Useful immunochromatographic assay of calprotectin in gingival crevicular fluid for diagnosis of diseased sites in patients with periodontal diseases

1 Background

Calprotectin, an inflammation‐related protein, is present in gingival crevicular fluid (GCF), and the determination of calprotectin is useful for diagnosing periodontal diseases. The authors have recently developed a novel immunochromatographic (IC) chip system to determine calprotectin levels in GCF. In the present study, the usefulness of this diagnostic system is investigated in patients with periodontal diseases.

2 Methods

Thirty‐six patients with periodontal diseases participated in this clinical test at multiple centers. Periodontitis sites (n = 118) and non‐periodontitis (healthy) sites (n = 120) were selected after periodontal examination. GCF collection and periodontal examination were performed at baseline, after supragingival and subgingival scaling and root planing. Calprotectin levels in GCF were determined using a novel IC chip system and evaluated as a visual score and an IC reader value. Correlations between GCF calprotectin levels, clinical indicators, and changes in calprotectin levels by periodontal treatments were investigated. Receiver operating characteristic (ROC) analysis of IC reader value for GCF calprotectin was performed to predict periodontal diseases.

3 Results

The visual score of GCF calprotectin was highly correlated with the IC reader value. IC reader values of GCF calprotectin in the periodontitis group were higher than those of the healthy group at three dental examination stages, and they significantly decreased with periodontal treatments. Visual scores and IC reader values of GCF calprotectin were correlated to levels of clinical indicators. ROC analysis for GCF calprotectin showed an optimal cutoff value to predict periodontal diseases.

4 Conclusion

Determination of GCF calprotectin using a novel IC chip system is useful for diagnosis of periodontal diseases.     

Periodontal profile classes predict periodontal disease progression and tooth loss

1 Background

Current periodontal disease taxonomies have limited utility for predicting disease progression and tooth loss; in fact, tooth loss itself can undermine precise person‐level periodontal disease classifications. To overcome this limitation, the current group recently introduced a novel patient stratification system using latent class analyses of clinical parameters, including patterns of missing teeth. This investigation sought to determine the clinical utility of the Periodontal Profile Classes and Tooth Profile Classes (PPC/TPC) taxonomy for risk assessment, specifically for predicting periodontal disease progression and incident tooth loss.

2 Methods

The analytic sample comprised 4,682 adult participants of two prospective cohort studies (Dental Atherosclerosis Risk in Communities Study and Piedmont Dental Study) with information on periodontal disease progression and incident tooth loss. The PPC/TPC taxonomy includes seven distinct PPCs (person‐level disease pattern and severity) and seven TPCs (tooth‐level disease). Logistic regression modeling was used to estimate relative risks (RR) and 95% confidence intervals (CI) for the association of these latent classes with disease progression and incident tooth loss, adjusting for examination center, race, sex, age, diabetes, and smoking. To obtain personalized outcome propensities, risk estimates associated with each participant's PPC and TPC were combined into person‐level composite risk scores (Index of Periodontal Risk [IPR]).

3 Results

Individuals in two PPCs (PPC‐G: Severe Disease and PPC‐D: Tooth Loss) had the highest tooth loss risk (RR = 3.6; 95% CI = 2.6 to 5.0 and RR = 3.8; 95% CI = 2.9 to 5.1, respectively). PPC‐G also had the highest risk for periodontitis progression (RR = 5.7; 95% CI = 2.2 to 14.7). Personalized IPR scores were positively associated with both periodontitis progression and tooth loss.

4 Conclusions

These findings, upon additional validation, suggest that the periodontal/tooth profile classes and the derived personalized propensity scores provide clinical periodontal definitions that reflect disease patterns in the population and offer a useful system for patient stratification that is predictive for disease progression and tooth loss.     

Effects of primary hyperparathyroidism on oral health. A longitudinal register-based study

Objectives

To analyze the effects of primary hyperparathyroidism on oral health and to investigate if the effects are linked to severity of the disease.

