Cigarette smoking, periodontal disease: and chronic obstructive pulmonary disease

BACKGROUND: Cigarette smoking is a significant risk factor for both chronic obstructive pulmonary disease (COPD) and periodontal disease. The goal of this study was to better understand the role of smoking in a possible relationship between periodontal disease and COPD. METHODS: The study population consisted of 7,625 participants in the Third National Health and Nutrition Examination Survey (NHANES III) during 1988-1994 who were aged 30 years or older when examined and who received a spirometric examination. The data analysis employed logistic regression models and accounted for the complex sampling design used in NHANES III. RESULTS: After adjustment for potential confounders, there was no statistically significant association between periodontal disease and COPD among former or non-smokers. Current smokers with > or = 4 mm mean loss of attachment had an odds ratio of 3.71 (95% confidence interval: 1.74, 7.89). CONCLUSIONS: These results suggest that cigarette smoking may be a cofactor in the relationship between periodontal disease and chronic obstructive pulmonary disease. The key role played by smoking in the etiology of both periodontal disease and chronic obstructive pulmonary disease suggests that much of the observed increase in risk may actually reflect the exposure to smoking. Additional research into smoking-related effect modification is needed to clarify the role of periodontal disease in the etiology of smoking-related systemic diseases.     

Current oral contraceptive status and periodontitis in young adults

BACKGROUND: The aim of this study was to investigate the influence of current hormonal contraceptive medication on periodontal health in young females. METHODS: Fifty women aged 20 to 35 years (mean +/- SD: 29.7 +/- 4.7 years) had a comprehensive periodontal examination. Current and previous contraceptive pill use was assessed by a questionnaire. Periodontal assessment included plaque index, gingival index, probing depth, and attachment level at six sites per tooth. The periodontal health of current pill users was compared to that of women not taking the pill. RESULTS: Forty-two percent of subjects were taking the contraceptive pill at the time of periodontal examination. Current pill users had deeper mean probing depths compared to non-users (3.3 mm versus 2.7 mm; P = 0.006) and more severe attachment loss (2.6 mm versus 1.7 mm; P = 0.015). Pill users had more sites with bleeding on probing (44.0% versus 31.1%; P = 0.017). CONCLUSION: Current users of oral contraceptives had poorer periodontal health.     

Hepatocyte growth factor levels in gingival crevicular fluid in health, disease, and after treatment

BACKGROUND: Hepatocyte growth factor (HGF) is a broad-spectrum multifunctional cytokine with mitogenic, motogenic, morphogenic, and antiapoptotic functions in various types of cells. It is secreted by mesenchymal cells, including gingival fibroblasts, and its expression is induced by inflammatory cytokines, such as interleukin-1 and tumor necrosis factor-alpha, which play a potential role in periodontal destruction. Hence, the present study was carried out to assess HGF's concentration in gingival crevicular fluid (GCF) and to determine its association with periodontal disease progression. METHODS: Sixty subjects (aged 29 to 39 years) were divided into three groups based on gingival index, probing depth, clinical attachment loss, and radiographic evidence of bone loss: healthy (group I), gingivitis (group II), and chronic periodontitis (group III). The fourth group consisted of the 20 subjects in group III, from whom GCF samples were collected 6 to 8 weeks after scaling and root planing (SRP). The levels of HGF were estimated using enzyme-linked immunosorbent assay. Further, the correlation between HGF levels and clinical parameters in all groups and before and after treatment in periodontitis patients was analyzed. RESULTS: The highest mean HGF concentration was observed for group III (26.28 +/- 14.77 pg/microl), and the lowest mean concentration was observed for group I (13.99 +/- 11.24 pg/microl). Following SRP, the mean HGF concentration decreased from 26.28 +/- 14.77 pg/microl to 14.35 +/- 13.96 pg/microl, which was statistically significant. CONCLUSIONS: HGF concentration increased proportionally with the progression of periodontal disease, and HGF concentrations showed a positive correlation with the clinical parameters, suggesting that HGF plays a key role in periodontal disease progression. Also, following non-surgical periodontal therapy, the levels of HGF decrease significantly suggesting that HGF could be useful for monitoring the response to periodontal therapy.     

Periodontal disease in pregnancy complicated by type 1 diabetes mellitus.

