bluuebunny/crossref_metadata_2025 huggingface dataset:
The periodontal abscess (II). Short‐term clinical and microbiological efficacy of 2 systemic antibiotic regimes *
Authors: Herrera David , Roldán Silvia , O'Connor Ana , Sanz Mariano
Published: March 2003

Background/aims: The aim of this short‐term open parallel longitudinal clinical study was to compare the clinical and microbiological efficacy of 2 different antibiotic regimes in the treatment of acute periodontal abscesses.

Method: After patient selection, a clinical examination was carried out recording the following variables: pain, edema, redness, swelling, bleeding on probing, suppuration, tooth mobility, lymphadenopathy, and probing pocket depth. Microbiological samples were taken from the lesion and the patient was randomly assigned to one of two antibiotic regimes: azithromycin or amoxicillin/clavulanate. Clinical variables were recorded, and microbiological samples were taken, at 3–5 days, 10–12 days and 30 days. Additional mechanical treatment (debridement and scaling) was performed in the third visit (10–12 days). Blood and urine samples were collected at baseline and after 10–12 days. Microbiological samples were processed by anaerobic culturing, and isolated periodontal pathogens were tested for antibiotic susceptibility by means of the spiral gradient endpoint methodology.

Results: 15 patients took azithromycin, and 14 amoxicillin/clavulanate. Subjective clinical variables demonstrated statistically significant improvements with both antibiotic regimes, which lasted for at least 1 month (p<0.01). Objective clinical variables also showed clear improvements, being statistically significant after 30 days with probing pocket depth in the azithromycin group (p<0.01). Microbiologically, short‐term reductions were detected with both antibiotics, however fast recolonization occurred after the third visit. No significant differences were found between both treatment regimes. Antibiotic susceptibilities demonstrated no resistances for amoxicillin/clavulanate, while 2–3 strains of each studied pathogen were resistant to azithromycin.

Conclusions: However, both antibiotic regimes were effective in the short‐term treatment of periodontal abscesses in periodontitis patients.
Microbial comparison of smoker and non‐smoker adult and early‐onset periodontitis patients by polymerase chain reaction
Authors: Darby I. B. , Hodge P. J. , Riggio M. P. , Kinane D. F.
Published: March 2003

A number of bacterial species are involved in the aetiology of periodontitis and include Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus and Treponema denticola. Several studies have shown differences in the microflora between the various forms of periodontal disease. It is recognised that smoking is a risk factor for periodontal disease, but there are conflicting reports on whether or not smoking has an effect on the periodontal microflora. We utilised the polymerase chain reaction to determine the presence of A. actinomycetemcomitans, P. gingivalis, P. intermedia, B.forsythus and T. denticola in subgingival plaque samples in 33 adult periodontitis (AP) patients and 24 generalized early‐onset periodontitis (GEOP) patients prior to treatment. When GEOP and AP patients were compared there were significant differences in the number of positive patients and sites for both A. actinomycetemcomitans and B. forsythus (p=0.0023 and 0.00001, respectively). No statistically significant differences in the prevalence of these organisms were found between smoker and non‐smoker groups. These results confirm that AP and GEOP sites harbour varied microflora, but show that B. forsythus and A. actinomycetemcomitans were detected to a significantly greater extent in this group of GEOP than in the AP patients investigated. Our findings do not support the hypothesis that smokers have significant differences in the prevalence of periodontal pathogens from non‐smokers.
Chlorhexidine spray versus chlorhexidine mouthwash in the control of dental plaque after periodontal surgery
Authors: Francetti Luca , Del Fabbro Massimo , Testori Tiziano , Weinstein Roberto L.
Published: March 2003

Background/aims: This clinical trial aimed at comparing 2 different means of delivering chlorhexidine digluconate (CHX) in the oral hygiene phase during the 2 weeks following periodontal surgery.

Method: 40 patients were randomly divided into 2 groups: A (using CHX mouthwash) and B (using CHX spray). Professional oral hygiene was carried out immediately before surgical operation. For 7 days after surgery, group A used CHX mouthwash and group B CHX spray on the teeth involved in the surgical procedure, while mechanical oral hygiene was maintained only on the teeth not involved surgically. After suture removal, on the 7th day, patients were allowed to perform mechanical oral hygiene also on surgical sites. Plaque index (PI) and stain index (SI) were evaluated on the 7th and 14th days after the operation.

Results: In both groups, PI increased similarly with respect to the baseline in surgically involved teeth, being 0.25±0.41 (SD) and 0.15±0.26, respectively, in A and B, on day 7, and 0.14±0.23 (A) and 0.10±0.22 (B), on day 14. There was no significant difference between A and B on either day 7 or 14. On the contrary, SI increased significantly in respect to the baseline over the 14 days in group A at both involved and not involved sites, while it did not differ from the baseline in group B.

Conclusions: The present results indicate that the efficacy of CHX spray in the post‐surgical control of dental plaque is not different from that of CHX mouthwash. Tooth staining, on the contrary, was significantly lower in the group using CHX spray. The observed effects might be related to the way of delivering CHX and to the total dose administered, about 80% lower in group B in respect to A. Further studies are needed to validate the preliminary findings of the present study.
PCR monitoring for tetracycline resistance genes in subgingival plaque following site‐specific periodontal therapy
Authors: Manch‐Citron Jean N. , Lopez Gilbert H. , Dey Anjana , Rapley John W. , MacNeill Simon R. , Cobb Charles M.
Published: March 2003

Background: The selection of antibiotic resistance genes during antibiotic therapy is a critical problem complicated by the transmission of resistance genes to previously sensitive strains via conjugative plasmids and transposons and by the transfer of resistance genes between gram‐positive and gram‐negative bacteria. The purpose of this investigation was to monitor the presence of selected tetracycline resistance genes in subgingival plaque during site specific tetracycline fiber therapy in 10 patients with adult periodontitis.

