Radiographic survey of periodontal disease in 264 adolescent schoolboys in Lagos, Nigeria

Periapical radiographs were taken of central incisor and first molar teeth in 264 Nigerian boys (12–20 years) from a school in Lagos. From the radiographs, bone loss involving central incisors and first molars was measured. Bone loss was evident in 28.4% of subjects examined. The prevalence of bone loss rose through the age groups from 23.2% at 12–13 years to 34.6% at 18–20 years. Over all ages the prevalence of bone loss involving mandibular central incisors was 14.4%, mandibular first molars 9.8%, maxillary first molars 8.3% and maxillary central incisors 7.6%. Two subjects showed features characteristic of juvenile periodontitis (periodontosis).     

Retrospective study of teeth with a poor prognosis following non-surgical periodontal treatment

Aim: The aim of this retrospective study was to assess teeth with a poor prognosis and the proximal periodontium of adjacent teeth, and to identify the risk factors associated with the loss of teeth with a poor prognosis following non-surgical periodontal treatment.
Material and Methods: Teeth with a poor prognosis ( n =113), teeth adjacent to those of poor prognosis ( n =105) and non-adjacent teeth ( n =51) were evaluated in 25 non-smoking patients who had received supportive periodontal treatment for 5–16 years following non-surgical periodontal treatment at a university hospital.
Results: Probing pocket depth (PPD), percentage of alveolar bone loss, presence of tooth mobility and bleeding on probing in all teeth improved significantly after treatment. Logistic regression analysis showed that loss of teeth with a poor prognosis depended on the initial deepest PPD, tooth mobility and multi-rooted tooth.
Conclusions: Teeth with a poor prognosis did not affect the proximal periodontium of the adjacent teeth, and progression of periodontal disease in these teeth and adjacent teeth can be prevented by non-surgical periodontal treatment in non-smokers. The risk factors for loss of teeth with a poor prognosis were the initial deepest PPD, tooth mobility and multi-rooted tooth.     

The effect of ketoprofen creams on periodontal disease in rhesus monkeys

Ketoprofen creams were evaluated for the treatment of periodontal disease in a placebo-controlled, double-blind study in the rhesus monkeys, Macaca mulatta. Two formulations containing ketoprofen (1%), with or without vitamin E, were evaluated against appropriate controls (8 monkeys per group). Two weeks prior to treatment, the animals received prophylaxis on only the left side of the mouth (spontaneous model). Selected teeth on the right side of the mouth were ligated (ligature model). The creams were administered to the gingiva once daily at a standard dose of 1.8 ml per monkey for 6 months. Clinical assessments were made 2 wk before initiation, at baseline and 1, 2, 3 and 6 months post-treatment. The clinical parameters included plaque formation, gingival redness, edema, bleeding on probing and Ramfjord Attachment Level measurements (RAL). Radiographs were taken at 2 wk before initiation, baseline and at 3 and 6 months post-treatment. Digital subtraction radiography was used to measure vertical linear bone loss along the interproximal root surfaces of the left and right mandibular first molars. Gingival crevicular fluid (GCF) was collected for biochemical assays on PGE₂, TxB₂, LTB₄, IL-1β and TNFα. There were no significant differences among groups with respect to gingival indices. Radiographic data demonstrated significant positive effects on bone activity in both groups treated with ketoprofen formulations with improvement over time in the ligature model (0.01 ≤p≤ 0.04). The placebo group exhibited bone loss of 1.96±0.48 and 1.40±0.56 mm per site at 3 and 6 months, respectively. The group treated with ketoprofen cream showed an apparent bone gain of 0.28±0.41 and 0.78±0.47 mm per site at 3 and 6 months, respectively. The group treated with ketoprofen cream containing vitamin E showed a mean bone loss of 0.41–0.48 mm per site at 3 months with improvement to an apparent bone gain of 0.31±0.44 mm per site at 6 months. The biochemical data demonstrated early and significant suppression of GCF-LTB₄ by both ketoprofen formulations at 1 month, which preceded the significant suppression of GCF-PGE₂ at 2 and 3 months in the ligature model (p≤0.003) and at 2 to 6 months in the spontaneous model (p≤0.02). We conclude that ketoprofen at 1% level in suitable topical vehicles can effectively inhibit GCF-LTB₄ and GCF-PGE₂ and positively alter alveolar bone activity in the ligature-induced model of periodontitis in the monkey.     

