Residual periodontal defects distal to the mandibular second molar 6-36 months after impacted third molar extraction

AIM: This retrospective study investigated the periodontal conditions distal to mandibular second molars 6-36 months after routine surgical extraction of adjacent impacted third molars. METHOD: Subjects were randomly selected by systematic sampling from computer records of 3211 surgical mandibular third molar extractions in the Hong Kong dental teaching hospital. Records and pre-extraction radiographs of the selected cases were retrieved. Selected subjects (n = 283) were invited for an interview followed by a clinical examination. Community Periodontal Index (CPI) protocol was used for the assessment of the general periodontal status (excluding the mandibular second molar of interest, i.e. the subject tooth) followed by a detailed periodontal examination of the subject tooth. RESULTS: In all, 158 subjects, aged 29 +/- 7 years, were examined with only 6% (nine subjects) having a highest CPI score of 4 (excluding the subject tooth), but local periodontal defects were prevalent at the distal surface of subject mandibular second molars: mean probing pocket depth (PPD) was 5.4 +/- 1.9 mm with 67% (106 subjects) exhibiting PPD >or= 5 mm and 23% (36 subjects) exhibiting PPD >or= 7 mm; mean recession was 0.8 +/- 1.0 mm; bleeding on probing 96% and suppuration on probing 5%. Multiple linear regression analysis was used to analyse the effects of 12 independent variables on the PPD at the distal surface of the involved mandibular second molar. Three possible risk indicators (P < 0.001, R2 = 0.27) associated with localised increased PPD at the distal surface of the mandibular second molars were identified: 1) third molar 'mesio-angular' impaction; 2) pre-extraction crestal radiolucency and 3) inadequate post-extraction local plaque control. CONCLUSION: The results suggest that periodontal breakdown initiated and established on the distal surface of a mandibular second molar in the vicinity of a 'mesio-angular' impacted third molar evidenced by pre-extraction crestal radiolucency in association with inadequate plaque control after extraction can predispose to a persistent localised periodontal problem.     

Reliability of Partial‐Mouth Recording Systems to Determine Periodontal Status: A Pilot Study in an Adult Portuguese Population

Background: The efficacy of various partial‐mouth recording (PMR) systems is analyzed in the evaluation of periodontal status, using index teeth and different combinations of quadrants. Methods: The study group was formed of 108 adults aged 25 to 65 years old. A full‐mouth examination (FME) was performed in all participants to determine the periodontal probing depth (PD) and clinical attachment level (CAL) at six sites per tooth. The results of PMR using the Ramfjord teeth, the Community Periodontal Index of Treatment Needs teeth, and the four quadrants individually and combined in pairs were compared to the results obtained with FME. Results: Concordance with FME in terms of the prevalence of patients with PD ≥4 mm, CAL ≥2 mm, and CAL ≥4 mm was lowest with examination of single quadrants and highest with combinations that included one superior and one inferior quadrant. Conclusions: PMR systems, particularly with combinations of a superior plus an inferior quadrant, could be useful to evaluate periodontal status based on PD and CAL. This tool could be useful for epidemiologic surveys on periodontal status.     

Clinical attachment loss: estimation by direct and indirect methods

Objective: This observational study aimed to compare the estimation of clinical attachment loss (CAL) as measured by direct (CAL_D) and indirect (CAL_I) methods. Methods: Periodontitis patients (n = 75; mean age: 50.9 ± 8.02 years; 72.2% women; 50.6% smokers) received a periodontal examination (six sites/tooth) to determine the presence of visible plaque and calculus, the gingival bleeding index (GBI), periodontal probing depth (PPD), bleeding on probing (BOP), CAL_D and gingival recession (GR). CAL_I values resulted from the sum of PPD and GR values. Statistical analysis considered only data from sites with visible GR (e.g. the gingival margin apical to the cemento–enamel junction; n = 4,757 sites) and determined the mean difference between CAL_I and CAL_D measurements. Based on the mean difference, univariate and multivariate analyses were also performed. Results: Mean CAL_D and CAL_I values were 3.96 ± 2.07 mm and 4.47 ± 2.03 mm, respectively. The indirect method overestimated CAL compared with the direct method (mean difference: 0.51 ± 1.23 mm; P < 0.001). On uni- and multivariate analyses, absence of GBI and BOP, PPD and proximal site location had significant influences on the overestimation of CAL by the indirect method (all P ≤ 0.01). The indirect method increased the CAL value by 0.38 mm for each additional 1 mm in PPD. Conclusions: To decrease the number of probing errors in daily practice it is suggested that direct examination is more appropriate than the indirect method for estimating CAL.Key words: Periodontal disease, dental practice, diagnosis     