Method: The polymerase chain reaction (PCR) was used in separate tests for the presence of 3 tetracycline resistance genes (tetM, tetO and tetQ) in DNA purified from subgingival plaque samples. Samples were collected at baseline, i.e., immediately prior to treatment, and at 2 weeks, and 1, 3, and 6 months post‐fiber placement. The baseline and 6‐month samples were also subjected to DNA hybridization tests for the presence of 8 putative periodontal pathogenic bacteria.

Results: PCR analysis for the tetM resistance gene showed little or no change in 5 patients and a decrease in detectability in the remaining 5 patients over the 6 months following tetracycline fiber placement. The results for tetO and tetQ were variable showing either no change in detectability from baseline through the 6‐month sampling interval or a slight increase in detectability over time in 4 of the 10 patients. DNA hybridization analysis showed reductions to unmeasurable levels of the putative periodontal pathogenic bacteria in all but 2 of the 10 patients.

Conclusions: These results complement earlier studies of tet resistance and demonstrate the efficacy of PCR monitoring for the appearance of specific resistance genes during and after antibiotic therapy.
Changes in substance P and neurokinin A in gingival crevicular fluid in response to periodontal treatment
Authors: Lundy Fionnuala T. , Mullally Brian H. , Burden Donald J. , Lamey Philip‐John , Shaw Christopher , Linden Gerard J.
Published: March 2003

Background: The study of periodontitis provides a unique model for assessing the involvement of neuropeptides in inflammatory disease.

Aim: To investigate the effects of periodontal treatment, resulting in a return to periodontal health, on the levels of substance P (SP) and neurokinin A (NKA) in gingival crevicular fluid (GCF).

Method: We completed a cause of non‐surgical treatment for 8 subjects with periodontitis (6 females 2 males, mean age 45.1, range 38–67 years) started a course of non‐surgical periodontal treatment. Clinical indices were measured at 2 periodontitis sites at the initial visit and at 8 weeks after the completion of treatment in each subject. A 30‐s sample of GCF was collected from each test site using perio paper strips. Each strip was placed into 500 μl of ice cold 0.1M PBS, pH 7.4, vortex mixed for 30 s, and then stored at −70°C until analysed by radioimmunoassay.

Results: The clinical condition of all test sites improved as a result of the periodontal treatment. The levels (pg/30 s sample) of SP fell from 56.3 (SD 66.0) at the initial visit to 4.2 (3.1) after treatment, p=0.017. The concentration (pg/μl) of SP in GCF fell from 140.6 (175.6) to 24.2 (11.1), p=0.036. The levels of NKA fell from 30.5 (17.1) to 10.6 (4.9), p=0.012 whereas the concentration changed little from 85.4 (43.5) to 61.6 (15.1), p=0.41.

Conclusion: The reduction in inflammation resulting from effective periodontal treatment is associated with a reduction in the levels of tachykinins in gingival crevicular fluid.
Testing the efficacy of plaque removal of a prototype brush head for a powered toothbrush
Authors: McCracken G. I. , Heasman L. , Stacey F. , Kelly P. J. , Heasman P. A.
Published: March 2003

Background/aims: The principal aim of the study was to compare the efficacy of a powered toothbrush (PTB) prototype (B) brush head in removing dental plaque to the relative efficacy of a marketed model (A).

Method: A 12‐week, 2‐group, 2‐treatment, double‐blind trial of 2, two‐brush heads (with the same power unit) recruited 62 volunteers (18–25 years) who were non‐clinical university students. After a screening visit, 31 subjects were allocated to each of groups A and B at baseline with stratification according to gender and plaque index. After 48 h of plaque growth, subjects underwent a timed and supervised brushing episode with the allocated PTB (visit 1). Subjects then used the PTBs at home for 12 days before being recalled (visit 2) and asked again to abstain from all oral hygiene measures for 48 h. Supervised brushing was repeated (visit 3) before the subjects were dismissed for a further 10‐week, unsupervised period of home use of the PTBs. The sequence of visits (2 and 3) was then repeated at visits 4 and 5.

Results: The sole outcome variable was plaque which was scored at all visits using the modified Quigley & Hein Index (PI) at full mouth (FM), interproximal (IP) and smooth surfaces (S). At visits 1, 3 and 5, the PI was recorded both before and after supervised brushing. There were no significant differences in PI between the brushing groups at baseline, visit 1, visit 2 or visit 5 (2 sided t‐test). At visit 3, the prototype achieved significantly lower PIs than the marketed PTB brush head for IP (and FM) surfaces, this difference was most apparent on posterior tooth surfaces. For within‐group changes, PIs at visit 2 were significantly lower than those at baseline (paired t‐test), an observation which may be attributable to the improved cleaning and ‘novelty effect’ of a PTB. The PIs at visit 5 were significantly higher than the baseline values (paired t test) and this may be accountable to an element of Hawthorne effect and/or, a fall off in compliance over the entire 12 weeks.

