Langerhans' cell histiocytosis in a 5-year-old girl: evidence of periodontal pathogens

BACKGROUND: Langerhans' cell histiocytosis (LCH) is a rare disorder characterized by Langerhans' cell proliferation in various organs or tissues. When periodontal tissue is involved, clinical manifestations can vary from gingival recession and pocket formation to severe alveolar bone loss. This case report describes periodontal pathogens found in the pockets of involved primary teeth. METHODS: A 5-year-old girl with LCH presented with loose teeth. Intraoral examination and radiographs revealed deep pockets and severe bone loss around all primary molars. Bacterial samples were obtained from saliva and subgingival plaque and analyzed for the presence of five periodontopathic bacteria using a polymerase chain reaction (PCR) method. Due to severe periodontal destruction, all primary molars were extracted, and a gingival biopsy was taken from tooth T to confirm the diagnosis of LCH. RESULTS: The biopsy specimen revealed the histologic features of LCH. The patient was diagnosed as having periodontitis as a manifestation of LCH. PCR results of subgingival plaque from LCH-affected molars indicated the presence of Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, and Prevotella intermedia. However, Actinobacillus actinomycetemcomitans was absent from these teeth. No tested bacteria were found in the non-affected anterior teeth. CONCLUSIONS: The bacteria commonly associated with periodontal disease were detected in subgingival plaque samples from this LCH patient. More microbiological data are required to understand the role of these bacteria in LCH-associated periodontal destruction.     

Changes of periodontal status in patients with Down syndrome during a 7-year period

The development of periodontal disease in Down syndrome adolescents (n = 34) was studied clinically and on intraoral radiographs during a 7-yr period. The occurrence of gingival inflammation (GBI), pathological periodontal pockets (>4 mm), sub- and supragingival calculus, alveolar bone height, alveolar bone loss, and the occurrence of the periodontal pathogens Actinobacillus actinomycetemcomitans, Capnocytophaga, and Porphyromonas gingivalis in subgingival plaque were determined. Of the subjects, 41% had one or more pathological periodontal pockets at baseline compared to 65% at follow-up. At the baseline examination, 35% of the individuals exhibited alveolar bone loss compared to 74% at the follow-up. The median value of sites with alveolar bone loss increased from 0 to 1, the new lesions mainly being located in the incisor region. The estimated annual reduction of alveolar bone height in each subject was 0.04 mm on average. The occurrence of the periodontal pathogens A. actinomycetemcomitans, Capnocytophaga, and P. gingivalis in subgingival plaque did not differ between baseline and follow-up. The results of the present study indicate that the frequency of periodontitis, mainly located on the lower incisors, markedly increased during a 7-yr period in Down syndrome individuals, although the severity and progression was limited compared to what has previously been described.     

Actinobacillus actinomycetemcomitans, Capnocytophaga and Porphyromonas gingivalis in subgingival plaque of adolescents with Down''s syndrome

Levels of Actinobacillus actinomycetemcomitans, Capnocytophaga and Porphyromonas gingivalis were determined in subgingival plaque samples from 37 adolescents with Down's syndrome and 37 healthy controls matched with respect to age and sex. Gingival inflammation, supra- and subgingival calculus, periodontal pockets ( > 4 mm) and alveolar bone loss were registered. Alveolar bone loss was more frequent in Down's syndrome subjects (32%) than in the controls (3%). A. actinomycetemcomitans was detected in the subgingival plaque in 35% of the Down's syndrome adolescents and in 5% of the controls. On site level, A. actinomycetemcomitans and Capnocytophaga were more frequent in the subgingival plaque samples of Down's syndrome children than in those of controls. Comparing Down's syndrome subjects positive or negative for A. actinomycetemcomitans and Capnocytophaga, no significant differences were found in terms of gingival inflammation, periodontal pockets ( > 4 mm) or number of sites with alveolar bone loss. The results indicate an altered microbial composition of the subgingival plaque of Down's syndrome subjects compared with healthy controls, with higher frequency of A. actinomycetemcomitans.     

Ligature‐induced marginal inflammation around osseointegrated implants and ankylosed teeth. Clinical and radiographic observations in cynomolgus monkeys (Macaca fascicularis).

