bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of repeated professional supragingival plaque removal on the composition of the supra‐ and subgingival microbiota
Authors: Ximénez‐Fyvie Laurie Ann , Haffajee Anne D. , Som Sovanda , Thompson Maureen , Torresyap Gay , Socransky Sigmund S.
Published: March 2003

Background, aims: The purpose of the present investigation was to determine the effect of weekly professionally administered supragingival plaque removal on the composition of the supra and subgingival microbiota.

Methods: 18 adult subjects with periodontitis who had been treated and were in a maintenance phase of therapy were clinically and microbiologically monitored at baseline, 3, 6 and 12 months. After the baseline visit, the subjects received scaling and root planing followed by professional supragingival plaque removal every week for 3 months. Clinical measures of plaque accumulation, bleeding on probing (BOP), gingival redness, suppuration, pocket depth and attachment level were made at 6 sites per tooth at each visit. Separate supra (N=1804) and subgingival (N=1804) plaque samples were taken from the mesial aspect of all teeth excluding third molars in each subject at each time point and evaluated for their content of 40 bacterial taxa using checkerboard DNA‐DNA hybridization. Significance of changes in mean counts, prevalence and proportions of bacterial species over time in both supra and subgingival samples were determined using the Quade test and adjusted for multiple comparisons.

Results: Mean % of sites exhibiting plaque, gingival redness and BOP were significantly reduced during the course of the study. Significant decreases in mean counts were observed in both supra and subgingival samples. Mean total DNA probe counts (×105, ±SEM) at baseline, 3, 6 and 12 months were: 133±19, 95±25, 66±6, 41±6 (p<0.001) for supragingival samples and 105±22, 40±10, 19±4, 13±3 (p<0.001) for subgingival samples. Mean counts of 22 of 40 and 34 of 40 species tested were significantly reduced in the supra and subgingival samples respectively over the monitoring period. For example, mean counts of Porphyromonas gingivalis×105 at baseline, 3, 6 and 12 months in the subgingival plaque samples were 2.0±0.4, 0.5±0.2, 0.6±0.3, 0.3±0.1 (p<0.001); Bacteroides forsythus 2.0±0.6, 0.4±0.1, 0.4±0.2, 0.1±0.2 (p<0.001); Treponema denticola 3.4±1.1, 0.8±0.3, 0.4±0.2, 0.3±0.3 (p<0.01). Similar reductions were seen in supragingival plaque samples. While counts were markedly reduced by professional plaque removal, the proportion and prevalence of the 40 test species were marginally affected.

Conclusions: Weekly professional supragingival plaque removal profoundly diminished counts of both supra‐ and subgingival species creating a microbial profile comparable to that observed in periodontal health. This profile was maintained at the final monitoring visit, 9 months after completion of therapy.
Treatment of dentine hypersensitivity by lasers: a review
Authors: Kimura Yuichi , Wilder‐Smith Petra , Yonaga Kazuo , Matsumoto Koukichi
Published: March 2003

Background, aims: Since the development of the ruby laser by Maiman in 1960, a variety of papers on potential applications for lasers in dentistry have been published. The purpose of this paper is to summarise laser applications for the treatment of dentine hypersensitivity. The effects of laser on pulp tissue and problems on laser treatment are also reviewed. This article reviews the role of lasers for the treatment of dentine hypersensitivity since 1985, summarises many research reports from the last decade, and surmises what the future may hold for lasers in this treatment.

Method: To date, 4 kinds of lasers have been used for the treatment of dentine hypersensitivity, and the effectiveness ranged from 5.2 to 100%, which was dependent on the laser type and parameters used. The mechanism involved in laser treatment of dentine hypersensitivity are relatively unknown.

Results: These require clarification to result in safely effective treatment optimization. In general, the efficiency for the treatment of dentine hypersensitivity using lasers is higher than other methods, but in severe cases, it is less effective.

Conclusion: It is necessary to consider the severity of dentine hypersensitivity before laser use.
Microbial composition of supra‐ and subgingival plaque in subjects with adult periodontitis
Authors: Ximénez‐Fyvie Laurie Ann , Haffajee Anne D. , Socransky Sigmund S.
Published: March 2003

Background, aims: The purpose of the present study was to compare and relate the microbial composition of supra and subgingival plaque in 23 adult periodontitis subjects (mean age 51±14 years).

Methods: A total of 1,170 samples of supra and subgingival plaque were collected from the mesial aspect of every tooth (up to 28 supra and 28 subgingival samples) from each subject and evaluated for the presence and levels of 40 bacterial taxa using whole genomic DNA probes and checkerboard DNA‐DNA hybridization. Clinical assessments including dichotomous measures of gingival redness, bleeding on probing, plaque accumulation and suppuration, as well as duplicate measures of pocket depth and attachment level, were made at 6 sites per tooth. The counts (levels), % DNA probe count (proportion) and % of sites colonized (prevalence) of each species in supra and separately in subgingival plaque were computed for each subject. Significance of differences between supra and subgingival plaque for each species was sought using the Wilcoxon signed ranks test and adjusted for multiple comparisons.

