Development of gingivitis in pre-school children and young adults

Earlier studies suggest that children and adults differ in the propensity to develop gingivitis when oral hygiene is abandoned. To confirm the existence of such a difference, a comparative study of pre-school children and young adults was made with objective registration methods. The author performed all registrations. After a period of intensive oral hygiene, all cleaning of teeth was discontinued for 21 days. The amount of bacterial plaque, the amount of gingival exudate and crevicular leukocytes and the bleeding tendency were registered on days 0, 7, 14 and 21. During the experiment the amount of bacterial plaque increased continously in both groups. The amount of gingival exudate and the tendency to gingival bleeding increased to high values in the adults, while only a small rise was seen in the children. The amount of crevicular leukocytes increased in both groups, but the increment was greater in the adults. A comparison concerning differences in gingival exudate and bleeding tendency between pre-school children and adults was undertaken for gingival units that showed a similar plaque development. Under these statistically acceptable prerequisites, it was shown that there is a real difference in the tendency to develop gingivitis between pre-school children and adults.     

Development of experimental gingivitis in the juvenile and adult beagle dog

Abstract. In a previous paper a lower tendency to develop gingivitis was reported among preschool children compared to adults. The aim of the present study was to clarify if the same age-dependent difference exists in dogs.
Six beagle dogs from the same litter were used. two periods of discontinued oral hygiene were studied, one period when the dogs were 3 months old and the other at 12 months. Prior to and between the experimental periods the animals were subjected to meticulous toothcleaning. During the experimental periods the Gingival and Plaque Index scores as well as the amounts of gingival exudate and crevicular leukocytes were determined on days 0, 4, 7, 14, 21 and 28.
During the juvenile period the development of dental plaque was lower compared with the adult period. The frequency of gingival units with high Gingival Index scores was lower at every registration interval during the juvenile period. The amounts of gingival exudate and crevicular leukocytes increased to high values during the adult stage but only small increments were found in the juvenile stage. An intraindividual comparison of the increase in the amount of gingival exudate from day 0 to day 28 in areas with the same amount of dental plaque accumulation showed a lower increase in gingival exudate during the juvenile stage in all dogs.     

Morphological aspects of the gingiva in children with Down''s syndrome during experimental gingivitis

In a previous investigation, children with Down's syndrome (DS) showed an earlier, more rapid and more extensive gingival inflammation than normal healthy control children. These differences in gingival inflammation may be the result of aberrant morphology of the gingiva related to the genetic disorder in DS children. The aims of the present study were (i) to describe the structural composition of "normal" gingiva in DS compared to control children, (ii) to analyse the histological changes in the gingiva during plaque development and (iii) to investigate whether the clinical findings could be supported by morphological observations. The study was carried out in 8 DS and 8 matched control children. Their ages ranged from 5-10 years. Gingival normality was guaranteed by strict oral hygiene procedures. During a period of 21 days in which oral hygiene was abolished, gingival biopsies were taken from buccal sites of deciduous teeth following a predetermined schedule on days 0, 7, 14 and 21. Results on day 0 showed no morphological differences between the DS and control children regarding oral epithelium, junctional epithelium or connective tissue. During the experimental phase of the study, the amount of plaque accumulation in the DS children gave rise to a more extensive gingival inflammation than in the control children. The gingival inflammation in the DS group started earlier and included: (1) an acute inflammatory response, (2) an increase of the junctional epithelium area, (3) an increase of the infiltrated connective tissue area (ICT) and (4) a decrease in collagen fibre density of about 35-40% compared to day 0. The same phenomena were not seen until 7 days later in the control group. Conversely, the development of a perivascular lymphocyte infiltrate (LI) in the DS children was delayed compared to the control group. This may be caused by the impaired delayed-type hypersensitivity response in DS children. The development of 2 separate infiltrates (ICT and LI) in this age group and the different temporal development of ICT (day 7 for the DS and day 14 for the control group) and LI (day 14 for the DS and day 7 for the control group) does suggest different immunological mechanisms for both areas and both groups.     

