Relationship between gingival inflammation and painfulness of periodontal probing

The relationship of gingival inflammation to the pain associated with periodontal probing was assessed at baseline (B), and 1 month (1M) and 3 months (3M) later in 46 subjects. At each of the 3 sessions, clinical measures of gingival inflammation included an observational gingival index and bleeding score. In addition, periodontal probings of all existing teeth was performed with a constant force probe (25 g). Following completion of the probing at each session, subjects rated the global painfulness of the probing using a visual analog scale for pain. Results of this study showed that judged painfulness of probing was related to clinical inflammation (bleeding score) at baseline and 1 month and suggest that the degree of periodontal inflammation is related to the pain and discomfort associated with periodontal probing.     

Bleeding on probing as it relates to probing pressure and gingival health

The present study was designed to determine the threshold pressure value to be applied in provoking bleeding on probing (BOP) in clinically healthy gingival units. 12 female dental hygiene students volunteered for the study. They were selected on the basis of excellent oral hygiene standards, absence of probing depths greater than 3 mm and absence of caries or dental restorations on smooth and proximal tooth surfaces. Applying a probing force of 0.25, 0.5, 0.75 and 1.0 N in one of the 4 jaw quadrants, respectively, on 2 different occasions with an interval of 10 days, bleeding on probing was assessed. Oral hygiene and gingival conditions were determined using the criteria of the plaque control record and the gingival index. On the basis of the BOP values, obtained using the lowest probing force (0.25 N), the subjects were divided into 2 groups: group 1 ("minimal BOP" value) consisted of 6 subjects yielding practically no bleeding (mean BOP = 0.9%) at both examinations, while the subjects of group 2 ("low BOP" value) had slightly higher BOP% (mean BOP = 13.4%). Both groups showed significant increase in mean BOP% with increasing probing force (0.9%-36.1% in group 1 and 13.4%-47.0% in group 2). Regression analysis revealed an almost linear correlation and a high correlation coefficient between BOP% and probing force. The comparison of the regression lines of the 2 groups showed almost identical slope inclination. However, slight differences in slope inclination were found for different sites: approximal sites clearly yielded steeper regression lines than buccal/oral sites.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of gingival wall on resistance to probing forces

Abstract This study was conducted to determine whether the gingival tissue lateral 10 the periodontal sulcus contributes resistance to the advancement of a periodontal probe tip into the sulcus under different applied pressures. An electromechanical device was used to advance a probe tip 0.6 mm in diameter into the facial sulcus at a constant speed until resisting forces of 0.70 N were encountered. The device registered the resisting force and probe advancement simultaneously. The gingiva of all 2nd incisors, 2nd premolars, and 1st molars of 4 young adult male beagle dogs were tested. After the first measurement, the buccal gingiva of experimental sites were incised mesiodistally from the gingival margin to the alveolar crest and the sulcus was reprobed. 2 experimental and control quadrants were selected randomly resulting in 6 sets of both experimental and control data from each animal. The data were analyzed with analysis of variance. The analysis demonstrated significant variation from site to site, and dog to dog; therefore, only changes between the 1st and 2nd probings at the same sites could be compared. Less variability of probing distance in different animals occurred at higher forces; however, the incision had a significant effect on probing distance at these forces. The pressure at which probing distance had less variability among animals and least affected when the gingival sulcular wall was incised was estimated to be 106 N/cm². This corresponds to 30 g force on the 0.6 mm diameter probe.     

Effect of interleukin-1 gene polymorphisms on gingival inflammation assessed by bleeding on probing in a periodontal maintenance population

