bluuebunny/crossref_metadata_2025 huggingface dataset:
Insulin Resistance and Periodontal Disease: An Epidemiologic Overview of Research Needs and Future Directions
Authors: Donahue Richard P. , Wu Tiejian
Published: February 2005

Poor periodontal health is known to be associated with Type 2 diabetes mellitus (DM). This relationship and underlying mechanisms are discussed elsewhere in this issue. Less is known concerning the link between the metabolic precursors to DM, including insulin resistance (IR), and its possible association with periodontitis. Indeed, there has been relatively little research to date in human populations concerning periodontal disease, IR, and the subsequent risk of chronic diseases, including DM. This paper will present an epidemiologist's view of how IR may link periodontal disease with DM and suggest several avenues of investigation to help clarify some of the outstanding issues. Ann Periodontol 2001;6:119‐124.
The Relationship Between Infections and Adverse Pregnancy Outcomes: An Overview
Authors: Gibbs Ronald S.
Published: February 2005

Preterm birth with its subsequent morbidity and mortality is the leading perinatal problem in the United States. Infants born before the thirty‐seventh week of gestation account for approximately 6% to 9% of all births, but 70% of all perinatal deaths and half of all long‐term neurologic morbidity. Current approaches focus on symptomatic treatment. Despite widespread use of drugs to arrest preterm labor (tocolytics), there has been no decrease in low birth weight or preterm infants in the last 20 years. It is likely that therapy directed at preventing or treating underlying causes would be more successful. Evidence from many sources links preterm birth to symptomatic infections, for example, of the urinary or respiratory tracts. In the last decade, great interest has been generated to support the hypothesis that subclinical infection is an important cause of preterm labor. Evidence to support this may be categorized as follows: histological chorioamnionitis is increased in preterm births; clinical infection is increased after preterm birth; there is significant association of some lower genital tract organisms and infections with preterm birth or preterm premature rupture of the membranes; there are positive cultures of amniotic fluid or membranes from some patients with preterm labor and preterm birth; there are markers of infections in preterm birth; bacteria or their products induce preterm birth in animal models; and some antibiotic trials have shown a lower rate of preterm birth or have deferred preterm birth. In the last 5 years, additional exciting information has suggested that not only is subclinical infection responsible for preterm birth but also many serious neonatal sequelae including periventricular leukomalacia, cerebral palsy, respiratory distress, and even bronchopulmonary dysplasia and necrotizing enterocolitis. In sum, a large body of clinical and laboratory information suggests that subclinical infection is a major cause of preterm birth, especially those occurring before 30 weeks. This concept holds promise that new approaches can be developed to prevent prematurity. Ann Periodontol 2001;6:153‐163.
Coagulation and Thrombosis in Cardiovascular Disease: Plausible Contributions of Infectious Agents
Authors: Herzberg Mark C.
Published: February 2005

An occlusive thrombus in the coronary arteries is the critical pathological event that immediately precedes most cases of myocardial infarction. Often the thrombus originates with a bleed from a fissured atheroma. Atheroma formation, therefore, creates risk of thrombosis; asymptomatic episodes of thrombosis and healing contribute to the pathogenesis of atherosclerosis and the development of atherosclerotic plaques. Based largely on in vitro and animal model evidence, infectious agents and their products can activate the coagulation cascade enzymatically or by up‐regulating tissue factor. By initiating a procoagulant response, infectious agents can indirectly trigger a prothrombotic response. Alternatively, some microbes can directly trigger platelet aggregation in vitro and in animal models, suggesting direct prothrombotic potential in human cardiovascular disease. Activation of coagulation and thrombosis characterizes the pathological response to infectious agents in human disseminated intravascular coagulation and infective endocarditis. Given the underlying biological plausibility, the cumulative lifetime burden of chronic pathogens may be expected to create risk of atherosclerosis and thrombosis, and, indirectly, signs of cardiovascular disease. Ann Periodontol 2001;6:16‐19.
Maternal Periodontitis and Prematurity. Part I: Obstetric Outcome of Prematurity and Growth Restriction
Authors: Offenbacher S. , Lieff S. , Boggess K.A. , Murtha A.P. , Madianos P.N. , Champagne C.M.E. , McKaig R.G. , Jared H.L. , Mauriello S.M. , Auten R.L. , Herbert W.N.P. , Beck J.D.
Published: February 2005