BACKGROUND: Systemic disease and hormonal changes have been implicated as complicating factors for periodontal disease. Diabetes has been identified as a risk factor for periodontal disease, and diabetics can experience periodontal destruction at an earlier age than non-diabetic individuals. Increased hormone levels during pregnancy can contribute to increased gingival inflammation. The purpose of this study was to examine the association of type 1 diabetes mellitus (DM) on the periodontal status of pregnant women. METHODS: Thirty-three (13 diabetic and 20 non-diabetic) subjects, 20 to 39 weeks gestation, participated in this study. The mean age of the diabetics and non-diabetics was 28.5 +/- 7.1 (SD) and 27.0 +/- 7.3 years, respectively. The following parameters were assessed at Ramfjord's reference teeth: plaque index (PI), gingival inflammation (GI), probing depth (PD), gingival margin (GM) location, and clinical attachment level (CAL). RESULTS: Diabetic subjects had significantly (P<0.001) higher PI (1.48 +/- 0.69) and GI (1.77 +/- 0.44) scores than non-diabetics (PI = 0.63 +/- 0.38; GI = 0.93 +/- 0.48). Mean PD for diabetics (2.95 +/- 0.69 mm) was significantly different (P<0.024) from that of non-diabetics (2.44 +/- 0.32 mm). Although mean GM location was coronal to the cemento-enamel junction (CEJ) in both groups, gingival margins were at a more apical position (P<0.001) in the diabetics (-0.20 +/- 1.24 mm) compared to non-diabetics (-1.76 +/- 0.53 mm). Mean CAL values also varied significantly (P<0.001) between diabetics (2.60 +/- 1.54 mm) and non-diabetics (0.68 +/- 0.65 mm). Significant differences were seen for GI (P<0.001), PD (P=0.005), GM location (P<0.001), and CAL (P<0.001) when assessing the effect of diabetes and controlling for plaque. When assessing the effect of plaque and controlling for diabetes, the only significant difference was GI (P=0.001). CONCLUSIONS: The results of this study demonstrate that periodontal inflammation and destruction are increased in pregnant diabetics as compared to non-diabetic pregnant patients. These findings may have implications for diabetic control and, hence, maternal and fetal outcomes in pregnant diabetic patients.     

Alcohol consumption and periodontal disease. The Third National Health and Nutrition Examination Survey

OBJECTIVE: This study was carried out to evaluate the effect of alcohol consumption on the severity of periodontal disease. MATERIAL AND METHODS: This cross-sectional study employed 13,198 subjects of the Third National Health and Nutrition Examination Survey (NHANES III) aged 20 and older who have at least six natural teeth. Alcohol intake was represented both as a continuous variable and dichotomized using 5, 10, 15, and 20 drinks/week as cut-points. Periodontal disease was represented by clinical attachment loss (CAL) and was assessed both as a continuous variable and dichotomized as <1.5 mm and >/=1.5 mm. Independent effect of alcohol on CAL was assessed by weighted multiple linear and logistic regression analyses adjusting simultaneously for the effects of age, gender, race, education, income, smoking, diet, diabetes, gingival bleeding, number of remaining teeth. RESULTS: There was a significant linear relationship between number of drinks per week and log CAL (p=0.0001). Odds ratios for the risk of attachment loss using 5, 10, 15, and 20 drinks/week as cut-points were 1.22 [1.02-1.47], 1.39 [1.13-1.71], 1.54 [1.22-1.93], and 1.67 [1.25-2.23], respectively. CONCLUSION: Alcohol consumption may be associated with increased severity of CAL in a dose-dependent fashion. Prospective studies and studies of mechanism are needed to confirm the role of alcohol as a risk factor for periodontal disease.     

