Comparative study on mineralization-related intraoral parameters in periodontitis-affected and periodontitis-free adults

The parameters related to an intraoral mineralization tendency in periodontitis-affected (P+) and periodontitis-free (P-) study subjects (16 adults, 46-74 yr, matched for sex and age) were compared. For this purpose the calcium (Ca) and phosphate (P) concentration of both plaque and saliva, resting pH and the acidogenic response of interdental plaque, plaque wet weight, salivary flow rate, buffering capacity and sucrase activity, interdental plaque, plaque S. mutans levels as well as salivary lactobacilli and yeast levels were estimated. Plaque Ca (micrograms/mg protein, P less than 0.025) and P (micrograms/mg protein, P less than 0.05), saliva Ca (micrograms/ml, P less than 0.005) and the saliva Ca:P ratio (P less than 0.005) were higher in the P+ than in the P- group. The resting pH values were higher (P less than 0.025) and the acidogenic response of the interdental plaque was lower (P less than 0.025) in the P+ group than in the P- group. The P+ group had lower S. mutans levels in saliva and interdental plaque. No differences were found in the wet weight of plaque and in the flow rate, buffering capacity or sucrase activity of saliva between the groups. The findings of the mineralization-related parameters in the two "extreme" groups of periodontal status suggest a higher intraoral mineralization tendency in periodontitis-affected persons than in periodontitis-free subjects. Ca and P accumulation of supragingival plaque seem to be connected with low acidogenicity of plaque and high salivary Ca concentration.     

Calcium and other salivary factors in periodontitis-affected subjects prior to treatment

Abstract Salivary calcium was shown to be higher in treated periodontitis-affected subjects (P+) than in periodontitis-free patients (P?). Here the aim was to study whether differences in calcium or other salivary factors exist prior to treatment. The test group consisted of 20 (15 men, 5 women) periodontitis-affected subjects and the control group 15 subjects (10 men, 5 women) free from periodontitis. Paraffin-stimulated whole saliva was collected to determine the flow-rate, calcium and phosphate concentrations, pH, buffering capacity, numbers of mutans streptococci, lactobacilli and yeasts. The results showed a higher calcium concentration (p < 0.05) in the P+ group (x?: 1.68 mmol/l; SE: 0.06 in men and x?: 1.49 mmol/l; SE: 0.10 in women) than in the P-group (x?: 1.48 mmol/l; SE: 0.09 in men and x?: 1.18 mmol/l; SE: 0.10 in women). The P+ group had more intact teeth (x?±SE: 9.9±0.8 in men and 11.2±2.0 in women) than the P-group (x?± SE: 8.3±0.7 in men and 8.2±2.4 in women). The present findings may indicate that an elevated level of salivary Ca is characteristic of P+ patients both before and after periodontal treatment.     

Effects of oral hygiene measures on clinical and microbiological parameters of periodontal disease

The effects of a 12-week period of oral hygiene alone on gingival conditions and subgingival microflora in 15 patients with severe periodontitis were investigated. Clinical measurements and plaque samples from selected sites were taken at week 0 (baseline), week 6, and week 12. Plaque samples were also taken at week 13, that is, 1 week following debridement. At week 0, the patients were instructed in supragingival plaque control and at week 6, the hygiene regimen was supplemented with the subgingival use of a toothpick device. At week 12, the patients received a full mouth supra- and subgingival debridement under local anesthesia. In those patients who complied with oral hygiene instructions (subgroup A), the gingival condition improved moderately while no improvement was found in less compliant patients (subgroup B). No significant changes were noted in the subgingival microflora in either subgroups A or B throughout the 12-week period of oral hygiene alone. However, significant reductions for all microbial parameters were found 1 week after debridement. Therefore, while moderate clinical improvements followed oral hygiene alone, no measurable changes in the subgingival microflora were observed concomitantly.     