Conclusion: We conclude that this in vivo model is appropriate for testing the efficacy of PTB prototypes but only over a 2‐week period, as the inter‐group differences were not maintained over the full 12 weeks of the trial.
Prevalence of Bacteroides forsythus, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans in subgingival microflora of Japanese patients with adult and rapidly progressive periodontitis
Authors: Yano‐Higuchi Kazuko , Takamatsu Nobuhiro , He Tao , Umeda Makoto , Ishikawa Isao
Published: March 2003

Background, aims: This study investigated the prevalence of Bacteroides forsythus, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans among various periodontitis patients and healthy individuals in Japan, and correlated it with clinical parameters.

Method: Subgingival plaque samples were collected from 21 patients with adult periodontitis (AP), 8 with rapidly progressive periodontitis (RPP) and 15 healthy individuals.

Results: The frequency detected in culture was as follows: B. forsythus was found in 47.6% of AP sites and in 37.5% of RPP sites. P. gingivalis was identified in 64.3% of AP and 59.4% of RPP sites. A. actinomycetemcomitans was detected in 4.8% of AP and 3.1% of RPP sites. The 3 species were detected in only 2 of the healthy individuals. The proportion of B. forsythus in the total microflora in culture was 0.07% in the healthy group, 4.1% in AP and 2.4% in RPP. The proportions of P. gingivalis were 0% in the healthy group, 18.8% in AP and 16.2% in RPP. The proportion of A. actinomycetemcomitans was very low in all 3 groups. A DNA probe detected B. forsythus in 78.6% of AP and 65.6% of RPP sites, as well as P.gingivalis in 58.3% of AP and 59.4% of RPP sites. A. actinomycetemcomitans was detected in only 1.2% of AP sites. The 3 species were undetectable in the healthy group.

Conclusions: The prevalence and the proportion of B. forsythus and P. gingivalis were significantly correlated with clinical parameters, suggesting that B. forsythus and P. gingivalis are closely related to AP and RPP in the Japanese population.
The association of cigarette smoking with alveolar bone loss in postmenopausal females
Authors: Payne Jeffrey B. , Reinhardt Richard A. , Nummikoski Pirkka V. , Dunning David G. , Patil Kashinath D.
Published: March 2003

Background, aims: The purpose of this 2‐year longitudinal clinical study was to determine the impact of smoking on alveolar bone height and density changes in postmenopausal females.

Methods: 59 postmenopausal women completed this study, including 38 non‐smokers and 21 smokers. All subjects had a history of periodontitis, participated in 3‐ to 4‐month periodontal maintenance programs and were within 5 years of menopause at the study outset. 4 vertical bite‐wing radiographs of posterior sextants were taken at baseline and 2‐year visits. Radiographs were evaluated using computer‐assisted densitometric image analysis (CADIA); changes in interproximal alveolar bone density and changes in alveolar bone height were determined. Relative clinical attachment levels (RCAL) and presence/absence of plaque and bleeding on probing were recorded.

Results: Smokers exhibited a higher frequency of alveolar bone height loss (p< 0.05) and crestal (p<0.03) and subcrestal (p<0.02) density loss relative to non‐smokers. Smokers exhibited a trend (p<0.08) toward a higher frequency of 2.0 mm RCAL loss over the 2‐year period. Plaque and bleeding on probing did not differ between smokers and non‐smokers. A significant interaction, determined by repeated measures ANOVA, was noted between systemic bone mineral density (BMD) at the lumbar spine and smoking on alveolar bone density change (p<0.05). Only non‐smoking patients with normal BMD realized a mean net gain in alveolar bone density; osteoporotic/osteopenic subjects (n=25) and smokers lost alveolar bone density.

Conclusion: Postmenopausal female smokers were more likely to lose alveolar bone height and density than non‐smokers with a similar periodontitis, plaque and gingival bleeding experience. In addition, both smoking and osteoporosis/osteopenia provided a negative influence on alveolar bone.
Cytokine, elastase and oxygen radical release by Fusobacterium nucleatum‐activated leukocytes: a possible pathogenic factor in periodontitis
Authors: Sheikhi M. , Gustafsson A. , Jarstrand C.
Published: March 2003

Periodontitis is characterised by tissue destruction caused by reactive oxygen species (ROS) and proteolytic enzymes, which are released by the interaction between bacteria and phagocytes. We estimated the ability of Fusobacterium species to induce release of tissue destructive and proinflammatory mediators from in vitro activated peripheral leukocytes. ROS was measured with the nitroblue tetrazolium (NBT) method, elastase with a specific chromogenic substrate and cytokines, including interleukin 1β (IL‐1β), tumour necrosis factor α (TNF‐α), and interleukin 8 (IL‐8) with a sandwich ELISA method. Various clinical isolates of unopsonized Fusobacterium species stimulated the neutrophils to an increased NBT‐ reduction. IL‐1β, TNFα, IL‐8 and elastase were released in significantly higher levels from neutrophils stimulated by Fusobacterium species. In conclusion, unopsonized Fusobacterium species can induce increased production of oxygen radicals, cytokines and elastase from leukocytes activated in vitro.
Detection of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in dental plaque samples from children 2 to 12 years of age
Authors: Okada Mitsugi , Hayashi Fumiko , Nagasaka Nobuo
Published: March 2003

