A clinical survey of periodontal conditions in Greece

Abstract The present study used full-mouth clinical assessments of plaque, calculus, bleeding on probing, probing pocket depth and probing attachment level to evaluate the periodontal conditions in a rural (A) and an urban (B) sample of 25–64 year old Greek adults, comprising 190 and 373 subjects, respectively. 13% of the subjects in sample (A) and 8% in sample (B) were edentulous, while mean values of teeth present in the four age cohorts ranged between 19.8—12.6 and 23.3—18.3. respectively. A poor level of oral hygiene was recorded in both samples with high plaque, calculus and bleeding scores. Deep pocketing was more pronounced in the rural than in the urban sample: between 1.7 and 8.0% of all sites probed showed a PPD of ≥6 mm and between 20 and 51.2% of the subjects in each age cohort had at least one deep pocket. Corresponding figures for the urban sample was 0.6-4.7% and 15.1-49.2%. However, the prevalence of severe attachment loss was of comparable magnitude in both samples: between 2.8–25.7% of the sites in sample (A) and 2.8–20.6% in sample (B) displayed a PAL of ≥6 mm, while 32.5-72.1% and 31.8-73.8% of the subjects, respectively, had at least one severely affected site. It was further found that the distribution of advanced disease in the samples was skewed; 14.4% of the subjects in sample (A) and 9.5% in sample (B) accounted for 75%, of all deep pockets, while 21.8 and 19.4% of the subjects, respectively, accounted for 75% of all sites with PAL of ≥6 mm. Multiple regression revealed that male sex and high plaque and bleeding scores had a significant, positive influence to the amount of attachment loss on a subject level.     

Left-to-right distribution of periodontal disease

To cite this article:
Int J Dent Hygiene 10 , 2012; 74–79
DOI: 10.1111/j.1601‐5037.2011.00509.x
Darby IB, Polster A, Gan JS, Guo Q, Henein N, Heredia A, Horina H, Sanduja D, Radvar M. Left‐to‐right distribution of periodontal disease. Abstract: Aim: Symmetry is a property established in many human biological systems and it is reasonable to expect that it may also exist in the mouth. The objective of this study was to examine whether there is a similar left‐to‐right distribution in periodontal disease. Method: Records of 197 patients from the Periodontics department of The Royal Dental Hospital of Melbourne were analysed. The clinical parameters recorded were pocket probing depth, recession, bleeding on probing, mobility and furcation involvement. Results: The average age of our sample group was 47.5 years old, with 34.5% men and 65.5% women. The results demonstrated significant left‐to‐right distribution with all the periodontal indices recorded. Conclusion: The findings support previous studies that show that a similar left‐to‐right distribution exists in the population studied.     

Bleeding on probing. A parameter for monitoring periodontal conditions in clinical practice

Abstract. The present study is a follow-up report on the use of bleeding on probing (BOP) as a clinical indicator for disease progression or periodontal stability, respectively. Following active periodontal therapy, 39 patients were incorporated in a program of supportive periodontal therapy for a period of 53 months with recall intervals varying between 2–8 months. The patients received supportive therapy 7 to 14 ×. At the beginning of each maintenance visit, the tissues were evaluated using BOP. Reinstrumentation was only performed at sites which bled on probing. However, supragingival plaque and calculus were always removed. Probing depth and probing attachment levels were determined after active treatment and at the conclusion of the study. Progression of periodontal disease was defined by a measured loss of probing attachment of 2 mm or more. During the observation period, 4.2% of all the sites lost attachment. Approximately 50% of these losses were due to periodontal disease progression, while the other half was the result of attachment loss in conjunction with recession of the gingiva. 2/3 of all the sites which lost attachment were found in a group of patients which presented a mean BOP 30%. In a group of patients-with a mean BOP of 20%, only 1/5 of the loser sites were found. This clearly indicated, that patients with a mean BOP of 20% have a significantly lower risk for further loss of probing attachment at single sites.     

Radiographic and clinical assessments of destructive periodontal disease

191 subjects, aged 35-80 years, were examined for periodontal disease using radiographic and clinical means. At all approximal tooth surfaces, assessments were made of (i) the distance on radiographs between the cementoenamel junction and the most coronal level of the alveolar bone, and (ii) probing attachment loss. The results revealed that (i) a strong correlation existed between the radiographic and the clinical assessments (r = 0.80, p = 0.0001), (ii) the difference between the 2 types of assessments was within 2 mm in 92% of the tooth sites examined, (iii) the degree of agreement between the 2 methods was similar, irrespective of tooth type and tooth surface, but (iv) the agreement was poor at sites with severe periodontal tissue breakdown.     