Leptin levels in gingival crevicular fluid in periodontal health and disease

BACKGROUND AND OBJECTIVE: A high concentration of leptin is associated with healthy gingival tissue, and the concentration of leptin decreases as periodontal disease progresses. However, to date, the leptin concentration in gingival crevicular fluid has not been documented. Hence, the present study was carried out to explore the presence of leptin in gingival crevicular fluid in periodontal health and disease, and to probe further into its possible role in periodontal disease progression. MATERIAL AND METHODS: A total of 45 adult patients were selected, based on their body mass index, for the study. They were categorized into three groups of 15 patients each, based on their periodontal tissue status, as follows: group I (clinically healthy gingiva with no loss of attachment); group II (chronic gingivitis with no loss of attachment); and group III (chronic periodontitis). Gingival crevicular fluid samples of 1 microL were collected extracrevicularly using white color-coded 1-5 microL calibrated volumetric microcapillary pipettes from one site in each person, and samples were analyzed for leptin using a commercially available enzyme-linked immunosorbent assay kit. RESULTS: The concentration of leptin in gingival crevicular fluid of patients in group I (2292.69 pg/mL) was statistically higher (p < 0.05) than in those of groups II (1409.95 pg/mL) and III (1071.89 pg/mL). This suggests a negative correlation of gingival crevicular fluid leptin concentration with clinical attachment loss (p < 0.05). CONCLUSION: As periodontal tissue destruction increased, there was a substantial decrease in gingival crevicular fluid leptin concentration. This observation extends our knowledge of the protective role of leptin in periodontal health.     

Prevalence of periodontal disease in young diabetics

In the present study, the frequency of sites exhibiting gingival inflammation and periodontal tissue breakdown was assessed in one group of 46 individuals (19-25 years old; test group T) who had suffered from diabetes mellitus (Type 1) for 10 years or more, and in another group of 41 non-diabetic controls (18-26 years old; control group C). Each individual was examined regarding oral hygiene status, gingival conditions, probing depths, probing attachment levels and gingival recessions. The interproximal marginal bone level was assessed in bitewing radiographs. No significant differences were found between the 2 groups regarding their oral hygiene status, frequency of sites with probing depths of greater than 3 mm and the position of the interproximal alveolar bone margin. The mean distance between the cemento-enamel junction (CEJ) and the interproximal bone crest was in group T, 0.91 +/- 0.14 (SD) mm and in group C, 0.95 +/- 0.18 (SD) mm. About 80% of the individuals in both groups were free from signs of marginal bone loss and only 1 subject in each group had greater than 6 sites with definitive bone loss. The group of diabetic patients had higher frequencies of inflamed buccal/lingual gingival units, gingival recessions and sites with attachment loss of greater than or equal to 2 mm. Most of the sites (85%) with attachment loss were located at the buccal and lingual surfaces. There were no significant correlations between the periodontal variables and the duration of diabetes, insulin dosage and HbA1 level. Individuals with both retinopathy and nephropathy had significantly more gingival inflammation than diabetic individuals without complications.     

Longitudinal study of predictive factors for periodontal disease and tooth loss

Longitudinal assessment of risk factors for periodontal disease is necessary to provide evidence that a putative risk factor or risk indicator is a true risk factor. The purpose of the present study was to explore longitudinally a variety of markers as possible periodontal risk factors in subjects with little or no periodontal disease at baseline. 415 subjects with mild or little periodontal disease were examined: medical and dental history; socioeconomic profile, clinical measurements, microbial samples and radiographic assessment of bone height were performed at baseline, and at a follow-up examination 2 to 5 years later. Mean probing pocket depth (PPD) at baseline was 1.99+/-0.37 mm while mean overall change was 0.1 mm which amounts to an annual rate of 0.04 mm. Overall mean clinical attachment level (1.75+/-0.6 mm) at baseline resulted in mean attachment change of 0.28 mm (0.12 mm annually). Alveolar crestal height (ACH) at baseline (mean 2.05+/-0.85 mm) resulting in a mean net loss of 0.1 mm. Approximately 10% of all sites presented for the second visit with attachment loss exceeding the threshold (4.4% annually), while only 2.2% of all sites exhibited attachment gain (0.88% annually). Older individuals exhibited greater mean bone loss but the least amount of attachment loss. Current smokers exhibited greater disease progression compared to non-smokers. Tooth morbidity (0.17 teeth/patient/year) was associated with greater baseline CAL and ACH loss, and an assortment of systemic conditions. Subjects who harbored Bacteroides forsythus (Bf) at baseline had greater loss in ACH; likewise, these subjects experienced greater proportions of losing sites and twice as much tooth mortality compared to Bf-negative patients. Baseline clinical parameters correlated strongly with the outcome, i.e., subjects with deeper mean pocket depth at baseline exhibited greater increase in pocket depth overtime; while subjects with greater attachment loss at baseline exhibited greater attachment loss between the 1st and 2nd visits.     