Results: All 40 taxa were detected in both supra and subgingival plaque. Actinomyces species were the most prevalent taxa in both habitats. 75 to 100% of supra and 62 to 100% of subgingival sites were colonized by at least one of the 5 Actinomyces species. Supragingival samples exhibited significantly higher counts of Actinomyces naeslundii genospecies 1, Actinomyces israelii, Actinomyces odontolyticus, Neisseria mucosa, Streptococcus gordonii, Capnocytophaga ochracea and Capnocytophaga sputigena when compared with mean counts in subgingival samples taken from the same tooth surfaces. Subgingival plaque samples presented significantly higher counts of Prevotella nigrescens, Prevotella intermedia, Bacteroides forsythus and Porphyromonas gingivalis. Subgingival samples exhibited a significantly higher proportion of “red” and “orange complex” species, while supragingival plaque exhibited higher proportions of “green” and “purple” complex species as well as Actinomyces species. Suspected periodontal pathogens could be detected in supragingival plaque from sites where subgingival samples were negative for the same species.

Conclusions: The data indicate that supragingival plaque can harbor putative periodontal pathogens, suggesting a possible rôle of this environment as a reservoir of such species for the spread or reinfection of subgingival sites.
Microbiological parameters associated with IL‐1 gene polymorphisms in periodontitis patients
Authors: Socransky S. S. , Haffajee A. D. , Smith C. , Duff G. W.
Published: March 2003

Background, aims: Polymorphisms in the cluster of IL‐1 genes have been significantly associated with the severity of adult periodontitis. The purpose of this study was to compare microbiological parameters in IL‐1 genotype negative and positive adult subjects with a range of periodontitis severities.

Method: The study included 108 subjects in good general health. Clinical parameters were recorded at 6 sites/tooth excluding 3rd molars and included: plaque accumulation, gingival erythema, bleeding on probing, suppuration, pocket depth and attachment level. Subgingival plaque samples were collected from the mesiobuccal surface of up to 28 teeth in each subject (mean 25.3) providing a total of 2736 samples. The levels of 40 subgingival taxa were determined in each sample using checkerboard DNA‐DNA hybridization. Fingerstick blood samples were collected for IL‐1A (+4845) and IL‐1B (+3954) genotyping using PCR‐based methods.

Results: The proportion of IL‐1 genotype positive subjects that exhibited mean counts of specific subgingival species above selected thresholds was significantly higher than the proportion of genotype negative subjects. Prominent among species that were detected at higher levels in genotype positive subjects were members of the “red” and “orange” complexes and included: Bacteroides forsythus, Treponema denticola, the Fusobacterium nucleatum subspecies, Fusobacterium periodonticum, Campylobacter gracilis, Campylobacter showae and Streptococcus constellatus. Streptococcus intermedius, Streptococcus gordonii and 3 Capnocytophaga species were also detected more frequently at high numbers in genotype positive subjects. Significantly higher mean counts of B. forsythus, Porphyromonas gingivalis, T. denticola, the F. nucleatum subspecies, F. periodonticum, Campylobacter rectus, C. showae, Eubacterium nodatum, S. constellatus, S. gordonii, and S. intermedius were detected at periodontal pockets >6 mm in subjects who were genotype positive when compared with genotype negative subjects. The increase was due to increased numbers of cells of these species rather than a major shift in proportion.

Conclusion: The data suggest that genotype positive subjects more frequently had higher levels of “red” and “orange” complex species that are known to be strongly associated with measures of periodontal inflammation.
Abrasion and stain removal by different manual toothbrushes and brush actions: studies in vitro
Authors: Dyer D. , MacDonald E. , Newcombe R. G. , Scratcher C. , Ley F. , Addy M.
Published: March 2003

Background and aims: A limited amount of data using flat trim multitufted toothbrushes shows that abrasion of substrate surfaces by a standard toothpaste varies dependent on filament stiffness and configuration; soft brushes producing the most abrasion. The aims of these studies in vitro were to assess toothpaste abrasion of acrylic and stain removal by 5 proprietary medium toothbrushes with different head filament arrangements, and a prototype brush with rectangular filaments. The prototype brush had a medium texture in the long axis and soft texture at right angles to the long axis.

Material and method: Optically clear acrylic was used as the substrate for abrasion by a standard toothpaste. Loss of substrate was determined by profilometry after 5000, 10 000, 15 000 and 20 000 linear or rotary brushing actions. Stain removal was determined spectrophotometrically from optically clear acrylic specimens stained by chlorhexidine tea soaking sequences. Stained specimens were brushed with water using linear or rotary actions and measurements taken every 10 s to 60 s.

Results: Abrasion was progressive with increasing strokes and the pattern for each brush and brush action was to a first approximation linear. Overall, abrasion was significantly greater with linear compared to rotary action. Also overall brushes differed in the abrasion produced with both actions and particularly at greater exposure times. Within brush differences for the two motions were all significant by 20 000 strokes except for the prototype brush. Stain removal was progressive over time with each brush but the pattern was non‐linear. For the proprietary brushes the rotary motion removed less stain. For the prototype brush more stain was removed with the rotary action. Overall brushes differed significantly in stain removal within each motion and for each motion most differences between the proprietary and prototype brushes reached significance.

Conclusions: The differences between brushes for both abrasion and stain removal must in large part relate to the filament contact area with the substrate surface. Whilst the model may not be predictive of clinical differences, it could find use to establish minimum criteria for toothbrush action.
Osseintegration following treatment of peri‐implantitis and replacement of implant components
Authors: Persson L. G. , Ericsson I. , Berglundh T. , Lindhe J.
Published: March 2003

Aim: The aim of the present experiment was to study if the quality of the titanium surface is a decisive factor for osseointegration and re‐osseointegration.

