Root proximity as a risk marker for periodontal disease: a case-control study

AIM: The aim of this study is first, to examine the prevalence, symmetry and spread of root proximity using the measurement tools and classification as described in part I of the study, and second to examine whether root proximity is a risk marker for periodontal disease. MATERIAL AND METHODS: The radiographs of 227 patients were examined. The study consisted of a study group of 197 patients with advanced periodontal disease with at least one site with bone loss more than one third of the root length and 30 controls without periodontal disease. Every inter-proximal space was assessed on the full-mouth radiographs and a score was assigned according to severity and location. Consequently prevalence of severity and location, symmetry, spread and an odds ratio and relative risk for periodontal disease was calculated. RESULTS: Root proximity is a symmetrical and localized but widespread phenomenon in periodontal patients and to lesser extend in the non-periodontal control group. In periodontal patients root proximity was most often encountered in the coronal and intervening part whereas subjects without periodontal disease had more root proximity in the apical and intervening part where it is less critical. Subjects with bilateral root proximity had a 3.6 times higher chance to have periodontitis. CONCLUSION: Root proximity must be taken into consideration as a risk marker for periodontal disease.     

Persistently raised C-reactive protein levels are associated with advanced periodontal disease

Objective: The aim was to investigate whether there was an association between periodontitis or tooth loss in a homogeneous group of 60–70‐year‐old Western European men and either a sustained high or low level of C‐reactive protein (CRP). Material and Methods: Men enrolled in a cohort study of cardiovascular disease in Northern Ireland were screened in 1990–1994 and rescreened in 2001–2004, when a periodontal examination was completed. High‐sensitivity CRP was measured from fasting blood samples. There were 806 men with six or more teeth who had either a high level (>3 mg/l) or a lower level of CRP at both time points. Multivariate analysis was carried out using logistic regression with adjustment for possible confounders. Models were constructed with the CRP level as the outcome variable and various measures of periodontal status (low and high threshold periodontitis) or tooth loss as predictor variables. Confounders included in the analysis were known cardiovascular risk factors of age, smoking, diabetes, BMI and socioeconomic status. Results: There were 67 men who had a high value of CRP (>3 mg/l) and 739 men who had a CRP value 3 mg/l at both time points. The unadjusted odds ratio (OR) for advanced periodontitis to be associated with high CRP was 3.62, p=0.0003. The association was somewhat attenuated but remained significant (OR=2.49, p=0.02) after adjustment for confounders. A high level of tooth loss was also associated with high CRP with an adjusted OR of 2.17, p=0.008. Low threshold periodontitis was not associated with the level of CRP. Conclusion: There was an association between advanced periodontitis and elevated CRP levels as measured at two time points at a 10‐year interval in the 60–70‐year‐old European males investigated. This association was adjusted for various cardiovascular risk factors. There was also an association between high levels of tooth loss and high CRP in the men studied.     

C-reactive protein in patients with coexistent periodontal disease and acute coronary syndromes

AIM: To evaluate periodontal disease (PD) influence on changes in high-sensitivity C-reactive protein (hsCRP) concentrations in patients with acute coronary syndromes and coexistent PD. MATERIALS AND METHODS: Dental examinations were carried out in a group of 50 consecutive patients, less than 60 years old, hospitalized as a result of acute coronary syndromes. The patients were divided into two groups on the basis of own-constructed combined PD score (group 2: more advanced; and group 1: less advanced PD) as well as clinical attachment loss (CAL) - group 4: CAL >3 mm; group 3: CAL 相似文献   

Effectiveness of aspartate aminotransferase as a marker of periodontal disease in children and adolescents

BackgroundBiochemical markers from saliva and gingival crevicular fluid are of interest in preventing periodontal disease. We investigated the possibility of detecting aspartate aminotransferase (AST) levels in children and teenagers, as well as the usefulness of the addition of measurements of N-bezyoyl-DL-arginine-2-naphthylamide (BANA) activity and AST release during regular oral check-ups.Subjects and methodsFifty-four children (33 males; 8–15 years) from the pediatric dental clinic of Hiroshima University Hospital were enrolled. Periodontal conditions were investigated using scores of the community periodontal index (CPI), BANA and AST. Bacterial species were also identified.ResultsIn 51 eligible subjects, 64.7% were CPI 1 and 35.3% were CPI 2, and these subjects were diagnosed as having gingivitis. A high BANA score was increased in the CPI 2 group (p = 0.022) and the AST score showed a similar trend. All scores of BANA and AST were found in the same CPI. The number of subjects with higher scores of BANA and/or AST increased with increasing age.ConclusionsIt was possible to measure AST levels in children and teenagers. It is suggested that we provide more specific information to children and their guardian using BANA and AST. Measuring biomarkers during regular oral check-ups could lead to an early diagnosis and intervention to avoid the progression of periodontitis during the childhood and teenage years.     

