The effect of cleaning on blood contamination in the dental surgery following periodontal procedures

Blood contamination of 16 surfaces in the dental surgery was investigated using the Kastle-Meyer test for haemoglobin, after three types of periodontal procedures had been performed on a total of 30 patients. The effect of cleaning surfaces contaminated by blood was investigated using the same test. Cleaning materials used in the dental surgery were tested to rule out the possibility of false positive outcomes and the sensitivity of the test was determined prior to the study. The results show a marked variation in the degree of contamination and efficacy of cleaning following treatment. Overall, root planing was associated with the most widespread and frequent blood contamination and gingival surgery the least. The surgery work surface, edge of the spittoon, aspirator tube and ultrasonic scaler handpiece into which the ultrasonic insert fits, were the most frequently contaminated surfaces. The work surface, dentist's pen, light switch and handle were cleaned most effectively. The least effectively cleaned surfaces were the water dispenser switch, aspirator tube, bracket table and ultrasonic scaler handpiece. Methods for reducing this potential source of crossinfection are discussed.     

A global perspective on changes in the burden of caries and periodontitis: implications for dentistry

The structure and contents of most oral health care systems and the contents of dental curricula reflect a deep-rooted tradition for attempting to cure oral diseases by refined technological means. However, better oral health conditions for the world's populations necessitate the application of up-to-date scientific knowledge to control the major oral diseases. This review points out that not only should the structure and contents of oral health care delivery systems be based on state-of-the-art knowledge about the biology of the oral diseases; they must also take into account the trends for change in caries and periodontal diseases within and between populations, and acknowledge the impact of changes in treatment philosophies for these trends. The oral disease profiles for populations in low- and high-income countries are briefly described, and it is concluded that the rapidly changing disease profiles observed in high-income countries necessitate re-thinking of the future role and organization of dentistry in such countries. The priorities for low- and middle-income countries must be to avoid repeating the mistakes made in the high-income countries. Instead, these societies might take advantage of setting priorities based on a population-based common risk factor approach. If such an approach is adopted, the training of personnel with oral health care competence must be rethought. The authors suggest three different cadres of dental care providers to be considered for an approach that allows health care planners in different populations around the world to prioritize appropriate oral health care with due respect for the socio-economic conditions prevailing.     

Blastogenic responsiveness of peripheral blood mononuclear cells from individuals with various forms of periodontitis and effects of treatment

Abstract Experiments were done to learn whether or not the blastogenic responsiveness of peripheral blood mononuclear cells (PBM) from 34 patients to mitogens and homogenates of a panel of periodontal bacteria differs significantly from that of cells from 16 normal individuals. Groups of control individuals and patients with juvenile (JP), rapidly progressive (RP) and adult periodontitis (AP) were formed. Blastogenic responsiveness was assessed after 72 and 120 h incubation by measuring the uptake of radioactive precursor into DNA. Bacterial preparations and mitogens used as stimulators included Bacteroides melaninogemcus (BMEL), Capnocytophaga (CAPNO), Fusobacterium nucleatum (FUSO), Actinomyces viscosus (AVIS), phytohemagglutinin (PHA), and pokeweed mitogen (PWM). When the data were calculated as Stimulation Index (E/C), responsiveness of cells from patients with AP and JP was enhanced relative to that of cells from normal control subjects, but the enhancement was not statistically significant. In contrast, responsiveness of cells from RP patients to FUSO and AVIS was significantly suppressed. Except in the case of AP cells activated with PHA, mitogenic responsiveness of all patient cells was significantly suppressed. When responsiveness was calculated as E minus C, these differences between patient and control cells disappeared except for suppression of the level of blastogenesis by AP and RP cells exposed to AVIS. After 120 h incubation, unstimulated cultures of AP cells incorporated significantly less, and RP cells significantly more, radioactivity than did unstimulated cultures from normal individuals indicating an abnormal autologous mixed lymphocyte reaction. Cells were harvested and tested from a group of AP patients before, during and following periodontal therapy. PBM responsiveness to horaogenates of CAPNO did not change significantly during therapy, but responsiveness to all of the other bacterial preparations including autologous plaque increased following initial therapy. Values for AVIS, FUSO, and PLAQ were statistically significant. Responsiveness to the bacterial preparations either remained at the enhanced levels or increased to even greater levels following completion of therapy, except in the case of autologous plaque, where the values had begun to return toward pretreatment levels. In addition, responsiveness to PWM and PHA dropped to about one-half the pretreatment values and responsiveness of unstimtilated cultures increased significantly to levels observed in cultures of ceils from normal donors.     

Periodontal healing after non-surgical therapy with a new ultrasonic device: a randomized controlled clinical trial

AIM: The aim of this study was to compare the clinical and microbiological healing outcomes following non-surgical periodontal therapy using the new Vector ultrasonic system versus scaling and root planing (S/RP) with Gracey curettes. MATERIAL AND METHODS: The study comprised 20 chronic periodontitis patients. Using a split-mouth design, both treatment modalities were randomly applied to one quadrant of the upper and the lower jaws each. Clinical and microbiological parameters were assessed at baseline, 4 weeks, and 6 months after treatment. Furthermore, post-operative hypersensitivity was assessed. The Wilcoxon signed rank test (alpha=0.05) was used for statistical analysis. RESULTS: Both therapies provided statistically significant clinical and microbiological improvements of periodontal conditions after 4 weeks and 6 months. Hypersensitive teeth were found only 4 weeks after S/RP. Besides a significantly better bleeding on probing reduction in deep S/RP sites, no other clinical and microbiological parameters revealed significant differences between the sites treated with the Vector system or S/RP. CONCLUSION: Both the Vector system and S/RP provided favourable periodontal healing results, although in deep pockets S/RP appeared to achieve a better resolution of inflammation.     

