bluuebunny/crossref_metadata_2025 huggingface dataset:
Citric acid treatment of periodontitis‐affected cementum
Authors: Hanes Philip , Poison Alan , Frederick Tom
Published: December 2005

Abstract Previous studies have described an inconsistent histological occurrence of a zone of surface demineralization on periodontitis‐affected cementum following treatment with citric acid, and a lack of connective tissue attachment to the latter surfaces. In view of these findings, the purpose of the present study was to use scanning electron microscopy to examine the surface morphology of cementum from normal and periodontitis‐affected root surfaces following citric acid treatment for differences in the effects of the demineralizing solution on these surfaces. Cementum surfaces were derived from the roots of extracted human teeth from areas beneath attached periodontal ligament fibers (normal) and calculus deposits (periodontitis‐affected). 5 specimens were evaluated in both groups. Periodontal ligament fibers were removed from normal root surfaces with a curette, and calculus deposits were removed from periodontitis‐affected root surfaces using an ultrasonic sealer. The resultant 5 specimens in each group were then sectioned in half, one‐half serving as the untreated control and the other as the experimental, citric acid treated specimen. Experimental specimens were immersed in a saturated solution of citric acid, pH 1 for 3 min and then rinsed in tap water. Both control and experimental specimens were dehydrated in ethanol, critical‐point dried, sputter‐coated with gold and examined in the scanning electron microscope for morphological characteristics. Citric acid treatment of cementum from normal root surfaces produced an undulating, markedly fibrillar surface morphology which is consistent with the exposure of a fibrillar, collagen substrate. Periodontitis‐affected cementum, however, was not appreciably altered in appearance by the citric acid treatment, having only a faint mat‐like surface texture. These findings suggest that cementum from beneath calculus covered areas of periodontitis‐affected roots had undergone changes which reduced the effects of the demineralizing solution. This limited demineralizing effect of citric acid on periodontitis‐affected cementum may partially explain the lack of connective tissue attachment reported in several animal studies and clinical trials utilizing citric acid conditioning of the root surface in efforts to obtain new attachment.
Comparison of the antimicrobial effect of the application of chlorhexidine gel, amine fluoride gel and stannous fluoride gel in debrided periodontal pockets
Authors: Oosterwaal P. J. M. , Mikx F. H. M. , van't Hof M. A. , Renggli H. H.
Published: December 2005

Abstract The clinical and microbiological effect of locally‐applied chlorhexidine gel 2%, amine fluoride gel 1.25%, stannous fluoride gel 4% or placebo gel in 40 periodontal pockets of 10 patients were studied. The gels were applied 3 x within 10 min. after mechanical debridement of the pockets. The treatment effect on the subgingival microflora was evaluated by microscopic and culture studies of the subgingival plaque samples. In addition, supragingival plaque, bleeding after probing and probing pocket depth were scored. Examination were carried out before and during a period of 36 weeks after treatment. At the start, the cultured microflora consisted mainly of anaerobic Gram‐positive bacteria. Following treatment, the clinical parameters were significantly reduced. Concomitantly, the %s of spirochetes, motile rods and non‐motile rods decreased significantly. A significant decrease was also found in the total anaerobic count, whereas the facultative counts remained at the same level found before treatment. This suggested that the treatment resulted in a mainly facultative subgingival microflora. The % Gram‐negative rods showed a significant reduction after treatment, but returned to base line at week 12. Statistical analysis of the bacteriological and clinical examinations failed to demonstrate any significant differences between the 4 treatment groups. Thus, in comparison to the placebo gel, subgingival application of chlorhexidine gel 2%, amine fluoride gel 1.25% or stannous fluoride gel 4% did not augment the effect of mechanical debridement on bacteriological and clinical parameters during the experimental period of 36 weeks. However the indicated treatments resulted in a facultative subgingival microflora which is compatible with the host.
The effect of some chlorhexidine‐containing mouthrinses on salivary bacterial counts.
Authors: Addy Martin , Jenkins Susan , Newcombe Robert
Published: December 2005

Abstract A number of chlorhexidine mouthwashes are available commercially which differ in formulation and regimen of use. As a comparative measure of antimicrobial persistance, this study evaluated the effect of 4 chlorhexidine mouth‐wash formulations on salivary bacterial counts after a single rinse. The study was a randomised single‐examiner blind 5‐way crossover investigation employing a panel of 10 young healthy human volunteers. The 0.12% and 0.2% commercial formulations when rinsed according to the respective manufacturers instructions produced similar large and prolonged reductions in salivary bacterial counts during the 7‐h period. A 0.1% formulation also commercially available produced minimal effects on salivary bacterial counts and was little different to the saline rinse. A reformulated 0.1% rinse, not commercially available at the time of the study, produced significant salivary bacterial count reductions over the 7‐h period albeit to a lesser degree of magnitude than to the 0.2% and 0.12% rinses. The results were consistent with comparative plaque inhibitory' studies of the formulations and suggest that the method is a quick and simple way of screening products for antimicrobial and antiplaque potential.
Short‐term bactericidal activity of chlorhexidine gel, stannous fluoride gel and amine fluoride gel tested in periodontal pockets
Authors: Oosterwaal P. J. M. , Mikx F. H. M. , van't Hof M. A. , Renggli H. H.
Published: December 2005