The purpose of the investigation was to gain more understanding of marginal inflammatory reactions around osseointegrated implants. The significance of the lacking periodontal ligament of implants was examined in the initial breakdown phase of supporting tissues by comparing clinical and radiographic manifestations of ligature‐induced marginal inflammation related to osseointegrated implants with those around ankylosed and normal control teeth in 8 cynomolgus monkeys ( Macaca fascicularis ). Bilateral extraction of the first and second mandibular molars was carried out initially, and 12 weeks later 2 implants were placed in each side. Ankylosis of the second maxillary molars was established by extracting and replanting the teeth after a drying period. When ankylosis and osseointegration were established, ligature‐induced marginal inflammation was induced in the right or left side at random around implants, ankylosed teeth and normal control teeth (second maxillary premolar) for 7 weeks. Although the clinical manifestations as expressed by plaque score, gingival score, probing depth and attachment loss were quite similar, the radiographic features differed. Significant loss of bone height was limited to implants and ankylosed teeth and did not occur in relation to normal control teeth. Furthermore, the bone loss around implants was significantly greater than the loss around ankylosed teeth. Bone loss was limited to implants and ankylosed teeth; the study therefore suggests that the presence of marginal inflammation around implants and ankylosed teeth may have more serious implications than does marginal inflammation around teeth with a periodontal ligament. However, variations in microbiota and susceptibility of different jaw positions to periodontal breakdown may influence the results of this study.     

Periodontal disease in children with Down's syndrome

The occurrence of supra- and subgingival calculus, gingival inflammation, periodontal pockets (greater than or equal to 5 mm) and alveolar bone loss was determined in children (10-19 yr) with Down's syndrome (D-S) and in an aged- and sex-matched control group (n = 39). Of D-S children (n = 71), 39 of the patients (mean age 15.5 yr) cooperated in a clinical and roentgenologic examination. Alveolar bone loss was determined around incisors and first molars on intraoral radiographs when the distance between cementoenamel junction (CEJ) to alveolar crest (AC) exceeded 2.0 mm. Alveolar bone loss was diagnosed in 39% of the D-S children compared to 3% in the control group (P less than 0.001). Of the total number of sites examined on radiographs the distance from CEJ to AC exceeded 2.0 mm in 8% in the D-S group compared to 0.2% in the control group (P less than 0.001). The frequency of sites with alveolar bone loss in D-S children was significantly (P less than 0.001) higher around the mandibular incisors compared to first molars. The study shows that early signs of periodontitis are frequently seen in D-S children as early as 11 yr of age and the lesions are first diagnosed in the mandibular anterior region.     

Periodontal disease in children with Down's syndrome

Abstract – The occurrence of supra- and subgingival calculus, gingival inflammation, periodontal pockets ( 5 mm) and alveolar bone loss was determined in children (10-19 yr) with Down's syndrome (D-S) and in an aged- and sex-matched control group ( n = 39). Of D-S children ( n = 71), 39 of the patients (mean age 15.5 yr) cooperated in a clinical and roentgenologic examination. Alveolar bone loss was determined around incisors and first molars on intraoral radiographs when the distance between cementoenamel junction (GEJ) to alveolar crest (AC) exceeded 2.0 mm. Alveolar bone loss was diagnosed in 39% of the D-S children compared to 3% in the control group ( P <0.001). Of the total number of sites examined on radiographs the distance from CEJ to AC exceeded 2.0 mm in 8% in the D-S group compared to 0.2% in the control group ( P <0.001). The frequency of sites with alveolar bone loss in D-S children was significantly ( P <0.001) higher around the mandibular incisors compared to first molars. The study shows that early signs of periodontitis are frequently seen in D-S children as early as 11 yr of age and the lesions are first diagnosed in the mandibular anterior region.     

