Immune cell composition and inflammatory profile of human peri-implantitis and periodontitis lesions

Peri-implantitis and periodontitis are common oral inflammatory diseases, which seem to exhibit critical differences in some of their molecular features. Thus, we assessed the immune cell composition of peri-implantitis and periodontitis lesions and the corresponding inflammatory profile in soft tissues and crevicular fluid. Peri-implantitis, periodontitis and control patients were recruited (n=62), and soft tissue biopsies were collected during surgery. Crevicular fluid around implant or tooth was collected. The proportions of major immune cell populations in tissues were analyzed by flow cytometry, and the inflammatory profile in tissue and crevicular fluid by a multiplex immunoassay. No significant difference was seen between peri-implantitis and periodontitis lesions in the proportions of immune cells. Peri-implantitis tissues showed an increased frequency of B cells in comparison with control tissues, along with higher levels of IL-1β, TNF-α, IL-4, and BAFF in tissue and crevicular fluid. Moreover, TNF-α, IL-17A and BAFF were higher in peri-implantitis tissues, but not in periodontitis, than in control tissues. The immune cell composition did not differ significantly between peri-implantitis and periodontitis, but an enhanced inflammatory profile was seen in peri-implantitis tissue. Peri-implantitis lesions were enriched in B cells, and displayed increased levels of IL-1β, TNF-α, IL-4, and BAFF in both tissue and crevicular fluid.

Patient's experiences of dental implants, peri-implantitis and its treatment-A qualitative interview study

OBJECTIVES

The aim of the present study was to explore peri-implantitis patients' sensations, expectations, and experiences of dental implants, the disease, as well as undergoing treatment with laser or mucosal flap surgery.

METHODS

Interviews were conducted with 18 patients who had been referred for treatment of peri-implantitis at a specialist clinic. The participants underwent either laser treatment or mucosal flap surgery of affected implants. Qualitative content analysis was used for processing the transcribed interviews with coding in categories and subcategories.

RESULTS

The analysis of the interviews was presented in a narrative way to display the variety of experiences in this patient group. Losing teeth was perceived as frustrating and negatively impacted their quality of life; however, receiving dental implants improved some aspects of the patients' lives. While some have symptoms, others did not seem to notice the incidence and development of peri-implantitis. Local anaesthesia was the worst part of both treatments and both modalities yielded only minor discomforts.

CONCLUSION

There were a variety of positive and negative sensations and experiences perceived by patients with dental implants as a consequence of peri-implantitis, including a negative impact on quality of life. These findings emphasize the importance of thoroughly informing the potential and established dental implant patients of the risk of developing disease and its impact. The treatment of peri-implantitis created in general only slight discomfort for the patient.

Dentists´ and Dental Hygienists´ experiences of the Capitation Contract System—the dilemma of conflicting loyalties

Objective

The Capitation Contract system (CCS) is a payment model adopted by the Swedish Public Dental Health Service (PDHS). Patients enrolled in the CCS are usually assessed as being at lower risk of dental disease and are more regular dental attenders than those treated by Fee for Service (FFS). With increasing numbers of patients and CCS enrolments, Sweden faces a shortage of dental personnel. Our aim was to analyse dentists´ and dental hygienists´ perceptions and experiences of the capitation contact system.

Material and methods

Eleven dentists and dental hygienists from three Swedish regions participated in online qualitative interviews conducted according to the Grounded Theory methodology.

Results

When working with CCS the informants tried hard ´to find a balance between attitudes, compliance with guidelines and clinical resources´. Not all patients were offered CCS, even though they qualified: among other determinants were the informants’ interpretations of guidelines and regulations, clinical resources, and patient interest.

Conclusions

When dental resources are in balance, the informants appreciate the CCS and consider it to be favourable to patient health but are aware of conflicting loyalties of their dual roles of insurance sales agent and care provider. The informants´ individual mindset affects which patients are offered CCS enrolment.

Stabilized stannous fluoride dentifrice in relation to dental caries, dental erosion and dentin hypersensitivity: A systematic review

PURPOSE

To review the scientific evidence for the efficacy of stabilized stannous fluoride (SnF₂) dentifrice in relation to dental caries, dental erosion and dentin hypersensitivity.

METHODS

Medline OVID, Embase.com, and the Cochrane Library were searched until January 2018. Two researchers independently selected studies according to inclusion and exclusion criteria, data were extracted, the risk of bias in eligible studies was assessed and a meta-analysis was performed wherever feasible.

RESULTS

Three studies on dental caries, eight studies on dental erosion and 11 on dentin hypersensitivity were included. Risk of bias was judged as high for most of the caries and erosion studies and low or medium for the hypersensitivity studies. A similar or slightly higher anti-caries activity compared with non-stannous fluoride dentifrices was observed. Stannous fluoride showed a greater anti-erosive potential in seven of the eight studies. A mean difference score in favor of stannous fluoride dentifrices compared with controls was found in a meta-analysis including six 8-week hypersensitivity studies.