Abstract The short‐term bactericidal effect of 2% chlorhexidine gel, 4% stannous fluoride gel or amine fluoride gel containing 1.25% fluoride on the subgingival microflora was determined in 40 periodontal pockets of 10 patients. The antimicrobial gels or placebo gel were applied in 5–9 mm deep periodontal pockets 3 times within 10 min. Before and 30 min after the applications, samples were taken of the subgingival microflora for determination of the total number of bacteria as well as the number of black pigmented Bacteroides. Reductions of the total number of bacteria were found in all test groups. The reductions found in the pockets treated with chlorhexidine gel or stannous fluoride get were significantly greater than the reduction found in the pockets treated with a placebo gel. A significant reduction of black‐pigmented Bacteroides was found after treatment with chlorhexidine gel or amine fluoride gel. It is concluded that 2% chlorhexidine gel or 4% stannous fluoride gel has a more than 99% reduction effect on the microflora of periodontal pockets within 30 min after application.
The effect of a plaque control programme on the incidence and severity of cyclosporin‐induced gingival changes
Authors: Seymour R. A. , Smith D. G.
Published: December 2005

Abstract The efficacy of plaque control as a means of preventing cyclosporin‐induced gingival overgrowth was assessed in 27 adult renal transplant patients. After baseline examination, patients were randomly allocated to receive intensive oral hygiene instructions, scaling and root planing (OH group) or no treatment (no treatment group). Gingival condition was assessed 6 months after baseline and changes in gingival form were related to various periodontal and pharmacokinetic measures. In both treatment groups, there was a significant increase (P < 0.05) in gingival hyperplasia scores at 6 months. In the OH group, plaque scores were significantly lower (P < 0.05) at 6 months, whereas in the no treatment group, a significant increase in plaque scores, gingival inflammation and probing depths was observed at 6 months. Dosages of cyclosporin, whole blood concentrations of cyclosporin, baseline gingival index, hyperplasia scores, and 6‐month plaque index were not important determinants for the increase in gingival overgrowth in both treatment groups. It is concluded that attention to plaque control and the removal of local irritants is of some benefit for the gingival health of cyclosporin‐treated adult renal transplant patients, but these measures alone did not prevent gingival overgrowth. Pharmacokinetic variables of cyclosporin and various periodontal measures were not good predictors of cyclosporin‐induced gingival changes.
Clinical risk indicators for periodontal attachment loss
Authors: Haffajee A. D. , Socransky S. S. , Lindhe J. , Kent R. L. , Okamoto H. , Yoneyama T.
Published: December 2005

Abstract The purpose of the present investigation was to evaluate the association of baseline clinical parameters of periodontal disease with disease progression in the following year. 271 randomly selected subjects from Ushiku Japan were monitored for overt gingivitis and plaque accumulation at 4 sites per tooth and probing pocket depth, probing attachment level and bleeding on probing at 6 sites per tooth for all teeth at baseline and 1 year. A subject was considered to exhibit additional attachment loss if one or more sites increased 3 mm or more in a probing attachment level measurement in one year. The clinical variables included age, sex, number of missing teeth, mean pocket depth and attachment level. In addition, the % of sites which exhibited overt gingivitis, visible plaque, pocket depths, attachment levels or gingival recession over certain mm thresholds or bled on probing were determined. X2 analysis was used to seek significant associations between the baseline clinical variables and subsequent attachment loss in a subject. Only 74 of the 271 subjects (27.3%) exhibited additional attachment loss of 3 mm or more at 1 or more sites after 1 year. Older subjects had a greater risk of disease progression than younger subjects. There were no significant differences in % of individuals exhibiting additional attachment loss when divided on the basis of sex, number of missing teeth or % of sites with overt gingivitis. However, the greater the % of sites with visible plaque or which bled on probing, the greater was the likelihood of subsequent attachment loss. Increasing mean levels of pocket depth or attachment level or increasing %s of sites exhibiting prior attachment loss were strongly related to the proportion of individuals with subsequent attachment loss. Gingival recession exhibited similar but weaker relationships. Log‐linear analysis suggested that the association between bleeding on probing, age, or plaque levels with additional attachment loss may be explained by the association of these variables with baseline attachment loss. The analyses were repeated with a positive subject defined as having only 1 active site or 2 or more active sites. 37 subjects fit the 1st criterion and the remaining 37 the 2nd criterion. The associations observed were almost identical to those found when subjects were considered positive on the basis of 1 or more changing sites. Discriminant analysis was used to classify subjects as active or inactive using up to 11 predictor variables. 217 of 271 subjects (80%) were correctly classified by discriminant analysis using all 11 predictor variables with a sensitivity of 65% and specificity of 86%. Logistic regression analysis employing 4 predictor variables produced an overall agreement, sensitivity and specificity of 78%, 38% and 93%, respectively.
Cross‐sectional and longitudinal reliability for clinical measurement of attachment loss*
Authors: Espeland Mark A. , Zappa Urs E. , Hogan Patricia E. , Simona Claudio , Graf Hans
Published: December 2005

