bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of an essential oil‐containing antiseptic mouthrinse on induction of platelet aggregation by oral bacteria in vitro
Authors: Whitaker E. J. , Pham K. , Feik D. , Rams T. E. , Barnett M. L. , Pan P.
Published: March 2003

Background: With an increasing body of data suggesting an association between periodontitis and cardiovascular disease, studies have been conducted to elucidate potential mechanisms by which oral bacteria might exert systemic effects.

2 oral bacteria, Streptococcus sanguis and Porphyromonas gingivalis, have been shown to induce platelet aggregation in vitro. This study was conducted to determine the effect of treatment with an essential oil mouthrinse (Listerine® Antiseptic) on the platelet‐aggregating activity of these organisms.

Method: Bacteria were grown under standard culture conditions. S. sanguis ATCC strain 10556 was exposed for 3 min to the essential oil mouthrinse at either full strength or a 1:1 dilution, while P. gingivalis FDC strain 381 was exposed to the essential oil mouthrinse at a 1:10 dilution. Positive control cells were treated with Hanks balanced salt solution (HBSS). Aggregation was measured using a recording platelet aggregometer. The assay of each organism in its respective mouthrinse dilution(s) or HBSS was repeated 5 times.

Results: In all cases, the HBSS‐treated organisms induced platelet aggregation, with mean(±S.E.) lag times of 12.30 (±1.36) min and 11.36 (±0.58) min for P. gingivalis and S. sanguis, respectively. In contrast, treatment with the essential oil mouthrinse completely inhibited the platelet aggregating activity of P. gingivalis and of S. sanguis exposed to the 1:1 mouthrinse dilution in all assays; the aggregating activity of S. sanguis treated with full‐strength mouthrinse was completely inhibited in 4 of 5 assays, and inhibited by 75% in the 5th, for a mean inhibition of 95±1.5%.

Conclusion: This study provides additional evidence that the essential oil mouthrinse can interfere with bacterial cell surface‐associated activities which may have clinical relevance.
Relation of motility of subgingival microflora as a clinical parameter to periodontal disease status in human subjects
Authors: Ojima M. , Tamagawa H. , Nagata H. , Hanioka T. , Shizukuishi S.
Published: March 2003

Background/aims: The purpose of this study was to evaluate the possible relationship between the motility of subgingival microflora and 5 clinical parameters commonly used in dental clinics.

Method: The clinical parameters were pocket depth, gingival inflammation, plaque accumulation, bleeding on probing and pus discharge. The motility of human subgingival microflora was estimated as the number of pixels remaining after subtraction of serial video frames using a high speed shutter camera and image analysis system, and was defined as the sum of pixels of 10 successive subtractions per sample over a 10‐s time period.

Results: The bacterial motility showed significant positive, moderate or low associations with the five clinical parameters. The highest correlation was observed between the bacterial motility and pocket depth (r=0.36, p=0.0001). Furthermore, clinically defined periodontal healthy and diseased sites were significantly different with respect to the bacterial motility (p<0.0001). To determine whether the bacterial motility was dependent or independent of the other clinical variables, the data were analyzed based on common factor analysis. Three factors were extracted and explained about 75% of the variance of the original 6 clinical parameters. Only the bacterial motility had a positive coefficient for all these three factors. The plot of bacterial motility was placed separately from those of other variables in the scatterplot of the loadings of factor 2 versus factor 1 and factor 2 versus factor 3.

Conclusions: This suggests that bacterial motility may be an independent variable among the clinical parameters. Taken together, these data indicate that bacterial motility provides unique information about the clinical periodontal condition and may be a useful tool for the monitoring of subgingival plaque in relation to periodontal disease.
Methodological considerations in the assessment of gingival crevicular fluid volume
Authors: Deinzer Renate , Mossanen Babak Saiidi , Herforth Armin
Published: March 2003

In 4 studies on gingival crevicular fluid volume (GCFV) determination, the reliability of measurements, influences of plaque, circadian rhythms and stability over 24 h were examined. Samples were taken at 2 sites with a modified intracrevicular method. Reliability (n=40): repeated GCFV determinations within 5 min revealed good reliablity coefficients (rtt>0.80). Influences of supragingival plaque (n=80): repeated GCFV determinations within 5 min with plaque removal between measurements in fourty subjects, the other subjects serving as control, revealed no group differences with respect to the differences between measurements. Circadian rhythms (n=20): GCFV was assessed 6× throughout the day. Repeated measures ANOVA revealed no significant time effect. Stability over 24 h under constant clinical conditions (n=20): measures were taken at 16:00 h on 2 consecutive days, several disturbing variables were kept constant. Retest correlations revealed a low stability (i.e., high variablity) of GCFV measures under constant clinical conditions (rtt=0.38 for tooth 11 and rtt=−0.25 for tooth 26). It is concluded that GCFV determination can be done with high reliability, the validity of measurements neither being affected by supragingival plaque nor by diurnal rhythms. The low stability of measurements questions the validity of GCFV for diagnostic purposes.
The rôle of time in reducing gingival overgrowth in heart‐transplanted patients following cyclosporin therapy
Authors: Montebugnoli Lucio , Servidio Dora , Bernardi Federico
Published: March 2003

Background, aims: In a previous cross‐sectional study, the relevant rôle of time in reducing gingival overgrowth (GO) in heart‐transplanted patients undergoing Cyclosporin A (CsA) therapy was hypothesized to explain the inverse relationship between GO and months since the graft.

