Smoking, a weak predictor of periodontitis in older adults

BACKGROUND: The impact of smoking habits on periodontal conditions in older subjects is poorly studied. AIMS: To assess if a history of smoking is associated with chronic periodontitis and medical history in older subjects. MATERIAL AND METHODS: The medical and dental history was collected from 1084 subjects 60-75 years of age. Smoking history information was obtained from self-reports. Periodontal variables [clinical probing depth (PD)>/=5.0 mm, clinical attachment levels (CALs) >/=4.0 mm], and radiographic evidence of alveolar bone loss were assessed. RESULTS: 60.5% had never smoked (NS), 32.0% were former smokers (FS) (mean smoke years: 26.1 years, SD+/-13.1), and 7.5% were current smokers (CS) (mean smoke years 38.0 years, (SD+/-12.1). The proportional distribution of CAL >/=4.0 mm differed significantly by smoking status (NS and CS groups) (mean difference: 12.1%, 95% confidence interval (CI): 1.5-22.6, p<0.02). The Mantel-Haenszel common odds ratio between smoking status (CS+FS) and periodontitis (>20% bone loss) was 1.3 (p<0.09, 95% CI: 0.9-2.0) and changed to 1.8 (p<0.02, 95% CI: 1.3-2.7) with 30 years of smoking as cutoff. A weak correlation between number of years of smoking and CAL>/=4.0 mm was demonstrated (r(2) values 0.05 and 0.07) for FS and CS, respectively. Binary logistic forward (Wald) regression analysis demonstrated that the evidence of carotid calcification, current smoking status, gender (male), and the number of remaining teeth were explanatory to alveolar bone loss. CONCLUSIONS: A clinically significant impact on periodontal conditions may require 30 years of smoking or more. Tooth loss, radiographic evidence of carotid calcification, current smoking status, and male gender can predictably be associated with alveolar bone loss in older subjects.     

Presence and antibiotic resistance of Porphyromonas gingivalis,Prevotella intermedia,and Prevotella nigrescens in children

BACKGROUND/AIMS: Only limited information exists about the prevalence in children of pathogens associated with periodontitis. The aim of the present study was to determine by culture whether 8-11-year-old children carry Porphyromonas gingivalis, Prevotella intermedia, and/or P. nigrescens in samples from the gingiva and/or the buccal mucosa taken before, and after caries treatment and oral hygiene instruction. A second aim was to assess the proportion of subjects who had gram-negative anaerobes carrying the tet(Q) and erm(F) genes, suggesting antibiotic resistance to tetracycline or erythromycin. METHOD: A total of 150 children provided gingival and buccal swab bacterial samples that were cultured for P. gingivalis, P. intermedia, and P. nigrescens. The species was verified using DNA-DNA hybridization with species-specific probes made from the variable region of the 16S rRNA sequences. Antibiotic-resistant genes, tet(Q) and erm(F), were identified using specific DNA-DNA hybridization with specific DNA probes. RESULTS: A total of 116 isolates of black-pigmented bacteria were cultured from 47 (31%) of 150 children. Five isolates were identified as P. gingivalis, 29 as P. intermedia, 33 as P. nigrescens, and 49 as other species. In general, the bacteria were not culturable at more than one time period. We found that 55% of these 47 children harbored black pigmented bacteria that carried either one or both of the two antibiotic-resistant genes studied (tet(Q), and erm(F)). CONCLUSION: The present study demonstrated that children not exposed to regular dental treatment carry bacteria outside the gingival sulcus that have been associated with periodontitis, and that standard treatment procedures may not clear the presence of the putative pathogens. In addition, antibiotic-resistant genes are common in identifiable gram-negative anaerobes, including putative pathogens.     

