Prevention and management of periodontal diseases and dental caries in the older adults

As a result of aging populations, in the future, dental practitioners will be caring for more older adults than ever before. These older adults, especially in developed countries, will demand a greater number of dental services, driven by increased tooth retention and an expectation of excellent oral healthcare throughout the life course. Further, the global rise in the prevalence and incidence of chronic diseases will increase the risk and/or severity of oral diseases and add a layer of complexity to the management of oral diseases in older adults. More older adults will be at a higher risk of periodontal disease and root caries as a result of reduced tooth loss and edentulism. This article reviews information on periodontitis and root caries, oral diseases which reflect the cumulative risk of the individual, and which are best addressed through prevention. Oral healthcare providers must embrace the concept of lifelong emphasis on prevention, as well as participation as active members of a healthcare team which provides healthcare for older adults in various settings (eg, hospital/clinic-based care, community-based settings, and long-term care facilities). National guidelines that address oral health are being considered by some countries, and if these are implemented they will increase the accessibility to oral health for older adults. In parallel to this, revisions of existing older adult insurance schemes (eg, the inclusion of routine oral healthcare in the US Medicare program) would promote the maintenance of a functional dentition that is pain-free and conducive to general health. The opportunity exists to implement a holistic approach to oral health that will align oral health with general health and emphasize that true health can only be achieved with the inclusion of oral health.     

Relationship between bleeding on probing and periodontal disease progression in community-dwelling older adults

OBJECTIVE: The main objective of this study was to determine the relationship between bleeding on probing (BOP) and periodontal disease progression in community-dwelling older adults. METHODS: A 3-year longitudinal study was carried out in 229 non-smoking healthy older adults aged 70 years. Using pressure-controlled periodontal probes, BOP, pocket depth and attachment level at 13,289 sites were measured annually. Periodontal disease progression was defined as an increase in attachment loss of >or=3 mm from the baseline to the final examination. The backward stepwise logistic regression analysis was performed to assess the relationship between the total number of sites with BOP in the four examinations and periodontal progression. RESULTS: Logistic regression analysis showed that the odds ratios of BOP frequency for periodontal disease progression ranged from 1.4 to 6.2 after controlling for pocket depth >or=4 mm at baseline, number of missing teeth, jaw type and tooth site. CONCLUSION: Increasing frequencies of bleeding might increase the probability of periodontal disease progression in community-dwelling older adults.     

Differential periodontal temperature measurements in the assessment of periodontal disease activity: an experimental and clinical study

The difference in surface temperatures between the bottom of periodontal pockets and the attached gingiva adjacent to the openings of the pockets were determined both in monkeys with experimental marginal periodontitis, and clinically in patients with marginal periodontitis. For this purpose a custommade, temperature-measuring device was developed which enabled immediate recording of temperature differences as well as periodontal pocket depths, bleeding, and attachment levels. The measurements were performed periodically. The differential temperature measurements were correlated to change in periodontal attachment over time. It was shown that differential periodontal temperatures are well correlated to change in periodontal attachment over time. It was furthermore concluded that differential periodontal temperature measurements have the potential of serving as a predictor of activity of marginal periodontitis. However, more extensive data are required to assess the sensitivity and specificity of the method.     

Stress and the periodontal diseases: effects of catecholamines on the growth of periodontal bacteria in vitro

Microorganisms possess the ability to recognize hormones within the host and utilize them to adapt to their surroundings. Noradrenaline and adrenaline, which are released during human stress responses, may act as environmental cues to alter the growth of individual organisms within subgingival biofilms. The aims of this study were to modify, for anaerobic culture, existing methodology used in determining microorganism catecholamine responses and to investigate the growth responses to noradrenaline and adrenaline of 43 microorganisms found within subgingival microbial complexes. We established initial inocula for each strain using anaerobic culture, re-inoculated into a minimal serum-based medium and grown anaerobically at 35 degrees C. We assessed organism growth by optical density (OD(600nm)) readings, with test and control cultures performed in triplicate. Test cultures were supplemented with 50 microm noradrenaline or 100 microm adrenaline. We observed significant growth effects for supplementation with noradrenaline (20 species responding positively) and adrenaline (27 species responding positively), with differences in growth response observed within bacterial species and within and between microbial complexes. The most pronounced positive growth effects of noradrenaline were demonstrated in Actinomyces naeslundii (+ 49.4%), Actinomyces gerenscseriae (+ 57.2%), Eikenella corrodens (+ 143.3%) and Campylobacter gracilis (+ 79.9%). We also observed inhibitory effects of noradrenaline supplementation for Porphyromonas gingivalis (- 11.9%) and Bacteroides forsythus (- 22.2%). Responses to adrenaline tended to mirror the responses seen with noradrenaline. Individual organisms from different microbial complexes vary in their in vitro growth responses to noradrenaline and adrenaline. Such variation may influence the in vivo composition of the subgingival biofilm in response to stress-induced changes in local catecholamine levels and play a significant role in the aetiology and pathogenesis of the periodontal diseases.     

