Evaluation of periodontal status and effectiveness of non-surgical treatment in patients with type 2 diabetes mellitus in Taiwan for a 1-year period

Background: The periodontal status and effects of non‐surgical periodontal treatment in patients with type 2 diabetes mellitus and periodontal disease are assessed. Methods: One‐hundred patients with type 2 diabetes (mean ± SD hemoglobin (Hb)A1c level: 7.3% ± 0.94%) and periodontal disease were recruited for this study. The group with moderate‐to‐severe periodontal disease included patients with >1 tooth with a probing depth (PD) ≥5 mm and >2 teeth with a clinical attachment loss (AL) ≥6mm, and the group with mild periodontal disease included patients with <1 affected tooth, and >2 affected with a clinical AL ≥6mm. Patients (28 patients in the mild group and 72 patients in the moderate‐to‐severe group) underwent non‐surgical periodontal treatments. We analyzed differences in serum concentrations of metabolic parameters (glycated hemoglobin and low‐density lipoprotein), inflammatory parameters (interleukin [IL]‐1β and C‐reactive protein [CRP]), and periodontal parameters between the two groups before treatment and at 3, 6, 9, and 12 months post‐therapy. Results: Seventy‐five patients with diabetes (21 patients in the mild group and 54 patients in the moderate‐to‐severe group) completed the study. Significant differences in the plaque index (PI), gingival index (GI), PD, and clinical AL at examination times were observed in the whole cohort (P <0.05). We observed significant differences in the PI, GI, and PD in the moderate‐to‐severe group (P <0.05), whereas there was only a significant difference in PD in the mild group (P <0.05) between baseline and 12 months post‐treatment. Both groups experienced improved glycemic control, but the difference was insignificant. CRP and IL‐1β levels were significantly different at examination times for the whole cohort (P <0.05). No significant positive association among metabolic and inflammatory parameters at 12 months post‐therapy were found. Conclusion: Non‐surgical periodontal treatment improved and maintained the periodontal health of patients with well‐controlled diabetes, but no significant reduction of metabolic parameters was observed over a 1‐year period.     

Comparison of Glycated Hemoglobin Levels in Individuals Without Diabetes and With and Without Periodontitis Before and After Non‐Surgical Periodontal Therapy

Background: Only a few studies have examined the association between periodontitis and glycated hemoglobin (HbA1c) levels in individuals without diabetes. The aim of this study is to compare HbA1c levels in individuals without diabetes and with and without periodontitis before and after non‐surgical periodontal therapy. Methods: This comparative study was done on individuals without diabetes who were 35 to 65 years old. Group A consisted of 30 individuals without periodontitis, and group B consisted of 30 individuals with periodontitis. Body mass indices and clinical parameters, including oral hygiene index‐simplified (OHI‐S) score, gingival index (GI), probing depth (PD), clinical attachment level (CAL), and HbA1c level, of all participants were recorded. All participants received non‐surgical periodontal therapy (scaling and root planing). After 3 months, all participants were reexamined, and clinical parameters and HbA1c levels were evaluated and compared to baseline values. Results: There were significant differences between group A and group B in regard to baseline OHI‐S, GI, PD, and HbA1c (P <0.05). There was no clinical attachment loss in group A, either at baseline or after 3 months. At the end of 3 months, group B showed improvement in all clinical parameters (P <0.05) and their HbA1c levels also significantly decreased (P <0.05), although the values never reached those of group A. Conclusion: The HbA1c levels of individuals without diabetes and with periodontitis (group B) were significantly reduced 3 months after non‐surgical periodontal therapy, although they never reached the same levels as those of the individuals without diabetes or periodontitis (group A).     