Methods: In the present study, the relationship between GO and time was investigated prospectively in a group of 21 heart transplanted patients who have been regularly followed up to 48 months.

Results: 6 months after beginning CsA therapy (1st appointment), 7 out of 21 patients (33%) had clinical GO as confirmed by a hyperplastic index (HI) >30. There was no significant difference between these values with respect to those detected during the 2nd appointment at 9 months. At this time, all patients underwent a regular oral hygiene program. Gingival and plaque indices significantly decreased at the 3rd appointment (12 months) both in the group of responders and in the group of non‐responders and remained significantly unchanged with time; HI significantly decreased with time only in the group of responders, the decrease becoming significant 36 months after heart transplantation. As a consequence, the number of responders decreased from 7 at the 1st appointment to 5 after 12 months, 4 after 24 months, 2 after 36 months following heart transplantation.

Conclusion: The results suggest that GO necessarily develops in responders within 6 months from heart transplantation and in most subjects may be a time‐related side‐effect probably due to a progressive reduction in the sensitivity of the periodontum to CsA.
Associations of periodontal disease with femoral bone mineral density and estrogen replacement therapy: cross‐sectional evaluation of US adults from NHANES III
Authors: Ronderos Mauricio , Jacobs David R. , Himes John H. , Pihlstrom Bruce L.
Published: March 2003

The objectives of this study were to evaluate the possible association of periodontal disease with (1) femoral bone mineral density (BMD), and (2) estrogen replacement therapy in a large sample of US adults (N=11,655). The mean clinical attachment loss (CAL) per person was the main outcome variable. Based on the total BMD of the proximal femur and using the WHO diagnostic criteria, subjects were classified as having osteoporosis, osteopenia, or normal BMD. After adjusting for confounders, females with high calculus scores and low BMD had significantly more CAL than females with normal BMD and similar calculus scores (p<0.0001). No association was observed among women with low and intermediate levels of calculus. The greater CAL present among women with low BMD was associated with gingival recession. Patterns of findings were similar but equivocal among men, of whom only 66 were osteoporotic. After adjustment for possible confounders, postmenopausal women who reported having used estrogen replacement therapy presented significantly less mean CAL than those who never used estrogen. These findings indicate that in the presence of high calculus scores, females with osteoporosis are at increased risk for attachment loss and that this risk may be attenuated by the use of estrogen replacement therapy.
Periodontal pocket clearance by gamma scintigraphy in human volunteers
Authors: Needleman Ian , Mather Stephen J. , Martin Gary P. , Sobnack Ravin
Published: March 2003

Background: With the interest in the delivery of drugs to the periodontal pocket has come an increased need to determine the loss of formulations from the site of application. In this respect, gamma scintigraphy has been used to measure formulation clearance in mucosal sites such as the oesophagus, nose and eyes by assessing the persistence of an incorporated radiolabel. However, the technique has not been used to follow clearance from the periodontal pocket.

Aims: The aim of this study was therefore to assess the potential of gamma scintigraphy to follow the loss of 2 contrasting formulations. 10% chitosan gel and normal saline.

Method: Technitium‐99m was used as the radionuclide and was incorporated into the formulations on the day of use. 9 subjects contributed up to 2 pockets for each formulation with probing depths 5 mm.

Results: The results demonstrated that gamma scintigraphy was able to follow the loss of the radiolabel despite the small volumes of formulation placed in situ. The mean (SD) times (min) for the original counts to decline to 10%, 50% and 90% of the original values were: T10: chitosan 74.5 (59.0), saline 40.3 (21.1), T50: chitosan 41.5 (34.1) saline 20.8 (11.7) and T90: chitosan 8.5 (10.8), saline 1.4 (3.7) respectively. Clearance times of the 2 formulations were significantly different from each other (p<0.05).

Conclusion: In conclusion, gamma scintigraphy is a sensitive method for assessing clearance from the periodontal pocket, and further studies are merited to optimise the use of the technique.
Smoking and subgingival microflora in periodontal disease
Authors: Boström Lennart , Bergström Jan , Dahlén Gunnar , Linder Lars E.
Published: March 2003

Aim: The present investigation was undertaken to analyze the influence of smoking on the periodontal disease associated subgingival microflora. The population included 33 smokers and 31 non‐smokers in the age range 36–86 years.

Methods: Microbial samples were obtained from 4 sites per patient. The checkerboard DNA‐DNA hybridization technology was used for detection of the bacterial species P. gingivalis, P. intermedia, P. nigrescens, B. forsythus, A. actinomycetemcomitans, F. nucleatum, T. denticola, P. micros, C. rectus, E. corrodens, S. noxia and S. intermedius.

Results: Using score 1 as cutoff, contrasting colonized versus non‐colonized patients, 8 out of 12 species were detected in 90% of both smokers and non‐smokers. Using score 4 as cutoff, contrasting heavily colonized patients versus non‐colonized and less heavily colonized patients, the detection rates decreased in both smokers and non‐smokers. No significant differences in detection rates were observed between smokers and non‐smokers. Logistic regression analysis indicated that neither smoking, probing depth nor gingival bleeding influenced the occurrence of the species analyzed. The lack of a smoking exposure dose‐response further supported the indication of a limited influence of smoking.

