Microbiological and immunological studies of adult periodontitis in patients with noninsulin-dependent diabetes mellitus

The subgingival microflora and serum antibody response was examined in periodontitis patients with noninsulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), and normal glucose tolerance (NGT). The predominant cultivable microflora was determined for subgingival plaque sampled from two deep periodontal pockets in each of eight adult periodontitis patients with NIDDM. Indirect immunofluorescence for Bacteroides intermedius, Bacteroides gingivalis, and Haemophilus actinomycetemcomitans was used to examine these same samples as well as 186 additional subgingival plaque samples from 47 patients with moderate to severe generalized periodontitis including 25 subjects with NIDDM, six subjects with IGT, and 16 subjects with NGT. Serum antibody levels to 13 microorganisms including seven oral bacterial species and one nonoral control species were measured by enzyme-linked immunosorbent assays (ELISA) in 377 subjects including 84 normal subjects without periodontal disease, 112 normal subjects with periodontitis, 19 periodontally normal subjects with IGT, 65 periodontitis patients with IGT, 15 periodontally normal subjects with NIDDM, and 82 periodontitis patients with NIDDM. Three hundred eighty-two bacterial isolates were recovered from the eight patients. B. intermedius was the most frequently isolated microorganism constituting 16% of the total isolates followed by Wolinella recta and B. gingivalis, which each accounted for 13% of the total. Streptococcus sanguis was the most prevalent microorganism, which was found in 75% of the sites. Subgingival plaque samples examined by immunofluorescence demonstrate a high prevalence of black-pigmented Bacteroides and suggest that the proportion of B. gingivalis but not B. intermedius is higher in NIDDM with periodontitis than in other groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Co-ordinated treatment of secondary cleft deformities

Secondary cleft deformities result from the cumulative effects of functional and morphological abnormalities. Treatment choices should be based on a comprehensive plan which is designed to minimize treatment time and iatrogenic effects and which is based on sound physical and psychosocial objectives. Conventional orthodontic and orthognathic surgical principles can be modified and applied to a variety of facial cleft problems. Direct surgical correction of secondary deformities instead of prosthetic or orthodontic compensation expands treatment possibilities and optimizes treatment results.     

Acquisition of alkali-soluble fluoride by enamel through treatment with NaF-containing toothpastes in vitro.

The first aim of the present study was to examine if alkali-soluble fluoride (calcium fluoride-like material and adsorbed fluoride) forms when a NaF-containing toothpaste is applied on human enamel surface in vitro. The centrifuged supernatants of toothpastes dissolved in distilled water were used and four different commercial NaF-containing toothpastes were tested. The second aim was to investigate if pyrophosphate would interfere with the deposition of alkali soluble fluoride. The formation of alkali-soluble fluoride was determined by chemical analysis and visualized by scanning electron microscopy (SEM). It was ascertained that all tested toothpastes contained free fluoride according to the manufacturers' specifications. It was shown that they promoted deposition of alkali soluble fluoride on the enamel surface. The amount of deposited material increased with the time of exposure. The clinical effect of a NaF-containing toothpaste may thus well depend on an initial formation of alkali-soluble fluoride. Fluoride from this reservoir may adsorb onto the enamel crystals and inhibit further demineralization or increase the rate of remineralization during cariogenic challenges. It was also demonstrated that pyrophosphate did not interfere with the deposition of alkali soluble fluoride.     

Shear bond strengths of resin adhesive cements to dentin and Ni-Cr-Be alloy.

Two adhesives, Super Bond and Panavia, were evaluated for shear bond strength to dentin. Twenty human teeth were used for each adhesive. Bonding sites were prepared in dentin (600 grit) and the adhesives applied according to the manufacturers' instructions. Bond strengths were determined with an Instron testing machine at 24 hours. Super Bond developed the strongest bond of 21.59 +/- 3.91 MPa. Panavia produced a lower bond strength of 2.68 +/- 1.45 MPa. Statistically, Super Bond was found to have a stronger bond than Panavia. The same two adhesives were applied to Ni-Cr-Be specimens and compared to Comspan. Twenty Rexillium III specimens were used for each adhesive at 24 hours and 20 for thermocycling. The metal specimens were ground flat (600 grit) and then air abraded with 50-micron aluminous oxide. The adhesives were applied to the metal surface in accordance with the manufacturers' instructions. One group was tested at 24 hours while the second group was tested after thermocycling (2,500 cycles at 6 degrees C to 60 degrees C). At 24 hours, Super Bond had a significantly stronger bond than the other materials. Comparison of the 24-hour to thermocycled bond strengths found Comspan had a significant increase in bond strength, Panavia had no significant change and Super Bond had a significant decrease in bond strength. After 2,500 thermocycles, Comspan, Panavia, and Super Bond were not significantly different in bond strength.     