Characterizing traditionally defined periodontal disease in HIV+ adults

Abstract – Background: Results have varied from previous studies examining the level and extent of periodontal disease (PD) in HIV‐1 infected (HIV+) adults. These studies used different methodologies to measure and define PD and examined cohorts with divergent characteristics. Inconsistent methodological approaches may have resulted in the underestimation of traditionally‐defined PD in HIV+ individuals. Objectives: To characterize the level, extent and predictors (i.e. immunologic, microbiologic, metabolic and behavioral) of PD in an HIV+ cohort during the era of highly active antiretroviral therapy (HAART). Study Design: Cross‐sectional study. Setting: HIV+ adults receiving outpatient care at three major medical clinics in Cleveland, OH. Subjects were seen from May, 2005 to January, 2008. Measurements: Full‐mouth periodontal examinations included periodontal probing depth (PPD), recession (REC) and clinical attachment level (CAL). Subgingival plaque was assessed for DNA levels of Porphyromonas gingivalis (Pg), Tannerella forsythia, and Treponema denticola by real‐time DNA PCR assays developed for each pathogen. Rather than using categories, we evaluated PD as three continuous variables based on the percent of teeth with ≥1 site per tooth with PPD ≥ 5mm, REC > 0 mm and CAL ≥ 4mm. Results: Participants included 112 HIV+ adults. Each subject had an average 38% (±24%) of their teeth with at least one site of PD ≥ 5 mm, 55% (±31%) of their teeth with at least one site of REC > 0 mm, and 50% (±32%) of their teeth with at least one site of CAL ≥ 4 mm. CD4+ T‐cell count <200 cells/mm³ was significantly associated with higher levels of REC and CAL, but not PPD. Greater levels of Pg DNA were associated with PPD, REC and CAL. By regression analysis, CD4+ T‐cell count <200 cells/mm³ had approximately twice the deleterious effect on CAL as did smoking (standardized β coefficient 0.306 versus 0.64). Annual dental visit compliance remained an independent predictor for lower levels of PD. Conclusions: The level and extent of PD were high in this cohort even though most patients were being treated with HAART. The definition of periodontal disease used and cohort characteristics examined can influence the level of periodontal disease reported in studies of persons with HIV. Traditional periodontal pathogens are associated with PD in this cohort. Those with CD4+ T‐cell counts <200 cells/mm³ are at greater risk for PD. Therefore, earlier HAART initiation may decrease exposure to immunosuppression and reduce PD morbidity. Continuity of dental care remains important for HIV+ patients even when they are being treated with HAART.     

Prevalence of dental caries and periodontal disease in patients with inflammatory bowel disease: a case-control study

AIM: Previous reports suggest a higher incidence of dental caries in patients with inflammatory bowel disease (IBD) and similarities in the immunopathogenesis of IBD and periodontitis. This study assessed the prevalence of periodontal disease and caries in patients with IBD. METHODS: In the present case-control study, 62 patients seeking treatment of IBD and 59 matched healthy controls of a dental practice were clinically examined. Oral soft-tissue alterations, the decayed, missing and filled tooth surface (DMF-S) index, dentine caries, plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD) and clinical attachment loss (CAL) were evaluated in each patient and in the controls. RESULTS: Patients with IBD showed a significantly higher number of oral manifestations compared with controls. The DMF-S index showed no significant differences, but there was a significantly higher number of subjects with dentine caries in patients with IBD. The mean PPD in patients with IBD was 2.08 versus 2.23 mm in controls (p=0.014). Compared with controls, patients with IBD had more sites with CAL of at least 4 mm (81% versus 64% in controls, p=0.07) and 5 mm (63% versus 46%, p=0.07), respectively. CONCLUSIONS: The results of this case-control study demonstrate a higher frequency of dentine caries in patients with IBD but the periodontal findings showed no distinct differences between cases and controls.     

