[Efficacy of taurine haloamines and chlorhexidine against selected oral microbiome species]

INTRODUCTION

Uncontrolled bacteria of dental plaque generate formation of oral biofilm located on teeth and subgingival surfaces. It may induce local inflammation (gingivitis) with further development of periodontal diseases. A variety of oral bacteria such as Streptococcus mutans and Porhyromonas gingivalis are involved in pathogenesis of dental carries and periodontitis. Very often bacterial infections are associated with candidiasis (Candida albicans). Chlorhexidine (CHX) is the most commonly used antiseptic in dentistry due to its strong antibacterial activity and capacity to reduce the accumulation of oral biofilms. However, other antiseptics, especially endodontic irrigants, are still tested to improve their preventive and therapeutic effects in oral cavity infections. In this in vitro study we have compared antimicrobial activity of CHX with that of taurine chloramine (TauC1) and taurine bromamine (TauBr), natural taurine derivatives with known antibacterial and anti-inflammatory properties.

METHODS

Antimicrobial activity of CHX, TauC1 and TauBr was tested by incubation of the compounds with S. mutans, P gingivalis and C. albicans. The agents were incubated in low (105/ml) and high (108/ml) density microbe suspensions, related to early and late biofilm infections, respectively. In some experiments bacteria were incubated with a combination of CHX + NaOCl and CHX + TauBr. MIC was determined by the pour-plate method.

RESULTS

CHX showed the strongest antimicrobial activity against all tested pathogens. On the contrary, TauC1 was the weakest antiseptics used without effect on the growth of C. albicans. TauBr at non-cytotoxic concentrations inhibited the growth of S. mutans and P gingivalis with slight effect on the low density C. albicans. All tested agents showed weaker antiseptic properties in the presence of serum. Moreover, we have shown that interactions between CHX and sodium hypochlorite (NaOC1), the main endodontic irrigant, but not between CHX and TauBr,resulted in precipitation. Therefore, it may restrict their simultaneous application in root canal treatment. However, in spite of this unwanted reaction, the mixture of CHX with NaOCl kills pathogens more effectively then CHX alone.

CONCLUSIONS

The results confirmed CHX exceptional potential as primary antiseptic in dentistry, especially in prevention and treatment of dental carries, periodontal diseases and mouth candidiasis. Moreover, our study shows that TauBr may be used alternatively or in combination with CHX in killing of oral pathogens, due to its strong antibacterial and anti-inflammatory properties.

Protective effects of Ginkgo biloba extract on ligature-induced periodontitis in rats

OBJECTIVE

The aim of this study was to test the hypothesis that the systemic administration of extract of Ginkgo biloba (EGb) would prevent excessive tissue destruction in ligature-induced periodontitis in a rat model.

MATERIALS AND METHODS

Thirty-two male Wistar albino rats were used in the current study. The rats were randomly divided into four groups of eight rats each: (1) non-ligated treatment (NL) group, (2) ligature-only (LO) group, (3) ligature plus GB28 (28 mg/kg, daily for 11 days) group and (4) ligature plus GB56 (56 mg/kg, daily for 11 days) group.

RESULTS

Measurement of alveolar bone loss in the mandibular molar tooth revealed significantly lower bone loss values in the LO group compared to groups NL, GB28 and GB56 (p < 0.05).

CONCLUSION

The present results are the first data which suggests that host response in periodontitis can be modified by EGb administration. EGb minimized progression of periodontal disease.

Role of gallium and silver from phosphate-based glasses on in vitro dual species oral biofilm models of Porphyromonas gingivalis and Streptococcus gordonii

Phosphate-based glasses (PBGs) are excellent controlled delivery agents for antibacterial ions such as silver and gallium. The aim of this study was to assess the potential utility of novel PBGs combining both gallium and silver for use in periodontal therapy. To this end, an in vitro biofilm model with the putative periodontal pathogen, Porphyromonas gingivalis, and an initial colonizer, Streptococcus gordonii, was established. The effect of increasing calcium content in gallium-silver-doped PBG on the susceptibility of P. gingivalis was examined. A decrease in degradation rates (30.34, 25.19, 21.40 μg mm(-2) h(-1)) with increasing PBG calciumcontent (10, 11, 12 mol.% respectively) was observed, correlating well with gallium and silver ion release and antimicrobial activity against planktonic P. gingivalis (approximately 5.4log(10) colony-forming units (CFU) reduction after 24h by the C10 glass compared with controls) and S. gordonii (total growth inhibition after 32h by C10, C11 and C12 glasses compared with controls). The most potent PBG (C10) was evaluated for its ability to inhibit the biofilm growth of P. gingivalis in a newly established constant-depth film fermentor model. The simultaneous release of silver and gallium from the glass reduced P. gingivalis biofilm growth with a maximum effect (1.92log(10) CFU reduction) after 168 h. Given the emergence of antibiotic-resistant bacteria and dearth of new antibiotics in development, the glasses, especially C10, would offer effective alternatives to antibiotics or may complement current therapies through controlled, localized delivery of gallium and silver ions at infected sites in the oral cavity.

Effect of an herbal mouth rinse in preventing periodontal inflammation in an experimental gingivitis model: a pilot study

BACKGROUND

Gingivitis is a chronic inflammatory condition, resulting from gingival bacteria and bacterial byproducts. Antiplaque oral rinses reduce inflammation by removing or inhibiting plaque formation. The purpose of this pilot study was to examine the anti-inflammatory effects of HM-302, a mouth rinse based on natural products, on gingival inflammation.

