bluuebunny/crossref_metadata_2025 huggingface dataset:
Autocrine growth factors in human periodontal ligament cells cultured on enamel matrix derivative
Authors: Lyngstadaas Staale P. , Lundberg Eva , Ekdahl Helena , Andersson Christer , Gestrelius Stina
Published: March 2003

Objective: Enamel extracellular matrix proteins in the form of the enamel matrix derivative EMDOGAIN® (EMD) have been successfully employed to mimic natural cementogenesis to restore fully functional periodontal ligament, cementum and alveolar bone in patients with severe periodontitis. When applied to denuded root surfaces EMD forms a matrix that locally facilitates regenerative responses in the adjacent periodontal tissues. The cellular mechanism(s), e.g. autocrine growth factors, extracellular matrix synthesis and cell growth, underlying PDL regeneration with EMD is however poorly investigated.

Material and Methods: Human periodontal ligament (PDL) cells were cultured on EMD and monitored for cellular attachment rate, proliferation, DNA replication and metabolism. Furthermore, intracellular cyclic‐AMP levels and autocrine production of selected growth factors were monitored by immunological assays. Controls included PDL and epithelial cells in parallel cultures.

Results: PDL cell attachment rate, growth and metabolism were all significantly increased when EMD was present in cultures. Also, cells exposed to EMD showed increased intracellular cAMP signalling and autocrine production of TGF‐β1, IL‐6 and PDGF AB when compared to controls. Epithelial cells increased cAMP and PDGF AB secretion when EMD was present, but proliferation and growth were inhibited.

Conclusion: Cultured PDL cells exposed to EMD increase attachment rate, growth rate and metabolism, and subsequently release several growth factors into the medium. The cellular interaction with EMD generates an intracellular cAMP signal, after which cells secrete TGF‐β1, IL‐6 and PDGF AB. Epithelial cell growth however, is inhibited by the same signal. This suggest that EMD favours mesenchymal cell growth over epithelium, and that autocrine growth factors released by PDL cells exposed to EMD contribute to periodontal healing and regeneration in a process mimicking natural root development.
Subgingival polishing compared to scaling with steel curettes: a clinical pilot study
Authors: Kocher Thomas , König Jörgen , Hansen Peter , Rühling Andreas
Published: March 2003

Background: Recently, we have developed teflon‐coated sonic scaler inserts which remove plaque without removing tooth substance; they polish subgingivally. In a preclinical test, we showed that these modified inserts remove plaque nearly as effectively as do conventional sonic scaler inserts. The present investigation was intended as a proof‐of‐principle of subgingival polishing. The aim was to study the effect of subgingival polishing on the resolution of gingival inflammation in comparison to conventional scaling.

Material and methods: In 10 patients with moderate to advanced periodontal disease, who had at least 2 single‐rooted teeth with a probing depth of >6 mm in each quadrant, all single‐rooted teeth were subjected to one treatment regimen consisting of 2 instrumentation episodes (1st/2nd treatment): curette/curette, curette/teflon‐coated sonic scaler, teflon‐coated sonic scaler/teflon‐coated sonic scaler, and an untreated control. The second treatment session was performed 3 months after the first instrumentation, and the final registration 3 months after the second instrumentation. Clinical measurements included probing depth, change of clinical attachment level, bleeding upon probing, and plaque scores.

Results: Probing depth, attachment level, and bleeding scores were reduced in the 3 instrumentation groups versus the control group in the 1st period; in the 2nd period, no further change occurred. Subgingival polishing with teflon‐coated sonic scaler inserts was slightly less effective than conventional scaling.

Conclusion: Subgingival polishing with teflon‐coated sonic scaler inserts seems to be nearly as effective as conventional scaling. Thus, it may be the instrumentation of choice for maintenance treatment of residual pockets.
A comparative in vitro study of a magnetostrictive and a piezoelectric ultrasonic scaling instrument
Authors: Busslinger André , Lampe Kathrin , Beuchat Michel , Lehmann Barbara
Published: March 2003

Background: The effects of magnetostrictive ultrasonic instruments and piezoelectric ultrasonic instruments on tooth surfaces seem to differ with regards to root debridement.

Aim: The purpose of this study was to compare a magnetostrictive ultrasonic scaling instrument with a piezoelectric ultrasonic scaling instrument and a hand curette regarding time taken, calculus removal, tooth surface roughness (Ra), and SEM examination before and after instrumentation.

Methods: 30 extracted human teeth with subgingival calculus were assigned to one of three treatment groups (n=10). The working force was standardised for both ultrasonic instruments at 200 g and for the curette at 500 g.

Results: The results revealed that the time needed for instrumentation was 126.1±38.2 s for the curette, significantly more than for the piezoelectric ultrasonic instrument (74.1±27.6 s; p<0.05) and 104.9±25.4 s for the magnetostrictive ultrasonic instrument. Remaining calculus was similar for all three groups. The end Ra values were significantly worse for the piezoelectric instrument (2.02±0.41; p<0.05) compared to 1.42±0.48 for the curette and 1.36±0.41 for the magnetostrictive instrument. The SEM examination revealed the smoothest surfaces but, subjectively, the most tooth substance loss after the curette, followed by the magnetostrictive instrument, with the least substance loss, and then the piezoelectric instrument, with medium substance loss.