Change of Periodontal Disease Status During and After Pregnancy

Background: This study explored whether there is any change of periodontal disease status during and after pregnancy. We also examined whether the change is different between females with a history of gestational diabetes mellitus (GDM) and females without GDM during pregnancy. Methods: A follow‐up study was conducted at Woman's Hospital, Baton Rouge, Louisiana. Thirty‐nine females who were previously enrolled in a case‐control study during pregnancy were followed an average of 22 months postpartum. Periodontal status was assessed through dental examinations performed both during and after pregnancy. Clinical periodontal parameters included bleeding on probing (BOP), mean probing depth (PD), and mean clinical attachment level (CAL). Periodontitis was defined as the presence of ≥1 sites exhibiting PD ≥4 mm or CAL ≥4 mm. We used generalized estimating equation analysis to examine the change of periodontal status. Results: Mean number and percentage of sites with BOP decreased from 10.7 ± 11.6 (mean ± SD) and 6.5% ± 7.0% during pregnancy to 7.1 ± 8.8 and 4.3% ± 5.3% at 22 months postpartum (P <0.05), respectively. Mean levels of PD and CAL decreased from 1.8 ± 0.4 mm and 1.9 ± 0.3 mm to 1.6 ± 0.3 mm and 1.6 ± 0.3 mm (P <0.01), respectively. The prevalence of periodontitis decreased from 66.7% to 33.3% (P <0.01, adjusted risk ratio = 2.1, 95% confidence interval = 1.3 to 3.4). There was no difference in the change of periodontal status between females with GDM and females without GDM during pregnancy. Conclusions: Pregnancy may be associated with an increased risk of periodontal disease. The association is not different between females with GDM and females without GDM during pregnancy.     

Periodontal status of adult Sudanese habitual users of miswak chewing sticks or toothbrushes

Miswak chewing sticks are prepared from the roots or twigs of Salvadora persica plants. They are widely used as a traditional oral hygiene tool in several African and Middle Eastern countries. The aim of this study was to assess and compare the periodontal status of adult Sudanese habitual miswak and toothbrush users. The study population comprised male miswak users (n = 109) and toothbrush users (n = 104) with age range 20-65 years (mean 36.6 years) having 18 or more teeth present. They were recruited among employees and students at the Medical Sciences Campus in Khartoum, Sudan. One examiner used the Community Periodontal Index (CPI) to score gingival bleeding, supragingival dental calculus, and probing pocket depth of the index teeth of each sextant. In addition, the attachment level was measured, which, along with the CPI, was used to assess the periodontal status of the two test groups. Gingival bleeding and dental calculus were highly prevalent in the study population. Approximately 10% of the subjects had ≥4 mm probing depth and 51% had ≥4 mm attachment loss in one or more sextants. Subjects in the age group 40-65 years had a significantly (p < 0.05) higher number of sextants with gingival bleeding and with ≥4 mm probing depth and attachment loss than the 30-39 years group. Miswak users had significantly (p < 0.05) lower dental calculus and ≥4 mm probing depth and higher ≥4 mm attachment loss as well as a tendency (p = 0.09) to lower gingival bleeding in the posterior sextants than did toothbrush users. These differences were not significant in the anterior sextants. It is concluded that the periodontal status of miswak users in this Sudanese population is better than that of toothbrush users, suggesting that the efficacy of miswak use for oral hygiene in this group is comparable or slightly better than a toothbrush. Given the availability and low cost of miswak, it should be recommended for use in motivated persons in developing countries.

