Microbial associations in periodontitis sites before and after treatment

Duplicate samples from 110 periodontal sites of 6 mm or more pocket depth in 16 patients were analyzed for the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Capnocytophaga spp., Campylobacter rectus, Eikenella corrodens and Fusobacterium nucleatum. The sites were sampled before and after nonsurgical periodontal treatment. No statistically significant associations were found before treatment between any of the analyzed species. After treatment, statistically significant associations were found between E. corrodens and all the other species, F. nucleatum and P. intermedia; Capnocytophaga spp. and C. rectus; P. intermedia vs Capnocytophaga spp. and P. gingivalis ; and C. rectus vs Capnocytophaga spp. and A. actinomycetemcomitans. Some of these associations could be explained either by patient-related factors or site-related characteristics such as the pocket depth. The proportion of P. gingivalis seemed to be unrelated to the proportion of P. intermedia in the samples. If one of the analyzed microbes was found in one of the sampled pockets in a patient, the probability of finding that microbe in all the sampled sites in the same patient before treatment was more than 50%. This probability was reduced after treatment for many species, especially P. gingivalis , which showed a probability of zero. The probability of detecting a bacterial species on at least one additional site if it was present on one in the same individual was nearly 100%, both before and after treatment, for all species studied. This study has shown several potential microbial associations in the subgingival plaque flora of deep periodontal pockets. Local factors of the periodontal pocket and factors related to the individual may mask the biological significance of these microbial interactions.     

Nine- to fourteen-year follow-up of implant treatment. Part III: factors associated with peri-implant lesions

OBJECTIVE: The aim of the present paper was to analyse, on patient and implant basis, factors related to peri-implant lesions. MATERIAL AND METHODS: Two hundred and eighteen patients treated with titanium implants were examined for biological complications at existing implants 9-14 years after initial therapy. The effects of several potentially explanatory variables, both on patient and on implant levels, were analysed. RESULTS: On the implant level, the presence of keratinized mucosa (p = 0.02) and plaque (p = 0.005) was associated with mucositis (probing depth > or =4 mm + bleeding on probing). The bone level at implants was associated with the presence of keratinized mucosa (p = 0.03) and the presence of pus (p < 0.001). On the patient level, smoking was associated with mucositis, bone level and peri-implantitis (p = 0.02, <0.001 and 0.002, respectively). Peri-implantitis was related to a previous history of periodontitis (p = 0.05). CONCLUSIONS: Individuals with a history of periodontitis and individuals who smoke are more likely to develop peri-implant lesions.     

Factors behind change in knowledge after a mass media campaign targeting periodontitis

Abstract:  The aim of this study was to investigate changes in knowledge before and after a mass media campaign, in relation to social attributes, care system attributes and oral health aspects. The study was based on a questionnaire in a cohort design, sent out to 900 randomly sampled people aged 50–75 in Sweden. The response rate to the questionnaire before and after the campaign was 70% and 65% respectively. Sixty-four percent answered both questionnaires. Two questions addressed knowledge, while 10 questions aimed to measure social attributes, care system attributes and oral health aspects. Data were analysed for bivariate relations as to change in knowledge and social attributes, care system attributes and oral health aspects. Data were also analysed in multiple regression analysis with knowledge before, knowledge after and knowledge differences as dependent variables. The results showed that there were a number of independent variables with influence on the dependent variables. Of the social attributes, secondary education gave almost 10% ( P  < 0.001) better knowledge both before and after the campaign. Among care system attributes, high care utilization was related to knowledge both before and after the campaign. The most important factors for knowledge about periodontitis were education, care utilization and perceived importance of oral health. In conclusion, this study demonstrates that mass media might increase knowledge about periodontitis as a health promotion strategy.     

Oral health problems in elderly rehabilitation patients

Abstract:  A combination of poor oral hygiene and dry mouth may be hazardous to the oral health status. However, systematic assessments in order to detect oral health problems are seldom performed in the nursing care of the elderly. The aims of this study were to investigate the occurrence of oral health problems measured using the Revised Oral Assessment Guide (ROAG) and to analyse associations between oral health problems and age, gender, living conditions, cohabitation, reason for admission, number of drugs, and functional and nutritional status. One registered nurse performed oral health assessments using ROAG in 161 newly admitted elderly patients in rehabilitation care. Oral health problems were found in 71% of the patients. Thirty per cent of these patients had between four and eight problems. Low saliva flow and problems related to lips were the most frequent oral health problems. Problems in oral health status were significantly associated with presence of respiratory diseases (problems with gums, lips, alterations on the tongue and mucous membranes), living in special accommodation (low saliva flow, problems with teeth/dentures and alterations on the tongue), being undernourished (alterations on the tongue and low saliva flow) and being a woman (low saliva flow). The highest Odds ratio (OR) was found in problems with gums in relation with prevalence of respiratory diseases (OR 8.9; confidence interval (CI) 2.8–27.8; P  < 0.0005). This study indicates the importance of standardised oral health assessments in order to detect oral health problems which can otherwise be hidden when the patients are admitted to the hospital ward.     