Oral Conditions and Pregnancy (OCAP) is a 5‐year prospective study of pregnant women designed to determine whether maternal periodontal disease contributes to the risk for prematurity and growth restriction in the presence of traditional obstetric risk factors. Full‐mouth periodontal examinations were conducted at enrollment (prior to 26 weeks gestational age) and again within 48 hours postpartum to assess changes in periodontal status during pregnancy. Maternal periodontal disease status at antepartum, using a 3‐level disease classification (health, mild, moderate‐severe) as well as incident periodontal disease progression during pregnancy were used as measures of exposures for examining associations with the pregnancy outcomes of preterm birth by gestational age (GA) and birth weight (BW) adjusting for race, age, food stamp eligibility, marital status, previous preterm births, first birth, chorioamnionitis, bacterial vaginosis, and smoking. Interim data from the first 814 deliveries demonstrate that maternal periodontal disease at antepartum and incidence/progression of periodontal disease are significantly associated with a higher prevalence rate of preterm births, BW <2,500g, and smaller birth weight for gestational age. For example, among periodontally healthy mothers the unadjusted prevalence of births of GA <28 weeks was 1.1%. This was higher among mothers with mild periodontal disease (3.5%) and highest among mothers with moderate‐severe periodontal disease (11.1%). The adjusted prevalence rates among GA outcomes were significantly different for mothers with mild periodontal disease (n = 566) and moderate‐severe disease (n = 45) by pair‐wise comparisons to the periodontally healthy reference group (n = 201) at P = 0.017 and P <0.0001, respectively. A similar pattern was seen for increased prevalence of low birth weight deliveries among mothers with antepartum periodontal disease. For example, there were no births of BW <1000g among periodontally healthy mothers, but the adjusted rate was 6.1% and 11.4% for mild and moderate‐severe periodontal disease (P = 0.0006 and P <0.0001), respectively. Periodontal disease incidence/progression during pregnancy was associated with significantly smaller births for gestational age adjusting for race, parity, and baby gender. In summary, the present study, although preliminary in nature, provides evidence that maternal periodontal disease and incident progression are significant contributors to obstetric risk for preterm delivery, low birth weight and low weight for gestational age. These studies underscore the need for further consideration of periodontal disease as a potentially new and modifiable risk for preterm birth and growth restriction. Ann Periodontol 2001;6:164‐174.
Maternal Periodontitis and Prematurity. Part II: Maternal Infection and Fetal Exposure
Authors: Madianos P.N. , Lieff S. , Murtha A.P. , Boggess K.A. , Auten R.L. , Beck J.D. , Offenbacher S.
Published: February 2005

Clinical data from the first 812 deliveries from a cohort study of pregnant mothers entitled Oral Conditions and Pregnancy (OCAP) demonstrate that both antepartum maternal periodontal disease and incidence/progression of periodontal disease are associated with preterm birth and growth restriction after adjusting for traditional obstetric risk factors. In the current study we present measures of maternal periodontal infection using whole chromosomal DNA probes to identify 15 periodontal organisms within maternal periodontal plaque sampled at delivery. In addition, maternal postpartum IgG antibody and fetal exposure, as indexed by fetal cord blood IgM level to these 15 maternal oral pathogens, was measured by whole bacterial immunoblots. The potential role of maternal infection with specific organisms within 2 bacterial complexes most often associated with periodontitis, conventionally termed “Orange” (Campylobacter rectus, Fusobacterium nucleatum, Peptostreptococcus micros, Prevotella nigrescens, and Prevotella intermedia) and “Red” (Porphyromonas gingivalis, Bacteroides forsythus, and Treponema denticola) complexes, respectively, to prematurity was investigated by relating the presence of oral infection, maternal IgG, and fetal cord IgM, comparing full‐term to preterm (gestational age <37 weeks). The prevalence of 8 periodontal pathogens was similar among term and preterm mothers at postpartum. There was a 2.9‐fold higher prevalence of IgM seropositivity for one or more organisms of the Orange or Red complex among preterm babies, as compared to term babies (19.9% versus 6.9%, respectively, P = 0.0015, chi square). Specifically, the prevalence of positive fetal IgM to C. rectus was significantly higher for preterm as compared to full‐term neonates (20.0% versus 6.3%, P = 0.0002, as well as P. intermedia(8.8% versus 1.1%, P = 0.0003). A lack of maternal IgG antibody to organisms of the Red complex was associated with an increased rate of prematurity with an odds ratio (OR) = 2.2; confidence interval (CI) 1.48 to 3.79), consistent with the concept that maternal antibody protects the fetus from exposure and resultant prematurity. The highest rate of prematurity (66.7%) was observed among those mothers without a protective Red complex IgG response coupled with a fetal IgM response to Orange complex microbes (combined OR 10.3; P <0.0001). These data support the concept that maternal periodontal infection in the absence of a protective maternal antibody response is associated with systemic dissemination of oral organisms that translocate to the fetus resulting in prematurity. The high prevalence of elevated fetal IgM to C. rectus among premature infants raises the possibility that this specific maternal oral pathogen may serve as a primary fetal infectious agent eliciting prematurity. Ann Periodontol 2001;6:175‐182.
Epidemiologic Associations Between Periodontal Disease and Chronic Obstructive Pulmonary Disease
Authors: Garcia Raul I. , Nunn Martha E. , Vokonas Pantel S.
Published: February 2005

The nature of the relationship of periodontal disease to a number of systemic health outcomes, including chronic obstructive pulmonary disease (COPD), remains unclear. Various causal mechanisms have been proposed to explain the observed epidemiologic associations between periodontal diseases and respiratory diseases. We have reviewed the epidemiologic and clinical evidence for this association. The methodologic approach we have taken is based on a structured systematic review of the indexed biomedical literature on these subjects. The primary focus of this review was on the analysis of periodontal health status measures and their association with COPD, which includes chronic bronchitis and emphysema. We found that a paucity of published results exist on this specific relationship and those which do exist typically represent secondary analyses of existing data sets. Nevertheless, the epidemiologic evidence identified in this systematic review indicates that worse periodontal health status is associated with an increased risk of COPD, with odds ratios ranging from 1.45 to 4.50 (significant at the 95% confidence interval). However, it is possible that residual confounding by tobacco smoking may account in part for the observations. A causal association between periodontal health status and risk of COPD, although biologically plausible, remains speculative. Randomized controlled trials will be required in order to address the question of causality and to better understand the biological basis of these epidemiologic associations. Ann Periodontol 2001;6:71‐77.
Population Studies of Microbial Ecology in Periodontal Health and Disease
Authors: Papapanou Panos N.
Published: February 2005