CLINICAL SIGNIFICANCE

The use of stabilized stannous fluoride dentifrices to relieve dentin hypersensitivity and to prevent the initiation of dental erosion speaks in favor of this treatment strategy.

Stakeholder Perception of the Professional Role and Competence of Swedish Dental Hygienists: A Questionnaire and Interview Study

Objectives:

This study investigated stakeholder opinions on the competence and role of dental hygienists in Sweden.

Materials and Methods:

A questionnaire was sent by e–mail to 94 stakeholders in eight Swedish counties. The survey queried the competence of recently graduated dental hygienists in skills in collaboration, communication, and problem–solving, and in clinical skills. In addition, 10 stakeholders from different Swedish dental organizations agreed to one–on–one deep interviews. Open–ended questions focused on dental hygienist competence to perform dental hygienist skills and tasks and to collaborate with other dental professionals and health–care professionals. Further topics concerning the dental hygienist included their future role and working in other European countries. The interviews were transcribed and then coded using qualitative conventional content analysis methods.

Results:

The stakeholder consensus in both the questionnaires and the interviews was that the dental hygienist profession is essential to modern dental care. The professional knowledge possessed by dental hygienists is unique and their role has developed and broadened over the years. Furthermore, the qualitative content analysis of the deep interviews identified a core category: The dental hygienist is an important profession for good oral health.

Conclusion:

Dental hygienists, responsible for prevention and oral health promotion, are an important members of the modern dental team. The need for dental hygienists to collaborate with other dental and general health–care professionals to meet the future demands of society will increase.

Effects of stabilized stannous fluoride dentifrice on dental calculus, dental plaque, gingivitis, halitosis and stain: A systematic review

Objectives

The aim of the present systematic review was to examine the scientific evidence for the efficacy of stabilized stannous fluoride (SnF₂) dentifrice in relation to dental calculus, dental plaque, gingivitis, halitosis and staining.

Data and sources

Medline OVID, Embase.com, and the Cochrane Library were searched from database inception until June 2017. Six researchers independently selected studies, extracted data, and assessed methodological quality. A meta-analysis of the 6-month gingivitis studies was done. Risk of bias was estimated using a checklist from the Swedish Agency for Health Technology Assessment (SBU, 2018).

Study selection

Two studies on dental calculus, 21 on dental plaque and gingivitis, 4 on halitosis, and 5 on stain met the inclusion criteria. Risk of bias was high for the studies on dental calculus, halitosis, and stain, and varied for the dental plaque and gingivitis studies. Significant reductions in dental calculus and in halitosis were reported for the SnF₂ dentifrice; no differences in stain reduction were noted. A meta-analysis on gingivitis found better results for the SnF₂ dentifrice compared to other dentifrices, though the results of the individual trials in the meta-analyses showed a substantial heterogeneity.

Conclusions

The present review found that stabilized SnF₂ toothpaste had a positive effect on the reduction of dental calculus build-up, dental plaque, gingivitis, stain and halitosis. A tendency towards a more pronounced effect than using toothpastes not containing SnF2 was found. However, a new generation of well conducted randomized trials are needed to further support these findings.

Clinical relevance

Adding a SnF₂ toothpaste to the daily oral care routine is an easy strategy that may have multiple oral health benefits.

Using 445 nm and 970 nm Lasers on Dental Implants-An In Vitro Study on Change in Temperature and Surface Alterations

The aim of this study was to evaluate the safety of using a 445 nm laser on dental implants by comparing it with a laser with 970 nm wavelength. Two models, a pig mandible and glass ionomer cement, were used to evaluate the temperature increase in dental implants during laser irradiation with both wavelengths. Temperature was measured every second at four different places on the dental implants. Different power settings, effects of water cooling, distance of the laser fibre to the dental implant and continuous comparison to a pulsed laser beam were tested. Surface alterations on titanium discs after laser irradiation for 4 min at 2.0 W, were analysed in a scanning electron microscope (SEM). The maximum temperature and time to reach each of the thresholds were comparable between the 445 nm and 970 nm lasers. Neither the 445 nm nor the 970 nm wavelength showed any signs of surface alterations on the titanium discs. Using a 445 nm laser on dental implants is as safe as using a 970 nm laser, in terms of temperature increase and surface alterations. Applying a generous amount of cooling water and irradiating in short intervals is important when using lasers on dental implants.

Oral Health Knowledge, Perceptions, and Habits of Adolescents from Portugal, Romania, and Sweden: A Comparative Study

Aims

The study aimed to assess and compare the self-reported oral health knowledge, habits, and perceptions of adolescents in Portugal, Romania, and Sweden and the factors that may affect them.