METHODS

A prospective, double-blinded, randomized parallel-group controlled trial involving 62 patients was conducted to assess efficacy and safety. During a 2-week period with no dental hygiene, subjects were randomized to receive either the study rinse (HM-302); a cetylpyridinium chloride (CPC) rinse; an essential oils (EO) rinse; or a water-only preparation. The gingival index (GI), plaque index (PI), and number of bleeding sites were measured at baseline and at the end of the study period.

RESULTS

Progression of gingival inflammation resulting from lack of dental hygiene was lowest in patients treated with the HM-302 rinse, and was significantly less marked than in patients treated with the water-only preparation. When compared to the CPC and EO treatments, HM-302 was the only mouth rinse that was significantlybetter than the control, with respect to both the change in absolute GI scores (p = .006) and to the percent increase in GI scores (p = .012). No serious adverse effects were noted in any of the study groups.

CONCLUSION

HM-302 is a safe and effective treatment for preventing the development of gingival inflammation in an experimental gingivitis model. Further research is needed to evaluate its long-term effects.

[Dental preparation features by subgingival location of circular ledge]

To prevent periodontal complications after esthetic rehabilitation it is essential to minimize soft tissues injury in case of subgingival ledge position. It was established that the border of ledge should not interfere with biological width of the tooth. Clinical researches showed that location of circular edge at 0.5 mm distance and more from epithelial attachment decreases the danger of periodontal tissues inflammatory response. From the clinical point of view the main factor determining subgingival level of preparation is an adequate assessment of gingival groove depth. This assessment is however complicated by the variations of morphometric features of biological width causing inaccuracy of subgingival border preparation and leading to undesirable effects in periodontal tissues (gingivitis, periodontitis, recession).

[Dental care in pregnancy. Ten questions and answers]

Dental care of pregnant patients is a demanding task. On one hand, clinicians are facing patients with an altered physiology that may cause a greater need for treatment. On the other hand, pregnancy in itself as well as the unborn child involves potential contraindications to dental interventions. It is therefore essential that dentists be knowledgeable of the ramifications pregnancy has on medical findings and therapy. Also, clinicians must be able to conduct their treatment based on well-grounded data to avoid any harm to the pregnant woman and her unborn child. This article focuses on facts specifically relevant to clinicians. Based on most current scientific data, we aim to answer the following ten questions: 1. What are the physiological changes during pregnancy? 2. What is the adequate lying position for a pregnant patient? 3. Is there a pregnancy-related gingivitis? 4. What is the association between periodontitis, pregnancy and preterm birth? 5. Are there oral manifestations of pregnancy-related therapies? 6. Are caries and erosions inevitable during pregnancy? 7. Should the intake of fluoride be advocated? 8. Is it permissible to x-ray pregnant patients? 9. Is orthodontics contraindicated during pregnancy and 10. Which medication should be administered with caution?

Clinical outcomes of single-visit oral prophylaxis: a practice-based randomised controlled trial

BACKGROUND

Practice-based general dental practitioners routinely provide "scale and polish" or "oral prophylaxis" to patients attending their practices. Despite its routine provision, there is no evidence to support the clinical effectiveness of single-visit scale and polish, nor the frequency at which it should be provided. A recent systematic review recommended that future trials investigating scale and polish should involve dental practice patients.

METHODS

A practice-based parallel randomised controlled trial with 24-month follow-up was conducted. Healthy adults (Basic Periodontal Examination [BPE] codes <3) were randomly assigned to 3 groups (6-month, 12-month, or 24-month interval between scale and polish). The primary outcome was gingival bleeding with the hypothesis that 6-monthly scale and polish would result in lower prevalence than 12-month or 24-month frequency. Follow-up measurements were recorded by examiners blinded to the allocation. 125, 122 and 122 participants were randomised to the 6-month, 12-month and 24-month groups respectively. Complete data set analyses were conducted for 307 participants: 107, 100, and 100 in the 6-month, 12-month and 24-month groups respectively. Chi-square test and ANOVA were used to compare treatment groups at follow-up. Logistic regression and ANCOVA were used to estimate the relationship between outcome and treatment group, adjusted for baseline values. Multiple imputation analyses were also carried out for participants with incomplete data sets.

RESULTS

Prevalence of gingival bleeding at follow-up was 78.5% (6-month), 78% (12-month) and 82% (24-month) (p = 0.746). There were no statistically significant differences between groups with respect to follow-up prevalence of plaque and calculus. Statistically significant differences detected in the amount (millimetres) of calculus were too small to be clinically significant. Seventeen (4.6%) participants were withdrawn from the trial to receive additional treatment.

CONCLUSIONS

This trial could not identify any differences in outcomes for single-visit scale and polish provided at 6, 12 and 24 month frequencies for healthy patients (with no significant periodontal disease). However, this is the first trial of scale and polish which has been conducted in a general practice setting and the results are not conclusive. Larger trials with more comprehensive measurement and long-term follow up need to be undertaken to provide a firm evidence base for this intervention. This trial informs the design of future practice-based trials on this subject.

Isolation and characterization of probiotic strains for improving oral health

Probiotics have been proven effective for preventing caries. In contrast, the effect of probiotics on improving oral diseases such as gingivitis, periodontitis and halitosis has been less explored.

OBJECTIVE

To perform a screening of lactic acid bacteria, according to international guidelines for the evaluation of probiotics, in order to select candidate probiotic strains for preventing oral disorders.

STUDY DESIGN

The strains were isolated from healthy children and were subjected to a variety of in vitro tests in order to show their functionality. The safety of the strains was assessed by determining antibiotic susceptibility and production of lactic acid.

