The effect of aspirin on the periodontal parameter bleeding on probing

BACKGROUND: The absence or presence of bleeding on probing (BOP) is a sign of periodontal health or disease, but the presence of BOP is not an accurate predictor of disease progression. Aspirin is increasingly used in the prevention of cerebrovascular and cardiovascular diseases and is a non-disease factor that may modify bleeding indices given its antithrombolytic activity. The purpose of this double-blind placebo-controlled randomized clinical trial was to study the effect of short-term daily aspirin ingestion on the clinical parameter BOP. METHODS: A total of 46 periodontally healthy subjects were included in this study: 16 received placebo, 15 low-dose aspirin (81 mg), and 15 regular dose (325 mg) aspirin. Clinical parameters assessed included plaque index, periodontal probing depth, and BOP using an automated pressure-sensitive probe. Measurements were recorded before and after 7-day exposure to placebo and aspirin regimens. RESULTS: A statistically significant difference in BOP was found in patients with > or = 20% of bleeding sites during the visit prior to placebo or aspirin exposure (n = 11). The group treated with 325 mg aspirin exhibited a moderate yet statistically significant increase in BOP (12.4%) compared to the placebo group (there was no significant difference between the 81 mg aspirin group and placebo). The tendency to bleed was not statistically significant in the group which exhibited <20% (n = 35) of bleeding sites during the visit prior to exposure. CONCLUSION: Aspirin intake of 325 mg daily for 7 days moderately increased the appearance of bleeding on probing in a population that had > or = 20% BOP sites.     

The influence of gingival dimensions on bleeding upon probing in young adults with plaque-induced gingivitis

In both cross-sectional and longitudinal studies of young adults with plaque-induced gingivitis it has been observed that bleeding upon probing is only weakly associated with supragingival plaque. It has been speculated that gingival bleeding may be influenced by several independent factors other than plaque. Great intra- and interindividual variation of gingival thickness and width has been reported. Based on respective observations, the existence of different gingival phenotypes has been suggested. The aim of the present study was to investigate the possible influence of gingival thickness and width on bleeding on probing. Forty young adults with mild, plaque-induced gingivitis, 24 non-smokers and 16 smokers, participated in this cross-sectional study. In addition to periodontal probing depth, clinical attachment loss, width of gingiva, bleeding on probing, and presence of plaque, gingival thickness was measured with an ultrasonic device. Multivariable models were separately calculated for buccal, mandibular lingual, and palatal surfaces and generally adjusted for tooth type. Generalised Estimation Equation methodology was employed in order to adjust for correlated observations. Plaque was significantly associated with bleeding upon probing only at buccal sites (odds ratio 1.80, 95% confidence interval 1.19-2.72) An influence of similar magnitude was identified for smoking (odds ratio 1.76; 1.07-2.89). At lingual sites in the mandible, bleeding was influenced by smoking (odds ratio 2.25; 1.18-4.25) and gingival thickness (odds ratio for thick gingiva >1 mm of 1.93; 1.02-3.65), but not plaque. At palatal sites, only periodontal probing depth had an influence (odds ratio 1.89; 1.25-2.84). It was concluded that, apart from supragingival plaque, smoking was an independent risk factor for gingival bleeding on probing. Thin and vulnerable gingiva of insufficient width was not more likely to bleed after probing than thicker tissue.     

Gingival bleeding on repeat probing after different time intervals in plaque-induced gingivitis