The association between vitamin D level and periodontal disease in Saudi population,a preliminary study

ObjectiveAmong other regulatory functions, vitamin D has a role in modulating the inflammatory process of periodontal disease. Therefore, this retrospective study aimed to assess the relationship between vitamin D levels and periodontal health in dental patients from the Eastern Province of Saudi Arabia.MethodsRadiographs and serum vitamin D levels of patients seeking dental treatment were collected. Exclusion criteria were systemic disease, smoking, recent vitamin D supplementation, and previous periodontal surgery. Gender, age, and alveolar crest height (ACH) were recorded. A total of 67 patients were categorized into three groups according to their serum vitamin D level (<10, <20, and > 20 ng/mL) and their bone loss compared.ResultsDifferences in means were compared by t-test. ANOVA was used to compare vitamin D groups and the corresponding ACH, as well as the correlation (p < .05). Patients with vitamin D levels > 20 ng/mL demonstrated a mean ACH of 1.6 mm. The mean ACH was 3.1 mm for those with vitamin D levels < 20 ng/mL, and 4.6 mm for vitamin D levels < 10 ng/mL. A weak negative correlation was found between vitamin D and ACH in all groups (r = −0.055, p = .7).ConclusionSerum vitamin D level seems to be an important factor that influences oral health, especially the periodontal condition, of both male and female patients.     

A radiographic survey of periodontal conditions in Greece

Abstract The present study used radiographic assessments to evaluate the pattern of destructive periodontal disease in a rural and an urban sample of 25—64 year old Greek adults. The rural sample (A) comprised 190 subjects and the urban sample (B) 400 subjects. 13% of the subjects in sample A and 8% in sample B were edentulous. Full-mouth intraoral radiographs were obtained from the 503 dentate subjects and were examined with respect to (i) number and type of teeth present, and (ii) alveolar bone level (ABL), i.e., the distance between the cementoenamel junction and the alveolar bone crest at the approximal tooth surfaces. The results revealed that alveolar bone loss was ubiquitous in both samples. Pronounced bone loss, however, (i.e., a subject mean ABL of >6 mm) affected 18% (sample A) and 8% (sample B) of the individuals. Although an ABL of >6 mm was scored at 7.2 sites/subject in sample A and at 4.5 sites/subject in sample B, more than 10 such sites were found in 23% (A) and 11% (B) of the examined subjects. 25%) of the subjects in the rural sample (A) and 12% in the urban sample (B) accounted for 75% of the total number of tooth sites with pronounced bone loss. Multiple regression revealed that age and number of remaining teeth were the parameters most strongly correlated with the amount of bone loss on both the individual subject and the tooth site level. The present findings (i) demonstrated a high prevalence and severity of destructive periodontal disease in these 2 samples, and (ii) confirmed the skewed distribution of advanced disease in the population.     

Mineral status of skeleton and advanced periodontal disease

Abstract Studies of the effect of general bone loss on periodontal condition and on development of periodontal pockets suggest that there is no clear correlation between periodontal health or number of teeth and the general mineral status of the skeleton. In some reports, however, deep periodontal pockets have been correlated with good mineral status in the jawbones and skeleton. The purpose of this study of 227 healthy postmenopausal women aged 48 to 56 years was to determine whether advanced alveolar bone loss, diagnosed by panoramic radiographs, and periodontal probing depths or number of remaining teeth were correlated with the bone mineral status of the skeleton and cortical bone in the mandible. The results suggest that individuals with high mineral values in the skeleton seem to retain their teeth with deep periodontal pockets more easily than those with osteoporosis. This finding may especially motivate treatment of persons suffering from advanced periodontal disease but having good mineral status.     

Natural history of periodontal disease in man

Abstract This paper describes the initiation, rate of progress of periodontal disease and consequent tooth loss in a population never exposed to any programs or incidents relative to prevention and treatment of dental diseases. The group consisted of 480 male laborers at two tea plantations in Sri Lanka. The study design and baseline data have been published. At the initial examination in 1970, the age of the participants ranged between 14 and 31 years. Subsequent examinations occurred in 1971, 1973, 1977, 1982 and 1985. Thus, the study covers the age range 14–46 years. Throughout the study, the clinical indices were scored by the same two examiners, both well-trained and experienced periodontitis. Intra-examiner reproducibility for each index was tested at baseline and repeated periodically during the study. The data for each examination were computerized and updated on an ongoing basis. At the last examination in 1985, there were 161 individuals who had participated in the first survey. This population did not perform any conventional oral hygiene measures and consequently displayed quite uniformly large aggregates of plaque, calculus and stain on their teeth. Virtually all gingival units exhibited inflammation. Based on interproximal loss of attachment and tooth mortality rates, three subpopulations were identified: (1) individuals (～8%) with rapid progression of periodontal disease (RP), those (～81%) with moderate progression (MP), and a group (～11 %) who exhibited no progression (NP) of periodontal disease beyond gingivitis. At 35 years of age, the mean loss of attachment in the RP group was ～9 mm, the MP group had ～4 mm and the NP group had less than 1 mm loss of attachment. At the age of 45 years, the mean loss of attachment in the RP group was ～13 mm and the MP group ～7 mm. The annual rate of destruction in the RP group varied between 0.1 and 1.0 mm, in the MP group between 0.05 and 0.5 mm, and in the NP group between 0.05 and 0.09 mm. Since this population was virtually caries free, essentially all missing teeth were lost due to periodontal disease. In the RP group, tooth loss already occurred at 20 years of age and increased throughout the next 25 years. At 35 years of age, 12 teeth had been lost, at 40 years of age 20 teeth were missing and at 45 all teeth were lost. In the MP groups, tooth mortality started after 30 years of age and increased throughout the decade. At 45 years of age, the mean loss of teeth in this group was 7 teeth. The NP group essentially showed no tooth loss.     

