Use of antimicrobial agents during supportive periodontal therapy

Individual susceptibility to periodontal breakdown involves an interplay of genes, periodontal pathogens and other modulating factors. Anti-infective treatment, which includes oral hygiene measures, mechanical debridement, pharmacologic intervention and surgery, has been shown to be effective in arresting the progression of periodontal disease. Nevertheless, due to the chronic nature of the disease, susceptible individuals who are not maintained in a supervised recall program subsequent to the active treatment phase, show signs of recurrent destruction. Supportive periodontal therapy (SPT) is an integral part of periodontal treatment for patients with history of periodontitis, and is needed to prevent recurrence of disease in susceptible individuals. To prevent re-infection with periodontal pathogens, SPT includes elimination of dental plaque and bacteria from the oral cavity, thereby preventing the recurrence of pathogens into the gingival area. For individuals at risk of developing periodontitis, SPT should combine self-performed and professional anti-infective therapy, using mechanical and pharmacological means. The existing evidence suggests that the adjunctive use of antimicrobial pharmacologic therapy during SPT may enhance the results of mechanical debridement. The use of antimicrobials varies between patients, and is dependent on risk assessment and longitudinal monitoring of the clinical status of the periodontium.     

β-防御素基因在牙龈组织中的表达

目的:检测人β-防御素(HBD-1,-2,-3)基因在牙周炎病变和健康牙龈组织中的表达。方法:应用反转录多聚合酶链反应(RT-PCR)技术检测健康牙龈(HC组,11例)、慢性牙周炎(CP组,12例)和侵袭性牙周炎(AgP组,9例)牙龈组织中HBD-1、HBD-2和HBD-3mRNA表达水平。结果:HBD-1,-2,-3在所有牙龈组织样本中均有mRNA表达;HBD-3mRNA在HC组、CP组、AgP组的表达水平分别为0.53±0.12,0.30±0.17和0.40±0.17,3组间差异有统计学意义(P<0.01),健康牙龈中HBD-3mRNA表达相对强度明显高于慢性牙周炎组;HBD-2和HBD-3基因的mRNA表达水平呈正相关(P<0.01,r=0.48)。结论:牙龈上皮表达的β-防御素(HBD-1,-2,-3),尤其是HBD-3在健康牙龈组织较高水平的mRNA表达,提示其在牙周宿主免疫防御反应中可能发挥重要作用。     

炎性病变累及下颌神经管的病因及多学科治疗策略

下颌后牙区尤其是下颌第一磨牙根尖到下颌神经管上缘的距离多数仅为1 ~ 4 mm。因此，当下颌后牙区罹患重度牙周炎和（或）根尖周炎时，炎症有可能扩散累及邻近的下颌神经管，引起相应区域的神经感觉异常。此类病例罕见，病情复杂，相应的治疗往往需要多学科医生参与共同完成。笔者根据自己的临床体会结合文献报道就其病因机制及多学科治疗策略做一梳理。     

Efficacy of bone-fill favoring treatment on juvenile periodontitis

In this study we evaluated the effect of bone-fill favoring mechanical treatment on the marginal bone level and periodontal pockets of juvenile periodontitis patients. A total of 10 patients (3 men and 7 women) 13–29 yr of age were treated until no gingivitis or periodontal pockets were present. The intensive therapy (3–8 wk) included scaling, curettage and modified Widman flaps. The maintenance therapy comprised 4 recall visits during the first year after therapy and 2–5 visits per year thereafter. The efficacy of the therapy was evaluated by radiologic measurements of bony defects (%) 12 and 16–65 months after the treatment. The results showed a significant improvement both 1 yr after treatment and at the end of the study. The bone loss was 10.1% less than prior to the treatment and no sites with new bone loss were found after therapy in any of the patients. The bulk of healing took place during the first year after the active therapy, while some further improvement was detected thereafter. Our results show that non-resective mechanical treatment allows excellent healing and regeneration of JP lesions. Our findings also suggest that an adequate follow-up period is needed before definite conclusions can be drawn about the efficacy of the treatment procedures used.     

Local immunoglobulin synthesis in juvenile and adult periodontitis

Local immunoglobulin synthesis by the gingival plasma cells in 5 patients with juvenile periodontitis (JP) was compared to that in 5 patients with adult periodontitis (AP). The peroxidase-antiperoxidase method was used with specific antisera to alpha, gamma, and mu heavy chains and kappa and lambda light chains. The following relative distribution of plasma cells in JP/AP was found: IgA 22.7/19.5, IgG 75.6/78.5 IgM 1.7/2.0, kappa 55.5/53.5 and lambda 44.5/46.5, calculated as a % of their sum, indicating that the relative distribution of the different immunoglobulin chains was similar in both patient groups. The ratio light:heavy chains was 1.78 in JP and 1.72 in AP. The ratio kappa:lambda was 1.28 in JP and 1.17 in AP, similar to the known free kappa:free lambda chain ratio in normal serum (1.2). This indicates that the excessive staining for light chains is caused by a physiological overproduction of light chains rather than a pathological imbalance in the synthesis of immunoglobulins.     