AbstractProgression of marginal periodontitis in humans is characterized by acute exacerbations during short periods of time followed by periods of remission. The analytical procedures used to distinguish actively progressing sites from non‐progressing sites within an individual's dentition are controversial. The purpose of the present investigation was to use measurements of probing depth and attachment level from a prospective longitudinal study of episodic periodontal disease progression to examine measurement and diagnostic reliability. In 10 systemically healthy adult human subjects with untreated advanced periodontitis, probing depth and attachment levels were measured at baseline and every 30 days for 10 to 12 months. Measurements were made at 6 sites of each tooth using an acrylic onlay as a reference point and a pressure sensitive probe. Replicate measurements were made on sites showing apparent changes in attachment loss of 2 mm or more in a month, and their contralateral counterparts. Cross‐sectional reliability was described by means and standard deviations for the absolute differences between replicate measurements: 0.63 + 0.87 mm for anterior teeth, 0.58 + 0.80 mm for premolars and 0.69 + 0.91 mm for molars. The mean differences tended to decrease with increasing time on study and tended to be greater in deeper pockets. Longitudinal reliability was described by analyzing site‐specific serial attachment level measurements across the study time period. Maximum likelihood methods were used to estimate false positive and false negative diagnostic rates associated with the diagnosis of attachment loss based on minimum threshold levels of 1 and 2 mm. The use of a 1 mm threshold resulted in estimated false positive rates of 0.08 to 0.11 and false negative rates of 0.11 to 0.15. The use of a 2 mm threshold resulted in estimated false positive rates of 0.02 to 0.03 and false negative rates of 0.17 to 0.23. The design of clinical studies involving probing measurement of attachment loss should involve consideration of the impact of such error rates.
Triclosan and sodium lauryl sulphate mouthwashes
Authors: Jenkins S. , Addy M. , Newcombe R.
Published: December 2005

Abstract A number of commonly used toothpaste ingredients, such as detergents, possess not inconsiderable antimicrobial activity. Additionally, specific ingredients including triclosan are now added to toothpastes to enhance such activity and to improve plaque inhibition. To date, there have been few studies of the antimicrobial properties in vivo of individual toothpaste ingredients. Most investigations have evaluated the whole toothpaste product. Persistance of antimicrobial action in vivo has been shown to relate to potential plaque inhibitory action. The aim of this study was to compare the magnitude and duration of salivary bacterial count reductions produced by a single rinse of 0.2% triclosan, 1% sodium lauryl sulphate (SLS) and 0.2% chlorhexidine mouthwashes. 16 volunteers took part in a single‐blind latin‐square randomised crossover designed study with balanced residual effects. Before and for time periods up to 420 min following rinsing with the allocated mouthwashes, saliva samples were obtained and processed for total anaerobic counts. With the exception of the saline control rinse, the 3 test solutions produced considerable reductions in bacterial counts which remained significant to 3 h for triclosan and 7 h for SLS and chlorhexidine. However, at most time periods after baseline, the effects of chlorhexidine were significantly greater than triclosan and SLS. Overall, SLS had significantly greater effects than triclosan. Incremental values from 30 min post rinsing were always positive for SLS and triclosan, indicating bacterial recovery, whereas these values were negative for chlorhexidine. The results indicate that triclosan and SLS provide some persistance of antimicrobial activity in the oral cavity when used at relatively high dose compared to a toothpaste vehicle.
Factors influencing the assessment of treatment needs
Authors: Gjermo Per
Published: December 2005

Abstract. Epidemiologic surveys have provided data for health planning by estimating prevalence and incidence of diseases in populations. New ways of presenting epidemiologic data on periodontal diseases have changed our understanding of their extent and severity, and conversion of prevalence data into treatment need estimates has proved difficult. Furthermore, new concepts of the pathogenesis of periodontal diseases have questioned the validity of epidemiologic methods currently used. Treatment need assessments vary considerably between studies even when prevalence data from the same populations are similar. This may be due to lack of described goals for periodontal health. Various aspects of the concept of need for treatment are discussed. It is suggested that periodontal treatment need on a population level is defined as the intervention needed in order to change the existing periodontal condition to the described goal. Thus, treatment need assessments will have to include descriptive epidemiologic data as well as defined periodontal health goals. It is recommended that goals are described in terms compatible with the indicators used in the epidemiologic description of the disease status.
The onset age of periodontal destruction
Authors: van der Velden Ubele
Published: December 2005

Abstract. In the present paper, the onset age of periodontal destruction is discussed. Results of epidemiological studies have shown that with increasing age, the prevalence of periodontitis in a population increases. Data show that after the age of 40 years, the % of the population affected by periodontitis remains rather constant. If it is supposed that the incidence of periodontitis after the age of 40 is zero (no new cases), then extractions resulting in edentulousness due to periodontitis should lead to a decrease of the prevalence of periodontitis. However, after the age of 40 years, the prevalence of periodontitis remains about the same, whereas edentulousness due to periodontitis increases. This suggests that even at a relatively old age, the onset of periodontitis may occur. On the other hand, periodontal destruction has also been found in the primary dentition. Especially on the basis of family studies and studies on localized juvenile periodontitis patients, it can be supposed that in a substantial part of the population, periodontal destruction starts early in life.
Importance of the host response in the periodontium
Authors: Seymour Gregory J.
Published: December 2005