Low-dose aspirin therapy and periodontal attachment loss in ex- and non-smokers

BACKGROUND, AIMS: This study investigated the periodontal status of non-smokers and ex-smokers in relation to their intake of low-dose aspirin. METHODS: A self-selected sample of 392 males aged 50 years and over was recruited from the general population. Subjects were included in the study if they had a minimum of 6 or more natural teeth, took aspirin (300 mg or less per day) for at least 2 years and were either ex- or non-smokers. Controls were subjects who did not take aspirin regularly. A questionnaire was used to record demographic data, medical and dental histories. Individuals who had diabetes or other systemic diseases were excluded from the study. Periodontal attachment loss (PAL) was calculated by adding measurements of gingival recession and periodontal pocket depth made by a single examiner at 6 sites around each tooth using non-pressure sensitive periodontal probes. Plaque and gingival bleeding indices were also scored. Subjects were divided into 4 groups: aspirin non-smokers, aspirin ex-smokers, no aspirin non-smokers and no aspirin ex-smokers. Data were analysed using two-way ANOVA with age as the covariate. Severity and extent of mean PAL and the cumulative distribution of the mean of the most severe sites (MSS) of PAL were analysed. RESULTS: Controlling for age, mean PAL in aspirin takers was significantly less 2.6+/-0.08 (se) mm than non-aspirin takers 2.9+/-0.06 (se) mm; this association was independent of smoking history. Ex-smokers had significantly more mean PAL 3.9+/-0.07 (se) mm than non-smokers 2.6+/-0.08 (se) mm, irrespective of aspirin status. When MSS-PAL was analysed, these differences became more pronounced; MSS-PAL in aspirin takers was significantly less 3.9+/-0.1 (se) mm than non-aspirin takers 4.2+/-0.08 (se) mm. Ex-smokers had significantly more MSS-PAL 4.3+/-0.08 (se) mm than non-smokers 3.8+/-0.08 (se) mm. Aspirin apparently had a protective association on PAL and it is hypothesised that low-dose aspirin may have reduced the rate of attachment loss. CONCLUSIONS: This hypothesis needs to be confirmed by a prospective study. The results of this study suggest that individuals aged over 50 years, particularly ex-smokers, may benefit by taking low-doses of aspirin daily to reduce their risk of periodontal attachment loss.     

牙周炎与慢性阻塞性肺疾病关系的流行病学研究

目的通过流行病学调查及临床检查,探讨牙周炎与慢性阻塞性肺疾病（COPD）之间的相关性。方法收集中国医科大学附属第一医院、盛京医院、第四医院和沈阳市第八人民医院2008年10月至2009年4月确诊为COPD的患者266例,其中稳定期COPD患者160例,急性加重期COPD（AE—COPD）患者106例,检查并记录所有患者6颗指数牙（61 6、6 16）的简化1：7腔卫生指数（OHI—S）、龈沟出血指数（SBI）、牙周探诊深度（PD）、临床附着丧失（CAL）,同时对所有患者进行肺功能指标的检查,并进行口腔问卷调查。结果（1）AE—COPD组的吸烟率为47．2％,明显高于稳定期COPD组（P〈0．01）;（2）AE—COPD组的SBI、PD及CAL明显高于稳定期COPD组（P〈0．01）;（3）AE—COPD组的OHI—S、SBI、PD及CAL均与FEVl％呈负相关（r分别为-0．309、-0．333、-0．395、-0．702,均P〈0．01）,其中CAL与FEVI％的相关性最强;稳定期COPD组CAL与FEVI％呈负相关（r=-0．657,P〈0．01）。结论（1）吸烟作为牙周炎和COPD的共同危险因素,在牙周炎和COPD的发生和发展中发挥重要作用;（2）AE—COPD患者的牙周炎症程度均随着肺功能的减弱而加重,提示牙周炎与COPD之间存在一定相关性。     