Conclusion: Smoking exerts little, if any, influence on the subgingival occurrence of several of the bacteria most commonly associated with periodontal disease.
PCR detection of 5 putative periodontal pathogens in dental plaque samples from children 2 to 12 years of age
Authors: Okada Mitsugi , Hayashi Fumiko , Nagasaka Nobuo
Published: March 2003

Background, aims: The purpose of this study was to detect the presence of Prevotella intermedia, P. nigrescens, Bacteroides forsythus, Treponema denticola, and Campylobacter rectus in plaque samples from 119 children, collected from their toothbrushes using a polymerase chain reaction (PCR).

Method: The subjects were 24, 83, and 12 children with healthy gingiva, gingivitis, and periodontitis, respectively, ranging in age from 2–12 years old. Plaque samples were collected from all erupted teeth sites using a sterile toothbrush. The mean concentration of DNA recovered from the plaque samples was approximately 640 μg/ml, which was deemed sufficient for performing a PCR‐based survey.

Results: The prevalence by PCR in healthy, gingivitis, and periodontitis subjects was 0.0%, 6.0% and 25.0% for P. intermedia, 45.8%, 79.5% and 50.0% for P. nigrescens, 33.3%, 63.9% and 58.3% for B. forsythus, 0.0%, 18.1% and 16.7% for T. denticola, and 100% in duplicate for C. rectus, respectively.

Conclusion: Our survey indicated that P. intermedia and T. denticola were more associated with periodontal diseases, B. forsythus and P. nigrescens had a moderate prevalence in all clinical groups, while C. rectus were the most commonly detected species in the oral cavities of children suggesting establishment in their early years.
Cyclosporin A‐induced gingival overgrowth is unrelated to allograft function in renal transplant recipients
Authors: Thomas D. W. , Baboolal K. , Subramanian N. , Newcombe R. G.
Published: March 2003

Background: Severe gingival hyperplasia (GH) is one of the most frequent side‐effects associated with the prescription of Cyclosporine‐A (CsA).

Aim: This study statistically modeled the medical and dental risk factors for the development of GH following CsA administration to determine whether renal function post‐transplantation was related to the incidence or extent of GH in 236 consecutive renal transplant patients.

Method: All patients were at least 6 months post‐transplant and medicated with both traditional oral CsA (n=220 individuals) and the new microemulsion form CsA‐Me (n=229 individuals). Patients had either received CsA alone (n=45 individuals) or cyclosporine and nifedipene (n=191 individuals). Gingival overgrowth was assessed and computerized data, available for all patients included; pre‐ and post‐transplant medical history and post‐transplant renal function, i.e., serum creatinine levels, documented rejection episodes and glomerular filtration rates (GFR). These data together with CsA serum levels and last‐recorded dose of CsA, CsA‐Me, nifedipene, azothioprine and prednisolone, were analysed by multivariate regression analysis using SPSS.

Results: The extent and severity of hyperplasia was significantly correlated with the dosage and serum level of CsA at 3, 6 and 12 months post‐transplantation; last recorded dosage, however (p<0.0001), was the most accurate predictor of hyperplasia. Gingivitis (p<0.0001) and plaque (p<0.002), were associated with hyperplasia. Duration of renal replacement therapy, age at transplantation, post‐transplant interval serum creatinine levels and documented rejection episodes were unrelated with the extent and severity of GH. Of all the renal variables only the correlation of GFR with last recorded doses of CsA and CsA‐Me, approached significance; this was then considered for inclusion in the model.

Conclusion: In a multiple regression analysis including GFR, however, only last CsA (and CsA‐Me) doses and gingivitis score were selected for inclusion in the final model. These data demonstrate that inter‐patient variation in the extent and severity of GH and renal function post‐transplantation are unrelated and are mediated independently.
Elevated blood glucose levels in patients with severe periodontal disease
Authors: Katz Joseph
Published: March 2003

Background, aims: The rôle of diabetes mellitus in various forms of periodontal disease was investigated intensively in the past; some studies have also indicated an impact of periodontal inflammation on diabetic balance. The purpose of this study was to evaluate the reciprocal relationship between abnormal serum glucose levels and elevated CPITN scores in non‐diabetic patients.

Material and Methods: 10,590 subjects were analyzed for normal and abnormal (higher than 120 mg/dl) serum glucose levels, their periodontal status reflected as CPITN was correlated with their glucose level category.

Results: The results of the present study reflect a significant association between elevated blood glucose levels (higher than 120 mg/dl) and CPITN scores of 4.5 with an odds ratio of 2.46.

Conclusion: A strong association exists between abnormal serum glucose level and periodontal disease as manifested by CPITN score.
Systemic and local antimicrobial use in periodontal therapy in England and Wales
Authors: Choudhury Mab , Needleman Ian , Gillam David , Moles David R.
Published: March 2003

Background/aims: The aim of this study was to investigate antimicrobial use during periodontal therapy in dental practice in England & Wales.

Method: This was a postal questionnaire survey of 800 dentists, 400 general dental practitioners (GDP) in National Health Service practice and 400 members of the British Society of Periodontology (Periodontal Society) primarily in dental practice. We designed and piloted a questionnaire to evaluate both systemic and local antibiotic use with periodontal therapy as well as factors affecting their prescription. In addition, we also investigated the potential use of antibiotic sensitivity testing, since this has been recommended prior to prescribing antibiotics. Two follow‐up mailings were used to encourage non‐responders.