Subjects and Methods

This prospective cohort study involved 6151 primary hyperparathyroidism patients registered in the Scandinavian Quality Registry of Thyroid, Parathyroid, and Adrenal surgery and the National Cancer Register after parathyroidectomy (exposure) during 2011–2017 (patient cohort) and 60,654 individuals without primary hyperparathyroidism (reference cohort), matched by age, gender, and county of resident at the date of parathyroidectomy. The outcomes were tooth extractions and periodontal interventions. The risk for the outcomes was assessed by Poisson regression models.

Results

After adjusting for covariates, the patient cohort had a higher incidence rate of tooth extraction during the two-year period after parathyroidectomy (IRR = 1.15; 95% CI = 1.01–1.31), but a lower incidence rate of periodontal interventions during the four- to six-year period after parathyroidectomy (IRR = 0.88; 95% CI = 0.79–0.99). Furthermore, patients with more severe primary hyperparathyroidism were more likely to have tooth extractions and periodontal interventions after parathyroidectomy.

Conclusions

The risk of tooth extraction increased slightly during the first two years after parathyroidectomy. Thereafter, the oral health effects subsided. Pre-surgical serum ionized calcium levels and adenoma weight may indicate negative dental outcomes after parathyroidectomy.     

Oral flurbiprofen spray for mucosal graft harvesting at the palatal area: A randomized placebo‐controlled study

1 Background

Flurbiprofen which is a non‐steroidal anti‐inflammatory drug (NSAID), has been safely used for the control of postoperative patient's morbidity after periodontal plastic surgeries requiring palatal graft harvesting, but there is little information on the efficacy of topical use. The aim of the study was to evaluate whether patient pain perception was reduced and patient morbidity was improved by using oral spray of flurbiprofen after palatal graft harvesting.

2 Methods

Forty‐eight patients (21 males and 27 females), scheduled for subepithelial connective tissue graft (SCTG) and free gingival graft (FGG) requiring periodontal plastic surgeries were selected. The patients were randomly assigned to each group and used oral spray of flurbiprofen or placebo three times a day for a week. The palatal donor area was evaluated at 1, 3, 7, 14, 21, 28, 42, and 56‐day follow‐up after the surgery for postoperative pain, patients’ discomfort, complete epithelialization, changes in dietary habits, burning sensation, color match, the amount of systemic analgesic consumption and the presence of delayed bleeding. Wound healing scores were recorded at 14‐day follow up.

3 Results

The prevalance of complete epithelialization was significantly higher in the placebo‐FGG group than flurbiprofen‐FGG group at 21 days postoperatively (P < 0.05), while there was no significant alteration for both flurbiprofen‐SCTG and placebo‐SCTG groups at any follow‐up periods. In flurbiprofen‐FGG group, significant improvements were observed for postoperative pain, patients’ discomfort and burning sensation at 14 days postoperatively (P < 0.05).

4 Conclusion

Oral flurbiprofen spray reduces patient's morbidity, however it might have negative effects on epithelialization of secondary wound healing after FGG operations.     