Effect of non-surgical treatment on chronic and aggressive periodontitis: clinical, immunologic, and microbiologic findings

Background: Our goal was to examine differences in clinical, microbiologic, and immunologic responses to non‐surgical mechanical therapy in patients with generalized chronic periodontitis (GCP) and generalized aggressive periodontitis (GAgP). Methods: Twenty patients with GCP and 14 patients with GAgP were evaluated. Clinical data, gingival crevicular fluid (GCF), and subgingival plaque samples were collected at baseline and 3 months after non‐surgical periodontal treatment. Levels of 40 subgingival species were measured using checkerboard DNA‐DNA hybridization. GCF interleukin (IL)‐1β, ‐4, and ‐8 and interferon‐γ (IFN‐γ) were analyzed using a multiplexed bead immunoassay, and elastase activity was measured using an enzymatic assay. The significance of changes with time was examined using the Wilcoxon rank sum test. Changes in clinical, microbiologic, and immunologic parameters after therapy were compared between groups using the Mann‐Whitney U test. Results: After periodontal therapy, we found significant improvements for all clinical parameters in both groups. We also observed significant reductions in elastase activity in shallow and deep sites from the GAgP group and in deep sites from the GCP group. Microbiologic data showed significant reductions in proportions of orange and red complexes and an increase in proportions of Actinomyces species in both clinical groups. When the clinical, microbiologic, and immunologic responses after therapy were compared between groups, only minor differences were found. Conclusion: This study fails to show any significant differences between severe forms of GCP and GAgP in response to non‐surgical periodontal treatment.     

侵袭性牙周炎和慢性牙周炎的龈下优势菌分析

目的 :分析侵袭性牙周炎 (aggressiveperiodontitis ,AgP)与慢性牙周炎 (chronicperiodontitis ,CP)的龈下优势菌群 ,为探讨牙周炎分类、病因和诊断提供实验依据。方法 :将中学生流调筛选 (16例 )及牙周病专科就诊(2 4例 )的AgP和CP患者 ,采集龈下菌斑样本 ,在厌氧菌基础培养基 (CDC)和选择性培养基 (TSBV)上培养分析。结果 :局限型AgP患者的伴放线放线杆菌 (Actinobacillusactinomycetemcomitans ,Aa)及兼性厌氧菌的检出率显著高于中度CP患者 (P <0 .0 5 ,P <0 .0 1) ,而广泛型AgP和重度CP患者的厌氧菌总数较局限型AgP和中度CP患者显著增加 (P <0 .0 5 )。结论 :局限型AgP和中度CP的龈下优势菌有明显差别 ,Aa是一个重要的危险因子。     

Comparison of salivary levels of mucin and amylase and their relation with clinical parameters obtained from patients with aggressive and chronic periodontal disease

Objective

Salivary mucin and amylase levels are increased in patients with chronic periodontitis (CP). Due to the fact that aggressive periodontitis (AgP) not only differs from chronic periodontitis in terms of its clinical manifestation, the aim of this study was to compare salivary mucin and amylase levels and their relation to the clinical parameters of patients with aggressive periodontitis with that of patients with chronic periodontitis.

Material and Methods

Eighty subjects were divided into two groups: 20 patients with AgP and their 20 matched controls and 20 patients with CP and their 20 matched controls, based on clinical attachment loss (CAL), probing pocket depth (PPD) and bleeding on probing (BOP). Whole unstimulated saliva was obtained and mucin, amylase and protein were determined by colorimetric methods. Pearson’s correlation analysis was used to determine the relationship between salivary mucin, amylase and protein levels and the clinical parameters.

Results

Salivary mucin, amylase and protein levels were increased in patients with AgP and CP but there were no differences between them or between control groups. Pearson’s correlation analysis, determined in the entire subjects studied, showed a positive and significant correlation of mucin, amylase and proteins with CAL and PPD and a negative correlation with the flow rate. When Pearson’s correlation analysis was carried out in each group separately, Fisher’s z transformation showed no significant difference between both groups.

Conclusion

Comparison of the salivary levels of mucin, amylase and protein and their relationship with clinical parameters of AgP patients with that of CP patients revealed no differences between both groups.     

