A systematic review of the effects of full-mouth debridement with and without antiseptics in patients with chronic periodontitis

Objectives: To assess the clinical and microbiological effects of full-mouth debridement with (FMD) and without the use of antiseptics [full-mouth scaling and root planing (FMSRP)] in comparison with conventional staged debridement (CSD) in patients with chronic periodontitis after at least 6 months.
Material and Methods: The search in MEDLINE (PubMed), covering a period of 1975 to October 2007, and hand searching yielded 207 titles. Forty-two abstracts and 17 full-text articles were screened for inclusion.
Results: Twelve articles allowed a direct comparison of FMD with CSD, FMSRP with CSD and FMD with FMSRP. Probing pocket depth reductions were significantly greater (0.2 mm) with FMD and FMSRP compared with CSD. Moreover, a modest reduction in BOP (9%) favoured FMD. Likewise, clinical attachment levels were improved by 0.2–0.4 mm in favour of FMD and FMSRP, respectively. In all comparisons, single-rooted teeth and deep pockets benefitted slightly from FMD and FMSRP. Limited differences in the changes of the subgingival microbiota were noted between the treatment modalities.
Conclusions: Despite the significant differences of modest magnitude, FMD or FMSRP do not provide clinically relevant advantages over CSD. Hence, all three treatment modalities may be recommended for debridement in the initial treatment of patients with chronic periodontitis.     

牙周内窥镜辅助超声龈下刮治对残留牙周袋临床疗效的评价研究

目的 评价牙周内窥镜下超声龈下刮治对牙周基础治疗后残留牙周袋的临床治疗效果.方法 收集20例慢性牙周炎患者259颗经牙周基础治疗后仍残留深牙周袋的患牙,行牙周内窥镜下超声龈下刮治,比较治疗前及治疗后3个月全口牙周探诊出血(BOP)和牙周探诊深度(PD)的变化.结果 内窥镜治疗后3个月全口平均PD值和BOP位点百分比有显著改善(P<0.001).单根牙和多根牙的平均PD均显著降低(P<0.001),PD≥5mm位点百分比显著改善(P<0.05),其中重度牙周袋位点的改善更明显(P<0.05).根分叉病变位点百分比治疗前后无明显变化.结论 残留牙周深袋经牙周内窥镜辅助超声龈下刮治后,单根牙和多根牙都有显著治疗效果,并且单根牙重度牙周袋位点改善更明显,但是多根牙II度及以上根分叉病变位点的改善有限.     

Incomplete adherence to an adjunctive systemic antibiotic regimen decreases clinical outcomes in generalized aggressive periodontitis patients: a pilot retrospective study

AIM: The objective of this study was to explore the effect of incomplete adherence to the prescribed antibiotic regimen, amoxicillin and metronidazole, in the non-surgical treatment of generalized aggressive periodontitis (GAP). METHODS: This retrospective study included 18 GAP subjects who received a conventional course of full-mouth non-surgical periodontal treatment using machine-driven and hand instruments and an adjunctive course of systemic antibiotics (500 mg amoxicillin and 500 mg metronidazole three times a day for 7 days). Clinical parameters were collected at baseline and at 2 months post-treatment. Self-reported adherence to the prescribed medication regimen was recorded at 2 months. RESULTS: All clinical parameters, except for the mean clinical attachment level (CAL) in sites with initial probing pocket depth (PPD) < or = 3 mm, improved at 2 months in all subjects. PPD reduction was 3.7 mm [95% confidence interval (CI) 3.2, 4.3 mm] in deep pockets (> or = 7 mm) and 2.2 mm (95% CI 1.9, 2.4 mm) in moderate pockets (4-6 mm), while CAL gain was 2.2 mm (95% CI 1.7, 2.6 mm) and 1.2 mm (95% CI 0.8, 1.5 mm), respectively. However, only 11 subjects (61.1%) reported full adherence to the medication. In deep pockets (> or = 7 mm), the difference between an adherent and non-adherent/partially adherent subject was 0.9 mm (95% CI 0.1, 1.7 mm, ancova, p=0.027) in PPD reduction and 0.8 mm (95% CI -0.2, 1.9, p=0.129) in CAL gain at 2 months. In moderate pockets (4-6 mm) this difference was smaller in magnitude: 0.4 mm (95% CI 0.1, 0.9 mm, p=0.036) in PPD reduction and 0.2 mm (95% CI -0.3, 0.9 mm, p=0.332) in CAL gain. CONCLUSIONS: Within the limits of this design, these data suggest that incomplete adherence to a 7-day adjunctive course of systemic metronidazole and amoxicillin is associated with decreased clinical outcomes in subjects with generalized aggressive periodontitis.     