The effect of glass ionomer cement and composite resin fillings on marginal gingiva

Abstract Glass ionomer cement and composite resin are the most popular restorative materials in operative dentistry today. Earlier studies have shown more crevicular exudate around different types of composite resins than around intact enamel surfaces. The aim of this study was (1) to investigate plaque, retention on and the condition of the gingiva around, 1-year-old, subgingivally located, glass ionomer cement and composite resin fillings, and (2) to compare the initiation of gingival inflammation around these materials with that around enamel during a 14-day period of experimental gingivitis. Plaque index, gingival index, bleeding on probing and crevicular fluid were recorded and compared intra-individually. The amount of plaque and the degree of gingivitis adjacent to the composite fillings were not significantly higher than those for the glass ionomer cement and enamel surfaces in both the cross sectional and the experimental gingivitis study. Composite resin surfaces showed significantly higher crevicular fluid levels than did enamel at all days in the experimental gingivitis study. Glass ionomer cement showed significantly higher values at day-0 and day-7.     

Cellular aspects of and effects on the gingiva in children with Down''s syndrome during experimental gingivitis

In a previous experimental gingivitis study, it was shown that in children with Down's syndrome (DS), gingival inflammation started earlier, was more extensive and developed faster, than in normal healthy control children. In both groups, the start of the process was accompanied by an acute inflammatory response and an increase of the infiltrated connective tissue area (ICT). The purpose of the present study was to investigate how these facts were reflected at a cytological level. The study was carried out in 8 DS and 8 matched control children. Their ages ranged from 5-10 years. A "normal" healthy gingiva was attained after strict oral hygiene procedures. During a period of 21 days in which oral hygiene was abolished, gingival biopsies were taken on days 0, 7, 14, and 21. In both groups, junctional epithelium (JE) and ICT contained low numbers of polymorphonuclear leucocytes (PMNs). The start of the inflammation (day 7 for the DS and day 14 for the control children) was marked by a significant positive correlation between the numbers of PMNs in the JE and the ICT, and a significant increase of the numbers of PMNs in ICT. In ICT, a concomitant decrease in collagen fibre density was observed. In the control group, the decrease correlated with the numbers of PMNs in ICT, which suggests that this collagen breakdown is caused by PMN products. After the initial decrease, the collagen fibre density remained fairly constant in this group throughout the study. In the DS group, there was a tendency to a further decrease in the ICT3 area, correlated with the numbers of PMNs in ICT.(ABSTRACT TRUNCATED AT 250 WORDS)     

Gingival inflammatory reactions in children with rhinoconjunctivitis due to birch pollinosis

Abstract – The present investigation was designed to study the degree of gingival inflammation in children with rhinoconjunctivitis due to birch pollinosis. Thirty-four children, 8-17 yr of age, participated. As controls, healthy classmates of the same age and sex were chosen. Dental examination was performed on three occasions: pollen season I (Spring 1987), off-season (Autumn 1987) and pollen season II (Spring 1988). The controls were examined on one occasion, mixed with the allergic children at the off-season examination. The degree of gingival inflammation was studied by determining the gingival bleeding tendency by standardized probing. Absence or presence of dental plaque was recorded after sulcular probing. In order to compensate for differences in oral hygiene level between the participants, the bleeding/plaque ratio according to A bbas et al. was calculated. The comparisons of the bleeding/plaque ratios revealed statistically significantly higher mean ratios in the allergic children during pollen seasons compared with offseason and with the controls. The results indicate that during the pollen season, children with allergic rhinoconjunctivitis exhibit an enhanced degree of gingival inflammatory reaction.     

