Longitudinal study of bone density and periodontal disease in men

Bone loss is a feature of both periodontitis and osteoporosis, and periodontal destruction may be influenced by systemic bone loss. This study evaluated the association between periodontal disease and bone mineral density (BMD) in a cohort of 1347 (137 edentulous) older men followed for an average of 2.7 years. Participants were recruited from the Osteoporotic Fractures in Men Study. Random half-mouth dental measures included clinical attachment loss (CAL), pocket depth (PD), calculus, plaque, and bleeding. BMD was measured at the hip, spine, and whole-body, by dual-energy x-ray absorptiometry, and at the heel by ultrasound. After adjustment for age, smoking, race, education, body mass index, and calculus, there was no association between number of teeth, periodontitis, periodontal disease progression, and either BMD or annualized rate of BMD change. We found little evidence of an association between periodontitis and skeletal BMD among older men.     

Aggressive periodontitis associated with Papillon-Lefèvre syndrome: Report of a 14-year follow-up

This case report describes the periodontal management, therapeutic approach, and 14-year follow-up of a patient diagnosed with Papillon-Lefèvre syndrome (PLS).
A female child, diagnosed with PLS-associated periodontitis at the age of 9 years and 11 months, presented with hyperkeratosis of the palms and soles, as well as generalized aggressive periodontitis. The dental treatment comprised standard periodontal debridement, scaling and root planing, instructions on oral hygiene, restorations, extraction of hopelessly affected teeth and a therapeutic use of antibiotics.
The concomitant supportive periodontal therapy and antibiotic coverage could not stop the loss of periodontal attachment and destruction of the alveolar bone. Four years after treatment was initiated, the last remaining teeth were extracted and complete dentures were constructed. The dentures have been periodically replaced and the patient continues to return for follow-up once a year.
The combination of intensive periodontal treatment and antibiotic regimen only temporarily delayed periodontal disease progression and did not prevent loss of both primary and permanent teeth. The outcome of this long-term follow-up case report shows that management of PLS-associated periodontitis is further complicated when the patient is first seen in the mixed dentition stage or later. In these situations, the chances of controlling the progression of periodontal breakdown and minimizing tooth loss are greatly reduced.     

Periodontitis as a manifestation of chronic benign neutropenia

BACKGROUND: A subcategory of chronic neutropenia is chronic benign neutropenia, which is characterized by a prolonged non-cyclic neutropenia as the sole abnormality, with no underlying disease to which the neutropenia can be attributed. Chronic neutropenia is defined as a low absolute neutrophil count for >6 months. In this presentation, periodontitis seems to be the sole manifestation of a juvenile patient with chronic benign neutropenia. A 7-year-old white male presented with periodontitis of the primary dentition and early tooth loss. His medical and dental history was otherwise unremarkable. Suspecting some systemic illness as the underlying cause, the patient was referred for a medical consultation and a series of blood tests. METHODS: Blood analyses included a complete blood count (CBC), sequential multiple analyzer 24 (SMA 24), glycated hemoglobin levels, and screening for anti-white blood cell antibodies. Blood levels of calcium, vitamin D, dihydroxyvitamin-D, phosphorus, and alkaline phosphatase were also measured. Liver function tests were performed. RESULTS: Following analysis of recent and previous blood test results, a diagnosis of chronic benign neutropenia was assigned. The patient's periodontal condition was treated with scaling and root planing, oral hygiene instruction, and antimicrobial mouthrinses. Three-month recall visits were recommended as a follow-up protocol. CONCLUSIONS: This case represents the importance of diagnosing periodontal disease as a possible indicator of underlying systemic disease. When a patient presents with an unusual, generalized form of periodontal disease, screening for systemic disorders is required, as the oral condition may be the first or only manifestation of a systemic abnormality. This case also illustrates the reason for the change in classification of such a condition to periodontitis as a manifestation of systemic disease. This condition was previously classified as prepubertal periodontitis, a disease diagnosis that focused on the patient's age at the onset of the disease rather than the etiology.     

Systemic conditions associated with periodontitis in childhood and adolescence. A review of diagnostic possibilities

The term periodontitis is used to describe a group of multifactorial diseases that result in the progressive destruction of the structures that support the teeth within the jaws, the so-called attachment apparatus, which includes the periodontal ligament, cementum and alveolar bone. If left untreated, this process can ultimately lead to tooth loss. The pathogenesis of these diseases involves the initial colonization of the gingival microenvironment of a susceptible host by pathogenic bacteria found in dental plaque. Subsequently, much of the tissue destruction characteristic of periodontitis is a , by-product, of the host response directed against these organisms. One of the major factors that appear to modulate disease severity is systemic health. Severe periodontitis in young individuals can therefore be a manifestation of an underlying systemic disease. In this review we will discuss the most important systemic diseases that should be considered in a differential diagnosis when evaluating a pediatric patient presenting with periodontitis.     