Conclusion: The piezoelectric ultrasonic scaler was more efficient than the magnetostrictive ultrasonic scaler in removing calculus but left the instrumented tooth surface rougher.
Mutans streptococci in subgingival plaque of treated and untreated patients with periodontitis
Authors: Van Der Reijden W. A. , Dellemijn‐Kippuw N. , Stijne‐van Nes A. M. , De Soet J. J. , Van Winkelhoff A. J.
Published: March 2003

Background: The etiology of root caries is thought to be identical to coronal caries, though root caries seem to be more complicated because of the higher susceptibility of exposed roots (dentin) by periodontal therapy to demineralization than intact enamel. This implies that mutans streptococci are the most likely pathogens in the development of root caries. Although it is known that both the numbers of mutans streptococci and the frequency of isolation in root caries lesions are negatively correlated with the distance from the gingival margin, the subgingival sulcus has not been considered a possible habitat for mutans streptococci. However, subgingival occurence of mutans streptococci in both untreated and treated periodontal patients has not been documented well in the literature.

Objective: To investigate the presence and levels of mutans streptococci in the subgingival plaque of patients (n=154) in different stages of periodontal therapy. The subgingival sulcus may be a possible habitat for mutans streptococci. This localisation of mutans streptococci may be of importance in the development of root caries after periodontal surgery.

Materials and methods:

In this cross‐sectional study, subgingival plaque samples from 154 consecutive adult periodontitis patients were tested for presence and levels of mutans streptococci and putative periodontal pathogens by anaerobic cultures. These patients were divided into 4 groups based on their stage of periodontal treatment: (1) untreated patients; (2) patients after initial periodontal therapy only; (3) patients in the maintenance phase who not underwent periodontal surgery; (4) patients after periodontal surgery.

Results: The prevalence of mutans streptococci in the 4 study groups varied from 82% in untreated patients to 94% in maintenance patients. The mean proportion of mutans streptococci was 6.65% in maintenance patients versus 1.86% in untreated patients (p=0.005) and 2.51% in patients after scaling and root planing (p=0.041).

Conclusions: The subgingival area is a microbial habitat for mutans streptococci that may be of importance in the development of root caries in periodontitis patients.
Reliability of assessing interproximal bone loss by digital radiography: intrabony defects
Authors: Wolf Britta , Bethlenfalvy Eric von , Hassfeld Stefan , Staehle Hans Jörg , Eickholz Peter
Published: March 2003

Aim: The aim of the present study was to assess the reproducibility and validity of linear measurements of interproximal bone loss in intrabony defects on digitized radiographic images after application of different filters and magnifications.

Methods: Immediately before surgery 50 radiographs of 50 periodontally diseased teeth exhibiting interproximal intrabony defects were obtained by a standardized technique in 50 patients. Intrasurgically the distances from the cementoenamel‐junction (CEJ) to the alveolar crest (AC) and from the CEJ to the deepest extension of the bony defect (BD) were assessed. All radiographs were digitized by a flatbed scanner (resolution: 600×1200 dpi). Using the FRIACOM‐soft ware, the linear distances CEJ to AC and CEJ to BD were measured at 50 intrabony defects on digitized but unchanged radiographic images and also after use of 2 different basic image processing modes (filters: enhancement of grey level differences, spreading of grey values) with 7‐fold and 14‐fold magnification by 2 different examiners.

Results: Repeated measures MANOVA revealed reproducibility of the measurement of the distance CEJ to AC to be significantly influenced by examiner (p=0.027) and filter in combination with the height of 2 wall component of the intrabony defect (p=0.066). For the distance CEJ to BD filters had significant influence on reproducibility in correlation with vertical angulation difference (p=0.001). On the average in this study radiographic measurements tended to overestimate the amount of bone loss as assessed by intrasurgical measurements (CEJ‐AC: 0.74–1.91 mm; CEJ‐DB: −0.04–0.77 mm). Validity of measurement of the distance CEJ‐AC was shown to be significantly influenced by the depth of the intrabony defect (p<0.003). Validity of the distance CEJ‐BD was significantly influenced by intrasurgically assessed bone loss (p=0.029), horizontal angulation (p=0.066). Filters influenced the validity only in combination with examiner (p<0.001).

Conclusions: In this study, the chosen digital manipulations (filters: spreading, structure) of radiographic images failed to result in statistically significantly more reproducible or valid measurements of interproximal bone loss within intrabony defects when compared to the digitized but unchanged images. All radiographic assessments on the digitized images except for use of enhancement of grey level differences (structure) came close to the intrasurgical gold standard.
Multivariate analysis of oral hygiene data from a representative sample*
Authors: Wolf Burkhard H. , Rieger Christian , Boening Klaus W. , Walter Michael H.
Published: March 2003

Background: This analysis was based on an oral health survey with dental examination and interview by questionnaire.

Method: The data set comprised a representative random sample of the over 14‐year‐old residents of the German Federal State of Saxony (n=714), in which a multivariate logistic regression analysis was conducted. The dependent variable was the debris index (DI) score of the oral hygiene index scoring system. The subjects were split into 2 groups by dividing DI scores into tertiles: those with acceptable oral hygiene (1st tertile, DI 0.001.20) and unacceptable oral hygiene (2nd and 3rd tertile, DI>1.20). The most important explanatory variable was the community periodontal index of treatment need (CPITN).

