary interest with targeted methodologically focused articles, in order to provide a valuable reference text to guide readers in their own critical assessment of new scientific findings, as well as to assist investigators in the design and analysis of their own original research in periodontal epidemiology. The 11 review articles that comprise this volume were selected with this goal in mind. They aim to inform readers on the methodological rigor that needs to be applied, both in the design of epidemiological studies and interpretation of their results, and the limitations to the inferences that may be drawn from epidemiological studies. Despite its various limitations, the field of periodontal epidemiology is expected to continue to grow in importance and relevance. There remains a need for well‐designed, carefully analyzed and correctly interpreted observational studies, including longitudinal cohort studies and case–control studies, in order to adequately understand both the causes of periodontal disease and the associations between periodontal disease and systemic disease in populations.     

Association between body weight and periodontal infection

Background: Besides being a risk factor for cardiovascular diseases, certain cancers and type II diabetes, obesity has been suggested to be a risk factor for periodontitis. A number of epidemiological studies have studied the association between obesity and periodontitis, but the results have been partly inconclusive. The aim of this study was to examine the association of body weight with periodontal infection. Material and Methods: The association between body weight and periodontal infection was examined using a nationally representative Health 2000 Health Examination Survey. The study was based on a subpopulation of dentate non‐diabetic subjects aged 30–49 (n=2841). Periodontal infection was measured by the number of teeth with periodontal pockets of 4 mm or deeper and 6 mm or deeper. Body weight was measured using body mass index (BMI). Results: We detected a weak exposure–response association of BMI with teeth with deepened periodontal pockets after controlling for smoking habits by restricting the sample to subjects who have never smoked and for other potential confounders by including them in the multivariate models. Conclusions: The results showed an association between body weight and periodontal infection among the non‐diabetic, non‐smoking population aged 30–49. Additional research is needed to determine the nature of this association.     

The global burden of periodontal disease: towards integration with chronic disease prevention and control

Chronic diseases are accelerating globally, advancing across all regions and pervading all socioeconomic classes. Unhealthy diet and poor nutrition, physical inactivity, tobacco use, excessive use of alcohol and psychosocial stress are the most important risk factors. Periodontal disease is a component of the global burden of chronic disease, and chronic disease and periodontal disease have the same essential risk factors. In addition, severe periodontal disease is related to poor oral hygiene and to poor general health (e.g. the presence of diabetes mellitus and other systemic diseases). The present report highlights the global burden of periodontal disease: the ultimate burden of periodontal disease (tooth loss), as well as signs of periodontal disease, are described from World Health Organization (WHO) epidemiological data. High prevalence rates of complete tooth loss are found in upper middle‐income countries, whereas the tooth‐loss rates, at the time of writing, are modest for low‐income countries. In high‐income countries somewhat lower rates for edentulism are found when compared with upper middle‐income countries. Around the world, social inequality in tooth loss is profound within countries. The Community Periodontal Index was introduced by the WHO in 1987 for countries to produce periodontal health profiles and to assist countries in the planning and evaluation of intervention programs. Globally, gingival bleeding is the most prevalent sign of disease, whereas the presence of deep periodontal pockets (≥6 mm) varies from 10% to 15% in adult populations. Intercountry and intracountry variations are found in the prevalence of periodontal disease, and these variations relate to socio‐environmental conditions, behavioral risk factors, general health status of people (e.g. diabetes and HIV status) and oral health systems. National public health initiatives for the control and prevention of periodontal disease should include oral health promotion and integrated disease‐prevention strategies based on common risk‐factor approaches. Capacity building of oral health systems must consider the establishment of a financially fair service in periodontal care. Health systems research is needed for the evaluation of population‐oriented oral health programs.     