Periodontal Attachment Loss in Independently Living Older Adults in Ontario, Canada

This paper describes the periodontal disease experience of a community-dwelling population aged 50 years and older, living in four communities in Ontario, Canada. The periodontal status of this population was assessed using attachment loss and the extent and severity index. Attachment loss was measured at two sites on each tooth using a pressure-sensitive periodontal probe. Complete periodontal data were obtained on 624 subjects. The mean number of sites per subject was 37.9. In line with recent US studies, the diagnostic threshold for a diseased or previously diseased site was set at 2 mm of loss. The overall mean attachment loss was 2.95 mm, with 19.7 percent of subjects having an overall mean attachment loss of 4.00 mm or more. The proportion of sites examined with loss of attachment of 2 mm or more was 77 percent. The severity of disease, defined as the average distance between the base of the sulcus or pocket and a point 1.00 mm apical to the cemento-enamel junction in sites with loss of 2 mm or more was 2.44 mm. These data indicate that the extent and severity of disease in this population were greater than that reported by some recent studies in the US. Taken together, the results of these studies suggest that there is some variation in the periodontal disease experience of population subgroups across North America.     

核苷酸结合寡聚化结构域蛋白与牙周病

核苷酸结合寡聚化结构域蛋白是新近发现的天然免疫系统中细胞质型模式识别受体中的一个重要家族成员,在机体天然免疫应答中发挥独特的功能。核苷酸结合寡聚化结构域蛋白和细菌的某些病原体相关分子模式的相互识别及相互作用与多种临床疾病有关。近年来牙周病与核苷酸结合寡聚化结构域蛋白的相关研究日益增多,下面就核苷酸结合寡聚化结构域蛋白的研究概况及其与牙周病的关系作一综述。     

基于催眠和认知行为疗法的儿童牙科行为管理

 恐惧是儿童牙科行为管理问题的核心，使患儿免于恐惧是行为管理的关键。借鉴催眠和认知行为疗法的理论与方法，由行为引导师带领患儿逐步逐级放松，培育积极正面牙科观念，最终实现自主配合牙科治疗的过程称为“行为管理”。针对常见的行为管理问题，文章简要介绍了快速赢得患儿信任、系统脱敏和记忆重构的引导流程。     

Association between respiratory disease in hospitalized patients and periodontal disease: a cross-sectional study

Background: Recent research indicated that periodontal infection may worsen systemic diseases, including pulmonary disease. Respiratory infections, such as pneumonia and the exacerbation of chronic obstructive pulmonary disease, involve the aspiration of bacteria from the oropharynx into the lower respiratory tract. Methods: A group of 100 cases (hospitalized patients with respiratory disease) and a group of 100 age‐, sex‐, and race‐matched outpatient controls (systemically healthy patients from the outpatient clinic, Department of Periodontics, Government Dental College and Hospital, Calicut, Kerala, India) were selected for the study. Standardized measures of oral health that were performed and compared included the gingival index (GI), plaque index (PI), and simplified oral hygiene index (OHI). Data regarding probing depths and clinical attachment levels (CALs) were recorded at four sites per tooth and compared statistically. The χ² and Student t tests were used for statistical analyses. Results: The comparison of study‐population demographics on the basis of age, sex, education, and income showed no significant differences between groups. Patients with respiratory disease had significantly greater poor periodontal health (OHI and PI), gingival inflammation (GI), deeper pockets, and CALs compared to controls. In the case group, patients with a low income were 4.4 times more prone to periodontal disease compared to high‐income patients. Smokers had significantly higher CALs compared to non‐smokers in the control group. Conclusion: The findings of the present analysis support an association between respiratory and periodontal disease.     

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白细胞介素-1(interleukin-1,IL-1)是人体内非常活跃的促炎细胞因子,可刺激内皮细胞和白细胞释放一系列炎性介质,由此引发局部组织或全身的的炎症.牙周病是发生在牙龈、牙周膜和牙槽骨等牙齿支持组织的一种慢性破坏性疾病,其病理机制与牙周局部炎症有密切的联系.本文就IL-1的分化、功能及其与牙周病的关系做一综述.     

Epidemiology and diagnosis of HIV-associated periodontal diseases

A review of periodontal disease as a manifestation of HIV infection suggests a shift in emphasis over the past 5 years. Initially the focus was on newly described forms of periodontal disease (ie, HIV-associated gingivitis or linear gingival erythema (LGE); HIV-associated periodontitis or necrotizing ulcerative periodontitis (NUP)). While the clinical definition of LGE varies from study to study, an association between LGE and Candida infection has been described. Furthermore, the prevalence of NUP is quite low and this disorder is associated with severe immunosuppression. In contrast, the focus today is on the accelerated rate of chronic adult periodontitis occurring in seropositive patients. While the organisms that characterize adult periodontitis in seronegative individuals are present in subgingival plaque from seropositive individuals, reports suggest that atypical pathogens are also present (ie, Mycoplasma salivarium, Enterobacter cloacae). Recent studies from our laboratory have identified a novel strain of Clostridium isolated from the subgingival plaque of injecting drug users that has pathologic potential. This organism, however, was found in both seropositive and seronegative individuals in this cohort, suggesting an association with lifestyle rather than serostatus. In addition, data has been published examining the local host response in periodontitis in seropositive individuals. Distinctly elevated levels of IgG in gingival crevicular fluid (GCF) have been observed in seropositive patients. Furthermore, data from our laboratory examining inflammatory mediators in GCF (polymorphonuclear leukocyte lysosomal enzyme β-glucuronidase and the pro-inflammatory cytokine interleukin-1β) suggests an altered response in patients with HIV infection. The alteration manifests as the absence of the expected strong correlation between polymorphonuclear leukocyte activity in the gingival crevice and clinical measures of existing periodontal disease, as well as elevated levels of interleukin-1β in sites with deeper probing depths. Therefore, it can be concluded that the progression of periodontal disease in the presence of HIV infection is dependent upon the immunlogic competency of the host as well as the local inflammatory response to typical and atypical subgingival microorganisms.     

