bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and microbiological studies of periodontal disease in Sjögren's syndrome patients
Authors: Kuru B. , McCullough M. J. , Yilmaz S. , Porter S. R.
Published: March 2003

Background:Little is known about the periodontal status of patients with Sjögren's Syndrome (SS), a chronic inflammatory autoimmune disease characterized by xerophthalmia and xerostomia. The aim of the present study was to evaluate whether the periodontal status of SS patients, in terms of clinical and microbiological parameters, differs from systemically healthy age‐ and gender‐matched controls.

Methods:8 primary SS and 10 secondary SS patients were examined in comparison with 11 control subjects. All patients were diagnosed by the European Community Criteria. Control subjects were systemically healthy and not undergoing periodontal treatment. The comparison of clinical status was made in terms of mean periodontal parameters (plaque index, gingival index, gingival recession, probing pocket depth, probing attachment level and bleeding on probing) as well as the frequency distribution of probing pocket depth and probing attachment level measurements. Microbiological assays of the subgingival dental plaque samples were carried out by both a chairside enzyme test (Periocheck®) for the detection of peptidase activity (PA) and a polymerase chain reaction (PCR) analysis for 9 selected periodontal micro‐organisms (Actinobacillus actinomycetemcomitans,Fusobacterium nucleatum,Prevotella intermedia,Treponema denticola,Porphyromonas gingivalis,Eikenella corrodens,Campylobacter rectus,Bacteroides forsythus,Streptococcus oralis).

Results:The occurrence, severity and extent of periodontal lesions were not significantly different between the 3 patient groups for all periodontal parameters examined. No significant differences in the sub‐gingival plaque samples from control, primary or secondary SS patients for the PA test, frequency or type of periodontal micro‐organisms observed.

Conclusion:No significant differences could be detected in either clinical or microbiological parameters of primary or secondary SS patients compared with that of control subjects. The results of the present study thus support the notion that the periodontal status of patients with SS do not differ from systemically healthy age‐ and gender‐matched controls.
Clinical, radiographic and biochemical assessment of IL‐1/TNF‐α antagonist inhibition of bone loss in experimental periodontitis
Authors: Oates T. W. , Graves D. T. , Cochran D. L.
Published: March 2003

Objectives: To assess clinical, radiographic, and biochemical markers as diagnostic indicators of disease activity by comparing ligature‐induced bone loss in the presence or absence of IL‐1/TNF‐α antagonist inhibition of bone loss in a primate model.

Material and Methods: 6 animals with a naturally‐occurring gingivitis were evaluated over a 6‐week time period following the placement of silk ligatures and initiation of a soft diet. Three animals received intrapapillary injections of soluble receptors (blockers), capable of blocking the biologic activity for both IL‐1 and TNF‐α, and 3 animals received vehicle (control) injections. Injections were given 3× per week over the course of the study. Clinical assessments included a gingival index and quantification of gingival crevicular fluid (GCF) levels. Collected GCF samples were then used in the biochemical assessment of pyridinoline (PYD) and bone alkaline phosphatase (BAP). Radiographic assessment was made using computer‐assisted subtraction radiography to measure both bone density (CADIA) values and linear changes in crestal bone height.

Results: Significant (p<0.01) changes using both radiographic measures occurred between 2 and 4 weeks following initiation of disease in this model. The use of the blockers significantly (p<0.01) reduced the levels of radiographic bone loss by approximately 50% over that found in the control sites. Both biochemical markers showed the greatest increase during the first two weeks of the study with PYD levels increased 35‐fold over baseline levels after 1 week. This difference in response was significantly (p<0.05) greater than the levels found in the non‐ligated teeth or in the ligated teeth receiving blockers injections. BAP levels showed significant increases in ligated teeth compared to non‐ligated teeth, but failed to show any significant differences between animals treated with vehicle and those treated with IL‐1/TNF antagonists. In contrast to these radiographic and biochemical effects, there were no significant differences detected between animals treated with antagonists and the control group for any of the clinical measures.

Conclusions: The results of this study demonstrate that both subtraction radiography and PYD crevicular fluid levels can detect relative differences in periodontal disease progression, while BAP crevicular fluid levels cannot.
Bone reactions at implants subjected to experimental peri‐implantitis and static load
Authors: Gotfredsen K. , Berglundh T. , Lindhe J.
Published: March 2003

Aim: The aim of the present experiment was to study peri‐implant tissue reactions to lateral static load at implants subjected to experimental mucositis or peri‐implantitis.

Material and methods: 5 beagle dogs were used. The mandibular premolars were extracted. After 12 weeks, 3 implants were installed in each quadrant of the mandible. In one side, the implants were designed with a SLA surface and in the contralateral side with a turned surface. A plaque control program was initiated. 12 weeks later, the central and posterior implants were connected with an appliance containing an expansion screw. Cotton ligatures were placed around the neck of the anterior and posterior implants in both sides, and the plaque control measures were terminated. Sixteen weeks later the ligatures were removed. After 8 weeks without ligatures, the expansion screws in both sides were activated. Once every 2 week during a 12‐week interval, the screws were reactivated. Thus, the model included 3 different experimental sites of each surface group: group M+L (mucositis+load); group P (peri‐implantitis); group P+L (peri‐implantitis+load). Fluorochrome labels were injected and standardized radiographs obtained. The animals were sacrificed and block biopsies of all implant sites dissected and prepared for histological analysis.