Materials and Methods

An oral health questionnaire with 25 questions was put together in English language and translated into Portuguese, Romanian, and Swedish language to investigate and compare oral health-related knowledge, habits, and perceptions of adolescents from the different countries. A voluntary sample of 879 teenagers completed it, mean aged 14.9 (±1.83) years, from Romania (n = 455), Portugal (n = 200), and Sweden (n = 224) as part of the EuHyDens project. The survey took place between November 2015 and June 2016.

Results

It showed some differences between the countries studied but more similarities between Portuguese and Romanian adolescents as related to perceptions of oral health and the use of oral services. Sweden and Portugal are more similar regarding oral health habits (toothbrushing and diet) as compared to Romanian adolescents. Portuguese adolescents have a higher oral health-related knowledge.

Conclusion

Assessment of knowledge, perceptions, and habits of a population is essential for the adequate understanding of the oral health-care needs of the society. From the data collected, several differences were found. These differences can be used for tailor interventions to minimize inequalities between countries.

The Dental Hygienists in Sweden and Portugal: A Comparative Study

Aims and Objectives:

The aim of the present study was to identify the dental hygienists (DHs)’ working areas and compare these findings between Sweden and Portugal.

Materials and Methods:

A web-based questionnaire was sent by E-mail to all 2943 members of the Swedish DH Association and 381 members of the Portuguese DH Association. The questionnaire contained questions about; number of years of work, which patient groups they worked with, if they had got sufficient knowledge from the education and what different tasks they worked with. Independent sample t-test, relative risk, and logistic regression analysis were used as statistical methods.

Results:

The response rate for Sweden was 31% (n = 923) and the corresponding figure for Portugal was 53.5% (n = 204). The most common tasks for the DHs, in both countries, were to diagnose and treat patients with periodontitis and to diagnose and perform caries prevention. In Portugal, 86.5% worked with orthodontic patients compared to 32.3% in Sweden (P = 0.001). The logistic regression analysis showed that there was a 25% (P = 0.02) higher probability that Swedish DHs took more X-rays and 38% (P = 0.042) probability that they had more communications skills compared to the Portuguese DHs.

Conclusion:

The DH profession in Sweden and Portugal was overall quite similar. Despite a few local differences, both the academic education and scope of practice corresponded well between the countries. The few discrepancies could be explained by differences in legislations in each country.

Self-reported oral health-related habits, attitudes and knowledge in adults from Portugal, Romania and Sweden-A comparative study

OBJECTIVE

The aim of the present study was to compare the self-reported oral health knowledge, habits and attitudes of adults in Portugal, Romania and Sweden, each benefitting from a different oral health system.

METHODS

A cross-sectional study was conducted on 1081 adults in the three countries, using an adapted version of the WHO oral health questionnaire. This survey took place between November 2015 and June 2016.

RESULTS

The mean age of the respondents was 46.85 with 95% CI (45.84, 47.86). Over 85% of the Portuguese and the Swedish, but only 55% of the Romanians, reported having 20 or more teeth left (P < 0.001). Most Swedes visit the dental office regularly, but only 50.5% of the Portuguese and 20.6% of the Romanians do so (P < 0.001). Interdental cleaning aids and fluoridated toothpaste were used the most in Sweden and the least in Romania. Daily consumption of sweets was lowest for Portugal and highest for Romania (P < 0.001), and daily intake of fresh fruits and vegetables was lowest for Sweden (P < 0.001).

CONCLUSIONS

There is a difference between the three countries regarding oral health, diet, dental attendance and oral health-related quality of life, with Romania being in most need of improvement in these areas. The differences could be explained by the distinct healthcare systems adopted by the countries.

Influence of culture conditions on porphyrin production in Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis

BACKGROUND

Increasing antibiotic resistance among pathogens has raised the demands for new treatment methods such as antimicrobial photodynamic therapy (aPDT) and phototherapy (PT). Experiments for investigating the effects of these methods are often performed in vitro, but the procedures for cultivation of microbes vary between different studies. The aim of this study has been to elucidate how the profile of endogenously produced porphyrins differs by changing the variables of bacteria culturing conditions.

METHODS

Two oral pathogens, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, were selected as model organisms. The contents of porphyrins and heme in the bacteria were analysed with liquid chromatography-tandem mass spectrometry when bacteria was cultivated for different lengths of time (3-9 days), upon passaging as well as when growth medium were supplemented with or without horse blood.

