A hidden periodontitis epidemic during the 20th century?

OBJECTIVES: Increasing evidence suggests a strong causal link between smoking and periodontitis. The goal of this study was to impute how the secular changes in smoking prevalence during the 20th century impacted the advanced periodontitis incidence in the US. METHODS: Epidemiological analyses based on US prevalence data of advanced periodontitis and smoking, and predictions of future smoking prevalence. RESULTS: Assuming other risk factors for periodontitis remained constant, we estimated that the incidence of advanced periodontitis decreased by 31% between 1955 and 2000. The changes in smoking habits, and consequently the changes in periodontitis incidence, depended strongly on education and gender. Between 1966 and 1998, we estimated a 43% decreased periodontitis incidence among college-educated individuals versus only an 8% decrease among individuals with less than a high school education. Between 1955 and 1999, we estimated a 41% decrease among males versus a 14% decrease among females. By the year 2020, the incidence of advanced periodontitis may decrease 43% from its level in 1955. CONCLUSIONS: A periodontitis epidemic fueled by smoking remained hidden for most of the 20th century. Because this epidemic was hidden, it distorted our understanding of the treatment and etiology of periodontitis. The socioeconomic polarization of this epidemic will dictate alterations in patterns of periodontal care.     

Inhibitory function of secretory leukocyte proteinase inhibitor (SLPI) in human saliva is HIV-1 specific and varies with virus tropism

OBJECTIVE: Secretory leukocyte proteinase inhibitor (SLPI) is an endogenous mucosa associated protein that has been proposed to possess anti-human immunodeficiency virus type 1 (HIV-1) activity. The aim of this study was to investigate the biological function of SLPI in salivary mediated inhibition of HIV infection and in addition the inhibitory effect of SLPI using isolates of varied virus tropism. MATERIAL AND METHODS: The inhibitory effect of HIV-1 infection in vitro, mediated by 60 different saliva samples was analyzed with respect to levels of SLPI. Salivary samples depleted from IgA and SLPI, respectively, were further analyzed for anti-HIV activity. The antiviral effect of recombinant SLPI was investigated within an in vitro system of HIV-1 infection of target cells using a panel of viral isolates with distinct coreceptor usage. Furthermore we tested a panel of overlapping synthetic peptides, representing the amino acids in SLPI, for their capacity to inhibit HIV-1 infection of human peripheral blood mononuclear cells (PBMCs). RESULTS AND CONCLUSIONS: These experiments show that elevated levels of salivary SLPI can be associated with an increased inhibitory effect of the whole saliva sample, and that this inhibitory effect is decreased with broad coreceptor usage of the virus.     

Fluoride concentration in supragingival dental plaque after a single intake or habitual consumption of fluoridated milk

The aim of this study was to evaluate the fluoride concentration in supragingival dental plaque after single and repeated intakes of fluoridated milk. The study group consisted of 22 schoolchildren, young adults and adults of both sexes, 8-41 years of age. After a 2-week fluoride depletion period and 3 days of plaque accumulation, 200 ml of fluoridated milk (1g F) was ingested along with a standardized lunch meal. Plaque samples were collected immediately before the intake and after 30, 120 and 240 min. From the adult participants (n = 9) additional samples were collected after 12 and 18 h. After a fluoride-free washout period of at least 2 weeks, the whole experimental procedure was repeated after 4 consecutive daily intakes of fluoridated milk. The fluoride concentration was determined after micro-diffusion with a fluoride selective electrode. The results showed a statistically significant 3-fold increase of the plaque fluoride levels up to 4 h after the intake. At 12 and 18 h after the intake, the recorded levels went gradually back to baseline. There was no significant difference between the fluoride concentrations in the supragingival plaque after the single intake compared with the repeated intakes. In conclusion, the findings support the suggestion that milk is a suitable vehicle for local fluoride administration into the oral cavity, also when consumed together with a meal.     