牙周炎对全身疾病和健康影响的研究进展

牙周炎是常见的慢性感染性疾病,可造成牙周支持组织破坏,是导致成年人失牙的最主要原因。此外,大量研究证明,牙周炎能通过龈下菌斑生物膜中的微生物及其产物引起全身炎症及免疫反应,可能成为一些全身疾病的危险因素。虽然牙周炎和全身疾病相互作用的具体生物学机制仍不清楚,但现有的一些研究证据确实证明了二者互相促进的关系。本文就牙周炎对全身疾病和健康的影响作简要阐述.     

Periodontal disease in the domestic cat

One hundred and fifty teeth from 15 cats of an average age of 6.8 years were examined macroscopically, radiographically, and histologically. Clinical inspection revealed plaque and calculus deposits on the facial surfaces of maxillary and mandibular premolars and molars. Radiography showed horizontal and vertical loss of alveolar bone with irregular defects of the dental hard structures. Histologically, typical features of gingival and periodontal destruction were found and resorptive lacunae were seen at the cemento-enamel junctions. In comparison with experimentally induced periodontitis in other animals, periodontal disease involving external root resorption seemed to occur spontaneously in the cat.     

Periodontal manifestations of systemic disease

Periodontitis is a chronic bacterial infection of the supporting structures of the teeth. The host response to infection is an important factor in determining the extent and severity of periodontal disease. Systemic factors modify periodontitis principally through their effects on the normal immune and inflammatory mechanisms. Several conditions may give rise to an increased prevalence, incidence or severity of gingivitis and periodontitis. The effects of a significant number of systemic diseases upon periodontitis are unclear and often it is difficult to causally link such diseases to periodontitis. In many cases the literature is insufficient to make definite statements on links between certain systemic factors and periodontitis and for several conditions only case reports exist whereas in other areas an extensive literature is present. A reduction in number or function of polymorphonuclear leukocytes (PMNs) can result in an increased rate and severity of periodontal destruction. Medications such as phenytoin, nifedipine, and cyclosporin predispose to gingival overgrowth in response to plaque and changes in hormone levels may increase severity of plaque-induced gingival inflammation. Immuno-suppressive drug therapy and any disease resulting in suppression of the normal inflammatory and immune mechanisms (such as HIV infection) may predispose the individual to periodontal destruction. There is convincing evidence that smoking has a detrimental effect on periodontal health. The histiocytoses diseases may present as necrotizing ulcerative periodontitis and numerous genetic polymorphisms relevant to inflammatory and immune processes are being evaluated as modifying factors in periodontal disease. Periodontitis severity and prevalence are increased in diabetics and worse in poorly controlled diabetics. Periodontitis may exacerbate diabetes by decreasing glycaemic control. This indicates a degree of synergism between the two diseases. The relative risk of cardiovascular disease is doubled in subjects with periodontal disease. Periodontal and cardiovascular disease share many common risk and socio-economic factors, particularly smoking, which is a powerful risk factor for both diseases. The actual underlying aetiology of both diseases is complex as are the potential mechanisms whereby the diseases may be causally linked. It is thought that the chronic inflammatory and microbial burden in periodontal disease may predispose to cardiovascular disease in ways proposed for other infections such as with Chlamydia pneumoniae. To move from the current association status of both diseases to causality requires much additional evidence. Determining the role a systemic disease plays in the pathogenesis of periodontal disease is very difficult as several obstacles affect the design of the necessary studies. Control groups need to be carefully matched in respect of age, gender, oral hygiene and socio-economic status. Many studies, particularly before the aetiological importance of dental plaque was recognised, failed to include such controls. Longitudinal studies spanning several years are preferable in individuals both with and without systemic disease, due to the time period in which periodontitis will develop.     

