Hydrogen sulfide and methyl mercaptan in periodontal pockets

A sensitive gas chromatographic method was developed to determine the amounts of volatile sulfur compounds in gingival fluid. Hydrogen sulfide was the predominant volatile sulfur compound and was detected in 61 out of 79 studied periodontal pockets. Methyl mercaptan was found in about 20% of the pockets. No other volatile sulfur compounds were detected. The highest concentration of hydrogen sulfide in gingival fluid was 1.9 mmol/liter, and of methyl mercaptan 0.16 mmol/liter.     

An epidemiologic survey of periodontal disease in Dutch adults

An epidemiologic survey was carried out to assess the prevalence and severity of periodontal disease in randomly selected samples of employed populations in the Netherlands. Of the 1,337 persons examined by five examiners, 19.8% were edentulous; 61% of dentate persons had intense gingivitis in an average of 2.4 segments of their mouths; 53% had pockets of 3-6 mm and a further 10.1% had pockets of greater than 6 mm. The prevalence of gingivitis and pocketing increased with increasing age and decreasing levels of education. As no measures of predicting compliance were used and because treatment philosophies differ, no reasonable assessment of treatment needs could be made.     

An immunohistochemical study on the localization of Porphyromonas gingivalis, Campylobacter rectus and Actinomyces viscosus in human periodontal pockets

The localization and distribution of Porphyromonas gingivalis, Campylobacter rectus and Actinomyces viscosus were studied in human periodontal pockets. After obtaining voluntary consent from 9 patients, 12 teeth and their surrounding periodontal tissue with advanced adult periodontitis were extracted carefully so as not to change the structure of the periodontal pockets. The specimens were processed into serial sections. One of the sections was stained with Brown & Brenn-modified Gram stain to observe the distribution of bacteria. The others were stained immunohistochemically by the Labelled Streptavidin Biotin method (LSAB method) using specific rabbit antibodies against selected bacteria. Some bacteria could be found within epithelial cells. P. gingivalis was found in 9/12 of the samples examined. Small aggregates of P. gingivalis were scattered in all parts of the periodontal pockets, and some of these aggregates could be seen in close contact with the epithelium. Conversely, C. rectus was observed in 5/12 of the samples examined and was predominantly located in the middle and deep pocket zones. C. rectus tended to form large clumps in both the tooth-attached and epithelium-associated plaque area. A. viscosus was observed in 7/12 of the samples examined and was localized predominantly in the tooth-attached plaque area, especially in the shallow and middle pocket zones. Although unexpected spills of unattached plaque from periodontal pockets was possible, immunohistochemical staining with species-specific antibodies was extremely sensitive and revealed the localization and the distribution of periodontal disease-associated bacteria in human periodontal pockets.     

Clearance of a topically applied fluorescein gel from periodontal pockets

The clearance of a fluorescein gel applied with an irrigation technique in periodontal pockets was studied. In order to evaluate the time a drug remains in a periodontal pocket, the alteration in concentration of this drug in a given time period was investigated. After application of the gel in 4 pockets of 10 patients, samples were taken from 1 of the 4 pockets at 5, 10, 20 and 40 min. The results show that in the 1st phase, directly after application, most of the gel disappeared from the pocket, while in the 2nd phase, the fluorescein gel is washed out with a calculated 50% reduction time of 12.5 min. The rapid clearance of the gel observed after irrigation might provide a partial explanation of the minor effect of pocket irrigation on the subgingival microflora.     

A double-blind placebo-controlled trial of azithromycin as an adjunct to non-surgical treatment of periodontitis in adults: clinical results

