The role of bleeding upon probing in the diagnosis of periodontal disease. A literature review

Efficacy of Oral Intake of Hydrogen-Rich Jelly Intake on Gingival Inflammation: A Double-Blind, Placebo-Controlled and Exploratory Randomized Clinical Trial

Background/Objectives: Initiation and progression of periodontal disease include oxidative stress. Systemic application of antioxidants may provide clinical benefits against periodontal disease including gingivitis. Recently, a jelly containing a high concentration of hydrogen (40 ppm) was developed. We hypothesized that oral intake of this hydrogen-rich jelly may be safe and effective on gingivitis. This clinical trial was designed to investigate the safety and efficacy of oral intake of hydrogen-rich jelly against gingival inflammation. Methods: Participants with gingivitis were instructed to orally ingest 30 g of hydrogen-rich jelly (experimental group) or placebo jelly (control group) three times a day for 14 consecutive days. The primary outcome of this trial was the percentage of bleeding on probing (BOP) sites. Secondary outcomes were oral parameters, serum reactive oxygen metabolites, antioxidant capacity, oxidative index, concentrations of cytokine (interleukin [IL]-1β, IL-6, IL-10, IL-17, and tumor necrosis factor-alpha) in gingival crevicular fluid, and adverse events. For all parameters, Mann-Whitney U test was used for comparison between experimental and control groups. Analysis of covariance, controlling for baseline periodontal inflamed surface area, was performed to evaluate the association between the effect of the hydrogen-rich jelly and gingival inflammation. Results: In the experiment and control groups, the percentage of sites with BOP and PISA significantly decreased at the end of the experiment compared to the baseline. However, no significant differences were found between groups (p > 0.05). Conclusions: Administration of hydrogen-rich jelly for 14 days decreased gingival inflammation. However, no significant differences were identified compared to the control group.

Effects of initial periodontal therapy on leucine-rich alpha-2 glycoprotein levels in saliva from Japanese patients with chronic periodontitis

PURPOSE

Examination of patients to detect periodontal disease is important for diagnosis and treatment planning, and accuracy of examination may be improved if salivary components can be applied for diagnosis. Leucine-rich α2 glycoprotein (LRG) is expressed in the serum of patients with inflammatory diseases, and salivary LRG may be applicable to the diagnosis of periodontal disease.

METHODS

To evaluate the effect of initial periodontal therapy (IPT) on clinical periodontal parameters such as probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), periodontal inflamed surface area (PISA), periodontal epithelial surface area (PESA), saliva samples were collected before and after IPT from 63 patients with chronic periodontitis. The amount of LRG protein in saliva was measured by enzyme-linked immunosorbent assay.

RESULTS

Salivary LRG levels of 30 patients with Stage III, Grade B or C periodontitis (Severe group) were higher than the LRG levels of 33 patients with Stage Ⅰ or Ⅱ, Grade A periodontitis (Mild group). LRG levels in the Severe group significantly decreased after IPT. Positive correlations were found between salivary LRG levels and mean PD, CAL, BOP rate, PISA and PESA.

CONCLUSION

These results suggest that there is an association between salivary LRG levels and severity of periodontitis.

Effectiveness of Mobile App Interventions to Improve Periodontal Health: Protocol for a Systematic Review and Meta-Analysis

BACKGROUND

Periodontal health plays a key role as a shared reference point for evaluating periodontal diseases and identifying significant treatment outcomes. Providing adequate instruction and enhancing the motivation of patients to maintain proper oral hygiene are crucial factors for successful periodontal treatment, with self-performed regular oral hygiene identified as a critical factor in improving the outcomes of treatment for periodontal diseases. Recently, mobile health (mHealth) solutions, especially mobile apps, have emerged as valuable tools for self-management in chronic diseases such as periodontal disease, providing essential health education and monitoring capabilities. However, the use of mHealth apps for periodontal health is complex owing to various interacting components such as patient behavior, socioeconomic status, and adherence to oral hygiene practices. Existing literature has indicated positive effects of mHealth on oral health behaviors, knowledge, attitude, practice, plaque index score, and gingivitis reduction. However, there has been no systematic review of mobile apps specifically targeting patients with periodontal disease. Understanding the design and impact of mHealth apps is crucial for creating high-quality apps.

OBJECTIVE

The aim of this systematic review and meta-analysis is to evaluate the effectiveness of existing mobile apps in promoting periodontal health.

METHODS

A comprehensive search strategy will be performed in multiple electronic databases (PubMed, EBSCOhost, CINAHL Plus, Dentistry & Oral Sciences, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials) with the following keywords in the title/abstract: "mobile application," "mobile health," "mHealth," "telemedicine," "periodontal health," "periodontitis," and "text message." Only randomized controlled trials will be included that assessed the following outcomes to measure periodontal health improvement: gingival index, bleeding index, periodontal pocket depth, and clinical attachment loss. Covidence will be used for data collection, and a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flowchart will be used to describe the selection process of the included, identified, and excluded studies. The Confidence in Network Meta-Analysis approach will be used for meta-analysis of the extracted data from the included studies.

RESULTS

This review will not require ethical approval since no primary data will be included. As of July 2024, a total of 83 articles retrieved from various databases have been imported to Covidence with 13 articles deemed eligible for inclusion in the review. The review is currently ongoing and is expected to be complete by the end of 2024 with the results published in early 2025.

CONCLUSIONS

This systematic review and meta-analysis will contribute to developing mobile apps with enhanced criteria to improve periodontal clinical outcomes. The review emphasizes the importance of mHealth and preventing periodontal disease, which can set the stage for informed global health care strategies.

TRIAL REGISTRATION

PROSPERO CRD42022340827; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=340827.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50479.

Is There a Correlation Between Periodontal Disease Symptoms and the COVID-19 Vaccination?

OBJECTIVE

This study aimed to investigate and compare potential associations between different COVID-19 vaccines and periodontal diseases, mainly gingival bleeding and oral malodor (bad breath).

MATERIALS AND METHODS

This cross-sectional study used an online questionnaire consisting of 15 questions regarding demographic information, medical history, type of COVID-19 vaccine received, history of COVID-19, and general and periodontal symptoms after vaccination. The survey was voluntary and privately accessed online using SurveyMonkey®. A total of 2000 participants from three regions of Saudi Arabia participated in the study from October 11, 2021, to October 11, 2022.

RESULTS

Of the participants, 95.8% received at least one dose of the available COVID-19 vaccine. Oxford-AstraZeneca was the most administered (41.7%). Patients who suffered from chronic diseases or had a history of COVID-19 infection were less likely to be vaccinated (OR= 0.62, 95% CI 0.40-0.97; OR=0.62, 95% CI 0.39-0.99) compared with people with no chronic diseases or who had a history of COVID-19. The odds ratios for gingival bleeding, oral malodor, mobility, and tooth loss indicated no significant differences regarding vaccination status.

CONCLUSION

COVID-19 vaccines might not affect periodontal tissue conditions. People should not avoid vaccination due to concerns with oral or general health, as the benefits of vaccination outweigh the potential side effects.

Efficacy of Visual Oral Health Reinforcement in Reducing Plaque Accumulation and Gingival Bleeding: A Pilot Randomized Controlled Trial

AIM

To compare oral hygiene (OH) differences during verbal or video OH instructions with or without images displaying poor oral health consequences.

MATERIALS AND METHODS

Twenty-one healthy females (18-30 years) were randomly and equally divided into three intervention OH instruction groups: (1) verbal, (2) video-based, (3) video-based with image displaying the consequences of poor OH. Gingival bleeding on probing (BOP), gingival bleeding index (BI), and plaque score (PS) were assessed at baseline and after 4 weeks. Within- and between-group differences were assessed by non-parametric tests.

RESULTS

Plaque score only showed a statistical group difference after follow-up [H(2) = 9.214, p = 0.01]. The post hoc test revealed that group III showed a significantly lower PS than groups I and II (p = 0.04 and p = 0.017, respectively). No differences were observed in PS between groups I and II. Group I showed no follow-up reduction in PS, BI, and BOP, while group II showed a statistically significant reduction in BI only after follow-up (p = 0.028). However, group III showed a statistically significant reduction in BOP and PS (p = 0.023 and p = 0.045, respectively) but not BI.