Results: It was demonstrated that the lateral static load failed to induce peri‐implant bone loss at implants with mucositis and failed to enhance the bone loss at implants with experimental peri‐implantitis. The proportion of bone labels and the bone density in the interface zone were significantly higher in group P+L than in group P.

Conclusion: It is suggested that a lateral static load with controlled forces may not be detrimental to implants exhibiting mucositis or peri‐implantitis.
Primary gingival leiomyosarcoma
Authors: Muzio Lorenzo Lo , Favia Gianfranco , Farronato Gianpietro , Piattelli Adriano , Maiorano Eugenio
Published: March 2003

Background: Leiomyosarcoma is a relatively uncommon mesenchymal tumor that exhibits smooth‐muscle differentiation. Only 3 to 10% of leiomyosarcomas arise in the head and neck, the nose and paranasal sinuses, skin and subcutaneous tissue and cervical esophagus being the most common localizations. Most leiomyosarcomas involving the oral tissues primarily affect the maxillary sinus, the maxillary or mandibular bone. A review of the English‐language literature since 1908 revealed 30 reported cases of primary leiomyosarcoma of the oral mucosa and soft tissues.

Material and Methods: We report on a case of gingival leiomyosarcoma, arising in a 31‐year‐old female and involving the upper alveolar mucosa. Following the diagnosis of malignant neoplasm on frozen sections and an en‐block resection, the tumour was formalin‐fixed and paraffin embedded for histological and immunohistochemical examination.

Results: Microscopically, the tumor was composed of interlacing fascicles of spindle‐shaped cells with elongated, blunt‐ended nuclei and eosinophilic cytoplasm, containing PAS‐positive granules. Mitoses, both typical and atypical, and scattered necrotic foci were present. Consistent desmin, muscle specific and α‐smooth muscle‐specific, and vimentin immunoreactivity was demonstrated in the tumor cells. The patient is alive and free of disease at a 7‐year follow‐up.

Conclusions: Intra‐oral leiomyosarcomas are exceptionally rare. Accurate diagnosis and treatment is largely based on the careful search of clinical signs indicative of malignancy (e.g., neoplastic bone destruction, wide invasion of adjacent tissues) and intra‐operative (frozen sections) examination of the lesion. Though the case reported herein showed an attenuated clinical behavior, prolonged follow‐up is mandatory in view of possible tumor relapse.
Psychosocial stress, lifestyle and periodontal health
Authors: Aleksejunñiené Jolanta , Holst Dorthe , Eriksen Harald M. , Gjermo Per
Published: March 2003

Background, aims: The hypothesis that psychosocial stress and lifestyle are related to periodontal status was tested.

Material and methods: The study was performed in 1997–98 in 10 areas in Lithuania (response rate 53%). Information comprised recordings of oral hygiene, calculated levels of remaining periodontal support and information about psychosocial and lifestyle factors. A hypothetical structure was tested in 2 age and gender subgroups by means of a structural equation model both for an overall fit and for the fit of individual parameters within the model.

Results: The hypothesised structure presented high confirmatory fit index values (CFI) in all subgroup models, i.e., CFI >0.94. However the probability value of 0.01 found in the older males model presented an unlikely event. When individual parameters within the models were tested, different misspecifications were found. Therefore the hypothesised structure needed to be revised and tested repeatedly. All revised models presented high CFI and probability values (p>0.35). The testing of individual parameters did not reveal any significantly misspecified parameters.

Conclusions: The path between lifestyle and levels of remaining periodontal support was empirically supported in the present study. Although the pathway between psychosocial stress and remaining periodontal support was not empirically supported, there is reason to believe that such link is likely.
Salivary microbiota levels in relation to periodontal status, experience of caries and miswak use in Sudanese adults
Authors: Darout Ismail A. , Albandar Jasim M. , Skaug Nils , Ali Raouf W.
Published: March 2003

Objectives : The purpose of the present investigation was to assess the salivary levels of 25 oral bacteria in relation to periodontal status and experience of caries, and to compare the levels of these bacteria between habitual miswak and toothbrush users in adult Sudanese subjects.

Material and methods : The study subjects consisted of 56 individuals with age range 19–53 years (mean 35.2 years) and included 30 miswak and 26 toothbrush users. The periodontal status and presence of dental caries were assessed clinically. Whole saliva was collected from all subjects, and the levels of 25 selected bacterial species in saliva were assessed by the checkerboard DNA–DNA hybridization method using whole genomic DNA probes.

Results : A high percentage of the subjects had detectable levels (≥ 105 bacterial cells) of several bacterial species in saliva. Between 12% and 16% of the subjects showed high (≥ 106 cells) salivary levels of the periodontitis‐associated bacteria A. actinomycetemcomitans, P. melaninogenica, P. intermedia, C. rectus and E. corrodens, whereas only two (3.6%) and four (7.1%) subjects had high levels of P. gingivalis and F. nucleatum, respectively. There were no significant differences in the levels of all or most bacterial species by age group, gender or periodontal status. Presence of ≥ 105L. acidophilus bacterial cells in saliva was associated with high caries scores (p = 0.02). There were significantly higher levels of A. actinomycetemcomitans, P. melaninogenica, C. rectus, P. micros, V. parvula, S. mutans, S. anginosus, A. israelii, C. sputigena, and C. gingivalis, and significantly lower levels of P. intermedia, F. nucleatum, S. sputigena, E. corrodens, L. acidophilus, S. sanguis, S. salivarius, S. oralis, and S. mitis in the miswak than in the toothbrush group.