BACKGROUND/AIMS: The aim of the study was to investigate the clinical and microbiological effects of azithromycin as an adjunct to the non-surgical treatment of periodontitis in adults. Azithromycin is an antibiotic which is taken up by phagocytes and is released over long periods in inflamed tissue but requires a total of only three doses of 500 mg to produce its therapeutic effect. METHOD: 46 patients were treated in a double-blind placebo-controlled study with assessments at weeks 0, 1, 2, 3, 6, 10 and 22. Throughout the trial measurements were made of plaque, gingival bleeding, calculus, probing pocket depths and bleeding on probing. Microbiological sampling was carried out from a selected pocket >or=6 mm at each visit. The regime employed consisted of OHI, scaling and root planing at weeks 0, 1 and 2 with reinforcement of OHI and minimal scaling at weeks 6, 10 and 22. Patients were randomly assigned to receive either azithromycin, (A), or placebo capsules, (C), 500 mg, 1x daily for 3 days at week 2. 44 patients completed the study. Mean pocket depths were analysed using analysis of covariance in 3 groups with initial pocket depth values of 1-3 mm, 4-5 mm and >or=6 mm. RESULTS: The results of the microbiology have been reported in a separate paper. The clinical data showed that by week 22 a lower % of pockets initially >5 mm deep remained above that level in the 23 patients taking azithromycin (A), than the 21 taking the placebo (C), (A, 5.6%; C, 23.3%). Also at week 22, for pockets initially 4 mm or more, the test group had fewer pockets >3 mm deep (A, 26.1%; C, 44.3%), fewer failing to improve in probing depth (A, 6.6%; C, 21.6%) and fewer continuing to bleed on probing (A, 46.9%; C, 55.6%) when compared with the control group. Pocket depths initially 4-5 mm or 6-9 mm analysed by analysis of covariance showed lower mean pocket depths in the patients on azithromycin, at weeks 6, 10 and 22, (pockets initially 4-5 mm, p<0.001 on all occasions, pockets initially 6-9 mm, p<0.001, week 6; p< 0.003, week 10; p<0.001, week 22). CONCLUSIONS: Azithromycin may be a useful adjunct in the treatment of adult periodontitis, particularly where deep pockets are present.     

Periodontal conditions in 35–44-yr-old adults in France, 1993

A national study was carried out in France in 1993 to assess the periodontal status of the population aged 35–44 yr. The study took part in the Second International Collaborative Study of Oral Health Outcomes developed and coordinated by the World Health Organization. The representative sample was composed of 1000 subjects. The Community Periodontal Index of Treatment Needs (CPITN) index was used. Gingivitis prevalence was high (80.4%) while 26.6% of dentate subjects had shallow pockets (4–5 mm). Deep pockets (> 6 mm) were rare (1.6%) concerning on average 0.1 sextant per subject; 87.5% of the 994 dentate adults needed periodontal treatment. Oral health education and scaling should reduce periodontal pathology in this population group.     

Predominant obligate anaerobes in human periodontal pockets

This study was carried out to investigate the predominant anaerobic bacteria of periodontal pockets in patients with advanced periodontitis, who had no previous treatment other than supragingival scaling, no history of recent or chronic systemic illness, nor any intake of antibiotics within 6 weeks prior to bacteriological sampling. Care was taken not to ignore tiny-colony-forming anaerobes, by means of a stereoscope and an anaerobic glove box system. Out of 422 (100%) isolates, 380 (90%) were obligate anaerobes, suggesting that the environment in periodontal pockets was anaerobic and favors the growth of obligate anaerobes. Among the 380 obligate anaerobes isolated, strains belonging to Eubacterium (54%) were predominant, and many of them occurred in tiny colonies. The other obligate anaerobes isolated were assigned to Wolinella (9%), unidentified motile rods which resemble Wolinella (7%), Peptostreptococcus (6%), Fusobacterium (5%), Bacteroides (2%; including those reclassified to Prevotella and Porphyromonas) and Selenomonas (0.5%). Among the isolates, 67% were Gram-positive bacteria, including 59% of rods (mostly asaccharolytic Eubacterium), suggesting that these bacteria, particularly strains of the Eubacterium species, may play an important role in etiology of adult periodontitis.     

Periodontal findings in spouses

Abstract Clinical, radiographic and microbiological examination of periodontal conditions was carried out in 2 groups of married couples to assess similarities between husband and wife. The diseased probands (n=10) exhibited advanced periodontitis and the healthy ones (n=10) were periodontally normal. The clinical examination comprised the assessment of plaque, probing pocket depths, gingival bleeding on probing, suppuration, supragingival and subgingival calculus. The extent and type of alveolar bone loss was determined from panoramic radiographs. Bacterial samples were taken from the 6 deepest and most inflamed periodontal pockets and from stimulated saliva. The samples were cultured for Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Campylobacter rectus and Peptostreptococcus micros. The mean detection frequency of moderately deep pockets (4–5 mm) and deep pockets (6 mm) was significantly higher in the diseased probands than in their spouses. The mean detection frequency of moderately deep pockets was significantly higher in the spouses of the diseased probands than in the spouses of the healthy ones. Deep pockets were found in 6 spouses of the diseased probands, whereas only in 2 spouses of the healthy ones. Both diseased proband and his/her spouse harbored A. actinomycetemcomitans, P. gingivalis, P. intermedia, C. rectus and P. micros in 4, 6, 9, 9 and 4 couples, respectively. Both healthy proband and his/her spouse harbored the pathogens in 0, 1, 9. 5 and 3 couples, respectively. P. gingivalis was found in 7 spouses of the diseased probands, but only in 2 spouses of the healthy ones. The results indicate that spouses of patients with advanced periodontitis may also exhibit frequent recovery of suspected periodontal pathogens and have a worse periodontal status than spouses of periodontally healthy subjects.     