The purpose of this study was to detect the presence of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in plaque samples from 104 children, collected from their toothbrushes using a polymerase chain reaction (PCR). The age range of all subjects was 2–12 years. 21, 73 and 10 children with healthy gingiva, gingivitis and periodontitis respectively were selected. Plaque samples were collected from all erupted teeth sites using a sterile toothbrush. The mean concentration of DNA recovered from brushing plaque samples was approximately 660 μg/ml, which was sufficient for performing a PCR‐based survey. Both A. actinomycetemcomitans and P. gingivalis were detected in the primary and mixed dentition. The prevalence of A. actinomycetemcomitans in healthy subjects was 4.8%, and those with gingivitis and periodontitis was 6.8% and 20.0% respectively, while the prevalence of P. gingivalis was 4.8% in healthy subjects, and 9.6% and 20.0% in those with gingivitis and periodontitis, respectively. Our survey, using a toothbrush, indicated that A. actinomycetemcomitans and P. gingivalis are rarely present in oral cavities of healthy children.
The prevalence of dentine hypersensitivity in general dental practice in the UK
Authors: Rees J. S.
Published: March 2003

Aim: The aim of this study was to establish the prevalence of dentine hypersensitivity in a cross‐sectional study of patients visiting general dental practitioners in the South West region of the UK over a period of 1 calendar month.

Method: Twelve dental practitioners examined 3593 patients over a period of 1 calendar month and 137 patients were diagnosed as having dentine hypersensitivity, giving a prevalence figure of 3.8%.

Results: The commonest teeth affected were the upper premolar and molar teeth and the commonest initiating factor was cold drinks.

Conclusions: The prevalence of dentine hypersensitivity in general dental practice in the UK was 3.8%.
Self‐esteem as a characteristic of adherence to diabetes and dental self‐care regimens
Authors: Kneckt Mirka C. , Keinänen‐Kiukaanniemi Sirkka M. , Knuuttila Matti L. E. , Syrjälä Anna‐Maija H.
Published: March 2003

Background, aims: There are biological associations between diabetes control and oral infections. We have also found psychological associations between diabetes self‐care and oral health behavior. The aim of this study was to evaluate whether self‐esteem can determine diabetes adherence and oral health behavior, both of with require daily, persistent self‐care.

Method:

Cross‐sectional data on 149 IDDM patients was collected by means of a quantitative self‐completed questionnaire.

Results: High self‐esteem was found to relate to good adherence with exercise regimens (p=0.005) and adjustment of insulin doses (p=0.040). These associations were also found when standardized for socio‐demographic variables and HbA1c‐level. In the dental sphere, logistic regression analysis showed an association between self‐esteem and frequency of tooth brushing.

Conclusions: It can be concluded that self‐esteem may be a common psychological factor influencing diabetes and dental self‐care. Strengthening patients’ self‐esteem could help patients to maintain daily self‐care.
Occurrence of Prevotella intermedia and Prevotella nigrescens in relation to gingivitis and gingival health
Authors: Lie M. A. , Van Der Weijden G. A. , Timmerman M. F. , Loos B. G. , Van Steenbergen T. J. M. , Van Der Velden U.
Published: March 2003

Aim: The occurrence of Prevotella intermedia (Pi) and Prevotella nigrescens (Pn) in relation to natural gingivitis, gingival health and 14‐day experimental gingivitis was investigated in 25 non‐dental students.

Materials and Methods:

Samples were taken from the dorsum of the tongue, the tonsils (or tonsillar area), and the supra‐ and subgingival plaque.

Results: The microbiological results show that 73% of the samples were positive for the bacterial species presumed to be Pi and/or Pn. In natural gingivitis, gingival health and in experimental gingivitis 25, 23 and 25 subjects were found to be positive for Pi and/or Pn, respectively. The results of the 889 isolates that were succesfully purified and differentiated, show that almost all subjects were colonized with Pn whereas approximately half of the study population harboured Pi. These 2 species were isolated from both dental plaque and mucosal sites and were found to colonize the oral cavity simultaneously.

Conclusion: In natural gingivitis, at the start and after 14 days of experimental gingivitis, Pn was the predominant micro‐organism.
Adverse effects of arecoline and nicotine on human periodontal ligament fibroblasts in vitro
Authors: Chang Yu‐Chao , Lii Chong‐Kuei , Tai Kuo‐Wei , Chou Ming‐Yung
Published: March 2003

Background, aims: The habit of betel nut chewing impinges on the daily lives of approximately 200 million people. Betel quid chewers have a higher prevalence of periodontal diseases than non‐chewers. This study examined the pathobiological effects of arecoline, a major component of the betel nut alkaloids, on human periodontal ligament fibroblasts (PDLF) in vitro.

Method: Cell viability, proliferation, protein synthesis, and cellular thiol levels were used to investigate the effects of human PDLF exposed to arecoline levels of 0 to 200 μg/ml. In addition, nicotine was added to test how it modulated the effects of arecoline.

Results: Arecoline significantly inhibited cell proliferation in a dose‐dependent manner. At concentrations of 10 and 30 μg/ml, arecoline suppressed the growth of PDLF by 20% and 50% (p<0.05), respectively. Arecoline also decreased protein synthesis in a dose‐dependent manner during a 24‐h culture period. A 100 μg/ml concentration level of arecoline significantly inhibited protein synthesis to only 50% of that in the untreated control (p<0.05). Moreover, arecoline significantly depleted intracellular thiols in a dose‐dependent manner. At concentrations of 25 μg/ml and 100 μg/ml, arecoline depleted about 18% and 56% of thiols (p<0.05), respectively. This suggests that arecoline itself might augment the destruction of periodontium associated with betel nut use. Furthermore, the addition of nicotine acted with a synergistic effect on the arecoline‐induced cytotoxicity. At a concentration of 60 μg/ml, arecoline suppressed the growth of PDLF by about 33%, and 5 mM nicotine enhanced the arecoline‐induced cytotoxic response to cause about 66% cell death.