CONCLUSIONS

Verbal and video-alone OH instructions similarly affect gingival health, while participants who were exposed to images displaying the severe OH consequences had lower PS than verbal or video-alone groups.

CLINICAL SIGNIFICANCE

The mode of OH instructions is not influential for optimum oral health. However, employing visuals highlighting the severe consequences of poor OH leads to short-term reduction of plaque accumulation. How to cite this article: Aleid AA, Alnowaiser A, AlSakakir A, et al. Efficacy of Visual Oral Health Reinforcement in Reducing Plaque Accumulation and Gingival Bleeding: A Pilot Randomized Controlled Trial. J Contemp Dent Pract 2024;25(2):186-190.

Estimation of Cancellous Changes Using Fractal Analysis in Patients with Periodontitis

Periodontal disease is a broad term given when the periodontium is affected by inflammation. There are several methods to diagnose periodontitis, but no method to quantify the cancellous bone is presently used. For this purpose, a non-invasive tool that is efficient in analyzing bone quality called fractal analysis can be employed. The objective of the study was to utilize fractal dimension (FD) to evaluate cancellous patterns of interproximal alveolar bone using a digital intraoral periapical radiograph (IOPAR) in different clinical presentations of periodontitis classified according to the latest classification by the World Workshop for Periodontal and Peri-Implant Diseases and Conditions, 2017 (WWDC, 2017). The study aimed to numerically calculate the periodontitis changes in the cancellous bone around the affected tooth on an IOPAR using fractal analysis and to provide an additional criterion for the staging of periodontitis. In this cross-sectional observational study, 75 patients were selected and equally allotted to five groups based on the staging system proposed by the WWDC, 2017. The region of interest was selected on the IOPA radiograph of the tooth with the site having the most significant clinical attachment loss, and FD was calculated using Image J analysis. The association of gender and age with stages of periodontitis was studied using the chi-square test of independence. A comparison of % bone loss and fractal dimension among stages was studied by using the non-parametric Kruskal Wallis test. The relationship between % bone loss and fractal dimension within stages and gender was studied by using the Karl Pearson correlation. A receiver operating characteristic (ROC) curve analysis was performed for FD value as a marker of periodontitis patients. We demonstrated that the FD values decreased significantly with the increase in stages (p < 0.0001). The overall relationship between % bone loss and FD showed a significantly strong negative correlation of -0.739 (p < 0.0001), except for stages III and IV. FD can be utilized as a quantitative method for detecting cancellous bone changes in different stages of periodontitis, aiding in diagnosing periodontitis.

The impact of electronic and conventional cigarettes on periodontal health-a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis examined the effects of electronic cigarettes on periodontal health compared to conventional cigarette smoke and a non-smoking population.

MATERIALS AND METHODS

MEDLINE, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov were screened for literature. Eligibility criteria included clinical studies published between 2006 and 2022 that compare e-cigarettes and conventional cigarettes on periodontal health (bleeding on probing (BoP), plaque index (PI), probing depth (PD), attachment loss (AL), marginal bone loss (MBL), tooth loss, molecular inflammation markers, salivary flow rate). Meta-regression analysis was used to examine the influence of moderator variables.

RESULTS

Sixteen studies were found to be eligible for qualitative synthesis. Individual analyses showed that cigarette smokers had significantly higher PI, PD, AL, and MBL and increased concentrations of proinflammatory mediators than e-cigarette users and non-smokers. Meta-analysis revealed a 0.33-fold lower chance for BoP in e-cigarette users compared to smokers (p = 0.03), whereby meta-regression failed to detect any effects regarding the age of users and frequency of smoking. A 0.01-fold decreased chance for positive BoP in e-cigarette users compared with non-smokers was seen (p < 0.01).

CONCLUSIONS

The current findings suggest that that e-cigarette use might be considered a healthier alternative to cigarette smoking concerning periodontal health. Even so, harmful effects of electronic nicotine delivery system (ENDS) usage on periodontal health were seen as well. However, a definitive decision on this research question remains elusive due to the absence of randomized controlled trials.

CLINICAL RELEVANCE

Electronic cigarettes, marketed as a safer alternative to traditional cigarettes, are becoming increasingly popular. Evidence on the use of electronic cigarettes as a cessation aid and its beneficial impact compared to cigarette smoke remains inconclusive, so the analysis conducted in this review addresses a recent question of high clinical relevance.

Intraoral Ultrasonography for Periodontal Tissue Exploration: A Review

This systematic review aims to investigate the possibilities of ultrasound imaging in the field of periodontal tissues exploration to visualize periodontal anatomical structures and to assess reliability in clinical evaluation using the PRISMA guidelines. An electronic search through the MEDLINE database was realized to identify studies that have explored ultrasonography in the field of periodontal imaging published from 2000 to March 2022. The search resulted in 245 records; after exclusions, a total of 15 papers were included in the present review. Various publications have shown the possibility of using intraoral ultrasound for a precise exploration of intraoral tissues and to perform measurements of periodontal structures. Studies argue that ultrasounds open the prospect of a complete paradigm shift on the diagnosis and follow-up of periodontal disease. However, there is currently no clinical device dedicated to periodontal ultrasound. This field is still under-studied, and studies are needed to explore the large field of applications from periodontal assessment to treatment reassessment, including surgery. Researchers should focus their efforts to develop special intraoral ultrasound device and explore the possibilities of clinical periodontal applications.

Correlation between BMI and Oral Health Status (DMFT, PI, mSBI, and Salivary 1,5-AG) among the Pediatric Population in Saudi Arabia: A Clinico-Biochemical Study

The study aimed to investigate the association of varying body mass index (BMI) with oral health status among children aged 5−14 years and correlate the concentration of salivary levels of 1,5-AG with varying BMI, dental caries, and periodontal disease. This cross-sectional study was conducted on subjects aged 5 to 14 years. The children were recruited from the Pediatric Dental Clinic, College of Dentistry, Majmaah University, by convenient sampling method. Sociodemographic details and clinical parameters, including body mass index (BMI), DMFT/def (deciduous decayed tooth (d), deciduous extracted tooth (e), deciduous filled tooth (f), permanent tooth decayed (D), permanent missing tooth (M), and permanent filled tooth (F)), plaque index (PI), and modified sulcular bleeding index (mSBI), were evaluated. Salivary 1,5-anhydroglucitol (1,5-AG) was analyzed using an enzyme-linked immunosorbent assay (ELISA) for all the subjects. Statistical analyses performed using SPSS v. 27 (IBM Statistics, Chicago, IL, USA) and the Kruskal−Wallis and chi-square tests were used for comparisons. The Spearman rank correlation coefficient was used to examine the association between the study subjects’ independent variables, BMI, and caries activity. The mean def score, PI, and mSBI scores were higher in obese children. PI score, mSBI score, and salivary concentrations of 1,5-AG between the BMI categories were statistically significant (p < 0.001). The study emphasizes promoting preventive oral health regimes, health awareness campaigns, and nutritional educational programs among the pediatric population.

Effect of Gum Arabic on plaque-induced gingivitis: A randomised controlled trial

New approaches to treating periodontal diseases aim to balance sustaining the natural oral microbiota and modifying the host immune response. Gum Arabic (GA) is a natural polysaccharide rich in prebiotics.

The aim of this study was to assess the effect of GA on clinical (Plaque Index (PI), Gingival Index (GI)) and immunological (Gingival Crevicular Fluid Interleukin 1 Beta (GCF IL-1 β)) parameters in patients with plaque-induced gingivitis.

Materials and methods

This placebo-controlled, double-blinded randomised clinical trial was conducted at the Department of Periodontology at Khartoum Dental Teaching Hospital, Khartoum, Sudan, from July to October 2016. Patients diagnosed with plaque-induced gingivitis meeting the study eligibility criteria were enrolled. At baseline, PI, GI and GCF IL-1β were measured. Patients received full-mouth scaling and were randomly assigned to receive either GA powder (intervention group) or Microcrystalline cellulose powder (placebo group). The patients were instructed to apply the treatment twice a day throughout the study. The PI, GI and GCF IL-1β were reassessed after 30 and 60 days.

Results

A total of 60 patients were enrolled (30 in each group). Compared to the placebo group, the intervention group showed a statistically significant reduction in GI scores after 30 days and improved PI scores at 30 and 60 days. Between baseline and 60 days, patients who received GA exhibited a significant reduction in GCF IL-1β levels compared to the placebo group.