RESULTS

Forty-six of the 100 new isolates were assigned to lactic acid bacteria genera after a biochemical characterization. Most of the new isolated strains seem to be resistant to oral conditions, have great ability to form aggregates and have high antagonistic activity against oral pathogens. None of the strains produced unpleasant volatile compounds. The strains showed high ability to adhere to oral tissues and they do not present any antibiotic resistance. Moreover, an increased risk of developing caries due to their ability to produce lactic acid was discarded in seven pre-selected probiotic candidates.

CONCLUSIONS

These lactic acid bacteria show promising properties to be used as potential probiotics for improving oral health.

Plasmin is essential in preventing periodontitis in mice

Periodontitis involves bacterial infection, inflammation of the periodontium, degradation of gum tissue, and alveolar bone resorption, which eventually leads to loss of teeth. To study the role of the broad-spectrum protease plasmin in periodontitis, we examined the oral health of plasminogen (Plg)-deficient mice. In wild-type mice, the periodontium was unaffected at all time points studied; in Plg-deficient mice, periodontitis progressed rapidly, within 20 weeks. Morphological study results of Plg-deficient mice revealed detachment of gingival tissue, resorption of the cementum layer, formation of necrotic tissue, and severe alveolar bone degradation. IHC staining showed massive infiltration of neutrophils in the periodontal tissues. Interestingly, doubly deficient mice, lacking both tissue- and urokinase-type plasminogen activators, developed periodontal disease similar to that in Plg-deficient mice; however, mice lacking only tissue- or urokinase-type plasminogen activator remained healthy. Supplementation by injection of Plg-deficient mice with human plasminogen for 10 days led to necrotic tissue absorption, inflammation subsidence, and full regeneration of gum tissues. Notably, there was also partial regrowth of degraded alveolar bone. Taken together, our results show that plasminogen is essential for the maintenance of a healthy periodontium and plays an important role in combating the spontaneous development of chronic periodontitis. Moreover, reversal to healthy status after supplementation of Plg-deficient mice with plasminogen suggests the possibility of using plasminogen for therapy of periodontal diseases.

Oral features in five adult patients with Wolf-Hirschhorn syndrome

The Wolf-Hirschhorn syndrome (WHS) is a rare genetic condition presenting with severe mental disability, growth retardation, muscular hypotonia, seizures, craniofacial abnormalities and defects in the cardiovascular, genitourinary and digestive apparata. To date, few data about oral status of afflicted patients were reported, and this syndrome is still unfamiliar among dental and maxillofacial professionals. Aim of the present case series was to provide oral data from five patients with WHS (3 women and 2 men) aged 19-41 years. All patients entered in a long-stay Institution with an inner dental service in 1998 and underwent regular dental examination and hygiene treatment. Neither tooth agenesis or dental size and shape anomalies were found in the analyzed subjects except for one man showing multiple cone-shaped teeth. At the beginning, bad dental and periodontal conditions with gingival signs and recurrent mucosal inflammation were found in all patients. After motivation of their tutors, dental and periodontal parameters were recorded during periodic assessments and a large decrease in the gingival index was found over time. These data could aware dentists about the therapeutic modalities to improve oral health of WHS patients.

A history of frequent dental care reduces the risk of tooth loss but not periodontitis in older subjects

OBJECTIVES

Information on the significance of dental care in older adults is limited. We hypothesized that regular dental visits has an effect on the number of remaining teeth and periodontal conditions in older subjects.

MATERIALS AND METHODS

1020 randomly selected individuals age 60 - 96 from the Swedish National Study on Aging and Care Blekinge received a comprehensive oral health examination.

RESULTS

Dentate women and men had, on average 18.4 teeth (SD +7.6,) and 18.9 teeth (SD + 7.5) respectively (NS). In the youngest group (60 and 66 years old) with less than one dental visit per year, 37% had >20 teeth, compared with 73% among those with at least annual visits. Among the old-old, comparable figures were 1.8 % and 37% respectively. Across age groups, bleeding on probing was 23 %.When adjusting for age, and number of teeth GLM univariate analysis failed to demonstrate an effect of dental visit frequency on alveolar bone loss (p = 0.18), the number of periapical lesions (p = 0.65), or the number of endodontically treated teeth ( p = 0.41). Frequent dental visitors had more teeth than infrequent visitors (p = 0.001).

CONCLUSIONS

Tooth loss and alveolar bone loss severity increase with age. Individuals with regular dental visits retained more teeth but the frequency of dental visits had no impact on plaque deposits, gingival inflammation, or alveolar bone levels.

n-3 fatty acids and periodontitis in US adults

BACKGROUND

Periodontitis is a common, chronic inflammatory disease. Although n-3 fatty acids have anti-inflammatory properties, it is unclear whether n-3 fatty acids can treat or prevent periodontitis.

METHOD

We studied 9,182 adults aged 20 years and older who participated in the National Health and Nutrition Examination Survey between 1999 and 2004. Periodontitis was assessed by dental exam and was defined as >4 mm pocket depth and >3 mm attachment loss in any one tooth. Intake of n-3 fatty acids was assessed by 24-hour dietary recall. We used multivariable logistic regression to estimate the associations between periodontitis and intakes of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and linolenic acid (LNA).