Levels of lipid peroxides and antioxidants in smokers and nonsmokers

BACKGROUND AND OBJECTIVE: The aim of the study was to evaluate the relationship between cigarette smoking and periodontal damage in terms of the levels of free radicals and antioxidants. MATERIAL AND METHODS: Thirty-five healthy subjects in the age group 25-56 yr and with chronic moderate inflammatory periodontal disease (attachment loss of 3-4 mm) were selected. All subjects were matched with respect to the clinical parameters plaque index, gingival index and attachment loss. Of the 35 subjects, 25 were smokers (smoking a minimum of 15 cigarettes/day) and 10 were nonsmokers. Smokers were subdivided into three subgroups: group I (10 subjects smoking 15-20 cigarettes/day); group II (10 subjects smoking 21-30 cigarettes/day) and group III (five subjects smoking > 50 cigarettes/day). Gingival tissue (obtained during Modified Widman surgery) and blood samples were collected from each of the subjects and analyzed for the following parameters: lipid peroxide, superoxide dismutase, catalase, glutathione and total thiol. RESULTS: The level of lipid peroxide was lowest in nonsmokers (2.242 +/- 0.775 in tissue and 1.352 +/- 0.414 in blood) and highest in smokers smoking > 50 cigarettes/day (6.81 +/- 1.971 in tissue and 4.96 +/- 0.890 in blood), both in tissue and in blood. The increase was statistically significant in all groups, except in tissue of group I smokers. Catalase showed a similar trend, where the levels increased from 0.245 +/- 0.043 in controls to 0.610 +/- 0.076 in group III smokers for tissue, and from 0.231 +/- 0.040 in controls to 0.568 +/- 0.104 in group III smokers for blood. The increase was statistically significant for all groups. Total thiol levels were also higher in smokers than in controls (0.222 +/- 0.050 in controls vs. 0.480 +/- 0.072 in group III smokers in tissue; 0.297 +/- 0.078 in controls vs. 0.617 +/- 0.042 in group III smokers in blood). Except for group I in both tissue and blood, the increase was statistically significant. The superoxide dismutase (SOD) level was higher in nonsmokers (2.406 +/- 0.477 in tissue and 2.611 +/- 0.508 in blood) than in group III smokers (1.072 +/- 0.367 in tissue and 0.938 +/- 0.367 in blood), both in tissue and in blood, but this was significant only in the case of blood and for group III smokers in tissue. The glutathione level in tissue was consistently lower in smokers than in controls, showing a decrease from 121.208 +/- 37.367 in controls to 46.426 +/- 14.750 in group III smokers, but the decrease was not significant in group I smokers. In the case of blood, the glutathione level dropped from 262.074 +/- 68.751 in controls to 154.242 +/- 51.721 in group III smokers, but was statistically significant only for group III smokers. CONCLUSION: The study results show that smoking increases the level of free radicals in periodontal tissues, which in turn may be responsible for the destruction seen in periodontal diseases.     

Periodontal attachment loss over 14 years in cleft lip,alveolus and palate (CLAP,CL, CP) subjects not enrolled in a supportive periodontal therapy program

OBJECTIVES: (i) To assess the overall and (ii) cleft-associated rate of periodontal disease (PD) progression in subjects with cleft lip, alveolus and palate (CLAP) and (iii) to compare these rates with those of subjects with cleft lip (CL) and cleft palate (CP). MATERIAL AND METHODS: Twenty-six subjects not enrolled in a supportive periodontal therapy (SPT) program were examined in 1979, 1987 and 1993. PD progression was assessed as increase in pocket probing depth (PPD in mm) and probing attachment loss (PAL in mm). RESULTS: Extensive plaque accumulation and high frequencies of gingival units bleeding on probing were observed at all three examinations. A statistically significant increase in mean PPD of 0.57+/-0.21 mm (SD) in both groups as well as a statistically significant loss of PAL of 1.85+/-0.23 mm (SD) in the CLAP group and of 1.72+/-0.21 mm (SD) in the CL/CP group occurred over the observation period (p<0.05). In subjects with CLAP, statistically significant increases in PPD and loss of PAL were recorded over time at sites adjacent to the cleft as well as at control sites (p<0.05). Over 14 years, however, PPD increased 1.72+/-1.08 mm (SD) at cleft sites versus 0.72+/-1.14 mm (SD) at control sites (p<0.05), and PAL amounted to 3.19+/-1.35 mm (SD) at cleft sites versus 2.41+/-1.52 mm (SD) at control sites (p<0.05). CONCLUSION: Both the CLAP and the CL/CP subjects are at high risk for PD progression if no SPT program is provided. This also suggests that alveolar cleft sites in subjects with high plaque and gingival inflammation scores underwent more periodontal tissue destruction than control sites over a 14-year period.     