Conclusions : The findings suggest that miswak may have a selective inhibitory effect on the level of certain bacteria in saliva, particularly several oral streptococci species. This is the first report that the checkerboard DNA–DNA hybridization method can be useful for assessing the levels of a wide range of bacterial taxa in saliva.
The theory of reasoned action in describing tooth brushing, dental caries and diabetes adherence among diabetic patients
Authors: Syrjälä Anna‐Maija H. , Niskanen Mirka C. , Knuuttila Matti L. E.
Published: March 2003

Objectives: Preventive oral health behaviour is important among diabetic patients, as it has been found that dental diseases and insulin‐dependent diabetes mellitus (IDDM) have some psychological and biological factors in common. The aim here was to analyze the variables of Ajzen and Fishbein's theory of reasoned action to explain the reported frequency of tooth brushing, dental caries, HbA1c level and diabetes adherence.

Material and Methods: Cross‐sectional data were gathered from 149 IDDM patients by means of a quantitative questionnaire, clinical examination and patient records.

Results: The results showed that a firmer intention to brush the teeth was related to a higher reported frequency of tooth brushing (p < 0.001). The attitude to and the subjective norm of tooth brushing were related to the intention to brush(p < 0.001) and to the reported frequency of tooth brushing. A better dental attitude was related to better diabetes adherence (p = 0.002) and fewer decayed surfaces (p = 0.01), and a firmer intention to brush the teeth was related to a lower HbA1c level (p = 0.015).

Conclusions: Our results suggest that in oral health promotion among diabetic patients, both subjective norm and attitude are important and that diabetes adherence may be influenced by promoting dental attitude.
Assessment of periodontal conditions and systemic disease in older subjects
Authors: Persson R. E. , Hollender L. G. , Powell L. V. , MacEntee M. I. , Wyatt C. C. L. , Kiyak H. A. , Persson G. R.
Published: March 2003

Background: Osteoporosis (OPOR) is a common chronic disease, especially in older women. Patients are often unaware of the condition until they experience bone fractures. Studies have suggested that OPOR and periodontitis are associated diseases and exaggerated by cytokine activity. Panoramic radiography (PMX) allows studies of mandibular cortical index (MCI), which is potentially diagnostic for OPOR.

Aims: i) To study the prevalence of self‐reported history of OPOR in an older, ethnically diverse population, ii) to assess the agreement between PMX/MCI findings and self‐reported OPOR, and iii) to assess the likelihood of having both a self‐reported history of OPOR and a diagnosis of periodontitis.

Materials and methods: PMX and medical history were obtained from 1084 subjects aged 60–75 (mean age 67.6, SD ± 4.7). Of the films, 90.3% were useful for analysis. PMXs were studied using MCI. The PMXs were used to grade subjects as not having periodontitis or with one of three grades of periodontitis severity.

Results: A positive MCI was found in 38.9% of the subjects, in contrast to 8.2% self‐reported OPOR. The intraclass correlation between MCI and self‐reported OPOR was 0.20 (P < 0.01). The likelihood of an association between OPOR and MCI was 2.6 (95%CI: 1.6, 4.1, P < 0.001). Subjects with self‐reported OPOR and a positive MCI had worse periodontal conditions (P < 0.01). The Mantel‐Haentzel odds ratio for OPOR and periodontitis was 1.8 (95%CI: 1.2, 2.5, P < 0.001).

Conclusions: The prevalence of positive MCI was high and consistent with epidemiological studies, but only partly consistent with a self‐reported history of osteoporosis with a higher prevalence of positive MCI in Chinese women. Horizontal alveolar bone loss is associated with both positive self‐reported OPOR and MCI.
Analysis of genetic polymorphisms at the interleukin‐10 loci in aggressive and chronic periodontitis
Authors: Gonzales J R. , Michel J. , Diete A. , Herrmann J. M. , Bödeker R. H. , Meyle J.
Published: March 2003

Background/Aims: Different cytokine genotypes have been described in periodontal disease. The aim of the present study was to investigate the genetic association of two previously described interleukin‐10 (IL‐10) polymorphisms in patients with aggressive (AP) and chronic periodontitis (CP) and to investigate possible associations with clinical manifestations.

Methods: Based on clinical parameters and radiographs, 23 patients with CP and 18 patients with AP were included in the study. Additionally, 21 age‐matched healthy subjects served as a control group. Genomic DNA was isolated from whole blood samples and the IL‐10 promoter sequences from positions − 597 to − 824 were amplified by polymerase chain reaction (PCR). Polymorphisms were detected by restriction‐enzyme cleavage. The A and C alleles at the − 597 position were associated with the T and C alleles at the − 824 position, respectively. Fisher's exact test was used for the statistical analysis.

Results: No significant differences were observed in the allele frequencies between controls and AP patients (p = 0.70) or CP patients (p = 0.43), although the previously reported association between allele A at position − 597 and allele T at position − 824 was observed in our population.

