Factors associated with periodontitis in an HIV-infected southeast USA study

OBJECTIVES: To determine the relationship of immunosuppression with measures of probing pocket depth (PPD), recession (REC), and clinical attachment level (CAL) in an HIV-infected population from North Carolina (NC), a state in the southeastern United States (USA). DESIGN: Cross-sectional study of HIV-infected adults (n = 326) treated at the University of North Carolina Hospitals. Clinical medical record review and sociodemographic interview data were collected. Median age of study participants was 37 years (range 19-67). Males comprised 78% and Blacks 60%. Analyses were limited to those who were dentate (n = 316). MAIN OUTCOME MEASURES: Main outcomes were cases vs non-cases of notable PPD, REC, and CAL. Immunosuppression measured by CD4+ cell count microL was the exposure of interest. RESULTS: Defined cases of PPD (n = 148) were 2.6 (95% CI = 1.3, 5.3) times less likely to occur at CD4+ cells < 200 than non-cases, whereas, cases of REC (n = 94) were 2.8 (95% CI = 1.2, 6.6) times more likely to occur at that level of severe immunosuppression, controlling for confounders. CONCLUSION: Sub-groups of persons with HIV experience a high burden of periodontitis where notable severity and extent of PPD, CAL, and REC were clearly evident at different stages of immunosuppression.     

Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994

BACKGROUND: Accurate information on the prevalence and extent of periodontal diseases in the United States adult population is lacking. This study estimated the prevalence and extent of periodontal disease in the United States using data from the third National Health and Nutrition Examination Survey (NHANES III). METHODS: A nationally representative sample was obtained during 1988 to 1994 by a stratified, multi-stage probability sampling design. A subsample of 9,689 dentate persons 30 to 90 years old who received a periodontal examination was used in this study, representing approximately 105.8 million civilian, non-institutionalized Americans in 1988 to 1994. Periodontal attachment loss, probing depth, and furcation involvement were assessed in 2 randomly selected quadrants per person. Attachment loss and probing depth were assessed at 2 sites per tooth, the mesiobuccal and mid-buccal surfaces. The periodontal status of each subject was assessed by criteria based on the extent and severity of probing depth and furcation involvement. These assessments were used to classify each subject as having a mild, moderate, or advanced form of the disease. In the analyses, weighted data were used to reflect the complex sampling method. RESULTS: Prevalence of attachment loss > or = 3 mm was 53.1% for the population of dentate U.S. adults 30 to 90 years of age and, on average, 19.6% of teeth per person were affected. The prevalence of probing depth > or = 3 mm was 63.9% and, on average, 19.6% of teeth were affected. Fourteen percent of these persons had furcation involvement in one or more teeth. We estimate that at least 35% of the dentate U.S. adults aged 30 to 90 have periodontitis, with 21.8% having a mild form and 12.6% having a moderate or severe form. The prevalence and extent of attachment loss and the prevalence of periodontitis increase considerably with age. However, the prevalence of moderate and advanced periodontitis decreases in adults 80 years of age and older. This is most likely attributed to a combination of a high prevalence of tooth loss and gingival recession in the oldest age cohorts. Attachment loss and destructive periodontitis were consistently more prevalent in males than females, and more prevalent in blacks and Mexican Americans than whites. We estimate that in persons 30 years and older, there are approximately 56.2 and 67.6 million persons who, on average, have about a third of their remaining teeth affected by > or = 3 mm attachment loss and probing depth, respectively. We also estimate that about 21 million persons have at least one site with > or = 5 mm attachment loss, and 35.7 million persons have periodontitis. These are conservative estimates based on partial-mouth examinations, and the true prevalence and extent of periodontal disease may be significantly higher than what is reported here. CONCLUSIONS: Periodontitis is prevalent in the U.S. adult population. The results show that black and Mexican American males have poorer periodontal health than the rest of the U.S. adult population. Primary and secondary preventive measures should therefore be specifically targeted towards these groups.     