Clinical outcomes of quadrant root planing versus full-mouth root planing

OBJECTIVES: To determine the clinical effects of full mouth compared with quadrant wise scaling and root planing. METHOD: Twenty patients with chronic periodontitis (> or = 2 teeth per quadrant with probing pocket depths (PPD) > or = 5 mm and bleeding on probing (BOP) were randomized into a test group treated in two sessions with subgingival scaling and root planing within 24 h (full-mouth root planing (FMRP)) and a control group treated quadrant by quadrant in four sessions in intervals of 1 week (quadrant root planing (QRP)). PPD, relative attachment level (RAL) and BOP were recorded at baseline, 3 and 6 months. RESULTS: Analysing first quadrant data, in moderately deep pockets (5 mm < or = PPD < 7 mm) there was no evidence for a difference (FMRP-QRP) between both groups for PPD reduction (mean: -0.128 mm; CI: [-0.949, 0.693]; p=0.747), RAL gain (mean: 0.118 mm; CI: [-0.763, 1.000]; p=0.781), and BOP reduction (mean: -20.1%; CI: [-44.3, 4.2]; p=0.099). Likewise, no significant differences between treatments were found for initially deep pockets (PPD > or = 7 mm), neither for first quadrant nor for whole mouth data. CONCLUSION: The results of the present study demonstrated equally favourable clinical results following both treatment modalities.     

One-year outcomes of repeated adjunctive photodynamic therapy during periodontal maintenance: a proof-of-principle randomized-controlled clinical trial

Background: Single photodynamic therapy (PDT) has been effective in initial periodontal therapy, but only improved bleeding on probing (BoP) in maintenance patients after a single use. Repeated PDT has not been addressed.
Objectives: To study the possible added benefits of repeated adjunctive PDT to conventional treatment of residual pockets in patients enrolled in periodontal maintenance.
Material and Methods: Ten maintenance patients with 70 residual pockets [probing pocket depth (PPD)5 mm] were randomly assigned for treatment five times in 2 weeks (Days 0, 1, 2, 7, 14) with PDT (test) or non-activated laser (control) following debridement. The primary outcome variable was PPD, and the secondary variables were clinical attachment level (CAL) and BoP. These were assessed at 3, 6 and 12 months following the interventions.
Results: Greater PPD reductions were observed in the test (−0.67 ± 0.34; p =0.01) compared with the control patients (−0.04 ± 0.33; NS) after 6 months. Significant CAL gain (+0.52 ± 0.31; p =0.01) was noted for the test, but not in the control (−0.27 ± 0.52; NS) patients after 6 months. BoP percentages dcreased significantly in test (97–64%, 67%, 77%), but not control patients after 3, 6 and 12 months.
Conclusions: Repeated (five times) PDT adjunctive to debridement yielded improved clinical outcomes in residual pockets in maintenance patients. The effects were best documented after 6 months.     