Conclusion: We conclude that the investigated polymorphisms are not associated with periodontal disease.
A cross‐sectional study of dentine hypersensitivity
Authors: Rees J. S. , Addy M.
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 United Kingdom over a period of one calendar month.

Methods: Nineteen dental practioners examined 4841 patients over a period of one calendar month and patients that had dentine hypersensitivity diagnosed were questioned further about their occupation and smoking habits. The amount of buccal gingival recession associated with the sensitive teeth was also recorded using a study form.

Results: 201 patients were diagnosed as having dentine hypersensitivity, giving a prevalence figure of 4.1%. The commonest teeth affected were the upper premolar teeth and the commonest initiating factor was cold drinks. A tendency for a greater number of sensitive teeth was also found for patients with periodontal disease who also smoked. There was also a tendency for the patients with sensitive teeth to come from higher social groups.
Tissue structure, and IL‐1β, IL‐8, and TNF‐α secretions after contact by engineered human oral mucosa with dentifrices
Authors: Mostefaoui Yakout , Claveau Isabelle , Ross Geneviève , Rouabhia Mahmoud
Published: March 2003

The use of dentifrice is part of an oral prophylaxis that aims at keeping bacteria in check within the dental plaque. When introduced into the oral cavity, dentifrice also comes in close contact with the oral epithelium. Our goal was to evaluate the effects of dentifrices on tissue structure and pro‐inflammatory mediator release by epithelial cells. For this purpose, tri‐dimensional engineered human oral mucosa (EHOM) was produced using normal human palatal fibroblasts and epithelial cells. EHOMs were either treated with Aquafresh® or Crest® for 1, 4, 8, and 24 h, or untreated, then used for cell viability assessment and structural analyses. Cultured supernatants were used to evaluate cytokine (interleukin (IL)‐1β, IL‐8 and tumor necrosis factor (TNF)‐α) secretion, and metalloproteinase (MMP)‐2 and ‐9 activities. The present in vitro study using engineered oral mucosa confirms that dentifrices (Aquafresh and Crest) contribute to tissue desquamation. The desquamation was substantial at 24 h of contact but was limited to the upper layers of the treated tissues. Cell death in these tissues was not increased, suggesting that the dentifrice had accelerated desquamation of the layers containing differentiated cells. Measurement of cytokines revealed that dentifrices up‐regulated IL‐1β while down‐regulating IL‐8 and TNF‐α secretion, thus indicating an impaired cascade of inflammatory responses. These dentifrices may also impair normal repair mechanisms as suggested by an up‐regulation of gelatinase activities. In conclusion, this study suggested that, via cytokines, dentifrice contributes to the modulation of the inflammatory (pro‐inflammatory/anti‐inflammatory responses) process.
Plaque removal with a novel manual toothbrush (X‐Active) and the Braun Oral‐B 3D Plaque Remover
Authors: Danser M. M. , Timmerman M. F. , Jzerman Y. , Piscaer M. I. , Van Der Velden U. , Van Der Weijden G. A.
Published: March 2003

Objectives: The study was designed to test the efficacy in plaque removal of three toothbrushes: two manual brushes, the Butler GUM 311®and the Dr Best X‐Active®, and one electric toothbrush the Braun Oral‐B 3D Plaque Remover (3D)®.

Method: The study was a split‐mouth, single‐blind, randomized clinical study consisting of three identical experiments testing three combinations of toothbrushes (experiment 1: 3DversusButler; experiment 2: 3DversusDr Best; experiment 3: ButlerversusDr Best), in which the teeth of the panellists were brushed by a dental hygienist. In a fourth experiment, the panellists brushed their own teeth (3DversusDr Best). Thirty‐five subjects participated in the study and received a professional prophylaxis prior to the first experiment. They were requested to refrain from brushing their teeth for 48 h prior to each experiment. Plaque was assessed according to the Silness & Löe plaque index at six sites per tooth. Next, the dental hygienist (experiments 1–3) or the panellist (experiment 4) brushed for 60 s with their first assigned brush in two randomly selected contralateral quadrants. Brushing was repeated (60 s) with the second brush in the opposing two contralateral quadrants. Prior to experiment 4, panellists were given two thorough hands‐on professional instructions in the use of the 3D and the Dr Best toothbrushes.

Results: In experiment 1, the 3D showed a mean plaque reduction of 72% compared to 63% with the Butler (P<0.01). In experiment 2, the 3D showed a mean plaque reduction of 79% and the Dr Best 76% (P<0.05). In experiment 3, the Butler showed a mean plaque reduction of 81% and the Dr Best 85% (P=0.01). In the hands of the panellists (experiment 4), the 3D showed a mean plaque reduction of 88% and the Dr Best 84% (P<0.05).

Conclusions: A 5‐week training period with repeated hands‐on instruction gives panellists the skill to perform brushing with efficacy comparable to that of professional brushing. In agreement with a previous study, the 3D was more effective than a flat‐trimmed manual toothbrush (Van der Weijden et al. 1994). Brushing with the criss‐cross resulted in small statistical differences with the 3D and the flat‐trimmed manual toothbrush. The clinical relevance of these statistically significant results should be the subject of a longitudinal study.
Impaired healing response of periodontal furcation defects following flap debridement surgery in smokers
Authors: Trombelli Leonardo , Cho Kyoo‐Sung , Kim Chong‐Kwan , Scapoli Chiara , Scabbia Alessandro
Published: March 2003

Objectives: The purpose of the present parallel‐design, controlled clinical trial was to evaluate the treatment outcome of periodontal furcation defects following flap debridement surgery (FDS) procedure in cigarette smokers compared to non‐smokers.