Periodontal bone loss in dry mandibles of South African blacks: a biometric study

Periodontal bone loss associated with periodontitis results in increase in the distance between the cemento-enamel junction (CEJ) and the alveolar bone crest (ABC). This study analyzed periodontal bone loss in 100 mandibles of South African blacks who were never exposed to preventive or restorative dental treatment. Specimens were equally distributed over the third to the seventh decade of adult life. CEJ-to-ABC (CA) distances were measured along 4904 surfaces of 1076 teeth. Analysis of the measurements showed that, generally, CA distances increased with age; differences were substantial between the first and fifth age groups. The incisors were most severely affected in all age groups, and bone loss was less severe around posterior teeth. Pre-molars and second molars lost the least bone. No significant differences between measurements on the buccal, lingual, mesial, or distal surfaces for these teeth were found. Measurements on the right and left sides of the mandible did not differ significantly. These observations may, in part, have been influenced by mid-life loss of teeth caused by severe periodontitis; their absence from the sample may have masked the true extent of periodontal bone loss. The difference in age of eruption and, therefore, the difference in period of exposure to the oral environment may account for the more severe bone loss in the anterior teeth, especially in specimens from younger individuals (21-30 years).     

Periodontal Health of 14-17-year-old US Schoolchildren

This paper describes the findings related to periodontal health in 14-17-year-old children who participated in the National Survey of Oral Health in US Schoolchildren, conducted by the National Institute of Dental Research (NIDR) during 1986-87. Gingivitis was observed in approximately 60 percent of children in this age group. The proportion of examined sites per child with gingivitis, however, was less than 6 percent. Gingivitis was most common in molar areas in the maxilla and incisor areas in the mandible. Supragingival calculus was observed in nearly 34 percent of the children, and subgingival calculus in approximately 23 percent. The proportion of teeth per child with calculus was approximately 8 percent for supragingival and 4 percent for subgingival calculus. Both types of calculus showed a predilection for molars in the maxilla and incisors and cuspids in the mandible. The mean periodontal attachment loss was 0.33 mm. The teeth most frequently affected by attachment loss of 2 mm or more were maxillary molars and bicuspids, followed by mandibular molars and cuspids.     

Prevalence and microbiology of localized prepubertal periodontitis

Loss of crestal alveolar bone at primary teeth was ascertained radiographically in a dental school clinical population of 2264 children. 19 patients (0.84%) demonstrated distinct periodontal bone destruction around one or more primary teeth; in only 2 of these patients had periodontal disease been identified in previous clinical examinations. A microbiological study of 35 subgingival samples from 9 available patients revealed a high prevalence of black-pigmented Bacteroides spp., mainly Bacteroides intermedius. Actinobacillus actinomycetemcomitans and Capnocytophaga spp. were predominant organisms in some samples. The present data indicate that localized prepubertal periodontitis is more common than previously realized and is associated with bacteria generally regarded as major periodontal pathogens.     

Subgingival microflora and treatment in prepubertal periodontitis associated with chronic idiopathic neutropenia

Abstract. Prepubertal periodontitis affects both primary and permanent dentition. The purpose of this study was to examine the composition of subgingival microflora of the permanent dentition in an 11-year-old Caucasian female, who had premature exfoliation of her deciduous teeth on her 5th year of age, and the response of this condition to the antibiotic therapy and supportive periodontal care. Gingival tissues were highly inflamed and alveolar bone loss was detected radiographically. The girl had experienced frequent upper respiratory tract infections, tonsilitis and recurrent otitis media. Her mother had history of early onset periodontitis associated with chronic idiopathic neutropenia. Blood chemistry tests and immunological examinations were also performed. Subgingival plaque samples were collected from the proximal sites of permanent molars, incisors, canines and maxillary premolars. 27 different microbial species were isolated from the subgingival microflora. Among the predominant species were Porphyromonas gingivalis (17.6%-7.3%), Prevotella intertnedia (12.4%-4.7%), Capnocytophaga sputigena (14.4%-10.4%), Capnocytophaga ochracea (13.2%-6.9%) and Actinobacillus actinomycetemcomitans (9.3%-5.5%.). Periodontal treatment consisted of scaling, root planing in conjunction with antibiotic administration of Augmentin® 312.5 mg and Flagyl® 200 mg, each t.i.d. for 10 days. 3 weeks after the antibiotic therapy, bacterial samples were collected from the same sites. All the periodontal pathogens were recovered in lower levels and A. actinomycetemcomitans was almost eliminated in the 3-week period. The evaluation of clinical indices at 3, 6 and 12 months showed that periodontal treatment in conjunction with antibiotics was effective and rapidly followed by marked clinical improvement. The microbiological monitoring at 3, 6 and 12 months after antibiotic treatment and each time prior to supportive periodontal care, revealed that the periodontal pathogens fluctuated in low levels even 12 months after treatment and could be maintained at low level by supportive periodontal care at 3-month intervals.     