Conclusion

GA was found to be effective in controlling plaque and gingivitis.

Clinical Trial Registration. ISRCTN registry ISRCTN14209449.

Anti-Inflammatory Efficacy of Curcumin as an Adjunct to Non-Surgical Periodontal Treatment: A Systematic Review and Meta-Analysis

Objective: Curcumin has been used as an adjunct to non-surgical periodontal treatment. However, the efficacy of curcumin in the periodontal therapy remained controversial. This study aimed to evaluate the anti-inflammatory efficacy of curcumin as an adjunct to non-surgical periodontal treatment (NPT) by systematic review. Methods: Databases including Embase, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov were searched to identify relevant RCTs on the use of curcumin as an adjunct to NPT for the treatment of periodontal disease from inception to July 21, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using Review Manager 5.3 software. Results: A total of 18 RCTs involving 846 patients/sites were included in this meta-analysis. The results of the meta-analysis revealed that as compared to NPT alone, curcumin as an adjunct to NPT resulted in significant reduction in gingival index (GI) at the 1-week (mean differences (MD) = -0.15, 95% confidence intervals (CI) -0.26 to -0.05, p = 0.005), 2-week (MD = -0.51, 95%CI -0.74 to -0.28, p < 0.0001), 3-week (MD = -0.34, 95%CI -0.66 to -0.02, p = 0.03), 4-week (MD = -0.25, 95%CI -0.48 to -0.02, p = 0.04) or 6-week (MD = -0.33, 95%CI -0.58 to -0.08, p = 0.01) follow-ups. Similar significant reductions were also observed for sulcus bleeding index (SBI) at 1, 2, 4, and 12 weeks. However, there were no statistically significant differences in reducing bleeding on probing (BOP) between curcumin as an adjunct and NPT alone at 4, 12, and 24 weeks. Conclusion: Based on the current evidence, curcumin demonstrates anti-inflammatory efficacies in terms of reducing GI and SBI compared with NPT alone. Moreover, curcumin is a natural herbal medicine with few side effects, and it is a good candidate as an adjunct treatment for periodontal disease.

Effect of Triweekly Interdental Brushing on Bleeding Reduction in Adults: A Six-Month Retrospective Study

This study assessed the effect of triweekly interdental brushing for a period of 6 months using the bleeding on full-mouth interdental brushing (BOFIB) index. All participants answered questionnaires and were instructed to clean all interdental areas using an interdental brush at least every second day. A dentist assessed the BOFIB index of 28 participants at baseline and at 3- and 6-month follow-up visits. We stratified the participants into three groups: IB-NN, those who used the interdental brush less than three times per week both before and after this program; IB-NY, those who used the interdental brush less than three times per week before the program but at least three times per week after the program; and IB-YY, those who used it at least three times per week both before and after the program. Owing to the weekly number of interdental brushings, the IB-YY and the other two groups showed a significant difference at baseline. At the 6-month follow-up, the weekly number of interdental brushings led to a significant difference between the IB-NN and the other two groups. The BOFIB index was lower among the compliant participants than among the noncompliant participants after 3 and 6 months of triweekly interdental brushing.

Living with Family Is Directly Associated with Regular Dental Checkup and Indirectly Associated with Gingival Status among Japanese University Students: A 3-Year Cohort Study

Although some studies showed that lifestyle was associated with oral health behavior, few studies investigated the association between household type and oral health behavior. The aim of this prospective cohort study was to investigate the association between household type, oral health behavior, and periodontal status among Japanese university students. Data were obtained from 377 students who received oral examinations and self-questionnaires in 2016 and 2019. We assessed periodontal status using the percentage of bleeding on probing (%BOP), probing pocket depth, oral hygiene status, oral health behaviors, and related factors. We used structural equation modeling to determine the association between household type, oral health behaviors, gingivitis, and periodontitis. At follow-up, 252 students did not live with their families. The mean ± standard deviation of %BOP was 35.5 ± 24.7 at baseline and 32.1 ± 25.3 at follow-up. In the final model, students living with their families were significantly more likely to receive regular dental checkup than those living alone. Regular checkup affected the decrease in calculus. The decrease in calculus affected the decrease in %BOP over 3 years. Living with family was directly associated with regular dental checkups and indirectly contributed to gingival status among Japanese university students.

The short-term effects of manual and interactive powered toothbrushes on the periodontal status of orthodontic patients: A randomized clinical trial

OBJECTIVE

To compare the effects of manual and interactive powered toothbrushes on periodontal status of patients during fixed orthodontic treatment.

MATERIALS AND METHODS

Thirty-six patients aged 12 to 18 years were included in this parallel design randomized clinical trial. Patients were randomly divided into two groups: manual toothbrushes (MT group) and interactive powered toothbrushes (PT group). The plaque index (PI), gingival index (GI), and bleeding on probing (BOP) scores were obtained before brushing (T0), 4 weeks (T1), 2 months (T2), and 4 months (T3) after brushing initiation. Periodontal measurements were performed by the same researcher that blinded to the groups' randomization. Data were analyzed with Mann-Whitney U and Friedman tests for the comparison of parameters between groups and times.

RESULTS

Significant differences were found in PI values at all time intervals (P < 0.001), with one exception (T2-T3 in the MT group). The GI changes between timepoints were parallel to the BOP findings of the PT group. Both groups had significantly lower bleeding scores in both T0-T2 and T0-T3 time intervals (P < 0.001). There was a significant reduction in the bleeding score of PT group between T1-T3 time interval (P < 0.05); however, there were no significant differences between the groups at any timepoint. PI and GI scores were statistically decreased in the PT group compared with the MT group from baseline to 4 months (P < 0.05).

CONCLUSION

All periodontal parameters decreased during the 4-month study period. The interactive powered toothbrushes may be an alternative to manual toothbrushes in terms of maintenance of periodontal health during fixed orthodontic treatment.

Low association between bleeding on probing propensity and the salivary aMMP-8 levels in adolescents with gingivitis and stage I periodontitis

BACKGROUND AND OBJECTIVE

Bleeding on probing (BOP) is a widely accepted measure used in periodontal diagnostics. Previous studies suggest that several factors can affect BOP propensity. The aim of this study was to investigate the relative impact of different local and modifying factors on BOP levels.

MATERIALS AND METHODS

The oral health of five hundred and forty-four adolescents (two birth cohorts) aged 15-17 years living in Kotka, Finland, was examined including periodontal probing depth, visible plaque index, root calculus, and BOP. Whole saliva samples were collected and measured for active matrix metalloproteinase-8 (aMMP-8) by time-resolved immunofluorometric assay (IFMA).

RESULTS

Bacterial plaque/calculus accumulation (oral hygiene) had a major influence on BOP levels. The relative impact was several times greater compared with the extent of periodontal pocketing, aMMP-8 levels, smoking, toothbrushing, or gender. Furthermore, BOP levels were significantly elevated among adolescents with poor oral hygiene than good oral hygiene even if adjusted for the extent of periodontal pocketing (P < .001). BOP levels could be low even if several ≥ 4 mm deep periodontal pockets existed. The difference in the extent of periodontal pocketing was not significant between the two birth cohorts of adolescents (P = .731).

CONCLUSIONS

BOP levels can be regarded as an important indicator of the extent of bacterial challenge and its adverse effects on the gingival inflammation. However, the level of oral hygiene may mask the association between the extent of gingival bleeding and the severity of the periodontal inflammatory condition. Thus, relying on BOP levels (below 10% or 20%) may provide insufficient information about the periodontal treatment need of an adolescent depending on his/her level of oral hygiene. Yet, more research is needed to confirm the results, also in adult populations.

Longitudinal Associations of Toothbrushing With Obesity and Hyperglycemia

Background

Toothbrushing is a health-related lifestyle habit and has been reported to contribute not only to oral health but also to some parameters of general health; however, little research has been conducted to understand the association of the frequency and timing of toothbrushing with the development of comprehensive metabolic abnormalities, with consideration of oral health condition. In this study, using longitudinal data, we examined this association in Japanese adults, adjusting for periodontal condition.