Results: The useable return rate for the questionnaires was 587/800 (73%). Systemic antibiotics were used by 7.4% Periodontal Society members and 18.4% GDP for untreated adult periodontitis patients (p<0.001). Antimicrobials were prescribed more frequently by Periodontal Society members in early onset (52.7%) and refractory periodontitis patients (49.6%), and this was highly statistically significantly greater usage than GDP (p<0.001). Regarding local antimicrobials, usage for untreated adult periodontitis was Periodontal Society 8.9% and GDP 5.4%. Higher usage of local antimicrobials was found both for the treatment of recurrent pocketing in adult periodontitis (Periodontal Society 26.3%, GDP 14.8%, p<0.014) and refractory periodontitis (Periodontal Society 30.8%, GDP 15.2%, p<0.001). As reasons for using local antimicrobials, more than 80% of all respondents stated superiority over root debridement alone. Barriers to use included cost, no perceived need and lack of supporting research data. The percentage of responders considering diagnostic microbiology either theoretically or at a cost of £60 were by group, Periodontal Society 83% & 70.4% and GDP 76% & 51.2%. 33% of Periodontal Society members and 3.8% of GDP spent at least 45 min per quadrant on root planing and Periodontal Society members had a greater exposure to lectures on both systemic and local drug therapy compared with GDP (p<0.001).

Conclusions: Systemic antimicrobial use was infrequent for adult periodontitis and generally in line with current recommendations for other disease types. Whilst local antimicrobial therapy for periodontitis was not widespread, a substantial minority of dentists use this form of therapy and most believe that it is more effective than root debridement alone.
Yeasts in periodontal pockets
Authors: Reynaud A. H. , Nygaard‐Østby B. , Bøygard G.‐K. , Eribe E. R. , Olsen I. , Gjermo P.
Published: March 2003

Objectives: The presence of yeasts in periodontal pockets has been described in a few studies. The association between yeasts and putative periodontal pathogens is not well described. This study aims at assessing the prevalence of yeasts in periodontal pockets and possible associations with the clinical conditions of the sampled sites and other micro‐organisms present.

Material and methods: 2 subject groups form the basis for this study. The 1st comprises results from microbiological samples from periodontal pockets of 128 subjects. The 2nd originates from 126 periodontal patients with untreated pockets. Microbiological identification was performed after cultivation on blood and Sabouraud agar plates, and “checkerboard” DNA‐DNA hybridisation.

Results: The prevalence of subjects with yeasts in the pockets was 15.6% and 17.5% in the 2 groups respectively and was inconsistent according to gender. No correlation was found between age and the presence of yeasts. Eubacterium saburreum was weakly correlated with presence of yeasts (r=0.194 p=0.03). Yeasts were rarely found in both samples from the same individual.

Conclusions: Our results indicate that yeasts can be expected to be present in periodontal pockets in one out of 6 periodontal patients independent of gender and age. Eubacterium saburreum seems to occur frequently together with yeasts.
Effects of metal salts on the oral production of volatile sulfur‐containing compounds (VSC)
Authors: Young A. , Jonski G. , Rölla G. , Wåler S. M.
Published: March 2003

Background, aim: Halitosis, mainly caused by bacteria located on the posterior dorsum of the tongue and in periodontal pockets, is due to formation of volatile sulfur compounds (VSC). The hypothesis to be tested was that the affinity of a metal for sulfur determines its anti‐VSC activity.

Method: Clinical tests were carried out on 12 subjects who rinsed with cysteine to induce halitosis (baseline) before rinsing with 7.34 mM ZnCl2, SnF2 and CuCl2. Mouth air VSC analyses were repeated following cysteine rinses at 1 h, 2 h and 3 h using a gas chromatograph. In vitro experiments tested toxic metals Hg2+, Pb2+ and Cd2+. 10‐μl aliquots of metal salts were added to 1‐ml aliquots of human whole saliva from 30 subjects. Samples were incubated overnight at 37oC and saliva headspace was analyzed for VSC in a gas chromatograph.

Clinical results:

Cu2+>Sn2+>Zn2+ (supports hypothesis). Zn2+ had significantly less anti‐VSC effect compared with Cu2+ and Sn2+ at 1, 2 and 3 h. In vitro results indicated that Hg2+, Cu2+ and Cd2+ had close to 100% anti‐VSC effect, and that Pb2+ was less effective and Cd2+ more effective than expected in inhibiting VSC.

Conclusions: Apart from Hg2+ and Cu2+, the metals had a significantly greater effect on H2S than on CH3SH. Cu2+ and Hg2+ have well‐known antibacterial activity and may presumably also operate by this mechanism.
GCF IL‐1β profiles in periodontal disease
Authors: Engebretson Steven P. , Grbic John T. , Singer Robert , Lamster Ira B.
Published: March 2003

Objectives: Studies suggest a genetic influence on levels of interleukin‐1β (IL‐1β) in gingival crevicular fluid (GCF). Levels of IL‐1β in GCF, however, are also dependent upon the clinical parameters at the site of collection, including probing depth (PD) and level of attachment (AL). To examine this issue, IL‐1β in GCF was evaluated from patients with varying degrees of periodontal disease. The influence of both the status of the patient and the probing depth at the sampled sites were considered in the analysis.