RESULTS

Both porphyrin and heme content in A. actinomycetemcomitans are highly affected by the age of the culture, and that the porphyrin profiles changes during cultivation. When cultivated colonies of A. actinomycetemcomitans were passaged onto a new, fresh growth medium a large change in porphyrin content occurred. Additional porphyrins were detected; uroporphyrin and 7-carboxylporphyrin, and the total porphyrin content increased up to 28 times. When P. gingivalis was grown on blood containing medium higher concentrations of protoporphyrin IX (2.5 times) and heme (5.4 times) were quantified compared to bacteria grown without blood.

CONCLUSIONS

This study demonstrate that there is a need for more standardized culturing protocols when performing aPDT and PT experiments in vitro to avoid large variations in porphyrin profiles and concentrations, the aPDT/PT target compounds, depending on the culturing conditions.

Dental patients' perceptions and motivation in smoking cessation activities

OBJECTIVE

The aim of the present study was to investigate smokers' perceptions of and motivation for smoking cessation activities in dentistry. MATERIALS AND METHODS PATIENTS: who smoked were consecutively recruited from general as well as specialist dental care clinics in Sweden. After a dental visit the patients completed a questionnaire about self-perceived oral health, smoking habits, motivation, reasons to quit and not to quit smoking, support to quit, smoking cessation activities and questions about smoking asked by dentists and dental hygienists.

RESULTS

The sample consisted of 167 adult patients (≥ 20 years) who smoked daily. During the last 6 months, 81% of the patients had experienced oral health problems. The most common complaints were discolourations of the teeth, periodontal problems and dry mouth (38%, 36% and 33%, respectively). Improved general health was a major reason to quit smoking (89%). It was also stated that it was important to avoid oral health problems. 71% of the patients preferred to quit by themselves and 16% wanted support from dentistry. High motivation to quit smoking was reported by 20%. Occurrence of periodontitis during the last 6 months was significantly associated with being highly motivated to stop smoking (OR = 3.0, 95% CI = 1.03-8.55).

CONCLUSIONS

This study revealed that, although it was important to quit smoking to avoid oral health problems, the patients were not aware that tobacco cessation activities can be performed in dentistry. Periodontal problems seem to be the most motivating factor among the patients who were highly motivated to stop smoking.

Smoking and inflammation: evidence for a synergistic role in chronic disease

Tobacco smoking is the most important preventable risk factor for periodontitis; however, the underlying biological mechanisms responsible for the detrimental effects of smoking on periodontal health remain largely unclear. It is also well established that smoking has a negative impact on several inflammatory diseases, including rheumatoid arthritis, multiple sclerosis and inflammatory bowel disease. The aim of this paper was to review smoking-related changes in local and systemic host responses with a focus on cellular and molecular effects that could explain a hyperinflammatory response leading to periodontal destruction. Biological mechanisms that may be common to periodontal disease and other chronic inflammatory diseases were also explored, together with gene-smoking interactions. An epidemiologic perspective on the burden of smoking on periodontal health and the potential for smoking cessation is also presented. Tobacco smoking seems to induce changes ranging from decreased leukocyte chemotaxis to decreased production of immunoglobulins. Smoking also seems to cause a stronger inflammatory reaction with an increased release of potentially tissue-destructive substances (e.g. reactive oxygen species, collagenase, serine proteases and proinflammatory cytokines). These findings support a hypothesis that periodontitis is a hyperinflammatory condition rather than a hypo-inflammatory condition.

Consumption of dental treatment in patients with inflammatory bowel disease, a register study

Objective

The aim of this study was to compare the consumption of dental treatment among patients with Crohn´s disease (CD) or ulcerative colitis (UC) compared to age and gender matched control groups.

Design

The study group comprised 2085 patients with CD and 3161 with UC from the Uppsala-Örebro region and from the Stockholm region. The patients in the cohort were diagnosed between 1960 and 1989. Patients up to 70 years of age were included in the study. The two patients groups were compared to age- and gender-matched, randomly selected control groups from the same geographic area comprising a corresponding number of participants.

Results

CD patients had significantly higher total number of procedures registered (p < 0.000). The difference was most pronounced for removable dentures (+65%), fillings in front teeth (+52%) and endodontic treatment (+46%) when Crohn’s patients were compared to controls (p<0.001). The corresponding figures for UC patients were also a significantly higher total number of procedures (p < 0.005), more clinical examinations (p<0.000), fillings in canines and incisors (p < 0.001) and fillings in bicuspids and molars (p < 0.000).

Conclusion

This study demonstrate that CD and UC individuals use more dental treatment compared to an age-gender matched control group, and more caries-related treatments. The difference was most pronounced for restorative treatment in patients with Crohn’s.

Dental caries, prevalence and risk factors in patients with Crohn's disease

OBJECTIVE

The present study tested the hypothesis that patients with Crohn's disease (CD) have a higher prevalence and risk for caries compared to people without CD.