Material and Methods: 2 Labrador dogs were used. The mandibular 1st molars and all premolars were removed bilaterally. 3 months later, 1 standard fixture and 3, 2‐part “test fixtures” were installed in each side of the mandible. The text fixtures consisted of 1 6‐mm long apical and 1 4‐mm long coronal part connected with an internal screw. After 4 months, abutment connection was performed. 5 months later, a period of experimental peri‐implantitis was initiated during which about 50% of the supporting bone tissue was lost. The dogs were later subjected to a treatment that included (i) systemic administration of antibiotics and (ii) surgical debridement of all implant sites. The abutments and the coronal parts of the text fixtures were removed. All parts of the exposed portion of the standard fixtures, the connecting screw and the apical part of the test fixtures were meticulously cleaned by mechanical means. A pristine, coronal fixture part was via the connecting screw attached to the apical fixture part of each text fixture. All fixtures were submerged. 2 weeks later, a fluorochrome was injected intravenously. After 4 months, biopsies of the implant sites were dissected and prepared for ground sectioning and analysis.

Results: It was demonstrated that re‐osseointegration failed to occur to implant surfaces (standard) exposed to bacterial contamination, but did consistently occur at sites where a pristine implant component was placed in the bone defect following surgical debridement.

Conclusion: The above findings seem to imply that the quality of the titanium surface is of decisive importance for both osseointegration and re‐osseointegration.
Clinical and microbial evaluation of a histatin‐containing mouthrinse in humans with experimental gingivitis
Authors: Mickels Nancy , McManus Colleen , Massaro Joseph , Friden Phillip , Braman Virginia , D'Agostino Ralph , Oppenheim Frank , Warbington Martha , Dibart Serge , Van Dyke Thomas
Published: March 2003

Objective: P‐113, a 12 amino acid histatin‐based peptide, was evaluated in a mouthrinse formulation for safety, prevention of the development of experimental gingivitis, and for its effects on periodontal flora.

Method: 159 periodontally healthy subjects abstained from oral hygiene procedures and self‐administered either 0.005%, 0.01%, 0.05% P‐113 or placebo mouthrinse formulations twice daily over a four week treatment period. During this time, the safety, anti‐plaque, and anti‐gingivitis effects of P‐113 were evaluated.

Results: There was a significant reduction in plaque (p=0.046) and a reduction in gingivitis (p=0.086) for subjects using 0.01% P‐113 mouthrinse. Significantly more subjects in the 0.01% and 0.05% treatment groups showed a small increase in plaque index of <0.25 as compared to the placebo group (p<0.05). Similar trends were noted for changes in the % of sites with bleeding on probing in the 0.01% P‐113 group. There were no treatment‐related adverse events, and there were no adverse shifts in supragingival microflora during the study.

Conclusion: These data suggest that P‐113 mouthrinse is safe and reduces plaque, gingivitis and gingival bleeding in the human experimental gingivitis model.
Plasma levels of lidocaine and prilocaine after application of Oraqix®, a new intrapocket anesthetic, in patients with advanced periodontitis
Authors: Friskopp Johan , Huledal Gunilla
Published: March 2003

Background, aims: Oraqix®, a new non‐injection local anesthetic, lidocaine/prilocaine gel 5%, has been developed to provide pain relief in association with periodontal probing and scaling/root planing (SRP). The aim of this open study was to describe the plasma profiles of lidocaine and prilocaine following a single dose of Oraqix® to patients with advanced periodontitis.

Methods: 10 patients with 18 to 28 teeth with pocket depths of at least 4 mm were included. Oraqix® was applied in the pockets around all the teeth in the mouth by means of a blunt applicator. The total dose applied per patient was 0.9 to 3.5 g. Directly thereafter all the pockets were probed and 3 teeth subjected to SRP. The mouth was rinsed out with a glass of water 20–27 min after the application of the gel. Blood samples were collected before and up to 90 min after the start of application of Oraqix®.

Results: Peak plasma concentrations of lidocaine (99–266 ng/ml) and prilocaine (46–118 ng/ml) occurred 20–40 min after the start of application. These levels were low compared to those reported to cause initial signs of CNS toxicity (5000–6000 ng/ml). Side‐effects were few and mild local effects of short duration.

Discussion: In conclusion, there is a large safety margin with respect to systemic effects following the application of up to 3.5 g Oraqix® in periodontal pockets.
Prepubertal periodontitis associated with chronic granulomatous disease
Authors: Buduneli Nurcan , Baylas Haluk , Aksu Güzide , Kütükçüler Necil
Published: March 2003

Background: Generalised prepubertal periodontitis is a rare entity that is usually a consequence of severe systemic diseases. Chronic granulomatous disease is one of the extremely rare inherited immunodeficiency diseases, which predisposes the patient to recurrent severe bacterial and fungal infections.

Aim: The purpose of this report is to describe a 5‐year old male patient suffering from prepubertal periodontitis associated with chronic granulomatous disease, who was referred to the Department of Periodontology for treatment of severe gingival inflammation.

Methods: A detailed past history was obtained and thorough clinical and laboratory examinations were performed.