The effect of supragingival plaque control on the composition of the subgingival flora in periodontal pockets

The effect of mechanical supragingival plaque control on the composition of the subgingival microflora in untreated 4-6 mm deep periodontal pockets was investigated. 13 subjects with chronic periodontitis were recruited for the study. Periodontally-diseased sites were subjected to professional plaque control 3 x weekly for a period of 3 weeks. Contralateral sites received no prophylaxis and served as controls. No instructions in oral hygiene procedures were given to the patients who maintained their habitual oral hygiene regime during the observation period. Clinical examination and darkfield microscopic analysis of bacterial samples were performed every week. The PlI scores for the experimental sites were reduced markedly, while those for the control sites remained stable throughout the observation period. No changes in the other clinical parameters were detected during the study. The composition of the subgingival microflora at the control sites did not change during the experimental period. In contrast, at the test sites, the proportion of spirochetes+motile rods decreased continuously. This decrease reached statistical significance at the end of the experiment. The results indicate that at periodontally diseased sites with an established subgingival ecosystem, supragingival plaque removal may influence the composition of the subgingival microflora.     

Antimicrobial resistance in the subgingival microflora in patients with adult periodontitis. A comparison between The Netherlands and Spain

BACKGROUND: The widespread use of antibiotics for prophylaxis and treatment of bacterial infections has lead to the emergence of resistant human pathogens. Great differences have been documented between European countries in the use of systemic antibiotics. In parallel, significant differences in levels of resistant pathogens have been documented. AIM: To investigate whether differences in antibiotic use influence the level of antimicrobial resistance of the subgingival microflora of untreated patients with adult periodontitis in The Netherlands and Spain. METHOD: Blood agar plates containing breakpoint concentrations of penicillin, amoxicillin, amoxicillin and clavunalate, metronidazole, erythromycin, azithromycin, clindamycin and tetracycline were used to determine the proportion of bacteria from the subgingival plaque that was resistant to these antibiotics. In the Spanish patients, statistically significant higher mean levels of resistance were found for penicillin, amoxicillin, metronidazole, clindamycin and tetracycline. The mean number of different bacterial species growing on the selective plates was higher in the Spanish patients, as was the % of resistant strains of most periodontal pathogens. A striking difference was observed in the frequency of occurrence of tetracycline-resistant periodontal pathogens. In Spain, 5 patients had > or =3 tetracycline resistant periodontal pathogens, whereas this was not observed in any of the Dutch patients. CONCLUSIONS: The widespread use of antibiotics in Spain is reflected in the level of resistance of the subgingival microflora of adult patients with periodontitis.     

Effect of oxybenzone on PGE2-production in vitro and on plaque and gingivitis in vivo

OBJECTIVES: To study the effect of oxybenzone on prostaglandin E2 (PGE2) production in cell culture and to evaluate the effect of an oxybenzone-containing dentifrice on plaque and gingivitis in a 6-week clinical trial. MATERIAL AND METHODS: Human embryo palatal mesenchyme (HEPM) cells were used for testing the inhibition of IL-1beta-stimulated PGE2-production in vitro by different concentrations of oxybenzone. For the in vivo study, a total of 66 individuals with a Quigley & Hein plaque index of at least 1.5 and an Ainamo & Bay gingival index of at least 0.2 were included in a double-blind clinical trial with two cells and a parallel design. Two compositions of fluoride dentifrice were used, one with the addition of 0.5% oxybenzone, and one without. Plaque and gingival index were obtained at three time points: (1) at baseline, (2) after 3 weeks, and (3) after 6 weeks. RESULTS: A dose-dependent inhibition of PGE2-production was found in the HEPM cell culture following oxybenzone exposure. In the clinical trial, a 25% reduction of gingival index was observed in the oxybenzone group (p<0.001) after 6 weeks as compared with 2% for the placebo group. CONCLUSIONS: These findings indicate that PGE2-production is reduced by oxybenzone in vitro and that the use of oxybenzone in a dentifrice reduces gingivitis in vivo.     