Root-dentin sensitivity following non-surgical periodontal treatment

BACKGROUND, AIMS: Little clinical data exist on the incidence and severity by which root dentin sensitivity (RDS) results from periodontal therapy. The aim of the present clinical trial was to study the degree to which a sample of patients requiring non-surgical periodontal treatment develops RDS. MATERIAL AND METHODS: Alterations in RDS was followed in 35 patients (29-65 years of age) requiring non-surgical treatment for moderate to advanced periodontal disease. Inclusion criteria for participation were need for periodontal treatment in at least 2 quadrants comprising a minimum of 4 teeth with vital pulps, no open caries lesions, no dental treatment in the last 3 months and no ongoing treatment for RDS. Baseline and follow-up recordings included responses of teeth to pain stimuli (directed compressed air) at buccal surfaces as graded by the patient on a 10-cm visual analogue scale (VAS). Periodontal therapy consisted of oral hygiene instruction (OH) followed by supra- and subgingival scaling/root planing by hand and ultrasonic instrumentation of one quadrant per each of the subsequent weeks. Thus, follow-up data included pain assessment after 1-3 weeks of OH alone, and 1-4 weeks post-instrumentation. RESULTS: There was a statistically significant reduction in mean VAS scoring over time in quadrants where only meticulous plaque control had been maintained, while VAS mean values increased significantly after instrumentation (p<0.001). Also the % of subjects reporting higher mean VAS values increased after instrumentation. Changes in mean VAS scores were generally moderate and only 9 patients gave an increase on VAS of >2 cm for 3 or more teeth. A statistically significantly higher increase of RDS was observed for initially sensitive teeth (VAS>0) than for teeth not responding at baseline (p<0.001). Although a reduction in the intensity of RDS could be noticed during the later phase of the 4-week follow-up period after scaling and root planing, the percentage of sensitive teeth remained unchanged. CONCLUSION: The data confirm that meticulous plaque control will diminish RDS problems and that scaling and root planing procedures in periodontal therapy result in an increase of teeth that respond to painful stimuli. However, pain experiences in general appeared minor and only a few teeth in a few patients developed highly sensitive root surfaces following instrumentation.     

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??Subgingival scaling and root planing plays a pivotal role in  periodontal initial therapy. It is the process of removing or eliminating the etiologic agents??including dental plaque and its products??and calculus??which cause inflammation??thus helping to establish a periodontium that is free of disease. The complications??after scaling and root planing??include gingival bleeding??periodontal abscess??tooth hypersensitivity??mobility??fever and so on. Here we discuss the pathogenesis and treatment of  the complications after scaling and root planing.     

Effectiveness of a transmucosal lidocaine delivery system for local anaesthesia during scaling and root planing

OBJECTIVE: This study compared the efficacy of transmucosal anaesthetic patches containing lidocaine (46.1 mg/2 cm(2)) to placebo for local anaesthesia during quadrant scaling and root planing using periodontal clinical indices and patient perception of pain. MATERIAL AND METHODS: Forty healthy adults with moderate periodontal disease and moderate subgingival calculus were scaled at weekly intervals, two quadrants randomized to treatment patches and two quadrants randomized to placebo patches. Bleeding, probing depths and attachment levels were evaluated prior to treatment and 1 month after quadrant scaling was completed. Subjects completed 100 mm visual analogue pain scales 15 min. after patch placement and at the end of treatment, and were asked for verbal assessment of perceived pain. RESULTS: Subjects' verbal ratings demonstrated consistently greater pain relief with active patches than placebo (p<0.0001). Visual analogue scales demonstrated significantly greater pain relief with the treatment patches after 15 min. (p=0.0003) and at the end of treatment (p=0.0149). Efficacy of periodontal therapy was equivalent for treatment and control groups. No adverse events were observed; localized minimal gingival irritation was noted in three subjects. CONCLUSION: Transmucosal lidocaine patches provided sufficient anaesthesia for therapeutic quadrant scaling and root planing procedures.     

Validity of self‐reported periodontal measures,demographic characteristics,and systemic medical conditions

1 Background

The objective of the present study was to assess self‐reported periodontal screening questions, demographic characteristics, systemic medical conditions, and tobacco use for predicting periodontal disease among individuals seeking dental therapy in a university dental clinic.

2 Methods

In this retrospective study, a total of 4,890 randomly selected dental charts were evaluated from among patients who had attended the University of Minnesota School of Dentistry clinics for treatment. Radiographic bone loss measurements were used to assess the severity of periodontal disease. Demographic characteristics as well as medical history of the patients were also recorded. Five self‐reported periodontal screening questions were included, with answers limited to Yes/No. Generalized logit models were used to assess the association between bone loss and the predictors.