Periodontitis in smokers and non-smokers: intra-oral distribution of pockets

AIM: The purpose of the present study was to establish retrospectively whether the disease severity differs between smokers and non-smokers. METHODS: The study population consisted of 183 periodontitis patients, 79 smokers and 104 non-smokers. These subjects had been referred by general dentists to the Clinic for Periodontology, Utrecht, because of periodontal problems and were selected on the basis of the clinical diagnosis: adult periodontitis. The proportion of bleeding sites and the intra-oral distribution of probing pocket depth was evaluated. RESULTS: No statistically-significant differences between smokers (SM) and non-smokers (NSM) were found regarding the mean % of sites that bled upon probing (SM=76%, NSM=72%). Overall differences in the prevalence of probing depths > or =5 mm between smokers and non-smokers were found (SM=44%, NSM=34%). The proportion of sites with a probing pocket depth of > or =5 mm was consistently higher in smokers in the anterior, premolar and molar regions. The data also show that in the upper jaw at the anterior and premolar teeth, the largest differences are found between smokers and non-smokers. Smokers have more sites with a pocket depth > or =5 mm, especially on the lingual surfaces of these teeth. CONCLUSIONS: The present study indicates that cigarette smoking is a factor associated with deeper periodontal pockets and an intra-oral distribution that is suggestive of a local effect.     

Periodontitis and coronary artery calcification: the Atherosclerosis Risk in Communities (ARIC) study

BACKGROUND: Periodontitis has been linked to coronary heart disease (CHD) risk, possibly through providing a systemic inflammatory burden. Few studies have evaluated periodontitis and subclinical measures of atherosclerosis. Coronary artery calcification (CAC) is an emerging marker for atherosclerosis, and past studies suggest that it predicts incident CHD in asymptomatic populations. METHODS: In 1996-1998, dental examinations were performed on 6,931 participants in the Atherosclerosis Risk in Communities (ARIC) cohort. Extent of periodontitis was measured by the percent of sites with attachment level (AL) > or = 3 mm. In 1999-2000, CAC was measured by cardiac gated mechanical or helical computed tomography in 269 dental examinees and edentulous subjects from the Minnesota and North Carolina field centers of ARIC who were free of clinically recognized CHD. A traditional Agatston score for CAC was calculated. RESULTS: Compared to subjects with no or mild periodontitis (<10% of sites with AL > or = 3 mm), subjects with moderate or severe periodontitis (> or = 10% of sites with AL > or = 3 mm) were more likely to have CAC > or = 100, but this difference was not statistically significant (odds ratio [OR]: 1.78; 95% confidence interval [CI]: 0.65 to 4.86). This association was partially but not completely attenuated when adjusted for demographic factors and traditional CHD risk factors (OR: 1.51; 95% CI: 0.54 to 4.23). CONCLUSIONS: These results suggest that periodontitis is not strongly associated with CAC. This study offers some reference for the magnitude of the association between CAC and periodontitis and information regarding the minimal power necessary for future studies.     

Investigating the Association Between Obstructive Sleep Apnea and Periodontitis

Background: Obstructive sleep apnea (OSA) is a sleep disorder characterized by disruptions of normal sleep architecture. Chronic periodontitis is a chronic disease of the periodontium that elicits a general inflammatory response to local dental plaque. It has been suggested that periodontal disease may increase in severity with increasingly severe OSA because both disease entities share common inflammatory pathways, acting synergistically to alter the host response. The aim of this study is to analyze the association between severity of OSA and the prevalence/severity of periodontitis. Methods: One hundred patients from a large veterans administration sleep study center (n = 26 normal, n = 21 mild, n = 19 moderate, n = 34 severe) diagnosed with an overnight polysomnogram underwent a comprehensive periodontal examination. Periodontal parameters measured included the following: 1) mean periodontal probing depth (PD); 2) clinical attachment level (CAL); 3) gingival recession; and 4) percentage of sites with bleeding on probing, plaque, PD ≥5 mm, and CAL ≥3 mm. Results: Seventy‐three percent of the sampled population had moderate/severe periodontal disease. χ² analyses revealed no significant differences in the prevalence of periodontal disease between the apnea–hypopnea index (AHI) groups, with a negligible Spearman correlation coefficient of 0.246 between AHI severity and periodontal disease severity categories. Analysis of covariance indicated a significant association between AHI severity categories and percentage of sites with plaque, after adjusting for age. Multivariable logistic regression analysis predicting moderate/severe periodontitis with AHI score, age, and smoking status indicated a significant association with age (P = 0.028) but no significant association with the other two predictors. Conclusion: OSA was not significantly associated with the prevalence of moderate/severe periodontitis and the periodontal parameters examined, except percentage plaque.     