MATERIAL AND METHODS

Patients with CD were divided into groups; 71 patients (50.7 ± 13.9 years) who had gone through resective intestinal surgery and 79 patients (42.0 ± 14.4 years) who had not. The patients were compared to 75 controls (48.6 ± 13.4 years) regarding DMF-T and DMF-S, Lactobacilli (LB), Streptococcus mutans (SM), salivary flow and dental plaque. Statistical methods including ANOVA or Chi-square test for calculation of demographic differences between groups, analysis of covariance (ANCOVA) to compare the clinical variable and Post hoc analyses were done with Fischers Least Significant Difference test or Chi-square. Non-parametric Spearman's correlation matrix coefficient was estimated between clinical variables and disease duration.

RESULTS

CD patients who had been subjected to resective surgery had a higher DMF-S score (50.7 versus 36.5; p = 0.01) compared to the control group after adjusting for age, gender and smoking. These patients had higher counts of SM (1.5 versus 0.9; p = 0.04) and LB (10000.0 versus 1000.0; p = 0.01), and more dental plaque (53.7 versus 22.6; p = 0.001). CD patients reported a more frequent consumption of sweetened drinks between meals compared to controls (p = 0.001).

CONCLUSIONS

The present study shows that patients with CD who had undergone resective surgery had a higher DMFs score, and higher salivary counts of Lactobacilli and Streptococcus mutans compared to the control group.

The importance of measuring toothpaste abrasivity in both a quantitative and qualitative way

OBJECTIVE

To evaluate the relative abrasivity of different toothpastes and polishing pastes both qualitatively and quantitatively.

MATERIALS AND METHODS

Acrylic plates were exposed to brushing in a brushing machine with a toothpaste/water slurry for 1 and 6 h. Twelve different toothpastes were used and also four different polishing pastes. The results were evaluated using a profilometer after 1 and 6 h of brushing (corresponding to 2000 and 12 000 double strokes, respectively). A surface roughness value (Ra-value) and also a volume loss value were calculated from the profilometer measurements. These values were then correlated to each other. An unpaired t-test for the difference in the abrasion values between the toothpastes and the abrasion values over time was used.

RESULTS

The polishing paste RDA® 170 yielded higher Ra-values than RDA 250®, both after 1 and 6 h of brushing (1.01 ± 0.22 and 8.99 ± 1.55 compared to 0.63 ± 0.26 and 7.83 ± 5.89, respectively) as well as volume loss values (3.71 ± 0.17 and 20.20 ± 2.41 compared to 2.15 ± 1.41 and 14.79 ± 11.76, respectively), thus poor correlations between the RDA and Ra and Volume loss values were shown. Among the toothpastes, Apotekets® showed the highest Ra value after 1 h of brushing and Pepsodent® whitening after 6 h of brushing. Pepsodent® whitening also showed the highest volume loss values, both after 1 and 6 h of brushing.

CONCLUSION

This study emphasizes the importance of not only considering the RDA value, but also a roughness value, when describing the abrasivity of a toothpaste. Furthermore, it can be concluded that so called 'whitening' toothpastes do not necessarily have a higher abrasive effect than other toothpastes.

Patient attitudes and expectations of dental implant treatment--a questionnaire study

The aim of the present study was to evaluate patient attitudes and expectations relative to dental implant treatment. A questionnaire was mailed to all 400 patients that had received dental implant treatment at a large multi-specialist clinic during 2008. The questionnaire included questions relative to the reasons for dental implant treatment, if the patient earlier had considered dental implants, expectations of the treatment, discomfort during and after surgery, and how the patient perceived the esthetic outcome. The response rate was 61% (114 men/130 women). The stated reason for tooth loss was in 50% of the patients periodontitis,19% caries, 8% accidents,13% other reasons, and 10% no stated reason. Almost all patients (96%) were satisfied with the esthetic appearance and also regarding the information of the treatment (94%). Regarding the time between surgery and completion of prosthetic work, 79% (n = 192) found it to be reasonable. 71% (n = 170) thought the cost was what they had expected. 47% of the patients experienced the implant surgery better than expected and 48% as expected. In conclusion, the present study revealed that almost all patients were satisfied with the function and esthetics of the dental implant reconstruction and most patients were also satisfied regarding the costs and treatment duration.