3 Results

The sample's mean age was 54.1 years and included 52.6% males and 14.9% smokers, with a mean of 3.5 missing teeth. Self‐reported tooth mobility, history of “gum treatment,” and the importance of retaining teeth as well as age, tobacco use, and cancer were statistically significant predictors (P < 0.05) of a radiographic diagnosis of moderate and severe periodontal disease. With respect to severe periodontal disease, significant associations (P < 0.05) were also found with “bleeding while brushing,” gender, diabetes, anxiety, and arthritis.

4 Conclusions

Self‐reported periodontal screening questions as well as demographic characteristics, smoking, and systemic medical conditions were significant predictors of periodontal disease, and they could be used as valid, economic, and practical measures.     

Influence of periodontitis and scaling and root planing on insulin resistance and hepatic CD36 in obese rats

1 Background

The aim of the study was to explore the influence of periodontitis and scaling and root planing (SRP) on insulin resistance and hepatic CD36 in obese rats with periodontitis.

2 Methods

Thirty‐two specific pathogen free Sprague‐Dawley rats were randomly divided into four groups of eight animals each as follows: healthy rats (healthy group), obese rats (obesity group), obese rats with periodontitis (non‐therapy group), and obese rats with periodontitis who underwent periodontal SRP (therapy group). Rats were fed with a high‐fat diet for 16 weeks to build an obesity model. Periodontal inflammation was induced by performing periodontal ligation with Porphyromonas gingivalis. The tissue around the maxillary second molars, bilaterally, were collected. The periodontal attachment level (from the cemento‐enamel junction to the bottom of the periodontal pocket) of the second molars was measured in all groups. All rats were subjected to fasting blood glucose, insulin, and serum C‐reactive protein tests (CRP). Insulin resistance was evaluated by homeostasis model assessment of insulin resistance (HOMA‐IR), oral glucose tolerance test (OGTT), and area under the curve (AUC). The liver was excised to detect intrahepatic free fatty acid (FFA) levels and pathologic observation. Real‐time quantification PCR, western blot, and immunohistochemistry were applied to detect hepatic CD36 expression.

3 Results

Compared with the obesity group, HOMA‐IR, AUC, intrahepatic FFA, and protein expression, and mRNA levels of hepatic CD36 in the non‐therapy group were significantly increased (P < 0.05). HOMA‐IR, AUC, CRP, protein expression, and mRNA levels of hepatic CD36 were all significantly decreased (P < 0.05) 2‐weeks after SRP.

4 Conclusions

Periodontitis increases insulin resistance while scaling and root planning could improve insulin resistance. Hepatic CD36 regulation may be considered a potential mechanism for this phenomenon.     

Povidone-iodine as a periodontal pocket disinfectant

OBJECTIVES AND BACKGROUND: Povidone-iodine [polyvinylpyrrolidone-iodine complex (PVP-iodine)] might constitute a valuable adjunct to current periodontal therapy because of its broad-spectrum antimicrobial activity, low potential for developing resistance and adverse reactions, wide availability, ease of use, and low financial cost. This investigation employed a randomized, split-mouth study design to determine the microbiological and clinical effects of 10% PVP-iodine subgingival irrigation in periodontitis lesions showing radiographic evidence of subgingival calculus. METHODS: Sixteen adults having at least one periodontal pocket of 6 mm or more in each quadrant of the dentition and harboring one or more periodontopathic bacteria participated in the study. In each subject, a study site in each quadrant was randomly chosen to receive either subgingival irrigation with 10% PVP-iodine together with scaling and root planing, scaling and root planing alone, subgingival irrigation with 10% PVP-iodine, or subgingival irrigation with sterile saline. Prior to therapy and at 5 weeks post-treatment, microbiological culture was carried out without knowledge of the clinical status or the type of treatment rendered. A blinded clinical examiner determined presence of dental plaque, probing pocket depth, and gingival bleeding on probing. Microbiological and clinical data were analyzed using a repeated measures analysis of variance and Kruskal-Wallis rank test with the Tukey and Mann-Whitney post hoc tests. RESULTS: At 5 weeks post-treatment, subgingival irrigation with PVP-iodine together with scaling and root planing caused a 95% or greater reduction in total pathogen counts in 44% of pockets having >/= 6 mm depth whereas scaling and root planing alone, povidone-iodine irrigation alone and water irrigation alone caused 95% reduction of total pathogens only in 6-13% of similar study sites (P = 0.02). Reduction in mean pocket depth was 1.8 mm for the PVP-iodine/scaling and root planing group, 1.6 mm for the scaling and root planing group, and 0.9 mm for the PVP-iodine and the saline monotherapy groups, with statistical significance reached for the scaling and root planing group vs. the PVP-iodine group (P = 0.04) and for the scaling and root planing group vs. the saline group (P = 0.02). Reduction in visible dental plaque, which ranged from 38% to 62%, showed no significant differences among treatment groups. CONCLUSIONS: The addition of subgingival PVP-iodine irrigation to conventional mechanical therapy may be a cost-effective means of reducing total counts of periodontal pathogens and helping control periodontal disease. However, subgingival irrigation with PVP-iodine without concomitant mechanical debridement might not improve microbiological and clinical variables in comparison with saline irrigation, at least not in sites with radiographic evidence of subgingival calculus.     