Clinical comparison of the effectiveness of novel sonic instruments and curettes for periodontal debridement after 2 months

AIM: The aim of this study was to evaluate in vivo the effectiveness of scaling and root planing of new oscillating instruments (Periosonic) using a sonic handpiece compared to hand curettes with a split mouth design after 2 months. METHODS: 11 patients with adult periodontitis participated in this study. Plaque index (PII) (O'Leary), bleeding on probing (BOP), probing pocket depth (PPD), recession (REC) and clinical attachment level (CAL) were recorded at baseline and 2 months after treatment. After oral hygiene instruction, 2 randomly assigned quadrants per patient were scaled and root planed with curettes (control side) and the remaining 2 quadrants with the Periosonic instruments 1 and 2 (test side). The student t-test for paired data was used to test the significance of difference between test and control sides. RESULTS: There was no statistical difference (p>0.05) between the 2 sides for the improvement of the clinical parameters excepted for the group with initial PPD of 4-6 mm (test: 1.3+/-0.4 mm PPD reduction, control: 1.6+/-0.4 mm). For PPD > or =7 mm, the test side had better clinical improvement in attachment levels (2.2+/-0.9 mm), less recession (-0.4+/-0.5 mm) with lower PPD reduction (2.4+/-0.6 mm) than the control side (AL: 1.6+/-1.8 mm; REC: -1.3+/-0.7 mm, PPD reduction: 3.0+/-1.4 mm). CONCLUSION: This clinical study demonstrated that Periosonic(R) instruments are clinically at least as effective as curettes in PPD reduction when initial PPD is < or =6 mm and show better clinical attachment level improvement with less recession for initial PPD of > or =7 mm.     

伴放线菌嗜血菌在慢性牙周炎患者和牙周健康者中的分布

目的分析伴放线菌嗜血菌在慢性牙周炎患者和牙周健康者中的分布情况。方法选择116例慢性牙周炎患者（CP组）和111例牙周健康者（健康组）为研究对象。CP组选取磨牙区牙周袋最深的2个患牙的探诊深度最深点作为患牙的取样位点,同时选取磨牙或前磨牙区1个健康牙的近中位点作为健康牙的取样位点;健康组选取上颌第一磨牙近中位点作为取样位点。收集取样位点的龈下菌斑,提取DNA,用16S rRNA聚合酶链反应检测伴放线菌嗜血菌的分布;同时检查并记录取样牙的牙周临床指数（包括探诊深度、临床附着丧失和探诊出血）,分析伴放线菌嗜血菌检出率和牙周临床指数的关系。结果CP组患牙伴放线菌嗜血菌检出率为33.62%,明显高于CP组健康牙和健康组（P<0.01）。伴放线菌嗜血菌检出率随着患者年龄的增加而降低,随着探诊深度、临床附着丧失的增加而增加,探诊出血阳性患牙的检出率（37.07%）也明显高于探诊出血阴性的患牙（7.41%）（P<0.05）。结论伴放线菌嗜血菌检出率随着牙周炎症程度的加重而升高,与慢性牙周炎的发生发展具有密切的联系。     

Use of Emdogain in the treatment of deep intrabony defects: 12-month clinical results. Histologic and radiographic evaluation