Relative effects of plaque control and instrumentation on the clinical parameters of human periodontal disease

The healing events of 7 patients with generalized chronic periodontitis were monitored clinically during 3 consecutive phases of treatment: 1) tooth brushing and flossing, 2) subgingival use of the Perio-Aid, and 3) supra and subgingival instrumentation. The clinical parameters evaluated were plaque score, bleeding score, probing pocket depth, probing attachment level, and gingival recession. Each phase continued until maximum effects were achieved (5, 3, and 9 months respectively) determined by minimal or no changes in bleeding scores and probing pocket depths between 3 successive examinations. The results showed limited improvement in the bleeding scores and probing pocket depths with tooth brushing and flossing only (Phase 1). During use of the Perio-Aid (Phase 2), there was no additional improvement, but the initial limited gains made during Phase 1 were maintained. By the end of Phase 2, however, a slight loss of probing attachment level was noticeable. After instrumentation (Phase 3), there was further and more pronounced improvement in bleeding scores and probing pocket depths, as well as a reversal of the probing attachment loss. The results of this study indicate that significant improvement in periodontal pockets should not be expected following home care procedures alone, and that instrumentation may account for the bulk of improvement seen following a combined therapy of plaque control and instrumentation.     

Relationship between salivary blood group antigens, microbial flora and periodontal condition in young adults

Abstract To investigate a possible role for salivary blood-group antigens in the relative frequencies of selected periodontal pathogens and commensal oral micro-organisms, we studied the clinical and microbiological condition in young adults with or without blood group reactive substances in saliva (secretors or non-secretors respectively). Clinical measurements were recorded at the Ramfjord teeth in 81 1st-year dental students. In addition, presence of interproximal loss of attachment (LA) was assessed at sites with a pocket depth of ≥4 mm. Microbiological samples were taken from one of the Ramfjord teeth (site without inteproximal LA), from interproximal sites of ≥4 mm in conjunction with LA, and from the saliva. The samples were analyzed for the presence of Actinomyces naesiundii, Actinomyces viscosus, Campylobacter rectus, Fusobacterium nucleatum, Peptostreptococcus micros, Prevotella intermedia. Porphyromonas gingivalis and Actinobacillius actinomycetemcomitans. Clinically, no statistically significant differences were found in the periodontal status between secretors (78% of our population) and n on-secretors. Furthermore, the occurrence of the monitored micro-organisms was not correlated to the secretor status. It is concluded that bacterial colonization with the micro-organisms tested in this study, apparently occurred independent of secretor status. Among the periodontal pathogens, only P. intermedia was more frequently recovered from the saliva of subjects with interproximal LA (49%) than in those without (33%; p=0.03). This finding was irrespective of the secretor status. Therefore, P. intermedia may be an important micro-organism in relation to the onset of periodontal destruction in young adults.     

Effect of controlled oral hygiene procedures on caries and periodontal disease in adults

Abstract The present report describes the result of a clinical trial in which a group of adults have been maintained on a proper oral hygiene standard over a 6-year period. In 1971–72, 375 individuals were recruited to a test group and 180 to a control group. During the 6 years of trial, 65 persons from the test group and 34 controls were lost. The patients were divided into three age groups; I <35 years, II 36–50 years, III >50 years. The members of the test and control groups were first subjected to a Baseline examination which included assessments of oral hygiene, gingivitis, periodontal disease and caries. Following this examination all caries lesions were treated and ill-fitting dental restorations adjusted. Each patient was also given a detailed case presentation and a dental prophylaxis. The control group patients were not involved in any further dental health programs during the subsequent 6-year period. Once a year, however, they were recalled to a public dental health clinic for examination and received symptomatic dental treatment. The test group participants, on the other hand, were given a preventive treatment, repeated once every 2–3 months which included (1) instruction and practice in oral hygiene techniques and (2) meticulous prophylaxis. The patients were re-examined 3 and 6 years after the baseline examination. At the Follow-up examinations the parameters studied at the Baseline examination were recorded again. The findings demonstrated that a preventive program which stimulates individuals to adopt proper oral hygiene habits may resolve gingivitis and prevent progression of periodontal disease and caries. Traditional dental care, on the other hand, did not prevent the progression of caries and periodontitis in adults.     