Conclusion: During thiol depletion, arecoline may render human PDLF more vulnerable to reactive agents within cigarettes. Taken together, people who combine habits of betel nut chewing with cigarette smoking could be more susceptible to periodontium damage than betel nut chewing alone.
The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus
Authors: Stewart James E. , Wager Karen A. , Friedlander Arthur H. , Zadeh Homayoun H.
Published: March 2003

Abstract Background, aims: This study was designed to explore the effect of periodontal therapy on glycemic control in persons with type 2 diabetes mellitus (DM).

Methods: 36 patients with type 2 DM (treatment group) received therapy for adult periodontitis during an 18‐month period. A 36‐person control group was randomly selected from the same population of persons with type 2 DM who did not receive periodontal treatment.

Results: These groups were well matched for most of the parameters investigated. During the nine‐month observation period, there was a 6.7% improvement in glycemic control in the control group when compared to a 17.1% improvement in the treatment group, a statistically significant difference. Several parameters that could confound or moderate this glycemic control were explored. These included the treatment of non‐dental infections, weight and medication changes. No moderating effect was associated with any of these variables. However, there were too few subjects in the study to have the statistical power necessary to assess these possible moderators of glycemic control.

Conclusions: We interpret the data in the study to suggest that periodontal therapy was associated with improved glycemic control in persons with type 2 DM.
Cigarette smoking, salivary/gingival crevicular fluid cotinine and periodontal status A 10‐year longitudinal study
Authors: Chen Xia , Wolff Larry , Aeppli Dorothee , Guo Zijie , Luan Wen‐min , Baelum Vibeke , Fejeskov Ole
Published: March 2003

Abstract Background, aims: The primary purpose of this study was to determine the association of salivary and gingival crevicular fluid (GCF) cotinine levels with periodontal disease status in smokers and non‐smokers.

Methods: 147 male smokers and 30 male non‐smokers were included in the current longitudinal study. The 177 individuals were part of a group of 200 subjects (89%) seen 10 years previously for a baseline survey. Oral hygiene indices, probing depth and attachment loss were recorded. Salivary and GCF cotinine levels of 58 smokers were determined by means of ELISA.

Results: Results indicated that no significant difference was found in subjects who smoked, when compared to subjects who did not smoke with respect to plaque accumulation and calculus deposits. Smokers, however, had fewer gingival bleeding sites. Cigarette smoking was associated with a greater increase in probing depth and attachment loss, as well as greater tooth loss at an earlier age. There was greater tooth loss in smokers than non‐smokers (p<0.001). 11 smokers became edentulous, while only 1 non‐smoker lost all his teeth within 10 years. The degree of periodontal tissue breakdown was different in each age group with greater periodontal deterioration as age increased. All smokers had detectable salivary and GCF cotinine. Mean GCF cotinine was about 4× higher than mean salivary cotinine levels. Individuals who smoked 20 pack years when compared to <20 pack years, had significantly higher saliva and GCF cotinine levels (p0.05).

Conclusion: Neither salivary cotinine nor GCF cotinine was significantly correlated with probing depth, attachment loss and tooth loss (p>0.05).
Treatment of intrabony defects with enamel matrix proteins and guided tissue regeneration
Authors: Sculean Anton , Windisch Péter , Chiantella Giovanni Carlo , Donos Nikolaos , Brecx Michel , Reich Elmar
Published: March 2003

Background: Utilisation of enamel matrix proteins (EMD) and application of the guided tissue regeneration principle (GTR) are treatment modalities which both have been shown to result in periodontal regeneration. However, it is yet unknown whether the combination of EMD and GTR may additionally favor the regeneration process.

Aim: The aim of the present controlled study was to evaluate clinically the treatment effect of EMD, GTR, combination of EMD and GTR, and flap surgery (control) on intrabony defects.

Material and Methods: 56 patients each of whom displaying one intrabony defect of a depth of at least 6 mm were randomly treated with one of the treatment modalities. Prior to surgery and at one year after, the following parameters were evaluated by a blinded examiner: Plaque index (PlI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), gingival recession (GR) and clinical attachment level (CAL). No statistical significant differences between the four groups were observed at baseline for any of the investigated parameters.

Results: At 1 year after therapy, the sites treated with EMD demonstrated a mean PPD reduction of 4.1±1.7 mm and a mean CAL gain of 3.4±1.5 mm (p<0.001). The sites treated with GTR showed a mean PPD reduction of 4.2±1.9 mm and a mean CAL gain of 3.1±1.5 mm (p<0.001). The sites treated with the combined treatment showed a mean PPD reduction of 4.3±1.4 mm and a mean CAL gain of 3.4±1.1 mm (p<0.001). In the control group, the mean PPD reduction was 3.7±1.4 mm (p<0.001) and the mean CAL gain measured 1.7±1.5 mm (p<0.01). All 4 treatments led to statistically significant PPD reduction and CAL gain. All three regenerative treatments led to higher CAL gain than the control treatment (p<0.05). No statistical significant differences in PPD reduction and CAL gain were observed between the three regenerative treatments.