     

The relationship of stress and anxiety with chronic periodontitis

AIM: This case-control study investigates the relationship of stress and anxiety with periodontal clinical characteristics. METHOD: Seventy-nine selected patients (mean age 46.8+/-8 years) were assigned to three groups in accordance with their levels of probing pocket depth (PPD): control group (PPD< or =3 mm, n=22), test group 1 (at least four sites with PPD > or =4 mm and < or =6 mm, n=27) and test group 2 (at least four sites with PPD >6 mm, n=30). An inclusion criterion of the study required that patients presented a plaque index (PI) with a value equal to or larger than 2 in at least 50% of dental surfaces. All subjects were submitted to stress and anxiety evaluations. Stress was measured by the Stress Symptom Inventory (SSI) and the Social Readjustment Rating Scale (SRRS), while the State-Trait Anxiety Inventory (STAI) was used to assess anxiety. Clinical measures such as PI, gingival index (GI), PPD and clinical attachment level (CAL) were collected. Patient's medical history and socioeconomic data were also recorded. RESULTS: The mean clinical measures (PI, GI, PPD and CAL) obtained for the three groups, were: control group, 1.56+/-0.32, 0.68+/-0.49, 1.72+/-0.54 and 2.04+/-0.64 mm; group 1, 1.56+/-0.39, 1.13+/-0.58, 2.67+/-0.67 and 3.10+/-0.76 mm, group 2, 1.65+/-0.37, 1.54+/-0.46, 4.14+/-1.23 and 5.01+/-1.60 mm. The three groups did not differ with respect to percentage of clinical stress, scores of the SRRS, trait and state anxiety. Frequency of moderate CAL (4-6 mm) and moderate PPD (4-6 mm) were found to be significantly associated with higher trait anxiety scores after adjusting for socioeconomic data and cigarette consumption (p<0.05). CONCLUSIONS: Based on the obtained results, individuals with high levels of trait anxiety appeared to be more prone to periodontal disease.     

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.     

Influence of Dyslipidemia and Diabetes Mellitus on Chronic Periodontal Disease

Background: Periodontal disease is closely related to certain systemic conditions, such as type 2 diabetes mellitus (DM2), and, as recently described, dyslipidemia, a condition with alterations in blood lipids levels. However, more than acting as disease modifiers, these conditions commonly occur as comorbidities, possibly synergically affecting periodontal tissues. The aim of the current study is to identify whether DM2 and dyslipidemia are related to the occurrence and severity of chronic periodontitis. Methods: A total of 254 individuals participated: 56 were patients with DM2, 67 had dyslipidemia, 74 had DM2 and dyslipidemia, and 57 were systemically healthy individuals. The clinical examination included a full‐mouth evaluation of periodontal probing depth, plaque score, bleeding on probing, and clinical attachment level (CAL). Blood samples were taken to assess fasting plasma glucose, low‐density lipoprotein, high‐density lipoprotein, and triglyceride levels. These parameters, as well as other medical conditions (i.e., smoking habits and body mass index), were considered in multiple regression analyses for data analyses (α = 5%). Results: Dyslipidemia was not related to periodontal disease (P >0.05). At the same time, DM2, age, and smoking showed a statistical and positive association, an increase in percentage of sites with CAL ≥3 and ≥5 mm. Regarding the percentage of sites presenting severe destruction (CAL ≥7 mm), only DM2 remained a significant risk factor (P <0.05). Conclusions: It could be concluded that dyslipidemia did not influence periodontal conditions in participants with normal health or those with DM2. However, age, smoking habits, and especially DM2 were significantly associated with loss of CAL.     