Results: Medical tests revealed the only immunodeficiency sign as the extremely low burst test result. The patient was diagnosed as having an autosomal recessive (AR) form of chronic granulomatous disease. He was put on prophylactic treatment with trimethoprim‐sulfamethoxazole (TMP‐SMX) and also a periodontal maintenance regimen with regular 1‐month intervals.

Conclusion: This case report emphasises the importance of the differential diagnosis of severe immunodeficiency in the background of prepubertal periodontitis.
Association between oral malodor and adult periodontitis: a review
Authors: Morita Manabu , Wang Hom‐Lay
Published: March 2003

Background: Bad breath has a significant impact on our daily social life to those who suffer from it. The majority of bad breath originates within the oral cavity. However, it is also possible that it can come from other sources such as gastric‐intestine imbalance. The term “oral malodor” is used to describe a foul or offensive odor emanating from the oral cavity, in which proteolysis, metabolic products of the desquamating cell, and bacterial putrefaction are involved. Recent evidence has demonstrated a link between oral malodor and adult periodontitis. The process of developing bad breath is similar to that noted in the progression of gingivitis/periodontitis. Oral malodor is mainly attributed to volatile sulfur compounds (VSC) such as hydrogen sulfide, methyl mercaptan and dimethyl sulfide. The primary causative microbes are gram‐negative, anaerobic bacteria that are similar to the bacteria causing periodontitis. These bacteria produce the VSC by metabolizing different cells/tissues (i.e., epithelial cells, leukocytes, etc.) located in saliva, dental plaque, and gingival crevicular fluid. Tongue surface is composed of blood components, nutrients, large amounts of desquamated epithelial cells and bacteria, suggesting that it has the proteolytic and putrefactive capacity to produce VSC. One of the challenges in dealing with oral malodor is to identify a reliable test for detecting bad breath.

Aims: The purposes of this review article were: (1) to correlate the relationship between oral malodor and adult periodontitis; (2) to analyze current malodor tests and discuss available treatment regimens.
On the association between hypercholesterolemia, cardiovascular disease and severe periodontal disease
Authors: Katz Joseph , Chaushu Gavriel , Sharabi Yehonatan
Published: March 2003

Background: Premature death in men is known to be significantly associated with coronary heart disease (CHD). More and more studies are pointing toward a possible association between periodontal disease and increased risk of cardiovascular disease. The association of poor oral hygiene and atherosclerosis can be explained by the effect of chronic inflammatory disease on blood rheology. The purpose of the present study was to assess the relationship between CHD and periodontal disease.

Patients and Methods:

The study population included 1094 Israeli army service men aged 26–53 years (mean: 39±5 years). The study group comprised 151 subjects classified as having coronary heart disease CHD, i.e., myocardial infarction, and or anginal syndrome with angiographic evidence of significant coronary disease, or suffer from atherosclerotic risk factors, i.e., diabetes (fasting glucose) and HTN according to strict, well‐established criteria. Blood levels of cholesterol and triglycerides were also determined. The severity of periodontal disease was assessed by the aid of CPITN. The control group comprised 943 healthy subjects. Statistical analysis was performed with χ2 test.

Results: Statistical analysis showed a significant association of CPITN score 4 with hypercholesterolemia and a possible association with CHD.

Conclusions: The generation of higher cholesterol blood levels is proposed as a possible link between chronic periodontal inflammation and atherosclerosis.
Relationship between oral health and mortality in cardiovascular diseases
Authors: Jansson Leif , Lavstedt Stig , Frithiof Lars , Theobald Holger
Published: March 2003

Background, aims: The purpose of the study was to investigate the relationship between periodontal health and fatal cardiovascular diseases (CVD).

Methods: The investigation was conducted on a sample of 1393 individuals in the County of Stockholm. The subjects were examined in an epidemiological study in 1970 with respect to dental health. At a follow‐up in 1997, the mortality rate of the sample during the years 1970–1996 was registered as well as cause of death according to the death certificate. Stepwise logistic regression analysis was performed in order to evaluate the influence of the investigated variables on the incidence of death from CVD.

Results: The interactional effect between plaque and oral health score (a sum of scores for number of missing teeth, apical lesions, caries lesions and marginal bone loss), adjusted for age, gender, smoking and CVD at baseline, was significantly correlated to fatal coronary events. For individuals younger than 45 years of age, the age‐adjusted incidence odds ratio of death due to CVD was 2.7 (p=0.04) if subjects with mean marginal bone loss of >10% were compared with subjects with mean marginal bone loss ≤10 %. If the stratum of individuals <45 years of age is confined to smokers, the odds ratio was found to be 3.4 (p=0.03).

Conclusion: Dental health was found to be a risk indicator of death due to CVD, especially in combination with another risk factor, smoking habits.
Association between bone loss in periodontal disease and polymorphism of N‐acetyltransferase (NAT2)
Authors: Kocher Thomas , Sawaf Hazem , Fanghänel Jutta , Timm Ramona , Meisel Peter
Published: March 2003

Background: The individual susceptibility to periodontal disease is probably the result of an interaction of multiple genetic and environmental influences. Polymorphism of the N‐acetyltransferase (NAT 2) modifies the individual susceptibility to toxicity from certain therapeutic drugs or heterocyclic amines including substances from cigarette smoke. Subjects are to be classified as ‘slow’ or ‘rapid’ acetylators according to how fast their bodies metabolise such xenobiotics. Differences in their ability to detoxify these substances may contribute to an increased risk for periodontitis in subjects exposed to cigarette smoke or other xenobiotics.