Clearance of topically-applied PVP-iodine as a solution or gel in periodontal pockets in men

Abstract

Objectives. The aim of the study was to investigate the clearance of PVP-iodine applied as a gel or solution in periodontal pockets. Methods. Teeth of 12 subjects with at least eight periodontal pockets of ≥5 mm probing depth were isolated with a rubber dam to allow contamination-free access to the pockets. In each subject, three pockets were filled with PVP-iodine gel (10%) and three with PVP-iodine solution (10%). One pocket of each subject without iodine application served as a negative control. The treatment allocation was assigned randomly. Any excess material was removed subsequently. After 1, 5 and 15 min, a paper point was used to collect the sulcus liquid and the concentration of PVP-iodine was chemically determined. In addition, PVP-iodine gel was administered into 12 periodontal pockets immediately after sub-gingival ultrasound debridement and the concentration of PVP-iodine was determined after 1 min. Results. Descending concentrations of PVP-iodine were determined at 1, 5 and 15 min after the application. No PVP-iodine was found in the pockets serving as negative controls. The mean concentrations of the gel and solution were 6.14 μg/ml and 4.44 μg/ml (1 min; p ≥ 0.028), 3.20 μg/ml and 1.44 μg/ml (5 min; p ≥ 0.126), 0.69 μg/ml and 0.23 μg/ml (15 min; p ≤ 0.019), respectively. In the pockets with previous debridement the mean concentration was 1.68 ± 1.97 μg/ml. Conclusion. The application of PVP-iodine gel in periodontal pockets allows a prolonged remnant effect as compared to that of the solution formula.     

Periodontal disease prevalence in different age groups in Japan as assessed according to the CPITN

A CPITN survey was conducted involving 12,832 Japanese subjects from 7 to 64 years of age. Subjects under 18 were schoolchildren, and 18-year-old and older subjects represented various social backgrounds, having been randomly selected from both urban and rural Japan. Fifty percent of the 7-yr-old children had signs of periodontal disease, and this percentage increased with increasing age. In those under 14, this increase in periodontal disease was mainly due to an increase in the proportion of children developing dental calculus. Subjects with 6 mm or deeper pockets were observed starting from the 20-29-yr-old age group. In subjects over this age, the prevalence of periodontal disease was higher in men than in women. The percentages of subjects having pathologic pockets had increased remarkably in the 30-44-yr-olds. In the 45-64-yr-old group, almost all subjects had some sign of periodontal disease, and the percentage of those with 4 or 5 mm pockets and 6 mm or deeper pockets were 37% and 21%, respectively.     

Periodontal status of 14–16-year-old Danish schoolchildren

Abstract – The purpose of this study was to determine the prevalence of periodontal disease in teenagers. The survey was conducted on 325 children aged 14,15 and 16 years, living in Aarhus, Denmark. Pocket depth and loss of attachment were measured in mm at the maxillary and mandibular first molars and incisors. Plaque, calculus and gingival bleeding on probing were recorded. A total of 221 children (68%) had 4–5 mm deep pockets and 19 children (5.8%) had pockets deeper than 5 mm on at least one tooth Approximately 11% of the subjects showed loss of attachment on at least on tooth. The frequency of surfaces with plaque and gingivitis was high in all three age groups. Plaque, gingivitis, deepened pockets and loss of attachment were most frequently observed on interproximal surfaces. No significant differences were observed between the sexes with regard to periodontal disease.     