Abstract. Immunological mechanisms have been implicated in the pathogenesis of periodontal disease for over 25 years. Studies throughout the 1970s established that advanced forms of the disease were dominated by B‐cells/plasma cells while early and putative stable forms of the disease were dominated by T‐cells/lymphocytes. Based on these observations, a model of disease was put forward which highlighted a possible T‐cell/macrophage immunoregulatory imbalance being involved in disease pathogenesis. Studies throughout the 1980s have supported such a concept although the precise nature of this imbalance remains elusive. At the same time, clinical studies have established that patient susceptibility may be of overriding importance in determining disease outcome. In this context therefore, factors which influence this susceptibility should be fundamental in determining periodontal disease activity. These factors may include genetic variation between individuals in the way in which they respond to periodontopathic bacteria upon which environmental factors would be superimposed. These environmental factors would include anything that altered the balance between the host and the parasite and may be as diverse as recent viral infections resulting in T‐cell energy or physical and mental stress. Recent studies have shown that in elite atheletes, physical stress during training and competition leads to a suppression of mucosal immunity as evidenced by a reduction in salivary IgA. The subsequent effect of these environmental factors at the level of the periodontium, however, remains to be determined.
Dentifrices containing new agents for the control of plaque and gingivitis: microbiological aspects
Authors: Marsh P. D.
Published: December 2005

Abstract. Antimicrobial agents have been proposed as playing an important role in controlling plaque and gingivitis. Unfortunately, a large number of potential compounds are unsuitable for use in dentifrices because they lack “substantivity”, produce undesirable side‐effects, or are incompatible with toothpaste ingredients. New agents that have been successfully incorporated into dentifrices include plant extracts, phenolic compounds and metal salts. Several products are currently being based on the phenol, Triclosan. Triclosan has a broad spectrum of antimicrobial activity against yeasts and oral bacteria. To enhance its clinical efficacy, Triclosan has been combined either with a co‐polymer or with another compatible antimicrobial agent, zinc citrate. The co‐polymer acts to increase the oral retention of Triclosan, and has resulted in further reductions in salivary bacterial counts in vivo. Zinc salts also have antimicrobial activity, and at low concentrations, can inhibit glycolysis and bacterial proteases. In mixed culture chemos‐tat studies, Triclosan selectively inhibited Gram‐negative periodontopathic bacteria; additive effects were obtained when zinc citrate and Triclosan were combined. In an experimental human gingivitis study, a zinc citrate/Triclosan dentifrice reduced plaque accumulation and gingivitis compared to a placebo paste; the ratio of anaerobic/aerobic bacteria and the proportions of Actinomyces species in plaque were also reduced. The prolonged use of a zinc citrate/Triclosan dentifrice neither significantly altered the ecology of supragingival plaque nor led to the selection of Triclosan‐resistant bacteria. The data suggest that dentifrices containing new antimicrobial agents could be of clinical relevance in the prevention and control of plaque and gingivitis.
The use of DNA probes to examine the distribution of subgingival species in subjects with different levels of periodontal destruction
Authors: Haffajee A. D. , Socransky S. S. , Smith C. , Dibart S.
Published: December 2005

Abstract The present investigation examined the distribution of 14 subgingival species at a total of 2299 sites in 90 subjects with different levels of periodontal destruction. Subgingival plaque samples taken from the mesial aspect of each tooth were anaerobically dispersed, diluted and plated on non selective media, After anaerobic incubation, colonies were lifted to nylon filters and specific species detected using digoxygenin‐labeled whole chromosomal DNA probes. The mean total viable count for all sites in all subjects was 8.3 × 106. The probes accounted for an average of 27.8% of the total, viable count. The % of subjects in which each species was detected was as follows; V. parvula, 98; B. intermedius I, 98; S. sanguis II, 96; B. intermedius II, 95: C. ochracea. 94: B. gingivalis. 91; S. sanguis I, 85; W. recta, 83; F. nucleatum ss. vincentii, 82; S. intermedius, 80; B. forsythus, 76; P. micros. 74; A. actinomycetemcomitans serotype a. 62 and A. actinomycetemcomitcins serotype b, 52. The % of sites colonized by each of the 14 test species varied considerably within different subjects. The median number of sites colonized by different species ranged from 3.6% for A. actinomvcetemcomitana serotype b to 43.5% for V. parvula. In half the subjects, the mean % of the total viable counts for each of the test species was < 4%. When subjects were divided on the basis of % of sites at baseline with > 3 mm attachment loss, the 14 probes accounted for 29.9% of the microbiota in the localized disease group and 25% in the widespread disease group. In general, suspected pathogens were slightly higher in the localized disease subjects, but suspected beneficial species were comparable in both groups. Cluster analysis was used to subset subjects on the basis of their mean percentages of the 14 test species. 5 groups were formed with > 60% similarity (Bray‐Curtis coefficient) but 21 subjects failed to fit any of the groups. The latter subjects were characterized by low numbers of the test species and were older exhibiting widespread disease and recession.
Metronidazole in periodontitis: reduced need for surgery
Authors: Loesche Walter J. , Giordano James R. , Hujoel Philippe , Schwarcz Jack , Smith Billy A.
Published: December 2005