Results: The higher the CPITN score, the lower the probability of acceptable oral hygiene. In relation to the reference category score 0, higher CPITN scores were associated with acceptable oral hygiene, with an odds ratio 0.05 (95% confidence interval (CI)=0.01–0.23) for CPITN score 1, and an odds ratio 0.02 (95% CI: 0.01–0.08) for score 4. Further significant variables were: self‐evaluation of tooth condition, gender, and the number of missing teeth.
Postnatal glutamate‐induced central nervous system lesions alter periodontal disease susceptibility in adult Wistar rats
Authors: Breivik Torbjørn , Thrane Per S. , Gjermo Per , Fonnum Frode
Published: March 2003

Background: Inability to mount a suitable brain‐neuroendocrine response to bacterial or other antigenic challenges has been found to play an important rôle in infectious and inflammatory disease susceptibility and progression, including periodontal disease.

Objective: The present study was designed to determine the effects of glutamate administration to new‐born Wistar rats on the development and progression of naturally occurring and ligature‐induced periodontal disease in the rats as adults. Postnatal glutamate administration is known to permanently damage neurones in the hypothalamic arcuate nucleus.

Method: New‐born rats were treated 1× daily subcutaniously with 2 mg/g of monosodium‐L‐glutamate (MSG) for 5 days from day 3 to 6. Control animals were injected with similar amounts of saline. Experimental ligature‐induced periodontal disease was induced in the rats at the age of 12 weeks at maxillary right 2nd molar teeth. The contralateral maxillary left 2nd molars served as control teeth, and for assessment of naturally occurring periodontal disease. Disease progression was evaluated histometrically.

Results: The results revealed that the glutamate‐lesioned rats developed significantly more periodontal tissue destruction compared to sham‐lesioned control rats in both the ligated and non‐ligated teeth.

Conclusions: This study supports our resent findings indicating that inappropriate brain‐neuroendocrine‐immune regulation may play a rôle in periodontal disease susceptibility and progression.
Video instruction to establish a panel of experts to compare tooth cleaning by 4 electric toothbrushes
Authors: Renton‐Harper P. , Addy M. , Newcombe R. G.
Published: March 2003

Background and Aims: Laboratory robots can reveal differences in the cleaning of artificial tooth surfaces by different electric toothbrushes. The primary aim of this study was to establish, through video instruction, a panel of experts in tooth cleaning with an oscillating rotating electric toothbrush in an attempt to mimic the highly reproducible laboratory robot. A secondary aim was to use the “expert” panel, in an attempt to distinguish between tooth cleaning efficacy of 4 head/model combinations of the oscillating rotating electric brush.

Method: A 24‐subject panel, after video training and home habituation for up to 12 weeks with the basic model of electric brush, participated in a single examiner blind, 4‐cell, randomised, cross‐over study balanced for residual effects. In each period, subjects suspended tooth cleaning for 4 days. Plaque was then scored by area before and after tooth brushing for 2 min in tandem with the instructional video with the allocated brush head/model combination.

Results: Differences between subjects was significant, but overall plaque removal with all brushes was of the order of 85% with one subject achieving >97% plaque removal. There were significant differences between the brushes with the oscillating rotating brush with the faster head movement, in most analyses, significantly more effective than the slower oscillating rotating brush with 2 head combinations. The faster oscillating rotating brush was also significantly more effective than the most recently introduced oscillating rotating reciprocating model.

Conclusions: Previous studies have shown that single uses of watch‐and‐follow video instruction significantly improve toothcleaning with electric toothbrushes. The present study shows that extended training using these videos results in almost complete plaque removal even when prebrushing plaque levels have been enhanced by a 4‐day period of no oral hygiene. Furthermore, the establishment of an “expert” panel can distinguish between brushes of different cleaning efficiencies. However, given the level of achievement of all panel members with all brushes, the absolute differences observed are of doubtful clinical significance for gingival health. Finally, the slightly‐reduced plaque removal by the 3 directional head action brush can be explained by the inability within the present protocol to habituate the subjects in its use.
Efficacy of manual and powered toothbrushes (I). Effect on clinical parameters
Authors: Haffajee Anne D. , Thompson Maureen , Torresyap Gay , Guerrero Denise , Socransky Sigmund S.
Published: March 2003

Background/aim: The purpose of the present investigation was to compare manual (Crest Complete) and powered toothbrushing (Braun Oral‐B 3D Plaque Remover) for their ability to affect clinical parameters of periodontal diseases.

Methods: 48 periodontal maintenance subjects completed this single‐blind 6‐month longitudinal study. Subjects had a minimum of 20 natural teeth excluding third molars and >10% of sites (approximately 17 sites) with pocket depth 4 mm and/or >10% sites with attachment level >4 mm. At baseline, subjects received full mouth clinical measurements (168 sites) to determine mean Plaque Index, Gingival Index, pocket depth and attachment level and % of sites exhibiting BOP. Subjects were then randomly assigned to one of two groups. The control group (N=26) used a manual toothbrush while the test group (N=22) used a powered toothbrush. Subjects received instruction in oral hygiene and used their assigned toothbrush twice daily according to instruction. Follow‐up clinical assessments were performed at 3 and 6 months. Significance of differences in clinical measures over time was determined using the Quade test and between brushing groups at each time point using the Mann–Whitney test.

Results: Mean pocket depth, mean plaque index and % of sites exhibiting BOP showed significant reductions from baseline to 3 and 6 months in both groups. Mean probing attachment level and mean Gingival Index were significantly reduced in the powered brushing group only. There was a significant positive correlation between plaque reduction and reduction in other clinical parameters in both brushing groups. The majority of subjects showed improvements in clinical parameters at 6 months, although a greater proportion of subjects in the powered group showed a reduction in Plaque Index (77% versus 65%) and in % sites exhibiting BOP (82% versus 69%). Mean pocket depth and mean attachment level showed significantly greater reductions between baseline and 6 months in lingual and mandibular areas in the powered group.