Periodontal conditions among the middle-aged and the elderly in Hong Kong

Abstract The aim of this study was to describe the periodontal conditions in 372 35–44-yr-old and 537 noninstitutionalized 65–74-yr-old Hong Kong Chinese who were examined clinically for loss of attachment, recession, probing depth, calculus, and bleeding after probing. Community Periodontal Index (CPI) data and treatment need indications were compiled from index teeth or their substitutes. The prevalence of loss of attachment varied considerably in both cohorts according to the definition of the threshold (≥6, ≥9, and ≥12 mm, respectively). The mean numbers of teeth with loss of attachment at the ≥6-mm threshold and at higher thresholds were small. In both age cohorts, about one-fifth of subjects had probing depths ≥6-mm, while al the ≥9-mm threshold only 2–3% were so affected. Although recession was an important component of loss of attachment in the younger cohort, in the older cohort the prevalence and extent of recession were greater than for probing depths at thresholds ≥4 mm. All subjects had one or more teeth with calculus, bleeding, or both, most teeth being so affected. Eighty-four of the 537 65–74-yr-old subjects were excluded either because of edentulousness or because extractions indicated for the remaining teeth would have rendered the subjects edentulous. The distribution of subjects according to their highest CPI score was remarkably similar for the two cohorts. No subjects in either age group were assessed as “healthy” (CPI code 0) or had “bleeding only” (code 1) as their highest score. While most subjects scored CPI code 2 or 3 us their highest score, only 17% of the younger and 15% of the older cohort scored Community Periodontal Index of Treatment Needs (CPITN) code 4. Differences in the mean number of sextants affected by CPI codes between the two cohorts were mainly due to a greater number of excluded sextants in the older cohort. CPI findings for 35–44-yr-olds differed little from those reported in 1984.     

Association Among Periodontitis and the Use of Crack Cocaine and Other Illicit Drugs

Background: Crack cocaine can alter functions related to the immune system and exert a negative influence on progression and severity of periodontitis. The aim of this study is to compare periodontal status between crack cocaine users and crack cocaine non‐users and investigate the association between crack cocaine and periodontitis after adjustments for confounding variables. Methods: This cross‐sectional study evaluated 106 individuals exposed to crack cocaine and 106 never exposed, matched for age, sex, and tobacco use. An examiner determined visible plaque index (VPI), marginal bleeding index, supragingival dental calculus, probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Logistic regression was used to model associations between crack cocaine and periodontitis (at least three sites with CAL >4 mm and at least two sites with PD >3 mm, not in the same site or tooth). Results: Prevalence of periodontitis among crack non‐users and crack users was 20.8% and 43.4%, respectively. Crack users had greater VPI, BOP, PD ≥3 mm, and CAL ≥4 mm than crack non‐users. Periodontitis was associated with age >24 years, schooling ≤8 years, smoking, moderate/heavy alcohol use, and plaque rate ≥41%. Crack users had an approximately three‐fold greater chance (odds ratio: 3.44; 95% confidence interval: 1.51 to 7.86) of periodontitis than non‐users. Conclusion: Occurrence of periodontitis, visible plaque, and gingival bleeding was significantly higher among crack users, and crack use was associated with occurrence of periodontitis.     

Evaluation of enamel matrix derivative as an adjunct to non-surgical periodontal therapy

OBJECTIVES: The aim of this study was to evaluate the adjunctive use of enamel matrix derivative (EMD) on periodontal healing following nonsurgical periodontal therapy (scaling and root planing - SRP). MATERIAL AND METHODS: The study was performed as an intraindividual, longitudinal trial of 3 months duration with a double-blinded, split-mouth, controlled, and randomized design. Twenty-two patients with moderate to severe chronic periodontitis were enrolled in the study. In each patient, two sites with pocket depths >/=5 mm and with radiographic angular bone defects >3 mm were selected. Baseline examination included measurement of probing pocket depth (PPD) and clinical attachment levels (CAL). The presence or absence of plaque and bleeding on probing at selected sites was also recorded. Following initial examination, full-mouth SRP was performed. Study sites were then treated with 24% EDTA for 2 min, followed by thorough irrigation with sterile saline. The sites were then randomized. The experimental site received subgingival application of enamel matrix derivative (Emdogain, BIORA AB, Malmo, Sweden). The control site received no additional treatment. At 3 months, all sites were re-examined. The response to therapy in experimental and control sites was evaluated, using change in probing depth and CAL as the primary outcome variables. Statistical analysis (paired t-tests) was used to compare response to treatment in control versus experimental sites. RESULTS: Statistically significant changes in PPD and CAL were seen in both treatment groups from baseline to 3 months. The mean PPD reduction was 2.3+/-0.5 mm for control sites and 2.0+/-0.3 mm for experimental sites. The mean CAL gain was 1.8+/-0.4 mm for control sites, and 1.4+/-0.3 mm for experimental sites. Statistical analysis, however, revealed no significant difference in PPD reduction or CAL gain between experimental and control groups (p>0.4). In addition, no difference was found between treatment groups in bleeding or plaque indices at 3 months. CONCLUSION: The findings from the present study do not support the use of EMD during routine, nonsurgical debridement of periodontal pockets as measured 3 months post SRP.     