It has been established that the bacterial diversity in any given environment is severely underestimated when assessed by means of culture‐based techniques. Yet, almost all currently available knowledge related to the periodontal microbiota in health and disease has been generated either by culture‐based surveys or by methods that require prior species identification by culture. A handful of recent studies using culture‐independent molecular methods providing 16S rRNA sequences for both cultivable and not yet cultivated species of human periodontal bacteria demonstrated a high bacterial diversity in the oral cavity. It has been estimated that approximately 500 species may colonize the human oral cavity, half of which have been cultivated to date.

A review of the available epidemiological data on the prevalence of certain periodontal microbiota on a population level reveals considerable variation in estimates with respect to 1) sampling strategy, 2) mode of bacterial identification, and 3) race/ethnicity of the studied population. Nevertheless, specific bacterial profiles appear to confer high odds ratios for pathological periodontal conditions and/or progressive periodontal disease. However, the currently recognized periodontal pathogens are commonly recovered from periodontally healthy children, and their carrier rate in adults is substantial. Virulent clones, such as a highly leukotoxic strain of Actinobacillus actinomycetemcomitans, have been found to be closely associated with aggressive forms of periodontitis.

In conclusion, while the majority of the periodontal microbiota are commensals, a subset of likely opportunistic pathogens fulfills the epidemiologic requirements needed in order to be ascribed as risk/causative factors. Given the large proportion of the periodontal microbial habitat that is currently insufficiently explored, and assuming that the hitherto uncultivated segment of the bacterial community will include similar levels of pathogenic species, the list of periodontal pathogens should be expected to expand. Ann Periodontol 2002;7:54‐61.
The Use of the Evidence‐Based Approach in a Periodontal Therapy Contemporary Science Workshop
Authors: Newman Michael G. , Caton Jack G. , Gunsolley John C.
Published: February 2005

Background: When appropriately evaluated and carefully managed, the integration of emerging technology into practice can improve health and enhance the quality of life. Since the last American Academy of Periodontology Workshop in 1996, great technological advances in the areas of data access, retrieval, and management have been made. The World Wide Web has “exploded” with great possibilities for gathering data from many sources. Evaluation methods such as meta‐analysis and modeling have likewise improved, permitting a more objective and useful assessment of the retrieved information. The purpose of this paper is to demonstrate how the evidence‐based (EB) approach was used to plan and implement a consensus conference on periodontal therapy, the Workshop on Contemporary Science in Clinical Periodontics.

Rationale:The methodologies and philosophies associated with the EB approach provided the ideal framework for assessing the applicability of the newest clinical research to patient therapy.

Methods: Evidence‐based systematic reviews on 15 topics associated with contemporary clinical periodontal practice were conducted prior to the Workshop. High standards of scientific rigor and scholarly ideals were stressed throughout the process. At the highly structured conference the reviews served as the basis for development of consensus reports that include implications for practice and research.

Material Covered:

The rationale, design, and implementation of a conference on contemporary clinical periodontics using an evidence‐based approach.

Data management, clinical versus statistical significance, and the challenges of technology transfer and dissemination.

The benefits and limitations of using the EB approach in a consensus conference.

Conclusions:

The consensus statements resulting from the conference should serve to augment clinical decision‐making, research priorities, education, and reimbursement.

The evidence‐based approach removed much of the subjectivity traditionally associated with classical reviews of the literature and allowed participants to focus on substantive issues.

Ann Periodontol 2003;8:1‐11.
Surgical Therapies for the Treatment of Gingival Recession. A Systematic Review
Authors: Oates Thomas W. , Robinson Melanie , Gunsolley John C.
Published: February 2005

Background: A variety of soft tissue augmentation procedures directed at root coverage have been documented in the literature utilizing autogenous or allogenic soft tissue grafting or guided tissue regeneration (GTR).

Rationale: The purpose of this systematic review was to assess the literature regarding the efficacies of various surgical gingival augmentation procedures relative to clinical and patient‐oriented outcomes.

Focused Question: What is the effect of surgical therapy for root coverage in patients with gingival recession compared with other treatment modalities or baseline values?

Search Protocol: PubMed and the Cochrane Oral Health Group Trials Register were searched to identify human studies in English investigating the therapeutic use of a soft tissue surgical procedure to treat gingival recession. Searches were performed for articles published by April 2002.

Selection Criteria: Initial screening of identified abstracts accepted all studies evaluating surgical intervention of gingival recession. Independent review by 2 reviewers evaluated full‐text reports regarding study characteristics. Only those studies determined to be randomized clinical trials (RCTs) were included in the final analysis.

Data Analysis and Collection: Outcome measures included changes in root coverage, clinical attachment levels (CAL), probing depth (PD), and width of keratinized tissue (KT). The only data suitable for metaanalysis were comparisons of the efficacy of connective tissue grafts with GTR.