Clinical, microbiological and host defense parameters associated with a case of localized prepubertal periodontitis

Abstract A 4-year-old Japanese boy was referred to Osaka University Dental Hospital because of severe mobility and pain of the right lower primary canine. The canine had severe bone loss and a pocket depth exceeding 5-6 mm. The left lower canine showed slight mobility and moderate alveolar bone loss. The other primary teeth showed no pathogenic findings. The subgingival microflora from the right lower canine was dominated by gram-negative rods, especially capnocytophaga and fusobacterium, while actinomyces sp. were the most common gram-positive bacteria. While neutrophil functions of the patient were within the normal ranges of healthy subjects, some lymphocyte functions such as IL-2 production and IgG and IgM syntheses were lower in the patient. 7 months after the extraction of the right lower primary canine, the patient complained of pain around the right lower primary lateral incisor. In 3-4 weeks, the alveolar bone was lost rapidly and mobility of the lower anterior teeth increased significantly. The primary lateral incisor was extracted and the other primary teeth were treated by scaling and systemic and local administration of antibiotics. After treatment, the lower anterior teeth became less mobile and the gram-positive cocci predominated.     

Orthodontic therapy in patients with juvenile periodontitis: clinical and microbiologic effects

The correction of malocclusions in juvenile periodontitis (JP) patients completing periodontal therapy is a problem of increasing clinical concern to orthodontists, since many teeth with severe alveolar bone loss in these patients can now be successfully treated without extraction. In this report, fixed edgewise orthodontic therapy was carried out after the completion of periodontal therapy on four JP patients. The orthodontic therapy included extensive intrusion of teeth severely affected by JP. Phase-contrast microscopic analysis of subgingival plaque from orthodontically treated teeth was used to monitor longitudinally the effects of fixed orthodontic bands on the subgingival flora and also to monitor the efficacy of topical and systemic antimicrobial therapy aimed at suppression of suspected periodontopathic bacteria. Orthodontic movement was completed on most periodontally compromised teeth without significant evidence of additional deterioration in periodontal status. However, within the first 6 months of orthodontic band placement, all patients had significant increases in the number of spirochetes and motile rods in their subgingival flora. Three of the patients also developed high levels of crevicular polymorphonuclear leukocytes around orthodontically treated teeth, indicating significant subgingival inflammation. Intensive antimicrobial measures, including topical inorganic salt applications and systemic tetracycline, were helpful in limiting clinical inflammation and subgingival colonization by periodontopathogens during orthodontic therapy. The results demonstrate that successful orthodontic repositioning can be carried out in treated JP patients. In addition, bacteriologic monitoring and chemotherapeutic suppression of periodontal pathogens may be valuable in the prevention of further destructive periodontal disease activity in periodontitis patients undergoing orthodontic therapy.     

Radiographic evaluation of juvenile periodontitis (periodontosis)

Of 49,380 male naval recruits who were screened for juvenile periodontitis (JP), 270 were clinically diagnosed as having the disease. Full-mouth radiographs identified 182 of these 270 patients as having JP with extensive bone loss on permanent first molars and/or incisors. These 182 patients, 137 (75.3%) of whom were black, were further classified into Type I: bone loss involving first molars and/or incisors and up to two additional teeth; Type II: involvement of first molars/incisors and several additional teeth; and Type III: generalized involvement (more than 14 teeth) but with bone loss notably more extensive on the first molars and/or incisors. Of the 182 patients, 129 (70.9%) were Type I; 43 (23.6%) were Type II, and 10 (5.5%) were Type III. The molars were involved more frequently than the incisors; more than one molar was always involved, with or without incisor involvement. Most cases had minimal or no radiographic caries, and 46% had demonstrable calculus. Of the remaining 88 cases from the 270 with the initial diagnosis of JP, 63 demonstrated severe bone loss on more than 14 teeth, with many of the teeth being involved to the same degree. These cases were termed rapidly progressive periodontitis. Six of the 88 cases had bone loss on only one tooth surface of the dentition. These cases were termed acute localized destruction of alveolar bone. The status of the other 19 cases could not be determined.     