Abstract A considerable amount of circumstantial evidence indicates that most forms of periodontitis are due to the presence or dominance of a finite number of bacterial species in the subgingival plaque, Almost all of the putative pathogens are anaerobic species, indicating that most forms of periodontitis could be diagnosed as anaerobic infections, In this double‐blind investigation, patients with elevated proportions or levels of spirochetes in 2 or more plaque samples, i.e., 60% spirochetes. were randomly assigned to receive either metronidazole, 250 mg 3 × a day for 1 week, or placebo (positive‐control) after the completion of all debridement procedures, When the patients were re‐examined 4 to 6 weeks later, the patients in the metronidazole group (n= 15) exhibited a highly significant (p< 0.01) reduction in probing depth and apparent gain in attachment levels relative to the patients (n= 18) in the positive‐control group about those teeth that initially had probing depths of 4 to 6 mm. This pattern was also observed about teeth that initially had probing depths 7 mm. This reduction in probing depths and apparent gain in attachment was associated with a significant reduction in the need for periodontal surgery in the metronidazole‐treated patients (difference 8.4 teeth per patient) compared to the positive‐control patients (2.6 teeth per patient). These clinical improvements in the metronidazole group were associated with significantly lower proportions of spirochctes, selenomonads, motile rods, and P. intermedius. and a significantly higher proportion of cocci in the plaques, These findings indicate that systemic metranidazole, when given after all the root surface debridement is completed, leads to additional treatment benefits, including a reduced need for surgery, beyond that which can be achieved by debridement alone.
Non‐surgical periodontal treatment: where are the limits?
Authors: Rateitschak‐Plüss Edith M. , Schwarz Jean‐Pierre , Guggenheim Richard , Duggelin Marcel , Rateitschak Klaus H.
Published: December 2005

Abstract In the present scanning electron microscopic study, the possibilities and limitations of non‐surgical root planing were investigated. 10 single‐rooted teeth from 4 patients with advanced periodontitis were studied. The root surfaces were cleaned and planed without flap reflection, using fine curettes. The teeth were then extracted and the root surfaces were systematically examined by scanning electron microscopy (SEM) for the presence of residual bacteria and calculus. 29 of 40 curetted root surfaces were free of residues, if they were reached by the curette. On the remaining 11 surfaces, only small amounts of plaque and minute islands of calculus were detected, primarily at the line angles and also in grooves and depressions in the root surfaces. Instrumentation to the base of the pocket was not achieved completely on 75% of the treated root surfaces, however. The primary reason for this was the extremely tortous pocket morphology on the teeth selected for study. In conclusion, it may be stated that during non‐surgical root planing in cases of advanced periodontitis. surfaces that can be reached by curettes are usually free of plaque and calculus. However, in many cases the base of the pocket will not be reached. It is for this reason that deep periodontal pockets should be treated with direct vision, i.e., after the reflection of conservative flaps.
Calcium and phosphorus content of roots exposed to the oral environment
Authors: Cohen Mark , Garnick Jerry J. , Ringle Robert D. , Hanes Philip J. , Thompson William O.
Published: December 2005

Abstsract

This study analyzed the calcium and phosphorus content of extracted tooth roots exposed to the in vivo oral environment. 20 teeth were obtained from 16 patients and divided into two groups of 10 teeth each. In group 1, the teeth had gingival probing depths of 5 mm or more, and teeth of group 2 had gingival recessions of 3 mm or more. Prior to extraction, the gingival margin location was recorded by placing a groove on the tooth surface. After extraction, the teeth were sectioned coronatapically, air dried and coated with carbon. Energy dispersive X‐ray spectra, excited in a scanning electron microscope, were analyzed to measure relative calcium and phosphorus contents and for calculation of their ratios. X‐rays were collected from two positions on the sectioned root. Experimental positions were selected within the exposed portion of the roots of groups 1 and 2, and unexposed positions were selected from that portion of the same root with attached periodontal membrane. At each position, calcium and phosphorus content was measured at 4 depths into the root surface: in cementum, in dentin three‐quarters of the distance to the pulp chamber, and at 2 locations in between on either side of the cemento‐dentinal junction. Analysis of data demonstrated large variations in calcium and phosphorus content from surface to surface of individual teeth and from tooth to tooth in a subject. No statistically significant differences were found between experimental and unexposed locations. Calcium and phosphorus contents were greater in roots exposed to pockets when compared to roots exposed by recession at both experimental and unexposed locations. The mean calcium/phosphorus ratio of 1.8 was increased over reported values for hydroxyapatite. Trend analysis across combined data from groups 1 and 2 showed both calcium and phosphorus were significantly higher toward locations nearer to the ptilp chamber. This study showed that the oral environment had little effect on either calcium or phosphorus content or ratios.
Quality assessment and meta‐analysis of systemic tetracycline use in chronic adult periodontitis
Authors: Hayes Catherine , Antczak‐Bouckoms Alexia , Burdick Elisabeth
Published: December 2005