Relationship between tooth irregularity and periodontal disease in children with regular dental visits

OBJECTIVES: The aim of this study was to investigate any association between irregular teeth and periodontal breakdown among children who attend dental clinics regularly. METHODS: The subjects were 80 children (39 females and 41 males) with a mean age of 12.38 +/- 0.75 years. Each subject had an alginate impression in the mandibular arch, periapical radiographs for the lower incisor teeth and clinical examination for periodontal health. Plaque accumulation, gingival condition and probing depth, bone level and status of lower incisor teeth contact areas were recorded. Spearman correlation test was used to observe any relationship between the clinical variables. RESULTS: The average probing depth, gingival index and plaque index scores in the subjects studied were 1.3 +/- 0.25, 0.99 +/- 0.28 and 1.17 +/- 0.52 respectively. The average number of sites with labiolingual displacement with mesiodistal overlap was 1.81 +/- 1.30 and those without mesiodistal overlap was 1.39 +/- 1.10. The average number of contact areas with spacing was 0.59 +/- 1.23. The correlation observed between irregularity and periodontal health indicated no association between the number and type of displacement and plaque accumulation, gingivitis, attachment loss and alveolar bone level. CONCLUSION: There was no association between irregularity of teeth and periodontal diseases in presence of good oral hygiene.     

Obesity and periodontal disease in diabetic pregnant women

This cross-sectional study investigated the impact of pregestational overweight and obesity on periodontal status of patients with gestational diabetes mellitus (GDM). Sixty pregnant women with gestational diabetes mellitus (GDM) were recruited for the study. According to the pregestational body mass index (BMI), patients were classified into 3 groups: normal, overweight or obese. The periodontal assessment parameters were the presence of gingival bleeding (GB) and bleeding on probing (BOP) per tooth. Clinical attachment loss (CAL) was assessed per tooth and classified according to following values: 1) absence of attachment loss; 2) between 1 and 2 mm, 3) between 3 and 5 mm; and 4) CAL > or = 6 mm. The means of individual percentage of teeth with GB and BOP and the means of the individual classified values of CAL were compared through ANOVA. Differences between the groups were established through post hoc Bonferroni test for multiple comparisons (p < 0.05). The analysis revealed significant differences between the normal group and the obese group considering GB (52.76% +/- 27.99% and 78.85% +/- 27.44%, respectively) and CAL (2.21 +/- 0.41 and 2.61 +/- 0.54, respectively). Although an increase was found in BOP as the BMI increased (ranging from 55.65% to 75.31%), no statistically significant differences were found among the groups. Patients with GDM and pregestational obesity had significantly more gingivitis and periodontal attachment loss that those with normal pregestational BMI. Periodontal treatment should be considered in the establishment of future recommendations for metabolic control for this special group of patients.     

Salivary spinability and periodontal disease progression in an elderly population

OBJECTIVE: To explore the relationship between the spinability of stimulated whole saliva and periodontal disease progression over 12 months in an elderly population. METHODS: Three hundred and thirty-two subjects aged 76 years at baseline were studied. Attachment loss was calculated on a site-by-site basis, and periodontal disease progression was defined as an attachment loss of >/=3mm. Stimulated whole saliva was collected and salivary spinability (SS) was measured. A multiple linear regression analysis was performed to assess the relationship between periodontal disease progression and SS after controlling for other covariates. The independent variables were selected from those which had significant relationships with disease progression in the bivariate analyses. RESULTS: Mean SS was 1.94+/-0.42mm in males and 1.88+/-0.32mm in females; this difference was not significant. Simple linear regression analysis showed a significant positive relationship between periodontal disease progression and SS (P=0.026), whereas there was no significant relationship between periodontal disease progression and salivary flow rate. Multiple regression analysis revealed a significant positive relationship between periodontal disease progression and SS (P=0.024) after controlling for the number of remaining teeth and baseline periodontal conditions. The model explained 15.5% of the variance in the percentage of sites where the disease had progressed. CONCLUSIONS: These findings suggest that elderly subjects with viscous saliva are prone to periodontal disease progression.     