Factors affecting patients' and potential patients' choices among anaesthetics for periodontal recall visits

OBJECTIVES: Dentinal hypersensitivity and recurrent disease may necessitate the use of anaesthetic during periodontal recall visits. However, an aversion to injections may affect patient compliance. The objectives of this study were to determine choices patients and 'potential' patients make when provided with information on the risks and benefits of alternative anaesthetic choices for root planing during periodontal recalls and to examine which factors influence these choices. METHODS: Using an interactive computer tool, scenarios described the risks and benefits of root planing during periodontal maintenance and the anaesthetic alternatives (no anaesthetic, an experimental thermosetting gel anaesthetic and traditional local infiltration anaesthesia). Compliant patients for whom anaesthesia was recommended during recall cleanings were recruited from private periodontal practices (n=97). General population subjects (potential patients) were recruited by random digit dialing (n=196) RESULTS: As dental insurance was one of the inclusion criteria, the sample was representative of a working population. Most subjects reported tooth sensitivity (recall 84.5%, general 59.9%). The majority of patients wanted some form of anaesthetic, either gel (recall 82.5%, general 81.0%) or local infiltration (recall 10.3%, general 16.4%). Fifty-five percent of subjects reported moderate or severe pain from their previous dental injection(s). Asked if they were to have a dental needle tomorrow, 52.5% would be somewhat or very anxious. Of those who chose gel, 63.47% would be more or much more willing to return for recall visits if the gel were available. Using multivariate logistic regression, concern about pain and anxiety associated with needles were the only statistically significant characteristics associated with anaesthetic preference. CONCLUSIONS: Concern about pain and anxiety associated with needles dominates preferences for dental anaesthesia. The overwhelming preference for a non-injectable anaesthetic reveals a strong clinical need for such alternatives.     

Change in self‐reported oral health in relation to use of dental services over 2 yr

To investigate change in oral health in relation to use of dental services, a random sample of 45‐ to 54‐yr‐old subjects from Adelaide, South Australia, was surveyed in 2004–2005 (n = 986, response rate = 44.4%). Service use and a global oral‐health transition (GOHT) statement were collected over 2 yr. Worsening in oral health was reported from the GOHT statement by 25% of persons, while improvement was reported by 30%. Prevalence ratios (PRs, 95% CI), adjusted for sex, education, health card status, and toothbrushing, showed that worsening oral health was inversely associated with dental visiting (PR = 0.5, 0.4–0.7) and with scaling and cleaning services (PR = 0.6, 0.4–0.9), whereas extractions (PR = 2.3, 1.6–3.4) and dentures (PR = 2.2, 1.3–3.7) were associated with a higher prevalence of worsening. Scaling and cleaning services were associated with improvement in oral health (PR = 1.5, 1.01–2.3), while endodontic services were inversely associated with improvement (PR = 0.3, 0.1–0.9). Worsening in oral health was associated with extractions and dentures and was inversely associated with visiting and preventive care. Improvement in oral health was associated with preventive care and was inversely associated with endodontic treatment.     