The aim of this study was to assess agreement and association of gingival bleeding after repeated probing at different time intervals in subjects with gingivitis. Twenty adults participated. Periodontal probing (P≈1.27 MPa) was conducted at six sites of every tooth present. Probing was repeated in different quadrants immediately after the first probing (T0), after 1 h (T1), 4 h (T4), and 24 h (T24). A total of 3,459 sites were probed twice. The mean proportion of sites bleeding on probing (BOP) was 0.23 (standard deviation 0.08, range 0.10–0.41). Probing itself had a significant effect on the results of repeated probing. For T0 through T24, respective mean differences of proportions were 0.04, 0.04, 0.01, and −0.03. Ninety-five percent repeatability coefficients of proportions were 0.17–0.18. Estimates of overall kappa were 0.390, 0.234, 0.233, and 0.046 for T0 through T4, respectively. Adjusted two-level binary response models revealed odds ratios (95% confidence interval) for BOP at T0 through T4 of 6.52 (4.34, 9.80), 3.23 (2.19, 4.76), 3.80 (2.63, 5.50), and 2.68 (1.85, 3.89). It was concluded that a certain degree of agreement of site-specific bleeding scores in subjects with plaque-induced gingivitis could be observed only if probing was repeated at once. Adjusted associations between repeat BOP were weak in general, but strongest immediately after first probing. There appears to be a significant effect of probing itself, which may last for more than 1 h, whereas 24-h results are obtained under different conditions.     

The effect of aspirin on gingival crevicular fluid levels of inflammatory and anti-inflammatory mediators in patients with gingivitis

BACKGROUND: Inflammatory and anti-inflammatory mediators may play a significant role in patients with gingivitis. The purpose of this study was to assess the short-term effects of the systemic administration of two different concentrations of aspirin (81 and 325 mg/day, by mouth) on clinical periodontal parameters and gingival crevicular fluid (GCF) levels of 15-epi-lipoxin A4 (15-epi-LXA4), lipoxin A4, leukotriene B4 (LTB4), prostaglandin E2 (PGE2), and interleukin (IL)-6 and -1beta in a sample of naturally occurring gingivitis patients. METHODS: At day 0, after initial screening for entry, baseline periodontal parameters, including bleeding on probing (BOP), periodontal probing depths (PDs), and plaque index (PI) were measured, and GCF was sampled from 12 intrasulcular sites with filter paper strips for the measurement of six types of inflammatory and anti-inflammatory mediators using competitive enzyme immunoassay and enzyme-linked immunosorbent assay (prevalues). Forty-seven subjects were assigned randomly to one of three treatment groups: placebo (15 subjects); aspirin, 81 mg (16 subjects); and aspirin, 325 mg (16 subjects) once daily. On day 7, subjects were recalled for the measurement of periodontal parameters and collection of GCF samples for the measurement of six types of mediators (postvalues). RESULTS: Changes in inflammatory and anti-inflammatory mediator levels were not statistically significant for any of the three treatment groups. However, when pre- and postvalues were compared in the subjects receiving aspirin, 325 mg, there was a negative trend in the relationship between 15-epi-LXA4 and PGE2, whereas the relationship between LTB4 and PGE2 was not as strong. This might indicate that the subjects responding to aspirin-mediated PGE2 suppression effects produced higher 15-epi-LXA4 in GCF than non-responders. No statistically significant differences in PD and PI between pre- and postvalues were found for any of the three treatment groups. However, the results demonstrated a significant increase in BOP when aspirin, 325 mg was compared to placebo (P <0.001) and aspirin, 81 mg (P = 0.001). CONCLUSIONS: Aspirin can have an affect on BOP in naturally occurring gingivitis patients. Although most of the inflammatory mediators did not show significantly detectable changes after aspirin treatment for 7 days, the trend of aspirin-associated increases of 15-epi-LXA4 implied that this recently discovered aspirin-dependent eicosanoid may be associated with the increased incidence of BOP observed in the subjects who received aspirin therapy.     