Conclusions: Both manual and powered toothbrushes reduced pocket depth, plaque index and BOP. The powered toothbrush significantly reduced mean gingival index and probing attachment level. The greatest benefit of the powered brush was at mandibular and lingual surfaces.
Molar root anatomy and management of furcation defects
Authors: Al‐Shammari Khalaf F. , Kazor Christopher E. , Wang Hom‐Lay
Published: March 2003

Background, aims: Furcally‐involved teeth present unique challenges to the success of periodontal therapy. Anatomical and morphological complicating factors dictate modifications in treatment approaches used for managing these areas.

Method: Various treatment approaches are available for furcally‐involved teeth, the choice of which depends on selected interdependent factors.

Results: These factors, along with various approaches used in the treatment of furcally compromised teeth are discussed in this review, with particular emphasis on morphology, etiology, classification and diagnosis.
Comparison of the validity of periodontal probing measurements in smokers and non‐smokers
Authors: Biddle A. J. , Palmer R. M. , Wilson R. F. , Watts T. L. P.
Published: March 2003

Aim: To determine whether the reduced inflammation and bleeding and increased fibrosis reported in tobacco smokers affect the validity of clinical probing measurements by altering probe tip penetration.

Method: A constant force probe was used to measure probing depths and sound bone levels at six sites on 64 molar teeth (384 sites) in 20 smoking and 20 non‐smoking patients from grooves made with a bur at the gingival margin prior to extraction. Connective tissue attachment levels were measured from the grooves with a dissecting microscope following extraction. Data were analysed using robust regression with sites clustered within subjects.

Results: Sites in smokers showed more calculus but less bleeding than sites in non‐smokers (p<0.05). The mean clinical probing depth was not significantly different (smokers: 5.54 mm, confidence intervals=4.81 to 6.28; non‐smokers: 6.05 mm, ci=5.38 to 6.72). The corresponding post‐extraction pocket depth measurements (smokers: 4.95 mm, ci=4.30 to 5.61; non‐smokers: 5.23 mm, ci=4.49 to 5.96) were less than clinical probing depth in sites from both smokers and non‐smokers (p<0.01). However, the proportional difference was less in smokers (p<0.05), particularly in deeper pockets, indicating that clinical probe tip penetration of tissue was greater in non‐smokers. Regression analysis indicated that the presence of calculus and bleeding also influenced the difference in clinical probe penetration (p<0.05).

Conclusion: Clinical probing depth at molar sites exaggerates pocket depth, but the probe tip may be closer to the actual attachment level in smokers due to less penetration of tissue. This may be partly explained by the reduced inflammation and width of supra‐bony connective tissue in smokers. These findings have clinical relevance to the successful management of periodontal patients who smoke.
Subgingival microbiota of indigenous Indians of Central America
Authors: Dowsett S. A. , Kowolik M. J. , Archila L. A. , Eckert G. J. , LeBlanc D. J.
Published: March 2003

Objective: To define the subgingival microbial profiles of adult subjects from a previously identified rural community of indigenous Indians in Guatemala, Central America.

Materials and methods: A full‐mouth periodontal examination was performed in 114 adult subjects from 45 families. Plaque samples were collected from both deep and shallow periodontal pockets and checkerboard DNA‐DNA hybridization was employed to identify 17 species previously associated with periodontitis or health.

Results: Plaque deposits and gingivitis were universal and widespread, and periodontal pocketing 5 mm was highly prevalent (84% of subjects). Streptococcus sanguis, Actinomyces naeslundii genospecies 2 and Fusobacterium nucleatum were significantly more prevalent in shallow sites. At the subject level, Actinomyces naeslundii and Peptostreptococcus micros were significantly more prevalent in periodontally‐healthy subjects. Actinobacillus actinomycetemcomitans was not detected in any sample.

Conclusion: There was no association between periodontal disease status and presence of suspected periodontal pathogens. These latter results conflict somewhat with those from treated populations. However, in this population where extensive plaque deposits and gingivitis are universal, the presence of putative pathogens may be more reflective of the local environment.
Clinical and microbial evaluation of a histatin‐containing mouthrinse in humans with experimental gingivitis: a phase‐2 multi‐center study
Authors: Van Dyke Thomas , Paquette David , Grossi Sara , Braman Virginia , Massaro Joseph , D'Agostino Ralph , Dibart Serge , Friden Phillip
Published: March 2003

Objective: P‐113, a 12 amino acid histatin‐based peptide, was evaluated in a mouthrinse formulation for safety and efficacy in a phase 2 multi‐center clinical study.

Method: 294 healthy subjects abstained from oral hygiene procedures and self‐administered either 0.01% P‐113, 0.03% P‐113 or placebo mouthrinse formulations twice daily over a 4‐week treatment period. During this time, the safety, anti‐gingivitis, and anti‐plaque effects of P‐113 were evaluated.

Results: There was a significant reduction in the change from baseline to Day 22 in bleeding on probing in the 0.01% P‐113 treatment group of the intent to treat population (p=0.049). Non‐significant trends in the reduction of the other parameters were observed in this population (p0.159). A sub‐group of subjects which developed significant levels of disease within the four‐week timeframe of the study was identified based on baseline gingival index scores 0.75. Significant findings were observed for bleeding on probing, gingival index and plaque index within this population (p<0.05). There were no treatment‐related adverse events, and there were no adverse shifts in supragingival microflora during the study. Significant amounts of the peptide were retained in the oral cavity following rinsing.