Clinical evaluation of partial- and full-mouth scaling in the treatment of chronic periodontitis

BACKGROUND: Full-mouth scaling (FMS) is claimed by some researchers to be superior to standard scaling and root planing (SRP). The aim of the present study was to evaluate clinical outcomes of two modalities of non-surgical periodontal therapy for patients with chronic periodontitis. METHODS: In a prospective, randomized, controlled clinical study, 37 subjects with chronic periodontitis were treated by SRP in two quadrants at 4-week intervals (N=20) or by FMS (N=17). Clinical attachment level (CAL), probing depth (PD), and bleeding on probing (BOP) were recorded at premolar and molar teeth at baseline and after 6 and 12 months. RESULTS: Both therapies resulted in significant improvements of all clinical variables. After 12 months, CAL at pockets with PDs of 4 to 6 mm was reduced significantly from 4.5+/-0.8 mm to 3.4+/-1.0 mm with SRP and from 4.7+/-0.9 mm to 3.8+/-1.1 mm with FMS (P<0.001). PD decreased from 4.4+/-0.6 mm to 3.3+/-0.9 mm in the SRP group and from 4.5+/-0.7 mm to 3.5+/-1.0 mm in the FMS group (P<0.001). BOP was reduced from 63.6%+/-45.3% to 29.0%+/-42.6% in the SRP group and from 59.6%+/-43.8% to 28.6%+/-38.3% in the FMS group (P<0.001 and P=0.001, respectively). There were no significant differences between the groups with respect to CAL gain, PD, and BOP reduction. CONCLUSION: Both therapy modalities have the same positive influence on clinical outcome at premolar and molar teeth with PDs of 4 to 6 mm.     

Bleeding on probing and pocket probing depth in relation to probing pressure and mucosal health around oral implants

Objectives: To assess the bleeding on probing (BOP) tendency and periodontal probe penetration when applying various probing forces at implant sites in patients with a high standard of oral hygiene with well-maintained peri-implant tissues.
Material and methods: Seventeen healthy patients with excellent oral hygiene in a maintenance program after having been treated for periodontitis or gingivitis were recruited. Missing teeth had been replaced using oral implants. The BOP and probing depth (PPD) were assessed at the mid-buccal, mid-oral, mesial and distal aspects of the buccal surfaces of each implant. Moreover, contralateral teeth were designated and assessed for BOP and PPD in the same locations and at the same observation visits. At each visit, implants and contralateral teeth were randomly assigned to one of the standardized probing forces (0.15 or 0.25 N). The second probing force was applied at the repetition of the examination 7 days later.
Results: Increasing the probing pressure by 0.1 N from 0.15 N resulted in an increase of BOP percentage by 13.7% and 6.6% for implants and contralateral teeth, respectively. There appeared to be a significant difference of the mean BOP percentage at implant and tooth sites when a probing pressure of 0.25 N was applied. A significantly deeper mean PPD at implant sites compared with tooth sites was found irrespective of the probing pressure applied.
Conclusions: The results of the present study demonstrated that 0.15 N might represent the threshold pressure to be applied to avoid false positive BOP readings around oral implants. Hence, probing around implants demonstrated a higher sensitivity compared with probing around teeth.     

Periodontal disease progression in subjects with orofacial clefts over a 25-year follow-up period

Aims: To assess rates of periodontal disease progression in subjects with cleft lip, alveolus and palate (CLAP) over a 25-year period without regular maintenance care in a specialist setting and to compare those with those of subjects without alveolar clefts, i.e. cleft lip (CL) or cleft palate (CP).
Material and Methods: Ten subjects with CLAP and 10 subjects with CL/CP were examined in 1979, 1987, 1993 and 2004. Probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP) and plaque control record (PCR) scores were recorded in all 20 subjects.
Results: High plaque and BoP scores were recorded at all examinations in both groups. Over 25 years, a statistically significant loss of mean full-mouth CAL of 1.52 ± 0.12 mm (SD) and 1.66 ± 0.15 mm occurred in the CLAP and CL/CP group respectively ( p <0.05). A statistically significant increase ( p <0.05) in mean full-mouth PPD of 0.35 ± 0.12 mm was observed in the CL/CP group, whereas only a trend for a mean full-mouth increase in PPD of 0.09 ± 0.11 mm was observed in the CLAP group. In subjects with CLAP, a statistically significant increase ( p <0.05) in PPD of 0.92 ± 1.13 mm at cleft sites was observed compared with that of 0.17 ± 0.76 mm at control sites. With respect to CAL, the loss at the corresponding sites amounted to 2.71 ± 1.46 and to 2.27 ± 1.62 mm, respectively ( p =0.36).
Conclusions: When stringent and well-defined supportive periodontal therapy was not provided, subjects with orofacial clefts were at high risk for periodontal disease progression. Over 25 years, alveolar cleft sites tended to have more periodontal tissue destruction compared with control sites.     