RESULTS

The weighted prevalence and 95% confidence interval (CI) of periodontitis was 8.2% (95% CI 7.0 to 9.4). Compared with the lowest tertiles, the adjusted odds ratios for periodontitis associated with the highest tertiles of dietary n-3 intake were 0.78 (95% CI 0.61 to 1.00; P=0.009) for DHA, 0.85 (95% CI 0.67 to 1.08; P=0.10) for EPA, and 0.86 (95% CI 0.60 to 1.23; P=0.28) for LNA. The associations were little changed by multivariable adjustment or exclusion of individuals reporting use of dietary supplements containing DHA, EPA, or LNA.

CONCLUSIONS

In this nationally representative sample, higher dietary intakes of DHA and, to a lesser degree, EPA, were associated with lower prevalence of periodontitis. Interventional studies are needed to confirm the potential protective effects of n-3 fatty acids on periodontitis.

Strategies for managing periodontal inflammation

Most of the tissue destruction in periodontal disease is caused by the patient's inflammatory response. Classical approaches to controlling inflammation rely on attempts to eliminate pathogenic bacteria that incite the inflammatory response through mechanical or chemical means. This approach still has a place in treating periodontal inflammation today. Emerging and future approaches will rely more on modifying the inflammatory response itself, by limiting the activity of proinflammatory pathways and by amplifying pathways that resolve inflammation.

[Does good oral hygiene guarantee the maintenance of a health periodontium?]

On the last European Workshop for Periodontology, it was accepted that the prevalence of periodontitis in certain regions of Europe and USA has decreased. It remains difficult to phrase a decision concerning the prevalence of periodontitis in general. This article wants to highlight the need of a good oral hygiene and different forms of prevention (primary, secondary & tertiary) in the maintenance of a healthy periodontium. The relationship between gingivitis and tooth loss is pointed out. The prevention is described in the complexity of the periodontitis proces and it's modifying factors. When dealing with different forms of periodontitis (refractory, necrotising gingivitis and periodontitis, agressive periodontitis) prevention needs to be adjusted to the etiology and specific situation. This is also the case in peri-implantitis. This article tends to find a scientific background for oral hygiene and prevention in periodontal disease.

[Subgingival air-polishing: new perspectives for periodontal maintenance?]

After completion of comprehensive periodontal therapy, the main objective is to maintain gingival tissues in a clinically healthy state. Traditional methods like curettes and ultrasonic devices used during maintenance are responsible of irreversible hard tissue damages ensuing from repeated mechanical scraping of tooth surfaces. A new approach to clean root surfaces without inducing these damages may be the air-polishing technology. Original air-polishing systems are highly abrasive to root cementum and dentin and cannot be used safely in the subgingival area (risk of inducing hard and soft tissue lesions and emphysema). New low abrasive powders and nozzles were designed in order to allow access to root surfaces and to permit the use of the air-polishing devices safely. Recent clinical studies have shown the short-term clinical efficacy of such devices in residual pockets and their safety when used on root surfaces. The new subgingival air-polishing devices are perceived more acceptable by the patients and are more time efficient than scaling and root planning during maintenance. Long-term studies are still lacking to prove their clinical and microbiological efficacy.

Antiinflammatory effect of BPC 157 on experimental periodontitis in rats

The pentadecapeptide BPC 157 has been shown to have anti-inflammatory and wound healing effects on multiple target tissues and organs. The purpose of the present study was to investigate the effect of BPC 157 on inflammation and bone resorption in experimental periodontitis in rats. First the acute effect of BPC was tested on gingival blood flow by laser doppler flowmetry. Then periodontitis was produced by a silk ligature placed around the lower left first molar. Rats were treated with BPC 157 (once daily for 12 days) or vehicle. At day 13, the gingivomucosal tissues encircling the molars were removed on both sides. Inflammation was assessed by Evans blue plasma extravasation technique and by histology. Alveolar bone loss was analyzed by microCT. BPC 157 had no effect on gingivomucosal blood flow. Twelve day ligature caused a significantly increased Evans blue extravasation in the gingivomucosal tissue, histological signs of inflammation, and alveolar bone destruction. BPC 157 treatment significantly reduced both plasma extravasation, histological alterations and alveolar bone resorption. In conclusion, systemic application of BPC 157 does not alter blood circulation in healthy gingiva. Chronic application of the peptide has potent antiinflammatory effects on periodontal tissues in ligature induced periodontitis in rats. Taken together, this proof of concept study suggests that BPC 157 may represent a new peptide candidate in the treatment of periodontal disease.

Do smokers benefit from dental hygiene oral prophylaxis? A Nigerian pilot study

Smoking is a major, preventable risk factor for periodontitis. This pilot study in Nigeria evaluated the effect of dental oral prophylaxis on oral hygiene and periodontal indices among 13 systemically healthy smokers and 8 non-smokers. All participants received full-mouth scaling and root planing, tooth polishing, demonstration of correct brushing technique and a new toothbrush and toothpaste. After 6 months, debris index, calculus index, oral hygiene index and community periodontal index of treatment needs status code 0 scores showed no improvement in smokers. There was a 50% improvement of all indices among non-smokers. Smokers showed no benefit from dental oral prophylaxis in this study.

[Microbiological evaluation of some commercial brands of Chamomillae floss]

Different strains of microorganisms contaminate medicinal herb, and theirs, enzymes could modify the normal composition of herbal products.

MATERIAL AND METHODS

We evaluated the microbiological quality of 12 samples of Chamomillae floss commercialized in, markets and specific stores. Microbiological quality has been evaluated according European Pharmacopoeia rules. In all samples we determined the total number of germs, total number of fungi and we evaluated the presence of coliform bacilli, respectively Staphylococcus species.