Methods

A 5-year longitudinal study was performed with 4,537 participants between 35 and 64 years old who underwent an annual dental examination in both 2003 and 2008. Data about toothbrushing habits and metabolic abnormalities, such as obesity, hyperglycemia, diabetes, hypertension, hypertriglyceridemia, and low levels of high-density lipoprotein-cholesterol, were analyzed using Poisson regression analysis.

Results

The percentage of participants with a toothbrushing frequency ≤1 time/day was 29.4%, and that for those not brushing their teeth at night was 21.4%. The incidences of obesity and hyperglycemia after 5 years were 5.5% and 28.4%, respectively. A toothbrushing frequency ≤1 time/day was associated with development of obesity (prevalence rate ratio [PRR] 1.77; 95% confidence interval [CI], 1.12–2.80), after adjusting for periodontal condition and potential risk factors. A significant association between not brushing teeth at night and hyperglycemia (PRR 1.30; 95% CI, 1.02–1.66) was observed in participants with toothbrushing frequency of 1 time/day. No association was found between toothbrushing habits and other metabolic abnormalities.

Conclusions

This study suggests that toothbrushing habits are associated with the development of obesity and hyperglycemia.

Use of digital periodontal data to compare periodontal treatment outcomes in a practice-based research network (PBRN): a proof of concept

Background

Scientific studies in dentistry are mainly conducted at universities. However, most patients are treated in dental practices, which differ in many ways from treatment at the university. Through the establishment of practice-based research networks, however, it is also possible to examine studies in a real-world setting in dental practices. For this reason the aim of this non-interventional, observational study was to develop and evaluate a digital procedure to access, extract and analyse recorded clinical data in practices to assess periodontal treatment outcomes.

Methods

Participating periodontists were former or active postgraduate students of a master’s course in periodontics in Freiburg who routinely used a digital periodontal diagnostic program. All available stored periodontal patient charts were extracted, anonymized and digitally sent to the study centre.

Results

In this study, data were collected from 6301 patients from 9 different practices. Information such as probing depth (PD), bleeding on probing (BOP), mobility, furcation and gingival attachment for 153,163 teeth at first visit were successfully transferred to the study centre. During the average observational period of 9.77 years, only 2.8% of all teeth were lost. The number of visits was significantly negatively correlated with BOP (p < 0.0001), and the number of BOP-positive sites was significantly correlated with deeper PDs (p < 0.001).

Conclusion

The presented procedure was able to gather a large amount of practice-based periodontal data, and thus this study may support practice-based research networks. The data indicate that systematic and supportive periodontal therapy is successful on a practice-based level.

Trial registration The study was internationally registered on 4 January 2017 in the German Clinical Trials Register (DRKS 00011448). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011448

Relationship between oral hygiene knowledge, source of oral hygiene knowledge and oral hygiene behavior in Japanese university students: A prospective cohort study

The aim of this prospective cohort study was to examine whether oral hygiene knowledge, and the source of that knowledge, affect oral hygiene behavior in university students in Japan. An oral exam and questionnaire survey developed to evaluate oral hygiene knowledge, the source of that knowledge, and oral hygiene behavior, such as the frequency of tooth brushing and regular dental checkups and the use of dental floss, was conducted on university student volunteers. In total, 310 students with poor tooth brushing behavior (frequency of tooth brushing per day [≤ once]), 1,963 who did not use dental floss, and 1,882 who did not receive regular dental checkup during the past year were selected. Among these students, 50, 364, and 343 in each respective category were analyzed in over the 3-year study period (follow-up rates: 16.1%, 18.5%, and 18.2%, respectively). The odds ratios (ORs) and 95% confidence intervals (CIs) for oral hygiene behavior were calculated based on oral hygiene knowledge and the source of that knowledge using logistic regression models. The results showed that dental clinics were the most common (> 50%) source of oral hygiene knowledge, and that a more frequent use of dental floss was significantly associated with dental clinics being a source of oral hygiene knowledge (OR, 4.11; 95%CI, 1.871-9.029; p < 0.001). In addition, a significant association was seen between dental clinics being a source of oral hygiene knowledge and more frequent regular dental checkups (OR, 13.626; 95%CI, 5.971-31.095; p < 0.001). These findings suggest the existence of a relationship between dental clinics being the most common source of oral hygiene knowledge and improved oral hygiene behavior in Japanese university students.

Effects of adhesive flash-free brackets on enamel demineralization and periodontal status

OBJECTIVES

To evaluate the effects of adhesive precoated (APC) flash-free brackets on enamel demineralization and periodontal status in patients during fixed orthodontic treatment.

MATERIALS AND METHODS

Thirty patients, age 12 to 18 years, who had Angle Class I or Class II malocclusion with mild to moderate crowding in the permanent dentition were selected for this study. APC flash-free and conventional ceramic brackets were bonded for a split-mouth study design. The quadrant allocation was randomized. Demineralization records were obtained immediately after bonding (T0), 1 month after bonding (T1), and 6 months after bonding (T2). Clinical periodontal measurements, including gingival index, plaque index, and bleeding upon probing, were obtained before bonding (T0) and at the same time points (T1 and T2). Data were analyzed using Mann-Whitney U and Friedman tests to compare parameters between groups and times.

RESULTS

Demineralization values decreased on most sides of the brackets for both groups between T0 and T1. In the conventional group, there was significantly higher demineralization on more sides compared with flash-free brackets between T1 and T2. With one exception, the decreased values were found in the incisal/occlusal sides of all brackets at T2. All periodontal parameters showed significant increases after 6 months of treatment in both groups. Intergroup comparison showed no significant differences in demineralization or periodontal measurements at any of the time points.

CONCLUSIONS

The effects of APC flash-free and conventional brackets on enamel demineralization and periodontal health did not differ from each other.

Association between Sleep Quality and Duration and Periodontal Disease among University Students: A Cross-Sectional Study

The purpose of this cross-sectional study was to investigate the association between sleep quality and duration, and periodontal disease among a group of young Japanese university students. First-year students (n = 1934) at Okayama University who voluntarily underwent oral health examinations were included in the analysis. Sleep quality and duration were assessed by the Japanese version of the Pittsburgh Sleep Quality Index. Dentists examined Oral Hygiene Index-Simplified (OHI-S), probing pocket depth (PPD), and percentage of sites with bleeding on probing (BOP). Periodontal disease was defined as presence of PPD ≥ 4 mm and BOP ≥ 30%. Overall, 283 (14.6%) students had periodontal disease. Poor sleep quality was observed among 372 (19.2%) students. Mean (± standard deviation) sleep duration was 7.1 ± 1.1 (hours/night). In the logistic regression analysis, periodontal disease was significantly associated with OHI-S (odds ratio [OR]: 2.30, 95% confident interval [CI]: 1.83-2.90; p < 0.001), but not sleep quality (OR: 1.09, 95% CI: 0.79-1.53; p = 0.577) or sleep duration (OR: 0.98, CI: 0.87-1.10; p = 0.717). In conclusion, sleep quality and duration were not associated with periodontal disease among this group of young Japanese university students.

Relationship of Salivary Microbiome with the Worsening of the Periodontal Health Status in Young Adults: A 3-Year Cohort Study

The purpose of this prospective cohort study was to investigate the influence of the salivary microbiome on the worsening of the periodontal health status among Japanese young adults. We assessed the data of systemically healthy and non-smoking young (18-22 years) university students (n = 457) from Okayama University at baseline (2013) and follow-up (2016). The worsening group was defined based on an increase in the percentage of bleeding on probing (%BOP) or an increase in probing pocket depth (PPD) from <4 mm to ≥4 mm. Unstimulated saliva samples were randomly collected from 69 students for microbiome analysis at follow-up. The salivary microbiome was assessed through 16S rRNA metagenomic sequencing. The type of community in the salivary microbiome clustered by statistical analysis and diversity was not significantly associated with the worsening of the periodontal health status in cases of increasing %BOP and PPD (p > 0.05). The prevalence of some species was significantly higher in the worsening group than in the non-worsening group (p < 0.05) in both cases. The worsening of the periodontal health status was associated with some species, but not the type of community and diversity in the salivary microbiome among Japanese young adults.