Materials and Methods: After initial therapy, 31 systemically healthy subjects with moderate to advanced periodontitis, who presented at least one Class I or II molar furcation defect, were selected. Nineteen patients (mean age: 40.3 years, 15 males) were smokers (≥10 cigarettes/day) and 12 patients (mean age: 44.8 years, 3 males) were non‐smokers. Full‐mouth plaque score (FMPS) and full‐mouth bleeding score (FMBS), probing pocket depth (PPD), vertical clinical attachment level (v‐CAL), and horizontal clinical attachment level (h‐CAL) were assessed immediately before and 6 months following surgery.

Results: Overall, statistically significant v‐CAL gain was observed in smokers (1.0 ± 1.3 mm) and non‐smokers (1.3±1.1 mm), the difference between groups being statistically significant (p=0.0003). In proximal furcation defects, v‐CAL gain amounted to 2.3±0.7 mm in non‐smokers as compared to 1.0±1.1 mm in smokers (p=0.0013). At 6 months postsurgery, non‐smokers presented a greater h‐CAL gain (1.3±1.1 mm) than smokers (0.6±1.0 mm), with a statistically significant difference between groups (p=0.0089). This trend was confirmed in both facial/lingual (1.4±1.0 versus 0.8±0.8 mm) and proximal furcation defects (1.2±1.3 versus 0.5±1.2 mm). The proportion of Class II furcations showing improvement to postsurgery Class I was 27.6% in smokers and 38.5% in non‐smokers. After 6 months, 3.4% of presurgery Class I furcation defects in smokers showed complete closure, as compared to 27.8% in non‐smokers.

Conclusions: The results of the present study indicated that (1) FDS produced clinically and statistically significant PPD reduction, v‐CAL gain, and h‐CAL gain in Class I/II molar furcation defects, and (2) cigarette smokers exhibited a less favorable healing outcome following surgery in terms of both v‐CAL and h‐CAL gain.
Guided tissue regeneration using a polylactic acid barrier. Part I: Environmental effects on bacterial colonization
Authors: Rüdiger S. G. , Ehmke B. , Hommens A. , Karch H. , Flemmig T. F.
Published: March 2003

Objectives: The purpose of this study was to assess the dynamics of bacterial colonization in intra‐osseous defects following guided tissue regeneration (GTR) therapy using a resorbable barrier.

Patients and methods: In each of 30 patients, one intra‐osseous defect was treated with GTR using a polylactic acid membrane (Guidor®). Plaque samples were taken from the defect site, other teeth and mucous membranes following initial therapy (baseline), and at 3, 6 and 12 months after periodontal surgery. Additionally, samples were taken from the defect sites at 1, 2 and 4 weeks. Actinobacillus actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), and Bacteroides forsythus (B.f.) were detected by polymerase chain reaction (PCR). Supportive periodontal therapy was performed at 3‐month intervals.

Results: In the 29 patients completing the study, the assessed microflora was detected in 3 (A.a.), 13 (P.g.) and 14 (B.f.) defect sites at baseline, in 2 (A.a.), 2 (P.g.) and 2 (B.f.) following surgical debridement, and in 6 (A.a.), 10 (P.g.) and 22 (B.f.) at 12 months. Defect site colonization following GTR therapy was significantly correlated with presurgical colonization at other assessed teeth (A.a. and P.g.: tau = 0.45 and 0.66, respectively; P < 0.001), or on mucous membranes (B.f.: tau = 0.44, P < 0.001).

Conclusion: The colonization of periodontal pathogens at sites treated by GTR may correlate with the intra‐oral presence of these pathogens before surgery. If colonization of GTR sites by periodontal pathogens is to be prevented, intra‐oral suppression/eradication of these pathogens may be required before surgery.
A rapid DNA probe test compared to culture methods for identification of subgingival plaque bacteria
Authors: Tsai Ching Yin , Wolff Larry F. , Germaine Greg , Hodges Jim
Published: March 2003

There has been a significant amount of interest in developing a more rapid and cost‐effective test to identify bacterial pathogens in plaque. DNA probe technology may meet both these objectives, it is more rapid and cost‐effective when compared to culture methods. The purpose of this study was to compare an automated DNA probe test with classical culture methods for identifying Bacteroides forsythus and Porphyromonas gingivalis in subgingival plaque of patients with adult periodontitis. Subgingival plaque samples were collected from sites with moderate to severe periodontitis and divided into two aliquots for analysis by either DNA probe or culture methods. When the DNA probe method was compared with the culture method (gold standard), the sensitivity and specificity for B. forsythus were 92.0% (SE = 3.4%) and 50.5% (SE = 7.8%), respectively; for P. gingivalis they were 52.2% (SE = 8.7%) and 74.7% (SE = 5.9%), respectively. Detection of B. forsythus and P. gingivalis by DNA probe correlated with probing depth (P = 0.01 for B. forsythus and P = 0.03 for P. gingivalis). It was concluded the DNA probe test was comparable to culture methods in detecting B. forsythus. In addition, when compared to the culture method, a better correlation was obtained with DNA probe detection of B. forsythus or P. gingivalis and clinical parameters.
Effect of inflammation, smoking and stress on gingival crevicular fluid cytokine level
Authors: Giannopoulou Catherine , Kamma Joanna J. , Mombelli Andrea
Published: March 2003

Background: Recent studies have shown that cytokines are pivotal to the pathogenesis of periodontal diseases and may be used as markers in diagnosis.