Bleeding on probing (BOP) is the most significant clinical parameter for the assessment of periodontal inflammation. The aim of this prospective longitudinal trial was to study the association between allelic variants of the IL-1 gene complex and gingival inflammation. Three hundred and twenty-three randomly selected periodontal maintenance patients (64.4% females) received a periodontal examination that included probing depth measurements and BOP at each of 4 supportive periodontal therapy (SPT) appointments. A blood sample taken from each subject was analysed for the presence of specific allotypes of the IL-1 gene complex. Two polymorphisms located at +4845 bp in the IL-1 alpha region and at +3954 bp in the IL-1 beta region were evaluated by a polymerase chain reaction method; 35.3% of the examined subjects were positive for specific combinations of allotypes of the IL-1 gene complex previously associated with an increased risk for severe periodontitis. The population consisted of 90 current smokers and 94 former smokers. An analysis of the association between the IL-1 genotype and BOP in the whole population (including smokers) did not reach statistical significance because of the overriding effect of smoking. A subset analysis of the 139 never smokers indicated that genotype positive patients had a significantly elevated chance of presenting an increase in the BOP% over a 4-appointment recall period (p = 0.03) after correcting for oral hygiene. In fact, patients who were genotype-negative had a 50% smaller chance of showing increases in BOP% during SPT. A further analysis explored the relationship between the genotype and the level of BOP% at the most recent recall visit. A generalized linear model showed a statistically significant effect of the genotype status after correcting for plaque accumulation and prevalence of residual pockets (> or = 5 mm). Genotype-negative subjects had significantly lower BOP% (p = 0.0097). It is concluded that the increased BOP prevalence and incidence observed in IL-1 genotype-positive subjects indicates that some individuals have a genetically determined hyper-inflammatory response that is expressed in the clinical response of the periodontal tissues.     

Relationship between periodontal probing velocity and gingival inflammation in human subjects

Abstract Little is known about the biophysical characteristics of the dentogingival junction in response to the development or resolution of inflammation. The Toronto Automated Periodontal Probe (TAPP) provides an estimate of the integrity of the dentogingival junction by measuring intrapocket probing velocity. The aim of this study was to measure changes of probing velocity in inflamed human periodontium before and after subgingival debridement. 32 subjects exhibiting gingival inflammation were selected; 29 completed the study. Gingival index (GI), plaque index (PLI), bleeding index (BI) and the rate of gingival crevicular fluid flow (CFF) were measured as concomitant variables. The experimental group (N= 16) received scaling, root planing and oral hygiene instruction at baseline. The control group (N=13) received no treatment until after 28 days. Subjects were seen at baseline, day 14, 21 and 28 for measurement of probing velocity and concomitant variables on 6 index teeth. At day 28, the control group was treated and then reassessed 28 days later. The experimental group showed a reduction of 51.6% for mean crevicular fluid flow (p<0.0001), 79.7% for mean plaque index (p<0.0001), 58.0% for mean gingival index (p<0.0001), and 72.0% for mean bleeding index (p<0.002) at day 28, confirming that inflammation was reduced compared with baseline. No significant changes were observed in the control group until after treatment. The velocity of probing and the formation of a plateau in the velocity profile were recorded. The experimental group demonstrated a significant increase (p<0.002) in the frequency of plateau formation and a decrease in mean slope between baseline and day 28 (p<0.02). No significant change was observed in the control until day 56, 28 days after treatment. These data indicate a direct relationship between improved clinical health and increased resistance to probe penetration near the base of the pocket, as reflected by the increased frequency of plateau formation and decreased slope for the terminal segment of the velocity profile curve.     

Comparison of the bleeding on marginal probing index and the Eastman interdental bleeding index as indicators of gingivitis

AIM: The purpose of the present study was to compare 2 indices, i.e., the Eastman interdental bleeding (EIB) index and the bleeding on marginal probing (BOMP) index. The comparison was made (a) in terms of the degree of bleeding provoked and the relationship with plaque in natural gingivitis and (b) for the ability of these 2 methods to detect differences between the development of experimental gingivitis in a control group and a group in which the development of gingival inflammation was suppressed by treatment. For the present studies, subjects were selected without interdental recession of the gingival tissues. METHODS EXPERIMENT 1: In this experiment, 43 subjects having established moderate gingivitis were assessed using a random splitmouth design (1st and 3rd/2nd and 4th quadrant). Plaque was scored on all approximal sites after which the BOMP index was assessed in one half of the mouth and the EIB index in the other. RESULTS EXPERIMENT 1: The BOMP index showed a bleeding score of 84% and the EIB index of 87%. The significant correlation between plaque and gingival bleeding for the BOMP index (0.55) was higher than for the EIB index (0.44). METHODS EXPERIMENT 2: For this experiment, 25 subjects participated in an experimental gingivitis trial of the lower jaw. At baseline, first the BOMP index and immediately thereafter the EIB index were assessed at all approximal sites. Experimental gingivitis (EG) was carried out in one randomly assigned quadrant and as a treatment modality only floss was used in the other (FL). RESULTS EXPERIMENT 2: In the EG quadrant, the BOMP index increased to 69% and the EIB index to 73%. Both indices showed a significant correlation with plaque; 0.60 and 0.64 respectively. In the FL quadrant, the BOMP index increased to 38% and the EIB index to 30%. No significant correlation between both gingivitis indices and the amount of plaque was present in the FL quadrant. CONCLUSION: The ability of the BOMP index and the EIB index to assess the level gingival inflammation appears to be comparable.     