Tobacco cessation interventions by Swedish dental hygienists--a questionnaire study

The aim of the study was to investigate tobacco cessation interventions by Swedish dental hygienists and their perception of the importance of tobacco cessation to oral health. A questionnaire was mailed to 400 randomly selected dental hygienists (DH) in Sweden. The questions covered such topics as tobacco cessation interventions, perceived barriers, and their perception of the importance of tobacco cessation in relation to caries, gingivitis, periodontitis and dental implants. The response rate was 57%. Tobacco habits were routinely recorded by 94% of the respondents. 52% of the dental hygienists reported time constraints, 50% reported insufficient competence and 43% answered that they had lack of experience to work with tobacco cessation. All respondents perceived tobacco cessation to be an important determinant of treatment outcomes in patients with dental implants and periodontitis. Bivariate analysis showed an association between training courses in tobacco cessation and tobacco cessation interventions (OR 3.25, CI 95% 1.80-5.85). A logistic multivariate regression model disclosed two other factors significantly correlated with tobacco cessation interventions: competence (OR 2.4, 95% CI 1.16-4.85), and experience (OR 2.1, 95% CI 1.06-4.28). The analyses were adjusted for age, length of undergraduate training course, and dental care organization. The dental hygienists considered tobacco cessation to be very important in patients with periodontitis and in those with dental implants. Most of the DH in this study undertook some tobacco cessation interventions, though not extensive; the main barriers reported were lack of time, competence and experience.

The invisible work with tobacco cessation - strategies among dental hygienists

OBJECTIVE

This study elucidates dental hygienists' experiences of work with tobacco cessation among patients who smoke or use snuff.

METHODS

Data were obtained and categorized by interviewing 12 dental hygienists, who worked actively with tobacco cessation interventions. Qualitative content analysis was used for analysis.

RESULTS

The latent content was formulated into the core category 'the invisible oral health promotion work'. The informants thought that they had a responsibility to work with tobacco cessation. They perceived the financial system in which they perform the activity as frustrating, because tobacco cessation has no treatment code in the dental care insurance. This was one of several reasons why they had to integrate it in other treatment procedures. The results identified three categories: 'balance in the meeting', 'possibilities and hindrance' and 'procedures'. In the narratives, both positive and negative aspects were displayed.

CONCLUSIONS

The financial conditions for tobacco cessation interventions need to be reformed and the activity has to be given a higher priority in the organization of dental care. Practical training in performing tobacco cessation interventions is important during the dental hygiene education; otherwise, tobacco cessation interventions will remain invisible in oral health promotion in the future.

The influence of academic stress on gingival inflammation

OBJECTIVE

The aim of the present study was to investigate the effects of academic stress on periodontal health, in relation to inflammatory markers in gingival crevicular fluid (GCF) and cortisol in saliva.

MATERIALS AND METHODS

The study included 20 healthy dental hygienists (females: mean age 29.3 +/- 8.5 SD) and was conducted during a major exam period and 4 weeks later after the exams. A clinical examination was performed and GCF was collected from four sites in each subject on these two occasions. Interleukin (IL)-1beta, IL-4, IL-6, IL-10 levels were determined using Luminex 100 and cortisol amounts by radioimmunoassay (RIA (125)I). Students registered their perceived stress on a visual analogue scale (VAS). Significance of the findings was determined using paired t-test, Wilcoxon-matched pair and Spearman's rank correlations.

RESULTS

Students had higher amounts of dental plaque (P < 0.007) and gingival inflammation (P < 0.001) during the exam period compared with after the exams. The amounts of IL-6 and IL-10 in GCF were significantly increased during the time of examinations. The median level of cortisol in saliva was also significantly raised during the exam period compared with after the exams, 20.52 nmol/l (range: 11.91-27.34) and 16.41 nmol/l (range: 10.91-24.17) respectively, P < 001. The results from the VAS registration revealed a significant difference (P < 001) between the two occasions.

CONCLUSION

Academic stress appears to affect periodontal health, shown by more plaque accumulation, gingival inflammation and increased amounts of IL-6, IL-10 in GCF and cortisol in saliva.

Perceived oral health in patients with Crohn's disease

PURPOSE

The aim of the present study was to investigate perceived oral health in patients with Crohn's disease (CD) in comparison with a control group without CD.

MATERIALS AND METHODS

The study population comprised 1943 patients with CD recruited from the Swedish National Patients Organisation of inflammatory bowel disease and 1000 randomly selected controls. All participants received a questionnaire with questions concerning socioeconomic variables, education, civil status, income, dental care habits, oral health and tobacco use.

RESULTS

Eighty-eight per cent of the patients and 75% of the controls answered the questionnaire. Patients with CD perceived their oral health to be worse than controls. The odds ratio (OR) for the patients to estimate their oral health as much worse than others in the same age group was 9.7 (95% CI, 5.8 to 16.4) after adjustment for age, smoking habit, gender and education. The patients also reported a significantly greater need for dental treatment than the controls, with an OR of 5.7 (95% CI, 4.2 to 7.9) after taking into account the age, smoking habit, gender and education. Furthermore, the patients with CD reported significantly more mouth-related problems than controls (OR 3.2), such as significantly more caries and more gingival bleeding. Of note, there were significantly more smokers in the patient group.

CONCLUSIONS

The results of the present study show that patients with CD perceived their oral health to be worse and have a greater need for dental treatment compared with the control group.