RESULTS

For all samples, the total number of germs was under the limits with variation between 320 CFU/g (P 4) and 14000 CFU/g (P 11). The total number of fungi was under the limits; in most of samples, we detected Penicillium sp. and Aspergillus sp. In 4 samples the total number of Escherichia coli strains was over the limits (100 CFU/g).

CONCLUSIONS

An important decrease of total number of coliform bacilli was observed after boiling water has been added but the total number of germs was decreased insignificantly, so these extracts are not very safe for patient especially when vegetal products contain a great number of germs.

Effects of vitamin C intake on gingival oxidative stress in rat periodontitis

Increased levels of oxidative stress due to excessive production of reactive oxygen species are involved in the pathogenesis of periodontitis. Studies suggest a negative association between plasma vitamin C level and the severity of periodontitis. We hypothesized that increases in plasma vitamin C levels after vitamin C intake might clinically reduce gingival oxidative stress in a rat periodontitis model. A ligature was placed around rat mandibular molars for 4 weeks to induce periodontitis, and the rats were then given drinking water with or without 1 g/L vitamin C for 2 weeks after the ligature was removed. The periodontitis-induced rats showed a 149% increase in 8-hydroxydeoxyguanosine level and a 40% decrease in reduced:oxidized glutathione ratio in gingival tissue. Vitamin C intake induced a 175% increase in plasma vitamin C level, resulting in an improvement in the gingival 8-hydroxydeoxyguanosine level (decreased) and in the reduced:oxidized glutathione ratio (increased). Furthermore, in ligature-induced periodontitis lesions, gene expression encoding inflammation, including interleukin-1 alpha and interleukin-1 beta, was more than twofold down-regulated by vitamin C intake. The results suggest that systemic administration of vitamin C could be clinically beneficial in improving periodontitis-induced oxidative stress by down-regulating inflammatory gene expression.

Periodontal maintenance therapy: an integral part of dental practice. Case reports on three periodontally involved patients

Periodontal maintenance therapy is an integral aspect of any general dental or specialist practice. Numerous studies have indicated that periodontal therapy in the absence of a carefully designed maintenance program invariably results in the relapse of the disease condition. Accordingly, dental practices that provide periodontal care without a maintenance program deal with significant patient management and disease management issues. In this article, three cases are presented with varying levels of disease severity but all sharing the common trait of having being enrolled in a good maintenance program with positive treatment outcomes.

[Periodontal tissues contamination prevention in the process of teeth endodontic treatment]

The main causative factors of microbial injury of periodontal tissues during endodontic treatment and ways of its prevention we are discussed. The own microbiological investigation results and bibliographic data we are presented. Microbiological investigation of debris extruded during root canal instrumentation using EDTA and sodium hypochlorite was executed by authors.

Practice of preventive measures, dental anxiety and dental status among young adults

The use of patient self-assessment is a good predictor of the patient's dental status. Dental practitioners could request patients to assess their dental status prior to treatment or appointment, especially when dental screening of large populations is performed to locate patients at risk. This might help the practitioner to accomplish more effective time and patient management.

Periodontal disease and preterm birth relationship: a review of the literature

Despite medical care improves consistently, the rate of preterm birth has risen in recent years. In Italy the rate of preterm birth between the XXXIII and the XXXVI week is 13.5%, while it amounts to 1.3% for preterm birth between XXIV and the XXXII week. Consequently, the identification of risk factors for preterm birth that might be modified would have far-reaching and long-lasting effects. A significant number of preterm birth may be attributed to infections of the urogenital tract, such as bacterial vaginosis. In the last decade, great interest has been generated to support the hypothesis that sub-clinical infection at sites that are also distant from the genito-urinary tract may be an important cause of preterm labour, probably through the activation of abnormal inflammatory responses within the uterus and intrauterine tissues. There is emerging evidence of a possible relationship between maternal periodontal diseases as a potential risk factor of adverse pregnancy outcomes, like preterm low birth weight even though not all of the actual data support such hypothesis. Further studies are clearly required to clarify the causes and/or relationships linking pathologic oral conditions and adverse pregnancy outcomes. So far, from a clinical standpoint, it would appear that the assessment of the periodontal status of pregnant women during an early pregnancy might be useful in providing an important indicator of risk for future obstetric complications.

Randomized clinical trial on the effects of full mouth disinfection versus conventional quadrant therapy in the control of chronic periodontitis

AIM

This clinical trial investigates the effectiveness of full-mouth disinfection (FMD) versus conventional etiological therapy in patients with chronic periodontitis (CP).

METHODS

The therapy effectiveness was assessed by a randomized trial, performed over 20 adult periodontitis (AP) patients, divided into two groups. Patients were recruited undergoing strict inclusion/exclusion criteria. The following parameters were considered to evaluate and compare the two procedures: bleeding on probing (BOP), Plaque Index (PLI), probing depth (PD), clinical attachment level (CAL). These clinical data were collected at baseline and at three follow-ups (three months, six months and twelve months from baseline). Each parameter was averaged within each group; then statistic comparisons were performed within groups and between groups.

RESULTS

In the test-group statistically significant improvements (P<0.001) were found for all parameters between baseline and every following review. The same result was reported in the control group (with a further significant difference between first and second review). Finally, the comparison between groups did not show any difference at any time for every parameter considered.

CONCLUSION

FMD outcomes are similar to those of the conventional therapy and improvements can be achieved more quickly. FMD does not cause remarkable side effects and reduces the number of therapy sessions. Some aspects about this treatment need further research: maybe FMD could give an extra reduction of bacterial load, in comparison with traditional therapy, resulting in a longer free-infection period; that could allow a decrease in the frequency of supporting periodontal treatment.