Clinical evaluation of periodontal surgical treatment with an Er:YAG laser: 5-year results

BACKGROUND: The aim of the present study was to evaluate and compare the long-term clinical outcomes of erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser-assisted periodontal flap surgery versus conventional treatment with the modified Widman flap procedure. METHODS: A total of 146 single-rooted periodontally involved teeth from 25 patients were included in this study. In each patient, left or right maxillary single-rooted teeth were assigned randomly to one of two groups: group A (Er:YAG laser) and group B (modified Widman flap surgery). Er:YAG laser was used to debride the bone pockets, scale the root surface, and trim the periodontal flap. Recession, probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and bleeding on probing (BOP) scores were recorded at baseline and at 3, 6, 12, 24, 36, 48, and 60 months. RESULTS: Both treatments resulted in decreases in PD, PI, GI, and BOP, increases in gingival recession, and gains in CAL. PD reduction in group A versus group B was statistically significant at 6, 12, 24, and 36 months (P < 0.05). Gains in CAL were significantly greater in group A versus group B at 6, 12, 24, and 36 months. BOP scores were significantly lower in group A versus group B at 3 and 6 months (P < 0.05). All other differences between treatment groups were not statistically significant. CONCLUSIONS: Surgical treatment of single-rooted teeth with chronic periodontitis using the Er:YAG laser yields greater PD reduction and gains in CAL for up to 3 years compared to conventional Widman flap surgery. The short-term results obtained with both treatments can be maintained over 5 years.     

Relationship between drinking and periodontitis: the Hisayama Study

BACKGROUND: Although recent studies suggest a relationship between alcohol consumption and periodontal disease, the dose-response relationship between drinking and the severity of periodontitis is unclear. METHODS: Alcohol consumption was evaluated using the frequency of drinking and the daily alcohol intake for 961 individuals aged 40 to 79 years. Periodontal status was evaluated using probing depth (PD) and clinical attachment loss (CAL). RESULTS: Alcohol consumption was linearly associated with the extent of PD and CAL in univariate analyses (P <0.001). In multivariate logistic regression analyses, the subjects drinking 15 to 29.9 g alcohol per day (odds ratio [OR] = 2.7; 95% confidence interval [CI] = 1.1 to 6.6) or more than 30 g per day (OR = 2.5; 95% CI = 1.1 to 5.7) had a significantly higher risk of having more than 35% of their teeth with PD > or = 4 mm than non-drinkers, independent of other confounding variables. No significant relationship between drinking and CAL was observed in the multivariate analysis. CONCLUSION: These results suggest that the effect of drinking on periodontal condition is limited to subjects with deep periodontal pockets associated with more than one-third of their teeth.     