Clinical and Immunoinflammatory Evaluation of One‐Stage Full‐Mouth Ultrasonic Debridement as a Therapeutic Approach for Smokers With Generalized Aggressive Periodontitis: A Short‐Term Follow‐Up Study

Background: This study aims to evaluate the effect of one‐stage full‐mouth ultrasonic debridement (OSFMUD) on clinical and immunoinflammatory parameters in smokers with generalized aggressive periodontitis (GAgP). Methods: Fourteen smoking and 14 non‐smoking patients with GAgP were selected. After initial supragingival therapy, patients were treated by OSFMUD. Full‐mouth parameters evaluated were: 1) plaque index (PI); 2) bleeding scores (BS); 3) probing depth (PD); and 4) clinical attachment level (CAL). Clinical evaluation was performed, and gingival crevicular fluid (GCF) was collected for selected sites (ss) at baseline and 1, 3, and 6 months. GCF was analyzed via enzyme‐linked immunosorbent assay for: 1) receptor activator of nuclear factor‐κ B ligand (RANKL); 2) osteoprotegerin (OPG); 3) interleukin (IL)‐6; and 4) tumor necrosis factor (TNF)‐α, whereas secreted osteoclastogenic factor of activated T‐cells (SOFAT) was evaluated by Western blotting. Results: Significant reduction (P <0.05) was observed between baseline and 6 months for: 1) PI; 2) BS; and 3) PD, with no difference between smoking and non‐smoking patients (P >0.05). Regarding CAL, only non‐smoking patients showed a significant decrease (P <0.05). Significant reduction (P <0.05) was observed in both groups for: 1) PIss; 2) PDss; 3) bleeding on probing; and 4) relative CAL. Smoking and non‐smoking patients presented significantly decreased levels of IL‐6 and TNF‐α over time (P <0.05); however, no difference was observed between groups (P >0.05). RANKL was significantly different (P <0.05) only for non‐smokers at 6 months, whereas OPG was not significant (P >0.05). SOFAT expression was significantly lower (P <0.05) after OSFMUD for non‐smokers only. Conclusion: Considering the clinical and immunoinflammatory parameters evaluated in this short‐term follow‐up study, it can be concluded that OSFMUD can be used as an alternative treatment for smokers with GAgP.     

侵袭性牙周炎与慢性牙周炎病变位点中人巨细胞病毒的定量检测

目的 应用实时荧光定量PCR方法 检测侵袭性牙周炎(AgP)及慢性牙周炎(CP)患者龈下样本中人巨细胞病毒(HCMV)的DNA载量,探讨HCMV感染与牙周炎之间的关系.方法 选择18例AgP患者、24例CP患者及15例牙周健康对照者,收集龈下样本114例.构建含有HCMV高保守片段的重组质粒,制备标准品DNA模板,建立...     

Occurrence of Bacteroides gingivalis, Bacteroides intermedius and Actinobacillus actinomycetemcomitans in severe periodontitis in relation to age and treatment history

A total of 242 subjects including 138 untreated severe periodontitis patients and 104 patients with refractory periodontal disease, previously treated for severe periodontitis, were examined for the occurrence of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius. Pooled subgingival samples of representative periodontal lesions were used for anaerobic cultivation on blood agar and for the enumeration of A. actinomycetemcomitans on selective TSBV medium. 97% of the untreated patients were infected with one or more of the test micro-organisms. In this patient group, the occurrence of A. actinomycetemcomitans, B. gingivalis and B. intermedius was 54%, 48% and 63%, respectively. The prevalence of A. actinomycetemcomitans positive patients appeared to be age related and decreased with increasing age. Likewise, the number of patients solely infected with A. actinomycetemcomitans decreased with increasing age. The prevalence of B. gingivalis infected patients appeared to increase with increasing age. These phenomena were not observed in the refractory periodontitis patients. The occurrence of A. actinomycetemcomitans, B. gingivalis and B. intermedius in the refractory periodontitis group was 55%, 27% and 59%, respectively. A statistical significant difference in the prevalence of B. gingivalis was found between the untreated and the refractory periodontitis patients. In both patient groups, the relative proportion of A. actinomycetemcomitans was significantly higher in subjects with this bacterium as the sole indicator micro-organism than in patients who, besides being infected with A. actinomycetemcomitans, were also infected with black-pigmented Bacteroides species. Furthermore, in comparison with untreated patients, unsuccessfully treated patients solely infected with A. actinomycetemcomitans had on average a lower number but also a higher mean % of this bacterium.(ABSTRACT TRUNCATED AT 250 WORDS)     

Association between Chronic Apical Periodontitis and Coronary Artery Disease

Introduction

Studies have shown that periodontal disease is independently associated with coronary artery disease. However, this same association has not been demonstrated with chronic apical periodontitis. The goal of this study was to establish the relationship between chronic apical periodontitis and coronary artery disease.