Evaluation of simple periodontal screening technique currently used in the UK armed forces

The need to prioritise resources for periodontal care within the UK Armed Forces has led to the development and introduction of a simple periodontal screening technique, the Periodontal Index for Treatment (PIT), based upon the clinical assessment of six teeth (all first molars and the maxillary right and mandibular left central incisors) with a specially designed periodontal probe (the PIT probe) and the use of bitewing radiography. This paper describes the evaluation of the technique. This was carried out by examining 406 subjects aged from 16 to 64 yr in four groups. All subjects received a full mouth periodontal assessment, performed by one of two periodontists with standardised bitewing radiography of their premolar and first and second molars. They were then categorised as periodontally healthy (PIT 0), with gingivitis but no pocketing exceeding 4 mm (PIT 1), with pocketing 4-5 mm (PIT 2), or with 6 mm + pocketing (PIT 3). The subjects were then examined and categorised by one of 32 General Dental Practitioners using the PIT technique upon the six test teeth and subsequently viewing the bitewing radiographs. The results of the two types of examination, with and without bitewing radiographic evidence, were tested for sensitivity and specificity to detect pocketing in excess of 4 mm and/or bone loss. The results showed that, when used without bitewings as an adjunct, the PIT technique showed a specificity of 95-100% but a low sensitivity in three groups (36%, 52% and 59%) and of 94% in the fourth group who had in fact been referred for periodontal treatment. When bitewing radiographs were used as an adjunct to periodontal probing, the PIT technique showed a specificity of 100% in each group and a sensitivity of 89-100% when screening for pockets and/or bone loss. It was concluded that, in the subjects studied, the PIT technique when used in conjunction with bitewing radiography provided simple, rapid and reliable periodontal screening.     

Prevalence of aggressive periodontitis in school attendees in Uganda

AIM: The prevalence and severity of early onset periodontitis (EOP) among students attending secondary schools in two regions of Uganda was studied. MATERIAL AND METHODS: 690 students (393 males and 297 females) aged 12-25 years (mean 17 years), representing a range of tribal groups, were recruited from six schools in the peri-urban Central and rural Western regions of Uganda. The study subjects were clinically examined in field conditions by a single calibrated examiner to measure gingival recession and probing depth at six sites per tooth, with subsequent calculation of clinical periodontal attachment level for each site. Subjects exhibiting >or= 4 mm of clinical periodontal attachment loss at approximal surfaces of one or more teeth were classified with EOP. A structured written questionnaire obtained demographic characteristics of the study subjects. RESULTS: 199 (28.8%) study subjects showed clinical features of EOP, of which 16 (2.3%) subjects exhibited generalized EOP, 29 (4.2%) localized EOP, and 154 (22.3%) incidental EOP. The percentage of EOP-affected males was significantly higher than females (33.8% vs. 22.2%, P < 0.001). EOP prevalence tended to increase with increasing age, but no association was found between EOP prevalence and socioeconomic status or residency in urban vs. rural areas of Uganda. Molars and mandibular incisors generally demonstrated the highest occurrence of >or= 4 mm attachment loss. Clinical periodontal attachment loss of >or= 5 mm was mainly seen at first molars and incisors, suggesting that these two tooth types are first affected with attachment loss. Approximal tooth surfaces showed greater probing depth and attachment loss than buccal and lingual surfaces. Gingival recession was most prevalent at mandibular anterior teeth, whereas gingival margin coronal to CEJ was most frequently observed at second molars and maxillary incisors. CONCLUSION: A relatively high prevalence of EOP (28.8%) was found in young Ugandan school attendees, with 6.5% of these showing severe disease. EOP in Uganda was significantly more prevalent in males than females, and most frequently characterized by approximal involvement of molars and mandibular incisors. Etiologic and predisposing factors associated with the high occurrence of EOP in Uganda, as well as therapeutic and preventive measures of the disease in this population, remain to be delineated.     

