The periodontal condition of regular dental attenders in Northern Ireland

Comparison of periodontal parameters in individuals with syndromic craniosynostosis

Craniosynostosis syndromes are characterized by premature closure of one or more cranial sutures, associated with other malformations, the most frequent of which are the Crouzon and Apert syndromes. Few studies in the literature have addressed the oral health of these individuals. The purpose of this study was to compare the periodontal status of individuals with Apert, Crouzon, Pfeiffer and Saethre-Chotzen syndromes before toothbrushing and compare the efficiency of plaque removal before and after mechanical toothbrushing. The probing depth, plaque index (according to Löe and O'Leary), clinical attachment level, gingival index (according to Silness and Löe) and amount of keratinized mucosa were evaluated before toothbrushing, and the O'Leary plaque index was assessed before and immediately after toothbrushing, on the same day, in 27 individuals aged 11 to 36 years. There was statistically significant difference in the mean probing depth and clinical attachment level among regions (p=0.00; p=0.01, respectively). The gingival index did not reveal statistically significant differences. With regard to the plaque index, the left region exhibited higher plaque index values than the right and anterior regions. No significant results were found in the analysis of keratinized mucosa. Comparison of the O'Leary plaque index before and after toothbrushing revealed statistically significant difference for all syndromes except for the Pfeiffer syndrome (p<0.05). In conclusion, there was no difference in the periodontal status among individuals with syndromic craniosynostosis. The posterior region was more affected than the anterior region as to the presence of plaque, loss of insertion and probing depth. Individuals with Pfeiffer syndrome exhibited greater toothbrushing efficiency than individuals with the other craniosynostosis syndromes.

Obesity and periodontitis in 60?70-year-old men

OBJECTIVE

The aim was to investigate whether there was an association between obesity and periodontitis in a homogeneous group of 60-70-year-old Western European men. The study also explored whether a high body mass index (BMI) in early life predicted poor periodontal status in later life.

METHODOLOGY

A representative sample of the male population of UK, who were enrolled in a cohort study of cardiovascular disease, was examined between 2001 and 2003. A total of 1362 men with six or more teeth completed a questionnaire, had a clinical periodontal examination and had their weight and height recorded. Multivariable analysis was carried out using logistic regression with adjustment for possible confounders. Models were constructed with low- and high- threshold periodontitis as dependent variables and with BMI as a categorical predictor variable. Low-threshold periodontitis was identified when at least two teeth had >/=6 mm loss of attachment and at least one site had a pocket of >/=5 mm. High-threshold periodontitis was identified when >/=15% of sites had >/=6 mm loss of attachment and there was deep pocketing (>/=6 mm). Modelling was repeated for other predictor variables including BMI at 21 years of age and change in weight since 21 years of age.

RESULTS

Two hundred and ninety-eight (21.9%) of the men studied, who had a BMI of >30 kg/m(2), were classified as obese. Obesity was associated with low-threshold periodontitis, odds ratio (OR)=1.77 (p=0.004) after adjustment for confounders. The BMI at 21 years of age did not predict periodontitis in the men investigated. Participants who had experienced a large (>30%) increase in weight during adulthood had an increased risk of poor periodontal condition; however, this was attenuated and no longer significant after adjustment for confounders.

CONCLUSIONS

It is concluded that obesity was associated with periodontitis in the homogeneous group of 60-70-year-old European men investigated. High BMI levels in early life did not predict periodontitis in later life in the men studied.

Angiographically confirmed coronary heart disease and periodontal disease in middle-aged males

BACKGROUND

The aim of this study was to investigate whether an association could be demonstrated between coronary heart disease (CHD) and chronic periodontitis in a population of middle-aged males in Northern Ireland.

METHODS

A case-control design was used. Cases were men aged over 40 years with angiographically proven CHD. Controls were age-matched males, with no evidence of CHD, randomly drawn from the same locality as the cases. Each subject had a clinical periodontal examination and completed a detailed sociodemographic questionnaire. High sensitivity C-reactive protein (CRP) was measured in serum by immunoturbidimetry.