Conclusion: These data suggest that P‐113 mouthrinse is safe and reduces the development of gingival bleeding, gingivitis and plaque in the human experimental gingivitis model.
Anti‐plaque effect of tempered 0.2% chlorhexidine rinse: an in vivo study
Authors: König Jörgen , Storcks Volker , Kocher Thomas , Bössmann Klaus , Plagmann Hans‐Christian
Published: March 2003

Objectives: The aim of this in vivo study was to compare the anti‐plaque effect of warm and cold chlorhexidine gluconate irrigation on matured human plaque.

Methods: In a split‐mouth design, the antibacterial effect of 47 °C “warm” 0.2% chlorhexidine solution was compared with that of 18 °C “cold” rinse at the same concentration on newly‐formed supragingival plaque that had been left undisturbed for 72 h. Before and 1 h after a 1‐min rinse procedure, plaque was sampled from 10 test persons and vitality determined using vital fluorescence technique.

Results: Cold and warm 0.2% chlorhexidine solution reduced plaque vitality significantly from 99.63% to 77.81% (p=0.014) and from 98.98% to 51.77% (p<0.001), respectively. Rinsing with warm chlorhexidine solution reduced plaque vitality to a significantly greater degree (p=0.003) than did cold chlorhexidine.

Conclusion: In this study, warm 0.2% chlorhexidine rinse showed a significantly more intensive anti‐plaque effect than cold chlorhexidine solution at the same concentration.
Clinical, genetic and microbiological findings in a Brazilian family with aggressive periodontitis
Authors: Trevilatto Paula C. , Tramontina Vinícius A. , Machado Maria A. N. , Gonçalves Reginaldo B. , Sallum Antonio W. , Line Sergio R. P.
Published: March 2003

Background, aim: Aggressive periodontitis comprises a group of rapidly progressive forms of periodontitis. Besides bacteria, a high level of subject susceptibility must be involved in the expression of disease. In the present study, we report the clinical, microbiological and genetic profile of a 14‐individual family with aggressive periodontitis.

Method: PCR was utilized to detect pathogenic bacteria of affected sites. DNA was obtained from epithelial cells through a mouthwash with 3% glucose and scrapping of the oral mucosa. RFLP‐PCR was used to analyze cytokine genetic polymorphisms.

Results: Localized aggressive periodontitis was diagnosed for an 18‐year‐old systemically healthy non‐smoking proband, with siblings displaying aggressive periodontitis. Bacteroides forsythus and Treponema denticola were the most frequent pathogens. The proband presented Actinobacillus actinomycetemcomitans and detectable levels of Porphyromonas gingivalis, Bacteroides forsythus and Treponema denticola. Allele 2 of IL‐1α (−889) polymorphism was found in all individuals as well as allele 1 of the IL‐1β (+3953) gene. Alleles 1 and 2 (50 % each) of IL‐1β (−511), allele 1 of TNF‐α (−308) and allele 2 (in homo or heterozygosity) of IL‐RN (intron 2) gene were present.

Conclusion: The results show that the present microbiological and genetic parameters were not relevant for the prediction of periodontitis susceptibility in this family.
The relationship of some negative events and psychological factors to periodontal disease in an adult Swedish population 50 to 80 years of age
Authors: Hugoson A. , Ljungquist B. , Breivik T.
Published: March 2003

Background: Clinical observations and epidemiological studies suggest that experiences of negative life events, especially those manifested as depression, may contribute to an increased susceptibility to periodontal disease.

Objective: In the present study, the prevalence of some negative life events and psychological factors and their relation to periodontal disease were investigated. The sample consisted of individuals 50–80 years of age from an extensive cross‐sectional epidemiological study performed in 1993 in the city of Jönköping, Sweden.

Method: 298 dentate individuals from the Jönköping study were randomly selected. Clinical and radiographic examinations included registration of the number of existing teeth, plaque index, gingival index, pocket depth, and alveolar bone loss. In addition, a questionnaire about socioeconomic status, life events, and psychological and stress‐related factors was used.

Results: The results revealed that, in addition to the well‐documented periodontal disease risk factors such as increased age, oral hygiene status, and smoking, the loss of a spouse (being a widow or widower) and the personality trait of exercising extreme external control were also associated with severe periodontal disease.

Conclusion: The findings support recent studies suggesting that traumatic life events such as the loss of a spouse may increase the risk for periodontal disease. Above all, the present results indicate that an individual's ability to cope with stressful stimuli (coping behavior), as measured by the beliefs of locus of control of reinforcements may play a role in the progression of periodontal disease.
Longitudinal association between plaque and gingival bleeding in smokers and non‐smokers
Authors: Müller Hans‐Peter , Stadermann Sabine , Heinecke Achim
Published: March 2003

Background/aims: Whereas accumulation of dentogingival plaque inevitably leads to inflammatory reactions in the adjacent gingival tissue, there is limited information with regard to factors influencing naturally occurring fluctuation between gingival health and disease. The major aims of the present study were to investigate site‐specific associations between plaque and gingivitis as well as transition dynamics of naturally occurring gingivitis in smoking and non‐smoking young adults.