Unveiling the role of stress in periodontal etiopathogenesis: an evidence‐based review

Periodontal disease is a multifactorial disease affecting the supporting tissues of the teeth, resulting in progressive attachment loss and bone loss. Periodontal disease is influenced by various systemic, environmental, and psychologic factors that have the potential to alter periodontal tissues and host immune response, resulting in more severe periodontal destruction. Several studies have documented the relationship between psychosocial stress and chronic forms of periodontal disease. Stress impairs periodontal health through changes in behavior and complex interactions among the nervous, endocrine, and immune systems. The influence of stress on periodontal disease is affected by the emotional coping skills of the individual. Psychologic stress and depression may also influence the outcome of periodontal therapy. Stressful life events and coping skills are factors to consider in the risk of periodontal disease destruction and the potential for successful periodontal therapy. Therefore psychosocial stress is considered as an important risk factor for periodontal disease, and emotional stress in periodontitis patients should be diagnosed and treatment should be administered for the proper management and successful outcome of periodontal disease.     

运用牙周特色治疗改善重度牙周炎的临床效果（附1例6年诊治随访观察报告）

牙周炎是最常见的失牙原因之一,不仅严重影响口腔健康,也是多种全身性疾病的风险因素。完善的牙周检查及系统的治疗计划是消除炎症、控制疾病进展、恢复口腔功能和美观的关键。如何尽最大可能保留存在牙周组织严重破坏的天然牙并维持其功能是口腔医生面临的挑战。文章展示了1例重度牙周炎病例的综合诊疗过程,通过完善的牙周基础治疗和恰当的手术治疗,控制了牙周炎症进展,并采用可摘局部义齿修复缺失牙,恢复口腔功能,同时定期行牙周维护治疗,随访6年,获得良好的治疗效果。基于此病例,文章探讨了重度牙周炎患牙的治疗决策,重度牙周炎诊疗中基础治疗和手术治疗的临床效果以及菌斑控制对长期维护治疗效果的作用,总结了本病例临床处理中的不足,为重度牙周炎的治疗积累了经验。     

OI：10.19538/j.kq.2020.09.003 牙周-正畸-种植修复多学科综合治疗重度牙周炎的临床效果观察（附1例5年随访报告）

 牙周炎作为一种发生于牙周支持组织的炎症性破坏性疾病，发展到晚期可引起牙齿松动、移位甚或脱落，对患者口腔功能和美观造成不同程度的损害，影响患者的全身健康及口腔健康相关的生活质量。针对合并错畸形、牙列缺损的重度牙周炎病例，需要在全面完善的口腔检查基础之上制定周密完善的系统治疗计划，积极实施包括牙周、正畸、修复等在内的多学科综合治疗，从而达到控制炎症、恢复健康、重建功能和改善美观的治疗目标。文章展示了1例牙周炎Ⅳ期C级病例的多学科综合诊治过程，通过对患者实施规范有序的牙周系统治疗，包括完善的牙周基础治疗和恰当的牙周手术治疗，控制牙周炎症、保留预后较差患牙，获得了健康稳定的牙周状况。在此前提下，通过正畸治疗，纠正不良咬合关系及因牙周炎导致的牙齿移位，消除咬合创伤，建立有利于牙周健康稳定的咬合关系，同时结合种植修复治疗重建完整牙列，最终达到了恢复健康、重建功能及改善美观的治疗目标。基于该病例，文章重点探讨了重度牙周炎的多学科诊疗策略，从一定程度上总结本病例在临床处理中的关键点，以期为重度牙周炎的临床诊治提供一定的经验。     

Increased susceptibility to periodontitis in mink affected by a lysosomal disease

The periodontal conditions of standard dark mink and mink affected with Chediak-Higashi syndrome were studied in 45 female animals, 2.5 years of age. Both animal groups suffered from chronic periodontitis. The inflammatory changes and bone loss in normal dark mink were slight. The Chediak-Higashi mink were regularly found to have both more intense inflammatory reactions and more advanced bone loss upon histologic and radiographic examination, and by the finding of larger distances between the cemento-enamel junction and the alveolar crest. The results of this investigation indicate that the periodontal lesion in mink is intimately related to calculus-plaque deposits in a way similar to periodontal disease in man. Further, the finding that mink affected by a systemic lysosomal abnormality develop a more severe gingival inflammation to dental plaque than do normal animals is considered to give some support to the concept that released lysosomal enzymes may be responsible for the final destruction of tissues in periodontitis although other qualities associated with the Chediak-Higashi syndrome may contribute.     