Comparison of different approaches to assess bleeding on probing as indicators of gingivitis

Abstract. The purpose of this study was to evaluate different methods of eliciting gingival bleeding as indicators of gingival inflammation in the experimental gingivitis model. Following a period of stringent oral hygiene, 103 dental students were scored for plaque and gingival bleeding assessed by 4 methods. From this group, 41 volunteers were randomly allocated to 2 treatment groups. Dental students with clean teeth and healthy gingivae were asked to abolish all mechanical tooth cleaning in the lower jaw for a period of 3-weeks. During the 21-day experimental period, chlorhexidine (Peridex®) or a placebo mouthrinse was applied to the lower jaw. Subjects brushed the upper jaw with a standard toothpaste. In principal, 2 different methods were employed to provoke bleeding: (1) at the marginal gingival tissue by running a probe along the soft tissue wall at the orifice of the pocket, and (2) by probing to the "bottom" of the pocket. Variations in the methods were based on angulation (AngBI, ParBI) of the probe in relation to the tooth surface and to the probing force (PPBI.25N, PPBI.757V). 1 randomly selected quadrant in the lower jaw was scored using the AngBI. The opposing quadrant was scored with a randomly-allocated bleeding index, either ParBI, PPBI.25 N or PPBI.75 N . The results of this study confirm earlier findings that the angulation of the probe determines the number of sites with bleeding observed. It also indicates that bleeding as elicited by probing to the bottom of the pocket is a poor indicator of early gingivitis. It is recommended that gingivitis should be assessed by probing the marginal gingiva.     

Comparison of the bleeding on marginal probing index and the Eastman interdental bleeding index as indicators of gingivitis

AIM: The purpose of the present study was to compare 2 indices, i.e., the Eastman interdental bleeding (EIB) index and the bleeding on marginal probing (BOMP) index. The comparison was made (a) in terms of the degree of bleeding provoked and the relationship with plaque in natural gingivitis and (b) for the ability of these 2 methods to detect differences between the development of experimental gingivitis in a control group and a group in which the development of gingival inflammation was suppressed by treatment. For the present studies, subjects were selected without interdental recession of the gingival tissues. METHODS EXPERIMENT 1: In this experiment, 43 subjects having established moderate gingivitis were assessed using a random splitmouth design (1st and 3rd/2nd and 4th quadrant). Plaque was scored on all approximal sites after which the BOMP index was assessed in one half of the mouth and the EIB index in the other. RESULTS EXPERIMENT 1: The BOMP index showed a bleeding score of 84% and the EIB index of 87%. The significant correlation between plaque and gingival bleeding for the BOMP index (0.55) was higher than for the EIB index (0.44). METHODS EXPERIMENT 2: For this experiment, 25 subjects participated in an experimental gingivitis trial of the lower jaw. At baseline, first the BOMP index and immediately thereafter the EIB index were assessed at all approximal sites. Experimental gingivitis (EG) was carried out in one randomly assigned quadrant and as a treatment modality only floss was used in the other (FL). RESULTS EXPERIMENT 2: In the EG quadrant, the BOMP index increased to 69% and the EIB index to 73%. Both indices showed a significant correlation with plaque; 0.60 and 0.64 respectively. In the FL quadrant, the BOMP index increased to 38% and the EIB index to 30%. No significant correlation between both gingivitis indices and the amount of plaque was present in the FL quadrant. CONCLUSION: The ability of the BOMP index and the EIB index to assess the level gingival inflammation appears to be comparable.     

The effect of mechanical oral hygiene procedures on bleeding on probing

Abstract The purpose of the present study was to investigate the effect of mechanical oral hygiene procedures on bleeding on probing in relation to age and periodontal status. The study was carried out on 49 indivuals divided into 7 experimental groups according to age and having been either treated for destructive periodontal disease or having an intact healthy periodontium. In order to eliminate any pre-existant gingival inflammation, all subjects received a carefully controlled oral hygiene program. At the start of the experiment, all subjects were instructed to abstain from oral hygiene procedures for 24 h. Thereafter, clinical baseline measurements were carried out, including bleeding on probing (BOP) using a standardized probing pressure. Next, all subjects cleaned their teeth according to their normal oral home care protocol using a multitufted toothbrush, toothpicks and interdental brushes. BOP scores were again assessed 30 min after completed tooth cleaning procedures. The results revealed a significant increase in BOP after the mechanical oral hygiene procedures in every individual in all experimental groups (p <0.05). Further analysis showed that the increase in BOP was independent of the periodontal status of the subjects. However the BOP scores after mechanical oral hygiene procedures were higher in the young age groups. It was concluded that the diagnostic predictability of BOP in the treatment of periodontal diseases might be affected by temporarily elevated BOP scores shortly after mechanical oral hygiene procedures.     