Objective: The purpose of this study was to assess whether the NAT2 genotype is a risk factor for periodontal disease in Caucasian patients suffering from adult periodontitis.

Material and methods: 154 Caucasian subjects were assigned to one of the 3 groups: no, moderate, and severe periodontal disease based on bone and attachment loss. In all subjects, genotyping for mutations on the N‐acetyltransferase (NAT2) gene was performed by means of PCR and RFLP analysis.

Results: Comparison of frequency distribution of NAT2 acetylation types between the most diseased group and not or moderately affected subjects showed a tendency to over‐representation of slow acetylators with severe disease. When using bone loss as measure of periodontitis, this over‐representation shows a significant association with the disease (odds ratio=2.13, p=0.025). In the logistic regression analysis, adjusted for age and smoking, NAT2 slow phenotype was significantly associated with the severity of bone loss, the odds ratio being 2.09 (95% C.I. 1.02–4.26, p=0.043). In a case‐control analysis (controlled for smoking, gender and age) mean bone loss showed a significant difference between the 2 NAT2‐type groups (Mann‐Whitney test p=0.041).

Conclusion: The data suggest that the slow acetylator phenotype may be associated with a higher risk of periodontitis, especially in smokers. Possible explanations regarding the mechanism are discussed; however, such attempts are highly speculative at this time.
The antioxidant capacity of saliva
Authors: Battino M. , Ferreiro M. S. , Gallardo I. , Newman H. N. , Bullon P.
Published: March 2003

Background/aims: Saliva, a heterogeneous fluid comprising proteins, glycoproteins, electrolytes, small organic molecules and compounds transported from the blood, constantly bathes the teeth and oral mucosa. It acts as a cleansing solution, an ion reservoir, a lubricant and a buffer. In addition to its other host‐protective properties, saliva could constitute a first line of defence against free radical‐mediated oxidative stress, since the process of mastication and digestion of ingested foods promotes a variety of reactions, including lipid peroxidation. Moreover, during gingival inflammation, gingival crevicular fluid flow increases the change of saliva composition with products from the inflammatory response; this, in turn, could have some rôle in controlling and/or modulating oxidative damages in the oral cavity. This is the reason why the antioxidant capacity of saliva has led to increasing interest, and the development of techniques suitable for saliva antioxidant evaluation.

Materials and Methods: Here, we review the current peer‐reviewed literature concerning the nature and characteristics of free radicals, reactive oxygen species, oxidants, pro‐oxidants and antioxidants in saliva, especially pro‐oxidant and antioxidant features, as well as current methods for assessing the antioxidant capacity of saliva.

Results and Conclusions:

In the last decade, several methods have been developed for assaying the antioxidant activity of saliva, indicating an increasing interest of researchers and clinicians. Unfortunately, systematic studies of saliva are still lacking, even in healthy populations.
Desensitizing effects of an Er:YAG laser on hypersensitive dentine
Authors: Schwarz Frank , Arweiler Nicole , Georg Thomas , Reich Elmar
Published: March 2003

Aim: The aim of the present study was to evaluate and compare the desensitizing effects of an Er:YAG laser (KEY II®, KaVo, Germany) and Dentin Protector® (Vivadent, Germany) on cervically exposed hypersensitive dentine.

Method: A group of 30 patients showing a total of 104 contralateral pairs of hypersensitive and caries‐free teeth was selected and randomly allocated in a split‐mouth design to either (1) Er:YAG laser (80 mJ/pulse, 3 Hz), or (2) the application of Dentin Protector® (polyurethane‐isocyanate 22.5%; methylenechloride 77.5%) whereat one pair served as an untreated control in each patient. The degree of sensitivity to a thermal stimulus was determined qualitatively with an evaporative stimulus defined as a 3‐s air blast at a distance of 2 mm from each site to be tested. A qualitative registration of the degree of discomfort was determined according to an arbitrary pain scale in 4 degrees. Recordings were assessed before treatment, immediately after, 1 week, 2 and 6 months after treatment by 1 blinded examiner.

Results: Both treatment forms resulted in significant improvements of discomfort immediately after and 1 week post treatment. After 2 months, the discomfort in the Dentin Protector® group increased up to 65% of the baseline score and even up to 90% after 6 months, whereas the effect of the laser remained at the same level that was achieved immediately after treatment. The differences immediately after, 1 week, 2 and 6 months post treatment between both groups were statistically high significant (p0.001; respectively). Compared to the untreated control group, both treatment forms resulted in a significant reduction of discomfort at each follow‐up examination.

Conclusion: It was concluded that desensitizing of hypersensitive dentine with an Er:YAG laser is effective and the maintenance of the positive result was more prolonged than with Dentin Protector®.
The mucosal attachment to titanium implants with different surface characteristics: an experimental study in dogs
Authors: Abrahamsson I. , Zitzmann N. U. , Berglundh T. , Linder E. , Wennerberg A. , Lindhe J.
Published: March 2003

Background: Findings from in vitro studies have indicated that the orientation and proliferation of cells on titanium surfaces may be influenced by the topography of the surface on which they are grown. It may be argued, therefore, that differences may occur in the mucosal attachment to titanium implants with different surface roughness.