Main Results

Thirty‐two articles (total study population: 687) met the criteria for RCTs: 11 (population: 286) related to various autogenous soft tissue augmentation procedures; 18 (population: 360) to GTR; and 3 (population: 41) to allogenic soft tissue augmentation

Meta‐analysis identified greater gains in both root coverage and keratinized tissue width for connective tissue graft procedures compared to GTR.

No other data were compatible with meta‐analysis.

Reviewers' Conclusions

Soft tissue augmentation procedures are effective means of obtaining root coverage.

Connective grafting techniques appear to have an advantage over GTR.

There is a need for further efficacy studies and for investigation of these procedures relative to patientoriented outcomes such as esthetics, root sensitivity, and postoperative morbidities.

Ann Periodontol 2003;8:303‐320.
Localized Ridge Augmentation/Preservation. A Systematic Review
Authors: Fiorellini Joseph P. , Nevins Marc L.
Published: February 2005

Background: Osseointegrated implants have been documented as efficacious, however, their placement may be contraindicated in some patients due to insufficient bone volume. Techniques such as guided bone regeneration (GBR), immediate implantation, and distraction osteogenesis (DO) have been utilized as ridge enhancement therapies.

Rationale: This systematic review evaluates dental implant survival rates in patients treated with ridge augmentation or preservation techniques.

Focused Question: In patients requiring dental implant placement, what is the effect of localized ridge preservation versus implant placement without augmentation on implant survival and adverse effects?

Search Protocol: MEDLINE and Cochrane Oral Health Group Specialized Trial Register were searched. Hand searches were performed on Clinical Oral Implants Research, International Journal of Oral and Maxillofacial Implants, International Journal of Periodontics and Restorative Dentistry, Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research. All searches were performed for articles published through April 2002.

Selection Criteria:Publications reporting survival rate of dental implants following ridge therapy were included in the analysis. Reports describing techniques were excluded.

Data Collection and Analysis:Due to the absence of controlled studies, a meta‐analysis was not performed. Descriptive statistics are used to report the data.

Main Results

A total of 18 studies were included: 13 reporting on guided bone regeneration (GBR, 1,741 patients) and 5 on distraction osteogenesis (DO, 92 patients).

There is a high level of predictable implant survival in sites treated by GBR or DO.

These survival rates are similar to those of implants placed in native bone.

Reviewers' Interpretations: Survival rates were similar for both GBR and DO implants. These survival rates were similar to implants placed in native bone.

Ann Periodontol 2003;8:321‐327.
Gingival Recession, Gingival Bleeding, and Dental Calculus in Adults 30 Years of Age and Older in the United States, 1988‐1994
Authors: Albandar J.M. , Kingman A.
Published: February 2005

Background: The aim of this study was to assess the prevalence and extent of gingival recession, gingival bleeding, and dental calculus in United States adults, using data collected in the third National Health and Nutrition Examination Survey (NHANES III).

Methods: The study group consisted of 9,689 persons 30 to 90 years of age obtained by a stratified, multi‐stage probability sampling method in 1988 to 1994. The weighted sample is representative of U.S. adults 30 years or older and represents approximately 105.8 million civilian, non‐institutionalized Americans. Gingival recession, gingival bleeding, and dental calculus were assessed at the mesio‐buccal and mid‐buccal surfaces in 2 randomly selected quadrants, one maxillary and one mandibular. Data analysis accounted for the complex sampling design used.

Results: We estimate that 23.8 million persons have one or more tooth surfaces with ≥3 mm gingival recession; 53.2 million have gingival bleeding; 97.1 million have calculus; and 58.3 million have subgingival calculus; and the corresponding percentages are 22.5%, 50.3%, 91.8%, and 55.1% of persons, respectively. The prevalence, extent, and severity of gingival recession increased with age, as did the prevalence of subgingival calculus and the extent of teeth with calculus and gingival bleeding. Males had significantly more gingival recession, gingival bleeding, subgingival calculus, and more teeth with total calculus than females. Of the 3 race/ethnic groups studied, non‐Hispanic blacks had the highest prevalence and extent of gingival recession and dental calculus, whereas Mexican Americans had the highest prevalence and extent of gingival bleeding. Mexican Americans had similar prevalence and extent of gingival recession compared with non‐Hispanic whites. Gingival recession was much more prevalent and also more severe at the buccal than the mesial surfaces of teeth. Gingival bleeding also was more prevalent at the buccal than mesial surfaces, whereas calculus was most often present at the mesial than buccal surfaces.

Conclusions: Dental calculus, gingival bleeding, and gingival recession are common in the U.S. adult population. In addition to their unfavorable effect on esthetics and self‐esteem, these conditions also are associated with destructive periodontal diseases and root caries. Appropriate measures to prevent or control these conditions are desirable, and this may also be effective in improving the oral health of the U.S. adult population. J Periodontol 1999; 70: 30‐43.
Prevalence of Gingival Overgrowth Induced by Calcium Channel Blockers: A Community‐Based Study
Authors: Ellis Janice S. , Seymour Robin A. , Steele James G. , Robertson Pauline , Butler Tim J. , Thomason J. Mark
Published: February 2005

Background: The prevalence of gingival overgrowth induced by chronic medication with calcium channel blockers is uncertain. Although there have been several studies examining this question, the results are conflicting, with previous estimates ranging from 20% to 83%. There have been only 2 studies examining the prevalence of overgrowth induced by diltiazem and amlodipine, with estimates of 74% and 3.3%, respectively.