Conclusion: It may be concluded that (a) all 3 regenerative treatment modalities may lead to higher CAL gain than the control one, and (b) the combined treatment does not seem to improve the outcome of the regenerative procedure.
The intra‐oral translocation of periodontopathogens jeopardises the outcome of periodontal therapy
Authors: Quirynen M. , De Soete M. , Dierickx K. , Van Steenberghe D.
Published: March 2003

Background: Although periodontitis has a multi‐factorial aetiology, the success of its therapy mainly focuses on the eradication/reduction of the exogenous/endogenous periodontopathogens. Most of the species colonise several niches within the oral cavity (e.g. the mucosae, the tongue, the saliva, the periodontal pockets and all intra‐oral hard surfaces) and even in the oro‐pharyngeal area (e.g., the sinus and the tonsils).

Methods: This review article discusses the intra‐oral transmission of periodontopathogens between these niches and analyses clinical studies that support the idea and importance of such an intra‐oral translocation.

Results and conclusions:

Based on the literature, the oro‐pharyngeal area should indeed be considered as a microbiological entity. Because untreated pockets jeopardise the healing of recently instrumented sites, the treatment of periodontitis should involve “a one stage approach” of all pathologic pockets (1‐stage full‐mouth disinfection) or should at least consider the use of antiseptics during the intervals between consecutive instrumentations, in order to prevent a microbial translocation of periodontopathogens during the healing period. For the same reason, regeneration procedures or the local application of antibiotics should be postponed until a maximal improvement has been obtained in the remaining dentition. This more global approach offers significant additional clinical and microbiological benefits.
Prevalence and risk indicators for destructive periodontal diseases in 3 urban American minority populations
Authors: Craig Ronald G. , Boylan Robert , Yip Julie , Bamgboye Patrick , Koutsoukos James , Mijares Dindo , Ferrer Jacqueline , Imam Mohammed , Socransky Sigmund S. , Haffajee Anne D.
Published: March 2003

Background, aims: Destructive periodontal diseases have been reported disproportionately more prevalent and severe in African‐Americans relative to other American populations. Differences in subgingival microbiota and host immune response have also been reported for African‐Americans, implying that risk factors for disease progression may also differ for these populations. Since it is not clear whether these differences are truly genetic or due to confounding variables such as social economic status, we examined a series of clinical, environmental, demographic, and microbiologic features associated with periodontal disease status in a group of 185 urban minority subjects resident within the greater New York metropolitan area.

Methods: The study population consisted of 56 Asian‐American, 71 African‐American and 58 Hispanic subjects. Clinical data recorded included pocket depth, attachment level, gingival erythema, bleeding upon probing, suppuration, and the presence of supragingival plaque. Environmental and demographic data recorded included smoking history, years resident in the United States, whether the subject reported a private dentist and occupational status. Subgingival plaque was sampled from the mesial aspect of all teeth exclusive of third molars and the levels of 40 subgingival species enumerated using checkerboard DNA‐DNA hybridization.

Results: The African‐American group had more missing teeth, deeper periodontal pocket depth and more attachment loss than the Asian‐American or Hispanic groups. However, the African‐American group were less likely to report having a private dentist, had a greater proportion of smokers and a greater proportion of unskilled individuals. The profile of subgingival species differed among the three ethnic/racial groups with A. actinomycetemcomitans, N. mucosa, S. noxia and T. socranskii significantly elevated in the Asian‐American group and P. micros significantly elevated in the African‐American group. When subset by occupational status, numbers of missing teeth, pocket depth, attachment level and prior disease activity were all found increased in the unskilled relative to the professional group. Local factors including the mean % of sites with plaque, marginal gingival erythema, bleeding upon probing and suppuration were also elevated in the unskilled group. The microbial profile differed among the 3 occupational groups with the unskilled group having elevated numbers of species associated with destructive periodontal diseases.

Conclusions: Although greater destructive periodontal disease prevalence and severity were found in the African‐American group, these results suggest that environmental and demographic variables, such as occupational status, may have a greater influence on risk indicators associated with disease prevalence and progression in these populations.
Infection‐mediated early‐onset periodontal disease in P/E‐selectin‐deficient mice
Authors: Niederman R. , Westernoff T. , Lee C. , Mark L. L. , Kawashima N. , Ullman‐Culler M. , Dewhirst F. E. , Paster B. J. , Wagner D. D. , Mayadas T. , Hynes R. O. , Stashenko P.
Published: March 2003

Background: Retrospective and correlation studies suggest that early‐onset periodontal disease may be due to a deficiency in phagocyte function, a pathogenic oral biofilm, and/or dysregulated gingival cytokine expression. Increased susceptibility to periodontal disease is therefore thought to result from multiple risk factors.

Methods: We tested this hypothesis prospectively using P/E‐selectin adhesion molecule deficient mice that mimic the human syndrome leukocyte adhesion deficiency II.

Results: Our studies demonstrate that, in comparison to wild type animals, P/E−/− mice exhibit: spontaneous, early onset alveolar bone loss which is significant by 6 weeks of age; a 10‐fold elevation in bacterial colonization of their oral cavities; and elevated gingival tissue levels of the bone resorptive cytokine IL‐1α. Alveolar bone loss is completely prevented by prophylactic antibiotic therapy.