Abstract The use of systemic tetracycline in the treatment of periodontal disease has been controversial. To investigate this controversy, we performed a quality assessment and attempted to perform a meta‐analysis of 13 published studies. We evaluated the quality of the study protocol and data analysis and presentation for each study. We were unable to combine data from the majority of studies due to heterogeneity of the outcomes evaluated and limitations in data reported in the individual studies. Therefore, only 2 studies were included in the quantitative meta‐analysis. On a scale of 0–1, the mean score for this group of studies was 0.27 (±0.19) for study protocol and 0.31 (±0.11) for data analysis and presentation. Mean reduction in probing depth for the group treated with tetracycline plus scaling was 2.45 mm; for the group which received only scaling, 2.02 mm; for the group that received only tetracycline, 3.98 mm; and for the control group, 0.65 mm. We conclude that analysis of data from the published literature does not demonstrate that the use of systemic tetracycline is more beneficial than conventional treatment in the management of adult periodontal disease. More information is needed in order to perform an extensive meta‐analysis of this subject.
The periodontal condition of regular dental attenders in Northern Ireland
Authors: Mullally Brian H. , Linden Gerard J.
Published: December 2005

Abstract The aim of this study was to assess the prevalence and severity of periodontal destruction in regular dental attenders in Northern Ireland. 132 individuals aged between 20 and 49 years who had recently had a course of routine treatment in the General Dental Service completed a questionnaire and had a periodontal examination. Measurements of plaque, subgingival calculus, bleeding, probing pocket depth and periodontal attachment level were made at 4 proximal sites per tooth. Plaque was present at an average of 17%, subgingival calculus at 13%, and bleeding on probing at 34% of interproximal surfaces examined. The mean probing pocket depth was 2.7 mm and the mean probing attachment level was 1.0 mm. Incipient periodontal destruction was common with all subjects having at least 1 pocket of ≥ 3 mm and 90% having at least 1 site with ≥ 2 mm attachment loss. Only 24 (18%) of those examined had deep pocketing or severe loss of periodontal attachment (≥ 6 mm). The extent of deep pocketing and severe attachment loss was low at only 0.2% and 0.6%, respectively, of the sites examined. It was concluded that gingivitis and incipient periodontitis were prevalent and extensive in the regular dental attenders investigated, but that severe periodontal destruction was uncommon.
Depth‐force patterns of periodontal probing
Authors: Mombelli Andrea , Mühle Tove , Frigg Robert
Published: December 2005

Abstract It was the purpose of this study to determine whether probing force had an influence on the amount of clinical attachment‐gain assessed after treatment by scaling and rootplaning. A probing device was constructed which allowed simultanious monitoring of probing force and probe penetration and which standardized the insertion pathway for repeated measurements. In 10 periodontal patients, 2 deep pockets were selected which were measured before and after periodontal treatment by scaling and root‐planing. Depth‐force plots were compared by superimposition. Depth values were determined at 5 different force levels (0.25, 0.50, 0.75, 1.00 and 1.25 N) on each plot and changes of clinical attachment levels were calculated. A significant relationship was seen between probing force and attachment level. The values obtained with 0.25 N were significantly different from the values obtained with higher forces (p < 0.001). Slight, but non‐significant differences were noted in the amount of attachment‐gain obtained at the 5 force levels. At a probing force level of 0.25 N, there was 0.80 mm mean attachment gain. With 0.50 N, there was a gain of 0.70 mm; with 0.75 N the gain amounted to 0.67 mm in mean. At 1.00 N and at 1.25 N, a gain of 0.66 mm was recorded.
Supragingival cleaning 3 times a week
Authors: McNabb Hal , Mombelli Andrea , Lang N. P.
Published: December 2005

Abstract It is generally believed that Supragingival plaque control has little effect on the subgingival micro flora of deep periodontal pockets. However, this may not be true for moderately deep pockets (4–5 mm), which may represent a pathological state between gingivitis and marginal periodontitis. In 6 patients with poor oral hygiene and severe gingival inflammation, 4 matched sites (1 in each quadrant), were chosen which demonstrated at least 20% spirochetes and 15% black‐pigmented Gram‐negative bacilli. During the first 12 weeks (phase 1), Supragingival calculus was removed from the right half of the mouth and then the teeth were professionally cleaned three times a week. At the beginning of phase 2, Supragingival calculus was also removed from the left quadrants and the entire mouth was subjected to the same protocol used in phase 1. At no time did patients receive oral hygiene instructions. Clinical parameters were assessed and microbiological samples were taken at 3‐week intervals. Samples were submitted to darkfield microscopy and anaerobic culturing. Analysis by multiple linear regression and the Wilcoxon signed‐rank test revealed significant changes in the composition of the subgingival microbiota at cleaned sites. While Gram‐positive organisms increased proportionally, a number of putative periodontal pathogens, such as P. gingivalis and spirochetes decreased.
Subgingival temperature Relation to microbial counts
Authors: Haffajee A. D. , Socransky S. S. , Smith C. , Dibart S. , Goodson J. M.
Published: December 2005