Methods

This cross-sectional study included 103 patients who underwent coronary angiography at the University Hospital Presidente Dutra, Federal University of Maranhão, São Luís–Maranhão, Brazil. The patients answered a structured questionnaire and underwent physical and laboratory examinations. For each patient, a full-mouth set of periapical radiographs was taken. To compare numerical data, Student's t test for independent samples or the Mann-Whitney U test (nonparametric) was used. The homogeneity of variance was assessed by using Levene's test. For comparison of categorical data, the chi-square test or Fisher's exact test was used. The logistic regression analysis was performed to identify the independent predictors of coronary artery disease. The criterion for statistical significance was set at 5%. Statistical analysis was conducted by using SAS version 6.11 software.

Results

The study comprised 103 patients (52 men, 51 women; mean age, 61.9 years); 31.1% were literate, and 55.3% were married. In the study sample, the prevalence of chronic apical periodontitis was 41.7% and of coronary artery disease, it was 65%. The patients with chronic apical periodontitis had a 2.79 times higher risk of developing coronary artery disease.

Conclusions

In these study patients, chronic apical periodontitis was independently associated with coronary artery disease.     

Psychosocial factors and adult onset rapidly progressive periodontitis

Abstract On the basis of clinical observations, some periodontologists have suggested an association between psychosocial factors such as depression, stress and anxiety, and adult onset rapidly progressive periodontitis (RPP). This study investigated more formally possible associations between a number of relevant psychosocial factors and RPP The significance of the psychosocial variables was assessed by comparing 3 groups: 50 patients with RPP, 50 patients with routine chronic adult periodontitis (RCAP). and 50 patients without significant periodontal destruction (controls). It was anticipated that the RPP group would show higher levels of psychosocial maladjustment than the RCAP and control groups. A between-subjects multivariate analysis of covariance indicated that the combined psychosocial variables were significantly related to the periodontal diagnosis. 2 psychosocial factors, depression and loneliness, were significant in distinguishing between groups. The RPP group presented significantly increased depression and loneliness compared to the RCAP and control groups. Future research is indicated to further clarify the significance of these psychosocial differences in relation to the onset and progression of RPP.     

A retrospective radiographic study of alveolar bone loss in the primary dentition in patients with localized juvenile periodontitis

Lately, it has been questioned whether localized juvenile periodontitis (LJP) is restricted to the permanent dentition, or if it sometimes might have a prepubertal onset, involving the primary dentition. To clarify this question, 17 patients with LJP, together with 17 non-LJP matched controls, were retrospectively examined for radiographic signs of alveolar bone destruction in their primary dentitions. All LJP subjects but one showed localized marginal bone loss, whereas no bone loss was observed among the controls. The results suggest that at least some cases of LJP start in the primary dentition prior to the involvement of the permanent teeth.     

IL-1基因多态性与牙周炎关系的研究

目的:研究中国汉族人IL-1 基因多态性与牙周炎易感性的关系。方法:收集30 例重度成人牙周炎(AP) 患者、20 例快速进展型牙周炎(RPP) 患者和94 例健康对照者的颊粘膜拭子,抽提DNA ,PCR-RELP 方法检测IL-1 基因簇基因多态性,比较三组患者各等位基因检出率的差异。结果:AP 组和RPP 组IL-1B + 3953PTaqI 等位基因Ⅱ的检出率均显著高于对照组(APP对照组OR = 618 ,RPPP对照组OR = 916 , P < 0105) ,AP 组IL-1RN 内含子2PVNTR 等位基因Ⅱ的检出率也显著高于对照组( OR = 613 , P < 0105) 。IL-1A-889PNcoI 等位基因在三组间的分布无显著性差异( P > 0105) 。结论:中国汉族人中携带IL-1B + 3953PTaqI 等位基因Ⅱ和IL-1RN 内含子2PVNTR 等位基因Ⅱ可能是牙周炎的遗传易感因素;AP 和RPP 存在遗传异质性。     

Bacterial penetration of pocket soft tissues in chronic adult and juvenile periodontitis cases

This study investigates bacterial invasion of the soft tissue walls of deep pockets from cases with adult (AP) and juvenile periodontitis (JP). Transmission electron microscopy was used to examine pocket soft tissue walls removed from extracted teeth from 5 patients with AP and 2 patients with JP. Bacteria were sparse throughout the epithelium and connective tissue, regardless of the level of tissue breakdown. However many inflammatory cells were seen, and these did appear to be located in regions of marked collagen loss. Accumulations of large numbers of bacteria were extremely rare and found only on the epithelial surface or in artefactual spaces within the deeper tissues. The findings indicate that the tissue destruction associated with periodontitis is not directly related to bacterial invasion. The sparse organisms within the pocket tissues probably result from passive entry rather than an invasive action. Under these circumstances, it would seem reasonable to suggest that bacterial metabolic products rather than the micro-organisms themselves penetrate the tissues in periodontitis.