Factors associated with pain induced by orthodontic separators

Pain resulting from the application of orthodontic forces varies markedly across individuals. The reasons of this variability are still largely unknown. To investigate factors that may be associated with orthodontic pain following the application of orthodontic separators. One hundred and seven participants were screened for pain response over 48 h following placement of orthodontic elastomeric separators. The highest (n = 10) and lowest (n = 10) pain responders were identified, and data collected on tooth pain sensitivity to electrical stimulation in conjunction with using the Pain Catastrophising Scale (PCS), Dental Anxiety Scale (DAS) and cold pressor test (CPT). There were statistically significant differences between high‐ and low‐pain responders in catastrophising score (P ≤ 0·023). For every PCS magnification score of 1 unit higher, the relative risk of being a high‐pain responder was 1·6 (P = 0·002); those scoring higher on helplessness had a lower risk of being so. DAS scores of high‐pain responders were twice as high as those of low‐pain responder (P = 0·043). During the first 2 min of CPT, the high‐pain responders experienced more pain than the low‐pain responders (P ≤ 0·029). Tooth pain thresholds did not differ between the two different pain responder groups. Pain catastrophising, dental anxiety and cold sensitivity appear to modify the pain experienced following placement of orthodontic separators. Further research is needed to determine the validity of screening questions to identify at‐risk patients prior to commencing orthodontic treatment.     

A placebo-controlled multi-centred evaluation of an anaesthetic gel (Oraqix) for periodontal therapy

AIMS: Six Canadian dental schools investigated the ability of a thermosetting gel containing 25 mg/g prilocaine and 25 mg/g lidocaine as active agents to produce analgesia in periodontal pockets utilizing a randomized, double-blind, placebo-controlled study. MATERIALS AND METHODS: The study consisted of 130 patients, each of whom received the active or placebo gel in periodontal pockets in one quadrant of the mouth for 30 s prior to periodontal debridement (scaling and root planing). Pain was measured using both a 100-mm Visual Analogue Scale (VAS) and a Verbal Rating Scale (VRS). RESULTS: The median VAS pain score for the patients treated with the anaesthetic gel was 5 mm (range 0-85 mm) as opposed to 13 mm (range 0-79 mm) in the placebo-treated patients (P=0.015). There was no significant difference in the percentage of patients reporting no or mild pain (78% and 76% for the anaesthetic gel and placebo, respectively). No significant differences were seen in patient demographics, or mandible versus maxilla. CONCLUSIONS: The VAS pain scores showed that the anaesthetic gel 5% was statistically more effective than the placebo in reducing pain during periodontal debridement.     

Meta-analysis of the effect of scaling and root planing,surgical treatment and antibiotic therapies on periodontal probing depth and attachment loss

OBJECTIVE: This paper reports a meta-analysis of studies that have investigated the effect of scaling and root planing on periodontal probing depth and attachment loss. MATERIAL AND METHODS: The criteria used for inclusion of studies were as follows: root planing and scaling alone was one of the primary treatment arms; patients or quadrants of each patient were randomly assigned to study groups; 80% of patients enrolled were included in first year follow-up examinations; periodontal probing depth and attachment loss were reported in mm; the sample size of each study and substudy was reported. Sample size was used to weight the relative contribution of each study since standard errors were not reported by many studies and sample size is highly correlated with standard error and therefore statistically able to explain a substantial portion of the standard error on studies that use similar measures. RESULTS: The meta-analysis results show that periodontal probing depth and gain of attachment level do not improve significantly following root planing and scaling for patients with shallow initial periodontal probing depths. However, there was about a 1-mm reduction for medium initial periodontal probing depths and a 2-mm reduction for deep initial periodontal probing depths. Similarly, there was about a 0.50-mm gain in attachment for medium initial periodontal probing depth measurements and slightly more than a l-mm gain in attachment for deep initial periodontal probing depth measurements. Surgical therapy for patients with deep initial probing depths showed better results than scaling and root planing in reducing probing depths. When patients were followed up over 3 years or more, these differences were reduced to less than 0.4 mm. Antibiotic therapy showed similar results to scaling and root planing. However, a consistent improvement in periodontal probing depth and gain of attachment is demonstrated when local antibiotic therapy is combined with root planing and scaling.     