Abstract The present investigation examined the relationship of selected bacterial species and Subgingival temperature. 35 subjects were measured at 6 sites per tooth for clinical parameters and Subgingival temperature. Measurements were repeated for 21 subjects at 2 month intervals providing a total of 66 subjects visits. At each visit, subgingival plaque samples were taken from the mesial aspect of each tooth and anaerobically dispersed, diluted and plated on non‐selective media. After anaerobic incubation, colonies were lifted to nylon filters and specific species detected using digoxigenin‐labeled whole chromosomal DNA probes. Species enumerated were; A. actinomycetemcomitans serotypes a and b, B. forsythus, B. gingivalis, B. intermedius I and II, C. ochracea, F. nucleatum ss. vincentii, P. micros, S. intermedius, S. sanguis I and II, V. parvula and W. recta. Total viable counts and counts of Capnocytophaga sp. were determined directly from the primary isolation plates. A total of 1581 samples were evaluated. Subject visits with higher mean subgingival temperatures had significantly higher mean %s of B. intermedius I and P. micros, and lower mean %s of Capnocytophaga sp. Sites with higher subgingival temperatures had elevated proportions of B. intermedius I and II, A. actinomycetemcomitans serotype a and B. gingivalis more frequently than sites with lower temperatures, while Capnocytophaga sp. were elevated more often at cooler sites. 43 of the subject visits had follow up attachment level measurements at 2 months. The 1026 microbial samples and the subgingival temperature measurements from these visits were related to longitudinal attachment change. Discriminant analysis indicated that combinations of temperature and microbial parameters were more effective in predicting subjects at risk and sites at risk for new attachment loss than either group of variables alone.
The effect of partial denture connectors on gingival health
Authors: Orr Sandra , Linden Gerard J. , Newman Hubert N.
Published: December 2005

Abstract The effect on the gingiva of a variety of relationships of a removable partial denture connector to the gingival margin was investigated in 10 subjects. Acrylic resin baseplates were designed incorporating a variety of relationships of the connector to the gingival margin. The appliances were worn for a 12 hour period daily, for 21 days. At baseline and at days 7, 21 and 49, plaque index, gingival index and probing pocket depth measurements were recorded, and subgingival plaque samples were examined using darkfield microscopy. No increase in plaque accumulation was detected in any area at any time interval. There was a significant increase in gingival index at day 21 in areas where the appliance covered the gingival margin. Small increases in probing pocket depth were recorded at day 21, there being no difference between any of the test areas. Baseline values were re‐established by day 49. No significant differences were detected in the percentage of motile organisms or spirochaetes counted in the subgingival plaque samples collected from any area. It was concluded that deterioration in gingival health occurred rapidly following the insertion of a removable appliance, and that coverage of the gingival margin, irrespective of the degree of gingival relief, had a detrimental effect.
Associations between volume and flow rate of gingival crevicular fluid and clinical assessments of gingival inflammation in a population of British male adolescents
Authors: Griffiths G. S. , Sterne J. A. C. , Wilton J. M. A. , Eaton K. A. , Johnson N. W.
Published: December 2005

Abstract Gingival crevicular fluid (GCF) sampling was performed on 2 occasions separated by 1 year, at 2 sites in the mouths of 102 male adolescents, mean age 17.85 years. Samples were collected onto 5 filter paper strips which were sequentially applied to the mouth of the crevice over a 9‐min collection period. Volume and flow rates of GCF were determined for each site and were compared with clinical measurements of plaque, gingival colour, bleeding, gingival index (GI) and pocket depth, using a general linear models (GLM) procedure. While the initial volume of GCF showed no association with any clinical measurement, there was an association between flow rate of GCF and gingival colour. The volume of GCF collected in the final. 5th sample was associated with the GI. The sample site strongly influenced all measures of GCF volume. It is proposed that the flow rate of GCF may be a better indicator of gingival inflammation than the more imprecise clinical assessments of inflammation, since GCF flow rates more precisely reflect changes in tissue permeability. The association between the final sample, collected after 9 min, and clinical measurements, was probably a reflection of the association between clinically‐detectable inflammation and the susceptibility of the site to mild irritation.
Validity issues in split‐mouth trials*
Authors: Hujoel P. P. , DeRouen T. A.
Published: December 2005

Abstract The main purpose of the split‐mouth design is to remove all components related to differences between subjects from the treatment comparisons. By making within‐patient comparisons, rather than between‐patient comparisons, the error variance (noise) of the experiment can be reduced, thereby obtaining a more powerful statistical test. Unfortunately, comparisons made on a within‐patient basis have potential disadvantages. Treatments may have effects on experimental units other than those which they were assigned to (carry‐across effects). Such effects cannot be estimated from split‐mouth data. Neither can treatment effects be estimated. The estimable parameter in a split‐mouth design is the treatment effect plus the sum of all carry‐across effects. Unless a priori knowledge indicates that no carry‐across effects exist, reported estimates of treatment efficacy are potentially biased. In the design of split‐mouth clinical trials, potential gain in precision should be carefully weighed against a potential decrease in validity.
Marginal bone level in the normal primary dentition
Authors: Sjödin Bengt , Matsson Lars
Published: December 2005