Aim: The present experiment was performed to study the composition of the soft tissue barrier that formed to implants prepared with well‐defined smooth or rough surfaces.

Material and Methods: Five beagle dogs were used. Four implants made of c.p. titanium were placed in the right edentulous mandibular premolar region. After 3 months, two different types of abutments were connected: one experimental (OA) with a dual, thermal acid‐etched surface (‘Osseotite®’), and one regular (RA) abutment with a ‘turned’ surface. At the end of a 6‐month period during which proper plaque control had been maintained, biopsies including the implant and the surrounding soft and hard tissues were obtained, decalcified and processed for light and electron microscopy. A confocal He–Ne laser profilometer was used to study the surface topography of the abutments.

Results: The attachment between the peri‐implant mucosa and titanium abutments with either a turned (RA; ‘smooth’) or acid‐etched (OA; ‘rough’) surface was similar from both a quantitative and a qualitative aspect. The attachment comprised a barrier epithelium and a zone of connective tissue attachment of similar dimension at RA and OA. It was further observed that the ‘inner’ zone of the connective tissue attachment at both types of abutment was composed of about 30–33% fibroblasts and 63–66% collagen.

Conclusion: It was demonstrated that the soft tissue attachment that formed to implants made of c.p. titanium was not influenced by the roughness of the titanium surface.
The effect of secondary hyperparathyroidism and hemodialysis therapy on alveolar bone and periodontium
Authors: Frankenthal S. , Nakhoul F. , Machtei E. E. , Green J. , Ardekian L. , Laufer D. , Peled M.
Published: March 2003

Background: Alveolar bone is particularly sensitive to increased levels of parathyroid hormone (PTH) from either primary or secondary hyperparathyroidism (HPT). The purpose of this study was to examine the effect of secondary HPT on the periodontium of patients on hemodialysis.

Methods: The experimental group consisted of 35 patients with secondary HPT, with chronic renal failure treated by hemodialysis (E group). A control group (C group) was formed from 35 healthy age‐ and gender‐matched subjects attending the maxillofacial outpatient clinic for a variety of reasons. Blood samples were taken from the E group, and the biologically active intact parathormone molecule, PTH(1–84), was assayed using two‐site immunoradiometric assay (IRMA). The time of onset and the duration since diagnosis of HPT was also recorded. In addition, for a subgroup of 25 matched pairs of patients, a clinical periodontal examination was performed, and the Ramfjord index teeth were recorded for: Plaque index (PI); Gingival index (GI); Probing depth (PD); and Clinical attachment level (CAL). A standardized panoramic X‐ray was taken from all patients and computer‐based linear measurements were used to assess alveolar bone loss (BL). Unpaired Student's t‐test served to compare the two groups. Pearson's correlation coefficient test was used to study the association between PI, PTH level, disease duration and BL.

Results: Demographically, both groups were similar with no statistical difference. PI was also similar in the C and E group (2.03 ± 0.13 and 1.76 ± 0.17, respectively). GI, however, was slightly greater in the C group (1.28 ± 0.09) compared to the E group (0.97 ± 0.01). PD in the E group (2.92 ± 0.14 mm) was almost identical to that of the C group (2.90 ± 0.12 mm). Likewise, CAL in the E group (4.43 ± 0.29 mm) did not differ from CAL in the C group (4.03 ± 0.25 mm). Mean BL was also similar in the E and C groups (3.60 ± 0.23 mm and 3.85 ± 0.24 mm, respectively). PI showed a positive, significant correlation with BL (r = 0.457, P = 0.0008).

Conclusion: From this study it can be concluded that secondary HPT does not have an appreciable effect on periodontal indices and radiographic bone height.
Periodontal attachment level of extractions presumably performed for periodontal reasons
Authors: Splieth Christian , Giesenberg Jan , Fanghanel Jutta , Bernhardt Olaf , Kocher Thomas
Published: March 2003

Background/aims: The aim of this study was to analyse the residual periodontal attachment in teeth extracted by East German dentists in order to determine a possible ‘forceps level’.

Methods: Out of about 8000 extracted teeth collected from a dental waste disposal company, 500 teeth were randomly selected. After exclusion of wisdom teeth and premolars extracted for orthodontic reasons (intact teeth with attachment > 90%), coronal and root caries, fillings, pulp exposure and incomplete root fillings (based on X‐rays) were registered. The periodontal ligament was stained with 1% Fuchsin Red and measured with a light microscope.

Results: For intact teeth (DF = 0, periodontal disease definition I), the mean periodontal attachment (50.5% ± 16.0) was significantly lower than for teeth with carious defects or fillings (64.7% ± 18.8. unpaired t‐test: p < 0. 00 1). There was a marked increase in frequency of extractions in intact teeth below 70% periodontal attachment and 37% were extracted at attachment levels between 50 and 69%. Teeth with pulpal involvement showed significantly different frequency distributions and mean attachment values (77.9% ± 17.8) than the remaining teeth (periodontal disease definition II; 55,2% ± 15.5).