The objective of this study was to evaluate the application of an enamel matrix derivative (Emdogain) in deep periodontal pocket therapy. Twenty-one patients presenting intrabony and interproximal defects that could be treated with guided tissue regeneration were selected. The intrabony defects were divided into deep (< 9 mm) and very deep (> or = 9 mm) defects. Bleeding on probing, Plaque Index, probing pocket depth, mobility index, gingival recession, probing attachment level, and surgical bone level were measured at baseline. At 12 months, cases were reexamined and indices recorded again. The mean probing depth decreased from 8.1 +/- 2.1 mm to 3.2 +/- 1.5 mm; attachment level decreased from 10.4 +/- 2.4 mm to 7.0 +/- 1.8 mm; recession increased from 2.3 +/- 1.4 mm to 3.8 +/- 1.8 mm; and surgical bone level decreased from 9.6 +/- 1.9 mm to 7.1 +/- 1.5 mm. No significant difference wa noted between bone defects with one or 2 walls, between local and generalized periodontitis, or between smokers and nonsmokers. Significant statistical difference was found, however, between deep intrabony defects and very deep defects when attachment gain was considered. No adverse reaction to the substance was noted. The good clinical results obtained were not confirmed by radiologic results; standardized and computerized radiographs at 12 months did not reveal significant improvement. The histologic examination carried out on 2 samples did not show evidence of new attachment. Further studies are necessary to clarify the action mechanism and to evaluate the long-term results of this method.     

Relationship Between Halitosis and Periodontitis: a Pilot Study

ObjectiveHalitosis, or oral malodour, is an unpleasant smell emanating from the oral cavity. It is a common complaint among patients with periodontitis, however, their relationship is not fully elucidated. This study aimed to evaluate the association between halitosis measures, clinical indicators of periodontitis and tongue coating, as well as a novel measure, periodontal inflamed surface area (PISA).Material and methodsData of 10 patients with periodontitis and halitosis were included in this study. Halitosis was assessed by the organoleptic method and the portable sulphide monitor, measuring volatiles sulphur compounds. A comprehensive periodontal examination was conducted, and the parameters of probing depth, gingival recession, clinical attachment level, bleeding on probing, plaque and tongue coating were registered. The PISA was calculated using clinical attachment level, gingival recession and bleeding on probing.ResultsA correlation between organoleptic score and tongue coating (r=0.554) and plaque (r=0.614) could be observed. No correlation between measures of halitosis and probing depth or the PISA could be detected. A significant correlation was found between organoleptic scores and volatiles sulphur compounds values (r=0.931).ConclusionThis pilot study has shown and further reiterated a complex interplay between different factors causative to halitosis in patients affected by periodontitis. The results suggest that tongue coating and oral hygiene may have an important role in halitosis in patients with periodontitis.     

Three-year Root Caries Incidence and Risk Modeling in Older Adults in North Carolina

Objectives : The purposes of this study were to describe the incidence of root caries and to identify its risk factors in a representative sample of older adults. Methods : Root caries incidence was estimated and multivariate risk assessment models were developed to identify predictors for root caries in a three-year follow-up study of 234 black and 218 white noninstitutionalized adults aged 65 and older residing in North Carolina. Results : During the observation period, 29 percent of blacks developed root caries, compared to 39 percent of whites (P<.05). The mean net DFS increment per person was 0.55±0.13 root surfaces for blacks vs 0.80±0.21 for whites (P>.32). Multivariate logistic regression analysis indicated that blacks wearing a partial denture, having some root fragments, having an average gingival recession ≥2 mm, and being free of P. intermedia were at greater risk for developing new root caries. The model for whites showed that retired people with their most severe gingival recession ≥4 mm, an average probing pocket depth ≥2 mm, and taking antihistamines were more likely to develop new lesions. Conclusions : These findings suggest that older blacks had less risk of root caries than whites, and in both groups indicators of poor periodontal status increased the risk of root caries.     