Methods: 65 systemically healthy young adults, 19 to 30 years old, participated. 33 volunteers smoked at least 20 cigarettes per day, whereas 32 subjects were non‐smokers. Clinical periodontal conditions were assessed four times within a time period of 6 months. An ecological approach in data analysis as well as site‐specific analyses considering the correlated structure of data were performed.

Results: At the outset and after 6 months, smokers had significantly more supragingival plaque than non‐smokers. At the final examination, bleeding upon probing as well as calculus were more prevalent in smokers. A site‐by‐site analysis revealed that smokers tended to have a weaker association between supragingival plaque and bleeding on probing than non‐smokers (median Mantel‐Haenszel's common odds ratio 1.91 vs. 2.89, p=0.07). Multiple logistic regression analyses adjusted for periodontal probing depth, plaque and calculus identified smoking status to significantly increase the risk for the first transition of non‐bleeding to bleeding upon probing by 86% (p<0.01). In contrast, recovery of bleeding sites was positively influenced by female gender, but not smoking.

Conclusions: In multivariate analyses adjusted for probing depth, plaque and calculus, smokers appeared to be at higher risk for the transition from non‐bleeding to bleeding on probing. Weaker associations between plaque and naturally occurring gingivitis in smokers may have important consequences for preventive strategies for gingivitis.
Comparative professional plaque removal study using 8 branded toothbrushes
Authors: Claydon N. , Addy M. , Scratcher C. , Ley F. , Newcombe R.
Published: March 2003

Background and aim: Considerable interest has been shown in the plaque removal properties of modern toothbrush designs. The primary aim of the study was to compare the plaque removal properties of 8 relatively recent designs of manual toothbrush using a professional tooth brusher and within a commonly used time frame. A secondary aim was established to utilise the data to observationally appraise plaque accumulation together with the patterns of removal as a consequence of using the timed professional tooth brusher.

Method: The method was an 8‐period, single‐examiner, randomized, blind cross‐over study involving 24 healthy volunteers, balanced for residual effects. Subjects accumulated plaque over a 4 day no oral hygiene period. On day 4, the accumulated plaque was scored by plaque index at the mesial, mid and distal sites of each of the buccal and lingual surfaces of the assessed teeth. Subjects were then removed from the assessment area where they received a professional brushing timed to last 48 s. Brushing was completed according to pre‐study training without toothpaste and was followed by a re‐scoring of the remaining plaque. A washout period of 3 days was then allowed prior to the next period during which normal oral hygiene was resumed.

Results: Similar quantities of plaque accumulated in each arch, although the difference between the buccal and lingual surfaces was of the order of 30%. The professional toothbrusher removed approximately 40% of the accumulated plaque in the 48 s allocated. The buccal surfaces were most effectively cleaned (≈45%) compared with the lingual (≈25%), with the plaque removal in the mesial and mid sections approaching 40% and 60% respectively. The difference in performance between the test brushes corresponded to 5% of the residual plaque values with none being significantly more efficient overall. Pair wise site comparisons did produce differences of the order of 10% (p=0.004) at the mesio‐buccal, and 8% (p=0.030) at the mid‐buccal sites respectively in favour of 2 brushes compared to one other brush.

Conclusions: These data derived from a standardized brushing method support the contention of many researchers that there is no one superior design of manual toothbrush. The minor and few site differences in favour of some brushes are unlikely to be of clinical significance to gingival health. This leaves uncontested the conclusion that the user is by far the most significant variable. Perhaps methods such as used in the present study could be more gainly employed to set a minimum standard of toothbrush efficacy.
5 polymorphisms in the transforming growth factor‐β 1 gene (TGF‐β 1) in adult periodontitis
Authors: Holla Lydie Izakovicova , Fassmann Antonin , Benes Petr , Halabala Tomas , Znojil Vladimir
Published: March 2003

Objectives: Transforming growth factor–β (TGF‐beta) represents a family of polypeptide growth factors, involved in inflammation and regulation of immune responses. The purpose of this study was to determine whether polymorphisms in the TGF‐beta 1 gene may confer susceptibility to adult periodontitis.

Material and methods: We studied 90 patients with adult periodontitis together with 108 unrelated subjects. 3 polymorphisms located in the 5′region at positions −988 (C/A), −800 (G/A) and −509 (C/T) and 2 polymorphisms located at codons 10 (L10P) and 25 (R25P) of exon 1 were investigated by PCR methods.

Results: There was no statistically‐significant difference in genotype or allele frequency distributions between patients and reference group for the −800G/A,

−509C/T, L10P and R25P polymorphisms (p>0.05 in all cases). The −988 A polymorphism was present neither in our patients nor in unrelated subjects. Upon stratification for smoking status no significant differences were found in the TGF‐β 1 genotype or allele frequencies either between adult periodontitis smokers compared to control smokers, or between periodontitis non‐smokers and control non‐smokers.

Conclusion: These data indicate that the mentioned polymorphisms of the TGF‐β 1 gene do not influence susceptibility to adult periodontitis. There was no association between any polymorphisms in the TGF‐beta 1 gene, severity of periodontitis and the smoking status in our study.
Local application ofn−3 orn−6 polyunsaturated fatty acids in the treatment of human experimental gingivitis
Authors: Eberhard Jörg , Heilmann Frederik , Açil Yahya , Albers Hans Karl , Jepsen Søren
Published: March 2003

Background:Polyunsaturated fatty acids have the potential to attenuate inflammation by the synthesis of mediators of the 15‐lipoxygenase pathways, which show opposite effects to the pro‐inflammatory arachidonic acid metabolites such as leukotriene B4(LTB4).