Clinical and patient-centered outcomes after minimally invasive non-surgical or surgical approaches for the treatment of intrabony defects: a randomized clinical trial

Background: The present study aims to compare the performance of minimally invasive non‐surgical and surgical approaches for the therapy of intrabony defects. Methods: Twenty‐nine patients who presented with intrabony defects were randomly assigned to: 1) a minimally invasive non‐surgical technique (MINST) group, or 2) minimally invasive surgical technique (MIST) group. The chair time of each therapeutic procedure was calculated. The probing depth (PD), position of the gingival margin (PGM) and relative clinical attachment level (RCAL) were evaluated at 3 and 6 months after treatments. The patient perception of discomfort/pain experienced during and after therapy and patient satisfaction regarding treatments were also evaluated. Results: Significant PD reductions, RCAL gains, and no changes in the PGM were obtained at 3 and 6 months in MINST and MIST groups (P <0.05). No differences were observed between groups at any time points (P >0.05). Patient‐oriented outcomes did not demonstrate differences between therapeutic approaches (P >0.05). Significant higher chair times were required in the MIST group than in the MINST group (P <0.05). Conclusions: Minimally invasive non‐surgical and surgical approaches were successfully used for the treatment of intrabony defects and achieved periodontal health in association with negligible morbidity and suitable patient satisfaction. However, non‐surgical therapeutic modality presented an advantage in terms of a reduction of treatment chair time.     

Level of Interleukin‐35 in Gingival Crevicular Fluid,Saliva, and Plasma in Periodontal Disease and Health

Background: A novel member of the interleukin (IL)‐12 family, IL‐35 is an important inhibitory cytokine released by regulatory T cells. The aim of this study is to evaluate gingival crevicular fluid (GCF), saliva, and plasma levels of IL‐35 in periodontal disease and health. Methods: Samples of GCF, whole saliva, and plasma were obtained from systemically healthy, non‐smoking individuals with gingivitis (n = 20) or chronic periodontitis (CP) (n = 20) and periodontally healthy individuals (n = 20). Full‐mouth clinical periodontal measurements, including probing depth (PD), bleeding on probing, gingival index, and plaque index (PI), were also recorded. Enzyme‐linked immunosorbent assay was used to determine IL‐35 levels in the samples. Data were tested statistically by analysis of variance and Pearson rank correlation test. Results: All clinical parameters were significantly higher in the CP group than the healthy and gingivitis groups (P <0.001). The GCF total amount of IL‐35 was significantly higher in the CP group than the other groups (P = 0.04), whereas the GCF concentration of IL‐35 was significantly higher in the healthy group than the other groups (P = 0.002). There were significant differences among the study groups in terms of salivary IL‐35 level (P <0.001), with the highest level observed in the healthy group and the lowest in the CP group. There was no statistical difference between groups in plasma levels of IL‐35 (P >0.05). There was a positive correlation between GCF total amount of IL‐35 and PD (r = 0.338, P = 0.03) and PI (r = 0.374, P = 0.005) parameters. Conclusions: IL‐35 could have an important role in suppressing periodontal inflammation and maintaining periodontal health. Additional studies are required to evaluate its role in periodontal diseases.     

低能量激光配合牙周基础治疗对糖尿病合并慢性牙周炎患者龈沟液细胞因子及LPS、leptin的影响

目的: 分析低能量激光照射疗法（low level laser treatment, LLLT）配合牙周基础治疗对糖尿病合并慢性牙周炎（diabetes mellitus complicated with chronic periodontitis, DMCP）患者龈沟内细胞因子及LPS、Leptin的影响。方法: 将2016年1月—2017年1月间收治的80例DMCP患者依照随机信封法分为实验组及对照组,每组40例。对照组采用牙周基础治疗,实验组采用低剂量激光配合牙周基础治疗。治疗前及治疗后3个月检测患者口腔PD、SBI及CAL水平;采集患者空腹静脉血,检测血液中糖代谢指标;采集患者龈沟液,检测龈沟液中炎症因子水平。采用SPSS19.0软件包对数据进行统计学分析。结果: 经治疗后2组CAL、PD及SBI水平均显著降低（P<0.05）,治疗后实验组CAL、PD及SBI水平显著低于对照组（P<0.05）。治疗后2组患者血中FBG及HbA1c水平均显著降低（P<0.05）,治疗后实验组FBG及HbA1c水平显著低于对照组（P<0.05）。治疗后2组患者龈沟液中hs-CRP、IL-1β及TNF-α水平均显著降低（P<0.05）,治疗后实验组患者龈沟液中hs-CRP、IL-1β及TNF-α水平显著低于对照组（P<0.05）。治疗后2组患者龈沟液LPS显著降低,Leptin水平显著升高（P<0.05）,实验组龈沟液中LPS显著低于对照组,Leptin水平显著高于对照组（P<0.05）。结论: 低能量激光配合牙周基础治疗,可有效降低DMCP患者血糖水平及龈沟内LPS水平,提高Leptin水平,显著改善病灶区炎症反应,提高临床疗效。     