Gingival inflammation, increased periodontal pocket depth and elevated interleukin-6 in gingival crevicular fluid of depressed women on long-term sick leave

BACKGROUND AND OBJECTIVE

The aim of this work was to investigate periodontal status, in relation to inflammatory markers and cortisol, in the gingival crevicular fluid and saliva of a homogenous group of women on long-term sick leave for job-stress related depression in comparison to nondepressed women.

MATERIAL AND METHODS

The participants comprised 20 women with depression (DSM-IV) (mean age 48.5 +/- 6.9 years) and 29 healthy controls (mean age 54.5 +/- 2.9 years). Clinical examination was performed. Gingival crevicular fluid was collected by an intracrevicular washing technique. Interleukin-1 beta, interleukin-6, matrix metalloproteinase (MMP)-8 and MMP-9 were determined with enzyme-linked immunosorbent assay and cortisol was determined by using a radioimmunoassay. One-way analysis of covariance was used as the statistical method.

RESULTS

The depressed patients had significantly higher gingival inflammation (p < 0.001), and deeper pockets (p < 0.003), than the healthy controls, after adjusting for age and smoking. The levels of interleukin-6 in the gingival crevicular fluid were significantly higher in the patients than in the controls: 3.84 +/- 1.58 pg per site and 0.79 +/- 1.83 pg per site, respectively, p < 0.003. There were no significant differences in the levels of interleukin-1 beta, MMP-8 and MMP-9. The patients had lower cortisol values in gingival crevicular fluid than the controls, whereas the levels of cortisol in saliva were similar in both groups.

CONCLUSION

Women on long-term sick-leave for depression had more severe periodontitis and higher concentrations of interleukin-6 in gingival crevicular fluid than healthy controls. An alteration of the immune system in these patients might be interpreted as reflecting the consequences of long-term stress exposure and might contribute to worse periodontal conditions in these particular patients.

Dental plaque, gingival inflammation, and elevated levels of interleukin-6 and cortisol in gingival crevicular fluid from women with stress-related depression and exhaustion

BACKGROUND

The aim of the present study was to investigate the importance of stress for the development of periodontitis by comparing oral health status, proinflammatory markers, and cortisol in gingival crevicular fluid (GCF) and saliva in patients with stress-related mental depression and controls.

METHODS

The participants consisted of 43 women with stress-related depression and exhaustion (Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV], with a mean age of 42.0 (+/- 9.3 SD) years, and 29 controls, with a mean age of 54.5 (+/- 2.9 SD) years. Clinical examination included the assessment of dental plaque, gingival inflammation (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and number of teeth. GCF was collected with an intracrevicular washing technique from four sites in each subject. Interleukin (IL)-1beta, IL-6, and matrix metalloproteinase-9 were determined with enzyme-linked immunosorbent assay and cortisol with radioimmunoassay (125I RIA). Analysis of covariance (one-way covariance analyses) was used to remove the influence of age and smoking.

RESULTS

The amount of plaque was significantly higher in patients compared to controls (P<0.003). The patients had an average GI of 1.53 (+/-0.13 SD) compared to 0.89 (+/- 0.10 SD) for the controls (P< 0.001). The levels of cortisol in GCF was significantly higher in patients than in controls, 3.46 nmol/l (+/- 3.25 SD) and 0.30 nmol/l (+/- 0.25 SD), respectively (P<0.001), whereas cortisol in saliva did not differ between groups. The levels of IL-6 in GCF were significantly higher in the patients than in controls (P<0.05).

CONCLUSION

Women with stress-related depression and exhaustion had more plaque accumulation, GI and increased levels of IL-6 and cortisol in GCF compared to normal controls, suggesting that depression might affect immune function, which could lead to impaired periodontal health.

Anxiety, gingival inflammation and periodontal disease in non-smokers and smokers - an epidemiological study

OBJECTIVES

The aim of the present study was to investigate the influence of anxiety, measured by one single question, on gingival inflammation and periodontal disease in non-smokers and smokers.

MATERIAL AND METHODS

The participants were 144 subjects with untreated periodontal disease 30-40 years of age, and 26 healthy controls, 30-40 years of age. All subjects were clinically examined and answered an uncomplicated question regarding anxiety in every day life, as well as smoking habits. The periodontitis subjects were divided into; an aggressive periodontitis (AP)-group and a chronic periodontitis (CP)-group. Fisher's exact probability t-test, analysis of variance (anova), Mann-Whitney U-test and analysis of covariance (ancova) were used as statistical methods.

RESULTS

Anxious subjects had a significantly higher gingival index than non-anxious subjects, when controlling for smoking (p<0.01). The healthy anxious non-smokers had an average score of GI 1.6 (+/-0.4 SD) compared with 1.2 (+/-0.4 SD), p<0.05 for the non-anxious non-smokers. Anxious smokers with periodontits (AP-/CP-group) had significantly more sites with pockets >/=5 mm, compared with non-anxious smokers, (p<0.05).