Aims:The aim of this clinical study was to evaluate the effects of topical application ofn−6 orn−6 polyunsaturated fatty acids in patients with experimental gingivitis.

Methods:In each subject, similar teeth served as experimental and control over a 21‐day non‐hygiene phase and a 9‐day resolving phase. Efficacy assessment was based on the bleeding on probing frequency (BOP) and the gingivocrevicular fluid volume (GCF). GCF was determined by inserting a filter paper strip for 30 s and measurements were performed on a Periotron 8000. The LTB4concentration was analyzed by reversed‐phase high‐pressure liquid chromatography.

Results:After 21 days of plaque growth, the BOP, GCF and LTB4levels were significantly increased in all groups, with no differences between the control and experimental side. Rinsing of an area with established gingivitis for a 9‐day period significantly reduced the GCF in then−6 group (71.9 (18.7) versus 47.4 (11.4) Periotron Units, median (inter quartile range)).

Conclusion:The topical application ofn−6 orn−6 fatty acids failed to inhibit the development of experimental gingivitis. Rinsing withn−6 fatty acids could reduce the level of GCF in established experimental gingivitis.
In vitro antioxidant activities of mouthrinses and their components
Authors: Battino M. , Ferreiro M. S. , Fattorini D. , Bullon P.
Published: March 2003

Objectives: Several forms of periodontal diseases (PD) are often associated with activated phagocytosing leukocytes and contemporary free radical production. Host antioxidant defenses could benefit from mouthrinses used as adjuncts to counteract plaque‐associated bacteria. The aim of the present study was to determine possible antioxidant activity (AA) of a number of antiseptic mouthrinses and of their stated active principles (AP), regardless of their efficacy as antimicrobial agents.

Material and Methods: The antioxidant activities of 11 mouthrinses and their active principles were tested with a specific spectrophotometric method. Comet assay was used to test whether pure chemical antioxidant activity actually corresponded to prevention of in vitro DNA fragmentation.

Results: Methylsalicylate‐containing mouthrinses were the most effective. Several compounds, and some vehicles, behaved as antioxidants. Fibroblast DNA fragmentation was limited by preincubation with methylsalicylate‐containing mouthrinse but was unaffected by treatment with chlorexidine.

Conclusion: The results described herein indicate that several mouthrinses possess AA; such a property could be ascribed to either AP or vehicles or both. All the data were obtained in systems in vitro and the demonstration of in vivo AA is necessary. These findings could be useful in the treatment of some forms of PD and should be considered when arranging new mouthrinse formulations.
Clinical efficacy of a new sonic/ultrasonic toothbrush
Authors: Zimmer Stefan , Nezhat Vida , Bizhang Mozhgan , Seemann Rainer , Barthel Claudia
Published: March 2003

Objectives: The purpose of this clinical study was to evaluate the efficacy of the Ultra Sonex Ultima® in comparison with a conventional manual toothbrush.

Material and methods: In all, 64 healthy volunteers (32 females, 32 males) took part in the parallel‐design treatment‐blind study. After a screening examination and stratification by age, sex and papillary bleeding index (PBI), the participants were randomly assigned to two groups with 32 subjects each. Four weeks later, the Turesky modification of the Quigley–Hein plaque index (PI), the approximal plaque index (API), and the PBI were recorded at baseline. Four and 8 weeks after baseline, the indices were recorded again.

Results: During the study period of 8 weeks, the API showed no difference between the manual and the electric toothbrush. For the median PI, a statistically significant difference (p < 0.001) was found after 4 (manual: 2.16 vs. electric: 1.34) and 8 weeks (1.96 vs. 0.92). After 4 weeks, the median PBI was 0.75 for the manual and 0.43 for the electric brush (p < 0.01). The values after 8 weeks were 0.63 (manual) and 0.29 (electric, p < 0.001).

Conclusion: The Ultra Sonex Ultima may be more efficacious than manual toothbrushes in removing plaque and preventing gingivitis in patients without severe periodontal disease.
Cervical external root resorption in vital teeth
Authors: Bergmans L. , Van Cleynenbreugel J. , Verbeken E. , Wevers M. , Van Meerbeek B. , Lambrechts P.
Published: March 2003

External resorptions associated with inflammation in marginal tissues present a difficult clinical situation. Many times, lesions are misdiagnosed and confused with caries and internal resorptions. As a result inappropriate treatment is often initiated. This paper provides three‐dimensional representations of cervical external resorption, based on X‐ray microfocus‐tomographical scanning of a case, which will aid the dental practitioner in recognizing characteristic features during clinical inspection. In addition, histopathological examination reveals the cellular morphology of the adjacent tissues.
Long‐term results of supportive periodontal therapy (SPT) in HIV‐seropositive and HIV‐seronegative patients
Authors: Hofer Dominik , Hämmerle Christoph H. F. , Grassi Markus , Lang Niklaus P.
Published: March 2003

Aim: The aim of the present study was to investigate the long‐term results of periodontal supportive therapy in HIV‐seropositive and HIV‐seronegative patients.

Material and methods: Baseline examination of 18 HIV‐seropositive patients (14 males and four females, median age of 29.7 years) revealed the following periodontal diagnoses: eight patients with linear gingival erythema, four patients with necrotizing periodontitis, five patients with conventional gingivitis and one patient with chronic periodontitis. In the HIV‐seronegative group, out of 16 patients (12 males and four females, median age 35.5 years), one patient presented with conventional gingivitis and 15 patients with chronic periodontitis. Periodontal therapy and maintenance care consisted of supra‐ and subgingival removal of plaque and calculus and instruction in oral hygiene. Based on the individual patient's needs, the mechanical therapy was repeated.