The role of obesity as a modifying factor in patients undergoing non-surgical periodontal therapy

Background: Earlier studies have shown an association between obesity and periodontitis, which is mediated by cytokine production. The aim of this study is to assess the role of obesity as a modifying factor on periodontal clinical parameters and on circulating proinflammatory cytokine levels in subjects undergoing non‐surgical periodontal treatment. Methods: Twenty‐seven obese subjects and 25 normal‐weight subjects were enrolled in this study. Subjects in both groups had generalized chronic periodontitis. The periodontal parameters measured before and 3 months after non‐surgical periodontal therapy were: visible plaque index, bleeding gingival index, bleeding on probing, probing depth, and clinical attachment level. In addition, subjects underwent anthropometric measurements and serum analyses of fasting glucose, glycated hemoglobin, interleukin‐1β, interleukin‐6, tumor necrosis factor‐α, and interferon‐γ. Results: Periodontal therapy significantly decreased visible plaque index, bleeding gingival index, bleeding on probing, probing depth of 4 to 6 mm, probing depth ≥7 mm, clinical attachment level of 4 to 6 mm, and clinical attachment level ≥7 mm in both groups (P ≤0.05). Circulating proinflammatory cytokines significantly decreased in obese and normal‐weight subjects after periodontal treatment (P ≤0.05). However, interleukin‐6 and tumor necrosis factor‐α levels remained higher in obese subjects 3 months after treatment (P ≤0.05). Conclusion: Obesity does not seem to play a negative role by interfering in the improvement of the periodontal clinical response or decreasing circulating proinflammatory cytokine levels after periodontal treatment.     

Chemerin as a Novel Crevicular Fluid Marker of Patients With Periodontitis and Type 2 Diabetes Mellitus

Background: The objectives of the present study are to: 1) determine whether gingival crevicular fluid (GCF) chemerin is a novel predictive marker for patients with chronic periodontitis (CP) with and without type 2 diabetes mellitus (t2DM); 2) analyze the relationship between chemerin and interleukin (IL)‐6 in periodontally healthy individuals and in patients with CP and with and without t2DM; and 3) evaluate the effect of non‐surgical periodontal therapy on GCF chemerin levels. Methods: Eighty individuals were split into four groups: 20 who were systemically and periodontally healthy (CTRL), 20 with t2DM and periodontally healthy (DM‐CTRL), 20 systemically healthy with CP (CP), and 20 with CP and t2DM (DM‐CP). Individuals with periodontitis were treated with non‐surgical periodontal therapy. GCF sampling procedures and clinical periodontal measures were performed before and 6 weeks after treatment. Enzyme‐linked immunosorbent assay was used to measure chemerin and IL‐6 levels. Results: Greater values for GCF chemerin and IL‐6 levels were found in CP groups than in periodontally healthy groups, in DM‐CP than in CP, and in DM‐CTRL than in CTRL (P <0.008). GCF chemerin and IL‐6 levels decreased following therapy in CP groups (P <0.02). A comprehensive overview of all groups showed a statistically significant positive correlation of chemerin with IL‐6, glycated hemoglobin, sampled‐site clinical attachment level, and gingival index (P <0.05). Conclusions: In this study, periodontitis and t2DM induced aberrant secretion of chemerin, and non‐surgical periodontal therapy influenced the decrease of GCF chemerin levels in patients with CP with and without t2DM. Furthermore, it suggests GCF chemerin levels may be considered a potential proinflammatory marker for diabetes, periodontal disease, and treatment outcomes.     