Methods: The current study aimed to address the problems associated with these studies by examining a sample of patients taking one of 3 calcium channel blockers, who were drawn from a community‐based population in northeastern England. Nine hundred eleven (911) subjects were recruited from general medical practices in the area. Of these, 442 were taking nifedipine, 181 amlodipine, and 186 diltiazem. In addition, 102 control subjects were examined. Drug and demographic data for each subject were recorded. The periodontal condition of all subjects was assessed including plaque index, papillary bleeding index, and a photograph of the anterior gingivae for subsequent analysis of overgrowth severity.

Results: More than six percent (6.3%) of subjects taking nifedipine were seen to have significant overgrowth. This overgrowth was statistically greater than the amount of overgrowth seen in either of the other 2 drug groups or the control population. The prevalence of gingival overgrowth induced by amlodipine or diltiazem was not statistically significant when compared to the control group. The severity of overgrowth within the nifedipine group was found to be related to the amount of gingival inflammation and also to the gender of the subject, with males being 3 times as likely to develop overgrowth than females.

Conclusions: The prevalence of clinically significant overgrowth related to chronic medication with calcium channel blockers is low, i.e., 6.3% for nifedipine. Males are 3 times as likely as females to develop clinically significant overgrowth. The presence of gingival inflammation is an important cofactor for the expression of this effect. J Periodontol 1999; 70: 63‐67.
Laser Irradiation of Bone: II. Healing Response Following Treatment by CO2 and Nd:YAG Lasers
Authors: Friesen Lynn R. , Cobb Charles M. , Rapley John W. , Forgas‐Brockman Lorraine , Spencer Paulette
Published: February 2005

Background: Currently, the most commonly used lasers for dental procedures are the Nd:YAG and CO2. Studies comparing healing of osteotomy defects prepared with rotary burs to those created by laser irradiation have reported conflicting results. The purpose of this study was to evaluate and compare the histologic healing of bone in rat tibial osteotomy defects created either by a dental bur, CO2 laser with and without removal of the char layer, and Nd:YAG laser with char layer removed and with and without use of an air/water surface cooling spray.

Methods: Tibial osteotomy defects were created in 4 groups of 6 rats each using the following: 1) #6 round bur with simultaneous saline irrigation; 2) CO2 laser with char layer intact; 3) CO2 laser with char layer removed; 4) Nd:YAG laser with air/water surface cooling, and char layer intact; 5) Nd:YAG laser with air/water surface cooling, and char layer removed; and 6) Nd:YAG laser without air/water surface cooling, and char layer removed. Both laser types were used at energy densities typically utilized for oral soft tissue surgery.

Results: Progressive healing from day 0 through day 21 post‐treatment was observed in all treatment groups. However, compared to controls treated by rotary dental bur, those specimens treated by laser, regardless of laser type, energy density, or other parameters, exhibited a delay in healing that appeared to be related to the presence of residual char in the osseous defect. Specimens treated with the Nd:YAG laser using an air/water surface coolant exhibited a decreased thickness and continuity of the char layer and yielded the only specimens with new bone formation at the surface of the laser ablation defect. In addition, the normal pattern of bone remodeling in the rat tibia appeared to have been altered by laser irradiation.

Conclusions: In this animal model, laser‐induced osteotomy defects, when compared to those prepared by rotary bur, exhibited a delayed healing response that appeared to be related to the presence of residual char in the osseous defect. J Periodontol 1999; 70: 75‐83.
Implications of Minocycline, Platelet‐Derived Growth Factor, and Transforming Growth Factor‐Beta on Inflammatory Repair Potential in the Periodontium
Authors: Soory M. , Virdi H.
Published: February 2005

Background: Semisynthetic tetracyclines used in the adjunctive treatment of inflammatory periodontal disease enhance collagen expression in induced periodontal lesions of rats. Polypeptide growth factors regulate key cellular events in tissue repair. The physiologically active androgen 5α‐dihydrotestosterone (DHT) stimulates bone and connective tissue turnover. It was relevant to study the effects of transforming growth factor beta (TGF‐β)/platelet‐derived growth factor (PDGF) and minocycline alone and in combination on the formation of biologically effective androgens which can influence repair.

Methods: Confluent monolayer cultures of human gingival fibroblasts of the fifth through the ninth passage were incubated in Eagle's minimum essential medium, with 14C‐testosterone/14C‐4‐androstenedione in the presence or absence of optimal concentrations of TGF‐β/PDGF/minocycline (M), alone and in combination. At the end of a 24‐hour incubation period, the medium was analyzed for steroid metabolites and quantified using a radioisotope scanner.

Results: The androgen substrates 14C‐testosterone (14C‐T) and 14C‐4‐androstenedione (14C‐4‐A) were metabolized to DHT and 4‐androstenedione/testosterone respectively. There were significant increases in the formation of DHT from 14C‐T in response to M, TGF‐β, and PDGF, alone and in combination (13 to 48%), compared with controls (n = 4; P <0.01). The yields of 4‐androstenedione were also greater in response to these agents (31%; 3‐fold). When 14C‐4‐A was used as substrate, there were 21 to 80% increases in the formation of DHT in response to these agents alone and in combination (n = 4; P <0.01).