Aim: The aim of the present study was to determine the levels of interleukin (IL)‐1β, IL‐4, IL‐6 and IL‐8 in gingival crevicular fluid of periodontally healthy and diseased individuals and to study their association to smoking, stress and clinical periodontal parameters.

Material and methods: A total of 80 patients were included in the study : 20 patients with early onset or aggressive periodontitis (EOP), 20 with chronic adult periodontitis (AP), 20 with gingivitis (G) and 20 patients with healthy periodontium (H). GCF was collected by means of Durapore strips, from four sites per patient, randomly selected in each quadrant. The contents of IL‐ 1β, IL‐4, IL‐6 and IL‐8 were measured in 320 samples by use of commercially available sandwich enzyme‐linked immunoadsorbent assays.

Results: In periodontally diseased subjects the total amounts of IL‐1β, IL‐6 and IL‐8 were significantly elevated as compared to healthy subjects, whereas IL‐4 showed an inverse relationship to periodontal status and higher amounts were found in the healthy group. The amounts of all four cytokines were positively correlated with probing depths. IL‐4, IL‐6 and IL‐8 were significantly correlated to smoking while stress was associated with IL‐1β, IL‐6 and IL‐8 levels.

Conclusions: The present data suggest that crevicular IL‐1β, IL‐6 and IL‐8 reflect the activity of periodontal destruction, whereas IL‐4 shows an inverse correlation to it. The enhanced production of inflammatory cytokines in the presence of smoking and stress may have clinical consequences.
Treatment of gingivitis with hyaluronan
Authors: Jentsch H. , Pomowski R. , Kundt G. , Göcke R.
Published: March 2003

Objectives:  Hyaluronic acid (hyaluronan) is a glycosaminoglycan with anti‐inflammatory and antiedematous properties. It was evaluated in a gel formulation for its effect in the treatment of plaque‐induced gingivitis.

Method:  In a randomised double‐blind study, 50 male subjects with plaque‐induced gingivitis were divided into two groups and used a verum or placebo gel twice daily additionally to oral hygiene for a 3‐week treatment period. Clinical indices (API, Turesky index, PBI) and crevicular fluid variables (peroxidase, lysozyme) were determined at baseline and after 4, 7, 14 and 21 days, respectively.

Results:  Significant improvements could be found for all clinical variables in both groups. The verum group showed significant improvement in the study area for the plaque indices beginning with day 4 (P = 0.011) and the PBI beginning with day 7 (P = 0.001) in comparison with the placebo group. The crevicular fluid variables were significantly improved in the centre of the studied inflammation area in the verum group. Here all studied sites had significant decreases in peroxidase (176.72–128.75 and 188.74–128.75 U/L) and lysozyme (1.27–0.27 and 1.30–0.33 mg/L) activities after 7, 14 and 21 days (P between 0.034 and < 0.001), whereas in the placebo group only one site showed a significant decrease for lysozyme (1.74–0.75 mg/L) after 7 and 21 days (P = 0.048 and 0.025).

Conclusions:  These data suggest that a hyaluronan containing gel has a beneficial effect in the treatment of plaque‐induced gingivitis.
Reliability and validity of the Dental Indifference Scale in a population of 18‐year‐olds in Norway
Authors: Skaret Erik , Raadal Magne , Kvale Gerd , Berg Einar
Published: March 2003

Abstract – Objectives: The aims of this study were to estimate the reliability and validity of the Dental Indifference Scale (DIS) (Nuttall, 1996) in a population of 18‐yr‐olds in Norway. Methods: The DIS‐scale was mailed to a sample of 1119 18‐yr‐olds in two Norwegian counties. Nearly 87% completed the questionnaire and consented to the collection of data from their dental records. Ten percent of the sample, drawn at random, was asked to complete the questionnaire a second time, after a time delay of 15 weeks (response rate 83%). The reliability estimation of the sum‐scores of DIS was based on Pearson's correlation between test‐retest scores and internal consistency (Cronbach's alpha). The frequency of missed appointments from age 12, recorded in the dental treatment records, was used as the validating criterion. The validity was analyzed by Pearson's correlation, and stepwise multiple regression. Results: The correlation coefficient (Pearson) for the test‐retest comparison was 0.43. The correlation coefficient between the DIS‐scores and the frequencies of missed dental appointments was 0.24. The Cronbach's Alpha coefficient for the eight DIS‐questions was 0.35 (n=868). Only two of the eight DIS‐questions entered the stepwise regression model and explained 15% of the variance of the frequency of missed appointments. Conclusions: The Dental Indifference Scale (DIS) was found to have a low reliability and validity in this study population, and it is recommended that it should not be used without further investigation. It may be necessary to design an alternative instrument if further work into the hypothesized trait of dental indifference is to be undertaken.
Effect of diagnostic threshold on the validity and reliability of epidemiological caries diagnosis using the Dundee Selectable Threshold Method for caries diagnosis (DSTM)
Authors: Fyffe Hazel E. , Deery Chris , Nugent Zoann J. , Nuttall Nigel M. , Pitts Nigel B.
Published: March 2003