Effect of Non‐Surgical Periodontal Therapy on Serum Ferritin Levels: An Interventional Study

Background: Ferritin, an acute‐phase reactant, has been found to be elevated in many chronic inflammation‐related diseases. The aim of the present study is to investigate differences in concentrations of serum ferritin in patients with and without periodontal disease before and after non‐surgical periodontal therapy and correlate these values with clinical variables associated with periodontal disease. Methods: Forty‐two individuals were included in this study, 20 with chronic periodontitis (CP) and 22 classified as periodontally healthy. Serum ferritin concentrations, hemoglobin levels, and periodontal parameters (probing depth [PD], clinical attachment level, gingival index, bleeding on probing, and plaque index) were recorded at baseline and 3 months after non‐surgical periodontal therapy. Results: Patients with CP showed higher concentrations of serum ferritin than periodontally healthy controls (P <0.01). After adjustment for confounders, a positive and significant correlation was observed between serum ferritin levels and the number of sites with PD ≥6 mm at baseline (P <0.01). Regression analyses revealed association between deep pockets and serum ferritin levels at baseline (R² = 0.823). Significant reductions in serum ferritin levels were observed at the 3‐month assessment after periodontal treatment (P <0.01), and the post‐treatment serum ferritin values were comparable to those of controls (P >0.05). Furthermore, the post‐treatment degree of change in the serum ferritin level was positively and significantly associated with improvement in PD (R² = 0.213, P <0.05). Conclusion: Serum ferritin levels are raised in patients with CP and decrease to control levels post‐treatment.     

Matrix Metalloproteinase (MMP)‐8 and Tissue Inhibitor of MMP‐1 (TIMP‐1) Gene Polymorphisms in Generalized Aggressive Periodontitis: Gingival Crevicular Fluid MMP‐8 and TIMP‐1 Levels and Outcome of Periodontal Therapy

Background: The aim of the present study is to investigate matrix metalloproteinase (MMP)‐8 and tissue inhibitor of MMP‐1 (TIMP‐1) gene polymorphisms in generalized aggressive periodontitis (GAgP) and to assess the effects of MMP‐8 and TIMP‐1 genotypes on the outcomes of non‐surgical periodontal therapy. Methods: Genomic DNA was obtained from peripheral blood of 100 patients with GAgP and 167 periodontally healthy controls. MMP‐8 +17 C/G, ?799 C/T, ?381 A/G and TIMP‐1 372 T/C, *429 T/G polymorphisms were determined by polymerase chain reaction‐restriction fragment length polymorphism. Patients with GAgP received non‐surgical periodontal therapy and were followed for 6 months. Clinical periodontal parameters and gingival crevicular fluid (GCF) samples were collected at baseline and at follow‐up visits. GCF biomarkers were analyzed by immunofluorescence assay and enzyme‐linked immunosorbent assay. Results: Distribution of the MMP‐8 ?799 C/T genotypes was significantly different between the GAgP and control groups (P <0.005). TIMP‐1 372 T/C and *429 T/G genotypes in males were also significantly different between study groups (P <0.004). GCF MMP‐8 levels decreased until 3 months after non‐surgical therapy compared with baseline in T and G alleles, as well as G and C allele carriers (P <0.0125), whereas no significant decreased was observed in non‐carriers (P >0.0125). Conclusion: On the basis of the present findings, it can be suggested that MMP‐8 ?799 C/T and TIMP‐1 372 T/C, *429 T/G gene polymorphisms in males may be associated with the susceptibility to GAgP in the Turkish population.     

Preliminary Results of Non‐Surgical Periodontal Treatment in Patients With Breast Cancer Undergoing Chemotherapy