[Relationships between diabetes mellitus and periodontal disease: current knowledges and therapeutic prospects]

Diabetes mellitus is a disorder of the endocrine system. An important pathology of dental interest to which the diabetic patient can go encounter, especially if not controlled from the metabolic point of view, is the periodontal disease. The aim of this review is to illustrate the relation between diabetes mellitus and periodontal disease estimating the several therapeutic options on hand in the clinical daily practice. Many studies show an important association between diabetes and the pathogenesis of periodontal disease. Vascular changes caused by hyper-glycemia are associated to the development of periodontal pathogens species. Moreover, diabetics show an exacerbate host response with hyperproduction of inflammatory mediators and polymorphonuclear dysfunction. Diabetics with good metabolic control and patients with good oral hygiene show a reduced risk of periodontitis. In conclusion, diabetes mellitus (of type 1 and type 2) is an important risk factor for periodontitis. Diabetes mellitus determines changes in bacterial population and production of inflammatory mediators, and reduces the efficacy of the host response. Good controlled diabetes do not cause a major risk of periodontitis and improve the results of the periodontal initial therapy and of the eventual surgical therapy. Moreover, periodontal therapy may reduce the request of insulin in diabetics. It is reasonable a reciprocal relation between diabetes and periodontal disease.

[Decision making in treatment and co-management of periodontal infection: elimination or progression?]

An accurate prediction of disease progression after periodontal therapy would enable the clinician to intervene where and whenever necessary and to individualize supportive care. Unfortunately, predicting continued clinical attachment loss on the basis of clinical parameters on a site and tooth level seems relatively unreliable. Consequently, the clinician could play safe by possibly performing overtreatment. Reality shows, however, that persistent pathology prevails in some cases. A recent study has indicated that deep residual pockets of at least 6 mm following active periodontal therapy represent a risk for further disease progression and tooth loss. Significant associations have been shown on a site, tooth and patient level. This finding promotes a pocket elimination approach for the treatment of periodontitis. The strategy, which includes a strict extraction policy for hopeless teeth and thorough pocket disinfection usually by means of surgery, reduces the work load during supportive care. Indeed, additional tooth loss will be limited and a low prevalence of deep residual pockets limits the need for re-treatment. Besides active periodontal therapy supportive care is of pivotal importance to limit disease progression. The appropriate interval is selected on the basis of the patient's risk profile by the periodontist. Since specialists are usually understaffed to provide this for all patients, a 'co-management' concept seems the best alternative. This concept includes regular visits to the specialist and general practitioner. On the other hand, auxiliary personnel can be helpful to assist careproviders in organizing supportive therapy. This concept has proven to be effective over the world except for Belgium where oral hygienists are nonexisting and not allowed by law. Maybe it is time to reorganise health care policy in the benefit of clinicians and patients.

Efficacy of sub-antimicrobial dose doxycycline in post-menopausal women: clinical outcomes

AIMS

To determine the clinical efficacy of a 2-year continuous sub-antimicrobial dose doxycycline (SDD; 20 mg bid) in post-menopausal, osteopenic, oestrogen-deficient women on periodontal maintenance.

MATERIALS AND METHODS

One-hundred and twenty-eight subjects were randomized to SDD (n=64) or placebo (n=64). Clinical measurements were performed at posterior interproximal sites at baseline and every 6 months during this 2-year randomized, double-blind, placebo-controlled clinical trial with adjunctive, no-cost 3-4-month periodontal maintenance. Statistical analyses of secondary outcomes from this clinical trial used Generalized Estimating Equations in primarily intent-to-treat analyses.

RESULTS

For the placebo group, 3.4% of the sites showed improvement in clinical attachment levels (CAL) and 2.7% had progressive loss in CAL; for the SDD group, 5.0% of the sites showed an improvement in CAL and 2.2% had progressive loss in CAL. This difference (2.1% of sites) was more favourable in the SDD group than in the placebo [odds ratio (OR)=0.81 [corrected] 95% confidence interval (CI): 0.67-0.97, p=0.03] in these well-maintained patients, whereas probing depths, bleeding on probing and supragingival plaque did not differ significantly between groups (p>0.2). However, in exploratory subgroup analysis of non-smokers, SDD showed reduced bleeding versus placebo (27%versus 33%; p=0.05). In protocol-adherent subjects, the odds of bleeding were 34% lower for SDD (p=0.05).

CONCLUSIONS

Analyses of secondary outcomes of this clinical trial indicated that SDD may be of benefit in reducing progressive attachment loss in post-menopausal females; additional research is needed to confirm these findings. Protocol registered at (ClinicalTrials.gov). Identifier:NCT00066027.

Subantimicrobial dose doxycycline effects on alveolar bone loss in post-menopausal women

AIM

Determine the efficacy of 2-year continuous subantimicrobial dose doxycycline (SDD; 20 mg bid) on alveolar bone in post-menopausal osteopenic, oestrogen-deficient women undergoing periodontal maintenance in a 2-year double-blind, placebo-controlled, randomized clinical trial.

MATERIAL AND METHODS

One-hundred and twenty-eight subjects randomized to SDD or placebo (n=64 each). Posterior vertical bite wings taken at baseline, 1 and 2 years for alveolar bone density (ABD), using radiographic absorptiometry (RA) and computer-assisted densitometric image analysis (CADIA), and alveolar bone height (ABH). Statistical analyses utilized generalized estimating equations; primary analyses were intent to treat (ITT). Results are presented as SDD versus placebo.