Association of T CD4 lymphocyte levels and subgingival microbiota of chronic periodontitis in HIV-infected Brazilians under HAART

OBJECTIVE: The aim of this study was to determine the subgingival microbiota of HIV-infected patients with chronic periodontitis and different T CD4 lymphocyte levels under HAART. STUDY DESIGN: 64 HIV+ patients (mean age 34.5 +/- 7.3; 75% males) were distributed into Group I: chronic periodontitis (> or = 3 sites with probing pocket depth (PPD) and/or clinical attachment level (CAL) > or = 5 mm); and Group II: periodontal health (no sites with PPD > 3 mm and/or CAL > 4 mm). All subjects received conventional periodontal therapy. Periodontal clinical parameters were evaluated at 6 sites/tooth in all teeth at baseline and 4 months after therapy. The levels of T CD4 were obtained from the patient's medical record. Subgingival plaque samples were taken from the 6 sites with the largest pocket depth in each subject of Group I, and 6 randomly selected sites in subjects of Group II. The presence of 22 subgingival species was determined using the checkerboard DNA-DNA hybridization method. Significant microbiological differences within and among groups were sought using Wilcoxon signed-rank and Mann-Whitney tests, respectively. Relationships between T CD4 levels and microbiological parameters were determined using Kruskal-Wallis test. RESULTS: Sixty-one percent of the HIV-infected patients represented AIDS cases, although 69% of them were periodontally healthy. The T CD4 lymphocyte mean level was 333 cells/mm3 and viral load was 12,815 +/- 24,607 copies/mm3. Yet, the prevalence of chronic periodontitis was relatively low (36%). Several periodontal pathogens, in particular T. forsythensis (P < .05), were more prevalent in HIV-positive patients with periodontitis than in HIV-positive subjects with periodontal health. Most of the species decreased in frequency after therapy, particularly P. gingivalis (P < .05). E. faecalis and F. nucleatum were significantly more prevalent in the subgingival microbiota of patients with chronic periodontitis and lower levels of T CD4 (P < .05), while beneficial species tended to be more frequently detected in individuals with T CD4 counts over 500 cells/mm3. CONCLUSION: The subgingival microbiota of HIV-infected patients with chronic periodontitis include a high prevalence of classical periodontal pathogens observed in non-infected individuals. Furthermore, the severe immunosuppression seems to favor the colonization by these species, as well as by species not commonly found in the subgingival microbiota.     

The associations between gingival crevice fluid matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1 and periodontitis in human immunodeficiency virus-positive patients

BACKGROUND AND OBJECTIVE: The study aimed to determine whether matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in gingival crevice fluid could serve as prognostic factors for the progression of periodontitis in human immunodeficiency virus (HIV) -positive patients. Activated inflammatory cells produce inflammatory mediators, which stimulate the production of MMPs and their inhibitors. It is likely that the compromised immune system contributes to the pathogenesis of periodontitis in HIV-positive patients. METHODS: Clinical measurements including gingival index, plaque index, bleeding index, probing depth, attachment loss, and gingival crevice fluid samples were taken from two healthy sites (including sites with gingival recession, gingival index = 0; probing depth < or = 3 mm; attachment loss < or = 2 mm), three gingivitis sites (gingival index > 0; probing depth < or = 3 mm; attachment loss = 0) and three periodontitis sites (gingival index > 0; probing depth > or = 5 mm; attachment loss > or = 3 mm) of each of the 35 patients at baseline visits and 6-month visits by means of paper strips. Gingival crevice fluid levels of MMP-9 and TIMP-1 were determined by sandwich enzyme-linked immunosorbent assays. RESULTS: The mean amounts of MMP-9 and TIMP-1 in the gingivitis and periodontitis sites sites were significantly higher than in the healthy sites (P < 0.0001). The progressing site was defined as a site that had 2 mm or more attachment loss during the 6-month study period. Gingival crevice fluid levels of MMP-9 were significantly correlated with probing depth, attachment loss, TIMP-1, age, smoking pack years, and viral load values at baseline and 6-month visits (0.0001 < P < 0.001). TIMP-1 levels were only correlated with CD4, viral load, attachment loss, and MMP-9 (0.001 < P < 0.01). Repeated measures analysis of 11 active sites vs. 269 inactive sites indicated that MMP-9 and TIMP-1 levels were significantly higher in active sites than in inactive sites (P < 0.0001). These data indicate that sites with high ginigval crevice fluid levels of MMP-9 and TIMP-1 in HIV-positive patients are at significantly greater risk for progression of periodontitis.     