Conclusions: The biologically effective androgen metabolites formed in response to minocycline, TGF‐β, and PDGF can contribute to reparatory events in the inflamed periodontium. Judicious, adjunctive usage of the chemically‐modified tetracyclines in the treatment of periodontal diseases can obviate the risk of microbial resistance, with potential applications of their anti‐inflammatory and proanabolic effects in regenerative technology. J Periodontol 1999;70:1136‐1143.
Relationship Between a Self‐Reported Health Questionnaire and Laboratory Tests at Initial Office Visits
Authors: Thompson Kelley S. , Yonke Mary L. , Rapley John W. , Cobb Charles M. , Johnson Valerie
Published: February 2005

Background: Dental patients routinely complete a medical questionnaire and have an oral interview during their initial visit, but may have undiagnosed systemic problems which can affect their dental treatment.

Methods: Thirty‐nine consecutive patients referred for a periodontal evaluation completed a medical questionnaire and an oral interview. They were referred to a hospital laboratory for an urinalysis, complete blood count, and a standard blood chemistry panel.

Results: The self‐reported medical history responses were compared with the laboratory data and several abnormalities were noted. Abnormal levels were found with cholesterol, (26/39 patients, 67%); triglycerides, (13/39, 33%); glucose, (6/39, 15%); eosinophils, (18/39, 46%); and monocytes, (10/39, 26%). Smokers (17/39, 44%) had a higher number of abnormal levels or percentages of cholesterol, triglycerides, basophils, lymphocytes, eosinophils, and monocytes. Gender differences were seen in elevated triglyceride levels, abnormal aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and self‐reported cardiovascular disease.

Conclusions: This study demonstrated that many patients are unaware of their current medical status and a significant number had undiagnosed abnormalities. J Periodontol 1999;70:1153‐1157.
Humoral Immunity to Stress Proteins and Periodontal Disease
Authors: Lopatin Dennis E. , Shelburne Charles E. , Van Poperin Neal , Kowalski Charles J. , Bagramian Robert A.
Published: February 2005

Background: There is evidence that microbial heat shock (stress) proteins (Hsp) are immunodominant antigens of many microorganisms. Immunity to these proteins has been shown in non‐oral infections to contribute to protection. This study was undertaken to assess the relationship(s) between immunity to human and microbial heat shock proteins, periodontal disease status, and colonization by periodontal disease‐associated microorganisms.

Methods: Subgingival plaque and blood samples obtained from 198 patients during an earlier clinical study were examined for the presence of specific periodontal disease‐associated microorganisms and antibodies to selected human and microbial heat shock proteins (Hsp70, Hsp90, DnaK, and GroEL). Particle concentration immunofluorescence assay (PCFIA) was used to detect anti‐Hsp antibodies and slot immunoblot assay (SIB) was used to detect subgingival plaque species. Regression models were used to examine the contribution of age, gender, gingival index, probing depth, attachment loss, calculus index, plaque index, and microbial colonization to the anti‐Hsp antibody concentrations.

Results: Our studies demonstrated that, when evaluated by ANOVA, patients with higher anti‐Hsp (Hsp90, DnaK, and GroEL) antibody concentrations tended to have significantly (P ≤0.05) healthier periodontal tissues. This was most obvious when the relationship between mean probing depths and antibody concentrations were studied. For Hsp90 antibodies, 2 variables (probing depth and P. gingivalis concentration) were found to have significant contributions (R = 0.293, P <0.0002). The equation derived from the regression model was y = 12558 − 2070* PD + 1842* PG. This confirmed the inverse relationship with probing depth and the positive relationship with colonization by P. gingivalis. Attempts to model the other stress protein antibodies were not successful.

Conclusions: We believe that the present observations reflect the presence of protective anti‐Hsp antibodies, rather than simply the presence of the microorganism in the gingival sulcus. The clinical significance of these observations lies in the potential of identifying patients who are at risk for developing periodontal disease based on their inability to mount an immune response to specific Hsp or Hsp epitopes, as well as the development of vaccines based on Hsp epitopes. J Periodontol 1999;70:1185‐1193.
Arbitrarily Primed‐Polymerase Chain Reaction for Identification and Epidemiologic Subtyping of Oral Isolates of Fusobacterium nucleatum
Authors: Avila‐Campos Mario J. , Sacchi Cláudio T. , Whitney Anne M. , Steigerwalt Arnold G. , Mayer Leonard W.
Published: February 2005

Background: Fusobacterium nucleatum is the most frequently isolated bacterium in periodontal disease and plays an important role in serious infections in other parts of the body. Arbitrarily primed‐polymerase chain reaction (AP‐PCR) was used to construct primers for specific identification and subtyping of F. nucleatum. Subtypes may differ in virulence and, hence, are important as periodontal pathogens. Subtypes also may differ in antibiotic susceptibility; therefore, knowing the subtypes may influence choice of treatment.

Methods: We analyzed 70 DNA samples of F. nucleatum isolated from patients with periodontal disease (PD) (N = 32) or AIDS‐related PD (N = 8) and from healthy carriers (N = 30). From 90 AP‐PCR primers screened, five amplification products were selected, cloned in pCR II vector, and sequenced. These sequences were used to design new pairs of specific primers. Sequences were compared to GenBank entries with BLAST and showed no significant matches.