Higher prevalence of periodontitis in patients with refractory arterial hypertension: a case-control study

Oral Diseases (2011) 17 , 560–563 Objective: The aim of this study was to assess the association of periodontitis with refractory arterial hypertension. Study design: A total of 137 patients were examined. Seventy patients (mean age of 55.2 ± 9.2 years) were included in the case group, while 67 non‐hypertensive subjects (mean age of 50.0 ± 7.2) served as a control group. Periodontal clinical examination included plaque index, bleeding on probing, probing pocket depth and clinical attachment loss (CAL). Patients with at least five sites with CAL ≥6 mm were considered as severe periodontitis, and with at least 30% of the sites with CAL ≥4 mm generalized chronic periodontitis. Results: The mean (±s.d.) number and percentage of sites with CAL ≥6 mm were 11 (±14) and 16.6 (±14) in the case group, and 5.7 (±9.5) and 5.8 (±9.7) in the control group (P < 0.05). The mean (±s.d.) percentage of sites with CAL ≥4 mm was 37 (±29.6) in the case group and 21.2 (±20) in the control group (P < 0.05). The significant associations with arterial hypertension were severe chronic periodontitis (OR = 4.04, 95% CI: 1.92; 8.49) and generalized chronic periodontitis (OR = 2.18, 95% CI: 1.04; 4.56). Conclusions: Severe and generalized chronic periodontitis seem to play a role as risk indicators for hypertensive patients.     

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 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.     

Local delivery of chlorhexidine gluconate in patients with aggressive periodontitis

The aim of this randomized, controlled, single-blinded trial was to evaluate the effectiveness of a biodegradable chlorhexidine chip as an adjunctive therapy to scaling and root planing. Eleven consecutive patients with aggressive periodontitis were recruited for this study. Each volunteer provided four sites with probing depth > or = 5 mm. Two sites received scaling and root planing (SRP) and placement of the chlorhexidine chip (PC), and the other two sites received scaling and root planing only. The clinical outcomes were measured at baseline, 6 weeks and 3 months after treatment. All patients completed the trial. None of the volunteers reported any adverse effect. Both groups showed a significant reduction in periodontal pocket depth (PPD) and gain in clinical attachment level (CAL) after treatment. However, there were no significant differences in the clinical parameters between the groups after 6 weeks and after 3 months. Sites presenting probing depths > or = 8 mm at baseline treated with SRP + PC demonstrated greater reduction in PPD and a greater CAL gain than sites treated with SRP alone after 6 weeks and after 3 months. The authors concluded that the adjunctive use of the biodegradable chlorhexidine chip resulted in greater reduction of PPD and additional gain in CAL in deep pockets (PPD > or = 8 mm) in patients with aggressive periodontitis when compared to scaling and root.     

Periodontal health of an adult population in Hungary: findings of a national survey

Objectives: To estimate the levels of periodontal health conditions of Hungarian adults.
Material and Methods: Periodontal data on 4153 adults in 304 survey locations from all Hungarian regions were analysed. The Community Periodontal Index (CPI) was used to report the occurrence of probing pocket depth, calculus, and gingival inflammation.
Age, gender, socioeconomic and health status, oral hygiene and lifestyle habits, dental office attendance, level of education, and fixed partial denture (FPD) treatment were evaluated for their association with periodontal conditions. CPI score as an outcome was dichotomized using an accepted threshold as low (<3) and high (3, 4) for multiple logistic regression modelling.
Results: CPI2 was the most prevalent score in all age groups. CPI scores were also strongly associated with the independent variables. Approximately 66% of subjects visited a dentist only in the case of an emergency. Lack of periodontal aspects of restorative care was demonstrated by the result of CPI0 among 16% of non-FPD wearers compared with only 9% of individuals treated with FPD.
Conclusion: The present survey indicates that oral hygiene standards and periodontal health conditions need improvement in Hungary. Effective intervention programme for the prevention and control of periodontal disease are recommended at a national level.     