Periodontal treatment needs in Central and Eastern Europe

The aim of the present review is to evaluate the periodontal conditions and treatment needs in Central and Eastern European countries joining the European Union and to compare these data to the epidemiological data from the industrialised and developing countries. The recent prevalence and severity data provided by national surveys based on the CPITN methods are summarised. The periodontal conditions in the age groups 15-19 and 35-44 are discussed in details. The CPITN data show no major differences in the extent and severity of destructive periodontal disease in the different countries. In the age group 15-19 just a few European surveys reported "score 4 sextant" and the prevalence of "score 3 sextants" was also below 10% in each survey. However calculus formation and bleeding on probing were very frequent findings both in Western and Eastern Europe. In the age group 35-44 the average prevalence of "score 4 sextant" in Western and Eastern Europe were comparable while the proportion of periodontally absolutely healthy individuals was lower in Eastern Europe than in the Western part of the Continent. Five to twenty per cent of the populations are affected by destructive periodontitis at the age of 40. This indicates the magnitude of the disease as a public health problem both in the industrialised West and the Eastern European countries. The some 10-15% prevalence rate of destructive periodontitis imposes a great challenge to the health authorities of these post-communist countries amid social and economic transition, because the nation-wide preventive and basic periodontal therapeutic measures should be managed and financed from a substantially lower GDP than in the industrialised West.     

Global periodontal disease epidemiology

Our understanding of the global epidemiology of periodontal disease has changed considerably over the past 50 years. This change has been influenced not only by our evolving knowledge of the natural history and distribution of the disease, but also by changing measurement methodologies. Although great strides have been made in describing the underlying contributions of microorganisms and plaque ecology, as well as the inflammatory and host responses, there is still much that is not known regarding risk susceptibility and prevention effectiveness. The focus of global periodontal epidemiology during the last half century has been on identifying populations who have periodontal disease and situations where disparities in disease prevalence exist between groups. Unlike dental public health activities directed toward dental caries, less effort has been made in periodontal epidemiology with regard to surveying or monitoring groups who may be at greater risk for moderate or severe disease and evaluating public health initiatives directed at mitigating risk or reducing such periodontal disease prevalence. Additionally, there is limited information regarding current national estimates of periodontal disease in most countries. Although numerous periodontal studies have been performed globally, very few are epidemiological studies using nationally representative samples. The aim of this critical review is to discuss the historical context of global periodontal disease epidemiology, highlight key activities and findings over the past decade in global periodontal epidemiology, and comment on how changes in the practice of epidemiology may affect global periodontology over the coming decade.     

Periodontal diseases in Asians

Asia encompasses three of the four most populous nations in the world (China, India and Indonesia), accounting for nearly two-fifths of the worlds' total population. Over half of the world's population now inhabits Asia, which by definition includes countries of the Middle East and some former Socialist Soviet Republics. There has been a generally held view that Asians are particularly susceptible to periodontitis. The aim of this review is to consider the reasons for this view having become entrenched and to examine the evidence on which it could have been established and sustained. This view of a particularly high prevalence of periodontal diseases in Asians appears in retrospect to have originated from early epidemiological studies using an index system which gives weight to gingivitis and moderate periodontitis resulting from poor oral hygiene and calculus deposition, very commonly encountered in Asian populations. Studies that have been conducted comparing Asians immigrants with native Caucasians in industrialized northern hemisphere nations broadly concluded that Asians displayed worse periodontal conditions than Caucasians. Similarly, a classic study comparing Norwegian males with Sri Lankan Tamil males demonstrated worse periodontal conditions in the Asian males. A recent review (Albander and Rams, 2002) has stated that those of African origin display the highest prevalence of periodontitis followed by Hispanics and Asians. Studies of the natural history of periodontal disease in Asians, of perio-dontopathogens in Asians, of risk for periodontal destruction, and of reasons for extraction do not appear to explain increased susceptibility of Asians to periodontal destruction. Poor oral hygiene and calculus deposits are widespread, however. Traditional assessments of periodontitis focus on destruction of the periodontal attachment in terms of attachment loss and probing pocket depths, with no consideration being given to the morphological features of the dentition from which the periodontal attachment is being lost, features that may predispose to or complicate the management of periodontal destruction. The Mongoloid dentition shows a high prevalence of such features, which adds a further dimension to the consideration of periodontal diseases among many Asian peoples. Appropriate strategies for the prevention and management of periodontal disease should focus upon improvements in the oral hygiene situation in the diverse continent of Asia.     