Initial periodontal treatment affects nucleotide-binding domain leucine-rich repeat-containing protein 3 inflammasome priming in peripheral blood mononuclear cells

OBJECTIVE

Accumulating evidence suggests an association between periodontitis and several systemic diseases, such as atherosclerosis. In the lesions of these diseases, nucleotide-binding domain leucine-rich repeat-containing protein 3 (NLRP3), apoptosis-associated speck-like protein containing a caspase activation and recruitment domain (ASC) and caspase-1 form inflammasome complex, which leads to the functional maturation of interleukin (IL)-1β via cleavage of caspase-1 in macrophages. IL-1β plays a critical role in the etiology of these diseases; however, inflammasome priming-specifically, IL-1β and NLRP3 upregulation-is necessary for effective IL-1β production. We investigated the effect of initial periodontal treatment on the inflammasome priming of peripheral blood mononuclear cells (PBMCs).

METHODS

Twenty-two patients with chronic periodontitis were enrolled in this study and given initial periodontal treatment. Peripheral blood samples were collected at baseline and re-evaluation (41.1 ± 29.1 d after the treatment), and the relative expression of IL-1β, and three inflammasome components, ASC, NLRP3 and Caspase-1, mRNA was determined using quantitative reverse transcription PCR. PBMCs were stimulated with silica crystals, and the IL-1β secretion was measured via enzyme-linked immunosorbent assay.

RESULTS

Probing pocket depth and bleeding on probing (BOP) were significantly improved after the treatment. Expression of IL-1β and ASC in the PBMCs decreased after the treatment. PBMCs stimulated with silica crystals secreted IL-1β. The treatment attenuated IL-1β secretion by PBMCs in low BOP percentages group whereas IL-1β secretion was increased in high BOP percentages group.

CONCLUSION

Periodontal treatment altered the inflammasome priming status of the PBMCs, however, the effects on systemic diseases need to be further investigated.

Plaque-induced gingivitis: Case definition and diagnostic considerations

OBJECTIVE

Clinical gingival inflammation is a well-defined site-specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a "gingivitis site") is completely different from defining and grading a "gingivitis case" (GC) (i.e. a patient affected by gingivitis), and that a "gingivitis site" does not necessarily mean a "GC". The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque-induced gingivitis and to propose a set of criteria to define GC.

IMPORTANCE

A universally accepted case definition for gingivitis would provide the necessary information to enable oral health professionals to assess the effectiveness of their prevention strategies and treatment regimens; help set priorities for therapeutic actions/programs by health care providers; and undertake surveillance.

FINDINGS

Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%) CONCLUSIONS: A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.

Periodontal health

OBJECTIVES

To date there is a paucity of documentation regarding definitions of periodontal health. This review considers the histological and clinical determinants of periodontal health for both intact and reduced periodontium and seeks to propose appropriate definitions according to treatment outcomes.

IMPORTANCE

Defining periodontal health is can serve as a vital common reference point for assessing disease and determining meaningful treatment outcomes.

FINDINGS

The multifactorial nature of periodontitis is accepted, and it is recognized that restoration of periodontal health will be defined by an individual's response to treatment, taking into account allostatic conditions.

CONCLUSIONS

It is proposed that there are 4 levels of periodontal health, depending on the state of the periodontium (structurally and clinically sound or reduced) and the relative treatment outcomes: (1) pristine periodontal health, with a structurally sound and uninflamed periodontium; (2) well-maintained clinical periodontal health, with a structurally and clinically sound (intact) periodontium; (3) periodontal disease stability, with a reduced periodontium, and (4) periodontal disease remission/control, with a reduced periodontium.

Expression of β-catenin and MMP-8 in gingival crevicular fluid and gingival tissue indicates the disease severity of patients with chronic periodontitis

The aim of the present study was to investigate the interaction among β-catenin, matrix metalloproteinase-8 (MMP-8) and severity in patients with chronic periodontitis. Both gingival crevicular fluid (GCF) and gingival tissue was collected from 21 healthy control individuals, 21 patients with moderate chronic periodontitis (mCP) and 23 patients with severe chronic periodontitis (sCP). The concentration of MMP-8 in GCF was detected via ELISA and the mRNA levels of β-catenin and MMP-8 in GCF and gingival tissue was detected via reverse transcription-quantitative PCR. The protein levels of β-catenin and MMP-8 in gingival tissue was detected using western blotting and the interaction between β-catenin and MMP-8 in gingival tissue was detected by co-immunoprecipitation. The expression of β-catenin and MMP-8 was significantly higher in the GCF and gingival tissue of patients with chronic periodontitis (mCP and sCP) compared with the control patients. Furthermore, the expression of β-catenin and MMP-8 in GCF and gingival tissue was positively correlated with the clinical attachment level. In addition, a positive interaction was identified between β-catenin and MMP-8, and the expression of β-catenin was positively correlated with the expression of MMP-8 in GCF and gingival tissue. The CGF and gingival tissue expression of β-catenin and MMP-8 may indicate disease severity in patients with chronic periodontitis.

Is there socioeconomic inequality in periodontal disease among adults with optimal behaviours

OBJECTIVE

To examine if socioeconomic inequalities exist in periodontal disease among adult with optimal oral health behaviours.

MATERIALS AND METHODS

Data were from the Adult Dental Health Survey 2009, a national survey of England, Wales and Northern Ireland. Overall, 4738 participants aged 35 years and older were included in the analysis. Periodontal disease indicated by pocket depth or loss of attachment ≥4 mm, and gingival bleeding were used as periodontal outcomes. Education and deprivation indicated socioeconomic position. Behavioural factors were dental visits, toothbrushing and smoking. The subset of adults with and without optimal health related behaviours included 2916 and 1822 participants, respectively. The associations between periodontal disease and socioeconomic position were tested adjusting for demographic and behavioural factors. Additional models stratifying the sample to those with and without optimal behaviour subgroup were constructed.

RESULTS

Education and deprivation were significantly associated with periodontal disease in the partially adjusted models. In the analysis of those with optimal behaviours, only deprivation and highest level of education showed significant association with periodontitis (PD), but not with gingival bleeding. Among those without optimal behaviours, all socioeconomic factors were associated with all outcomes except deprivation and PD.

CONCLUSIONS

Oral health behaviours marginally contributed to inequalities in gingival bleeding and periodontal disease. Socioeconomic inequalities were attenuated among those with optimal behaviours and persisted among those without optimal behaviours. Behaviours appeared to be an effect modifier for the relationship between periodontal outcomes and socioeconomic factors.

Progressive muscle relaxation therapy to relieve dental anxiety: a randomized controlled trial

Dental anxiety causes patients to refuse or delay treatment, which may exacerbate oral diseases. The aim of the current randomized controlled trial was to determine whether progressive muscle relaxation therapy could relieve dental anxiety. The trial included 68 periodontal patients with dental anxiety scores of ≥13 who were randomly assigned to either an intervention group or a control group (n = 34 per group). The intervention group was administered progressive muscle relaxation therapy for 20 min and oral health education for 15 min before periodontal treatment once per week for 4 wk. The control group was provided with oral health education only, for the same duration. Changes in dental anxiety, depression symptoms, blood pressure, heart rate, and salivary cortisol were evaluated 4 wk and 3 months after the intervention. The intervention group exhibited statistically significantly greater reductions in dental anxiety scores than did the control group at the 4-wk (-3.82 vs. -0.89) and 3-month (-4.22 vs. -0.28) assessments. They also exhibited significantly greater reductions in depression symptoms, systolic and diastolic blood pressure, pulse rate, and salivary cortisol levels at both time-points. Progressive muscle relaxation therapy relieves tension and anxiety in dental patients.

QUANTITATIVE ASSESSMENT OF GINGIVAL INFLAMMATION USING HIGH-RESOLUTION ULTRASOUNDEX-VIVO

This study investigates the feasibility of using high-resolution ultrasound imaging echogenicity to quantitatively diagnose gingival inflammation. Gingival samples were extracted from the study participants during gingivectomy procedures. Ultrasound mechanical scanning of the samples was immediately conducted ex-vivo to render cross-sectional images of high resolution, at different locations. Samples’ histological preparation and analysis was followed after performing ultrasound imaging. Histological sections were then matched with ultrasound images at different sections for each gingival sample. The matched image pairs were used to estimate two quantitative measures; relative inflammation area and ultrasound image echogenicity. These parameters were employed to judge the diagnostic potential of gingival ultrasound imaging. The results show that ultrasound images exhibited low intensity levels at the inflamed gingival regions, while healthy layers showed higher intensity levels. The relative area parameter implied a strong relationship between ultrasound and histological images. Ultrasound echogenicity was found to be statistically significant in differentiating between some inflammation degrees in the studied gingival samples. In summary, ultrasound imaging has the potential to be a noninvasive adjunct diagnostic tool for gingival inflammation, and may help assess the stage of the disease and ultimately limit periodontal disease occurrence; taking into consideration the limits of this study.