The effect of pulp obliteration on pulpal vitality of orthodontically intruded traumatized teeth

Limited information exists on the impact of pulp obliteration on pulpal vitality of orthodontically treated traumatized teeth. Pulpal condition was examined in 269 traumatized maxillary incisors after orthodontic intrusion (OT group) and in 193 traumatized maxillary incisors without subsequent orthodontic treatment (C group). According to the degree of initial pulp obliteration, the teeth were divided into three categories: teeth without, teeth with partial, and teeth with total pulp obliteration. Teeth in the OT group revealed a significantly higher rate of pulp necrosis than teeth in the C group (p < 0.001). In addition, teeth in the OT group with total pulp obliteration showed a significantly higher rate of pulp necrosis than teeth without (p < 0.001) or only partial pulp obliteration (p = 0.025). The results indicate that traumatized teeth with total pulp obliteration have a higher susceptibility to pulpal complications during orthodontic intrusion than traumatized teeth without or only partial pulp obliteration.     

Relationship between kinematic center and TMJ anatomy and function

The kinematic center (KC)-defined by coinciding jaw-opening/-closing and protrusion-retrusion trajectories-has been proposed in the literature as a reference point to represent TMJ movements. In this study, we tested whether the KC lies in a peculiar anatomical point and whether its trajectory reflects intra-articular distance. In 11 asymptomatic individuals (seven females, four males, aged 24-37 yrs), 4 openings/closings and 4 protrusions/retrusions were tracked with dynamic stereometry. In a 3D lattice (0.5 mm grid) constructed solidly around each condyle, the KC was the point with maximal cross-correlation between opening-closing and protrusion-retrusion paths. KC trajectories were more cranial on closing than on opening, consistent with intra-articular distances being smaller on closing than on opening. However, KCs were never located on condylar main axes (distance, 4.5 +/- 2.9 mm), nor did they coincide with points best approximating fossa shapes (distance, 12.5 +/- 6.4 mm). The kinematic center's anatomical and functional significance therefore appears to be questionable.     

Cholinergic submandibular effects and muscarinic receptor expression in blood vessels of the rat

In order to functionally characterise the muscarinic vasodilator responses, effects of cholinergic agonists were studied on isolated preparations of the rat submandibular artery and vein and carotid and jugular vessels. Tentatively, a cholinergic regulatory mechanism having different effects on the arterial and venous vessels would enhance vascular fluid recruitment for the secretory response. In vitro functional findings were correlated to the expression and cellular location of the different receptors that were assessed by immunohistochemistry. In order to find in vivo correlates to the in vitro findings, the influence of muscarinic receptors on permeability was studied on the vasculature of the submandibular gland in anaesthetised rats. Staining for muscarinic M1 receptors occurred in the endothelium, and muscarinic M5 receptors, and possibly M3 also, were detected in the arterial smooth muscle. In venous endothelium, muscarinic M1 and M4 receptors occurred. In the jugular smooth muscle layer, staining for M1, and possibly also for M3, appeared. Muscarinic agonists caused arteries to relax and veins to contract. The nitric oxide synthase inhibitor Nomega-nitro-L-arginine (L-NNA; 10(-4)M) markedly reduced the cholinergic-evoked relaxation of pre-contracted carotid arterial preparations. In the presence of 4-DAMP (10(-7)M), the relaxation to cholinergic agonists was inhibited. Pirenzepine (10(-5)M) did not only inhibit the relaxatory effects, but even reversed the effects, while it in the jugular vein abolished the cholinergic effects. The arterial nitric oxide-dependent response to muscarinic receptor stimulation consisted of two parts -- one sensitive to pirenzepine and 4-DAMP and the other to 4-DAMP only. Inhibition of the former part only, resulted in cholinergic arterial contraction. Also, the submandibular artery and vein responses to muscarinic receptor stimulation show a resemblance with those of the carotid and jugular vessels, i.e. a pronounced arterial relaxation and a contractile component in the venous response. In vivo examination of submandibular glandular vasculature by studying glandular permeability to Evans blue, confirmed the in vitro observations indicating muscarinic M1 receptors preserving perfusion pressure during the secretory process.     

No alteration in bone mineral density in patients with periodontitis

Alveolar bone destruction can be magnified in the presence of generalized skeletal disorders. We questioned whether severe generalized periodontitis patients display signs of bone metabolism disturbances. Our objective was to assess skeletal bone mineral density (BMD) and biochemical bone parameters in premenopausal women with periodontitis. Forty-five patients and 40 control individuals were included in the study. We measured BMD by dual-energy x-ray absorptiometry. The results showed no difference in BMD values between the periodontitis and control groups (p > 0.05). A positive relationship between the clinical attachment level and Body Mass Index (BMI) scores was observed (p = 0.03). Increased serum creatinine levels were noted in the periodontitis group (p = 0.04). Analysis of the data suggests that there is no evidence for an association between skeletal BMD and severe periodontitis in premenopausal women. There may be a link between elevated creatinine levels and periodontitis. The persons with high BMI scores seemed to be at risk for periodontitis.     