Relationship of clinical parameters to attachment loss in subsets of subjects with destructive periodontal diseases

23 subjects were followed prior to treatment for 5 to 12 months in an attempt to relate attachment loss during this period to attachment level, probing depth, gingival redness and bleeding on probing. The subjects were divided into 3 groups based on amount and distribution of prior attachment loss: minor periodontitis, predominantly molar periodontitis and generalized periodontitis. The % of sites that exhibited attachment loss during the study period in the minor periodontitis, predominantly molar periodontitis and generalized periodontitis groups, were 1.3, 8.1 and 5.4, respectively. Subjects with minor periodontitis and predominantly molar periodontitis exhibited attachment loss more frequently in molar sites, proximal sites and sites with attachment level greater than or equal to 4 mm. In subjects with generalized periodontitis, attachment loss was related to tooth surface and attachment level, but not to tooth type. The relationship between the clinical parameters and attachment loss was improved compared with previous studies by using more homogeneous subject groups, more sensitive methods of analyzing attachment change and multivariate data analysis. However, the clinical parameters could not be used as diagnostic tests to predict attachment loss at individual sites.     

Peri‐implant soft tissue inflammatory parameters and crestal bone loss among waterpipe (narghile) smokers and never‐smokers with and without type 2 diabetes mellitus

1 Background

Peri‐implant soft tissue inflammatory parameters and crestal bone loss (CBL) among waterpipe smokers (WS) with and without type 2 diabetes mellitus (T2DM) remains uninvestigated. The aim of the present study was to assess peri‐implant soft tissue inflammatory parameters and CBL among WS and never smokers (NS) with and without T2DM.

2 Methods

Demographic data and information regarding duration of implants in function, daily frequency of smoking, duration and treatment of T2DM, and daily toothbrushing was collected using a questionnaire. Peri‐implant plaque index (PI), bleeding on probing (BOP), probing depth (PD) ≥4 mm, CBL, and hemoglobin A1c (HbA1c) levels were assessed in all individuals. Level of significance was set at 5%.

3 Results

Seventy‐nine male individuals (39 patients with T2DM [20 WS and 19 NS] and 40 systemically healthy individuals [21 WS smokers and 19 NS]) were included. The mean age was comparable among individuals in all groups. The mean HbA1c levels were significantly higher among patients with T2DM compared to controls (P < 0.01). Peri‐implant PI, BOP, PD, and CBL were comparable among WS and NS with T2DM. Among patients without T2DM, PI (P < 0.05), PD ≥4 mm (P < 0.05) and mesial and distal CBL (P < 0.05) were significantly higher in WS than NS. Among individuals without T2DM, BOP was significantly higher among NS (P < 0.05) than WS. In patients with T2DM, BOP was comparable among WS and NS.

4 Conclusions

Peri‐implant soft tissue inflammatory parameters and CBL were comparable among WS and NS with T2DM. Among individuals without T2DM, these parameters were worse among WS than NS.     

Prevalence and distribution of alveolar bone loss in a population of 15-year-old schoolchildren

Abstract The prevalence and distribution of bone loss, as assessed by the measurement of loss of attachment, was determined in a group of 15-year-old schoolchildren living in an industrial area in the North-West of England. A total of 46% of the population had loss of attachment ≥ 1 mm, including 11% who had loss of attachment ≥ 2 mm, on at least one tooth. Children of West Indian or Indo-Pakistani origin were most severely affected. Among children of European origin, those attending non-grammar schools showed the higher prevalence. Diagnostic criteria may explain some of the differences between this and previous reports on British teenage populations. The presence of early destructive periodontal disease may represent a useful measure of the need for periodontal treatment in such populations.     

Validation of a dental image analyzer tool to measure alveolar bone loss in periodontitis patients

Background and Objective:  Radiographs are an essential adjunct to the clinical examination for periodontal diagnoses. Over the past few years, digital radiographs have become available for use in clinical practice. Therefore, the present study investigated whether measuring alveolar bone loss, using digital radiographs with a newly constructed dental image analyzer tool was comparable to the conventional method, using intra-oral radiographs on film, a light box and a Schei ruler.
Material and Methods:  Alveolar bone loss of the mesial and distal sites of 60 randomly selected teeth from 12 patients with periodontitis was measured using the conventional method, and then using the dental image analyzer tool, by five dentists. The conventional method scored bone loss in categories of 10% increments relative to the total root length, whereas the software dental image analyzer tool calculated bone loss in 0.1% increments relative to the total root length after crucial landmarks were identified.
Results:  Both methods showed a high interobserver reliability for bone loss measurements in nonmolar and molar sites (intraclass correlation coefficient ≥ 0.88). Also, a high reliability between both methods was demonstrated (intraclass correlation coefficient nonmolar sites, 0.98; intraclass correlation coefficient molar sites, 0.95). In addition, the new dental image analyzer tool showed a high sensitivity (1.00) and a high specificity (0.91) in selecting teeth with ≥ 50% or < 50% alveolar bone loss in comparison with the conventional method.
Conclusion:  This study provides evidence that, if digital radiographs are available, the dental image analyzer tool can reliably replace the conventional method for measuring alveolar bone loss in periodontitis patients.     