CONCLUSIONS

The results of the present study, suggest that self-reported anxiety was associated with an adverse affect on the gingiva. Anxiety seemed to be associated with increased severity of periodontal disease in smokers.

Percent of plaque on individual tooth surfaces and differences in plaque area between adjacent teeth in healthy adults

OBJECTIVES

To apply a planimetric method to determine the percentage of the tooth area covered by plaque on individual tooth surfaces and to compare the percentage of plaque between adjacent tooth surfaces.

METHODS

Forty-three adults, mean age 43.0 years, with no signs of periodontal disease, participated. The subjects underwent comprehensive professional cleaning of all teeth. The subjects were then instructed to maintain their ordinary oral hygiene habits. Plaque was registered after 1 month, on each individual tooth surface by use of P%I.

RESULTS

The pattern of plaque accumulation was in large symmetrical, with differences in mean P%I between several adjacent tooth surfaces, e.g. for the maxillary buccal and lingual tooth surfaces between the first and second molars (P<0.001) and for the lingual tooth surfaces between the canines and the first premolars (P<0.01).

CONCLUSION

In the present study, it was possible to identify and describe adjacent tooth surfaces with the most pronounced plaque accumulation, to make further improvements of oral hygiene possible.

[Animal nutrition for veterinarians--recent cases of clinical disorders in horses after intake of ionophore-containing feed]

Anamnesis and clinical signs of horses form five different stables after ingestion of ionophores are reported and techniques of feed examination are described. Within a few hours or days after feeding of new types or batches of concentrates horses fell ill. They showed colic-like symptoms with intense sweating and ataxia. Most of the sick animals died within a short time span. Samples of the concentrates were analysed and different types and amounts of ionophores were detected. In four cases contamination by monensin in concentrations of less than 5 mg to 679 mg/kg feed were found. One feed sample contained monensin (8.8 mg/kg feed) as well as salinomycin (67.3 mg/kg feed). In one case lasalocid (7.9 mg/kg feed) was present. One horse from the stable where animals had obtained concentrates containing monensin (679 mg/kg feed) was necropsied. Typical signs of monensin intoxication with severe myocardial degeneration were found. Veterinarians should be alert to this rare but severe intoxication of horses.

Renal osteodystrophy. Effect of hemodialysis and 1 alpha-hydroxy vitamin D3 on bone lesions and metacarpal bone mass

Radiologic bone lesions in 20 long-term hemodialyzed patients with chronic renal failure are described. During chronic dialysis the bone lesions increased. Treatment of 8 patients with 1 alpha-OH-D3 for 6 months prevented progression of the bone lesions or improved them.

Recurrent instability of the ankle joint. Surgical repair by the Watson-Jones method

Twenty-one ankle joints with recurrent lateral instability, treated with surgical repair by the Watson-Jones method, were included in a follow-up study 1--5 years after operation. Good results were achieved in 80 per cent. However, the results were not better than those after free dissection and direct suture of the ligamentous ruptures. It is therefore recommended that the more extensive Watson-Jones procedure be reserved for selected cases.

Bone maturation in children with chronic renal failure. Effect of 1 alpha-hydroxy vitamin D3 and renal transplantation

In 8 of 11 children with terminal chronic renal failure, bone age was retarded 6 months to 3 years. During hemodialysis the bone maturation rate decreased. 1 alpha-OH vitamin D3 treatment and renal transplantation normalized the bone maturation rate.

Increased serum calcitonin in patients with mammary carcinoma

Serum calcitonin war within normal range in 11 patients with benign breast tumour. In cases with local malignant breast tumour increased calcitonin was found in 25 per cent (4/16), in cases with regional metastases in 40 per cent (2/5), and in cases with osteolytic bone metastases in 77 per cent (10/13). Two patients with osteosclerotic bone metastases had low calcitonin concentration. It is suggested that increased calcitonin in mammary carcinoma is a physiologic response to osteolytic bone metastases.

Chronic sclerosing osteomyelitis of the mandible. Radiographic differential diagnosis from fibrous dysplasia

Among 13 patients with chronic osteomyelitis of the lower jaw, clinical, radiologic and histologic difficulties were encountered in 5 cases, in the differential diagnosis from fibrous dysplasia. The radiologic, and in some measure the clinical and histologic features typical of the two diseases are described. Variations in the bone structure during the course of the disease, as well as periosteal new-bone formation, are characteristics of chronic osteomyelitis. When problems are encountered in differentiating between fibrous dysplasia with periodical pain and swelling, and osteomyelitis, repeated radiologic examinations are to be recommended.