Conclusions: A considerable number of teeth with no or minor coronal destruction were extracted at an attachment level of 50–70%, regardless of the tooth type. The threshold for ‘periodontal’ extractions seem to be too low and undifferentiated, which calls for an improvement in knowledge of periodontal diagnosis and treatment.
Evidence for healing of periodontal defects 5 years after conventional and regenerative therapy: digital subtraction and bone level measurements
Authors: Eickholz Peter , Hausmann Ernest
Published: March 2003

Objective: The aim of the present study was to compare radiographic assessment of bony fill by digital subtraction analyses (DSA) after periodontal surgery of infrabony and furcation defects with bone level measurements.

Methods:  For 19 patients with 19 infrabony lesions and 20 degree II furcation defects, five defects were treated conventionally and 34 defects were treated by regenerative periodontal surgery. At baseline and 60 ± 3 months after surgery, clinical measurements (GI, PPD, PAL‐V, PAL‐H, PlI) and standardized radiographs were obtained. Furthermore, intrasurgically after reflection of a mucoperiosteal flap and 60 months after surgery after local anesthesia without flap reflection, the distance from the cementoenamel junction (CEJ) to bottom of the bony defect (BD) was measured vertically (PBL‐V) and, in furcation defects, horizontally (PBL‐H). Pre‐ and postsurgical radiographs were analyzed by digital subtraction. Bone level gain and DSA results were compared by simple regression analysis.

Results: Surgical treatment revealed significant PPD reduction (− 3.45 ± 1.56 mm; P < 0.001), PAL‐V gain (2.84 ± 1.36 mm; P < 0.001), and PBL‐V gain (1.68 ± 1.20 mm; P < 0.001) in infrabony defects, as well as PPD reduction (− 1.68 ± 1.73 mm; P = 0.001) and PAL‐H gain [1.43 ± 1.70 mm (P = 0.001)] in furcation defects after 5 years. A correlation could be found in furcation defects between PBL‐H gain and DSA (R2 = 0.34, P = 0.003), whereas the study failed to demonstrate a consistent correlation between PBL‐V and DSA in infrabony defects (R2 = 0.12, P = 0.149).

Conclusions:  DSA correlates significantly with PBL‐H measurements in furcation defects. Thus, either method is a sufficient tool to evaluate bony fill within furcation defects. On the other hand, DSA did not correlate significantly with PBL‐V measurements in infrabony defects. This discrepant contribution of DSA in the evaluation of these two types of defects may be explained by the fact that DSA primarily evaluates change in a buccolingual direction.
Presence and antibiotic resistance of Porphyromonas gingivalis, Prevotella intermedia, and Prevotella nigrescens in children
Authors: Sanai Yasaman , Persson G. Rutger , Starr Jacqueline R. , Luis Henrique S. , Bernardo Mario , Leitao Jorge , Roberts Marilyn C.
Published: March 2003

Background/aims: Only limited information exists about the prevalence in children of pathogens associated with periodontitis. The aim of the present study was to determine by culture whether 8–11‐year‐old children carry Porphyromonas gingivalis, Prevotella intermedia, and/or P. nigrescens in samples from the gingiva and/or the buccal mucosa taken before, and after caries treatment and oral hygiene instruction. A second aim was to assess the proportion of subjects who had gram‐negative anaerobes carrying the tet(Q) and erm(F) genes, suggesting antibiotic resistance to tetracycline or erythromycin.

Method: A total of 150 children provided gingival and buccal swab bacterial samples that were cultured for P. gingivalis, P. intermedia, and P. nigrescens. The species was verified using DNA–DNA hybridization with species‐specific probes made from the variable region of the 16S rRNA sequences. Antibiotic‐resistant genes, tet(Q) and erm(F), were identified using specific DNA–DNA hybridization with specific DNA probes.

Results: A total of 116 isolates of black‐pigmented bacteria were cultured from 47 (31%) of 150 children. Five isolates were identified as P. gingivalis, 29 as P. intermedia, 33 as P. nigrescens, and 49 as other species. In general, the bacteria were not culturable at more than one time period. We found that 55% of these 47 children harbored black pigmented bacteria that carried either one or both of the two antibiotic‐resistant genes studied (tet(Q), and erm(F)).

Conclusion: The present study demonstrated that children not exposed to regular dental treatment carry bacteria outside the gingival sulcus that have been associated with periodontitis, and that standard treatment procedures may not clear the presence of the putative pathogens. In addition, antibiotic‐resistant genes are common in identifiable gram‐negative anaerobes, including putative pathogens.
Evidence for the early onset of gingival inflammation following short‐term plaque accumulation
Authors: Zhang Jie , Kashket Shelby , Lingström Peter
Published: March 2003

Aim: A study was undertaken to examine cytokine markers in gingival crevicular fluid (GCF) during the early stages of plaque accumulation.

Methods: A panel of five subjects with good oral hygiene went without brushing for 1 or 3 days, after which GCF samples were taken by placing paper strips into the gingival margins of the maxillary premolars and first molar for 30 s. GCF flow rates were determined with a Periotron® instrument (Oraflow, Inc., Plainview, New York), and neutrophils (polymorphonuclear leukocytes) were determined as myeloperoxidase activity. Interleukin‐1b (IL‐1b) and IL‐8 were eluted from the paper strips and assayed with enzyme‐linked immunosorbent assay (ELISA) systems.