Conclusions: These experiments provide the first prospective evidence for the multiple risk factor hypothesis of periodontal disease, and validate the first animal model for early onset periodontitis in which both the microbiota and host response can be systematically manipulated. P/E−/− animals should be useful in testing the virulence of putative periodontal pathogens, in determining the role of host resistance factors in periodontitis, in exploring the proposed relationship(s) between infection mediated alveolar bone loss and systemic health disorders, and exploring their genetic relationships.
A multifactorial investigation of the ability of oral health care products (OHCPs) to alleviate oral malodour
Authors: Silwood Christopher J. L. , Grootveld Martin C. , Lynch Edward
Published: March 2003

Aim, background: Oral malodour (halitosis) is generally ascribable to oral microbial putrefaction generating malodorous volatile sulphur compounds which predominantly comprise dihydrogen sulphide and methyl mercaptan. This study assesses the relative effectiveness of 6 oral health care products in reducing oral cavity volatile sulphur compound concentrations.

Method: A mixed model 3‐factor factorial experimental design involving 6 volunteers, 7 treatment regimens (products I–VI* and water placebo) and 5 time‐points (0.00–5.29 h) was undertaken. Electron‐donating volatile sulphur compound levels were determined in triplicate using a sulphide monitor (Interscan model 1170) both prior to (0.00 h) and following oral rinsing (20 ml of 5 of the products) or chewing (2 capsules of the remaining product) episodes with each product examined (0.29, 1.29, 2.29 and 5.29 h post‐administration).

Results: Results were recorded as peak and steady‐state volatile sulphur compound equivalents (ppb). With the exception of one of the products, each oral health care product tested was found to reproducibly reduce volatile sulphur compound concentrations within 20 min of treatment; the mean % decreases in peak (and corresponding steady‐state) levels ranging from 3.6 (0.0) to 16.8 (16.4)%. Subsequently, volatile sulphur compound concentrations returned to their zero‐control (baseline) values within 5 h, the rate of this regression being in the reverse of the order observed for the magnitude of the primary 20 min reduction for both peak and steady‐state measurements. As expected, the water placebo exerted no influence on oral cavity volatile sulphur compound levels. The most effective oral health care products contained admixtures of chlorite anion and chlorine dioxide (both of these agents have the ability to directly oxidise volatile sulphur compounds to non‐malodorous products and the latter is also powerfully cidal towards odourigenic micro‐organisms).

Conclusions: We therefore conclude that oral health care products containing such oxohalogen oxidants may provide a useful therapeutic strategy for the treatment of oral malodour.
Efficacy of manual and powered toothbrushes (II). Effect on microbiological parameters
Authors: Haffajee Anne D. , Smith Claire , Torresyap Gay , Thompson Maureen , Guerrero Denise , Socransky Sigmund S.
Published: March 2003

Background/aim: The purpose of the present investigation was to determine the effect of self‐performed supragingival plaque removal using either manual (Crest Complete) or power (Braun 3D Plaque Remover) toothbrushing on supra and subgingival plaque composition.

Methods: 47 periodontal maintenance subjects completed this single‐blind 6 month longitudinal study. At baseline, samples of supra and separately subgingival plaque were taken from the mesial aspect of each tooth in each subject using sterile curettes and individually analyzed for their content of 18 bacterial taxa using checkerboard DNA‐DNA hybridization. After random assignment to groups receiving either a manual (n=25) or power toothbrush (n=22), subjects received instruction in oral hygiene and used their assigned toothbrush 2× daily for 6 months. Clinical monitoring and microbiological sampling were repeated at 3 and 6 months. Significant differences in microbiological measures over time were sought using the Quade test and between brushing groups at each time point using the Mann‐Whitney test.

Results: Mean total counts were significantly reduced for supra‐ and subgingival plaque samples in the manual group and subgingival samples in the powered brushing group. Actinomyces naeslundii and Actinomyces israelii/gerencseriae were the most numerous organisms detected at baseline and showed the greatest reductions in counts in both brushing groups. Streptococcus constellatus/intermedius was significantly reduced in both groups, while Streptococcus mitis/oralis/sanguis was significantly reduced in the manual toothbrushing group. Mean counts of species were more markedly altered in subgingival plaque. Major reductions occurred in both groups for A. naeslundii, A. israelii/gerencseriae, Peptostreptococcus micros, Veillonella parvula, Prevotella intermedia/nigrescens, S. mitis/oralis/sanguis and S. constellatus/intermedius. All taxa examined were reduced in prevalence (% of sites colonized) in the subgingival plaque samples for both brushing groups. The reductions in prevalence were greater for A. naeslundii, S. constellatus/intermedius, V. parvula, A. israelii/gerencseriae, S. mitis/oralis/sanguis, P. micros, Streptococcus mutans and P. intermedia/nigrescens. Mean prevalence was decreased more for Porphyromonas gingivalis, Campylobacter rectus/showae, Treponema denticola and Bacteroides forsythus in supragingival plaque than subgingival plaque.

Conclusions: The major finding was the effect of supragingival plaque removal on the composition of the subgingival microbiota. Counts and prevalence of most taxa examined were markedly decreased in both toothbrushing groups. This reduction should translate to a decreased risk of periodontal disease initiation or recurrence. Further, the decreased prevalence of periodontal pathogens in supragingival plaque lowers potential reservoirs of these species.
A double‐blind placebo‐controlled trial of azithromycin as an adjunct to non‐surgical treatment of periodontitis in adults: clinical results
Authors: Smith S. R. , Foyle D. M. , Daniels J. , Joyston‐Bechal S. , Smales F. C. , Sefton A. , Williams J.
Published: March 2003

Background/aims: The aim of the study was to investigate the clinical and microbiological effects of azithromycin as an adjunct to the non‐surgical treatment of periodontitis in adults. Azithromycin is an antibiotic which is taken up by phagocytes and is released over long periods in inflamed tissue but requires a total of only three doses of 500 mg to produce its therapeutic effect.