Are cardiac transplant patients more likely to have periodontitis? A case record study

In several large epidemiological studies chronic periodontitis has been implicated as an additional risk factor, independent of other risk factors, for the development of ischaemic heart disease. The underlying mechanism is thought to be a localised infection giving rise to an inflammatory host response, and some experimental data agree with this hypothesis. Recently, however, some studies have questioned the post dated relationship between the two diseases. The current case-record study was undertaken to evaluate the prevalence of chronic periodontitis and the severity of such periodontal disease in a heart transplant population, assuming the latter represented a relatively severely compromised cardiovascular patient population. The study demonstrated that 76% of the patients had various degrees of periodontal disease prior to undergoing a heart transplant. Thus, it is possible that a relationship between cardiovascular disease and periodontal disease exists, but further, large intervention studies will be needed to confirm such a conclusion.     

Various aspects of dental prevention in the elderly

The number of old people shows increasing tendency worldwide. The prevalence of oral diseases has been increased with age. In the older adult population tooth loss, dental caries and periodontal diseases frequently can be observed as characteristic features of their oral health condition. Additionally people in elderly are frequently suffered from other oral diseases such as xerostomia, orofacial pain, oral cancer. Results of the latest epidemiological studies show that the level of oral health of Hungarian old population is very low. In many cases oral healthcare can't show an optimal situation due to low economic and social circumstances. The present situation need more changes in oral care. It is necessary to recognize the risk factors, to treat the oral diseases properly and to organize an effective oral/dental care system for the old population.     

Is the observed association between periodontitis and atherosclerosis causal?

Most of the documentation of possible causal links between periodontitis and atherosclerosis-related diseases appears indirect or circumstantial. There is, however, an increasing number of both experimental and longitudinal epidemiological studies which seem to support a causal relationship. A critical evaluation of the epidemiological data available might therefore be appropriate. The present study is based on a literature search using Ovid medical data base covering the period from 1989 to October 2000 and applying specific inclusion criteria. Based on a critical evaluation of the 14 investigations selected from a total of 21 retrieved from the search, a causal relationship between periodontitis and atherosclerosis-related diseases appeared possible. However, the nature both of periodontitis and atherosclerosis is multifactorial, and caution should be exercised when implicating periodontal disease in the causation of atherosclerotic disorders.     

慢性牙周炎和慢性肾病相关关系的 研究进展

慢性牙周炎不仅可以导致牙周支持组织的破坏和丧失,还与多种全身系统性疾病如高血压、糖尿病等有关.慢性肾病是一种破坏肾功能的威胁人类健康的常见的全身性疾病.近年来大量研究显示,慢性牙周炎与慢性肾病可能具有相关关系,通过治疗牙周炎有可能改善肾功能.本文就慢性牙周炎与慢性肾病相关性的流行病学调查研究、牙周治疗对慢性肾病的影响以...     

Dental geriatrics and periodontitis

The present literature review is focused on two main areas: (i) periodontal conditions in older individuals; and (ii) the scientific data available on periodontal treatment outcomes in individuals ≥ 75 years of age. The population of older people is increasing but the data on periodontal therapies and their efficacy in this population are limited and need to be carefully reviewed. Although life expectancy has increased, this does not mean that older people are medically healthy. Several chronic systemic diseases are associated with periodontitis, and the prevalence of most chronic diseases increases with age. Furthermore, older people are challenged by impaired immunity (immune senescence) with a decline in the numbers of naïve T‐cells in peripheral blood and lymphoid tissues. The most frequent significant correlates with successful ageing include not smoking and the absence of disability, arthritis and diabetes mellitus. Periodontal diseases in older individuals may have specific features that are not consistent with periodontal diseases. In this respect, data suggest that gingival lesions in older individuals develop differently from gingival lesions in younger adults. The progression of periodontitis may be slower in older individuals, and older individuals with periodontitis may benefit from more conservative treatment approaches. Diagnostic criteria used for the assessment and diagnosis of periodontitis in younger adults may not be fully applicable in older individuals. In summary, declining health, perception of treatment needs, dietary changes, comorbidity with other diseases and immune senescence are challenging factors to clinicians and researchers, in terms of therapies and in understanding periodontitis etiology in older individuals.