Gingival inflammatory reactions in children with rhinoconjunctivitis due to birch pollinosis

The present investigation was designed to study the degree of gingival inflammation in children with rhinoconjunctivitis due to birch pollinosis. Thirty-four children, 8-17 yr of age, participated. As controls, healthy classmates of the same age and sex were chosen. Dental examination was performed on three occasions: pollen season I (Spring 1987), off-season (Autumn 1987) and pollen season II (Spring 1988). The controls were examined on one occasion, mixed with the allergic children at the off-season examination. The degree of gingival inflammation was studied by determining the gingival bleeding tendency by standardized probing. Absence or presence of dental plaque was recorded after sulcular probing. In order to compensate for differences in oral hygiene level between the participants, the bleeding/plaque ratio according to Abbas et al. was calculated. The comparisons of the bleeding/plaque ratios revealed statistically significantly higher mean ratios in the allergic children during pollen seasons compared with off-season and with the controls. The results indicate that during the pollen season, children with allergic rhinoconjunctivitis exhibit an enhanced degree of gingival inflammatory reaction.     

Effect of a novel ceramic filling material on plaque formation and marginal gingiva

The aim of this clinical investigation was to evaluate a novel ceramic (CF) filling material (DoxaDent) compared to resin composite (RC) and enamel in regard to plaque formation and gingival inflammation. The CF material is inorganic, non-metallic, and contains calcium aluminate, silicate, and water. To make intra-individual comparisons possible, each participant had at least one set of three test surfaces: two Class V restorations with subgingival cervical margins (one of the novel CF material and one of a hybrid RC) and one non-filled enamel surface (E). The amounts of plaque, gingival crevicular fluid, and clinical signs of gingival inflammation were intra-individually compared in 20 sets of the three test surfaces. In a cross-sectional study (CSS), the effect of oral hygiene on plaque formation and gingivitis around the surfaces was evaluated. In a following 10-day experimental gingivitis study (EGS), plaque formation and the induction of gingivitis during refrain from oral hygiene was compared. In the CSS, no significant differences were found between the surfaces in terms of amount of plaque and degree of gingival inflammation. At the end of the EGS the restorative materials showed a significantly higher amount of plaque (CF versus E, P = 0.014; RC versus E, P = 0.034), but no significant differences were found in degree of gingival inflammation. In condusion, the ceramic filling material was comparable to RC regarding plaque formation and gingival inflammation with customary oral hygiene. With neglected oral hygiene, significantly less plaque growth and a non-significant tendency toward lower amounts of gingival crevicular fluid were observed on enamel surfaces.     

Inflammatory reactions in the gingival region during the development of bacterial plaque in alloxan-diabetic dogs

The effect of experimentally induced diabetes on inflammatory reactions in the gingival region of the beagle dog has been studied in connection with the development of dental plaque.
The investigation, which was undertaken in 5 dogs, had an intra-individual design, the increases in the amounts of gingival exudate and crevicular leukocytes during plaque development being studied in each animal before and after the induction of alloxan-diabetes.
The increases in gingival exudate and crevicular leukocytes in response to plaque accumulation showed a tendency to be lower during diabetic compared with non-diabetic periods. It is suggested that the lower vascular reaction and the reduced leukocyte migration that were observed shortly after onset of the experimental diabetes might reflect an impaired defense mechanism of importance in the longer run for the development of pathological changes in the periodontium.     

Influence of frequent sugar intakes on experimental gingivitis

Few studies have investigated directly the possible role of dietary sugar in the etiology of periodontal disease, although an association between the amount of plaque formed and the frequency of sugar intake has been demonstrated. The purpose of this study was to examine the influence of frequent sugar intakes on experimental gingivitis in young adults. Twenty male dental students took part in a single blind crossover study which involved two 3-week experimental periods with random allocation to high or low sugar diets. The experimental site was the lower anterior area. The labial aspects of the lower anterior teeth were examined at baseline and Weeks 1, 2 and 3. Inflammation was assessed by recording bleeding on probing at 12 sites at 2 levels of severity--"pin prick" and "excess." In addition gingival crevicular fluid flow was recorded and plaque amount was assessed. At 3 weeks significantly higher bleeding scores at the two designated levels were found with the high sugar diet but no significant differences were observed with crevicular fluid flow and plaque amount. It was concluded that frequent sugar intakes result in increased gingival inflammation in experimental gingivitis, as measured by gingival bleeding on probing.     