Results: Three primer pairs produced bands of approximately 1 Kb (primer 5059S) or 0.5 Kb (primers FN5047 or M1211) with all F. nucleatum DNAs tested. PCR amplification using primer pair M8171 produced a 1 Kb band with isolates from 7 (22%) PD and 5 (63%) PD‐AIDS patients and 9 (30%) healthy controls. Using the same primer pair, 2 other bands of approximately 0.5 Kb and 0.4 Kb were observed with DNA from isolates from 2 (6%) PD and all PD‐AIDS patients, but were not observed with DNA samples from healthy controls (P <0.0001). All the primer pairs produced no or different amplicon profiles with DNA samples from bacterial species other than F. nucleatum.

Conclusions: Our results suggest that PCR primer pairs 5059S, FN5047 or M1211 can be used to specifically identify F. nucleatum isolates and distinguish them from other bacteria. The primer pair M8171 could also be used to differentiate F. nucleatum isolated from periodontal patients or healthy individuals. These specific primers can be used in PCR analysis for specific identification of F. nucleatum and to distinguish it from other bacteria associated with human periodontitis. These approaches appear promising in facilitating laboratory identification, molecular subtyping, and taxonomy of putative periodontopathogens. J Periodontol 1999;70:1202‐1208.
Progression and Treatment of Chronic Adult Periodontitis
Authors: Preshaw Philip M. , Lauffart Brenda , Zak Elena , Jeffcoat Marjorie K. , Barton Ian , Heasman Peter A.
Published: February 2005

Background: The periodontal status of 41 medically healthy adults with untreated chronic periodontitis was monitored before and after scaling and root planing (SRP).

Methods: During a 6‐month pretreatment phase, clinical measurements, digital subtraction radiography (DSR) analysis of alveolar bone, and measurement of gingival crevicular fluid (GCF) prostaglandin E2 (PGE2) levels were undertaken. SRP was provided during a 1‐month treatment phase. Clinical, radiographic, and biochemical analyses were repeated in a 6‐month post‐treatment healing period.

Results: Pretreatment: no clinically significant changes in mean plaque indices (PI), probing depths (PD), bleeding on probing (BOP), or relative clinical attachment levels (CAL) were detected (P >0.05). DSR revealed small but statistically significant bone height (0.04 mm) and mass (0.97 mg) loss (P <0.001). GCF PGE2 levels gradually increased from 38.8 ng/ml at month 1 to 79.4 ng/ml at month 6. Post‐treatment: statistically and clinically significant reductions were observed in mean PI, BOP, and PD (P <0.05). A statistically significant reduction in CAL was noted (P <0.05). The trend towards progressive bone loss was halted and reversed, and a statistically significant decrease in GCF PGE2 concentrations was detected (P <0.001). Smokers, non‐smokers, and ex‐smokers did not differ significantly in PI, BOP, CAL, radiographic, or biochemical parameters at any time. Mean PD was significantly greater in current smokers than in non‐ and ex‐smokers (P <0.005). PD reduced comparably in all 3 smoking subgroups following treatment (P <0.01).

Conclusions: Conventional clinical measurements failed to identify disease progression over a 6‐month period. Significant improvements were observed in clinical parameters after SRP, and a trend towards progressive bone loss was halted and reversed. Regular and frequent maintenance visits are important following treatment to maintain improvements in clinical parameters. Smokers had deeper probing depths than non‐ and ex‐smokers, but pockets were reduced significantly and comparably in all 3 smoking subgroups following efficacious treatment. J Periodontol 1999;70:1209‐1220.
Assessment of a Novel Screening Test for Neutrophil Collagenase Activity in the Diagnosis of Periodontal Diseases
Authors: Mancini Sabrina , Romanelli Raquel , Laschinger Carol A. , Overall Christopher M. , Sodek Jaro , McCulloch Christopher A.G.
Published: February 2005

Background: Increased levels of active neutrophil collagenase (MMP‐8) in the gingival crevicular fluid (GCF) are associated with progressive periodontitis. The measurement of this enzyme in GCF could facilitate diagnosis. However, assays with sufficient sensitivity to detect collagenase in whole‐mouth GCF currently use radiolabeled substrates and require several days to complete. To provide more rapid analyses of collagenase activity that are better adapted to clinical studies, we developed and validated a novel assay (soluble biotinylated‐collagen assay: SBA) based on chemiluminescent detection of biotinylated collagen digestion products.

Methods: The concordance of the novel SBA assay with a radioactive collagen substrate assay was assessed by parallel analyses of enzyme from 35 neutrophil preparations and from 41 samples of GCF from periodontitis patients, followed by Pearson correlation analysis. To test whether the assay appropriately measured MMP‐8 activity, enzyme activity was assessed after incubation with specific collagenase blockers. We examined the diagnostic utility of the SBA in cross‐sectional and longitudinal analyses of 125 patients with adult periodontitis, 5 patients with early‐onset periodontitis, 1 edentulous patient, and in 32 control patients without periodontitis.