RESULTS

Under ITT, there was no statistically significant effect of SDD on ABD loss (RA: p=0.8; CADIA: p=0.2) or ABH loss (p=0.2). Most sites (81-95%) were inactive. For subgroup analyses, mean CADIA was higher with SDD for non-smokers (p=0.05) and baseline probing depths > or =5 mm (p=0.003). SDD was associated with 29% lower odds of more progressive ABH loss in women >5 years post-menopausal (p=0.05) and 36% lower among protocol-adherent subjects (p=0.03).

CONCLUSIONS

In post-menopausal osteopenic women with periodontitis, SDD did not differ overall from placebo. Based on exploratory subgroup analyses, additional research is needed to determine the usefulness of SDD in non-smokers, subjects >5 years post-menopausal and in deeper pockets. Protocol registered at (ClinicalTrials.gov). Identifier: NCT00066027.

Initiating tobacco curricula in dental hygiene education: a descriptive report

Two hours of tobacco instructions were incorporated into the baccalaureate dental hygiene curricula in a university in the Northwestern United States. Prior to graduation, all senior students were invited to complete anonymously a questionnaire surveying attitudes and clinical skills in providing tobacco services to their clinic patients. Twenty students (67%) responded but no data was collected on the non-respondents. Eighteen (90%) reported practicing some of the "5 A's," and a few reported sustained adherence to all "5 A's." Moderately successful clinical outcomes parallelled students' moderate self-rating of their knowledge/skills. When asked to identify barriers to sustained and ongoing full adherence, most students cited "patient resistance/disinterest," and their own "lack of knowledge or confidence in the skills." Our preliminary findings suggest that additional content and training time may be required for dental hygiene graduates to feel highly confident and knowledgeable, and for them to sustain comprehensive tobacco services once in practice.

Impact of supportive periodontal therapy and implant surface roughness on implant outcome in patients with a history of periodontitis

OBJECTIVE

This review searched for a relationship between susceptibility to periodontitis and peri-implantitis, with implant outcome as the primary outcome variable and supportive periodontal therapy (SPT) and implant surface roughness as confounding factors.

MATERIAL AND METHODS

It is based on a MEDLINE search up to June 2006. Only 16 fulfilled the selection criteria. The heterogeneity of the studies (e.g. periodontal status, SPT, prosthetic design, ...) rendered a meta-analysis impossible. The impact of a history of periodontitis on early implant loss was negligible. Only five papers reported sub-data for patients with different degrees of periodontitis. Four out of five papers indicate a higher incidence of late implant loss and/or marginal bone loss in patients with a history of periodontitis. This difference was most obvious for very rough implants (three papers), and/or when SPT was not organized (one paper). Other confounding factors were often neglected. Another 10 papers only reported the outcome of implants in patients with a history of periodontitis. In case of SPT and when avoiding roughened surfaces, late implant loss remained below 3%, and marginal bone loss remained low.

CONCLUSIONS

These results seem to indicate that periodontally compromised patients can be successfully treated with minimally/moderately rough implants, in the presence of SPT.

Omega-3 fatty acid regulates inflammatory cytokine/mediator messenger RNA expression in Porphyromonas gingivalis-induced experimental periodontal disease

INTRODUCTION

Porphyromonas gingivalis is strongly implicated in the etiology of adult periodontitis by inducing inflammatory cytokines, resulting in gingival and periodontal tissue inflammation and alveolar bone resorption. This study tested the hypothesis that supplementing the diet with omega-3 fatty acid (omega-3 FA; i.e. fish oil) would exert anti-inflammatory effects in the gingival tissues of P. gingivalis-infected rats.

METHODS

Rats were fed either fish oil or corn oil diets ad libitum for 22 weeks and infected with P. gingivalis strain 381 or strain A7A1-28. After sacrifice, rat gingival tissues were excised and the RNA was isolated and analyzed for proinflammatory mediators [interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), IL-6], T helper type 1 and type 2 cytokines [interferon-gamma (IFN-gamma), IL-4, IL-10), antioxidant enzymes [catalase (CAT), superoxide dismutase (SOD)], and genes critical for eicosanoid mediator production [cyclo-oxygenase-2 (COX-2), 5-lipoxygenase (5-LO)] by reverse transcription-polymerase chain reaction using rat-specific primers.

RESULTS

Rats on the omega-3 FA diet exhibited decreased proinflammatory cytokine gene expression (IL-1beta, TNF-alpha) and enhanced IFN-gamma, CAT and SOD messenger RNA expression compared to rats fed a corn oil diet, supporting a diet-induced modulation of host inflammatory reactions. Analyses of alveolar bone resorption in the rats related to gene expression profiles demonstrated significant positive correlations with IL-1beta, IL-6 and COX-2 and negative correlations with CAT and SOD.

CONCLUSION

These findings suggest that diets enriched for omega-3 FA modulate the local gingival inflammatory milieu of the host following oral P. gingivalis infection, which impacts on alveolar bone resorption in rats.

Vaccination against periodontitis: the saga continues

Periodontal disease can be considered to be one of the most common chronic inflammatory diseases inflicting humans. With the advent of advanced molecular diagnostic techniques, a better understanding of the role of specific pathogens and the contributory role of the host immune response in the initiation and progression of periodontal disease has been possible - although not completely. However, successful vaccine development that fully utilizes the current level of understanding has not yet occurred for human use. This paper reviews various in vitro, animal studies and human trials undertaken to develop a vaccine against periodontal disease, with emphases on the shortfalls of these efforts and future prospects of developing a successful vaccine against periodontal disease.