The effect of aspirin on bleeding after extraction of teeth

Acetylsalicylic acid (ASA) generically known as aspirin is used clinically as an analgesic, antipyretic, anti-inflammatory and as a medication to prevent platelet aggregation. Many studies have investigated bleeding associated with ASA.

Objective

The aim of this study was to determine if ASA was associated with bleeding after dental extraction.

Patients and methods

One hundred and eighty-nine subjects were divided into four groups. Group 1A subjects who received ASA, underwent simple extraction. Group 1B subjects who received ASA, underwent surgical extraction. Group 2A subjects who did not receive ASA, underwent simple extraction which served as control group. Group 2B subjects who did not receive ASA, underwent surgical extraction which also served as control group.

Results

The results showed that Group 1B was the only group which showed bleeding after 24 h. All groups had similar results after 48 h and 5 days post-operatively.

Conclusion

The study concluded that subjects who received 81 mg ASA daily could undergo dental extraction without bleeding risks.     

The effect of a single mechanical treatment on the subgingival microflora in patients with HIV-associated gingivitis

Abstract The purpose of the present study was to investigate the effect of a single episode of scaling and root planing on clinical periodontal parameters and on the subgingival microflora in human immunodeficiency virus (HIV)-positive and HIV-negative subjects. 13 subjects participated and were clinically scored at days -7. 7, 30 and 90. 7 subjects were infected with HIV and presented an HIV-associated gingivitis. 6 subjects were HIV-negative with at least 12 teeth affected by conventional gingivitis. No significant differences were seen between both groups regarding the presence of P. gingivalis. P. intermedia and A. actinomycetemcomitans. The mean plaque index (PII) was 1.79 in the HIV-negative and 1.29 in the HIV-positive group. The mean gingival index (GI) was higher in the HIV-positive group (HIV-positive: 1.55; HIV-negative: 1.47). Whereas, the PII decreased significantly in the HIV-negative group during the course of the study, no change was observed in the HIV-positive group. GI as well as bleeding upon sampling decreased significantly in both patient groups during the same period. The bacterial counts decreased from day –7 to day 7 and generally remained on a lower level until day 90. Small differences were seen in the microbiological flora of the HIV-positive and the HIV-negative subjects following mechanical treatment.     

The effect of triclosan on developing gingivitis

Abstract The aim of the study was to examine whether triclosan has an effect on developing gingival inflammation. 10 volunteers, with clinically healthy gingivae were enrolled. The study was performed as a 2-week, double-blind, crossover, experimental gingivitis trial. Between each plaque accumulation period, there was a wash-out phase of 4 weeks. A baseline examination was performed which included assessment of plaque and gingivitis. The volunteers were asked to refrain from mechanical oral hygiene measures for 2 weeks. During this period, they rinsed 2× daily with one of the randomly assigned mouthrinse preparations. Solution A (period A): 0.06% triclosan + 2%tween 80. Solution B (period B): 0.06% triclosan +0.25% sodium lauryl sulphate. Re-examinations were performed on days 4, 7, 11 and 14. The mean plaque score increased during period A to 2.2 (day 4), 2.8 (day 7), 3.1 (day 11) and 3.1 (day 14). The corresponding scores for period B were significantly lower; 1.2 (day 4), 1.8 (day 7), 2.0 (day 11) and 2.2 (day 14). The mean gingivitis scores at baseline were 0.17 (periods A and B). The mean gingivitis scores increased to 0.45 (day 4), 0.69 (day 7), 0.83 (day 11) and 0.96 (day 14) when the subjects rinsed with solution A and 0.42 (day 4), 0.64 (day 7), 0.78 (day 11) and 0.92 (day 14) in period B. There were no statistically significant differences between periods A and B with respect to gingivitis. Thus, although significantly more plaque formed during period A than period B, no differences could be found between the gingivitis scores in the 2 periods.     