Background: Although priority is often given to treat the cancer itself, focus should also be directed to prevention and improvement of oral complications that may occur as a result of cancer and/or its treatment. This study compares periodontal treatment results in healthy patients and patients with breast cancer undergoing chemotherapy by monitoring clinical conditions and C‐reactive‐protein (CRP) levels. Methods: Thirty‐five participants were allocated to one of two groups: patients with periodontitis (P) (n = 18) and patients with breast cancer and periodontitis (CAN/P) (n = 17). The following clinical parameters were assessed at baseline and 45, 90, and 180 days after non‐surgical periodontal treatment (NSPT): 1) probing depth (PD); 2) clinical attachment level (CAL); 3) plaque index (PI); 4) gingival index (GI); 5) CRP; and 6) complete blood count. Clinical parameters and CRP levels were statistically analyzed. Results: P and CAN/P groups presented a statistically significant decrease in PD after NSPT at 45, 90, and 180 days compared with baseline (P <0.05). There was a CAL gain in the P group and a significant reduction in PI and GI at 45, 90, and 180 days for both groups (P <0.05). At 180 days after NSPT treatment, the CAN/P group showed a higher number of residual pockets (P <0.05) compared with the P group (46.48 ± 26.80 and 7.58 ± 7.40, respectively). The P group demonstrated a significant reduction in CRP levels at 45 and 180 days after NSPT compared with baseline (P <0.05), whereas this reduction was not observed in the CAN/P group. Conclusion: Patients with breast cancer who were undergoing chemotherapy responded to periodontal non‐surgical therapy, although with less favorable results than patients with periodontitis without cancer, and may require additional or adjunctive periodontal treatments.     

Effect of Non‐Surgical Periodontal Treatment on Gingival Crevicular Fluid and Serum Endocan,Vascular Endothelial Growth Factor‐A,and Tumor Necrosis Factor‐Alpha Levels

Background: Periodontitis is a chronic inflammatory disease that occurs due to the interaction between pathogenic microorganisms and host defenses. Endocan is a proteoglycan secreted by endothelial cells under the control of inflammatory cytokines. Aims of the study are to determine serum and gingival crevicular fluid (GCF) endocan levels in the pathogenesis of periodontal diseases, supported with vascular endothelial growth factor (VEGF‐A) and tumor necrosis factor (TNF)‐alpha levels. This study additionally aims to evaluate correlation between GCF endocan levels, VEGF‐A, and TNF‐α levels with periodontal probing depth (PD). Methods: The study consists of two groups: group 1 (n = 20), healthy individuals; group 2 (n = 20), individuals with generalized chronic periodontitis (CP). Clinical measurements were recorded; GCF and serum samples were obtained from each participant before and 6 weeks after therapy. Levels of biomarkers were measured by enzyme‐linked immunosorbent assay. Intergroup comparisons of biochemical and clinical parameters were analyzed by Kruskal–Wallis/Bonferroni‐adjusted Mann–Whitney U test using statistical software. Results: Serum and GCF endocan, VEGF‐A, and TNF‐α levels were significantly higher in patients with CP than in healthy individuals (P <0.001) and decreased after treatment (P <0.03). A significant correlation was observed between GCF TNF‐α and PD (4 mm ≤ PD ≤5 mm and PD ≥6 mm). A significant relationship was found among GCF endocan and TNF‐α, VEGF‐A, CAL, and GI for all groups (P <0.05). Conclusions: Endocan and TNF‐α levels, both in GCF and serum, increased from health to periodontitis and decreased with non‐surgical periodontal treatment. Within the limits of the study, endocan may be considered as a potential inflammatory marker for periodontal disease.     

Effect of Non‐Surgical Periodontal Treatment on Visfatin Concentrations in Serum and Gingival Crevicular Fluid of Patients With Chronic Periodontitis and Type 2 Diabetes Mellitus

Background : This study aims to assess visfatin concentrations in serum and gingival crevicular fluid (GCF) and investigate this relationship in patients with type 2 diabetes mellitus (T2DM) and chronic periodontitis (CP) before and after non‐surgical periodontal treatment. Methods: Fifty‐four patients with T2DM and CP were recruited. The patients were randomly divided into two groups: treatment and control. Serum and GCF visfatin concentrations and glycated hemoglobin (HbA1c) levels were measured by enzyme‐linked immunosorbent assay at different time points (at baseline and 3 and 6 months after non‐surgical periodontal treatment). Results: Serum and GCF visfatin concentrations showed no significant differences between the groups at baseline (t test, P >0.05). A significant decline of visfatin in the treatment group was found in serum and GCF 3 months after non‐surgical periodontal treatment (t test, P <0.01). Baseline and 3‐month HbA1c levels were not significantly different, but at 6 months, a statistically significant difference was detected (t test, P >0.05). Conclusions: The data suggest that non‐surgical periodontal treatment is helpful for glucose control, an effect that may be associated with reduced visfatin in patients with T2DM and periodontitis. Furthermore, the data suggest that visfatin may be considered an inflammatory marker for periodontal diseases.     