Method: 46 patients were treated in a double‐blind placebo‐controlled study with assessments at weeks 0, 1, 2, 3, 6, 10 and 22. Throughout the trial measurements were made of plaque, gingival bleeding, calculus, probing pocket depths and bleeding on probing. Microbiological sampling was carried out from a selected pocket 6 mm at each visit. The regime employed consisted of OHI, scaling and root planing at weeks 0, 1 and 2 with reinforcement of OHI and minimal scaling at weeks 6, 10 and 22. Patients were randomly assigned to receive either azithromycin, (A), or placebo capsules, (C), 500 mg, 1× daily for 3 days at week 2. 44 patients completed the study. Mean pocket depths were analysed using analysis of covariance in 3 groups with initial pocket depth values of 1–3 mm, 4–5 mm and 6 mm.

Results: The results of the microbiology have been reported in a separate paper. The clinical data showed that by week 22 a lower % of pockets initially >5 mm deep remained above that level in the 23 patients taking azithromycin (A), than the 21 taking the placebo (C), (A, 5.6%; C, 23.3%). Also at week 22, for pockets initially 4 mm or more, the test group had fewer pockets >3 mm deep (A, 26.1%; C, 44.3%), fewer failing to improve in probing depth (A, 6.6%; C, 21.6%) and fewer continuing to bleed on probing (A, 46.9%; C, 55.6%) when compared with the control group. Pocket depths initially 4–5 mm or 6–9 mm analysed by analysis of covariance showed lower mean pocket depths in the patients on azithromycin, at weeks 6, 10 and 22, (pockets initially 4–5 mm, p<0.001 on all occasions, pockets initially 6–9 mm, p<0.001, week 6; p< 0.003, week 10; p<0.001, week 22).

Conclusions: Azithromycin may be a useful adjunct in the treatment of adult periodontitis, particularly where deep pockets are present.
Antimicrobial effects of 2.94 μm Er:YAG laser radiation on root surfaces: an in vitro study
Authors: Folwaczny Matthias , Mehl Albert , Aggstaller Hans , Hickel Reinhard
Published: March 2003

Objectives: This in vitro study investigated the antimicrobial effects of 2.94 μm Er:YAG laser radiation on root surfaces.

Materials and methods: The study used 125 extracted teeth which were divided into 2 groups (A, B) of 40 teeth and 3 groups of 15 teeth (C, D, E). A defined and similarly‐sized area of the root surface was inoculated with an aliquot of 7 μl of a bacterial suspension of Escherichia coli (ATCC 25922), Staphylococcus aureus (ATCC 25923), Actinobacillus actinomycetemcomitans (ATCC 43719), Eikenella corrodens (ATCC 51724), or Peptostreptococcus micros (ATCC 33270). Subsequently, the samples from each group were further divided into subgroups which have been irradiated either with 55, 75, and 105 (group A, B) or 55 and 75 (group C, D, E) laser pulses. 1 subgroup of each group was left untreated as control. The source of laser radiation was an Er:YAG laser emitting pulsed infrared radiation at a wavelength of 2.94 μm. The number of bacteria was determined using the surface spread plate technique. The statistical analysis was performed using ANOVA followed by the Scheffé‐test.

Results: Depending on the number of laser pulses the bacterial load in the E. coli group was reduced by the Er:YAG laser radiation after exposure to 105 laser pulses to 5.5% of the initial count and that in the Staph. aureus group to 15.1%. The number of bacteria in case of A. actinomytemcomitans was reduced to 8.3%, in case of E. corrodens to 3.0% and in case of P. micros to 22.0% after application of 75 laserpulses.

Conclusion: Besides the selective removal of plaque and calculus, the 2.94 μm Er:YAG laser radiation causes reduction in bacteria on root surfaces.
Clinical evaluation of cervical dentin sensitivity (CDS) in patients attending general dental clinics (GDC) and periodontal specialty clinics (PSC)
Authors: Taani S. D. M. Quteish , Awartani Fatin
Published: March 2003

Aim: The objective of this study was to compare the prevalence, severity and distribution of CDS in patients attending general dental clinics (GDC) and periodontal specialty clinics (PSC) and to correlate them to possible causal factors.

Material and Methods: 2 groups of patients aged 20–60 years recruited from GDC (144) and PSC (151) were evaluated for CDS by means of a questionnaire and intraoral clinical examinations. Furthermore, gingival recession and plaque scores were recorded at the same visit.

Results: The results showed that patients referred to PSC had a significantly higher prevalence of CDS (60.3%) than those examined at GDC (42.4%) (p<0.001). Also, mean plaque scores of PSC patients (1.87±0.88) was found to be significantly higher than that of GDC (1.44±0.7) (p<0.01). The occurrence and extent of gingival recession associated with hypersensitive teeth was significantly higher in PSC than GDC patients (p<0.01), with a 5% incidence of severe recession (5 mm) in PSC only. The association of periodontal disease and periodontal treatment to the high prevalence of CDS and gingival recession in PSC patients would suggest their role in predisposition to hypersensitivity. The distribution of CDS in tooth types revealed that upper molars and lower anteriors of PSC patients were mainly affected, and followed by, to a lesser extent, lower right canine and right first molars of GDC patients.

Conclusion: The prevalence of CDS among our periodontal patients appears somewhat lower than that reported in periodontal specialty clinics of earlier studies but still higher than those reported in other dental populations. This indicates that periodontal disease and its treatments may increase the occurrence of hypersensitivity.