Material and methods: GCF IL‐1β was determined by ELISA at 6–8 molar sites from 29 non‐smoking adults with mild, moderate, or severe periodontal disease at baseline, 2 weeks, and 24 weeks following scaling and root planing. For later analysis, patients were dichotomized on the basis of disease severity (mild/moderate vs severe). Sampled sites were classified at baseline by PD as, shallow (<4 mm), intermediate (4–6 mm), or deep (>6 mm).

Results: PD and AL were each strongly correlated with IL‐1β levels at baseline. However, patients with severe disease had higher levels of IL‐1β in each PD category than those with mild/moderate disease. As compared to patients with mild/moderate disease, IL‐1β levels in shallow sites from patients with severe disease was elevated nearly 2 fold (p<0.001). IL‐1β levels were reduced in all groups at 2 weeks and were still significantly reduced in patients with mild/moderate disease at 24 weeks. At 24 weeks IL‐1β returned to near baseline levels in patients with severe disease.

Conclusion: While PD and AL are each associated with increased GCF IL‐1β, patients with severe disease show higher IL‐1β GCF levels in shallow sites, suggesting that high GCF IL‐1β expression is in part a host trait, and not strictly a function of clinical parameters.
Effect of the enamel matrix derivative Emdogain® on the growth of periodontal pathogens in vitro
Authors: Spahr Axel , Lyngstadaas Staale Petter , Boeckh Clemens , Andersson Christer , Podbielski Andreas , Haller Bernd
Published: March 2003

Objectives: The aim of this study was to evaluate the effect of Emdogain® (EMD), used for periodontal regeneration, on the growth of periodontal pathogens like Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia. For comparison, we studied the effect of EMD on several microbes associated with other oral diseases as well as its effect on non‐pathogenic oral inhabitants.

Methods: Freshly prepared EMD or its vehicle propylene glycol alginate (PGA) alone were added to calibrated suspensions of microbes. As a control, imitating the post‐surgical subgingival situation after flap closure, a serum/NaCl‐solution mixture was used. Aliquots for growth assays were taken at scheduled times for calculation of colony‐forming units and cell densities over an observation period of 24 h. Additionally, EMD was spotted onto selected, newly seeded microbes growing on agar plates to see if growth inhibition zones could be produced.

Results: The study revealed a marked inhibitory effect of EMD on the growth of the gram‐negative periodontal pathogens. A. actinomycetemcomitans showed a significant decrease (p=0.012) in viable counts after 24 h when EMD was added at baseline. P. gingivalis and P. intermedia also showed a marked growth reduction in the presence of EMD and in these cultures no viable microbes could be detected anymore after 24 h. In contrast, no significant growth inhibition was observed in gram‐positive bacteria.

Conclusions: The results suggest that EMD has a positive effect on the composition of bacterial species in the post‐surgical periodontal wound, by selectively restricting growth of periopathogens that could hamper the wound healing and reduce the outcome of regenerative procedures.
The presence of local and circulating autoreactive B cells in patients with advanced periodontitis
Authors: Berglundh Tord , Liljenberg Birgitta , Tarkowski Andrej , Lindhe Jan
Published: March 2003

Aim: The aim of the present investigation was to study the local (gingival) and systemic occurrence of autoreactive B cells (CD5+CD19 positive) in subjects with a high or low susceptibility to periodontitis.

Material and Methods: 2 groups of subjects (Group A and B) susceptible to periodontitis were included. Group A consisted of 22 adult patients (7 females and 15 males, aged 24–66 years) with advanced and generalized chronic periodontitis and group B comprised 7 children (4 girls and 3 boys aged 9–13 years) with localized aggressive periodontitis. 26 periodontally healthy subjects, Group C (aged 23–80 years, mean 49.6±16.3), were also recruited. Assessment of clinical and radiographical characteristics of periodontal disease was performed. Gingival biopsies and peripheral blood samples were obtained and prepared for immunohistochemical analysis. Blood samples only were obtained from the periodontally healthy subjects (group C).

Results: The proportion of autoreactive B cells (CD5+CD19 positive) of peripheral blood lymphocytes was about 6 times higher in group A and 4 times higher in group B than in the samples from the control subjects (group C). About 40–50% of the B cells in the peripheral blood of the periodontitis susceptible individuals expressed markers for autoreactive features while less than 15% of the circulating B cells in the subjects of group C exhibited such markers. The periodontitis lesion in the adult periodontitis patients contained a substantial number of B cells out of which about 30% demonstrated autoreactive features.

Conclusion: It is suggested that both circulating and local B cells in periodontitis susceptible individuals have a higher propensity to autoreactive properties than B cells of patients with a low susceptibility to periodontitis.
Comparative evaluation of adjunctive oral irrigation in diabetics
Authors: Al‐Mubarak Sultan , Ciancio Sebastian , Aljada Ahmad , Mohanty P. , Mohanty P. , Ross Candy , Dandona Paresh
Published: March 2003

Aim: The purpose of this study was to assess the response of diabetics to scaling and root planing treatment and subgingival oral irrigation as adjunctive therapy.