运用牙周特色治疗改善重度牙周炎的临床效果（附1例6年诊治随访观察报告）

 牙周炎是最常见的失牙原因之一，不仅严重影响口腔健康，也是多种全身性疾病的风险因素。完善的牙周检查及系统的治疗计划是消除炎症、控制疾病进展、恢复口腔功能和美观的关键。如何尽最大可能保留存在牙周组织严重破坏的天然牙并维持其功能是口腔医生面临的挑战。文章展示了1例重度牙周炎病例的综合诊疗过程，通过完善的牙周基础治疗和恰当的手术治疗，控制了牙周炎症进展，并采用可摘局部义齿修复缺失牙，恢复口腔功能，同时定期行牙周维护治疗，随访6年，获得良好的治疗效果。基于此病例，文章探讨了重度牙周炎患牙的治疗决策，重度牙周炎诊疗中基础治疗和手术治疗的临床效果以及菌斑控制对长期维护治疗效果的作用，总结了本病例临床处理中的不足，为重度牙周炎的治疗积累了经验。     

Periodontal disease and systemic illness: will the evidence ever be enough?

The concept of focal infection or systemic disease arising from infection of the teeth was generally accepted until the mid‐20th century when it was dismissed because of lack of evidence. Subsequently, a largely silo approach was taken by the dental and medical professions. Over the past 20 years, however, a plethora of epidemiological, mechanistic and treatment studies have highlighted that this silo approach to oral and systemic diseases can no longer be sustained. While a number of systemic diseases have been linked to oral diseases, the weight of evidence from numerous studies conducted over this period, together with several systematic reviews and meta‐analyses, supports an association between periodontitis and cardiovascular disease, and between periodontitis and diabetes. The association has also been supported by a number of biologically plausible mechanisms, including direct infection, systemic inflammation and molecular mimicry. Treatment studies have shown that periodontal treatment may have a small, but significant, systemic effect both on endothelial function and on glycemic control. Despite this, however, there is no direct evidence that periodontal treatment affects either cardiovascular or diabetic events. Nevertheless, over the past 20 years we have learnt that the mouth is an integral part of the body and that the medical and dental professions need to work more closely together in the provision of overall health care for all patients.     

20-year follow-up of patients receiving high-cost dental care within the Swedish Dental Insurance System: 1977-1978 to 1998-2000

The objective was to perform a long-term follow-up study of patients that had received high cost dental care within the Swedish National Dental Insurance System in 1977-1978 with special focus on remaining teeth, periodontal disease progression, change in the prevalence of root-filled teeth and teeth with apical periodontitis as well as the survival of fixed prosthetic reconstructions. All 262 patients who had had their treatment plans sent for approval for high-cost dental care in 4 local health insurance districts and who were sampled for base-line studies in 1977-1978, were offered a free clinical examination including radiographs in 1998. 177 patients (68 % of the original sample) could be reached for telephone interview and 104 of them (40 % of the original sample) were examined clinically and radiographically. Comparisons were made with records and radiographs from 1977-1978. The analyses were performed with the individual patient as the studied unit. The low progression of severe periodontal disease during the 20-23 year follow-up period and the decrease in number of teeth with apical periodontitis among a majority of the patients examined, indicated that the dental care received resulted in a limitation of dental disease on the individual level. Furthermore 63 % of the patients had the fixed prosthetic reconstructions, received after approval 1977-1978, in full extention after 20-23 years. However, more tooth losses were observed among the patients in this study than in similar studies in Swedish general populations over the same decades. Furthermore multiple tooth extractions were significantly more frequent in patients with severe periodontitis at baseline and in patients with less apical periodontitis at follow-up in this study. Thus it seems that tooth extraction not seldom was a treatment choice for teeth with severe periodontitis and apical periodontitis among the patients examined clinically in this study.     

Current Concepts in the Management of Periodontitis

Periodontitis is a common disorder affecting >40% of adults in the United States. Globally, the severe form of the disease has a prevalence of 11%. In advanced cases, periodontitis leads to tooth loss and reduced quality of life. The aetiology of periodontitis is multifactorial. Subgingival dental biofilm elicits a host inflammatory and immune response, ultimately leading to irreversible destruction of the periodontium (i.e. alveolar bone and periodontal ligament) in a susceptible host. In order to successfully manage periodontitis, dental professionals must understand the pathogenesis, primary aetiology, risk factors, contributing factors and treatment protocols. Careful diagnosis, elimination of the causes and reduction of modifiable risk factors are paramount for successful prevention and treatment of periodontitis. Initial non-surgical periodontal therapy primarily consists of home care review and scaling and root planing. For residual sites with active periodontitis at periodontal re-evaluation, a contemporary regenerative or traditional resective surgical therapy can be utilised. Thereafter, periodontal maintenance therapy at a regular interval and long-term follow-ups are also crucial to the success of the treatment and long-term retention of teeth. The aim of this review is to provide current concepts of diagnosis, prevention and treatment of periodontitis. Both clinical and biological rationales will be discussed.     