Relationships between radiographic alveolar bone height and probing attachment level: data from healthy post-menopausal women

OBJECTIVE: To determine the cross-sectional and longitudinal relationships between radiographic alveolar bone height and probing attachment level in a population of healthy postmenopausal women. MATERIALS AND METHODS: The 81 patients in this report were part of a prospective estrogen replacement interventional study. All patients were in good oral health at entry and received annual oral prophylaxis as part of the study. Standard probing measurements were made with a pressure sensitive probe at 6 sites on each tooth. Vertical bitewing radiographs were digitized, and 6 linear measurements corresponding to probing-site measurements were made from the cementoenamel junction to the alveolar crest. These procedures were performed at baseline and at annual intervals for three years. Data were analyzed both by site and by patient. RESULTS: Moderately strong correlations were found between cross-sectional measurements of probing attachment height and radiographic bone height. Correlations were stronger for patient data (r=0.44-0.61) than for site data (r=0.19-0.36). No relationships were found between longitudinal changes in alveolar bone height and attachment level in either the site data (r=-0.10-0.04). or the patient data (r=-0.005-0.10). CONCLUSION: Healthy patients may experience sporadic, temporary changes in attachment level or alveolar bone height which are resolved without one affecting the other.     

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.     

Simvastatin therapy in cyclosporine A-induced alveolar bone loss in rats

Background and Objective:  Cyclosporine A treatment is important in the therapy of a number of medical conditions; however, alveolar bone loss is an important negative side-effect of this drug. As such, we evaluated whether concomitant administration of simvastatin would minimize cyclosporine A-associated alveolar bone loss in rats subjected, or not, to experimental periodontal disease.
Material and Methods:  Groups of 10 rats each were treated with cyclosporine A (10 mg/kg/day), simvastatin (20 mg/kg/day), cyclosporine A and simvastatin concurrently (cyclosporine A/simvastatin) or vehicle for 30 days. Four other groups of 10 rats each received a cotton ligature around the lower first molar and were treated similarly with cyclosporine A, simvastatin, cyclosporine A/simvastatin or vehicle. Calcium (Ca²⁺), phosphorus and alkaline phosphatase levels were evaluated in serum. Expression levels of interleukin-1β, prostaglandin E₂ and inducible nitric oxide synthase were evaluated in the gingivomucosal tissues. Bone volume and numbers of osteoblasts and osteoclasts were also analyzed.
Results:  Treatment with cyclosporine A in rats, with or without ligature, was associated with bone loss, represented by a lower bone volume and an increase in the number of osteoclasts. Treatment with cyclosporine A was associated with bone resorption, whereas simvastatin treatment improved cyclosporine A-associated alveolar bone loss in all parameters studied. In addition, simvastatin, in the presence of inflammation, can act as an anti-inflammatory agent.
Conclusion:  This study shows that simvastatin therapy leads to a reversal of the cyclosporine A-induced bone loss, which may be mediated by downregulation of interleukin-1β and prostaglandin E₂ production.     

内窥镜辅助下微创牙周基础治疗的临床疗效评价

目的 探讨牙周内窥镜辅助下超声龈下刮治及根面平整(subgingival scaling and root planning,SRP)对重度牙周炎治疗的临床疗效.方法 选取2017年6月至2019年1月于南京大学医学院附属口腔医院就诊的Ⅲ-Ⅳ期牙周炎患者19例,随机分为内窥镜组及对照组.内窥镜组在龈上洁治术1周后,牙周...     

Periodontal status in relation to age and tooth type

The purpose of the present study was to assess by radiographic means the pattern of destructive periodontal disease within the dentition of individuals of different ages. Full-mouth series of intra-oral radiographs from 531 dentate individuals aged 25-75 years were examined with respect to number and type of remaining teeth, location of the alveolar bone in relation to the cemento-enamel junction and presence of angular bony defects. The assessments of alveolar bone levels and angular bony defects were performed at the approximal surfaces of all teeth present. The results showed that although most individuals had experienced a reduction in alveolar bone height with age, only a small number of subjects had developed advanced breakdown of the periodontium. Hence, pronounced bone loss was observed in only 11% of the subjects and was non-existent in ages below 35 years. 23% of the individuals accounted for 3/4 of the total number of sites with bone level values (bone loss) of greater than or equal to 6 mm. Out of the total number of tooth sites examined, 28% showed no bone loss, while 13% demonstrated pronounced periodontal tissue breakdown. Angular bony defects were found at 8% of all teeth examined and were most frequent at the maxillary first premolars. Teeth in the incisor regions consistently showed the highest frequency of advanced alveolar bone loss and the lowest frequency of normal tissue support, while corresponding figures for teeth in the molar regions were found to be the opposite. However, molars were the most frequently missing teeth.