Type D personality and periodontal disease in university students: A prospective cohort study

The purpose of this prospective cohort study was to investigate whether Type D personality was related to periodontal disease in Japanese university students. Among students ( n = 600) who were interested in receiving oral health examinations, logistic regression analysis showed that the risk of developing periodontal disease during a 3-year period was associated with body mass index ⩾ 25 (odds ratio: 2.543; 95% confidence interval: 1.297-4.989; p = 0.007) and Type D personality (odds ratio: 1.473; 95% confidence interval: 1.027-2.111; p = 0.035). In this short-term prospective cohort study, a significant association between periodontal disease and Type D personality was observed in Japanese university students.

Effectiveness of Oral Hygiene Instructions Given in Computer-Assisted Format versus a Self-Care Instructor

Background: This randomized, single-blinded, controlled study compares the effectiveness of two modes of delivering the same set of oral hygiene instructions: those loaded on a computer-assisted teaching format versus those given personally by a self-care instructor. Methods: 60 participants with mild to moderate periodontitis were randomized to either the computer-teaching format or the self-care instructor. Plaque score and bleeding indices were assessed at baseline and at 4 week re-evaluation to compare the instructional modalities. Results: At baseline, there was no difference in the parameters between the two groups. At re-evaluation, all parameters were significantly improved compared to baseline; however, there was no difference between any parameters in the computer group versus the instructor. Plaque score was significantly different between younger and older participants, such that participants under 50 years old had lower plaque scores when they received instructions using the computer format (72.5 ± 12.6 vs. 87.2 ± 10.4; p < 0.001). Additionally, in those under-50 year olds, plaque scores were significantly better in the group using the computer format (87.2 ± 10.4 vs. 78.3 ± 15.6; p = 0.03). Conclusion: Computer teaching formats and self-care instructors are both effective means of communicating oral hygiene instructions. Computer-assisted instruction format effectiveness may amplify as the population ages. Applications of computer formats teaching oral hygiene instructions and cost effectiveness comparison studies warrant significant future investigation.

Relationship between sjögren syndrome and periodontal status: A systematic review

OBJECTIVE

This study aimed to examine whether Sjögren syndrome (SS) is related to periodontal status.

STUDY DESIGN

A systematic review was performed on the basis of PRISMA (PROSPERO: CRD42017055202). A search was performed in the PubMed/MEDLINE, LILACS, Web of Science, and Science Direct databases. Hand searches and review of the gray literature were also performed. Three researchers independently selected studies, extracted data, and assessed methodologic quality. Studies that correlated primary and/or secondary SS with plaque index, gingival index, probing depth, and bleeding on probing were included. The risk of bias was estimated on the basis of the Newcastle-Ottawa scale.

RESULTS

Seventeen studies were included in the review and 9 included in the meta-analysis, with a total of 518 and 544 patients, with or without SS, respectively. The mean difference of plaque index (0.29; 95% confidence interval [CI] 0.17-0.41), gingival index (0.52; 95% CI 0.14-0.89), and bleeding on probing (9.92; 95% CI 4.37-15.47) were larger in patients with SS than in controls. In primary SS (0.47; 95% CI 0.10-0.83) and secondary SS (0.74; 95% CI 0.10-1.38), only the mean gingival index was larger compared with that in control group. The majority of the included studies were judged as having a high risk of bias.

CONCLUSIONS

The present review did not provide strong evidence that periodontal status is affected by SS.

A controlled clinical study of periodontal health in anticoagulated patients: Assessment of bleeding on probing

Background

According to the Spanish Society of Cardiology, 700,000 patients receive oral anticoagulants, and in these cases bleeding on probing (BOP) could be altered. However, no studies have analyzed the periodontal status of these patients and the effects anticoagulants may have upon BOP. A study was made of the possible relationship between plaque index, probing depth, INR (International Normalized Ratio) and acenocoumarol dose versus the clinical signs of BOP in a sample of anticoagulated patients. Likewise, an analysis was made of oral hygiene habits and attitude towards bleeding in these patients.

Material and Methods

A controlled observational clinical study was made in La Ribera Hospital (Valencia, Spain) involving 44 anticoagulated patients treated with Sintrom® (acenocoumarol) and a homogeneous control group of 44 non-anticoagulated patients. A survey on oral hygiene habits and attitude towards bleeding was carried out, and the main periodontal parameters were recorded.

Results

Probing depth was the parameter with the strongest correlation to BOP (p<0.001), followed by the plaque index (p<0.002). In contrast, no relationship was observed between acenocoumarol dose or INR and BOP. Mean BOP was greater in the control group than in the anticoagulated group (p<0.001). Oral hygiene habits and attitude towards bleeding differed significantly between groups.

Conclusions

We have found no explanation why BOP was greater in the control group. What seems clear is that in the presence of the same plaque index and probing depth, anticoagulated patients did not bleed more than non-anticoagulated patients. A lack of knowledge of health and oral hygiene habits was observed in these subjects. Key words:Anticoagulant therapy, bleeding on probing, periodontal health.

Associations between dental knowledge, source of dental knowledge and oral health behavior in Japanese university students: A cross-sectional study

The aim of this study was to investigate the associations between dental knowledge, the source of dental knowledge and oral health behavior in a group of students at a university in Japan. A total of 2,220 university students (1,276 males, 944 females) volunteered to undergo an oral examination and answer a questionnaire. The questionnaire assessed dental knowledge, the source of dental knowledge and oral health behavior (e.g., daily frequency of tooth brushing, use of dental floss and regular dental checkups). The odds ratio and 95% confidence interval for oral health behavior based on dental knowledge and source of dental knowledge were calculated using logistic regression models. Of the participants, 1,266 (57.0%) students obtained dental knowledge from dental clinics, followed by school (39.2%) and television (29.1%). Logistic regression analyses indicated that use of dental floss was significantly associated with source of dental knowledge from dental clinics (P = 0.006). Receiving regular dental checkups was significantly associated with source of dental knowledge; the positive source was dental clinic (P < 0.001) and the negative sources were school (P = 0.004) and television (P = 0.018). Dental clinic was the most common source of dental knowledge and associated with better oral health behavior among the Japanese university students in this study.

The Bleeding on Brushing Index: a novel index in preventive dentistry

BACKGROUND

The aim of this study was to evaluate the suitability of a dichotomous index, based on a special interdental brushing tool, to detect initial pathological processes in interproximal areas. Furthermore, different techniques of interdental hygiene were compared.

METHODS

Participants (n = 108) were instructed to clean their teeth using the Bass technique and were randomly assigned to three groups according to the type of interdental cleaning used: group A, use of interdental brushes; group B, no interdental hygiene (the control group); and group C, use of dental floss. Approximal Plaque Index (API), Plaque Index (PI), modified Sulcus Bleeding Index (mSBI) and the Bleeding on Brushing Index (BOB) were measured at baseline, and after 2 (t1) and 4 (t2) weeks. Statistical analysis was performed using the Wilcoxon test and the Mann-Whitney U-test.

RESULTS

One-hundred and six participants completed the study. The BOB decreased significantly in all groups (P < 0.001) with the most pronounced reduction being recorded for group A (baseline: 49.3 ± 23.0%; 4 weeks: 5.1 ± 6.9%). Also, the mSBI (P < 0.001) decreased significantly in all groups during the study. The API appeared to be less affected by the oral hygiene than other indices. The highest correlation was observed between BOB and mSBI (r = 0.785, P < 0.001).

CONCLUSION

The BOB is a valuable complement for the existing array of indices in preventive dentistry, and is able to detect potential pathological processes in interproximal spaces. Additionally, this study suggests that interdental hygiene with individually selected brushes is superior to flossing.

CLINICAL RELEVANCE

With the BOB, gingival inflammation can be demonstrated to patients, which could increase compliance.