Results: The assay detected <56 pg collagen degraded/hour/μl sample, which is comparable to the most sensitive radioactive assay. The total assay time was 22 hours and reproducibility on replicate measurements was high (r = 0.96). In direct comparisons of MMP‐8 activity in GCF with enzyme from peripheral blood neutrophils using the SBA and radioactive assays, there was a high correlation (r = 0.97). As expected, EDTA and TIMP‐1 and ‐2, known inhibitors of MMP‐8, completely blocked enzyme activity with this assay. Cross‐sectional and longitudinal analyses of GCF showed that MMP‐8 activity was >18‐fold higher in severe periodontitis than in stable periodontitis and decreased to < 25% of pretreatment levels following therapy. Based on measurements of collagenase activity in different disease groups, we estimated a value of 80 nano units as a threshold for severe periodontitis.

Conclusions: These results indicate that active MMP‐8 is detected in GCF by a novel assay that is specific, simple, rapid, and reproducible and which may facilitate diagnostic discrimination between stable and progressive lesions. J Periodontol 1999;70:1292‐1302.
The Association Between Smoking Cessation and Periodontal Status and Salivary Proteinase Levels
Authors: Liede Kirsti E. , Haukka Jari K. , Hietanen Jarkko H.P. , Mattila Mika H. , Rönkö Hanne , Sorsa Timo
Published: February 2005

Background: Little information is available about the effects of the cessation of cigarette smoking on oral health, although cigarette smoking has been shown to be associated with a variety of oral diseases. The aim of this study was to compare periodontal status, salivary proteolytic activity, especially collagenase‐2 (MMP‐8) levels, and oral mucosal status in individuals who had quit smoking for at least 6 months (mean 3.5, SD 1.3 years) and in regular smokers.

Methods: The subjects were 409 white male smokers aged 55 to 74 years with 15 or more remaining teeth. They had participated in a major cancer prevention study (ATBC Study). Eighty‐two of the men had given up smoking and 327 were smokers. The subjects were examined clinically to determine the prevalence of periodontal pockets, gingival bleeding (BOP) and suppuration, and prevalence of keratotic oral mucosal lesions. The loss of alveolar bone was determined radiographically. Candida albicans was cultivated, and lesions showing leukoplakia were examined histopathologically. General proteolytic activity and collagenase‐2 or matrix metalloproteinase‐8 (MMP‐8) levels in saliva, salivary pH, and buffering capacity were measured. Linear regression, logistic regression, or Fisher's exact test were used in statistical analysis.

Results: Salivary general proteolytic activity and MMP‐8 levels were lower in current smokers than in ex‐smokers (P <0.05 and P <0.05, respectively). The prevalence of ≥ 4 mm deep pockets, gingival suppuration, and loss of crestal bone were statistically significantly lower (P = 0.003, P <0.001, and P <0.05, respectively) and salivary buffering capacity higher (P <0.05) in those who had quit smoking compared to current smokers; there was no difference in BOP. The prevalence of oral leukoplakia did not differ significantly between smokers and quitters, but was higher in those who smoked >15 cigarettes per day compared to quitters (odds ratio 3.5, 95% CI, 0.8 to 15.3).

Conclusions: These data suggest that periodontal status and oral mucosal health are better in those who have quit cigarette smoking compared to current smokers. However, the data further suggest that smoking may significantly lower both general proteolytic enzyme activity and MMP‐8 levels in saliva. Thus, care should be taken in interpreting results revealing salivary/mouthrinse proteinases as diagnostic markers for oral/periodontal disease activity. J Periodontol 1999;70:1361‐1368.
A Comparative Evaluation of Hemostatic Agents in the Management of Soft Tissue Graft Donor Site Bleeding
Authors: Rossmann Jeffrey A. , Rees Terry D.
Published: February 2005

Background: Periodontal plastic surgery has increased the use of palatal wounds for donor tissue, with the most common complication being excessive bleeding from the palate after harvesting tissue. This study was conducted to evaluate the efficacy of 3 methods for achieving hemostasis on the palate after harvesting donor tissue for autogenous soft tissue grafts.

Methods: Thirty sites were evaluated at surgery for hemostasis and followed over 21 days for healing and adverse events. Three treatment groups were randomly selected and patients received either a test product or control comprising: 1) oxidized regenerated cellulose; 2) absorbable gelatin sponge; or 3) sterile gauze with external pressure as the control. All patients received a surgical stent for the palate.

Results: The results were analyzed for smokers and non‐smokers, and the median time to hemostasis was significantly shorter when a hemostatic agent was applied to the palatal wounds compared to controls in both groups. Pain assessment showed no differences across treatment groups. However, by 21 days, only the oxidized regenerated cellulose group had complete healing based on blinded clinical evaluation with all sites rated as normal to rapid healing, compared to the absorbable gelatin sponge group where 40% of the sites were rated as slow healing. Adverse events, primarily bleeding episodes during the first 7 days after surgery, were found in 40% of the oxidized regenerated cellulose and gauze control groups, while no sites in the absorbable gelatin sponge group had an adverse event. The patients were followed for an average of 10 months and demonstrated a mean shrinkage of their recipient grafts of 24% in total surface area.

Conclusions: This study concluded that the use of hemostatic agents for palatal wounds is confirmed as the treatment of choice when performing free soft tissue grafts. J Periodontol 1999;70:1369‐1375.