Effect of a novel ceramic filling material on plaque formation and marginal gingiva

The aim of this clinical investigation was to evaluate a novel ceramic (CF) filling material (DoxaDent) compared to resin composite (RC) and enamel in regard to plaque formation and gingival inflammation. The CF material is inorganic, non-metallic, and contains calcium aluminate, silicate, and water. To make intra-individual comparisons possible, each participant had at least one set of three test surfaces: two Class V restorations with subgingival cervical margins (one of the novel CF material and one of a hybrid RC) and one non-filled enamel surface (E). The amounts of plaque, gingival crevicular fluid, and clinical signs of gingival inflammation were intra-individually compared in 20 sets of the three test surfaces. In a cross-sectional study (CSS), the effect of oral hygiene on plaque formation and gingivitis around the surfaces was evaluated. In a following 10-day experimental gingivitis study (EGS), plaque formation and the induction of gingivitis during refrain from oral hygiene was compared. In the CSS, no significant differences were found between the surfaces in terms of amount of plaque and degree of gingival inflammation. At the end of the EGS the restorative materials showed a significantly higher amount of plaque (CF versus E, P = 0.014; RC versus E, P = 0.034), but no significant differences were found in degree of gingival inflammation. In conclusion, the ceramic filling material was comparable to RC regarding plaque formation and gingival inflammation with customary oral hygiene. With neglected oral hygiene, significantly less plaque growth and a non-significant tendency toward lower amounts of gingival crevicular fluid were observed on enamel surfaces.     

Gingival condition in areas of minimal and appreciable width of keratinized gingival

Sixteen dental, dental hygiene, and dental assisting students and dental faculty members who had contralateral or unilateral areas of minimal (less than or equal to 1.0 mm) and appreciable (greater than or equal to 2.0 mm) widths of keratinized gingiva on mid-buccal plaque-free surfaces of mandibular bicuspids were examined. Gingival exudate amounts and clinical inflammation based on color change and/or swelling and bleeding on probing were evaluated. The results showed that gingiva with "appreciable" width as well as gingiva with "minimal" width of keratinized tissue exhibited only minute amounts of gingival exudate. Also, there were generally no clinical signs of inflammation for both types of tissue. From the groups of 16, six subjects were selected who had contralateral pairs of minimal and appreciable keratinized gingiva. They were instructed to cease oral hygiene in the lower bicuspid area for 25 days. At day 0, 4, 7, 11, 14, 18, 21, and 25, plaque, gingival exudate, and clinical gingival inflammation were evaluated. Results revealed increases in plaque, gingival exudate scores and clinical gingival inflammation over the 25-day period with no apparent difference between the areas with minimal and appreciable width of keratinized gingiva.     

Modulation of clinical expression of plaque-induced gingivitis: response in aggressive periodontitis subjects

AIM: The aim of this study was to characterize the gingival inflammatory response to de novo plaque accumulation in subjects treated for aggressive periodontitis (AP). The gingival inflammatory response of the AP subjects was retrospectively compared with that of periodontally healthy individuals (PH) matched for exposure to plaque and of periodontally healthy subjects previously identified as "high responders" (HR) and "low responders" (LR). MATERIALS AND METHODS: 13 AP subjects and 26 matched PH subjects participated in a 21-day experimental gingivitis trial. Plaque index (PlI), Gingival index (GI), gingival crevicular fluid volume (GCF) and angulated bleeding score (AngBS) were recorded at days 0, 7, 14 and 21. Cumulative plaque exposure (CPE), i.e. PlI over time, was also calculated. RESULTS: GCF was significantly higher in AP compared with PH group at each observation interval (p< or =0.001). In addition, GCF was significantly higher in AP group compared with either LR or HR groups at each observation interval (p<0.001). CONCLUSIONS: These results suggest that susceptibility to gingival inflammation in response to de novo plaque accumulation may be related to susceptibility to periodontitis.     