Periodontal tissue alterations following Emdogain treatment of periodontal sites with angular bone defects. A series of case reports

The aim of the present study was to assess the predictability of probing attachment gain and probing pocket depth reduction following Emdogain treatment at sites with deep angular bone defects. MATERIAL AND METHODS: 108 consecutively-treated periodontal patients (mean age 55.8 years) were included. Each subject exhibited at least 1 deep interproximal intrabony defect that could be identified as an experimental site based on the inclusion criteria: (i) probing pocket depth > or = 5 mm, (ii) probing attachment loss > or = 6 mm, (iii) radiographic evidence of an interproximal bone defect with a > or = 3 mm intrabony component. A total of 145 defects met the criteria for inclusion. All subjects received non-surgical periodontal therapy. This included subgingival instrumentation in all parts of the dentition. At least 6 months after the completion of this treatment, a baseline examination was performed to characterise the experimental site. Reconstructive therapy was subsequently performed. Full-thickness periodontal flaps were elevated, and the root surface scaled and planed. No bone recontouring was performed. A gel containing 24% EDTA was applied on the exposed root and was kept in place for 2 min. A preparation of enamel matrix proteins was applied to the root surface and adjacent defect space. The flaps were replaced and closed with sutures. The experimental sites were re-examined 12 months after reconstructive surgery. RESULTS: The re-examination demonstrated that a treatment including the application of enamel matrix proteins at periodontal sites with angular defects resulted in a mean probing attachment level gain of 4.6 mm and a probing pocket depth reduction of 5.2 mm. 87% of all sites treated exhibited a probing attachment gain of > 2 mm. One site suffered probing attachment loss. The radiographic assessments revealed that the bone defect had been reduced in depth by 2.9 mm on average. The reduction in defect size corresponded to an average bone fill of 69% of the original defect. In 43% of the defects, the bone fill amounted to > or = 80%. CONCLUSION: The overall probing pocket depth reduction, probing attachment level gain, and soft tissue recession, that results following Emdogain therapy, is similar to the corresponding outcome variables following GTR.     

Association of T CD4 lymphocyte levels and chronic periodontitis in HIV-infected brazilian patients undergoing highly active anti-retroviral therapy: clinical results

BACKGROUND: Controversial data regarding the association between immunosuppression and prevalence/ severity of periodontal diseases in HIV infection have been reported. Thus, the aim of this study was to test the hypothesis that lower T CD4 lymphocyte levels are not related to a higher prevalence of chronic periodontitis in HIV-infected Brazilians undergoing highly active anti-retroviral therapy (HAART). METHODS: Sixty-four HIV-infected patients under HAART were classified as having chronic periodontitis; i.e., > or = three sites with probing depth (PD) and/or clinical attachment level (CAL) > or = 5 mm or periodontal healthy (no sites with PD > 3 mm and/or CAL > 4 mm). All subjects received conventional periodontal therapy. Bleeding on probing, plaque accumulation, PD, and CAL were registered at six sites/tooth at baseline and 4 months after therapy. Epidemiological features and levels of T CD4 lymphocytes were obtained from medical records. Significance of differences in periodontal clinical parameters within and between groups were determined using Wilcoxon signed-rank and Mann-Whitney or independent sample t tests. Associations between T CD4 levels and clinical parameters were determined using the chi square test. RESULTS: Sixty-one percent of the HIV-infected patients represented AIDS cases, although 69% of them were periodontally healthy. The overall T CD4 lymphocyte mean levels was 333 +/- 254 cells/mm3 and viral load was 12,815 +/- 24,607 copies/mm3. Yet the prevalence of chronic periodontitis was relatively low (36%). In addition, patients with periodontitis presented a moderate disease (mean PD = 2.2 +/- 0.10; mean CAL = 2.6 +/- 0.13) and responded successfully to periodontal therapy. These subjects showed higher levels of T CD4 cells, but lower counts of neutrophils than periodontally healthy patients. Among periodontally healthy and chronic periodontitis patients, 41.7% and 22.9%, respectively, had low levels of T CD4 lymphocytes. No significant differences between periodontal status and epidemiological and immunological parameters were observed. CONCLUSION: Based on these results, the hypothesis that lower T CD4 lymphocyte levels are not associated with higher prevalence of chronic periodontitis in HIV-infected Brazilians under HAART cannot be rejected.     