Some periodontal tissue reactions to orthodontic tooth movement in monkeys

The purpose of the experiment reported was to study soft tissue changes at teeth which were orthodontically moved into areas with varying thickness and quality of periodontal tissues. The maxillary central incisors and first premolars in 5 adult monkeys were used as experimental teeth. 6 months prior to the start of the orthodontic treatment phase, the maxillary second premolars were extracted. By surgical means, areas with varying width of the keratinized gingiva were established in the incisor and premolar region. Following a clinical baseline examination which involved assessments of gingival width, location of the gingival margin in relation to cemento-enamel junction and probing attachment level, fixed orthodontic appliances were inserted in order to bodily move the two contral incisors in labial direction through the alveolar bone envelope and the first premolars in distal direction into contact with the first molars. Orthodontic forces were applied for a period of 3-4 months. The lateral incisors and first molars were selected as non-moved control teeth. After the experimental teeth had been retained in their new positions for 1 month, the clinical examination was repeated. Tissue blocks containing test and control specimens were subsequently dissected and prepared for microscopic analysis. The analysis included histometric assessments of loss of connective tissue attachment and height of alveolar bone. The results showed that at every second labially moved incisor, the gingival margin had become displaced in apical direction. The degree of displacement, however, was small and only at 2 teeth accompanied by loss of connective tissue attachment. Throughout the study, these particular teeth also showed obvious signs of gingival inflammation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mandibular second molar periodontal status after third molar extraction.

BACKGROUND: Extraction and treatment of third molars have been cited as causing periodontal problems. To evaluate the long-term effects of third molar extraction on the periodontal health of the mandibular second molar, a comparison of the periodontal status was performed around 2 groups of mandibular second molars, with and without third molar extraction. METHODS: A total of 312 sites in 57 adult periodontitis patients were examined and the buccal and lingual locations of the mesial and distal root surfaces around the second molars were recorded. Two-hundred and thirty-two sites were experimental teeth; i.e., third molars had been surgically removed more than 5 years ago, 80 sites served as control molars; i.e., congenitally missing third molars. Clinical periodontal parameters including probing depth, attachment loss, and gingival recession and radiographic intrabony level were measured. The effects of the surgery and the examination (buccal or lingual) locations on the measurements were statistically analyzed. RESULTS: Neither extraction history nor examination location affected the probing depth on mesial surfaces. However, significant effects of the surgical history on the probing depth were observed on the distal surfaces. Similar results of greater attachment loss and radiographic alveolar bone loss were observed only at the distal sites of the experimental group. In addition, the increased radiographic bone loss was only found at the distal sites (adjacent to the surgical location) and not at the mesial sites (distant from the surgical location) on the experimental group. CONCLUSIONS: In this study, greater periodontal breakdown, including probing depth, attachment loss, and radiographic alveolar bone loss, was found at the distal sites, but not at the mesial sites, of the experimental molars where the third molar was surgically extracted compared with the control teeth (no surgery). In the experimental molars, more radiographic bone loss was found at the sites adjacent to the surgical location than at the sites distant to the surgical location. Therefore, we suggest that the surgical removal of the mandibular third molar may lead to a periodontal breakdown on the distal surface of the second molar. Periodontal re-evaluation after the initial healing of third molar extraction is indicated.     