Full- versus partial-mouth disinfection in the treatment of periodontal infections

Abstract A standard periodontal treatment consists of 4 to 6 scalings and root-planings at a 1- to 2-week interval, which allows reinfection of a previously disinfected area before completion of the treatment. The present pilot study aims to examine the microbiological long-term effects of a full-mouth disinfection. 10 patients with advanced chronic periodontitis were randomly allocated to a test and control group. The patients from the control group received scaling and root-planing and oral hygiene instructions at a 2-week interval. The full-mouth disinfection (test group) consisted of a full-mouth scaling and root planing in 2 visits within 24 h in combination with; tongue brushing with 1% chlorhexidine gel for 1 min, mouth rinsing with 0.2% chlorhexidine solution for 2 min and sub-gingival irrigation of all pockets (3× in 10 min) with 1% chlorhexidine gel. The patients of the test group were instructed to rinse 2× daily with 0.2% chlorhexidine. Plaque samples were taken at baseline and after 1. 2, 4 and 8 months. Differential phase-contrast microscopy showed a significantly larger reduction of spirochetes and motile organisms in the test group up to month 2 for the single-rooted and up to month 8 for the multi-rooted teeth. Furthermore, the culture data supported the effectiveness of the new treatment strategy. In both groups, the number of anaerobic CPU decreased 1 log around single- and 0.5 log around multi-rooted teeth. The number of anaerobic CPU remained low in the test group, in contrast to the control group. At 1 month, the test group harboured a significantly (p < 0.01) lower proportion of pathogenic organisms, but this difference disappeared with tune. Moreover, the test sites showed a significantly higher (p < 0.02) increase in the proportion of beneficial micro-organisms up to 4 months. These findings suggest that a full-mouth disinfection leads to a significant microbiological improvement up to 2 months, which could be consolidated, although not significant, for the next 6 months.     

Association of Untreated Metabolic Syndrome With Moderate to Severe Periodontitis in Thai Population

Background: Metabolic syndrome (MetS) correlates with systemic inflammation. A relation of MetS to periodontitis has been reported. This study aims to evaluate whether periodontitis is associated with untreated MetS, plasma adiponectin, and leptin among Thai people. Methods: One hundred twenty‐five participants (aged 35 to 76 years) were recruited. Demographic and biologic data, bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) of all teeth were examined. Plasma adiponectin and leptin levels were measured. Results: Forty‐four participants (35.2%) were healthy, and 81 (64.8%) had MetS. All periodontal conditions (BOP, PD, and CAL) were significantly worse in patients with MetS than healthy participants. After adjustment for confounders, MetS was strongly associated with severe periodontitis (odds ratio [OR] = 3.60, 95% confidence interval [CI]: 1.34 to 9.65). MetS with four to five components had a higher association with periodontitis than did MetS with three components (OR = 5.49, 95% CI: 1.75 to 17.19), whereas each separate component had no association with periodontitis, except for high diastolic blood pressure. Periodontitis was also associated with age (OR = 1.08, 95% CI: 1.01 to 1.14) and education (OR = 3.76, 95% CI: 1.05 to 13.40). The risk of MetS was predicted by body mass index and plasma adiponectin (OR = 1.90, 95% CI: 1.24 to 2.92 and OR = 0.93, 95% CI: 0.88 to 0.98, respectively). Conclusions: There may be a relationship between untreated MetS and periodontitis in Thai people. Periodontal diagnosis should be regularly conducted in patients with MetS.     

Long-term effects of supportive therapy in periodontal patients treated with fibre retention osseous resective surgery. I: recurrence of pockets, bleeding on probing and tooth loss