Gingival resistance to probing forces. II. The effect of inflammation and pressure on probe displacement in beagle dog gingivitis

This study was undertaken to determine the effect of gingival inflammation and probing pressure on probe tip placement in relation to the base of the gingival crevice and the most coronal connective tissue attachment fibers. Nine young male beagle dogs were divided into three groups as determined by clinical status of the gingiva following implementation of a protocol designed to produce gingival health and disease. An electromechanical device was used to advance 0.6 mm diameter probes into the facial gingival crevices of selected teeth and to obtain force-displacement curves. The instrument stopped the probe at pressure of either 80, 160, 320, 640, 1280, or 2560 kPa which were randomly allocated to 12 test teeth in each dog. After the probe came to rest, it was attached to the tooth. When all 12 probes were attached, the animal was sacrificed. Blocks consisting of gingiva, probe, and tooth were processed to obtain two buccolingual sections, one containing the probe and the other immediately adjacent to it. Clinical and histometric measurements were performed and the data evaluated. Although three groups of animals were discernable by clinical criteria, only two groups, health and disease, could be formulated based on the degree of histologic inflammation. The histologic grouping was used in data analysis. Histometric distances from the cemento-enamel junction to the base of the crevice (cJ), to most coronal connective tissue attachment (cC) and to the probe tip (cP) all increased with change from health to disease. However, changes in health/disease did not influence difference between distances (cP-cJ,cP-cC).(ABSTRACT TRUNCATED AT 250 WORDS)     

Variability of gingival bleeding in experimental gingivitis trials

Gingival bleeding is a difficult parameter to assess in experimental trials. The Confirmed Bleeding Day was recently developed as a measurement for this purpose. It was observed that considerable variations existed between the measurements made in a pilot study and an experimental trial, and these variations were subjected to a statistical analysis. The reasons for the variations are discussed, and recommendations made for the design of experimental trials involving gingival bleeding.     

The effect of levamisole on experimental gingivitis in juvenile periodontitis

In four patients with juvenile periodontitis (group A), five adults with advanced periodontitis (group B), and in four controls (group C) the concentration of serum immunoglobulins, serum complement (C₃C₄, and C₅) T and B lymphocyte ratio, leukocyte migration inhibition and lymphocyte transformation responses to dental plaque bacteria ( A. viscosus, B. melaninogenicus, F. nucleatum, and V. parvula ) and PPD or PHA, and lymphocyte ATP-ase activity were assessed before and during development of experimental gingivitis.
All the patients in group A and B Had completed extensive periodontal treatment, and at the time of the experiment the periodontal conditions were excellent. Plaque accumulation and gingival inflammation were assessed and blood samples were drawn: at day 0; after plaque accumulation for 14 d (no oral hygiene) (period I); after 14 d with optimal oral hygiene (period II); after plaque accumulation for 14 d (no oral hygiene) and concomitant immunostimulatory treatment with levamisole (period III); after 14 d with optimal oral hygiene. After period I, gingival inflammation and increased gingival fluid flow developed in all groups; however, in group C some of the clinical and immunological responses were slightly enhanced as compared wiht group A and group B. On the other hand, after period III (plaque accumulation + levamisole) more pronounced clinical and immunological changes were recorded in group A and B than in group C, including a significant rise in gingival fluid flow, LIF production, and lymphocyte ATP-ase activity. The present study has supported the asumption that a state of immunodeficiency can be an underlying, predisposing factor for juvenile periodontitis. The results, however, give only vague information on the nature of this deficiency     