壳聚糖和氯己定协同抗菌斑作用的实验研究

目的：评估壳聚糖和氯己定协同控制菌斑的作用效果。方法：用伴放线放线杆菌（Actinobacillus actinomycetemcomitans Aa）诱导Wistar大鼠牙周炎模型,24只大鼠模型随机分两组,实验组用0.1%氯己定和0.2%壳聚糖混合制剂口腔冲洗,对照组用0.1%氯己定单独冲洗,1周后对大鼠牙菌斑和颊黏膜处Aa取样菌落计数分析,并进行菌斑指数和牙龈指数评分。结果：实验组和对照组颊黏膜Aa菌落计数（×104cfu/ml）分别为0.00±0.12和0.02±0.09,无显著性差异（P〉0.05）,牙菌斑Aa菌落计数（×10^4cfu/ml）分别为0.19±0.08和0.47±0.14,实验组少于对照组,有显著性差异（P〈0.05）;两组牙菌斑Aa菌落计数均大于颊黏膜（P〈0.05）。实验组菌斑指数小于对照组（P〈0.05）,而牙龈指数无显著性差异（P〉0.05）。结论：壳聚糖和氯己定具有协同抗菌斑作用,联合使用比单独使用氯己定能取得更好的菌斑控制效果。     

Longitudinal analysis of metalloproteinases, tissue inhibitors of metalloproteinases and clinical parameters in gingival crevicular fluid from periodontitis-affected patients

BACKGROUND: The aim of this work was to improve the assessment of the periodontal disease status through measurements of extracellular matrix metalloproteinases (MMPs) and their tissular inhibitors (TIMPs) in the gingival crevicular fluid from patients diagnosed with chronic periodontitis. METHODS: Gingival crevicular fluid samples from patients (n = 13) were taken from 60 sites initially, and from 51 and 41 sites, respectively, 3 and 6 months after scaling and root planing. Gingival crevicular fluid samples were also taken from healthy subjects (n = 11, 24 sites). The presence of MMP-9 and MMP-8 was assessed by zymography and immunowestern blotting, respectively. The actual MMP activity (gelatinase and collagenase) was measured using the fluorogenic substrate assay. TIMP-1 and -2 levels were measured by immunodot blot. RESULTS: The fluorogenic substrate assay determinations showed higher MMP activity in sites with probing depth > or = 4 mm, with significant reduction post-treatment. Gelatinase activity followed by zymography consisted mainly of MMP-9. A different pattern of MMP-8 in control and patient sites was found. Controls only showed species of a partially active form (69 kDa), whereas patient sites showed a high frequency of the active form (56 kDa), and in some cases the latent form (85 kDa) was also observed. The active form reduced its frequency in sites with probing depth > or = 4 mm. TIMP-1 and -2 levels in patients were significantly lower than in controls, and after treatment the recovery of TIMP-1 level similar to control was observed. CONCLUSION: Significant correlations between the severity of the periodontal disease and the actual MMP activity, the active form of MMP-8 and the low level of both TIMP-1 and TIMP-2 were found.     