BACKGROUND: Periodontal surgery is indicated in the treatment of persistent pockets following cause-related therapy. The aim of this study was to evaluate the long-term effect of supportive therapy in periodontal patients treated with fibre retention osseous resective surgery. METHODS: Three-hundred and four consecutive patients were identified and retrospectively examined while presenting for a supportive periodontal care (SPC) appointment (T2). All had received non-surgical periodontal treatment and osseous resective surgery as needed, to obtain no sites with probing depth (PD) >3 mm before being enrolled in the SPC programme. The mean SPC duration for the patients was 7.8+/-3.2 years while the mean interval of SPC was 3.4+/-0.8 months. RESULTS: During SPC, a total of 67 teeth had been removed (0.9%). At T2, mean full-mouth plaque scores (FMPS) was 13+/-11.3% and full-mouth bleeding scores (FMBS) was 2+/-3%. In 98.5% of the sites, PD was minimal (or=6 mm was 68 and limited to 41 patients (13.8% of sample). Initial periodontal diagnosis of severe periodontitis, smoking habits, FMBS, number of teeth at completion of active periodontal therapy (T1), number of surgically treated teeth, number of teeth with furcation involvement and number of multi-rooted teeth were associated with the number of pockets at T2. A total of 598 sites (2.1%) displayed bleeding on probing (BOP) at T2. The odds ratio of sites 4 mm or deeper to be BOP positive was 32.9 compared with sites of <3 mm depth. Gender, FMBS, FMPS, furcation involvements and overall number of pockets were associated with the number of bleeding pockets at T2. CONCLUSION: Shallow PDs achieved by treatment of the persistent pockets by fibre retention osseous resective surgery can be maintained over time. These patients displayed minimal gingival inflammation and tooth loss during SPC.     

Periodontal debridement as a therapeutic approach for severe chronic periodontitis: a clinical, microbiological and immunological study

Aim: To clinically, microbiologically and immunologically characterize periodontal debridement as a therapeutic approach for severe chronic periodontitis.
Material and Methods: Twenty-five patients presenting at least eight teeth with a probing pocket depth (PPD) of 5 mm and bleeding on probing (BOP) were selected and randomly assigned to quadrant-wise scaling and root planing or one session of full-mouth periodontal debridement. The following clinical outcomes were assessed: plaque index, BOP, position of gingival margin, relative attachment level (RAL) and PPD. Real-time PCR was used for quantitative analysis of Aggregatibacter actinomycetemcomitans , Porphyromonas gingivalis and Tannerella forsythia . The enzyme-linked immunosorbent assay permitted the detection of IL-1 β , prostaglandin E₂, INF- γ and IL-10 in gingival crevicular fluid (GCF). All the parameters were evaluated at baseline, and at 3 and 6 months after treatment.
Results: Both the groups had similar means of PPD reduction and attachment gain over time. Besides a significant reduction in the bacterial level after treatment in both groups, microbiological analysis failed to demonstrate significant differences between them. Finally, no difference was observed between groups with respect to the levels of inflammatory mediators in GCF.
Conclusion: Periodontal debridement resulted in a similar clinical, microbiological and immunological outcome when compared with standard scaling and root planing and therefore may be a viable approach to deal with severe chronic periodontitis.     

Influence of different curette insertion depths on the outcome of non-surgical periodontal treatment

This study was undertaken to compare the effects of scaling and root planing (Sc/RP) performed from approximately 1 mm coronal to (test Sc/RP) or at the bottom of (control Sc/RP) the probeable pocket to the gingival margin. 2 male and 5 female patients with moderate to severe periodontitis participated in the study. Initial examination was performed with respect to probing pocket depth (PPD) and probing attachment level (PAL) using a pressure-controlled periodontal probe and stents. The patients received repeated instruction in oral hygiene, and their plaque control reached an excellent level. Baseline examination including PPD and PAL measurements was then performed. Following the baseline examination, single-rooted teeth in 1 quadrant of each dentition were randomly selected and subjected to the test Sc/RP (test teeth) or control Sc/RP (control teeth). The PPD and PAL were measured 1 and 3 months following Sc/RP. It was demonstrated that: (i) the PPD reduction following Sc/RP was larger at the sites with initially deep pockets than at the sites with shallow pockets; (ii) the mean PPD reduction at the sites with an initial PPD > or =3.5 mm was significantly larger in the control teeth than in the test teeth; (iii) there was a significant PAL gain in the initially deep pockets but not in the initially shallow pockets; (iv) the PAL gain in the initially shallow pockets was significantly larger in the control teeth than in the test teeth. In the treatment of periodontitis, trauma caused by Sc/RP to the most coronal part of the connective tissue attachment seems to be of minor importance compared to the effective removal of subgingival deposits.     