The effect of age on the development of gingivitis

Abstract In the present “experimental gingivitis” study, the response of the marginal gingiva to plaque formation was studied in one group of young subjects, 20-25 years of age, and in one group of older subjects, aged 65-80 years. During a 4-week period, all subjects received a series of professional tooth cleaning to establish healthy gingival conditions. A baseline examination (Day 0) included assessments of plaque and gingivitis. Sites that were examined (the experimental sites) included the mesiopalatal, palatal, and dislopalatal surfaces of all teeth present in the 15. 25 tooth region. Among the experimental sites, microbial sampling and gingival fluid assessment were performed and one gingival biopsy harvested from each subject. Following the baseline examination, the participants abolished mechanical tooth cleaning measures in the palatal and approximal surfaces of 15, 25. The clinical examination and the gingival fluid measurement were repeated on days 7, 14 and 21 of no oral hygiene. The microbiological sampling and the biopsy procedure were repeated on days 7 and 21. The data collected demonstrated that old subjects, during a 3-week period of oral hygiene abstention, formed similar amounts of plaque as the young subjects, but developed more gingivitis than young subjects. Thus, the clinical gingivitis assessments, the gingival fluid measurements and morphometric determinations made in the biopsy samples documented that the gingival lesion which formed in the old individuals was more pronounced and contained more inflammatory cells than the corresponding lesion in the young subject sample.     

探龈缘出血法的临床应用评价

目的：研究探龈缘出血法（BOMP法）的临床应用价值.方法： 实验一是对31名受检者的5100个位点分别用Williams刻度牙周探针探龈缘法和压力恒定的Florida探针探袋底法（BOPP法）检查出血指数;实验二是对另31名受检者的4 974个位点用Williams刻度牙周探针分别用BOMP法、BOPP法检查出血指数.结果：在PD＜4 mm时,BOMP法与其他两种方法的一致率、相关程度最高,而且有较高的阴性预测值.BOMP法与其他两种方法在位点水平、牙位水平、区段水平和个体水平上的相关性呈逐渐增加的趋势.结论：BOMP法较适用于评价牙龈炎和种植体周围早期炎症,适用于人群的流行病学调查.     

Effect of probing depth and bleeding tendency on the reproducibility of probing depth measurements

The aim of this study was to determine the influence of the probing depth and the bleeding tendency on the reproducibility of probing depth measurements. Duplicate probing depth and bleeding tendency measurements were performed at 717 interproximal sites in 13 subjects. Analysis indicated that the factor probing depth had a larger effect on the accuracy of probing depth measurements than the factor bleeding tendency.     

Gingival bleeding on probing increases after quitting smoking

BACKGROUND: Gingival inflammation associated with plaque accumulation is delayed or impaired in smokers. Anecdotal evidence suggests that smokers who quit experience an increase in gingival bleeding. METHOD: A group of 27 subjects on a Quit-smoking programme were examined for changes in gingival health over a 4-6-week period. RESULTS: The bleeding on probing with a constant force probe increased from 16% of sites to 32% of sites, despite improvements in the subjects oral hygiene. CONCLUSION: This provides further evidence that tobacco smoking affects the inflammatory response and that these changes are reversible on quitting.     

The therapeutic effect of toothbrushing on naturally occurring gingivitis

A majority of previous toothbrushing studies have examined proposed virtues of particular brushing techniques or the relative cleaning ability of various toothbrushes. A smaller number were concerned with their role in prevention of gingivitis. Whether toothbrushing could be therapeutic in naturally occurring gingivitis was tested in 40 teenagers aged 12 to 14 years. Groups from two public schools were examined for gingivitis and plaque. Students from both groups were given a soft multi-tufted toothbrush and nonfluoridated toothpaste to be used daily. Students at one school were given a single intensive oral hygiene session. All students were reexamined 42 days later and given a thorough prophylaxis. Final readings were obtained 84 days after baseline and the results analyzed statistically. Sign test analysis disclosed a significant (P less than .01) improvement in plaque and gingivitis scores for both groups. Wilcoxon tests of patient means revealed a significant improvement in plaque scores, whereas gingivitis means were more variable. Chi square analysis between groups showed that the groups receiving oral hygiene instructions had significantly better (P less than .01) plaque and gingivitis scores at session 2. Gingivitis differences were generally significant at session 3. Toothbrushing has a therapeutic effect on naturally occurring gingivitis, enhanced by oral hygiene instruction.