Results: In the test group, the mean maintenance period was 22.7 ± 9.4 months (range 11.0–37.4) and in the control group, 48.9 ± 32.0 months (range 9.3–110.8). In the test group, the mean PlI (1.1 ± 0.8) remained at the same level (1.1 ± 0.5; p = 0.73, Wilcoxon sign rank test, p < 0.05) throughout the observation period, the mean GI was reduced from 1.6 ± 0.5 to 1.4 ± 0.4 (p = 0.18), the mean PPD was reduced from 2.9 ± 0.3 to 2.8 ± 0.2 (p = 0.15) and the mean PAL (3.1 ± 0.5) remained unaltered as well (3.1 ± 0.4; p = 0.83). None of these differences was statistically significant. In the control group, PPD (3.0 ± 0.4) and PAL (3.0 ± 0.5) were significantly reduced: PPD = 2.7 ± 0.2 (p = 0.0003) and PAL = 2.9 ± 0.5 (p = 0.0034).

Conclusion: In HIV‐seropositive patients, attachment level can be maintained. However, oral hygiene and compliance are the key factors for this.
Comparison of new and 3‐month‐old toothbrushes in plaque removal
Authors: Tan Eugene , Daly Christopher
Published: March 2003

Objectives: It is often recommended that manual toothbrushes should be replaced every 3 months. The aim of this study was to compare the effectiveness of new and 3‐month‐old toothbrushes in the removal of dental plaque.

Materials and methods: A single examiner blind, randomized study was performed in which 40 adult patients attended the clinic on two occasions following 48‐h periods of no oral hygiene. Following plaque scoring, patients brushed with a new toothbrush at one visit and with a brush that they had used previously for 3 months at the other visit. Brushing time was 60 s. Plaque was then re‐scored and percentage reductions in plaque scores calculated. The amount of wear of the 3‐month‐old brushes was determined by measurement of brushing surface areas.

Results: Plaque scores after each 48‐h period of no oral hygiene were not significantly different. The percentage reductions in plaque scores achieved with the new brushes were not significantly different from those achieved with the 3‐month‐old brushes. Both the new and the 3‐month‐old toothbrushes reduced plaque scores by approximately 34%. Compared with new brushes in the same subjects, no significant differences were found for plaque score reductions for 3‐month‐old brushes with minor, moderate or marked wear.

Conclusion: The 3‐month‐old toothbrushes were as effective as new brushes in plaque removal.
A study of triclosan and its solubilizers as inhibitors of oral malodour
Authors: Young Alix , Jonski Grazyna , Rölla Gunnar
Published: March 2003

Background: It is known that the detergents or organic solvents used to solubilize lipid‐soluble triclosan can affect the biological activities exhibited by this molecule, such as its antibacterial, antiplaque, and anti‐inflammatory effects.

Objective: To examine whether solubilizing agents influence the effect of triclosan against formation of volatile sulphur compounds (VSC), as these are known to be a major component of oral malodour.

Material and methods: Part A: one ml of human whole saliva (n = 10) was incubated for 24 h at 37°C in a closed test tube with addition of 10 µl triclosan solubilized in alcohol. Part B: in a clinical experiment, VSC formation enhanced by mouth‐rinses with cysteine was followed by subjects (n = 9) rinsing with triclosan solubilized in different detergents and organic solvents. The amount and nature of VSC in the saliva headspace and in the mouth air of the test subjects were determined by gas chromatography.

Results: Triclosan had a marked dose‐dependent effect against VSC in vitro when solubilized in alcohol, independent of the alcohol per se. In vivo, triclosan lost its anti‐VSC effect when solubilized in oil, in an uncharged detergent or in a chromophor, whereas it maintained its effect when solubilized in a combination of sodium lauryl sulphate, propylene glycol and water.

Conclusion: The solubilizing agent influences the anti‐VSC effect of triclosan.
MMP‐1 promoter polymorphism: association with chronic periodontitis severity in a Brazilian population
Authors: De Souza A. P. , Trevilatto P. C. , Scarel‐Caminaga R. M. , Brito R. B. , Line S. R. P.
Published: March 2003

Background:  A single nucleotide polymorphism was described in the promoter region of the human MMP‐1 gene, and this polymorphism has been associated with risk of cancer metastasis and inflammatory diseases. In this paper, we studied the possible relationship between the MMP‐1 promoter polymorphism and the severity of chronic periodontitis.

Methods:  Genomic DNA from oral mucosa was amplified by PCR and analyzed by restriction endonuclease. The alleles were separated by polyacrylamide gel electrophoresis. The significance of the differences in observed frequencies of polymorphism in moderate and severe disease and healthy groups was assessed by Chi‐squared test.

Results: In the healthy group, the 2G allele was observed with a frequency of 48.7%, while in severely diseased patients the 2G allele was seen in 69.2% (P = 0.0344). The genotype 2G/2G was found in 46.15% of the group with severe periodontitis, and 24.3% and 25.0%, respectively, of the healthy and moderate groups (P = 0.0647).

Conclusion:  These results show that a polymorphism in the promoter region of MMP‐1 gene is associated with the severe chronic periodontitis phenotype in non‐smokers.