Analysis of periodontal risk profiles in adults with or without a history of myocardial infarction

BACKGROUND: An association between periodontitis and cardiovascular diseases has been suggested. AIMS: To study whether a combination of clinical variables in a functional risk diagram enhanced the ability to differentiate between subjects with or without an immediate history of acute myocardial infarction (AMI). MATERIAL AND METHODS: A functional periodontal pentagon risk diagram (PPRD) with five periodontal risk vectors was created. The surface of individual PPRDs was calculated using data from 88 subjects with recent AMI and 80 matched control subjects with no history of AMI. RESULTS: Age, gender, number of remaining teeth (mean value: 21.1 versus 21.6 teeth), smoking status, and pocket probing depth (PPD) distribution did not differ by group. Gingival recession was greater in control subjects (mean difference: 5.7, SD: +/- 1.9, p<0.01, 95% CI: 1.8-9.6). Bone loss > or = 4.0 mm was at all levels studied was significantly greater in subjects with AMI and bone loss > or = 50% (> or = 4 mm) was the best individual predictor of AMI (beta = 2.99, p < 0.000, 95% CI: 7.5-53.4). Only PPRD scores were associated with AMI status when factors not included in the PPRD were studied (beta = 22.1, SE: 5.9, p < 0.0001, 95% CI: 10.3-33.7). The best association between AMI status and study variables was the combination of > or = 4 mm of bone loss > or = 50%, proportion of bleeding on probing (%BOP), %PPDs > or = 6 mm, and tooth loss (Nagelkirke r2 = 0.46). CONCLUSIONS: The combination of five periodontal parameters in a PPRD added predictive value, suggesting that comprehensive data should be used in studies of associations between periodontitis and heart diseases. Radiographic evidence of bone loss was the best individual parameter.     

Assessing periodontal disease risk: a comparison of clinicians' assessment versus a computerized tool

BACKGROUND: The authors conducted a study to compare risk scores assigned by subjective expert clinician opinion with quantitative scores generated for the same subjects using the Periodontal Risk Calculator, or PRC. METHODS: The authors assembled a group of 107 subjects and performed standard periodontal examinations. The authors entered the resulting information into the PRC and calculated risk scores for two and four years, assuming no treatment would be performed. Using the same subject records, three groups of expert clinicians assigned risk scores for years 2 and 4. The authors analyzed the data to reveal the extent of interevaluator variation and the level of agreement between expert clinician scores and PRC scores. RESULTS: The extent of variation among scores assigned by individual expert clinicians was greater than the authors had expected. Expert clinicians consistently assigned more subjects to PRC risk group 2 and fewer to risk group 5 than did the PRC. The authors observed very high heterogeneity in the risk scores expert clinicians assigned to patients in each of the PRC-assigned groups. Thus, expert clinicians varied greatly in evaluating risk and, relative to the PRC, they appeared to underestimate periodontitis risk, especially for high-risk patients. CONCLUSIONS AND PRACTICE IMPLICATIONS: The authors' observations suggest that use of risk scores generated for individual patients by subjective expert clinician opinion about risk in periodontal clinical decision making could result in the misapplication of treatment for some patients and support the use of an objective tool such as the PRC. Use of the PRC over time may be expected to result in more uniform and accurate periodontal clinical decision making, improved oral health, reduction in the need for complex therapy and reduction in health care costs.     

Overstenting the hypogastric artery during endovascular aneurysm repair with and without prior coil embolization: A comparative analysis from the ENGAGE Registry

Background

Endovascular aneurysm repair of aortoiliac or iliac aneurysms is often performed with stent graft coverage of the origin of the hypogastric artery (HA) to ensure adequate distal seal. It is considered common practice to perform adjunctive coiling of the HA to prevent a type II endoleak. Our objective was to question the necessity of pre-emptive coiling by comparing the outcomes of HA coverage with and without prior coil embolization.

Between‐hospital variation in rates of complications and decline of patient performance after glioblastoma surgery in the dutch Quality Registry Neuro Surgery

Journal of Neuro-Oncology - For decisions on glioblastoma surgery, the risk of complications and decline in performance is decisive. In this study, we determine the rate of complications and...