Periodontal changes during chronic benign granulocytopenia in childhood A case report

Abstract This report describes two children with chronic benign granulocytopenia, suffering from gingivitis and marginal periodontitis in the deciduous dentition. The radicular areas of the attached gingiva were well delineated against the alveolar and papillary mucosa.     

Periodontal response to long-term abuse of the gingival attachment by supracrestal amalgam restorations

The combined length of the supracrestal connective tissue attachment and the junctional epithelium is referred to as the "biologic width". The long-term (1-year) effect of complete violation of the supracrestal connective tissue attachment was examined in beagle dogs. Full thickness periodontal flaps were elevated, exposing the buccal bony crests of the maxillary and mandibular canines of 3 beagle dogs. The roots of the experimental teeth were planed and class V cavities were prepared. The apical border of each cavity was located at the alveolar bone crest. The cavities were restored with amalgam and the flaps were repositioned and sutured. In the control sites, a notch was prepared at the CEJ and the distance between the notch and the bony crest was measured. The dogs were sacrificed 57 weeks after the operation and the experimental and control sites prepared for histologic analysis. Every 5th section was examined and measurements were taken of the amount of gingival and bone recession, the length of the connective tissue and the epithelial attachment. Control sites healed uneventfully. Gingival recession averaged only 0.5 mm; bone loss was minimal and averaged 0.15 mm. The combined length of the supracrestal connective tissue and epithelial attachment measured 4.47 mm. In experimental sites, the gingiva receded 3.16 mm on average. Moderate bone loss (mean = 1.17 mm) was noted, but no signs of bone resorption were seen at the time of sacrifice. After bone loss, root surfaces which were previously attached to alveolar bone by periodontal ligament were mainly (0.90 mm) attached to connective tissue.(ABSTRACT TRUNCATED AT 250 WORDS)     

Radiographs in periodonties

Intraoral radiographs are widely used in periodontal diagnosis and research. However, accurate radiographic interpretation is only possible with high quality images. Some of the technical and geometric variables to consider have been presented. Early periodontal lesions are not detected in radiographs. The amount of periodontal destruction in more advanced disease is generally underestimated. The accurate topography of periodontal pockets and the buccal and lingual aspects of the teeth cannot be visualized. Clinical probing is therefore a prerequisite for a complete periodontal diagnosis. However, radiographs are a valuable adjunct for the periodontal diagnosis and the diagnosis of trauma from occlusion. With standardized systems, radiographs may furnish additional quantitative data in clinical research.     

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.     

Detection of Epstein–Barr virus in saliva by real‐time PCR

The purpose of this investigation was to assess the salivary levels of Epstein–Barr virus (EBV) in patients with periodontitis using real‐time PCR. EBV was detected in 16 out of 33 (48.5%) periodontitis patients and in 3 out of 20(15%) healthy subjects. The baseline mean values for bleeding on probing in EBV‐positive patients were significantly higher than those in EBV‐negative patients. A significant decrease in EBV levels was observed after initial periodontal treatment. Our findings indicate that levels of EBV in saliva may reflect the status of periodontal inflammation.     

Traumatic intrusion of permanent teeth. Part 3. A clinical study of the effect of treatment variables such as treatment delay,method of repositioning,type of splint,length of splinting and antibiotics on 140 teeth

Abstract – A prospective study of 140 intruded permanent teeth was examined for the following healing complications: pulp necrosis (PN), root resorption (RR; surface, inflammatory and replacement resorption), and defects in marginal periodontal bone healing (MA). The occurrence of these healing complications was related to various treatment factors such as treatment delay, method of repositioning (i.e. expecting re‐eruption, orthodontic reposition and surgical reposition), type of splint (rigid, semirigid and flexible), length of splinting (days) and the use of antibiotics. Treatment delay, i.e. before and after 24 h, had no effect upon healing. Active repositioning in individuals with incomplete root formation (surgical or orthodontic) had a negative effect upon the three healing parameters compared with spontaneous eruption. In teeth with complete root formation and an age of 12–17 no repositioning was still the best treatment in regard to MA. In individuals older than 17 years of age, cases were not anticipated to spontaneously erupt and in these cases, the general choice of treatment was either active orthodontic or surgical repositioning. The former procedure appeared in this treatment scenario to slightly reduce the risk of MA complications. However, this treatment procedure was also found to be more time demanding (an average of 22 consultations for orthodontic repositioning compared with 17 consultations for surgical repositioning). If a surgical repositioning was performed, the type of splint (i.e. flexible, semirigid or rigid) appeared to have no significant effect on the type of healing. The same applied to the length of splinting time (shorter or longer than 6 weeks). No effect of dentin covering procedures for associated crown fractures (enamel–dentin fractures) could be demonstrated. Likewise, antibiotics had no apparent effect upon healing. In conclusion, in patients with intruded teeth with incomplete root formation, spontaneous eruption should be expected. In patients with completed root formation and with an age of 12–17 spontaneous eruption can still occur, but must be monitored very carefully. In older patients (i.e. >17 years) with completed root formation, either surgical or orthodontic extrusion should be attempted. The latter procedure appeared to lead to a slight reduction (not significant) in the risk of MA complications. The extent and direction of the intrusion may however favour surgical repositioning.