2‐Year Assessment of Tissue Biostimulation With Low‐Level Laser on the Outcomes of Connective Tissue Graft in the Treatment of Single Gingival Recession: A Randomized Clinical Trial

Background: Periodontal wound healing has been accelerated by different low‐level laser therapy (LLLT) protocols. However, just a few studies have evaluated use of this therapy adjunctive to periodontal plastic surgery procedures. The present study shows 2‐year results of a connective tissue graft (CTG) associated with LLLT in the treatment of gingival recession (GR) defects. Methods: Forty patients presenting Miller Class I and II GRs were previously treated by CTG (control group; n = 20) or CTG + LLLT (test group; n = 20). A diode laser (aluminum‐gallium‐arsenide, 660 nm) was applied to test sites immediately after surgery and every other day for 14 days (total of eight applications). After a follow‐up of 2 years, clinical and esthetic evaluations were performed in 36 patients. Results: Mean percentage of root coverage was 93.43% for the test group and 92.32% for the control group (P = 0.55). Complete root coverage was 79% (n = 15) for the test group and 76% (n = 13) for the control group (n = 13) (P = 0.80). Both groups showed esthetics maintenance after 2 years. Conclusion: Within the limitations of this study, results indicate that LLLT showed no additional benefit in the long term when associated with a CTG in the treatment of Miller Class I and II GRs.     

不同牙龈生物型在牙冠延长术后牙周稳定性的评价

目的 评价不同牙龈生物型在牙冠延长术后牙周的稳定性。方法 选取需行前牙牙冠延长术的30例患者共128颗患牙,分为薄龈生物组（n=52）和厚龈生物组（n=76）,牙周基础治疗后行牙冠延长术,检测术前、术后2周、术后1、3、6个月两组患者牙龈缘位置,牙周探诊深度（PD）以及龈沟出血指数（SBI）并进行分析。结果 两组术后PD和SBI较术前均有明显改善（P<0.05）,手术前后两组之间的PD和SBI均无明显差异（P>0.05）,术后3个月薄龈生物型龈缘位置已基本稳定,术后6个月厚龈生物型组龈缘冠向移位更明显。结论 冠延手术后,厚龈生物型需要更长的恢复期稳定龈缘位置,修复体的制作应在术后6个月以后进行。     

Periodontal treatment and HbA1c levels in subjects with diabetes mellitus

It has earlier been reported that individuals with poorly controlled diabetes have severe periodontal disease (PD) compared to well‐controlled diabetes. This longitudinal interventional study compared periodontal treatment outcomes with HbA1c level changes in four groups of diabetic and non‐diabetic patients with or without PD, respectively. HbA1c, bleeding on probing (BOP), plaque index and periodontal pocket depth (PPD) 4 < 6 mm and ≥6 mm were recorded at baseline to 3 months after non‐surgical treatment and 3–6 months for surgical treatment in subjects with or without T2D, and with or without PD. A total of 129 patients were followed from baseline to 6 months. Diabetics with PD and without PD showed reductions in HbA1c levels with a mean value of 0·3% after 3 months and mean values of 1% and 0·8%, respectively, after 6 months. Diabetics with PD showed higher levels of BOP versus non‐diabetics without PD (P < 0·01) and versus diabetics without PD (P < 0·05) at baseline. After 6 months, diabetics with PD showed higher number of PPD 4 < 6 mm versus diabetics without PD (P < 0·01) and non‐diabetics with PD (P < 0·01). Diabetics without PD showed higher levels of PPD 4 < 6 mm versus non‐diabetics without PD (P < 0·01). Surgical and non‐surgical periodontal treatment in all groups improved periodontal inflammatory conditions with a decrease in HbA1c levels in a period of three and 6 months. No change was seen in the number of pockets PPD 4 < 6 mm in diabetic subjects with PD after non‐surgical and surgical treatment.     