RESULTS

There were 92 cases (mean age 56.7 years; SD = 6.3) and 79 controls (mean age 58.2 years; SD = 6.7). The CHD cases had an average of three teeth less than the controls (P <0.0001). A higher proportion of sites examined in cases than controls had plaque (P = 0.004), bleeding on probing (P = 0.013), and probing depths of > or = 4 mm (P = 0.006) or > or = 6 mm (P = 0.03). Subjects with > or = 4 mm pocketing in more than 20% of their interproximal sites and those with deep pocketing (> or = 6 mm) were classified as having poor periodontal status. A total of 35 cases (38%), compared to only 13 controls (16%), had a poor periodontal status (P = 0.0017). Men with a poor periodontal condition had higher levels of CRP (median 2.19 mg/l) than those with good periodontal health (median 1.42 mg/l), P = 0.007. After adjusting for smoking, academic achievement, alcohol consumption, unemployment, ability to maintain body weight, regular exercise, ability to relax daily, having a hobby or pastime, plaque, and CRP, logistic regression analysis showed that poor periodontal status was significantly associated with CHD, with an adjusted odds ratio of 3.06 and 95% confidence intervals of 1.02 to 9.17, P = 0.046.

CONCLUSIONS

There was an association between coronary heart disease and poor periodontal status in the middle-aged males investigated. This association was independent of diabetes and all other cardiovascular risk factors investigated.

A Model of Spontaneous Periodontitis in the Miniature Goat

BACKGROUND

The pathogenesis and progression of periodontal disease have been extensively studied through the use of animal models. However, no animal model has yet been established that is precisely similar to periodontitis in humans. In the present study, we examined the use of Shiba goats as a model for spontaneous periodontitis.

METHODS

Thirty-four Shiba goats (seven males and 27 females, aged 10 to 98 months) were used. We examined periodontitis in Shiba goats clinically, histopathologically, and microbiologically.

RESULTS

The mean probing depth (PD) of the 68 teeth examined was 2.7 +/- 0.8 mm. The incidences of PD > or =3 and 4 mm were 46.4% and 22.1%, respectively. The incidence of bleeding on probing in 68 sites and in 34 animals was 60.7% and 73.5%, respectively. The formation of vertical alveolar bone defects and downgrowth of gingival epithelial cells were found in the areas of periodontitis. The prevalence of Tannerella forsythensis, Campylobacter rectus, Fusobacterium necrophorum, Fusobacterium nucleatum, and Actinobacillus actinomycetemcomitans in subgingival plaque by polymerase chain reaction was 46.4%, 28.5%, 28.5%, 17.8%, and 3.5%, respectively. These percentages were increased in subgingival plaque from PD > or =3 mm.

CONCLUSIONS

The clinical, histopathological, and microbiological features of spontaneous periodontitis in Shiba goats were somewhat similar to those in human periodontitis. Moreover, there are some advantages of using the Shiba goat; the size of the oral cavity is suitable for periodontal treatment, and handling and housing are relatively easy. Therefore, these results suggest that the Shiba goat is a useful animal model for human periodontitis.

Risk Indicators for Periodontal Disease in a Remote Canadian Community?a Dental Practice-based Study

OBJECTIVES

The purpose of this cross-sectional study was to identify risk markers and risk indicators for periodontal attachment loss in a remote Canadian community. Of special interest was the association between smoking and periodontal disease experience.

METHODS

Data were collected from a convenience sample of 187 adult patients attending a dental office in a rural community located in Northern Ontario. Information was obtained via a questionnaire and a periodontal examination. The questionnaire included the use of dental services, self-care behaviors, general health status, smoking, and personal characteristics. Periodontal health was assessed using the mean periodontal attachment loss (MPAL), measured at two sites on all remaining teeth and the proportions of sites examined with loss of 2 mm or more and 5 mm or more. Plaque scores and measures of the number of missing teeth also were obtained. The relationships between mean periodontal attachment loss, the proportion of sites with 5 mm or more of loss and independent variables such as age, sex, current smoking status, mean tooth plaque scores, flossing frequency, and regularity of preventive dental visits were examined in bivariate and multivariate analyses.

RESULTS

The data revealed a mean periodontal attachment loss of 3.9 mm (SD=1.5). The mean proportion of sites examined with loss of 2 mm or more was 0.89 and the mean proportion with loss of 5 mm or more was 0.35. In linear regression analysis, plaque scores, the number of missing teeth, age, current smoking status, regularity of dental visits, and flossing frequency had statistically significant independent effects and explained 60.0 percent of the variance in mean periodontal attachment loss. Just over 30 percent of subjects had severe periodontal disease, defined as 50 percent or more of sites examined with loss of 5 mm or more. In logistic regression analysis, missing teeth, dental visiting, smoking status, age, and flossing frequency had significant independent effects. The strongest association observed was with smoking, which had an odds ratio of 6.3. The logistic regression model correctly predicted 64.3 percent of cases with severe disease.

CONCLUSIONS

The data indicate that the periodontal health of these patients is poor. Risk indicators or markers of poor periodontal health in the population studied included missing teeth, plaque scores, age, current smoking status, regularity of dental visits, and flossing frequency. This supports previous findings that behavioral factors play an important role in periodontal disease.