Relationship between the gingival sulcus depth and interleukin-1 isoform concentrations within the adjacent gingival tissue

Background and Objective: While there is substantial information concerning the concentrations of interleukin‐1 isoforms within gingival crevicular fluid, there is little information concerning their concentrations within either normal or diseased gingival tissues. Therefore, the aim of this study was to evaluate the relationship between the concentrations of gingival interleukin‐1 isoforms and the adjacent sulcular depth. Material and Methods: Interdental gingival papillae were excised and grouped based on adjacent pocket depth and the presence of bleeding on probing. Gingiva adjacent to a sulcus of ≤ 3 mm without bleeding on probing were classified as ‘normal’; gingiva adjacent to a 3‐mm sulcus with bleeding on probing were classified as ‘diseased‐slight’; gingiva adjacent to a 4–6‐mm sulcus featuring bleeding on probing were classified as ‘diseased‐moderate’; and gingiva adjacent to a sulcus of > 6 mm featuring bleeding on probing were classified as ‘diseased‐severe’. Tissues were solublized and the concentrations of interleukin‐1β, interleukin‐1α, interleukin‐1 receptor antagonist and interleukin‐6 were assessed by enzyme‐linked immunosorbent assay. Data were compared by factorial analysis of variance, the post‐hoc Tukey test and the Pearson’s correlation test. Results: Gingival concentrations of interleukin‐6, interleukin‐1 receptor antagonist, interleukin‐1α‐ and interleukin‐1β were significantly greater at diseased‐severe sites than at normal, diseased‐slight, or diseased‐moderate sites (p < 0.05); the gingival concentrations of interleukin‐1 receptor antagonist and interleukin‐1α were significantly greater at diseased‐severe than at diseased‐moderate sites (p < 0.05). Interleukin‐1 receptor antagonist concentrations were significantly correlated with both interleukin‐1α and interleukin‐1β concentrations. The ratios of concentrations of the interleukin‐1 isoforms were different at the various stages of inflammation. Conclusion: Our data indicated a progressive increase in gingival concentrations of interleukin‐1 isoforms with increased adjacent sulcular depth. However, within ‘diseased’ tissues, the proportional concentrations of interleukin‐1α and ‐β to interleukin‐1 receptor antagonist were lowest within diseased‐severe tissues.     

The dimensions of keratinized mucosa around implants affect clinical and immunological parameters

Objectives: To investigate the association between keratinized mucosa (KM) width and mucosal thickness (MTh) with clinical and immunological parameters around dental implants. Methods: Sixty‐three functioning dental implants (3I osseotite) were examined. Clinical examinations included plaque index (PI), probing depth (PD), bleeding on probing (BOP), KM width, MTh and buccal mucosal recession (MR). Peri‐implant crevicular fluid (PICF) samples were collected for PgE2 assay. Results: KM width ranged from 0 to 7 mm (mean 2.5±2), MTh ranged from 0.38 to 2.46 mm (mean 1.11±0.4) and the mean MR was 0.62 mm, ranging from 0 to 3 mm. A negative correlation was found between MTh and MR (r=?0.32, P=0.01); Likewise, KM width showed a negative correlation with MR, periodontal attachment level (PAL) and PgE2 levels (r=?0.41, P<0.001; r=?0.26, P=0.04; r=?0.26, P=0.04, respectively). In contrast, a positive correlation was found between KM width and PD (r=0.27, P=0.03). When data were dichotomized by KM width, a wider mucosal band (>1 mm) was associated with less MR compared with narrow (≤1 mm) band (0.27 and 0.9 mm, respectively, P=0.001). A wider KM band was also associated with a greater PD (3.13 mm) compared with a narrow band (2.66 mm, P=0.04). Similarly, a thick mucosa (≥1 mm) was associated with lesser recession compared with a thin (<1 mm) mucosa (0.45 and 0.9 mm, respectively, P=0.04). Conclusion: The KM around dental implants affects both the clinical and the immunological parameters at these sites. These findings are of special importance in the esthetic zone, where thin and narrow KM may lead to a greater MR.     