Time as a factor in the identification of subjects with different susceptibility to plaque-induced gingivitis

OBJECTIVES: The purpose of this study was to assess whether identification of subjects with different susceptibility to plaque-induced gingival inflammation is dependent on the length of time of de novo plaque accumulation. METHODS: Retrospective analysis of data obtained from a recently reported randomized split-mouth localized experimental gingivitis trial involving 96 healthy non-smokers. Gingival and plaque index, gingival crevicular fluid volume (GCF), angulated bleeding score, and the derived parameter cumulative plaque exposure (CPE) were recorded at days 0, 7, 14, and 21. The primary outcome variable to express severity of inflammation was GCF and each subject was a statistical unit. Based on subject distribution of GCF-day 21 residuals after standardization for CPE-day 21, two sub-populations (upper and lower distribution quartiles) were selected. They were, respectively, defined as "high responders" (HR) (n=24) and "low responders" (LR) (n=24) and characterized by significantly different severity of gingivitis to similar amounts of plaque deposits. The same analysis was repeated at days 7 and 14. Prevalence of HR and LR was compared between days using the chi(2) [ML] test. RESULTS: For both day 7 and day 14, the quartile distribution of LR and HR was statistically significant (p=0.02). Fifty percent of LR and 71% of HR presented a consistent level of susceptibility to plaque-induced gingival inflammation even after only 7 and/or 14 days of plaque accumulation. CONCLUSIONS: These findings support the concept that the subject-based susceptibility to plaque-induced gingival inflammation is an individual trait, only partly related to the length of time of exposure to plaque.     

Gingival inflammatory reaction in children at different ages

Earlier studies have demonstrated that, with similar levels of plaque accumulation, the tendency to develop gingivitis is lower in pre-school children than in young adults. No studies are available in which the gingival reaction in older children and adults to a given amount of plaque has been compared. The aim of the present study was to compare the gingival reaction to dental plaque in children of different ages and in adults. 3 groups of children (4-6, 7-9 and 14-16 years of age) and 1 group of adults (20-22 years of age) were studied. The degree of gingivitis was determined using the gingival index and the amount of dental plaque was assessed in terms of the plaque index. The results showed that with a given plaque score, the % of high gingivitis scores was less in the 4-6-year-old children than in the older children and adults. At all levels of plaque accumulation, the highest degree of gingival inflammation was noted in the 14-16-year-old children and in the adults. The results indicate that the gingival reactivity increases gradually from early childhood to adult age.     

Myeloperoxidase activity in human gingival crevicular neutrophils

Myeloperoxidase (MPO) activity in neutrophil leucocytes from gingival crevicular exudate and peripheral venous blood was assayed both spectrophotometrically and cytochemically in 50 healthy subjects with and without clinically evident gingival inflammation. All blood neutrophil MPO levels were within the normal range; gingival neutrophil MPO levels were normal in all subjects with inflamed tissue but enzyme activity was not detected in approximately 50 per cent of those with no inflammation. There was positive correlation (p less than 0.0003) between the gingival index and MPO activity. The gingival crevice is an accessible example of a functional site in host defence and it may be that subpopulations of neutrophils are selectively sequestered into such areas in response to chemotactic stimuli.     

实验性龈炎的临床观察和龈沟液量的分析

目的　观察实验性龈炎发展过程中的临床表现及龈沟液 (GCF)量的变化 ,探讨GCF量与牙龈炎症发生和发展的关系。方法　选取 11名受试者 ,在其停止口腔卫生措施后 2 1d内 (第 0、7、14、2 1天 )和恢复口腔卫生措施 1周后 (第 2 8天 )记录临床指标的变化 ,并且测量GCF量 (每人测18颗牙 )。结果　在实验性龈炎发展过程中 ,各项临床指标 (菌斑指数、出血指数、牙龈指数、探诊深度 )和GCF量在基线时数值较低 ,停止刷牙后随着菌斑量的不断增多而逐渐上升 ,恢复刷牙后又下降到接近基线水平。GCF量与各项临床指标均为显著正相关。结论　临床指标和GCF量在基线、停止刷牙和恢复刷牙 1周后随菌斑量的改变而存在显著差异 ,反映了牙龈炎症的形成和发展过程     