The effects of periodontal curette handle weight and diameter on arm pain: A four-month randomized controlled trial

BackgroundThe design of periodontal curette handles may cause or aggravate arm pain in dental practitioners. The authors conducted a four-month randomized controlled trial to evaluate the effects of curette handle diameter and weight on arm pain among dental hygienists and dentists.MethodsOne hundred ten dental hygienists and dentists who performed scaling, root planing or dental prophylaxis procedures participated in this study. The authors assessed right wrist/hand, elbow/forearm and shoulder pain levels weekly. They randomized participants to receive either a set of light (14 grams) periodontal curettes with a large diameter (11 millimeters) or a set of heavy (34 g) periodontal curettes with a narrow diameter (8 mm). The authors compared changes in mean pain scores across the study period between intervention groups by using general linear models and controlling for covariates.ResultsThe improvement in pain scores across the three body regions was greater for participants who used the lighter, wider-diameter curettes. In the final adjusted model, the differences were statistically significant only for the shoulder region (P = .02).ConclusionsThe study results show that dental instrument design has an effect on upper-extremity pain in dental practitioners. Using a lighter instrument with a wider diameter may be an easy and cost-effective intervention to reduce or prevent upper-extremity pain associated with dental hygiene procedures.Clinical implicationsTo prevent or reduce arm pain, practitioners should consider using lightweight instruments with large diameters when performing scaling and root planing procedures.     

Commentary: Is There Clinical Benefit From Using a Diode or Neodymium:Yttrium‐Aluminum‐Garnet Laser in the Treatment of Periodontitis?

Despite a quarter of a century of laser research, there is a persistent debate regarding the efficacy of dental lasers in the treatment of periodontitis or periodontal maintenance therapy. There are many claims and much hyperbole surrounding the use of lasers, either as a monotherapy or adjunctive to scaling and root planing, to treat periodontitis. There is little evidence that using a diode or neodymium:yttrium‐aluminum‐garnet laser adds clinical value over and above conventional non‐surgical or surgical periodontal treatment. There is a significant need for better designed human clinical trials. Data from such trials should be analyzed according to initial probing depth and characteristics of the treated sites, such as non‐molar, molar flat surfaces, and molar furcations, and evaluated for long‐term post‐treatment results.     

Periodontal disease and its connection to systemic biomarkers of cardiovascular disease in young American Indian/Alaskan natives

1 Background

Periodontal disease has been shown to be associated with cardiovascular disease (CVD). No known studies evaluate the relationship between periodontal disease status and biomarkers of CVD risk in the American Indian/Alaskan Native (AI/AN) population despite their disproportionately high rates of poor oral health and cardiovascular disease–related outcomes. This study compared levels of interleukin (IL)‐6 and C‐reactive protein (CRP) across increasing severity of periodontal disease status among younger adults between the ages of 21 and 43 years.

2 Methods

Plasma levels of IL‐6 and CRP were measured in adult participants (ages 21 to 43 years) as part of a study of periodontal disease and CVD risk among an AI/AN population in southern California (n = 59). Periodontal evaluations were performed and disease status was classified into three categories based on highest probing depth (none/mild: < 3 mm; moderate: 4 to 5 mm; severe: ≥6 mm). Participants with known systemic disease or active infection were excluded.