Prevalence of deep periodontal pockets in New Mexico adults aged 27 to 74 years

The purpose of this study was to describe the distribution of advanced periodontal destruction (pocket depth equal to or deeper than six mm) in continuous residents, aged 27 to 74 years, of Lordsburg and Deming, New Mexico. The distance from the free gingival margin to the base of the gingival crevice or pocket was measured on the facial and mesiofacial sides of six index teeth. The presence of supragingival calculus, subgingival calculus, and plaque, as well as gingival bleeding around the index teeth, also were evaluated. Of the 372 examinees, only 46 individuals (12.4 percent) had at least one deep pocket equal to or deeper than six mm on at least one site on the six index teeth. Age was significantly associated with prevalence of deep pockets, although about 80 percent of those aged 47 to 74 years did not have deep pockets. Of those with deep pockets, 89.1 percent had fewer than four tooth sites (out of 12) affected. The only significant risk factor of the presence of deep pockets, other than age, was the number of teeth with plaque accumulations. Age and the number of teeth with plaque explained only 10.5 percent of the variability in the prevalence of deep pocketing, suggesting that risk factors other than those included in this study may be important. The results of this study indicate that destructive periodontal disease occurs at selected sites within the mouth, and that about 87 percent of the adults over age 27, in this population, do not have deep pockets in the six index teeth examined.     

Relation between wound healing after surgery and susceptibility to periodontal disease

Abstract. In the present investigation wound healing was studied clinically in 8 younger (mean age 33.5 years) and 8 older patients (mean age 48 years), who were surgically treated for the same amount of severe periodontitis. This implies that the patients in the younger age group represented individuals with a higher degree of susceptibility to periodontal disease than the patients in the older age group. After surgery all patients were subjected to a carefully controlled oral hygiene program. Patients were recalled weekly until 8 weeks post surgery and again after 15 weeks for a final examination. At every recall session oral hygiene measurements were carried out and the bleeding tendency of the pockets was determined after probing with a standardized pressure. Bleeding on the basis of mechanical trauma after probing was considered to be a clinical parameter for wound healing in a plaque free environment.
Results indicate that the oral hygiene program resulted in equally low plaque scores in both age groups. However, in a period from 5–15 weeks after surgery younger patients showed significantly more bleeding pockets than older patients. Furthermore it was found in both groups that the more loss of attachment there was, the slower the rate of wound healing.
It was concluded that the time span for wound healing is longer in patients who are more susceptible to periodontal disease, than in those who are less susceptible.     

A 4-year controlled clinical study into the use of a ceramic hydroxylapatite implant material for the treatment of periodontal bone defects

10 patients with chronic adult periodontitis who had greater than 1 tooth with infra-bony pockets were treated at the test defects by periodontal flap procedures with implantation of hydroxylapatite particles; the control defects were treated by the same surgical procedures but without the implant. A total of 58 test defects and 59 control defects were treated. Each defect had measurements carried out at given sites on the involved tooth surfaces, the sites being considered for subsequent tabulation purposes under the category of shallow (less than 3 mm) moderate (3-6 mm) and deep (greater than 6 mm) initial pocket depths. There were 146 and 152 shallow sites, 216 and 241 moderate sites and 140 and 133 deep sites, at test and control sites, respectively. Measurements of recession, probing pocket depths and probing attachment levels were made at 6 months and 1, 2, 3 and 4 years. At all sites over the period of the study, for the moderate and deep initial pockets there was a significant reduction in probing depths and an increase in the probing attachment levels. At the 4th year of assessment for the initially deep pockets, the reduction in probing depths was significantly greater for the sites treated with the implant material. In view of the difficult clinical problem posed by the treatment of teeth with deeper periodontal bone defects, further research using either this type of implant material or similar material should be considered.     

The relationship between periodontal conditions and perceptions of periodontal health among Pakistani immigrants in Norway

The purpose of the present study was to assess the periodontal status of Pakistani immigrants in Norway, a Third World population in an industrialized country. The findings were related to treatment needs, socio-demographic variables and cultural beliefs about periodontal health. The mean number of remaining teeth ranged from 27.7 in the 20-24-year-old age group to 25.1 in the group of 35-year-olds and older. Very few of the study population had no plaque or no subgingival calculus. Only 7.5% of the participants exhibited no bleeding at any index teeth. Age and residence in Pakistan were the strongest predictors of subgingival calculus and pocket depth. Those from the rural areas of Pakistan had deeper pockets than those from the cities. The data showed a population with high prevalences of teeth with plaque, subgingival calculus and frequent gingival bleeding, but few sites with deep pockets. A periodontal treatment need index would indicate a substantial amount of treatment time. The present study suggests that also the perceived periodontal conditions, should be taken into account when periodontal services and health education strategies are planned. The concept of periodontal illness is introduced, defined as a person's perceptions and interpretations of periodontal symptoms.     