Abstract The aim of the present study was to establish the normal range for the radiographic distance between the cemento‐enamel junction (CEJ) and the marginal bone level (MBL) in the primary dentition, and to relate this distance to various physiological and pathological factors. 128 children at the ages 7, 8 and 9 years took part in the study. Clinical and radiographic examinations of the mesial and distal surfaces of all primary molars and the distal surface of the primary canines were performed. The clinical examination included measurements of the amounts of plaque, bleeding on probing, probing depth and probing attachment loss. In addition, increased mobility of the primary teeth and stage of eruption of the neighbouring permanent teeth were recorded. The radiographic examination included measurements of the CEJ‐MBL distance and the remaining root length. Also, exfoliating teeth, presence of proximal dentin caries, restorations and calculus were recorded from the radiographs. Associations between various explanatory variables and the CEJ‐MBL distance were tested with both a X2 test and a variance components analysis. The mean CEJ‐MBL distance for all primary tooth surfaces was 1.0 mm. Individual surfaces displayed distances ranging from 0.0–0.4 mm. Of the variables tested for association with the CEJ‐MBL distance, eruption of neighbouring permanent tooth and exfoliation of neighbouring primary tooth seemed to be associated with large CEJ‐MBL distances. When surfaces with these characteristics were excluded, a CEJ‐MBL range of 0.0–2.0 mm was obtained. Based on these findings, it seems reasonable to consider sites with a distance of > 2 mm to have pathological bone loss, providing the above physiological conditions related to large CEJ‐MBL distances are taken into consideration.
The effect of supragingival plaque control on the subgingival microbiota in subjects with periodontal disease
Authors: Dahlén Gunnar , Lindhe Jan , Sato Kenjiro , Hanamura Hiroyuki , Okamoto Hiroshi
Published: December 2005

Abstract. The present investigation was performed to study the effect on the subgingival microbiota, of a plaque control program which included meticulous oral hygiene instruction, supragingival scaling and professional monitoring during a 2 year period. 300 subjects were examined for periodontal disease and monitored for 2 years without treatment. After the 2 year examination, 80 subjects were invited to participate in a treatment program intended to improve the standard of their self‐performed plaque control. 40 of the invitees had a gingivitis and only minor attachment loss, while 40 subjects had moderate signs of periodontitis. 62 subjects volunteered for this treatment. 23 of the volunteers (Group AB) had several sites with deep pockets (> 4 mm). 39 of the volunteers had gingivitis but shallow pockets only (Group C). Group AB contributed 31 shallow pocket sites (A‐sites) and 40 deep pocket sites (B‐sites), while Group C contributed 63 shallow sites (C‐sites). After the clinical examination, samples of the subgingival microbiota were harvested from the 134 A, B and C sites. The 62 subjects were enrolled in a supervised oral hygiene program. Supragingival scaling was carried out. Oral hygiene instruction was provided and repeated on an individual need basis so that all subjects reached and maintained a supragingival plaque score which was < 20%. 24 months after the year 2 examination, the 62 subjects were examined again using both clinical and microbiological examination procedures. The findings demonstrated that carefully performed supragingival plaque control changed the quantity and the composition of the supragingival microbiota. The total viable counts of bacteria in both deep and shallow pockets were markedly reduced 2 years after the initiation of the enhanced oral hygiene efforts. Also the number of subjects and sites from which micro‐organisms such as P. gingivalis, A. actinomycetemcomitansand others could be harvested was markedly decreased between the sampling at years 2 and 4.
Root caries susceptibility in periodontally treated patients
Authors: Ravald Nils , Birkhed Dowen , Hamp Sven‐Erik
Published: December 2005

Abstract The aim of the investigation was to study the individual susceptibility to root caries in periodontally treated patients in a long‐term follow‐up of 12 years. Age, plaque score, salivary counts of lactobacilli and mutans streptococci, salivary secretion rate and buffer effect, oral sugar clearance time and dietary habit index were tested as possible predictors for root caries incidence. During the whole observation period of 12 years, new root caries lesions were recorded in 24 of a total of 27 patients. In 8 of these, the root caries incidence was between 1 and 5, in 7 between 6 and 9 and in 9, 12 or more new DPS. However, the annual mean number of new DPS was rather low. 13 patients with > 5 new DFS% during the 3rd 4‐year period (years 9–12) differed significantly from 14 patients with 5 new DFS% in salivary mutans streptococcus counts (p < 0.001), plaque scores (p < 0.001) and new DFS% during the 2nd 4‐year period (years 5–8) (p < 0.001). Simultaneously, risk values among the variables tested at the 8‐year examination were about 3 × more prevalent in patients that developed > 5 new DFS% in years 9–12 than in those with 5 new DFS%. During the whole 12‐year observation period, smokers had significantly more root caries than non‐smokers (p < 0.05). The main conclusions from this study are (1) that root caries in this category of periodontally treated patients is a minor problem although some individuals show a high incidence, and (2) that patients at risk for development of root carties may be possible to identify by using readily available tests in addition to clinical examination and the patient's medical history.