Periodontal diseases and dental implants in older adults.

Older adults present special problems for the dentist trying to establish or reestablish esthetics. Periodontal diseases are of concern for this population since tooth loss from these widespread problems increases with age. In general, this loss occurs because of increased exposure time to pathogenic bacteria, not some change inherent in the body brought on by the aging process. The profession has begun to place more emphasis on systemic risk factors and their role in modifying periodontal inflammation. The current thinking is that bacteria are necessary to initiate and sustain periodontal diseases, but the clinical manifestation is dictated to a significant extent by systemic factors. Smoking, diabetes, and being positive for the interleukin-1 genotype predispose the patient to developing more severe disease. For those older adults who lose teeth, dental implants have emerged as reliable replacements, and concerns about placing these devices in patients who have lost teeth as a result of periodontitis appear to be largely unfounded.     

Periodontal disease in patients from the original Kostmann family with severe congenital neutropenia

BACKGROUND: Patients with Kostmann syndrome (severe congenital neutropenia [SCN]) typically normalize their absolute neutrophil count (ANC) upon granulocyte colony-stimulating factor (G-CSF) therapy. However, although they no longer experience life-threatening bacterial infections, they frequently still have recurrent gingivitis and even severe periodontitis, often starting in early childhood. METHODS: We studied the periodontal disease in the four surviving patients belonging to the family originally described by Kostmann. Their odontological records, x-rays, color photos, bacterial cultures, serum antibodies to oral bacteria, and histopathological examinations were reviewed. The data were also correlated to previous investigations on their antibacterial peptides and molecular biology. RESULTS: Three patients had periodontal disease, despite normal ANC and professional dental care, and had neutrophils deficient in antibacterial peptides. One of these patients also had a heterozygous mutation in the neutrophil elastase gene, had severe periodontal disease and overgrowth of the periodontal pathogen Actinobacillus actinomycetemcomitans in the dental flora, and 15 permanent teeth had been extracted by the age of 27. One bone marrow-transplanted patient had no periodontal disease. CONCLUSIONS: Normalized ANC levels are not sufficient to maintain normal oral health in SCN patients, and because neutrophils are important for first-line defense and innate immunity, the deficiency of the antibacterial peptide LL-37 probably explains their chronic periodontal disease. Professional dental care is still important for SCN patients, despite treatment with G-CSF and normal ANC levels. Whether antibacterial peptides play a role in the pathogenesis of periodontitis in other patients remains to be elucidated.     

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.     

综合治疗重度牙周炎患牙临床疗效的个案报道

报道1例重度牙周炎(Ⅳ期C级)患者经过牙周基础治疗、牙周手术联合拔牙、种植修复最终恢复咀嚼功能的病例.提示系统的牙周治疗可减少重度牙周炎患者失牙数,同时恢复咀嚼功能,提高生活质量.     

A case of severe periodontal disease in adolescence associated with hypophosphatasia

Hypophosphatasia is an inherited disorder characterized by defective bone mineralization, deficiency of alkaline phosphatase (ALP) activity, increased excretion of phosphoethanolamine (PEA) in the urine and premature loss of the deciduous teeth. A male hypophosphatasia patient aged 15 years 6 months, with premature exfoliation of the deciduous teeth and manifesting severe periodontal destruction in the permanent dentition, was examined. Antibody titers against seven strains by the enzyme-linked immunosorbent assay (ELISA), monocyte and neutrophil chemotaxis studies and cellular immunity tests were performed. Low levels of ALP in serum and PEA in the urine were found. Radiographic examination showed a similar pattern of alveolar bone loss to that of the localized juvenile periodontitis. Suppressed monocyte and neutrophil chemotaxis were not detected. Slightly depressed CD2+, CD3+ and CD4+ and slightly elevated activity of NK cells were found. An elevated level of antibody to Porphyromonas gingivalis was observed and this antibody titer was decreased by periodontal treatments. The affected sites of the patient showed resistance to conventional periodontal therapy. P. gingivalis was estimated to associate as an important pathogen in the etiology of periodontal destruction in this hypophosphatasia patient in addition to the dental abnormalities such as abnormal enamel, dentin, or cementum formation.