Azithromycin as an Adjunctive Treatment of Generalized Severe Chronic Periodontitis: Clinical,Microbiologic, and Biochemical Parameters

Background: This study examines the efficacy of azithromycin in combination with non‐surgical periodontal therapy on clinical and microbiologic parameters and gingival crevicular fluid (GCF) matrix metalloproteinases‐8 (MMP‐8) levels over 6 months in patients with severe generalized chronic periodontitis (CP). Methods: Twenty‐eight of 36 patients with severe generalized CP were included in this randomized, double‐masked, placebo‐controlled, parallel‐arm study. They were randomly assigned to azithromycin or placebo groups (500 mg, once daily for 3 days). Probing depth (PD), clinical attachment level, dichotomous presence or absence of supragingival plaque accumulation, and bleeding on probing were recorded. GCF samples were obtained from one single‐rooted tooth with PD ≥ 6 mm, whereas microbiologic samples were collected from two single‐rooted teeth with PD ≥ 6 mm. Microbiologic parameters were analyzed by quantitative real‐time polymerase chain reaction for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia, and total bacteria. GCF MMP‐8 levels were determined by immunofluorescence assay. Results: Azithromycin and placebo groups demonstrated similar but significant improvements in all clinical parameters (P <0.05). A. actinomycetemcomitans, P. gingivalis, T. forsythia, P. intermedia, and total bacteria significantly decreased over the 6‐month period in both groups, whereas F. nucleatum was significantly reduced in all visits in the azithromycin group, with the levels also being lower compared with those of the placebo group (P <0.05). The azithromycin and placebo groups exhibited significant reduction in GCF MMP‐8 levels at the post‐treatment visit and at 2 weeks (P <0.05). Conclusion: On the basis of the present findings, it can be concluded that adjunctive azithromycin provides no additional benefit over non‐surgical periodontal treatment on parameters investigated in patients with severe generalized CP.     

Salivary Biomarkers in a Biofilm Overgrowth Model

Background: The purpose of this study is to determine whether baseline salivary inflammatory biomarkers could discriminate between different clinical levels of disease and/or detect clinical changes over a 3‐week stent‐induced biofilm overgrowth (SIBO) period. Methods: A total of 168 participants were enrolled in a 21‐day experimental gingivitis investigation and grouped according to clinical measures of periodontal status of health and diseased individuals representing each of five biofilm gingival interface (BGI) periodontal groups: 1) health, all probing depth (PD) <3 mm and bleeding on probing (BOP) <10%; 2) gingivitis, all PD <3 mm and BOP ≥10%; 3) periodontitis (P)1, ≥1 site with PD >3 mm and BOP ≤10%; 4) P2, ≥1 site with PD >3 mm and BOP >10% but ≤50%; and 5) P3, ≥1 site with PD >3 mm and BOP >50%. Stents were used to prevent plaque removal during brushing over one maxillary and one mandibular posterior dental sextant for 21 days. Clinical periodontal parameters and unstimulated saliva were collected at screening, baseline, and each week during SIBO. Saliva samples were assessed for levels of 13 different biomarkers by multiplex immunoassay. Results: Higher salivary levels of interleukin (IL)‐1β, matrix metalloproteinase (MMP)‐3, MMP‐8, MMP‐9, and neutrophil gelatinase‐associated lipocalin (NGAL) were found in diseased groups compared with the healthy group at baseline. Conversely, higher IL‐1 receptor antagonist (ra) levels were found in healthy patients at baseline. In addition, during SIBO, MMP‐1, tissue inhibitor of metalloproteinase (TIMP)‐1, and TIMP‐2 levels increased across all participant groups. A stepwise linear regression model using all salivary biomarkers demonstrated that, at baseline, increased IL‐1ra (P = 0.004) and IL‐6 (P = 0.009) were significantly associated with change in PDs during SIBO. Conclusions: In summary, this investigation supports salivary levels of IL‐1ra and IL‐6 as potential indicators for PD changes during induced gingival inflammation. In addition, participants from the BGI‐P3 group (severe periodontitis) demonstrated elevated baseline levels of IL‐1β, MMP‐3, MMP‐8, MMP‐9, and NGAL compared with the other study groups, strengthening the relevance of participants’ biologic phenotype on expression of salivary biomarkers.     