Quantitation of Bacteroides forsythus in subgingival plaque comparison of immunoassay and quantitative polymerase chain reaction

Our objective was to compare three methods (enzyme-linked immunosorbent assay [ELISA], endpoint and quantitative polymerase chain reaction [E-PCR and Q-PCR]) for detection and quantitation of Bacteroides forsythus in 56 plaque samples from seven subjects with progressive periodontal disease. Samples collected in buffer were pelleted and resuspended in 500 microl of water. Fifty microl aliquots were removed for an ELISA performed on bacteria or plaque immobilized on 96-well plates and probed with B. forsythus specific antibody. An occurrence of 3.7+/-0.6 x 10(4) or more bacteria were detected by ELISA in pure culture; 26 of 54 plaque samples were positive, two samples could not be analyzed. Samples for PCR were autoclaved for 10 min prior to use. The detection level of E-PCR using primers specific for B. forsythus 16S rRNA was 200 cells and 42 out of 56 samples were positive based on ethidium bromide stained agarose gels. Q-PCR using the same primers combined with a nested fluorescent oligonucleotide probe detected 10+/-0.32 bacteria in pure culture; 43 of 56 plaque samples were positive. The ELISA and Q-PCR obtained identical results with 36 of the 54 samples assayed; there were one false positive and 17 false negative ELISA results using Q-PCR as standard. The positive proportions of plaque samples were almost the same for E-PCR and Q-PCR. We conclude that the PCR methods are more appropriate for a multicenter study because of greater sensitivity and convenience of sample transportation from clinics to a central laboratory.

Variation in periodontal referral by general dental practitioners

This study investigated the extent of and reasons for variation in the periodontal referral patterns of general dental practitioners in Northern Ireland. A questionnaire was circulated to all general dental practitioners in Northern Ireland. This questionnaire investigated the management of periodontal disease in the general dental service and referral for specialist periodontal advice and treatment. A usable return was made by 355 (68%) of those surveyed. The mean number of periodontal referrals by each respondent in the past year was 6.5 (SD 7.7), range 0 to 80. Backward stepwise logistic regression analysis indicated that independent predictors of high referral rate were practice location close to the referral centre (p<0.0001); dissatisfaction with ability to treat periodontal disease under the National Health Service (p=0.001); that previous refusals of referral had not dissuaded a dentist from continuing to offer referral (p=0.002); not offering root planing as a treatment (p=0.005); and perceived inadequate postgraduate education in periodontology (p=0.03). It is concluded that considerable variation exists between general dental practitioners working in Northern Ireland in relation to the referral of patients for specialist periodontal advice and treatment. It is further concluded that in many cases non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in relation to periodontal referral.

Stress and the progression of periodontal disease

This study examined the association between occupational stress and the progression of periodontitis in employed adults. 23 regular dental attenders, enrolled in a longitudinal study of periodontal disease, were examined on 2 occasions at an interval of 5.5 (SD 0.6) years. The mean age at the 2nd examination was 41.1 (SD 7.3) years. Clinical measurements of periodontal status including clinical attachment level were made at four proximal sites on all teeth. A questionnaire, the occupational stress indicator, was used at the second examination to assess stress retrospectively. The mean change in clinical attachment level was 0.63 (SD 0.42) mm and 9.6 (SD 8.6)% of sites measured at both examination lost > or = 3 mm of periodontal attachment. Multiple regression analysis was used to explore the relationship between mean loss of periodontal attachment and measures of occupational stress and sociodemographic data. In the final regression model, an increase in loss of periodontal attachment was significantly predicted by increasing age, lower socio-economic status, lower job satisfaction and type A personality. In addition, locus of control was included in the regression model which explained 65% of the variance in the loss of periodontal attachment. The results suggest that occupational stress may have a relationship to the progression of periodontitis.

The periodontal status of irregular dental attenders

The aim of this investigation was to assess the prevalence and severity of periodontal destruction in irregular dental attenders. 50 subjects aged between 20 and 49 years completed a questionnaire and had a periodontal examination. Measurements of plaque, calculus, bleeding, probing depth and clinical attachment level were made at 4 proximal sites per tooth. Results were compared to those for 132 regular attenders. The irregular attenders had more sites with plaque (46.3 +/- 27% versus 17.3 +/- 21.1%) than the regulars and significantly more sites which bled (53.7 +/- 20.4% versus 33.6 +/- 20.7%) and with calculus (35 +/- 21.1% versus 13.4 +/- 12.8%). However, the irregulars had virtually the same number of teeth as the regular attenders, 25.6 +/- 3.3 compared with 25.4 +/- 4.3. Irregular attenders had slightly deeper mean probing depths (2.9 +/- 0.4 versus 2.7 +/- 0.4 mm) but the prevalence and extent of attachment loss was no different between the groups. It was concluded that the prevalence and severity of destructive periodontal disease as indicated by periodontal attachment loss was not related to the regularity of dental attendance in the groups studied.