Clinical course of chronic periodontitis. I. Role of gingivitis

OBJECTIVES: The purpose of this study was to determine the influence of long-standing gingival inflammation on periodontal attachment loss. On the basis of repeated examinations, the present report describes the influence of gingival inflammation on the initiation of periodontitis from 16 to 59 years of age. MATERIAL AND METHODS: The data originated from a 26-year longitudinal study of Norwegian males, who practiced daily oral home care and received state-of-the-art dental care. The initial examination included 565 individuals. Subsequent examinations took place in 1971, 1973, 1975, 1981, 1988 and 1995. Thus, the study covers the age range of 16-59 years. All tooth sites were divided into four categories according to their history of gingival inflammation over the entire observation period: sites always scoring GI = 0, GI = 1 and GI = 2 sites (GI = gingival index). Sites disclosing various GI scores at different observation periods were not considered. RESULTS: The mean cumulative attachment loss for non-inflamed (GI = 0) sites in individuals approaching 60 years of age was 1.94 mm. Sites always scoring GI = 1 yielded 2.42 mm, and sites that always scored GI = 2 exhibited 3.31 mm of periodontal attachment loss. At interproximal sites of all three groups where gingival trauma was assumed to be minimal or non-existent, only very few sites expressed attachment loss due to gingival recession (2-4%). At interproximal sites always scoring GI = 0, 20% loss of attachment was in the form of pocket formation by 59 years of age. The GI = 1 and the GI = 2 cohorts exhibited attachment loss with pocket formation in 28% and 54%, respectively. CONCLUSION: This study has shown that, as men approach 60 years of age, gingival sites that throughout the 26 years of observation bled on probing had approximately 70% more attachment loss than sites that were consistently non-inflamed (GI = 0). Before 40 years of age, there was a slight increase in periodontal attachment loss due to pocket formation, but after this, the frequency increased significantly. Loss of attachment due to gingival recession was very small in all three groups.The fact that sites with non-inflamed gingiva also exhibited some loss of attachment and pocket formation may be explained by fluctuation in the variations of tissue status during long observation intervals combined with the presence of subclinical inflammation.     

A possible influence of gingival dimensions on attachment loss and gingival recession following placement of artificial crowns

The aim of the present study was to determine the influence of gingival dimensions on the development of gingival recession following placement of artificial crowns. The study population consisted of 11 periodontally healthy patients in whom 44 maxillary anterior teeth and/or premolars had to be crowned. A total of 36 teeth (82%) had, after crown placement, a mean intracrevicular crown margin of 0.57 +/- 0.47 mm. Thirty-nine teeth without restorations served as controls. Immediately after incorporation, as well as after 3, 6, 9, and 12 months, periodontal examinations were carried out. Gingival thickness was determined sonometrically and averaged 1.25 +/- 0.40 mm. Mean periodontal probing depth was 1.80 +/- 0.54 mm. Twelve months later, crowned teeth had experienced a mean attachment loss of 0.17 +/- 0.99 mm as compared to an attachment gain of 0.18 +/- 0.46 mm at control teeth. At test teeth, the gingival margin had receded a mean of 0.43 +/- 0.74 mm. In multivariate analyses considering the correlated structure of the data employing generalized estimating equation methods, crown placement was identified as a major factor for attachment loss and development of gingival recession. In addition, a shallow probing depth and narrow band of gingiva negatively influenced the level of periodontal attachment. The present results point to the importance of a more detailed periodontal diagnosis of the dentogingival region before placement of artificial crowns.     

The association between cumulative periodontal disease and stroke history in older adults

BACKGROUND: Since the late 1980s, several studies have been conducted to investigate the relationship between periodontal disease and ischemic stroke. The purpose of this study is to investigate the relationship of periodontal disease to the self-reported history of stroke in the elderly (60 years of age and older) by examining the data of the Third National Health and Nutrition Examination Survey (NHANES III). METHODS: Data from NHANES III, a large population-based cross-sectional survey of the United States, were used for this study. Because 1,563 of the 5,123 subjects in the study were edentulous, and periodontal disease is a major cause of tooth loss, it was necessary to account for edentulousness in the statistical analysis to avoid bias. Hence, a new index called the periodontal health status (PHS) index was developed to address this problem. Two measures of PHS were developed: PHS I, based on the median percentage of sites with >/=2 mm clinical attachment loss (CAL), and PHS II, based on the median percentage of sites with >/=3 mm CAL. Multiple logistic regression analysis was used to test for the association of PHS with stroke history. Two types of a multiple logistic regression model were fit: 1) logistic regression modeling with adjustment for age and tobacco use only; and 2) logistic regression modeling with adjustment of all statistically significant confounders. RESULTS: Based on multiple logistic regression analysis of PHS with adjustment for age and tobacco use only, completely edentulous elderly adults (PHS Class 5) and partially edentulous (teeth in one arch) elderly adults with appreciable clinical attachment loss (PHS Class 4) were significantly more likely to have a history of stroke compared to dentate adults (teeth in both arches) without appreciable clinical attachment loss (PHS Class 1). When multiple logistic regression models were fit with adjustment of all significant confounders, no statistically significant association was found between PHS and stroke. CONCLUSIONS: Based on the results of this study, there is evidence of an association between cumulative periodontal disease, based on PHS, and a history of stroke. However, it is unclear whether cumulative periodontal disease is an independent risk factor for stroke or a risk marker for the disease.     