Validity of a New Kit Measuring Salivary Lactate Dehydrogenase Level for Screening Gingivitis

Aim. The aim of this study was to determine the usefulness of a new kit that can evaluate salivary lactate dehydrogenase (LD) level in real time for screening gingivitis. Materials and Methods. The study included 70 systemic healthy volunteers [29 males and 41 females; mean age ± SD: 24.1 ± 2.6 years]. Resting saliva was collected from each participant and LD level was evaluated in real time using the kit (a color-changing sheet with an integer scale ranging from 1 to 10). A dentist measured probing pocket depth, clinical attachment level, and the proportion of sites with bleeding on probing (% BOP) at six sites on all teeth. Gingivitis was diagnosed when the BOP value was ≥20%. Results. Salivary LD level was positively correlated with mean % BOP (odds ratio: 1.47, 95% confidence interval: 1.132–1.916, and P < 0.001) in a logistic regression model. The sensitivity and specificity of the kit were 0.89 and 0.98, respectively, at a cut-off value of 8.0 for LD level. Conclusions. The new kit for measurement of salivary LD level may be a useful tool to screen for gingivitis in young adults, which contributes to early detection of future periodontitis.

PAR-2 expression in the gingival crevicular fluid reflects chronic periodontitis severity

Recent studies investigating protease-activated receptor type 2 (PAR-2) suggest an association between the receptor and periodontal inflammation. It is known that gingipain, a bacterial protease secreted by the important periodontopathogen Porphyromonas gingivalis can activate PAR-2. Previous studies by our group found that PAR-2 is overexpressed in the gingival crevicular fluid (GCF) of patients with moderate chronic periodontitis (MP). The present study aimed at evaluating whether PAR-2 expression is associated with chronic periodontitis severity. GCF samples and clinical parameters, including plaque and bleeding on probing indices, probing pocket depth and clinical attachment level, were collected from the control group (n = 19) at baseline, and from MP patients (n = 19) and severe chronic periodontitis (SP) (n = 19) patients before and 6 weeks after periodontal non-surgical treatment. PAR-2 and gingipain messenger RNA (mRNA) in the GCF of 4 periodontal sites per patient were evaluated by Reverse Transcription Polymerase Chain Reaction (RT-qPCR). PAR-2 and gingipain expressions were greater in periodontitis patients than in control group patients. In addition, the SP group presented increased PAR-2 and gingipain mRNA levels, compared with the MP group. Furthermore, periodontal treatment significantly reduced (p <0.05) PAR-2 expression in patients with periodontitis. In conclusion, PAR-2 is associated with chronic periodontitis severity and with gingipain levels in the periodontal pocket, thus suggesting that PAR-2 expression in the GCF reflects the severity of destruction during periodontal infection.

Chronic Periodontitis in Type 2 Diabetes Mellitus: Oxidative Stress as a Common Factor in Periodontal Tissue Injury

INTRODUCTION

The prevalence of periodontitis is significantly higher among people with poorly controlled diabetes mellitus. Majority of tissue destruction in periodontitis is considered to be the result of an aberrant inflammatory/immune response to microbial plaque and involve prolonged release of reactive oxygen species (ROS). There is increased evidence for compromised antioxidant capacity in periodontal tissues and fluids which may be an added factor for tissue damage in periodontitis.

AIM

To study the possible role of Reactive oxygen species (ROS) and antioxidant status in blood among chronic periodontitis patients with and without Type 2 Diabetes mellitus.

MATERIALS AND METHODS

The study comprised of total 100 subjects among which 25 were normal healthy controls, 25 were gingivitis patients, 25 were chronic periodontitis patients (CP) and 25 were having chronic periodontitis with type 2 diabetes (CP with DM). ROS levels were determined as MDA (Malondialdehyde) and antioxidant status as plasma total antioxidant capacity (TAC), vitamin C and erythrocyte Superoxide dismutase (SOD) and catalase activity.

RESULTS

There was significant increase in MDA levels in all the patient groups compared with healthy controls (p<0.05). The decrease in TAC, Vitamin C and SOD levels among CP with DM patients as compared to controls was highly significant (p<0.01). There was a positive correlation between the probing pocket depth and MDA levels among periodontitis patients with diabetes (r=0.566, p=0.003).

CONCLUSION

There is increased oxidative stress in chronic periodontitis with and without type 2 diabetes indicating a common factor involvement in tissue damage. More severe tissue destruction in periodontitis is associated with excessive ROS generation which is positively correlated in type 2 diabetic subjects.

Relationship Between Prehypertension/Hypertension and Periodontal Disease: A Prospective Cohort Study

BACKGROUND

Most cross-sectional studies have found a significant positive relationship between periodontal disease and prehypertension/hypertension. However, these studies had limitations and there are few prospective cohort studies in young adults. The purpose of this prospective cohort study was to investigate whether periodontal disease was related to prehypertension/hypertension in Japanese university students.

METHODS

Students (n = 2,588), who underwent health examinations before entering university and before graduation, were included in the analysis. The association between periodontal disease such as the percentage of bleeding on probing (BOP) and community periodontal index (CPI) scores, and change in blood pressure status was determined.

RESULTS

At the reexamination, the numbers of participants with prehypertension (systolic blood pressure 120-139mm Hg or diastolic blood pressure 80-89mm Hg) and hypertension (≥140/90mm Hg) were 882 (34.1%) and 109 (4.2%), respectively. In a logistic regression model, the risk of hypertension was significantly associated with male (odds ratio (OR): 6.31; 95% confidence interval (CI): 2.63-15.13; P < 0.001), no habitual physical activity at baseline (OR: 2.90; 95% CI: 1.56-5.38; P < 0.01) and periodontal disease defined as the presence of both probing pocket depth (PPD) ≥ 4mm and BOP ≥ 30% at baseline (OR: 2.74; 95% CI: 1.19-6.29; P = 0.02) in participants with prehypertension at baseline. On the other hand, the risk of prehypertension was not associated with presence of periodontal disease (OR: 0.93; 95% CI: 0.51-1.70; P = 0.82).

CONCLUSION

In the short-term prospective cohort study, a significant association between presence of periodontal disease and hypertension was observed in Japanese university students.

The Association of Gum Bleeding with Respiratory Health in a Population Based Study from Northern Europe

BACKGROUND

There is little knowledge about how oral and respiratory health is interrelated even though the mucosa of the oral cavity and airways constitutes a continuum and the exposures to these are partly similar.

AIMS

To investigate whether gum bleeding is related to asthma, respiratory symptoms and self-reported COPD.

METHODS

A postal questionnaire including questions about respiratory and oral health was sent to general population samples in seven Northern European centres. In 13,409 responders, gum bleeding when brushing teeth was reported always/often by 4% and sometimes by 20%. Logistic regressions accounted for age, smoking, educational level, centre and gender. Effects of BMI, cardio-metabolic diseases, early life factors, gastro-oesophageal reflux, dental hygiene, nasal congestion, and asthma medication were addressed.

RESULTS

Gum bleeding always/often was significantly associated with ≥ 3 asthma symptoms (OR 2.58, 95% CI 2.10-3.18), asthma (1.62 [1.23-2.14]) and self-reported COPD (2.02 [1.28-3.18]). There was a dose-response relationship between respiratory outcomes and gum bleeding frequency (≥ 3 symptoms: gum bleeding sometimes 1.42 [1.25-1.60], often/always 2.58 [2.10-3.18]), and there was no heterogeneity between centres (p(heterogeneity) = 0.49). None of the investigated risk factors explained the associations. The observed associations were significantly stronger among current smokers (p(interaction) = 0.004).

CONCLUSIONS

A consistent link between gum bleeding and obstructive airways disease was observed, not explained by common risk factors or metabolic factors. We speculate that oral pathogens might have unfavourable impact on the airways, and that the direct continuity of the mucosa of the oral cavity and the airways reflects a pathway that might provide novel opportunities for interventions.

Self-efficacy and progression of periodontal disease: a prospective cohort study

AIM

The purpose of this longitudinal study was to investigate whether self-efficacy scale for self-care (SESS) was related to changes in oral health behaviours and progression of periodontal disease in Japanese university students.