牙周治疗对冠心病患者血清C-反应蛋白的影响

目的 探讨冠心病伴牙周炎患者牙周基础治疗后,牙周状况及血清C-反应蛋白(CRP)水平的变化。方法 选择已确诊冠心病同时患牙周炎40~65岁男性患者30例,测量血液指标及口腔指标,4个月内不做任何牙周治疗,4个月后进行牙周基础治疗,比较治疗前及治疗后3个月的牙周状况和血清CRP、低密度脂蛋白胆固醇(LDL-C)、白细胞(WBC)、总胆固醇(TC)水平变化。结果 患者经过牙周基础治疗后,牙龈出血指数、探诊深度明显减轻(P<0.01),治疗后血清CRP水平及LDL-C水平均有所降低,差异有显著性(P<0.05),基础治疗对患者白细胞和TC水平无显著影响。结论 冠心病伴牙周炎患者牙周基础治疗后牙周效果是满意的,血清CRP的水平降低,牙周治疗对冠心病的预防和治疗有重要意义。     

Efect of periodontal disease and non surgical periodontal treatment on C-reactive protein. Evaluation of type 1 diabetic patients

Objectives: The purpose of this study was to analyze how anti-infectious periodontal treatment affects C reactive protein (CRP) values in patients with type 1 diabetes, and correlate baseline CRP levels with periodontal disease severity. Study Design: A cohort of fifty three subjects with type 1 diabetes and moderate to severe periodontitis were recruited. Periodontal parameters were measured, and blood samples were obtained to evaluate high-sensitivity C-reactive protein (hs-CRP). Group 1 was treated with scaling, root planning, and systemic administration of doxycycline. Group 2 received only scaling and root planning. Results: Hs-CRP was reduced after periodontal treatment in group 1 (-0.22 mg/l) and 2 (-0.21 mg/l ) but this reduction was not statistically significant, even in the patients with the best response to periodontal treatment. However, significant correlation appeared between hs-CRP and mean probing pocket depth (PPD) (p=0, 01) and mean clinical attachment level (CAL) (p=0,03). Conclusions: Non-surgical periodontal treatment couldn’t reduce hs-CRP values, however, it was found an association between advanced periodontitis and elevated blood hs-CRP levels in patients with type 1 diabetes. It can be speculated that periodontal disease increases production of pro-inflammatory mediators in patients with type 1 diabetes, but other producing sources of these pro-inflammatory substances may exist. Key words:Periodontal disease, periodontitis, diabetes mellitus type 1, periodontal therapy, C reactive protein.     

Hepatocyte growth factor in saliva is a potential marker of symptomatic periodontal disease

Evidence has been emerging that hepatocyte growth factor (HGF) - a pluripotential regenerative cytokine - is a key factor in the pathogenesis and progression of periodontal disease, mostly through its over-stimulation of gingival epithelial cell growth and impairment of the regeneration of collagenous structures. We measured the levels of immunoreactive HGF in unstimulated whole mixed saliva from 26 patients referred for treatment of periodontal disease, and from 20 healthy subjects. HGF was detected in all saliva samples from the patients, the concentration ranging from 0.06 to 5.38 ng/ml, with a mean concentration of 1.87 +/- 1.32 ng/ml. In healthy individuals, the median salivary HGF level was 0.68 ng/ml (range: 0 - 7.33 ng/ml), being almost 3-fold lower (P < 0.0001) than that in the patients. Periodontal parameters in the patients were: gingival index (GI) 2.0 (0 - 2.8), papillary bleeding index (PBI) 2.2 (0 - 3.2), plaque index (PI) 2.0 (0 - 3.0), probing depth (PD) 3.0 (1.8 - 5.9) mm, and loss of clinical attachment level (CAL) 4.7 (1.1 - 10.6) mm. We found that the salivary HGF level was positively correlated with GI (P = 0.004), PBI (P = 0.046) and PI (P = 0.001), but not with PD (P = 0.351), CAL loss (P = 0.172), number of teeth (P = 0.279) or patient age (P = 0.362). Our findings suggest that salivary HGF concentration may be a novel marker of symptomatic periodontal disease, and that it warrants further validation.     

Gingivitis as a risk factor in periodontal disease

Background: Dental plaque has been proven to initiate and promote gingival inflammation. Histologically, various stages of gingivitis may be characterized prior to progression of a lesion to periodontitis. Clinically, gingivitis is well recognized.
Material & Methods: Longitudinal studies on a patient cohort of 565 middle class Norwegian males have been performed over a 26-year period to reveal the natural history of initial periodontitis in dental-minded subjects between 16 and 34 years of age at the beginning of the study.
Results: Sites with consistent bleeding (GI=2) had 70% more attachment loss than sites that were consistenly non-inflamed (GI=0). Teeth with sites that were consistently non-inflamed had a 50-year survival rate of 99.5%, while teeth with consistently inflamed gingivae yielded a 50-year survival rate of 63.4%.
Conclusion: Based on this longitudinal study on the natural history of periodontitis in a dentally well-maintained male population it can be concluded that persistent gingivitis represents a risk factor for periodontal attachment loss and for tooth loss.     