Comparative Efficacy of Stabilized Stannous Fluoride/Sodium Hexametaphosphate Dentifrice and Sodium Fluoride/Triclosan/Copolymer Dentifrice for the Prevention of Periodontitis in Xerostomic Patients: A 2-Year Randomized Clinical Trial

BACKGROUND

The primary objective of this study was to compare the efficacy of a stannous fluoride (SnF2) dentifrice relative to a positive control triclosan dentifrice for prevention of clinical attachment loss (CAL) in xerostomic patients. A secondary objective was to compare the dentifrices for root caries remineralization.

METHODS

This was a 2-year, randomized, double-masked, parallel-group study. A 0.454% SnF2/sodium hexametaphosphate dentifrice was tested versus a positive control dentifrice (sodium fluoride/0.30% triclosan/copolymer) in 440 medication-induced xerostomic adults identified in a 1-year, run-in phase (no treatment) as high risk for periodontitis and root caries. During the study phase, subjects were stratified based on gender and attachment level into two groups. Subjects brushed twice a day for 60 seconds using their assigned product. Clinical examinations including probing depth, attachment level, bleeding on probing, and root caries remineralization were performed at baseline and 1 and 2 years.

RESULTS

A total of 334 subjects were evaluable. During run-in, average CAL relative to initial examination was 1.33 mm. Probing depth increased 0.95 mm. At year 2 in the treatment phase, attachment gain was 0.77 mm for the test group and 0.79 mm for the control group versus baseline. Probing depth decreased 0.57 mm for the test group, similar to the control group (0.53 mm). These changes versus baseline were statistically significant (P <0.01) for each group. Products were not statistically significantly different from each other. Both treatments resulted in similar remineralization for root caries lesions at study completion (P = 0.40).

CONCLUSION

The results establish comparable benefits for the SnF2 dentifrice in preventing CAL and root caries versus the sodium fluoride/triclosan/copolymer control in xerostomic patients.

Effect of Supragingival Plaque Control in Smokers and Never-Smokers: 6-Month Evaluation of Patients With Periodontitis

BACKGROUND

The effect of supragingival plaque control on clinical signs of periodontitis is controversial, particularly when smoking habits are considered. This study evaluated the clinical effects of supragingival plaque control on clinical signs of periodontitis in smokers and never-smokers.

METHODS

The following data were collected for 25 never-smokers and 25 smokers at baseline and 30, 90, and 180 days: visible plaque index (VPI), gingival bleeding index (GBI), bleeding on probing (BOP), periodontal probing depth (PD), and clinical attachment loss (CAL). After baseline examinations, supragingival scaling was performed. Oral hygiene practices were reinforced and reevaluated weekly during the experimental period. Linear models adjusted for clustering of observations within individuals were used for statistical analysis.

RESULTS

Reductions in VPI were significant for both groups, with no intergroup differences. GBI at baseline was similar between groups, and at 30, 90, and 180 days, smokers had a lower GBI than never-smokers. Significant reductions were observed in PD for shallow (1 to 3 mm), moderate (4 to 5 mm), and deep sites (> or = 6 mm) in both groups. CAL was significantly greater in smokers throughout the study, but gains in attachment were similar for both groups (0.71 to 1.00 mm). BOP reductions were similar in both groups.

CONCLUSIONS

Supragingival plaque control resulted in significant changes in clinical parameters associated with gingivitis and periodontitis. Smoking did not affect results, regardless of initial PD.

1-Tetradecanol complex reduces progression of Porphyromonas gingivalis-induced experimental periodontitis in rabbits

BACKGROUND

It has been recently shown that monounsaturated fatty acids inhibit endothelial activation and reduce tissue responsiveness to cytokines. The present study has been planned to investigate topical application of a novel monounsaturated fatty acid complex (1-tetradecanol complex) for prevention of Porphyromonas gingivalis-induced periodontitis in rabbits.

METHODS

Experimental periodontitis was induced in New Zealand white rabbits with silk sutures tied around the mandibular second premolars bilaterally, followed by the topical application of 10(9) colony forming units (CFU) of P. gingivalis. 1-Tetradecanol complex (1-TDC) was topically applied at 1- and 10-mg/ml concentrations in five animals in each group, whereas control animals received olive oil vehicle (five animals) three times per week for 6 weeks. Negative controls included ligature alone (14 animals) or ligature + P. gingivalis (non-treatment; 15 animals). Rabbits were sacrificed after 6 weeks, and mandibular block sections were obtained; tissues were decalcified and embedded in paraffin. Thin sections (5 microm) were stained with hematoxylin and eosin or tartrate-resistant acid phosphatase. Macroscopic and histologic evaluation of samples was followed by the characterization of cellular inflammatory infiltrate and quantitative histomorphometric measurements.

RESULTS

Treatment with both concentrations of 1-TDC and vehicle resulted in significant prevention of macroscopic periodontal inflammation and bone loss (75%; P <0.05) compared to the non-treatment (ligature + P. gingivalis) group, where significant periodontal tissue destruction characterized by attachment and bone loss was detected. However, there was no statistically significant difference between the vehicle and both 1-TDC groups. Histologically, 1-TDC inhibited inflammatory cell infiltration and prevented osteoclastogenesis, whereas treatment with vehicle did not show the same effect as in the 1-TDC groups; the difference between vehicle and the higher concentration of 1-TDC (10 mg/ml) was statistically significant.

CONCLUSION

Topical application of an esterified monounsaturated fatty acid complex (1-TDC) was found promising in preventing bone loss, inflammatory cell infiltration, and connective tissue destruction in the rabbit periodontitis model.