Plausibility of periodontal disease estimates from NHANES III

OBJECTIVES: This study investigated possible reasons for observed discrepancies in prevalence estimates and measures of association for periodontal disease between phases (1988-91 and 1991-94) of the third National Health and Nutrition Examination Survey (NHANES III). METHODS: NHANES III data on CD-ROM were obtained from the National Center for Health Statistics. Accompanying documentation states that each phase and combined phases constitute national probability samples of the US population. Weighted estimates of prevalence (percent of persons affected) and extent (percent of sites affected) for previously reported thresholds of gingival bleeding (GB), attachment loss (AL), and probing pocket depth (PD) were generated using data from all 15,511 persons aged 13-90 years who received periodontal examinations. Odds ratios for associations between four selected risk indicators and both PD and AL were compared between phases. RESULTS: Phase 2 estimates of GB and PD were as much as 56 percent lower than phase 1 estimates and both were different from combined-phase estimates. However, AL prevalence was consistent between phases. Prevalence differences between phases could be explained in part by examiner variations. Odds ratios for PD differed between phases by as much as one-third, although the direction and precision of associations were not affected, and differences were reduced after controlling for examiner. CONCLUSIONS: Combined-phase estimates of GB and PD prevalence and extent differ from previously published estimates derived from Phase 1, apparently because estimates in at least one phase of the NHANES III study are biased. However, associations with selected risk indicators were fairly consistent between phases.     

Levels of interleukin-17 in gingival crevicular fluid and in supernatants of cellular cultures of gingival tissue from patients with chronic periodontitis

BACKGROUND AND AIMS: Interleukin-17 (IL-17) is a T-cell-derived cytokine that may play an important role in the initiation or maintenance of the pro-inflammatory response and has recently been found to stimulate osteoclastic resorption. The purpose of the present study was to determine the presence of IL-17 in gingival crevicular fluid (GCF) samples and in the culture supernatants of gingival cells from patients with chronic periodontitis. METHOD: GCF samples were collected during 30 s from two sites in 16 patients from periodontally affected sites (probing depth > or =5 mm, attachment loss > or =3 mm). The comparison with healthy controls was carried out by collecting GCF samples from eight healthy volunteers. GCF was collected using a paper strip and ELISA was performed to determine the total amount of IL-17. Supernatant cellular cultures of gingival cells were obtained from periodontal biopsies taken from 12 periodontitis patients and from eight healthy control subjects during the surgical removal of wisdom teeth. Spontaneous and phytohaemagglutinin (PHA)-stimulated levels of IL-17 were determined by ELISA. RESULTS: The total amount of cytokine IL-17 was significantly higher in the periodontitis group than the control group (45.9 versus 35.6 pg, p=0.005). Significantly higher GCF volume and amount of total proteins were obtained from periodontitis patients as compared with control subjects (0.98 versus 0.36 microl, p=0.0005; 0.12 versus 0.05 microg, p=0.0005, respectively). A higher concentration of IL-17 was detected in culture supernatants from periodontitis patients compared with healthy subjects, either without stimulation (36.28+/-8.39 versus 28.81+/-1.50 microg/ml, p=0.011) or with PHA stimulation (52.12+/-14.56 versus 39.00+/-4.90 microg/ml, p=0.012). Treatment with PHA induced a significant increase in the production of IL-17 in healthy subjects and periodontitis patients (p=0.001 and 0.003). CONCLUSIONS: The total amount of cytokine IL-17 in GCF samples and in the culture supernatants of gingival cells are significantly increased in periodontal disease.