Using the PerioChip in treating adult periodontitis: an interim report

Multicenter clinical trials have established that the adjunctive use of the subgingival controlled release of chlorhexidine, in the form of the PerioChip, significantly reduces pocket probing depth, improves probing attachment levels, and reduces bleeding on probing compared to scaling and root planing alone, for periods up to 9 months. The purpose of the present study was to report on the adjunctive use of the PerioChip for the long-term management of adult periodontitis for 2 years. A total of 836 patients with adult periodontitis from private dental offices were recruited into the trial. This interim report is on the first 72 patients to have completed the 2-year study. Treatments included initial definitive therapy followed by PerioChip placement in pocket sites with a pocket probing depth of > or = 5 mm after 1 month. Subsequently, the patients received routine periodontal maintenance therapy together with the placement of a PerioChip in pockets with pocket probing depths > or = 5 mm every 3 months. Results indicated that there was a continuous decrease in pocket probing depth over the 2 years (1.26 +/- 0.77 mm). This decrease in pocket probing depth was marked over the first 9 to 12 months, and then appeared to be less marked over the next 12 months. At 2 years, 60% of the patients had at least 2 pockets showing a reduction of 2 mm or more, and only 10% of the patients showed no change or increased pocket probing depth. The results indicate that adjunctive PerioChip use is a clinically effective treatment option for dental professionals and their patients for the long-term management of adult periodontitis.     

米诺环素对慢性牙周炎辅助治疗的疗效观察

目的 评价牙周袋局部应用米诺环素软膏联合刮治和根面平整治疗慢性牙周炎的疗效。方法 64名患中到重度慢性牙周炎的男性吸烟者随机分成SRP和SRP+M两组。对SRP组患者施行刮治和根面平整,对SRP+M组患者在刮治和根面平整的基础上,牙周袋局部应用米诺环素软膏。记录两组患者在基线、3个月和6个月时的菌斑指数（PlI）、牙龈指数（GI）、探诊出血（BOP）、探诊深度（PD）及附着丧失（AL）的变化并进行统计学分析。结果 治疗过程中有6例患者被排除,有效病例数为58例,每组29例。牙周治疗3个月和6个月后,两组患者的PlI、GI和BOP均无统计学差异（P>0.05）,但PD和AL有统计学差异（P<0.05）。治疗后3个月SRP组PD下降1.32 mm,AL减轻1.14 mm;而SRP+M组PD下降1.98 mm,AL减轻1.87 mm。对于基线检查PD≥7 mm的深牙周袋,治疗后3个月SRP组PD下降2.21 mm,AL减轻1.23 mm;而SRP+M组PD下降3.48 mm,AL减轻2.62 mm。治疗后6个月PD和AL状况与3个月相比变化不大。与SRP组相比,SRP+M组临床症状改善更明显。结论 龈下局部应用米诺环素软膏辅助治疗慢性牙周炎可取得较好的疗效,特别是对于有深牙周袋、吸烟的牙周炎患者,机械治疗联合局部应用缓释抗菌素较单纯机械治疗的疗效更好。     

GTR treatment of intrabony defects in patients with early-onset and chronic adult periodontitis

Young, systemically healthy subjects may suffer from early-onset forms of periodontitis characterized by the presence of localized deep vertical bony defects. The aim of this study was to compare the healing response after guided tissue regeneration (GTR) treatment of similar intrabony defects in patients affected by early-onset and chronic adult periodontitis. Twenty systemically healthy, nonsmoking subjects were enrolled in the study; 10 were affected by early-onset periodontitis (EOP) and 10 by chronic adult periodontitis (CAP). In each subject, only one deep vertical bony defect (intrabony component > 4 mm, probing attachment level > or = 8 mm) was treated according to the principles of GTR therapy with titanium-reinforced e-PTFE membranes. At the time of the surgery and at the 1-year follow-up, a microbiologic test for the identification of the main periodontopathogens was performed in each of the treated sites. There was no statistically significant difference at 1 year in the amount of clinical attachment gain (P = .4), reduction of probing pocket depth (P = .3), or increase in gingival recession (P = 1.0) between EOP and CAP patients. The 1-year microbiologic results demonstrated the complete disappearance of the putative periodontopathogens from all surgically treated sites in both patient groups. The results of the study demonstrated that deep intrabony defects in patients with EOP can be successfully treated by means of GTR procedures and that the suppression of periodontopathogens under threshold values can be maintained for at least 1 year, provided that the patient is enrolled in a maintenance program consisting of recalls for professional tooth cleaning and reinforcement of self-performed oral hygiene measures at 1-month intervals.     