Distribution of Porphyromonas gingivalis and Treponema denticola in human subgingival plaque at different periodontal pocket depths examined by immunohistochemical methods

Localization of Porphyromonas gingivalis and Treponema denticola in different areas of subgingival plaque from advanced adult periodontitis patients was studied immunohistochemically using sensitive immunogold-silver staining and immunoelectron microscopy. Fourteen periodontally diseased teeth were extracted without damaging the subgingival plaque, fixed, and embedded. The subgingival plaque samples were sectioned according to four different pocket depths (0–2 mm, 2–4 mm, 4–6 mm and ≤6 mm). Serial thin sections were stained using specific antisera to P. gingivalis or T. denticola and then with secondary antibody labelled with colloidal-gold. Cells of both P. gingivalis and T. denticola were predominantly found in subgingival plaque located at depths of more than 4 mm in periodontal pockets. T. denticola cells were found in the surface layers of subgingival plaque, and P. gingivalis were predominant beneath them. However, in the deeper subgingival plaque, the coexistence of P. gingivalis and T. denticola was observed. The present findings suggest that P. gingivalis and T. denticola play important roles in the pathogenicity of periodontal disease and provide the useful information for elucidating the pattern of colonization of microorganisms in the periodontal pocket.     

Effect of calcium, given before or after a fluoride insult, on hamster secretory amelogenesis in vitro

We tested the hypothesis that high-calcium medium given prior to or immediately after exposure to fluoride (F) reduces the negative effects of F on secretory amelogenesis. Hamster molar tooth germs were grown in organ culture in media with different calcium levels. Deposition of enamel matrix and matrix mineralization were monitored by incorporation of [³H]proline and uptake of ⁴⁵Ca and acid-soluble ³²PO₄. Ameloblast structure and the occurrence of a fluorotic enamel matrix were examined by light and electron microscopy. A preculture of explants in high-calcium medium partially prevented the formation of fluorotic (non-mineralizing) enamel matrix, increased matrix secretion but could not prevent F-induced hypermineralization of the pre-exposure enamel. High-calcium medium, applied after F insult, accelerated the recovery of fluorotic matrix, improved ameloblast structure, enhanced amelogenin secretion, and increased enamel thickness. The data indicate that it might be the balance between the amount of mineral deposition and that of matrix secretion which is critical for the mineralization of newly secreted enamel. Exposure to F disturbs this balance by enhancing mineralization of the pre-exposure enamel, probably generating an excess of protons. High calcium may protect against F exposure by enhancing amelogenin secretion into the enamel space, thereby increasing the local buffering capacity at the mineralization front.     

Clinical and microbiologic effects of single-dose metronidazole or scaling and root planing in treatment of adult periodontitis

Sites affected with adult periodontitis were observed for 3 months to compare their clinical and microbiologic responses to a single 2 g dose of metronidazole, scaling and root planing, or no treatment. 2 sites with probing depths greater than or equal to 5 mm in each of 18 female subjects (6 in each treatment group) were evaluated clinically (plaque and bleeding indices, probing depth, attachment loss) and microbiologically (%s of cocci, motile rods, non-motile rods and spirochetes, and of obligate anaerobic colony-forming units, black-pigmented Bacteroides, Fusobacterium and Actinobacillus actinomycetemcomitans in subgingival plaque). No significant differences in these variables existed between the 3 groups at baseline. The no-treatment (control) group showed no substantial clinical or microbiologic changes during the study. After 1 month, scaling and root planing had effected significant clinical improvement and significant shifts in the subgingival flora to a pattern more consistent with periodontal health; these changes were still evident at 3 months. In contrast, 1 month after metronidazole, there was some clinical improvement and a significant increase in cocci and a decrease in motile rods, but at 3 months these changes were no longer evident. The results show that the benefits of scaling and root planing are sustained for at least 3 months. However, the benefits of a single 2 g dose of metronidazole are both few and transient, indicating that this regimen, while effective against anaerobic infections in other organ systems, is not clinically or microbiologically effective in the treatment of adult periodontitis.     