Amount and type of alcohol and periodontitis in the Copenhagen City Heart Study

Aim: The aim of this study was to study the association between alcohol consumption and periodontitis assessed as clinical attachment loss (CAL) and bleeding on probing (BOP) in a cross‐sectional design. Material and Methods: The study included 1,521 adults aged 20–95 years, who underwent an oral examination including full‐mouth registration of CAL and BOP. Alcohol was ascertained using a food‐frequency questionnaire. The association between total and type‐specific alcohol and periodontitis was assessed by means of multivariate logistic regression. Results: A lower odds ratio (OR) for CAL (defined as mean 3 mm) was observed in men consuming 21–34 [OR=0.51, 95% confidence interval (CI), 0.27–0.95] and 35+ drinks/week (OR=0.34, 95% CI, 0.15–0.79) compared with men drinking 1–13 drinks/week. Also, men with a weekly wine consumption of more than 14 drinks compared with men who reported no wine intake had lower OR for CAL (OR=0.24; 95% CI, 0.09–0.62). A higher OR for BOP (defined as 25%) among male abstainers was observed (OR=1.79, 95% CI, 1.03–3.12) compared with men in the light‐drinking group (1–13 drinks/week). No significant association was observed for either CAL or BOP in women. Conclusions: The results indicate that higher alcohol consumption, particularly intake of wine, is inversely associated with CAL in men. Such an association is not found in women.     

Maternal periodontitis as a potential risk variable for preeclampsia: a case-control study

BACKGROUND: Association studies between maternal periodontitis and an elevated risk for preeclampsia have shown conflicting results. The aims of the present case-control study were: 1) to evaluate the association between maternal periodontitis and preeclampsia before and after matching, assessing confounding and interaction; and 2) to evaluate the influence of the extent and severity of periodontal parameters, bleeding on probing (BOP), probing depth (PD), and clinical attachment loss (CAL), in association with preeclampsia. METHODS: Initially, 1,206 Brazilian women were included and divided into a control group (1,042 non-preeclamptic women who gave birth to infants with adequate gestational age and birth weight) and a case group (164 preeclamptic women). Further, 125 preeclamptic women were matched according to age, chronic hypertension, and primiparity to 375 non-preeclamptic women randomly selected from the control group. Maternal periodontitis was defined as PD > or =4 mm and CAL > or =3 mm at the same site in at least four teeth. The effect of variables of interest and confounding were assessed by univariate and multivariate analysis. RESULTS: After controlling for confounders, maternal periodontitis was included in the multivariate final model (odds ratio [OR] = 1.94; 95% confidence interval [CI]: 1.37 to 2.77; P <0.001) and remained associated with preeclampsia after matching (OR = 1.52; 95% CI: 1.01 to 2.29; P = 0.045). The odds of preeclampsia were associated with an increase in the number of sites with BOP and PD and CAL > or =4 mm. CONCLUSION: Maternal periodontitis is a risk factor associated with preeclampsia, emphasizing the importance of periodontal care in prenatal programs.     

Association between passive and active smoking evaluated by salivary cotinine and periodontitis

AIM: This study attempted to determine the relationship between passive and active smoking on the basis of salivary cotinine levels and periodontitis severity. METHODS: Japanese workers (n=273) were surveyed via an oral examination, a self-administered questionnaire and collection of whole saliva. Probing pocket depth (PPD) and clinical attachment level (CAL) served as periodontal parameters. Periodontitis was defined as the presence of two or more teeth with PPD > or =3.5 mm and CAL > or =3.5 mm. Salivary cotinine was determined using ELISA. Statistical methods included Wilcoxon's rank-sum test and multiple logistic regression analysis. RESULTS: Based on the results of receiver-operating characteristic plots for cotinine-level classification derived from self-reported smoking status, non-, passive and active smokers were defined as those subjects exhibiting cotinine levels of 0, 1-7 and > or =8 ng/ml, respectively. Numbers of teeth displaying CAL > or =3.5 mm in passive and active smokers were significantly higher than those in non-smokers. Multiple logistic regression analysis revealed significantly higher periodontitis odds ratios in passive and active smokers relative to non-smokers following adjustment for other lifestyle factors; odds ratios were 2.87 [95% confidence interval (CI); 1.05-7.82] and 4.91 (95% CI; 1.80-13.35), respectively. CONCLUSION: These findings suggest that passive smoking classified in terms of salivary cotinine level may be an independent periodontitis risk indicator.     