Five-year clinical, microbiological, and radiological outcome following treatment of peri-implantitis in man

BACKGROUND: The aim of this study was to evaluate the long-term outcome of a combined surgical and antimicrobial treatment of peri-implantitis lesions in humans. METHODS: Nine partially dentate individuals with titanium implants demonstrating a marginal bone loss of > or = three threads as compared to baseline measurements made from 1-year intra-oral radiographs, bleeding on probing, and/or suppuration from the peri-implant sulci were included in the study. In each individual, subgingival bacterial samples were obtained and subjected to microbiological analysis by culture. Surgical exposure of the lesions and cleaning of the implants using hydrogen peroxide were performed. The patients were given systemic antibiotics according to a susceptibility test of target bacteria. The treatment was evaluated clinically, microbiologically, and radiograpically at 6 months, 1 year, and 5 years. RESULTS: Seven out of 26 implants with peri-implantitis at baseline were lost during the 5-year follow-up period despite a significant reduction in the presence of plaque and gingival bleeding. Four implants continued to lose bone, 9 had an unchanged bone level, and 6 gained bone. Five of the patients were treated with antibiotics directed against putative periodontopathogens, i.e., A. actinomycetemcomitans, P. intermedia, or P. gingivalis; three patients were treated for presence of enterics (E. coli and E. cloace); and, in one patient, treatment was directed against S. aureus. CONCLUSIONS: Despite treatment and retreatment, seven implants were lost. However, the applied surgical and antimicrobial treatment strategy for advanced peri-implantitis lesions was successful in 58% of the implants treated during the 5-year follow-up period. Smoking seemed to be a negative risk factor for treatment success.     

Healing after treatment of periodontal intraosseous defects

The present study compared surgical therapy to root planing alone in the treatment of periodontal intraosseous defects. 25 defects in 14 patients were subjected to root planing only and another 25 defects in the same patients were surgically exposed and citric acid treated. The healing response was evaluated 6 months after treatment. The mean gain of probing attachment level was 0.8 mm in the root-planed defects as compared to 1.3 mm for the surgically exposed and acid-treated defects. The probing bone level improved an average of 0.2 mm for the root-planed areas as compared to 0.6 mm for the acid-treated defects. The mean preoperative probing pocket depths of 6.7 mm and 6.8 mm for the 2 groups were reduced to 5.2 mm and 4.1 mm, respectively. The differences in these parameters were statistically significant between the 2 groups. However, both groups demonstrated limited regeneration.     

Effect of root debridement on the elimination of Actinobacillus actinomycetemcomitans and Bacteroides gingivalis from periodontal pockets

The aims of this 6-month longitudinal study were: (1) to investigate to what extent root debridement of pockets in adult periodontitis will reduce the subgingival presence of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and some other bacterial groups; (2) to relate the microbiological results following debridement to clinical measurements of healing. 16 patients and a total of 111 periodontally involved sites with probing depth greater than or equal to 6 mm served for the study. Duplicate subgingival microbial samples and duplicate clinical recordings were obtained 1 week apart at baseline and at 6 months following supra- and subgingival debridement. The results demonstrated reductions of the mean total viable counts and reductions of the mean counts of several of the cultured groups of micro-organisms coupled with significant improvements of mean clinical measurements. B. gingivalis was eliminated from a majority of infected subgingival sites. A. actinomycetemcomitans, on the other hand, still remained after therapy in a high proportion of sites initially infected with this microorganism. Subgingival persistence of A. actinomycetemcomitans appeared to be associated with a reduced healing response following debridement. Further studies are needed to clarify why A. actinomycetemcomitans is poorly eliminated following debridement. Also, the long-term clinical significance of the subgingival perseverance of A. actinomycetemcomitans needs to be elucidated.     

Tensile strength,histological and immunohistochemical observations of periodontal wound healing in the dog

This study was designed to study wound strength at the dentine/connective tissue interface and at the bone/connective tissue interface following full thickness flap surgery. Flaps of uniform dimension were outlined in four young adult beagle dogs using a standardised double bladed knife and vertical incisions 10 mm apart, which extended 8 mm apical to the gingival margin. Bone was removed from half the sites (eight sites in each dog), giving 32 flaps replaced on dentine and 32 sites on bone. A tensile force was applied using a microprocessor force gauge at 1, 2, 3, 7, 10, 14, 21, and 28 days. Mean tensile strengths were markedly weaker for the dentine/flap interface. At 7 days the value for flaps to dentine was 1.82 N, in contrast to 5.08 N for flaps replaced on bone. Inflammatory cell counts tended to fall markedly at 3 days for both modalities, but were higher for the dentine/flap modality at all time points. Fibroblast density peaked at 7-14 days but did not vary with type of flap over the time points studied. The amounts of fibrin were greater for the dentine/flap interface at all time points but decreased for both flap types as time progressed. Collagen type V was localised to the basement membrane and blood vessels and tended to show more foci for flaps replaced on dentine. Procollagen levels showed little change over the healing interval for both flap/bone and flap/dentine interfaces. Type III collagen synthesis was at peak levels during the first week. These findings would support efforts to stabilise periodontal flaps at early time points, especially those on dentine.     

Effect of a triclosan-containing toothpaste supplemented with 10% xylitol on mutans streptococci in saliva and dental plaque. A 6-month clinical study

The aim of the present investigation was to evaluate the effect of the combination of triclosan and xylitol in toothpaste on mutans streptococci (MS) in saliva and dental plaque. 155 individuals with >10(5) MS/ml saliva were included in a 6-month double-blind clinical study. They were divided into three groups (n = 51-52) balanced according to their MS counts at baseline. Each group used one of the following types of dentifrice: (1) Colgate Total with the addition of 10% xylitol (Total-Xylitol), (2) Colgate Total and (3) Colgate Total without triclosan and without xylitol. Whole saliva and pooled plaque samples were obtained after 2, 4 and 6 months. When comparing the MS counts within the groups for saliva and plaque samples, Total-Xylitol showed significant reduction at all three sampling occasions (p < 0.001). Mean reduction at the 6-month sample for saliva was 0.81/ml and for plaque 0.89 per sample (log values). ANOVA revealed significant differences between Total-Xylitol and the two other products at 6 months for MS in saliva and dental plaque. The conclusion from this 6- month study is that the addition of 10% xylitol to a triclosan-containing dentifrice reduces the number of MS in saliva and dental plaque.