Risk of severe periodontal disease in a Swedish adult population

Abstract. The aim of this study was to identify risk factors for severe periodontal disease progression in a Swedish adult population between the years 1973 and 1988–91. In 1973, a random sample of 474 dentate adults living in Jönko ping County was examined clinically and radiographically. A questionnaire on demographic and socio-economic status, general health, and dental care habits was also used. During the years 1988–1991, 361 of the individuals examined in 1973 were re-examined. A total of 506 (6%) teeth or in average 1.4 teeth per subject were lost between the 2 examinations. 4 subjects had become completely edentulous. The mean loss of teeth in the different age groups 20–60 years was 0.2, 0.9, 1.4, 2.3, and 2.6, respectively. The periodontal bone level decreased by age both in 1973 and in 1988–91. The mean annual progression rate was 0.06 mm for all 357 individuals and varied between 0.04 and 0.07 mm per subject in the different age groups. The presence of periodontal disease progression was defined as bone loss of >20% at a proximal site between the 2 examinations. The most prevalent tooth types with bone loss of >20% at proximal sites were the maxillary and mandibular 2nd molars and the 1st maxillary molar, representing a % of 18.0, 12.8, and 13.5, respectively. The degree of association between severe periodontal disease progression and explanatory variables was investigated using logistic regression models. The dependent variable was no progression of periodontal disease or severe periodontal disease progression, i.e., subjects with periodontal bone loss >20% at ≥6 sites. Age was found to be correlated with severe periodontal disease progression by an odds ratio of 1.05 (CI: 1.02–1.07). The frequency of females in the group with severe bone loss was 58% and higher than in the non-progressing group, 50%. Only 9% in the group with no bone loss smoked as compared to 38% in the group of individuals with severe periodontal bone loss. % supragingival plaque, gingival inflammation, and deepened periodontal pockets (≥4 mm) at baseline were related to severe periodontal disease progression by odds ratios of 1.03 (CI: 1.02–1.05), 1.01 (1.00–1.03), and 1.03 (1.00–1.05), respectively. In the multivariate logistic regression model, age (odds ratio 1.13 (CI: 1.06–1.19)), smoking (odds ratio 20.25 (5.07–80.83)), and % pockets ≥4 mm (odds ratio 1.15 (1.04–1.27)) remained significantly associated with severe disease progression. Furthermore, female gender and differences in income level appeared in the multivariate analysis to be related with severe bone loss, with odds ratios of 3.19 (CI: 1.02–9.97) and 8.46 (CI: 1.97–36.37), respectively.     

Periodontal and oral microbiological status of an adult population undergoing haemodialysis: a cross-sectional study

OBJECTIVES: The aim of this cross-sectional study was to evaluate the periodontal status and oral microbiological patterns of a population with end-stage renal disease (ESRD), undergoing haemodialysis (HD). DESIGN: This was a cross-sectional study, involving 52 patients from the Nephrology Department and 52 matched control subjects. MATERIALS AND METHODS: The subjects had a periodontal clinical examination; subgingival plaque samples were taken and analysed using a semiquantitative polymerase chain reaction (PCR) test to detect Porphyromas gingivalis, Tannerella forsythia, Prevotella intermedia, Prevotella nigrescens and Actinobacillus actinomycetemcomitans. Subgingival plaque and saliva samples were studied for Candida and Enterobacteriaceae. MAIN OUTCOME MEASURES: Most of the 104 subjects had some degree of loss of periodontal attachment (LPA) > or =3 mm [11 (10.5%) had severe LPA; 16 (15.4%) moderate LPA; and 64 (61.5%) mild LPA]. Only 13 subjects (12.5%) presented good periodontal health. Results: No statistically significant differences were found between the HD patients and the control group regarding bleeding index, number of teeth, or percentage of LPA > or =3 mm. However, a statistically significant difference was seen in the degree of oral hygiene. CONCLUSIONS: On the basis of the findings presented here, we cannot associate ESRD with more severe periodontal destruction. Although HD patients presented a higher number of periodontopathic microorganisms than the matched controls, a prolonged duration of HD did not bear a statistically significant relationship with the percentage of sites with LPA > or =3 mm, specific microbiota or composition of biofilm.     

Microflora in adult periodontitis

The subgingival microflora of adult periodontitis was studied in 8 adults (36–47 years) and compared with that of 10 periodontally healthy individuals (36–43 years). A total of 64 periodontal lesions were examined, and classified according to the attachment level in three categories: attachment loss >6 mm, attachment loss 4–6 mm and attachment loss <4 mm. Also for comparative purposes 20 gingival sulci were evaluated. Samples were taken using three standardized paper points and were incubated anaerobically in selective and non-selective media. The results showed a statistically significant association of Capnocytophaga gingivalis and Capnocytophaga sputigena with moderate periodontal lesions, while Haemophilus segnis has been correlated to severe periodontal lesions. We concluded that C. gingivalis, C. sputigena and H. segnis might be potentially conducive to periodontal deterioration in adult periodontitis.