3 Results

Severe periodontitis was significantly associated with increased levels of IL‐6 compared with those with none or mild periodontitis before controlling for other variables (P = 0.02), but lacked significance after controlling for sex, BMI, smoking status, and high‐density lipoprotein (P = 0.09). Moderate periodontal disease was positively associated with IL‐6 levels after controlling for potential confounders (P = 0.01). Periodontal status was not associated with CRP, before or after adjusting for covariates.

4 Conclusions

In this otherwise healthy AI/AN adult sample, moderate periodontal disease compared with none or mild periodontal disease was associated with increased levels of IL‐6. High levels of CRP found in this population warrant further research.     

Progressive muscle relaxation therapy to relieve dental anxiety: a randomized controlled trial

Dental anxiety causes patients to refuse or delay treatment, which may exacerbate oral diseases. The aim of the current randomized controlled trial was to determine whether progressive muscle relaxation therapy could relieve dental anxiety. The trial included 68 periodontal patients with dental anxiety scores of ≥13 who were randomly assigned to either an intervention group or a control group (n = 34 per group). The intervention group was administered progressive muscle relaxation therapy for 20 min and oral health education for 15 min before periodontal treatment once per week for 4 wk. The control group was provided with oral health education only, for the same duration. Changes in dental anxiety, depression symptoms, blood pressure, heart rate, and salivary cortisol were evaluated 4 wk and 3 months after the intervention. The intervention group exhibited statistically significantly greater reductions in dental anxiety scores than did the control group at the 4‐wk (?3.82 vs. ?0.89) and 3‐month (?4.22 vs. ?0.28) assessments. They also exhibited significantly greater reductions in depression symptoms, systolic and diastolic blood pressure, pulse rate, and salivary cortisol levels at both time‐points. Progressive muscle relaxation therapy relieves tension and anxiety in dental patients.     

Antimicrobial photodynamic therapy for the treatment of periodontitis and peri‐implantitis: An American Academy of Periodontology best evidence review

1 Background

This systematic review evaluates the efficacy of antimicrobial photodynamic therapy (aPDT), as an adjunct to non‐surgical or surgical therapy, on clinical and patient‐centered outcomes in patients with periodontitis or peri‐implantitis.

2 Methods

Randomized controlled trials (RCTs) with a follow‐up duration ≥ 3 months that evaluated mechanical root/implant surface debridement (i.e., scaling and root planing [SRP] or implant surface scaling [ISS]) versus SRP or ISS plus aPDT for the treatment of adult patients (≥ 18 years old) with moderate‐to‐severe chronic (CP)/aggressive periodontitis (AgP) or peri‐implantitis, respectively, were considered eligible for inclusion. The MEDLINE, EMBASE, and CENTRAL databases were searched for articles published up to and including March 2017. Random‐effects meta‐analyses were used throughout the review using continuous data (i.e., mean changes from baseline), and pooled estimates were expressed as weighted mean differences with their associated 95% confidence intervals. Additionally, summaries are presented of the included RCTs, critical remarks of the literature, and evidence quality rating/strength of recommendation of laser procedures.

3 Results

Of 729 potentially eligible articles, 28 papers (26 studies) were included in the review. Individual study outcomes and four sets of meta‐analysis showed potential statistical significant benefit of aPDT in improving clinical attachment level (CAL) (non‐surgical treatment of AgP) and probing depth (PD) (non‐surgical treatment of AgP and CP). However, the comparative differences in clinical outcomes were modest (< 1 mm), and the level of certainty for different therapies was considered low‐to‐moderate (i.e., more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes). Overall, most of the strengths of clinical recommendations of aPDT were guided by the expert opinion.

4 Conclusions

aPDT may provide similar clinical improvements in PD and CAL when compared with conventional periodontal therapy for both periodontitis and peri‐implantitis patients. The restricted base of evidence for some treatment approaches and conditions precludes additional conclusions.