Bleeding on probing as it relates to probing pressure and gingival health in patients with a reduced but healthy periodontium. A clinical study.

A previous study demonstrated that the bleeding on probing (BOP) test using uncontrolled forces may result in a proportion of false positive readings when used as a parameter for inflammation. A strong possibility exists for the traumatization of clinically healthy gingival tissues if a probing force exceeding 0.25 N is applied. While these results originated form young dental hygienists exhibiting excellent oral hygiene, the aim of the present study was to evaluate the relationship between probing pressures and gingival conditions in patients with a history of treated periodontal disease, i.e., in situations with a reduced but healthy periodontium. 10 patients who had been enrolled in a periodontal maintenance program following treatment of moderate to advanced chronic inflammatory periodontal disease consented to participate in the study. They were all selected on the basis of a record of excellent oral hygiene practices for at least 2-6 years and almost complete absence of clinical inflammation following successful periodontal therapy. Applying a probing force of 0.125, 0.25, 0.375 and 0.5 N in the 4 jaw quadrants, respectively, at 2 different occasions with an interval of 10 days, bleeding on probing was assessed. Oral hygiene and gingival conditions were determined using the criteria of the plaque and gingival index systems. All subjects showed significant increases in mean BOP% with increasing probing force applied (2.5%-7.9%). Regression analysis revealed an almost linear correlation and a significant correlation coefficient between BOP% and probing force. Almost identical slope inclinations were found when the 6 subjects with the lowest mean BOP% at 0.25 N were compared with the regression analysis of the total group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Suppression of overt gingival inflammation in tobacco smokers - clinical and mechanistic considerations

Abstract:  Gingivitis is a reversible inflammatory disease of the periodontal tissues. Periodontitis, in addition, involves destruction of the supporting structures of teeth. Diagnoses of gingivitis and periodontitis are predominantly dependent on clinical measurements of key inflammatory indices. Smokers are more susceptible to developing periodontal diseases, yet smoking masks overt signs of inflammation, presenting dental professionals with a clinical conundrum. We review the evidence that tobacco smoke may (i) cause acute periodontal vasoconstriction, (ii) inhibit periodontal angiogenesis in response to inflammatory stimuli, and/or (iii) suppress the production of pro-inflammatory mediators. It is clear that the mechanisms by which cigarette smoking dampens the periodontal inflammatory response are not yet fully understood. Further research into inflammatory suppression is warranted and should point to improved methods of diagnosis, not only in smokers, but also in non-smokers.     

Transient effect of a short-term educational programme without prophylaxis on control of plaque and gingival inflammation in school children

Abstract The development of chronic inflammatory periodontal diseases is strongly correlated with the growth and maturation of subgingival bacterial colonies. Consequently a major preventive goal should be the control of plaque formation. We conducted a randomized, controlled trial to examine the short-term effect of an intensive instructional program without professional prophylaxis on the gingival health of 240. 11-14 year old school children. Plaque index (P1I), gingival index (GI), bleeding index (BI) and probing pocket depth (PD) were examined 4 × by 1 examiner blinded to the instruction. During the period of instruction, subjects in the experimental groups were involved in a plaque and gingivitis prevention program provided in separate educational sessions. One of the experimental groups (E-l: n=80) was provided with a new toothbrush, toothpaste and instruction while the second experimental group (E-2: n=80) was provided with toothbrush, toothpaste, dental floss and instruction. In the control group (C; n=80) only dental examinations were provided: no preventive program or oral health measures were conducted. Examinations were conducted every 3 months during the instructional period and at 6 months following the completion of the active preventive programme. During the experimental period there was a significant decrease (p<0.001) in the mean P1I. GI and BI of the experimental groups following the program while in controls there was a slight but not significant increase of mean values (p > 0.05). During the preventive program experimental groups exhibited small but not significant (p > 0.05) reductions of PD. Experimental group 1 showed similar PH. GI. BI and PD scores as experimental group 2 during the study. After the instructional program was completed and a period of 6 months had passed, there was a large and significant (p < 0.001) increase of mean P1I. GI and BI scores in both experimental groups back to the baseline levels. We conclude that a short-term preventative program without professional instrumentation induces a transient improvement of gingival health of schoolchildren but only during the instructional period. The maintenance of improved gingival health over longer time periods requires prolonged, repeated instruction by professionals. These measures may be difficult to institute and are of questionable cost-effectivness.     