Method: A total of 52 type 1 and 2 diabetics (mean age 51.3±14) with adult periodontitis were randomized to two groups. Treatment included ultrasonic scaling and scaling and root planing in both groups (control and test) plus subgingival water irrigation 2× daily for the test group. Assessments were made prior to and at 6 and 12 weeks after treatment. Parameters measured were modified gingival index (MGI), probing pocket depth (PPD), plaque index (PI), clinical attachment level (CAL), and bleeding on probing (BOP). Systemic measurement of Reactive Oxygen Species (ROS) generation, cytokines (TNF‐α, IL‐1β, IL‐10, and PGE2), and glycated hemoglobin (HbA1C).

Results: After treatment, analysis of data showed that both groups had clinical and systemic improvement. The test group had a statistically significant reduction for MGI, PI, and BOP compared to controls (p<0.03) at 12 weeks and for ROS generation at 12 weeks (p<0.012). Unlike controls, systemic analysis of cytokines showed a statistically significant reduction from baseline for IL‐1β at 6 weeks and PGE2 at 6 and 12 weeks (p<0.05) within test group.

Conclusion: These results suggest that scaling and root planing and adjunctive therapy may be of value in establishing a healthy periodontium in diabetics.
Coronary heart disease and periodontitis − a case control study in Chilean adults
Authors: López Rodrigo , Oyarzún Marcela , Naranjo Claudia , Cumsille Francisco , Ortiz Mario , Baelum Vibeke
Published: March 2003

Objectives :To investigate the association between periodontal disease parameters and coronary ischemic disease among 30–50‐year‐old Chileans.

Material and methods: Cases were 30–50‐year‐olds who were hospitalized in one of four Cardiologic Units in Santiago, Chile, for acute myocardial infarction, unstable angina or angina pectoris. Controls had undergone surgery due to gall bladder stones or abdominal hernia. Information on blood pressure, serum cholesterol, body weight and height, age, occupation, smoking, diabetes and use of antidepressants was obtained. A total of 86 persons participated based on informed consent, but the analysis is based on 61 persons, for whom a complete set of data was obtained. Cases and controls were given a clinical periodontal examination comprising assessment of number of teeth present, periodontal pocket depth and clinical attachment level at six sites per tooth. The association between mean attachment level; mean pocket probing depth; number of teeth present and case status was analyzed by conditional logistic regression controlling for known risk factors for CHD.

Results: The mean attachment level was positively associated with case status (OR = 3.17; 95% CI = [1.31; 7.65]), as was the mean pocket depth (OR = 8.64; 95% CI = [1.22; 61.20]). The number of teeth present was not statistically significantly associated with case status (OR = 0.93; 95% CI = [0.83; 1.04]).

Conclusion: The results are in accordance with those of several previous reports. If the results reflect a causal link between periodontal diseases and CHD they emphasize the need for better control of periodontal diseases. If the associations are‐non‐causal, they still demonstrate that CHD and periodontal diseases cluster in the same sections of the population, which is important from a public health point of view.
Retrospective study of tooth loss in 92 treated periodontal patients
Authors: Checchi Luigi , Montevecchi Marco , Gatto Maria Rosaria Antonella , Trombelli Leonardo
Published: March 2003

Background/Aims: In this retrospective study, the efficacy of periodontal therapy and maintenance in preventing tooth loss was evaluated.

Methods: The study included 92 patients with 2310 teeth diagnosed with chronic adult periodontitis and observed over a mean period of 6.7 years, with each patient receiving surgical therapy in two or more quadrants. The group was divided into two subgroups: those who complied with the recommended maintenance schedule and those whose compliance was erratic. Individual tooth prognosis was assigned according to radiographic parameters.

Results: At the completion of active periodontal therapy, 2184 teeth were present. During the maintenance period, 44 teeth were lost due to periodontal reasons. Tooth mortality revealed a mean annual adjusted tooth loss rate of 0.07/year. Molars were the teeth most frequently lost; canines the least. The number of teeth lost in the three prognostic categories was: one (0.07%) for teeth with good prognoses, 21 (3.63%) for questionable prognoses and 22 (11.34%) for hopeless prognoses. Patients complying erratically with supportive periodontal therapy were at a 5.6 times greater risk for tooth loss following active therapy than regularly compliant patients.

Conclusions: The results demonstrated a low tooth mortality rate in periodontal patients following active treatment combined with a strict maintenance program.
Use of barrier membranes and systemic antibiotics in the treatment of intraosseous defects
Authors: Loos B. G. , Louwerse P. H. G. , Van Winkelhoff A. J. , Burger W. , Gilijamse M. , Hart A. A. M. , Van Der Velden U.
Published: March 2003

Objectives: Current literature is ambivalent on the use of barrier membranes for regeneration of intraosseous defects. One of the reasons for unpredictable results may be related to infection before, during and after the surgical procedure. Therefore, the purpose of the present controlled study was to evaluate both the use of membranes (MEM) and antibiotics (AB), separately and in combination.