Smoking and caries experience in subjects with various form of periodontal diseases from a teaching hospital clinic

Abstract: Objective: The aim of this study was to assess the relationships between aggressive periodontitis (AgP), caries and smoking. Method and materials: A cross‐sectional study was conducted among patients who were specifically referred to the Dental Teaching Clinic in Irbid, Jordan for periodontal treatment. Self‐administered questionnaire related to socio‐demographic data and smoking habits was completed. The oral hygiene, gingival status, periodontal health and dental status of the participants was determined by using the plaque index of Silness and Loe [Acta Odontol Scand, 22 (1964), 121], the gingival index of Loe and Silness [Acta Odontol Scand, 21 (1963), 233], clinical attachment level (CAL) and decayed, missing and filled teeth (DMFT) index respectively. Result: The prevalence of smoking was greater in chronic periodontitis (CP) group (44.2%) than in either chronic gingivitis (CG) (27.4%) or AgP (29.9%) group. Self‐reported perio‐diseases in the close family was more prevalent (77%) among subjects diagnosed with AgP. The mean plaque scores were significantly higher for smoker than non‐smoker in AgP group only (P = 0.04), with significantly greater plaque and gingival scores in CG and CP groups than AgP group (P = 0.012, 0.004). A significantly greater mean gingival scores were noted among CG and CP groups than AgP group (P = 0.004). The mean CAL was higher in smokers than in non‐smokers in the three groups, with statistically significant differences in CP and AgP groups (P = 0.04, 0.01 respectively).The mean number of DMFT was significantly higher in smoker than in non‐smoker of all age groups (P = 0.016, 0.043 and 0.01). However, mean DMFT was significantly greater in CP and CG than AgP groups. Conclusion: It was concluded that (i) higher plaque and gingival index among smokers in all groups; (ii) significant difference in the CAL between smoker and non‐smoke in CP and AgP groups; (iii) significant increase in caries risk among smokers in all groups; (iv) smokers and non‐smokers of AgP group had significantly lower mean DMFT scores than those of CG or CP groups.     

Clinical and Biochemical Evaluation of Lozenges Containing Lactobacillus reuteri as an Adjunct to Non‐Surgical Periodontal Therapy in Chronic Periodontitis

Background: This study evaluates the effects on clinical and biochemical parameters of Lactobacillus reuteri–containing probiotic supplementation adjunctive to initial periodontal therapy in patients with chronic periodontitis (CP). Methods: Thirty patients with CP were included and divided into two groups. Every patient had, in each quadrant, ≥2 teeth each with approximal sites with a probing depth (PD) of 5 to 7 mm and gingival index (GI) of ≥2. The test group received scaling and root planing (SRP) and probiotic‐containing lozenges. The control group received SRP and placebo lozenges. Plaque index (PI), GI, bleeding on probing (BOP), PD, and attachment gain were measured. Gingival crevicular fluid (GCF) was sampled for the analysis of matrix metalloproteinase (MMP)‐8 and tissue inhibitor of metalloproteinase (TIMP)‐1 by enzyme‐linked immunosorbent assay. All evaluations were performed at baseline and on days 21, 90, 180, and 360. Results: Differences in intergroup comparisons of PI, GI, BOP, and PD were found to be significant (P <0.05) in favor of the test group at all time points. Decreased GCF MMP‐8 levels and increased TIMP‐1 levels were found to be significant up to day 180 (P <0.05). Mean values of attachment gain were significantly higher in the test group compared with the control group on days 90, 180, and 360. Conclusions: Lozenges containing L. reuteri may be a useful supplement in moderately deep pockets of patients with CP. Low MMP‐8 and high TIMP‐1 levels may indicate the role of the lozenges in reduction of inflammation‐associated markers up to day 180.