An association between long-term non-steroidal anti-inflammatory drug therapy and the severity of periodontal disease

The present study was undertaken to compare the periodontal status of a group of 50 patients on long-term non-steroidal anti-inflammatory drug (NSAID) therapy with that of an age and sex-matched group of 42 controls. The mean duration of drug therapy in the study group was 9 years (range 2-30 years). The clinical parameters investigated were plaque index (PI), gingival index (GI), pocket probing depth (PPD), loss of attachment (LOA), gingival recession (GR) and gingival fluid flow (GFF). Long cone periapical radiographs were also taken to score the amount of alveolar bone resorption. Examinations were carried out on 6 Ramfjord teeth in each subject. The results showed that there were no significant differences between the groups for PI, GI, PPD, LOA, GR or alveolar bone resorption. However, a highly significant difference was seen between the gingival fluid flow in the study (16.74 +/- 10.61) and control (37.72 +/- 28.63) groups (p less than 0.001). It is suggested that this may be associated with the specific effects of NSAIDs in reducing the vascularity and permeability of small blood vessels.     

Autophagy and its significance in periodontal disease

Autophagy is an evolutionarily conserved process essential for cellular homeostasis and human health. As a lysosome‐dependent degradation pathway, autophagy acts as a modulator of the pathogenesis of diverse diseases. The relationship between autophagy and oral diseases has been explored in recent years, and there is increasing interest in the role of autophagy in periodontal disease. Periodontal disease is a prevalent chronic inflammatory disorder characterized by the destruction of periodontal tissues. It is initiated through pathogenic bacterial infection and interacts with the host immune defense, leading to inflammation and alveolar bone resorption. In this review, we outline the machinery of autophagy and present an overview of work on the significance of autophagy in regulating pathogen invasion, the immune response, inflammation, and alveolar bone homeostasis of periodontal disease. Existing data provide support for the importance of autophagy as a multi‐dimensional regulator in the pathogenesis of periodontal disease and demonstrate the importance of future research on the potential roles of autophagy in periodontal disease.     

The significance of alveolar bone in periodontal disease

The periodontal conditions in 19 patients with unilateral cleft lip, alveolus and palate (CLAP) and in 6 patients with bilateral CLAP, were evaluated in 1979 and re-examined in 1987. During these 8 years, these patients were not subjected to any professionally supervised maintenance care program. Pronounced plaque accumulation and high frequency of gingival units exhibiting bleeding on probing were noted in the majority of the patients both in 1979 and 1987, documenting inadequate oral hygiene standards with resulting inflammatory reactions of the periodontal tissues. Progression of periodontal disease over time was assessed as loss of clinical attachment and loss of alveolar bone height. The periodontal destruction was not found to be more severe at cleft sites with a long connective tissue attachment than at control sites not affected by cleft defects. It was concluded that sites with a long supracrestal connective tissue attachment do not seem to be more prone to periodontal destruction, induced by bacterial infection, than sites with a normal length of the supraalveolar fibrous attachment. The results also show that the alveolar bone height, as visualized in radiographs at sites with alveolar defects, is of limited value for the diagnosis of the degree of periodontal destruction at such sites.     

A comprehensive approach to assigning periodontal prognosis

Aim

The purpose of this retrospective case series study was to evaluate the usefulness and performance of a comprehensive approach to assigning periodontal prognosis by assessing the risk of tooth loss due to periodontal disease (TLPD) and estimate the survival time (ST) of periodontally compromised teeth (PCT).

Material and Methods

The Long‐Term Outcome (LTO) index was utilized to assess the risk of TLPD, at baseline, in 100 patients following periodontal maintenance for a mean 24.7 year (±2.4). A TLPD prediction model was utilized to assign ST to PCT. The performance of the TLPD prediction based on both parameters was assessed.