Relationship of gingival thickness and bleeding to loss of probing attachment in shallow sites following nonsurgical periodontal therapy

Periodontal sites of shallow initial probing depth often seem to lose probing attachment following various types of periodontal therapy, including nonsurgical therapy. The susceptibility to this treatment-associated probing attachment loss may conceivably be related to gingival architecture as well as to the inflammatory status of the tissues. This study was designed to study the relationship of buccolingual gingival thickness and bleeding on probing in shallow buccal sites (less than or equal to 3.5 mm probing depth) to loss of probing attachment following nonsurgical therapy. 3 months following treatment consisting of oral hygiene instruction and supra- and subgingival debridement, thin (less than or equal to 1.5 mm), initially non-bleeding sites displayed a mean loss of probing attachment of 0.3 mm. Thick (greater than or equal to 2.0 mm), non-bleeding sites displayed a less noticeable mean loss of probing attachment, whereas bleeding sites of both categories of gingival thickness showed a tendency towards gains in probing attachment levels. It may be concluded that the mean loss in probing attachment levels, commonly seen for shallow sites post-therapy, may be primarily due to the changes in shallow, thin healthy areas.     

探龈缘出血法的临床应用评价

目的：研究探龈缘出血法（BOMP法）的临床应用价值.方法： 实验一是对31名受检者的5100个位点分别用Williams刻度牙周探针探龈缘法和压力恒定的Florida探针探袋底法（BOPP法）检查出血指数;实验二是对另31名受检者的4 974个位点用Williams刻度牙周探针分别用BOMP法、BOPP法检查出血指数.结果：在PD＜4 mm时,BOMP法与其他两种方法的一致率、相关程度最高,而且有较高的阴性预测值.BOMP法与其他两种方法在位点水平、牙位水平、区段水平和个体水平上的相关性呈逐渐增加的趋势.结论：BOMP法较适用于评价牙龈炎和种植体周围早期炎症,适用于人群的流行病学调查.     

Comparison of the clinical effects and gingival abrasion aspects of manual and electric toothbrushes

AIMS: The clinical effects and gingival abrasion aspects of 2 electrical tooth-brushes (Braun Oral-B Plak Control Ultra and the novel development Braun Oral-B Plak Control 3D) were to be compared with conventional manual tooth-brushing. MATERIAL AND METHODS: In a cross-over study, 26 dental student volunteers participated and were assigned to 1 of 3 groups. Following instruction in the use of the electric as well as manual toothbrushes, the volunteers were timed for 2 min each day to apply one electric or the manual toothbrush, respectively, during 3 experimental phases of 2 weeks. No other methods of tooth cleaning were to be performed except the one specified for the respective test period. When brushing manually, the Bass toothbrushing technique was applied. Between each test period, a recovery period of 1 week was allowed during which no oral hygiene was performed at all. At the start and the end of each of the experimental periods, the extension of plaque deposits from the gingival margin in coronal direction was assessed using the Turesky et al. modification of the Quigley and Hein plaque index. Presence or absence of gingival inflammation was evaluated by bleeding and probing (BOP). The extent and severity of gingival abrasions were assessed by use of a modified method of Breitenmoser et al. and adapted by Danser et al. RESULTS: The plaque-reducing effect was similar in all groups with the same cleaning regime. For that reason, the result of the different experimental phases with the respective cleaning modalities were collapsed. Cleaning with the Braun Oral-B Plak Control Ultra electric toothbrush resulted consistently in the lowest plaque scores when compared to both the Braun Oral-B Plak Control 3D and the manual toothbrush. Although the differences in plaque reduction were statistically significant between cleaning with Braun Oral-B Plak Control Ultra and 3D, they were small and of questionable clinical relevance. No significant differences in plaque reductions were found between manual brushing and any of the 2 electric brushes. Gingival abrasions were least pronounced following brushing with the Braun Oral-B Plak Control 3D electric toothbrush. However, no significant differences in gingival abrasion were encountered following brushing with the Braun Oral-B Plak Control Ultra electric in comparison with the manual toothbrush. CONCLUSIONS: The results of the present study have shown that in a group of dental students trained in manual brushing technique, where efficacy was similar with the 3 toothbrushes tested, there is no evidence of greater gingival abrasion with either Braun Oral-B Plak Control Ultra or 3D when compared with a manual brush.