Higher elastase activity associated with lower IL-18 in GCF from juvenile systemic lupus patients

PURPOSE: Our aim was to evaluate the expression of interleukin-18 (IL-18), interleukin-l-beta (IL-1beta) and the amount of elastase activity in gingival crevicular fluid (GCF) from inflamed gingival sites in patients with juvenile systemic lupus erythematosus (JSLE), and compare these to the expression in GCF from inflamed sites in generally healthy controls. In addition, the local inflammation in periodontal tissues was related to systemic inflammation by the assessment of IL-18 levels in plasma. MATERIALS AND METHODS: GCF from 16 patients with JSLE and 14 controls were collected using a washing device. Elastase activity was measured with a specific substrate, and IL-18 and 11-1 were measured by ELISA. RESULTS: The percentage of visible plaque index, gingival bleeding index and attachment level were similar in JSLE and controls, while the percentage of probing depth greater or equal to 3 mm was significantly higher in the controls. The total amount of IL-1beta and IL-18 in GCF were significantly decreased in JSLE, while the total amount and the percentage of free elastase activity were significantly higher in JSLE when compared with the controls. The plasma levels of I1-18 and the erythrocyte sedimentation rate were significantly higher in JSLE patients. CONCLUSION: We found more active elastase in GCF from inflamed sites in JSLE patients even in the presence of significantly lower levels of IL-18 and IL-13. The increased elastase activity suggests a hyperactivity of neutrophils in JSLE, possibly generated by a priming effect caused by the higher plasma levels of IL-18 found in these JSLE patients.     

The influence of a probiotic milk drink on the development of gingivitis: a pilot study

Aim: The aim of this study was to determine the effect of a probiotic milk drink on gingival health and the development of experimental gingivitis.
Material and Methods: Fifty volunteer students took part in a parallel-designed non-blinded study. The test group drank a probiotic drink once a day; the control group did not receive any product to drink. After 8 weeks, individual mechanical plaque control was interrupted for 96 h. Papilla bleeding index, interproximal plaque and Turesky plaque index (PI) were recorded at baseline, after 8 weeks and again 96 h later. At the same time points, gingival crevicular fluid had been collected for analysis of polymorphonuclear elastase, myeloperoxidase (MPO) and matrix metalloproteinase-3 (MMP-3).
Results: Interproximal PI and papillary bleeding were not different between the groups. In the test group, elastase activity and MMP-3 amount were significantly lower after the intake of the probiotic milk drink ( p <0.001 and 0.016). There was a significant increase of MPO activity in the control group; both groups were different at the end of the study ( p =0.014).
Conclusions: The data suggest a beneficial effect of the probiotic milk drink on gingival inflammation.     

The effect of a 0.125% chlorhexidine rinse on inflammation after periodontal surgery

The purpose of this study was to determine the effect of a 0.125% chlorhexidine gluconate rinse on inflammation and bacterial plaque formation after periodontal surgery. Nine patients who required two periodontal surgeries in two posterior areas were selected. The first surgical site was randomly assigned into either 1) active or 2) placebo groups. The patient's second site was assigned to the alternate group. In Group 1 the patients rinsed with chlorhexidine (CH) and in Group 2 with placebo solution, both for 14 days. No periodontal dressing was used and at least 1 month elapsed before the second surgery was performed. Plaque index, gingival index, and crevicular fluid flow measurements were obtained at baseline, and at 1 and 2 weeks after surgery. The chlorhexidine rinse significantly reduced the amount of plaque at both 1 and 2 weeks, and gingival inflammation remained similar to base line measurements at 2 weeks. Neither solution had any effect on the amount of crevicular fluid flow. There was an increase in amount of perceived postoperative pain and gingival swelling with the use of the chlorhexidine rinse, but no difference in the number of pain pills taken during this study. The chlorhexidine rinse was an effective plaque preventive agent after surgical procedures.