Results

The mean TLPD rate increased as the LTO index increased (Kruskal–Wallis p < .001). The percentage of TLPD increased as the ST decreased, with significantly differences between the LTO categories <4 and ≥4 for all ST intervals (Mann–Whitney p < .001 to p .021). Only 21% of PCT were lost. This percentage was 58% for teeth assigned the shortest ST and increased to 71% and 88% for these teeth in LTO ≥4 patients.

Conclusions

This approach might be useful to predict TLPD in patients with an initial higher risk of TLPD while it was not useful in patients with lower risk of TLPD.     

Radiographic and clinical examination of periodontal status of first molars in 15–16-year-old Danish schoolchildren

Abstract – The prevalence of alveolar bone loss was investigated in 2813, 15- and 16-year-old Danish schoolchildren using bitewing radiographs. The interproximal spaces of the mesial and distal aspects of the first molar tech were examined. Inly defects with depths of more than 2 mm were considered periodontal bone loss. Radiographic evidence of bone resorption was found in 48 children. When evaluated clinically, 42 out of the 48 children with radiographic sings of bone loss demonstrated clinical loss of attachment. Only four children (0.1%) had the characteristic radiographic features of juvenile periodontitis. Loss of attachment of more than 2 mm was oberved in these children.     

A longitudinal study of the relationship between periodontal disease and bone mineral density in community-dwelling older adults

OBJECTIVE: Bone loss is a common feature of periodontitis and osteoporosis. Both diseases may share common etiologic agents which may either affect or modulate the process of both diseases. The purpose of this study was to evaluate the relationship between systemic bone mineral density (BMD) and periodontal disease among older people. MATERIALS AND METHODS: Among all 4,542 inhabitants aged 70 years according to a registry of residents in Niigata city in Japan, 600 people were selected randomly. One hundred and eighty-four subjects who did not have diabetes mellitus, whose blood sugar was <140 mg/dl, who had more than 20 teeth, who were non-smokers, and who did not take medication for osteoporosis, were included in the study. Four dentists performed clinical evaluations on probing attachment level (PAL). We also utilized the data on BMD of the heel, which we measured using an ultrasound bone densitometer. Follow-up clinical surveys were done by measuring PAL after 3 years. Finally, 179 subjects who could participate in both the baseline and the follow-up examinations were included in the analysis. After dividing the subjects into an osteopenia group (OG) and non-osteopenia group (NOG), we evaluated the relationship between BMD and the number of progressive sites which had > or =3 mm additional attachment loss during 3 years after controlling the known confounding factors. RESULTS: The mean number of progressive sites for the OG and the NOG, respectively, were 4.65+/-5.51 and 3.26+/-3.01 in females and 6.88+/-9.41 and 3.41+/-2.79 in males. Two-way analysis of variance was performed to discriminate among effects of gender, BMD, and gender-BMD interaction. A significant effect of BMD (OG or NOG, p=0.043) with a significant interaction (p=0.038) was observed. Furthermore, BMD was associated with the number of progressive sites which had > or =3 mm additional attachment loss during the 3 years (p=0.001) by multiple linear regression analysis. CONCLUSIONS: This study suggested that there was a significant relationship between periodontal disease and general BMD.     

Tooth mortality and periodontal conditions in 60–80-year-old Chinese

Abstract — The study comprised 544 persons aged 60 yr or more from two urban Residential Areas and one rural village (including a nursing home) of Beijing area. Overall, the sample accounted for 81% of the total population of elderly aged 60 yr or more in the village/areas so defined. Each person was examined for dental status, plaque, calculus, gingivitis, loss of attachment, pocket depth and tooth mobility. Edentulousness was seen in 0–29% of trie persons examined, depending on age and sex. The mean number of teeth present ranged from 6.9 to 23.9, depending on age, sex, and area. The oral hygiene was poor; approximately 50% of all surfaces had immediately visible plaque deposits and calculus. About 50% of the surfaces had a loss of attachment ≥4 mm, while less than 15% presented pockets ≥4 mm. More than 50% of the individuals had loss of attachment ≥4 mm on more than 40% of their surfaces. The proportion of surfaces per person with loss of attachment ≥7 mm; and pockets ≥4 mm, respectively, showed a pronounced skewed distribution. These findings indicate that a subfraction of individuals is responsible for a substantial proportion of the severe periodontal breakdown leading to loss of teeth. This, in turn, raises important questions as to the most appropriate strategies for the prevention and control of periodontal diseases for the Chinese population.