Methods: In all, 25 patients with two intraosseous periodontal defects each were randomized in two groups: AB+ group receiving systemic antibiotics (n = 13) and AB– group without antibiotics (n = 12). After raising flaps and after debridement, both defects in each patient were covered by a bioresorbable membrane (MEM+). However, just before suturing the flaps in a coronal position, the membrane over one of the two defects was removed at random (MEM–). This protocol resulted in four groups of defects: (i) MEM– AB–; (ii) MEM+ AB–; (iii) MEM– AB+ ; (iv) MEM+ AB+. Patients were monitored clinically and microbiologically for 1 year. Data were analyzed in repeated measures ancova's and adjusted means for clinical variables were obtained from the final statistical model.

Results:  Reduction in probing pocket depth (PPD) at 12 months postoperatively varied between 2.54 and 3.06 mm between the four treatment modalities, but overall no main effect of MEM or AB was found. Gains in probing attachment level (PAL) at 12 months postoperatively varied between 0.56 and 1.96 mm for the 4 treatments. In the overall analysis for PAL, no main effect of MEM or AB was found. Gains in probing bone level (PBL) 12 months postoperatively ranged from 1.39 to 2.09 mm between the treatment groups. Again, overall, no main effects of MEM or AB were found for PBL. Explorative statistical analyses indicated that smoking and not MEM or AB is a determining factor for gain in PBL (P = 0.0009). Nonsmokers were estimated to gain 2.04 mm PBL compared to 0.52 mm in smokers. The prevalence of several periodontal pathogens, at the day of surgery or postoperatively, and specific defect characteristics, were not determining factors for gain in PAL and PBL.

Conclusions:  Neither the application of barrier membranes nor the use of systemic antibiotics showed an additional effect over control on both soft and hard tissue measurements in the treatment of intraosseous defects. In contrast, smoking was a determining factor severely limiting gain in PBL in surgical procedures aimed at regeneration of intraosseous defects.
Antiplaque biocides and bacterial resistance: a review
Authors: Sreenivasan Prem , Gaffar Abdul
Published: March 2003

Modern dentistry emphasizes the importance of dental plaque control to improve oral health. The use of oral care formulations with antiplaque biocides plays a crucial role in patient‐directed approaches for plaque control. The antiplaque efficacies of these formulations have been extensively studied in many long‐term clinical studies designed in accordance with well‐accepted guidelines. The results from these studies conclusively demonstrate that long‐term use of oral care formulations with well‐known antiplaque biocides such as chlorhexidine and triclosan reduce supragingival plaque and gingivitis. This review summarizes microbiological results from clinical studies conducted with oral care formulations containing antiplaque biocides. Results from a number of long‐term clinical studies conducted under real‐life use conditions indicate no adverse alterations in the bacteria found in dental plaque or emergent microbial resistance. Additionally, microbial sampling of dental plaque subsequent to extended use of antiplaque biocides reveals no increase in resistant microflora. Large numbers of common oral bacteria isolated from patients using chlorhexidine indicate no increase in microbial resistance to chlorhexidine or to commonly used antibiotics. The effects of antiplaque biocides containing oral care formulations on dental plaque that exists naturally as a biofilm are examined. These formulations contain biocide, surfactants, polymers and other components that are effective against the biofilm. In summary, the results of studies on the real‐life use of oral care formulations with antiplaque biocides show no emergence of resistant microflora or alterations of the oral microbiota, while such formulations have been found to provide the benefits of reducing plaque and gingivitis.
Interactions between stress, interleukin‐1β, interleukin‐6 and cortisol in periodontally diseased patients
Authors: Mengel Reiner , Bacher Michael , Flores‐de‐Jacoby Lavin
Published: March 2003

Background/Aims: The aim of the present study was to measure interleukin‐1β, interleukin‐6 and cortisol levels in the peripheral blood of periodontally diseased patients in order to record any interactions with psychosocial stress.

Material and methods: The test group comprised 16 patients with untreated and 14 with treated aggressive generalized periodontitis (AGP), five patients with untreated aggressive localized periodontitis (ALP) and five with chronic generalized periodontitis (CGP). The control group comprised 40 periodontally healthy probands. Blood was taken from the cephalic vein of all patients and controls at the same time (8 a.m.) each day. IL‐1β, IL‐6 and cortisol levels were then measured with a sensitive ELISA, the ‘Quantikine HS Immunoassay Kit’ (Biermann Diagnostica, Bad Nauheim, FRG). The clinical examination covered probing depth, gingival recession, gingival index, plaque index and clinical attachment level. A questionnaire was used to ask the patients and controls about their attitude to life and the stress induced by their jobs and their families. Previous and current levels of tobacco consumption were also recorded. Statistical evaluation was based on the Mann–Whitney U–Wilcoxon test for comparison of blood serum values and clinical parameters between patients and controls, and the Kruskal–Wallis test for intergroup comparison. All data were correlated by means of Spearman's rank correlation coefficient, and significance levels relating to stress and smoking were determined with the chi‐square test.

Results: With respect to cortisol, the results showed no significant differences either between the patient groups or in comparison with the controls. IL‐1β was detected only in the AGP patients and their controls, but with no significant differences. IL‐6 was detected in virtually all patients and controls, but with no significant differences. Only in the untreated AGP patients was IL‐6 significantly elevated (P < 0.05) and a slight correlation with attachment loss recorded. In all AGP patients a slight correlation between IL‐1β and IL‐6 was recorded. Evaluation of the questionnaire revealed a higher proportion of untreated AGP patients than of controls with a pessimistic attitude to life. In all AGP patients, family‐induced stress and smoking were found to correlate with attachment loss. In the untreated AGP patients, smoking correlated with IL‐1β protein content, and in the controls there was a moderate correlation between smoking and IL‐6 levels.