Effect of nanoporous TiO2 coating and anodized Ca2+ modification of titanium surfaces on early microbial biofilm formation

Background

(i) to describe oral health counselling in Norway to parents with infants and toddlers, ii) to assess existing collaboration and routines in oral health matters between nurses and personnel in the PDS, iii) to evaluate to what extent oral health was integrated in the basic educational curriculum of public health nurses.

Methods

This study was based on two separate surveys: the sample of Study I was 98 randomly selected child health clinics. A questionnaire covering oral health promotion counselling of parents with young children was returned by 259 nurses. Study II was a telephone survey addressing teachers of public health nurses at the eight educational institutions in Norway.

Results

The response rate in Study I was 45%. Nutrition (breast feeding, diet) was the health subject most often prioritized in the counselling targeting parents of young children (by 60% of the nurses). Oral health was not among the first priority counselling subjects. The subject was seldom spontaneously mentioned by parents. Seventy percent of respondents reported (agreed or totally agreed) that they managed to provide information parents needed and 72% believed that the information they gave influenced parents' health behaviours. Seven nurses (5.2%) responded that they agreed with the statement that the information they gave only slightly influenced parents' health behaviour. Lack of time was mentioned as being a problem. Approximately half of the nurses (48%) had regular contact with the PDS for the 0-3 year-old children, but only a quarter of the nurses claimed that children's teeth were routinely examined at the child clinics. Some forms of previously established contact with the PDS enhanced the likelihood of nurses' referrals. Oral health was a minor part of the educational curriculum for public health nurses; at three institutions, the subject was totally absent.

Conclusion

Collaboration between nurses and the PDS in Norway could be improved. Oral health should have a bigger place in the basic educational curriculum.     

Rigid external distraction of the midface with direct wiring of the distraction unit in patients with craniofacial dysplasia

The development of craniofacial distraction techniques represents a significant advancement in the management of craniofacial dysplasias. For distraction of the midface after Le Fort III osteotomy, two levels of anchorage to the moving segments are necessary. In this report, the authors connected the distraction forces directly to the infraorbital rims, using a surgical wire for superior anchorage. They performed this technique in four patients with craniofacial dysplasia for the management of severe maxillary hypoplasia using RED II system. This configuration not only simplified the placement of the system but also made the removal of the device much easier. The authors did not have any problems with the wire traction unit, such as wire breakdown or bony tunnel disruption. It is a cheap, simple, and effective configuration that can be easily performed without any complication.     

Association of the -159 CD14 gene polymorphism and lack of association of the -308 TNFA and Q551R IL-4RA polymorphisms with severe chronic periodontitis in Swedish Caucasians

BACKGROUND: Severe forms of periodontitis are suggested to have a genetic basis. OBJECTIVE: The aim of the present investigation was to study the association of gene polymorphisms related to some immune regulation components (G-308A TNFA, Q551R IL-4RA and C-159T CD14) with severe chronic periodontitis. MATERIALS AND METHODS: Sixty patients (aged 36-74 years; mean 54.5+/-8.5) with severe and generalized chronic periodontitis were included. The patients exhibited bone loss >50% at all teeth. Thirty-nine periodontally healthy subjects between 35 and 78 years of age (mean 51.0+/-10.9) were recruited as controls. DNA was isolated from peripheral blood cells and genotyping was performed by combination of PCR and restriction endonuclease mapping. RESULTS: While gene polymorphisms for TNFA and IL-4RA did not show any association with severe chronic periodontitis, the analysis of the -159 CD14 gene polymorphism revealed significant differences between test and control groups. The proportion of subjects that exhibited the TT genotype was significantly smaller in the group with severe periodontitis than in periodontal healthy group (p=0.028; Fisher's exact test). The C allele carriage was 90% in the periodontitis group and significantly higher than in the healthy control group (72%). CONCLUSION: It is suggested that the -159 CD14 gene polymorphism is associated with chronic periodontitis in Caucasian subjects of a north European origin.