Effect of periodontal treatment on serum C-reactive protein levels: a systematic review and meta-analysis

BACKGROUND: Systemic inflammation is increasingly being recognized as a risk factor for adverse cardiovascular events. Evidence is accumulating that associates periodontal disease with a higher risk for atherosclerotic plaque formation. A positive association between circulating C-reactive protein (CRP) levels and periodontal disease may be responsible for these observations. We undertook a systematic review and conducted a meta-analysis of the available evidence to examine the effect of periodontal treatment on systemic CRP levels and to assess the quality of the available evidence. METHODS: We conducted a systematic search of the English-language literature on the effect of periodontal treatment on CRP levels, as assessed by high-sensitivity assays, at least 2 months after periodontal treatment. The search was conducted in MEDLINE between 1966 and July 2005 and the Cochrane Central Register of Controlled Trials. We performed a meta-analysis using the DerSimonian and Laird random-effects model. RESULTS: The literature search yielded 814 citations of which 10 met the inclusion criteria. The meta-analysis of the randomized controlled trials (RCTs) showed that the difference in serum CRP levels is not significantly different between the two arms. Similarly, results from the single-cohort studies showed that the difference on serum CRP levels was not significantly different before and after treatment. CONCLUSIONS: There is now a large body of evidence to indicate that systemic inflammation is present in patients with periodontal disease. Thus, information from RCTs and single-cohort studies does not support the hypothesis that periodontal treatment can reduce systemic CRP levels.     

Crevicular and serum levels of monocyte chemoattractant protein-4 and high-sensitivity C-reactive protein in periodontal health and disease

ObjectivesChemokines are chemotactic cytokines that are involved in destruction of the periodontal structures. The aim of this study is to determine the presence of MCP-4 and high sensitivity C reactive protein (hsCRP) levels in gingival crevicular fluid (GCF) and serum in periodontal health and disease and to find a correlation between MCP-4 and hsCRP in GCF and serum.Methods40 subjects (20 males and 20 females) were selected and divided into three groups based on clinical parameters and radiologic parameters: Group 1 (10 healthy); Group 2 (15 gingivitis subjects) and Group 3 (15 chronic periodontitis subjects). The levels of serum and GCF MCP-4 were determined by ELISA and hsCRP levels were determined by immunoturbidimetry method.ResultsThe mean GCF and serum concentration of MCP-4 were the highest for group 3 followed by group 2 and least in group 1. Similarly, the mean hsCRP concentrations were highest for group 3 and least in group 1. Moreover, a significant positive correlation was found between serum and GCF MCP-4 and hsCRP levels and periodontal parameters.ConclusionThe levels of MCP-4 and hsCRP increased from healthy to periodontitis. It can be proposed that MCP-4 and hsCRP are the potential biomarkers of inflammation in periodontal health and disease.     

Hepatocyte growth factor in saliva: a possible marker for periodontal disease status

Hepatocyte growth factor (HGF) acts as a mitogen, motogen, morphogen and anti-apoptotic factor for various kinds of epithelial cells. We previously showed that periodontal fibroblasts secreted an HGF-like chemoattractant for a gingival epithelial cell line and found that HGF content in gingival crevicular fluid was well correlated with probing depth, gingival index, and interleukin-1beta concentration. To examine whether HGF in whole (mixed) saliva would be a useful marker for periodontal disease status, we investigated the relationship between salivary HGF levels and clinical parameters of 65 adults (50 men and 15 women). Unstimulated whole (mixed) saliva was collected from each subject and the HGF level was determined with an ELISA kit. After sample collection, probing depths and bleeding on probing were monitored. Significant correlations were found between salivary HGF levels and the number of probing depths exceeding 4 mm (r = 0.541), the number of probing depths exceeding 6 mm (r = 0.683), the deepest probing depth of each subject (r = 0.558) and the percentage of sites positive for bleeding on probing (r = 0.511). These results suggest that salivary HGF may be a novel marker for periodontal diagnosis in screening tests.     

���ܻ������ƶ�Ѫ�峬��C��Ӧ����Ӱ���о�

目的研究牙周基础治疗对血清超敏C反应蛋白(Hs-CRP)的影响。方法选择2007年9月至2008年9月中日友好医院口腔科收治的未经过牙周治疗的40岁以上的中、重度慢性牙周炎患者35例,分为以下3组:单纯慢性牙周炎组(即牙周炎组,6例)、慢性牙周炎伴冠心病危险因素组(即高血压/高血脂组,22例)及慢性牙周炎伴冠心病组(即冠心病组,7例)。所有患者均进行牙周基础和维护治疗。治疗前、治疗后3个月均进行牙周检查[菌斑指数(PLI)、出血指数(BI)、探诊深度(PD)、附着丧失(AL)]和静脉血Hs-CRP检测。结果与治疗前比较,牙周基础治疗后3个月各组患者牙周指标均明显改善,PD、PLI、BI、AL均显著减小(P<0.05),但各组间各牙周指标差异无统计学意义(P>0.05);高血压/高血脂组Hs-CRP明显降低(P<0.05);冠心病组和牙周炎组Hs-CRP均略有下降(P>0.05)。Hs-CRP的变化与治疗前Hs-CRP显著相关,相关系数为0.811(P<0.05)。结论对于有冠心病危险因素或冠心病的牙周炎患者,牙周治疗可降低其血清Hs-CRP,提示牙周治疗可降低冠心病发病或再发的风险。