Conclusions: The present study found no correlation between the immunological mediators (IL‐1β, IL‐6), glucocorticoids (cortisol) and the registered stress values. However, the patients with untreated AGP showed signs of a pessimistic attitude to life, and an elevated IL‐6 level was recorded in the peripheral blood. As a restrictive factor it should be borne in mind that the number of patients investigated was too small for adequate conclusions to be drawn.
Immunohistochemical characteristics of inflammatory lesions at implants
Authors: Gualini Federico , Berglundh Tord
Published: March 2003

Objective: The aim of the present investigation was to study some immunohistochemical features of peri‐implant mucositis and peri‐implantitis lesions.

Materials and methods: Two groups of subjects (Groups A and B) were included. Group A consisted of 10 partially edentulous subjects (eight females and two males; 45–72 years of age) who had been restored with implants (Brånemark System®, Nobel Biocare AB, Göteborg, Sweden). The implants had been in function between 2 and 5 years. In each subject, one implant site demonstrating signs of peri‐implant mucositis, i.e. soft tissue inflammation but no bone loss, was selected. The site was anaesthetized and a soft tissue biopsy was collected. In Group B, six subjects were included. They had been restored with implants (Brånemark System®, Nobel Biocare AB, Göteborg, Sweden) between 5 and 11 years prior to the current study. In each individual ≥ 1 implant site exhibited signs of peri‐implantitis and was selected for biopsy. All sites of peri‐implantitis had (i) a history of continuous marginal bone loss (assessed in radiographs), (ii) clinical symptoms of soft tissue inflammation (bleeding on probing and suppuration) but (iii) no implant mobility. From each selected peri‐implantitis site a 4 × 4 mm large soft tissue biopsy was obtained. All specimens were snap frozen and prepared for immunohistochemical analysis regarding the proportions of cells positive for the CD3, CD4, CD8, CD19 and elastase markers.

Results: Peri‐implantitis lesions were considerably larger and contained significantly greater proportions of B cells (CD19+) and elastase‐positive cells than mucositis lesions. Peri‐implantitis sites, in contrast to sites with mucositis, consistently displayed elastase‐positive cells in the central portions of the infiltrate.

Conclusion: It is suggested that peri‐implantitis lesions exhibit properties that are different from mucositis lesions.
Systemic medications: clinical significance in periodontics
Authors: Ciancio Sebastian G.
Published: March 2003

Systemic medications are of value as adjuncts to periodontal therapy. These medications can be divided into two major categories: antibiotics and agents for host modulation. Antibiotics have been shown to be valuable adjuncts in specialized types of periodontal disease, such as localized and generalized aggressive periodontitis, and of possible value in severe chronic periodontitis. Antibiotics have been studied individually, in combination and in sequential therapy. Host modulators include Periostat, non‐steroidal anti‐inflammatory agents, alendronate (Fosamax), hormone replacement therapy and anti‐arthritic medications. These agents produce their beneficial effects by a variety of mechanisms of action, including inhibition of matrix metalloproteinases, inhibition of prostaglandin production, stimulation of osteoblasts, inhibition of osteoclasts, and other anti‐inflammatory mechanisms of action.
Trends in periodontal status and oral hygiene habits in Dutch adults between 1983 and 1995
Authors: Kalsbeek Huib , Truin Gert‐Jan , Poorterman Jan H. G. , Van Rossum Ger M. J. M. , Van Rijkom Hans M. , Verrips Gijsbert H. W.
Published: March 2003

Abstract – In 1995, a dental survey, similar to one carried out in 1983, was performed among persons aged 25–54 in the city of 's‐Hertogenbosch, the Netherlands. Objective: To describe trends in adults periodontal health between 1983 and 1995. Methods: The participants were interviewed at home and clinically examined in a dental van. Results: Average scores for plaque, calculus, bleeding after probing and number of buccal root surfaces exposed to the oral cavity were lower in 1995 than in 1983. There was no significant change in the percentage of teeth with pocket depth of 3.5 mm or more between 1983 and 1995. No difference was found between frequency of toothbrushing in 1983 and 1995. Conclusion: The results suggest that the periodontal health of Dutch adults aged 25–54 years has improved since 1983.
Factors related to betel chewing among junior high school students in Taiwan
Authors: Ho Ching‐Sung , Gee Mei‐Jih , Tsai Chi‐Cheng , Lo Ching‐I , Hwang Mei‐Nah
Published: March 2003

Abstract – A cross‐sectional study was conducted to explore the betel‐chewing behavior of junior high school students in Taichung County in 1998. The sample consisted of 2244 students in the general area and 84 students in the aboriginal area. Fifty percent of the students in the aboriginal area had had the experience of chewing betel, and this figure includes 30.1% of the habitual chewers. The prevalence of habitual betel chewers among the students in the general area is 4.3% to 5.0%. The major source of betel quid is friends or classmates, and curiosity accounts for most students' first experience of betel chewing. Sixty percent of the students started betel chewing in elementary school. An effective health education program for students in the aboriginal area and younger students in the general areas as well as an evaluation procedure for the effectiveness of the program are needed to prevent the increase of betel chewing among Taiwan's youth.