Prostaglandin E2 and interleukin-1 levels in smokeless tobacco-induced oral mucosal lesions

Inflammatory mediators released as a result of smokeless tobacco (ST)-induced irritation may play a role in the development of oral mucosal lesions at habitual tobacco placement sites in ST users. The present study examined levels of interleukin-1 (IL-1) and prostaglandin E2 (PGE2) in ST-induced mucosal lesions and compared these to mediator levels in clinically normal mucosa. Soft tissue biopsies were obtained from white mucosal lesions at habitual placement sites and normal alveolar mucosal tissue at non-placement sites in 18 ST users. Fifteen non-tobacco using subjects also provided normal alveolar mucosal biopsies. IL-1 and PGE2 were recovered from the specimens, and mediator levels were determined by enzyme immunoassay. Prostaglandin E2 levels (pg/mg) were lower in both regions in the ST subjects, but values did not vary significantly between the regions with 2.77±0.72 and 2.86±0.99 at placement and non-placement sites, respectively, in ST users and 7.31±3.84 in non-tobacco users. Both IL-1α and IL-lβ (pg/mg) were significantly (p < 0.0I) elevated in ST lesions (IL-lã=25.56±4.00; IL-1β=7.76±1.68) compared to either non-placement sites in ST users (IL-lα=14.64±2.65; IL-lβ=1.63±0.72) or non-tobacco users (IL-lα=12.84±2.60; IL-lβ=2.04±0.75). In view of IL-l's role in keratinocyte proliferation and its inflammatory effects, this cytokine may contribute to mucosal and gingival alterations observed in ST users.     

Juvenile ossifying fibroma. An analysis of 33 cases with emphasis on histopathological aspects

Juvenile ossifying fibroma (JOF) is a maxillofacial fibro-osseous lesion that may show cell-rich osteoid strands or psammoma-like ossicles. Whether both types are variants of a single entity or different lesions under the same diagnostic label is a subject of debate. This problem was investigated by analyzing a series of 33 patients with lesions having one or both of the above histological appearances. It was concluded that osteoid strands define a unique fibro-osseous lesion but that lesions with psammoma-like ossicles fall within the morphological spectrum of cemento-ossifying fibroma. Therefore the term juvenile ossifying fibroma should be reserved for the lesion with the osteoid strands.     

Chemotaxis and degranulation of polymorphonuclear leukocytes in the presence of sulfide

In polymicrobial infections such as periodontal disease, the polymorphonuclear leukocytes (PMN) may have to work in the absence of oxygen and in the presence of significant levels of hydrogen sulfide. There are conflicting results reported on the chemotactic capacity of PMN under anaerobic conditions. It is not known whether PMN are able to migrate and release the contents of their granules in the presence of sulfide. PMN were exposed to various levels of sulfide and their chemotaxis and degranulation were studied when they were stimulated with N-formyl-inethionyl-leucyl-phenylalanine or zymosan-activated serum. Chemotaxis was evaluated with the agarose method. The release of granule markers, lactoferrin and myeloperoxidase, was evaluated with enzyme-linked immunosorbent assay. PMN had similar capacity for chemotaxis under aerobic and anaerobic conditions. The migration of PMN was only to a minor extent inhibited by 1–2 mM sulfide. The release of lactoferrin and myeloperoxidase was the same under aerobic and anaerobic conditions and was not significantly influenced by sulfide. PMN seem to be very well suited to defend the tissue against bacteria under the harsh conditions prevailing in the periodontal pocket.     

The effectiveness of the Titan-S sonic scaler versus curettes in the removal of subgingival calculus. A human surgical evaluation

This study evaluated clinically the effectiveness of hand versus sonic subgingival scaling and root planing in the removal of calculus by visually examining the root surface at the time of periodontal flap surgery. Consideration was given to the method of instrumentation, probing depth, number of roots, and type of tooth surface. Eleven patients with moderate to advanced periodontal disease were evaluated. Four subjects were scaled and root planed with the Titan-S only, four with curettes only, and three with the Titan-S + curettes. At reevaluation 3 to 6 weeks after scaling and root planing, the decision to perform periodontal flap surgery was made based upon probing depth, bleeding upon probing, previous access to the root surface, furcation involvement, and the patient's level of oral hygiene. A full thickness mucoperiosteal flap was elevated to gain access to the root surface and measure the distance from the cementoenamel junction to the residual calculus. A total of 690 surfaces were evaluated surgically. The percentage of surfaces with residual calculus for each method of instrumentation was: Titan-S only (31.9%), curettes only (26.8%), and Titan-S + curettes (16.9%). Overall, 15.7% of the surfaces probing 0 to 3 mm, 29.3% of the surfaces probing 4 to 5 mm, and 44.4% of the surfaces probing 6 to 12 mm had residual calculus.(ABSTRACT TRUNCATED AT 250 WORDS)