Relationship between electrocardiographic abnormalities and periodontal disease: the Hisayama Study

BACKGROUND: Recent studies have suggested a relationship between periodontitis and cardiovascular disease (CVD). This study investigated the relationship between periodontitis and electrocardiographic (ECG) abnormalities, which are known predictors of CVD. METHODS: We examined the periodontal status of 1,111 residents of Hisayama Town, Fukuoka, Japan. Nine hundred fifty-seven (957) subjects (374 males, 583 females) with > or = 10 teeth and without a medical history of CVD were included in the analysis. Probing depth (PD) and clinical attachment level (CAL) were measured on two randomly selected quadrants, one maxillary and one mandibular. A 12-lead ECG was recorded using a standard electrocardiograph. ECG abnormalities included left ventricular hypertrophy (Minnesota code 3-1) and ST depression (4-1, 2, 3). The relation of periodontal condition and ECG abnormalities was assessed with logistic regression analysis. RESULTS: Univariate analysis revealed that mean probing depth, mean attachment loss, number of teeth, and plaque index were significantly associated with ECG abnormalities, as well as with known risk factors of CVD. In multivariate analysis, the subjects with deep pockets (mean probing depth > or = 2 mm) had an increased risk for ECG abnormalities (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.01 to 2.50) compared to the subjects with mean PD < 2 mm. Subjects with severe attachment loss (mean CAL > or = 2.5 mm) had also significant risk for ECG abnormalities (OR = 1.7; 95% CI = 1.07 to 2.67) compared to those whose mean CAL was < 2.5 mm. CONCLUSION: This study clearly shows the relationship between periodontitis and ECG abnormalities, which are important predictors of CVD.     

Clinical evaluation of the use of locally delivered chlorhexidine in periodontal maintenance therapy

BACKGROUND: The objective of this study was to evaluate clinically the effectiveness of a chlorhexidine gluconate chip in sites still showing signs of disease during periodontal maintenance therapy. METHODS: Forty-two maintenance non-smoking patients (previously treated with non-surgical scaling and root planing [SRP]), presenting at least one probing depth (PD) of 5 to 8 mm, and bleeding on probing (BOP) at single-rooted teeth were assigned randomly to two groups: treated with a chlorhexidine gluconate chip (CHIP group) and treated with SRP (SRP group). Patients were assessed for plaque index, gingival index, BOP, PD, clinical attachment level (CAL), and gingival recession at baseline, 6 weeks, and 3 and 6 months. RESULTS: Both treatments resulted in improvements in all parameters evaluated. After 6 months, a reduction in PD of 2.64 +/- 0.02 mm and 2.12 +/- 0.02 mm was observed for CHIP and SRP groups, respectively (P >0.05). The observed gain in CAL was 2.19 +/- 0.87 mm and 2.07 +/- 1.53 mm for CHIP and SRP groups, respectively (P >0.05). In deep pockets, PD reduction was 3.60 +/- 0.70 mm for CHIP group and 2.83 +/- 0.62 mm for SRP group (P = 0.01). CONCLUSIONS: Both treatments were equally effective in periodontal health reestablishment in inflamed single-root sites of maintenance patients. However, for deep pockets, the chlorhexidine gluconate chip was more effective than SRP in reducing PD.