Studies on immunologic and inflammatory factors in saliva in patients with asthma and in patients with periodontitis

Abstract To study the salivary response in asthma and periodontitis, calcium and phosphorus concentrations were determined from parotid and whole saliva. The IgE and histamine concentrations and the activities of lysozyme and arginine aminopeptidases were assayed from whole saliva. The values were compared with those obtained from matched healthy controls (n = 20 in each group). In whole saliva the phosphorus concentrations were elevated in the asthma group and the calcium concentrations in the periodontitis group. Regarding parotid saliva no significant differences between the group? were observed. The results indicate that in patients with asthma the IgE concentrations in whole saliva were elevated, while in patients with periodontitis and in healthy controls no detectable values were obtained. Both histamine and lysozyme concentrations seemed to increase in the asthma and periodontitis groups. A slight increase was also observed in the arginine aminopeptidase activities in the saliva of patients with asthma and patients with periodontitis.     

Comparative antiplaque activity of sanguinarine and chlorhexidine in man

This clinical investigation examined the effect of a sanguinarine extract on bacterial plaque growth in man. Three different mouthrinses were examined: (i) Veadent containing 0.03% sanguinarine and 0.2% zinc chloride (test rinse); (ii) a vehicle solution containing all the excipients of Veadent except the 0.03% sanguinarine (control rinse); (iii) Hibident a 0.2% chlorhexidine digluconate formulation (positive control rinse). The trial in which 12 dental students participated, was designed as a single-blind, cross-over study. During 3 experimental periods of 18 days, the participants refrained from mechanical oral hygiene and rinsed twice a day with one of the above mentioned solutions. Between experimental phases, a wash-out period of 11 days was instituted. In each subject, 4 teeth were randomly selected for assessment. Clinical evaluations were performed at days 1 (0, 4, 8, 12 hours), 2, 4, 11 and 18. The plaque on the buccal surfaces of the selected teeth was disclosed with neutral red 0.05% and colour slides taken. The % of the tooth surface covered with plaque was calculated planimetrically from these colour slides. The present results show an excellent anti-plaque effect with Hibident, a very small effect with Veadent and a negligible effect with the vehicle solution without the sanguinarine. These findings would suggest that the Veadent mouthrinse would have at most only a limited role as a plaque inhibitor.     

Salivary factors and dental plaque levels in relation to the general health of elderly residents in a long‐term care facility: a pilot study

The goal of this study was to examine salivary factors and formation of dental plaque in elderly subjects who were institutionalized and to relate these factors to general health and medication use. This cross‐sectional study consisted of 50 elderly individuals who were institutionalized and 25 healthy young volunteers who served as a reference group. For each subject, salivary flow rates, salivary pH, and buffering capacity were assessed. Baseline Plaque Index and Plaque Formation Rate Index were used as a measure of oral hygiene. Information on each patient's general health and medication use was acquired from the institution. An evaluation of the results of this study suggests that salivary protective qualities and dental plaque levels in the elderly subjects who were institutionalized were worse than in healthy young individuals. An association between the general health of the elderly and salivary flow rate was found.     

Interleukin-1 beta (IL-1 beta) levels in gingival crevicular fluid from adults with previous evidence of destructive periodontitis. A cross sectional study.

We have estimated the levels of Interleukin-1 beta (IL-1 beta) by ELISA in gingival crevicular fluid (GCF) at 58 sites from 37 patients with adult periodontitis. GCF was collected for 5 s on filter papers and a 2nd sample was collected for 30 s 1 min later. 68/116 strips yielded detectable levels of IL-1 beta. IL-1 beta was present in both the 1st and 2nd samples at 28 sites, in the 1st only at 4 sites and in the 2nd only at 8 sites; 18 sites were below the level of detection for the assay. When the concentrations of IL-1 beta were calculated in the original volume of GCF on each strip, the mean value for positive strips was 34.16 +/- 29.45 (SD) pg/microliters with a range from 1.75 to 97.13 pg/microliters. There were no statistically significant correlations with the plaque index, bleeding index or probable crevice depth (pocket depth). The results indicate that IL-1 is present in the GCF from a proportion of sites with evidence of previous periodontal destruction.