Abstract – Objectives: To develop a method for recording dental caries at the D1 (enamel and dentine) diagnostic threshold (without loss of D3 information) and assess its reliability, ‘benchmark’ validity and potential effects on reported caries prevalence and needs assessment. Methods: Multi‐examiner training, calibration and validation trial. Two groups of 10 dental examiners were trained to diagnose dental caries at the D1 (enamel and dentine) diagnostic threshold under the conditions of a caries prevalence survey, prior to a calibration trial being undertaken. Results: Where ‘experienced examiners’ were trained to examine at the D1 (enamel and dentine) diagnostic threshold, under the conditions of a cross‐sectional epidemiological survey, there was no significant deterioration in inter‐examiner agreement on the assessment of teeth and a significant difference in one of two comparisons on the assessment of surfaces using the kappa statistic. Assessed against a benchmark examiner, there was no significant loss of sensitivity at the D1 diagnostic threshold compared with the D3 threshold and, although there was a significant loss of specificity at the D1 threshold, all specificity values could be considered to be high. Conclusions: Modifying the diagnostic criteria typically used in surveys of caries prevalence (to allow assessment of the levels of enamel caries which could benefit from preventive care as well as dentinal caries requiring restorative care) in adolescents does not adversely affect the reliability or benchmark validity of experienced examiners to a significant degree.
Oral hygiene in 12‐year‐old disabled children in Flanders, Belgium, related to manual dexterity
Authors: Martens Luc , Marks Luc , Goffin Guy , Gizani Sotiria , Vinckier Frans , Declerck Dominique
Published: March 2003

Abstract – As part of a larger epidemiological survey of a stratified sample of 12‐year‐old handicapped children in Flanders, Belgium, the present study describes gingival health, gingival hypertrophy, oral cleanliness and the presence of calculus. Statistical analysis was performed with motor skills, brushing help, the use of chemical agents, the use of anti‐epilectic drugs, the knowledge of parents and educators (or caregivers) and their opinion of the oral hygiene of their children/pupils as response variables. From this study, it became clear that mildly mentally retarded and learning‐impaired children had significantly better manual dexterity skills than moderately and severely mentally retarded and physically impaired children. However, this was not reflected in improved oral hygiene. The use of chemical plaque controlling agents was found to be extremely low and, with the exception of children with gingival hyperplasia, the users of these agents did not have better oral hygiene. No difference was found between subtypes in the opinion of parents and educators on oral status. There was, however, a difference between their assessment and the clinical picture. It was concluded that there was a need for in‐service training programmes in oral health care for educators as well as for parents.
The efficiency of the Community Dental Service in England: a data envelopment analysis
Authors: Buck David
Published: March 2003

Abstract – Objectives: To assess the efficiency with which health authorities’ Community Dental Services provide dental care in England. Methods: A data envelopment analysis of inputs (hours worked by dental officers, therapists, hygienists and others) and outputs (screening, treatment, prevention) of the Community Dental Service (CDS) was conducted. Relative efficiency ratings of the CDS by health authority were further analysed in order to identify external factors which effect efficiency and are outside the control of the Community Dental Service. Results: The relative efficiency of the CDS varies widely in England – on average the CDS is operating at 75% of efficient levels compared to best‐practice services. This could not be explained by plausible factors outside the CDS’s control, such as differences in deprivation and urban‐rural differences between health authorities. Conclusions: These results, if validated by further studies, should be disturbing since many Community Dental Services services appear to be under‐performing. However, this data‐driven study could not uncover the detailed context of an individual service’s performance. A useful next step would be detailed case‐studies of several “star” and under‐performing services to search for deeper reasons underpinning relative performance levels.
Oral health promotion evaluation – time for development
Authors: Watt Richard , Fuller Sabrina , Harnett Robert , Treasure Elizabeth , Stillman‐Lowe Catherine
Published: March 2003

Abstract – Increasing emphasis is now being placed upon the evaluation of health service interventions to demonstrate their effects. A series of effectiveness reviews of the oral health education and promotion literature has demonstrated that many of these interventions are poorly and inadequately evaluated. It is therefore difficult to determine the effectiveness of many interventions. Based upon developments from the field of health promotion research this paper explores options for improving the quality of oral health promotion evaluation. It is essential that the methods and measures used in the evaluation of oral health promotion are appropriate to the intervention. For many oral health promotion interventions clinical measures and methods of evaluation may not be appropriate. This paper outlines an evaluation framework which can be used to assess the range of effects of oral health promotion programmes. Improving the quality of oral health promotion evaluation is a shared responsibility between researchers and those involved in the provision of programmes. The provision of adequate resources and training are essential requirements for this to be successfully achieved.
An assessment of sensitivity to change of the Oral Health Impact Profile in a clinical trial
Authors: Allen P. Finbarr , McMillan Anne S. , Locker David
Published: March 2003