Utilization of dental services as a risk factor for periodontitis

The relation between utilization of dental services from community dentists and the extent and severity of alveolar bone loss is reported for a panel of men followed for over 6 years. Oral health data were collected by the Department of Veterans Affairs, Dental Longitudinal Study, which began in 1969 and still continues. Participants have received regular oral examinations approximately every 3 years. A variety of oral health conditions were assessed, including plaque, calculus, gingival inflammation, probing depth, tooth mobility, clinical attachment level, and alveolar bone loss. Utilization data were abstracted from the dental records of dental offices that participants attended from 1979 through 1988. Multivariate modeling as well as comparisons of high utilizers and non-utilizers indicate that utilization of routine diagnostic and preventive services was not predictive of the extent and severity of periodontitis.

Comparative reproducibility of proximal probing depth using electronic pressure-controlled and hand probing

This investigation assessed the effect of an electronic pressure-sensitive probe on the reproducibility of probing-depth measurement. Clinical measurements were made at the mesial and distal aspects of all teeth from the buccal and palatal or lingual aspects. Probing was carried out either in a conventional manner using gentle pressure referred to as hand probing or using an electronic pressure-sensitive probe set at 25 g and referred to as pressure-controlled probing. Probing-depth recordings were repeated for one randomly selected quadrant in each subject with random application of the 4 different combinations of pressure-controlled and hand probing. A total of 2584 replicate pairs of probing depth measurements were recorded on 4 proximal surfaces in 646 teeth in 100 adult subjects. The majority (98%) of all repeated measurements were within 1 mm of the initial values. The highest levels of agreement resulted when the same probing method was used at both examinations with electronic pressure-controlled probing being superior to hand probing regardless of tooth position or site. Duplicate measurements recorded with combinations of hand and pressure-controlled probing showed significant systematic bias towards shallower pocket depths with electronic pressure-controlled probing.

Periodontal status in an urban adult population in Sweden

The purpose was to describe the current periodontal status in a Swedish urban population aged 31-40 yr. 1681 individuals, 840 men and 841 women, participated in the study. 68.5% of the subjects had low amount of plaque, 82.8% low level of calculus and 28.9% healthy gingiva or mild gingivitis. 82.8% of the subjects had no pockets with probing depth (PD) > or = 5 mm. 4.9% of the subjects had one tooth with PD > or = 5 mm, 6.7% 2-5 teeth, 2.4% 6-9 teeth and 3.2% > or = 10 teeth with pockets. 55.8% of the subjects had no missing teeth, third molars excluded. 16.5% had one tooth missing, 23.8% 2-5 teeth, 2.7% 6-9 teeth and 1.2% > or = 10 teeth. 8.6% of the subjects had at least one front tooth missing, 28.7% one premolar and 24.1% one molar missing. Men had significantly higher scores than women for plaque (DI-S), calculus (CI-S), gingivitis (GI-M), and number and percent of remaining teeth with PD > or = 5 mm. Smokers had significantly higher scores than non-smokers for DI-S, CI-S, GI-M, number and percent of remaining teeth with PD > or = 5 mm, and number of missing teeth. The individuals who visited the dentist every year had better oral hygiene and gingival status than those who attended for > 3 yr. The multiple regression analysis showed that calculus (P = 0.0001) smoking (P = 0.001), and dental visits (P = 0.0284) were significantly correlated to the number of teeth with PD > or = 5 mm.

Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The annual review of selected dental literature this year cites 384 published papers and reports. This year's review contains more editorial comment than reviews of years passed. New data on the biological responses to materials is emphasized in several sections. Observations on new compounds able to prevent plaque formation are presented. Clinically relevant advances in knowledge concerning the etching of different tooth structures are reported along with the effect of etching procedures on the dental pulp. Evaluation of periodontal diseases in all age groups is a topic. Limitations of current diagnostic techniques in periodontal disease, temporomandibular disorders, and implant therapy are included. There are new views on the use of dental amalgam. The future use of dental mercury is predicted. Interest in new ceramic systems is indicated as the demand for esthetics continues. Clinical information is emphasized over scientific information throughout this year's review.