Locally delivered doxycycline improves the healing following non-surgical periodontal therapy in smokers

OBJECTIVE: The outcome of non-surgical periodontal therapy is known to be inferior in smokers compared to non-smokers. In the present study, the question was asked whether such a difference in healing response may be less evident following adjunctive use of locally delivered controlled-release doxycycline. METHODS: One hundred and three patients (42 smokers, 61 non-smokers), each having at least eight periodontal sites with PPD (probing pocket depth) > or =5 mm, were following stratification for smoking randomly assigned to two different treatment protocols; non-surgical scaling/root planing (Control) or ultrasonic instrumentation+application of a 8.5% w/w doxycycline gel (Atridox trade mark ) (Test). Instructions in oral hygiene were given to all patients. Clinical examinations of plaque, PPD, clinical attachment level (CAL) and bleeding following pocket probing were performed at baseline and after 3 months. Primary efficacy endpoints were changes in PPD and CAL. Patient mean values were calculated as basis for statistical analysis (multiple regression analyses). RESULTS: The baseline examination revealed no significant difference in mean PPD between treatment groups or between smokers and non-smokers (mean PPD 5.7-5.9 mm). The mean PPD reduction in the control group at 3-month was 1.1 mm (SD=0.45) for smokers and 1.5 mm (0.67) for non-smokers. In the test group the PPD reduction was 1.4 mm (0.60) and 1.6 mm (0.45) for smokers and non-smokers, respectively. The mean CAL gain for smokers and non-smokers amounted to 0.5 mm (0.56) and 0.8 mm (0.71), respectively, in the control group, and to 0.8 mm (0.72) and 0.9 mm (0.82), respectively, in the test group. Multiple regression analysis revealed that smoking and initial PPD negatively influenced the treatment outcome in terms of PPD reduction and CAL gain, while the use of doxycycline had a significant positive effect. CONCLUSION: Locally applied controlled-release doxycycline gel may partly counteract the negative effect of smoking on periodontal healing following non-surgical therapy.     

Combined effects of Nd:YAG laser irradiation with local antibiotic application into periodontal pockets

The purpose of the present study was to assess the effects of Nd:YAG laser irradiation into periodontal pockets with or without the combination of local antibiotic application on clinical parameters and microbiological prevalence. Sixteen patients, each of whom had 4 or more sites with probing depth e x 4mm were included in this study. They were monitored clinically and microbiologically at baseline, 1 and 3 months after the treatment. Subgingival plaque samples were taken from periodontally involved sites with a probing depth of e x 4mm. A total of 135 sites were randomly assigned to the following treatments; Nd:YAG laser alone (Group L: 10 pps, 200 mJ for 90 sec, n = 37), local minocycline administration following laser treatment (Group LP, n = 33), povidone-iodine irrigation following laser treatment (Group LI, n = 33), and control group (Group C: sham procedure, n = 32). The prevalence of 18 subgingival taxa were determined using the checkerboard technique. The mean value of the pocket probing depth (PPD) significantly decreased in Group L, Group LP and Group LI, and the mean clinical attachment loss (CAL) decreased in all three treatment groups. Multivariate logistic regression analysis showed that Group LP showed the most improvement in PPD or CAL at 3 months. The proportions of Porphyromonas gingivalis, Tannerella forsythia (formerly Bacteroides forsythus) and Prevotella intermedia were significantly lower in Group LP than in Group L after 3 months. These results showed that Nd:YAG laser irradiation plus local minocycline provides a much greater reduction in PPD, CAL and the amount of periodontopathogenic bacteria than laser irradiation alone in periodontitis patients.