益生菌生态调节在牙周病防治中的应用

牙周病的始动因子为菌斑生物膜,近年来菌斑学说越来越倾向于牙周微生态失调。目前牙周病经典的治疗方法为机械性去除菌斑,但疗效存在个体差异性,部分患者需要辅助其他治疗方法。益生菌具有重建宿主微生物群落、调节免疫炎症反应的特点,可能起到改善牙周病微生态的作用。本文从牙周相关疾病分类角度,对目前益生菌生态调节在牙周炎、牙龈炎、口腔异味及种植体周围疾病防治上的临床效应、作用机制及临床应用加以总结。     

Longitudinal study on periodontal conditions in healthy elderly people in Japan

OBJECTIVES: A strategy for the control of periodontal disease progression is required to prevent tooth loss in older people. However, detailed epidemiological data on periodontal conditions in elderly people is limited. The purpose of the present study is to describe the natural history of periodontal disease and to evaluate the intraoral factors relating to the disease progression in systemically healthy elderly people. METHODS: In the cross-sectional study, 599 and 162 subjects aged 70 and 80 years, respectively, were examined. Of those subjects aged 70 years, 436 (73%) participated in the 2-year longitudinal study. Pocket depth (PD) and attachment level (AL) were measured for all functioning teeth at six sites per tooth. In the cross-sectional study, AL of 4 mm or greater and 7 mm or greater were defined as moderate and severe disease, respectively. In the longitudinal study, a change in AL of 3 mm or greater at each site was defined as periodontal disease progression. RESULTS: In the cross-sectional study, 97.1% of the subjects had at least one site of AL of 4 mm or greater (4+ mm). The prevalence of AL of 7 mm or greater (7+ mm) was 47.9%, with 2.8 affected teeth per person in those with AL 7+ mm. These findings reveal that periodontal disease is extremely widespread in the elderly population. However, very few had many teeth with severe periodontal conditions. In the longitudinal study, 75.1% experienced attachment loss of 3 mm or greater (3+ mm) during the 2-year study period. Of those subjects who experienced attachment loss, a mean of 4.7 teeth exhibited attachment loss. Multivariate logistic regression showed that both the highest AL in each tooth at baseline and abutment teeth for removable partial dentures were significantly related to periodontal disease progression as well as tooth loss incidence. CONCLUSIONS: These results suggest that teeth with poor periodontal conditions as well as abutment teeth for removable partial dentures were significant intraoral factors relating to periodontal disease progression as well as tooth loss.     

Association between long-term aspirin use and periodontal attachment level in humans: a cross-sectional investigation

Background: Pharmaceutical inhibition of host response pathways may be an adjunctive or alternative strategy for treating periodontal diseases. In addition to inhibition of prostaglandin synthesis, aspirin is known to modify the action of cyclo‐oxygenase, changing its activity to a lipoxygenase and leading to formation of lipoxins which have a proresolving effect. This study evaluated the periodontal attachment level of subjects on long‐term low dose aspirin therapy. Methods: Oral hygiene index simplified, clinical attachment loss and bleeding index were recorded for 162 subjects who were on long‐term (>6 months) low dose (75 mg and 150 mg) aspirin therapy (study group) and 146 subjects not taking the drug (control group). Results: Mean clinical attachment loss was 2.38 ± 0.49 mm in the control group and 2.01 ± 0.69 mm in the study group. The difference was statistically significant at p < 0.001. Correlation analysis suggested that there was a negative correlation between clinical attachment loss and duration of aspirin intake but the clinical attachment loss was not significantly different in the two dosage groups. Conclusions: The results of this study suggest that low dose aspirin may reduce the risk of periodontal attachment loss. This hypothesis needs to be tested by larger sample sized prospective cohort studies.     

细胞因子信号传导抑制因子与牙周病的关系

细胞因子信号传导抑制因子是对细胞因子具有负反馈调节作用的蛋白质分子,可在各种细胞因子和某些抗原的刺激下迅速表达,并通过干涉细胞因子信号传导中的JAK-STAT通路抑制进一步的信号传导。牙周病是一种多因素疾病,其发病过程涉及多种致病因素和复杂的细胞因子信号传导。下面就细胞因子信号传导抑制因子与牙周病的关系进行综述。