MATERIAL AND METHODS

Students (n = 533) who were interested in receiving oral health examinations before entering the university and before graduation were included in the analysis. Self-efficacy was assessed using SESS, which uses three subscales: self-efficacy for brushing of the teeth (SE-BR), for dentist consultations (SE-DC) and for dietary habits. The informations about oral health behaviours were also collected. For all participants, oral hygiene instructions was performed at baseline. After 3 years, the oral health behaviours and the periodontal condition were re-assessed.

RESULTS

The progression of periodontal disease was related to low baseline SE-BR. Logistic regression analysis showed that progression of periodontal disease risk during a 3-year period was associated with low baseline SE-BR (OR: 1.516; 95% CI: 1.010-2.275; p < 0.05). The increase in the score of SE-DC was related to the increase in regular dental checkups (p < 0.05).

CONCLUSION

Low SESS was associated with progression of periodontal disease and improvement of oral health behaviours in university students who received oral hygiene instructions at baseline.

Impact of body mass index on oral health during orthodontic treatment: an explorative pilot study

AIM

To answer the question: is there a correlation between body mass index (BMI), oral health, and patient cooperation during multibracket (MB) appliance therapy?

MATERIALS AND METHODS

All adolescent MB patients started and finished between 2007 and 2012 were analysed. According to their pre-treatment BMI, patients were divided into one of the following groups: normal weight, overweight, or obese. Using the patients' records, the cooperation during treatment was classified as good, bad, or poor and the treatment duration was calculated. Using pre- and post-treatment photographs, white spot lesion (WSL) formation and gingivitis before and after MB therapy were assessed.

RESULTS

Of the 175 subjects, 138 had a normal BMI (79 per cent), 22 were overweight (12.5 per cent), and 15 obese (8.5 per cent). Whereas 42.8 per cent of the normal weight patients showed a good cooperation, only 22.7 per cent of the overweight and 20.9 per cent of the obese patients cooperated sufficiently. On average, normal weight patients were treated for 22.2 months, overweight patients for 23.0 months, and obese patients for 27.7 months. Normal weight patients developed less WSL (41.3 per cent) during MB treatment than overweight (50 per cent) or obese (66.7 per cent) patients. Furthermore, patients with a normal weight or overweight had less gingival inflammation (79.5 per cent) after treatment than obese individuals (93.3 per cent).

CONCLUSION

An increased BMI appears to be a risk factor for less cooperation, a longer treatment duration, and more oral health-related problems during MB treatment, indicating that these patients require special attention during orthodontic therapy.

Gingival condition and tooth-brushing behavior after alcohol consumption

BACKGROUND AND OBJECTIVE

Various studies have reported the relationship between alcohol consumption and gingival condition. However, they focus on the direct effects of alcohol consumption or alcohol sensitivity on gingival condition, and it is unclear how oral health behaviors relate these relationships. The aims of this study were to assess the inter-relationships between gingival condition, tooth-brushing behavior after drinking alcohol and alcohol sensitivity in university students who drink more than once per week on average.

MATERIAL AND METHODS

A total of 808 students (541 males, 267 females) that habitually consume alcohol were analyzed. The disease activity of gingival condition was assessed as the percentage of bleeding on probing (%BOP). Additional information regarding alcohol sensitivity and oral health behaviors, including tooth-brushing behavior after drinking, were also collected.

RESULTS

Thirteen percent of the current participants reported neglecting tooth-brushing after drinking, and their alcohol consumption was higher than those who did not neglect tooth-brushing. Logistic regression analysis showed that high %BOP (%BOP ≥ 20) was associated with male (OR = 1.53; 95% CI, 1.01-2.33), neglect of tooth-brushing after drinking (OR = 2.60; 95% CI, 1.20-5.61) and debris index (OR = 8.38; 95% CI, 4.24-16.60) in participants with low alcohol sensitivity. In participants with high alcohol sensitivity, high %BOP was associated with debris index (OR = 7.60; 95% CI, 3.12-18.51), but not with any oral health behaviors.

CONCLUSIONS

The study revealed that alcohol consumption was indirectly related to gingival disease activity through the neglect of tooth-brushing after drinking alcohol in university students with low alcohol sensitivity.

Relationship between xerostomia and gingival condition in young adults

BACKGROUND AND OBJECTIVE

Xerostomia is a subjective symptom of dryness in the mouth. Although a correlation between xerostomia and oral conditions in the elderly has been reported, there are few such studies in the young adults. The aim of this study was to examine the relationship of xerostomia with the gingival condition in university students.

MATERIAL AND METHODS

A total of 2077 students (1202 male subjects and 875 female subjects), 18-24 years of age, were examined. The disease activity and severity of the gingival condition were assessed as the percentage of teeth with bleeding on probing (%BOP) and the presence of teeth with probing pocket depth of ≥ 4 mm, respectively. Additional information on xerostomia, oral health behaviors, coffee/tea intake and nasal congestion was collected via a questionnaire. Path analysis was used to test pathways from xerostomia to the gingival condition.

RESULTS

One-hundred and eighty-three (8.8%) students responded that their mouths frequently or always felt dry. Xerostomia was related to %BOP and dental plaque formation, but was not related to the presence of probing pocket depth ≥ 4 mm. In the structural model, xerostomia was related to dental plaque formation (p < 0.01), and a lower level of dental plaque formation was associated with a lower %BOP. Xerostomia was associated with coffee/tea intake (p < 0.01) and nasal congestion (p < 0.001).

CONCLUSION

Xerostomia was indirectly related to gingival disease activity through the accumulation of dental plaque. Nasal congestion and coffee/tea intake also affected xerostomia. These findings suggest that xerostomia should be considered in screening for gingivitis risk in young adults.

Relationship between increases in BMI and changes in periodontal status: a prospective cohort study

AIM

The purpose of this prospective cohort study was to investigate whether body mass index (BMI) and oral health behaviour are related to changes in periodontal status in Japanese university students.

MATERIALS AND METHODS

Students (n = 224) who were interested in receiving oral health examinations before entering university and before graduation were included in the analysis. Subjects were investigated regarding the correlations of oral health behaviours and increases in BMI with the percentage of bleeding on probing (%BOP) and Community Periodontal Index (CPI) scores as indicators of changes in periodontal status.

RESULTS

The risk of increased %BOP was associated with the non-use of dental floss (adjusted odds ratio [OR]: 3.11; 95% confidence interval [CI]: 1.31-7.37; p < 0.05), whereas the risk of increased CPI score was associated with increases in BMI (OR: 1.95; 95% CI: 1.05-3.65; p < 0.05) and simplified oral hygiene index score (OR: 2.28; 95% CI: 1.23-4.22; p < 0.01).

CONCLUSION

Increases in BMI were associated with worsening of periodontal status, defined as increased CPI score in Japanese university students, whereas lack of inter-dental cleaning was associated with exacerbated gingival bleeding.

Different treatment strategies are applied to patients with the same periodontal status in general dentistry

OBJECTIVE

To analyse how general dental practitioners (GDPs) and dental hygienists judge and plan to treat patients with different periodontal conditions.

MATERIALS AND METHODS

Seventy-seven GDPs and 50 dental hygienists in a Swedish county, Halland, participated in a questionnaire study. The response rate was 94%. The questionnaire consisted of four simulated patient cases and an attached answer sheet. The patient cases had different periodontal status, ranging from healthy to moderate bone loss with general inflammation. The clinicians judged the periodontal status as healthy or diseased. If judged as diseased the clinicians suggested a diagnosis, selected treatment options and estimated the number of treatment sessions for each patient case. The clinicians were compared to each other regarding their judgement, as healthy or diseased, diagnostics and treatment.

RESULTS

Three out of four patients were judged both as healthy and diseased by different clinicians. If judged as diseased the patients were diagnosed as having gingivitis or periodontitis. Regardless of the clinicians' former judgement and diagnostics there were no differences (p > 0.05) in the selected treatment options but there was a difference (p < 0.05) in the suggested number of treatment sessions.

CONCLUSIONS

Clinicians' judgement of the same periodontal condition, as healthy or diseased, varies, which partly results in different treatment decisions considering the number of treatment sessions. The suggested number of treatment sessions varied also between clinicians even if they judged and diagnosed the condition likewise. The willingness to treat and suggested treatment options were not influenced by the variation in judgement and diagnostics.