Epidemiology of periodontal diseases in the study of health in Pomerania

Aim: The aim of this study was to assess the prevalence and extent of periodontal diseases among adults in a province in Eastern Germany.
Material and Methods: The Study of Health in Pomerania is a population-based study conducted during 1997–2001. The net random sample comprised 4310 20–81-year-old subjects. Periodontal status was assessed at four surfaces using a half-mouth recording protocol.
Results: The prevalence of attachment loss 3 mm was 89.7%, with 62.8% of teeth being affected. Probing depths 4 mm were prevalent in 69.7% of subjects, and 29.6% of teeth were affected. 25.3% of all subjects had severe pockets (6 mm). Periodontitis was significantly more prevalent in males. For attachment loss, the prevalence and extent increased significantly with increasing age, whereas probing depth values levelled off after the age of 40. In older subjects, increased recession and attachment loss were found, while the probing depth remained constant. According to the recent CDC classification, 17.6% and 33.3% of persons had severe and moderate periodontitis, respectively. The prevalence of periodontitis increased significantly with age and remained constant after the age of 50–59.
Conclusions: Periodontitis is more prevalent in Pomerania than in the United States or Western Europe. In older subjects, attachment loss steadily increased, while the probing depth remained constant.     

Subepithelial connective tissue grafts for the coverage of denuded root surfaces: a clinical report.

AIMS AND OBJECTIVES: The aim of this study is to determine the effectiveness of subepithelial connective tissue grafts (SCTG) in the coverage of denuded roots. MATERIALS AND METHODS: A total of 16 sites with > or =2 mm of recession height were included in the study for treatment with SCTG. The clinical parameters, such as recession height, recession width, width of keratinized gingiva, probing pocket depth, and clinical attachment level were measured at the baseline, third month, and at the end of the study [sixth month]. The defects were treated with a coronally positioned pedicle graft combined with connective tissue graft. RESULTS: Out of 16 sites treated with SCTG, 11 sites showed complete (100%) root coverage; the mean root coverage obtained was 87.5%. There was a statistically significant reduction in recession height, recession width, and probing pocket depth. There was also a statistically significant increase in the width of keratinized gingiva and also a gain in clinical attachment level. The postoperative results were both clinically and statistically significant ( P 0.05). CONCLUSION: From this study, it may be concluded that SCTG is a safe and effective method for the coverage of denuded roots.     

The influence of stress and anxiety on the response of non-surgical periodontal treatment

AIM: The aim of this study was to evaluate the influence of stress and anxiety on the response to non-surgical periodontal treatment (NPT) in patients with chronic periodontitis. METHOD: Sixty-six patients (mean age 46.1 +/- 8 years) were assigned to three groups: control group, probing pocket depth (PPD) or=4 and 6 mm, n=20. Stress, state anxiety (SA) and trait anxiety (TA) and plaque index (PI), gingival index, PPD and clinical attachment level (CAL) were recorded at baseline and 3 months after NPT. RESULTS: TA scores were different among groups at baseline and after NPT. TA was related to periodontitis at baseline and after NPT. PI was associated with the SA at baseline. The reduction of frequency of CAL >6 mm was correlated with TA after adjusting for confounders. Stressed subjects did not show reduction of frequency of PPD >6 mm (T1), CAL 4-6 mm and CAL >6 mm (T2). CONCLUSIONS: The data suggest an influence of trait of anxiety and stress on the response to NPT.