Results: The plaque index rose to 2.7 ± 0.2 (mean ± SE) after 3 days without brushing, and the GCF flow rate increased to 146.8% of baseline. PMN and IL‐8 concentrations fell but, when corrected for dilution as a result of increased GCF flow, were not statistically different from baseline. IL‐1b was slightly elevated after 1 day, and increased to 223.8 ± 54.3% (from 6.8 ± 1.7 to 13.8 ± 3.6 pg/30 s; p = 0.04) after 3 days of plaque accumulation. Resumption of tooth brushing led to a return of IL‐1b to baseline (109.1% after 2 days of brushing). When subjects rinsed with 0.12% chlorhexidine during the 3‐day no‐brushing period, the increases in plaque index, GCF flow rates and IL‐1b release rates did not occur.

Conclusions: The results indicate that IL‐1b release rates increase in the GCF after 3 days of plaque accumulation, before any clinical signs of inflammation appear.
Ultrasonic dental scaler: associated hazards
Authors: Trenter S. C. , Walmsley A. D.
Published: March 2003

Background:  The ultrasonic dental scaler is a valuable tool in the prevention of periodontal disease; however, this equipment has a number of hazards with which it is associated. These include heating of the tooth during scaling, vibrational hazards causing cell disruption, possible platelet damage by cavitation, associated electromagnetic fields that can interrupt pacemakers, auditory damage to patient and clinician and the release of aerosols containing dangerous bacteria.

Objective:  To collate the research reported on the various hazards associated with the ultrasonic dental scaler and discuss possible future research areas.

Data Sources:  The scientific literature was searched using Web of Science, EMBASE and Medline, and the results of these were then hand‐searched to eliminate nonrelevant papers.

Conclusions:  This review outlines some of the research conducted into these areas of associated hazard in order to assess their significance in the clinical situation, and discusses ideas for future research. Suggestions of recommendations are given, which have been previously investigated for their aid in reducing possible hazards, to ensure the safe working of ultrasonic scalers in the dental practice.
In vitro evaluation of novel low abrasive air polishing powders
Authors: Petersilka G. J. , Bell M. , Häberlein I. , Mehl A. , Hickel R. , Flemmig T. F.
Published: March 2003

Aim of the study: Though efficient in stain and plaque removal, air polishing is highly abrasive on root cementum or dentin even if working parameters are adjusted to minimize damage. As abrasiveness is also influenced by the physical properties of the powders used, the aim of the study was to evaluate the safety of novel low abrasive air polishing powders in vitro.

Material and methods: Using four novel air polishing powders (A, B, C and D) and a standard sodium bicarbonate (NaHCO3) powder, roots of 126 extracted teeth were air polished under standardized conditions at various working parameter combinations (distance: 2 mm, 4 mm and 6 mm; powder and water setting: low, medium and high) at an angulation of 90° for 20 s. Instrumentation was performed in triplicate; resulting root defects were quantified laser‐optically.

Results: Mean defect depths after application of powders A, B, C and D were significantly lower than with standard powder (A: 17.9 ± 10.9 µm, B: 48.2 ± 32.7 µm, C: 92.5 ± 57.9 µm, D: 33.9 ± 19.6 µm, NaHCO3: 163.1 ± 71.1 µm) (Kruskal–Wallis test). Among the experimental powders, D was transported most reliably in the air polishing unit and allowed complete removal of disclosed plaque as assessed on freshly extracted teeth.

Conclusion: The novel air polishing powder D is of low abrasiveness to root cementum and dentin while being effective in removing dental plaque. Thus, it may be useful for safe and efficient plaque removal on exposed root surfaces.
What is clinical significance?
Authors: Jeffcoat Marjorie
Published: March 2003

This paper summarizes the clinical trial designs for therapies to reverse probing depth or control the progression of periodontitis, therapies to be used as an adjunct to scaling and root planning, as well as regenerative therapies. The apporach to statistical significance is summarized and compared to clinical significance.
Children's acceptance of xylitol‐based foods
Authors: Lam Malinda , Riedy Christine A. , Coldwell Susan E. , Milgrom Peter , Craig Ross
Published: March 2003

Abstract – Daily consumption of xylitol (5–10 g/day) added to chewing gum and confectionary foods has been previously shown to prevent dental caries in children. Methods: Snack foods containing xylitol were developed and tested for acceptability in a convenience sample of 31 children ages 3 to 6 years. In order to mimic an after‐meal snack, all children were tested during mid‐morning, approximately 1 h after eating. Preference testing was based on the methodology of Birch et al. (J Nutr Educ, 1979; 11: 77–80). In the first phase, each child was presented with a tray of six xylitol‐based foods (popsicles, pudding, gum drops, gelatin dessert, cookies, popcorn) and asked to taste each item in any desired order. Immediately after tasting a food, the child was asked to place it in front of one of three cartoon faces (smile, frown or neutral) representing the child's response to the taste of that particular food. In the second phase, the child was asked to rank order the foods in each face category (smile, frown or neutral). Ranks within categories were then combined to obtain a rank ordering for all of the foods. Results: Non‐parametric data analysis indicated significant differences in ranking between the foods when they were compared to each other (Friedman ANOVA by ranks, P<0.01). Pudding was significantly less preferred than the other foods (sign tests, P<0.04). At least 84% of the children found five of the six foods very good or satisfactory, when considered individually. Conclusions: These results suggest that snack foods developed with xylitol are generally well accepted by children.