Changes in amount of gingival crevicular fluid after a single episode of periodontal treatment

A total of 51 periodontal sites from 6 adults with no systemic diseases or medication were selected for the study. All sites showed radiologic bone loss and pockets of 4 mm or more. Crevicular fluid (CF) was collected by inserting filter paper strips into periodontal pockets for 5 s and was measured by Periotron. Samples were collected before and 2, 5, 10, 20, and 40 days after a single episode of periodontal treatment (scaling, root planing and curettage). Plaque Index (PII), Papilla Bleeding Index (PBI) and pocket depth (PD) were measured before and 40 days after treatment. The amount of bone loss was estimated from orthopantomograms taken immediately before the trial. Two days after treatment an increase in the amount of CF was seen. After this the amount of CF decreased, reaching the pretreatment level on day 5 after treatment and a level clearly below pretreatment level on day 10 after treatment. Forty days after treatment a slight increase in the amount of CF was seen. The difference between pretreatment values and values at days 2, 10, 20, and 40 was highly significant. In pretreatment samples, positive correlations were found between the amount of CF and PD, PBI and bone loss and, in samples collected 40 days after treatment between CF and PD. CF measurements made before treatment were of no value in predicting the changes in clinical parameters after treatment.     

From manual periodontal probing to digital 3‐D imaging to endoscopic capillaroscopy: Recent advances in periodontal disease diagnosis

Deepened periodontal pockets exert a significant pathological burden on the host and its immune system, particularly in a patient with generalized moderate to severe periodontitis. This burden is extensive and longitudinal, occurring over decades of disease development. Considerable diagnostic and prognostic successes in this regard have come from efforts to measure the depths of the pockets and their contents, including level of inflammatory mediators, cellular exudates and microbes; however, the current standard of care for measuring these pockets, periodontal probing, is an analog technology in a digital age. Measurements obtained by probing are variable, operator dependent and influenced by site‐specific factors. Despite these limitations, manual probing is still the standard of care for periodontal diagnostics globally. However, it is becoming increasingly clear that this technology needs to be updated to be compatible with the digital technologies currently being used to image other orofacial structures, such as maxillary sinuses, alveolar bone, nerve foramina and endodontic canals in 3 dimensions. This review aims to summarize the existing technology, as well as new imaging strategies that could be utilized for accurate evaluation of periodontal pocket dimensions.     

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.     

Associations between gingivitis, pocket depths, and radiographic bone loss in interproximal areas in young adults

Abstract – Fifty-five 15-yr-old Brazilian students were selected on the basis of presence or absence of radiographic bone loss. One hundred and fourteen sites were selected, representing areas with and without bone loss, with varying degrees of inflammation and pocket depths. The association between the parameters were evaluated on a site by site basis. Areas with deep pockets more often showed severe inflammation and bone loss than did areas with shallow pockets. However, deep pockets often occurred where no bone loss could be detected radiographically. In this age group clinical assessments seem to overestimate the prevalence of destructive periodontitis, and should be supplemented with radiographic examination for screening purposes and for identification of risk subjects.     

Periodontal treatment needs in a population of Ljubljana, Yugoslavia

1692 citizens of Ljubljana in the age range from 15 to 65 yr participated in a survey to assess their periodontal treatment needs. Eighty-three of the participants (4.9%) were edentulous and excluded from the study. Of the 1609 dentate subjects only 2.4% were free of any signs of periodontal disease. According to the Community Periodontal Index of Treatment Needs, (CPITN), reversible gingivitis was present in 19.9% of the population, calculus and shallow pockets (4-5 mm) in 57.4%, and deep pockets (greater than or equal to 6 mm) in 20.3% of the examined participants. Bleeding on probing was the most common finding in a group of 15-yr-old subjects, calculus was most frequently found in 25- and 35-yr-old groups, and shallow and deep pockets in 45-, 55- and 65-yr-old adults. Complex treatment needs increased with age, reaching 42.9% in the 65-yr-old population. However, deep pocketing was in 60% limited to one sextant of the participants with complex treatment needs.