Abstract – Patient‐based assessment of oral health outcomes is of growing interest. Measurement of change following clinical intervention is a key property of a health status measure. To date, most of the research on oral health status measurement has focused on construct and discriminant validity of health status measures. Objectives: The objective of this study was to assess sensitivity to change of an oral – specific health status measure, the Oral Health Impact Profile (OHIP). Methods: Study subjects were in three groups, namely, edentulous/edentate subjects who requested and received complete implant stabilised oral prostheses (IG, n=26), edentulous/edentate subjects who requested implants but received conventional dentures (CDG1, n=22), and edentulous subjects who had new conventional complete dentures (CDG2, n=35). Data were collected pre‐ and post‐operatively using the OHIP and a validated denture satisfaction questionnaire. Results: All subjects reported similar low levels of denture satisfaction pre‐operatively. Denture problems had a more significant impact on oral health‐related quality of life (OHRQL) for implant seekers (IG and CDG1 subjects) than subjects seeking conventional dentures (CDG2). Following treatment, significant improvement in satisfaction with oral prostheses and OHRQL was reported by IG and CDG2 subjects; the level of improvement was more moderate for CDG1 subjects. OHIP change scores were correlated with denture satisfaction change scores. Conclusions: It was concluded that sensitivity to change of the OHIP was good. This property was not improved by using statement weights.
Emergence of permanent teeth in Tanzanian children
Authors: Mugonzibwa Emeria A. , Kuijpers‐Jagtman Anne M. , Laine‐Alava Maija T. , Van‘t Hof Martin A.
Published: March 2003

Abstract –

Objective:  The aim of the present study was to investigate the emergence of permanent teeth among Tanzanian children.

Methods: A total of 869 Tanzanian children were recruited from 16 schools in age groups 3.5–5, 6.5–8, 9.5–11 and 15–16 years of whom 428 (49%) were boys and 441 (51%) were girls. The effects of age and gender on the emergence stages of the dentition were determined for the four age groups.

Results: Girls, but not boys, had some permanent maxillary canines, second premolars and mandibular and maxillary second molars as early as at the age of 6.5–8 years. Permanent teeth of both the first and the second transitional periods were already emerging at the age of 3.5–5 years and 6.5–8 years, respectively. At 3.5–5 years, 9% of the permanent teeth belonging to the first transitional period were already in occlusion. Emergence of incisors and first molars was more advanced in girls than in boys in age groups 3.5–5 and 6.5–8 years.

Conclusions: Parallel to earlier reports on different ethnic groups, the results of this study indicate that the permanent teeth of Tanzanian children erupt earlier in girls than in boys, and the mandibular teeth erupt earlier than the corresponding maxillary teeth. The difference between boys and girls was found in both the first and second transitional period. Permanent teeth in Tanzanian children clearly emerge earlier than in Caucasian children.
Use of specific dental treatment procedures by dentate adults during a 24‐month period
Authors: Gilbert Gregg H. , Shelton Brent J. , Duncan R. Paul
Published: March 2003

Abstract –

Objectives: To (a) describe the incidence of use of specific dental services; (b) test the hypothesis that certain predisposing, enabling, and need (PEN) factors are differentially predictive of service use; and (c) test the hypothesis that even with other PEN factors taken into account, race and household income are differentially predictive of certain dental services. Previously, this study identified PEN factors that predicted use of any care; herein we identify whether these same factors were differentially predictive of specific service use among users of at least one service.

Methods:  The Florida Dental Care Study was a longitudinal study of persons aged 45 years or older who had at least one tooth. Subjects participated for interviews and clinical examinations at baseline and 24 months later, with 6‐monthly telephone interviews between those times.

Results:  Seventy‐seven percent of subjects reported one or more visits. Results from a single multivariate multiple logistic regression suggested that even once analysis was limited to persons who used at least one dental service, at least one measure from each of the PEN domains was predictive of specific dental service use.

Conclusions:  Each PEN domain was predictive of service use, even once limited to persons with at least one visit. Even with differences in other PEN variables taken into account, African‐Americans were much less likely to receive dental cleanings, restorative dentistry and fixed prosthodontic services, and were much more likely to have a tooth extracted. Household income was predictive of receipt of fixed prosthodontic services, but not other service categories.
Oral hygiene instructions and dietary sugar advice received by adolescents in 1989 and 1997
Authors: Honkala Sisko , Honkala Eino , Rimpelä Arja , Vikat Andres
Published: March 2003

Objectives: The aim of this study was to find out how commonly adolescents receive oral hygiene instructions and dietary sugar advice in the Finnish public oral health care system and whether there have been any changes between 1989 and 1997. Methods: The data were collected as part of a nationwide research program, the Adolescent Health and Lifestyle Survey. Since 1977, a questionnaire has been sent every second year to a representative sample of 12‐, 14‐, 16‐ and 18‐year‐old Finns eligible for free comprehensive oral health care. The sample size was 3105 in 1989 and 8390 in 1997. Results: Almost all adolescents (95–96%) had visited a dentist during the last 2 years. In all age groups, boys reported having received toothcleaning instructions during their dental visit more often than girls did (40%/35%). There was only a minor decrease in instructions received between 1989 and 1997. Boys and those who brushed their teeth once a day or less often were the most likely to receive instructions in 1997. Only one‐fifth of adolescents reported having received dietary sugar advice, and there was a slight decrease between 1989 and 1997. In 1997, the groups of adolescents most likely to be advised were 12–16‐year‐old‐boys, those using sweets daily and those living in Central Finland. Conclusions: Oral health instructions were only given to a minority of adolescents. The targeting of adolescents with health‐damaged behavior is therefore important.