Randomized Trial to Test a Chemo-Mechanical Antiplaque Regimen as Adjunct to Periodontal Therapy

BACKGROUND

The control of dental biofilm regrowth after nonsurgical periodontal therapy is associated with better clinical outcomes. However, many patients have difficulty achieving optimal plaque control. Subjects with diabetes, in which immune and wound-healing responses are typically impaired, may benefit from intensive antiplaque control regimens after scaling and root planing (SRP).

OBJECTIVES

This study aimed to evaluate the effects of an intensive, at-home, chemical, and mechanical antiplaque regimen as an adjunct to SRP for the treatment of moderate to severe periodontitis. A secondary objective was to compare responses in subjects with type 2 diabetes and nondiabetics.

METHODS

This was a 6-mo, single-center, parallel-group, randomized trial. The test group received SRP and oral hygiene instructions, and subjects were instructed to use a 0.12% chlorhexidine gluconate mouthrinse twice a day for 3 mo and utilize rubber interproximal bristle cleaners twice a day for 6 mo. The control group received SRP and oral hygiene instructions. The main outcome was change in mean probing depth (PD) from baseline to 6 mo. Secondary outcomes included change in sites with deep PDs, mean clinical attachment level, bleeding on probing, plaque index, hemoglobin A1C, fasting blood glucose, C-reactive protein, and taste assessment. This study was registered at ClinicalTrials.gov as NCT04830969.

RESULTS

In total, 114 subjects were randomized to either treatment. Eighty-six subjects completed the trial with no missing visits. Neither an intention-to-treat nor a per-protocol analysis showed statistically significant differences between treatment groups in mean PD at 6 mo. In a subgroup analysis, subjects with diabetes in the test group showed a statistically significant greater reduction in mean PD at 6 mo when compared to subjects with diabetes receiving the control treatment (Δ = 0.15, P = 0.04), while there were no differences within nondiabetics (Δ = 0.02, P = 0.75).

CONCLUSION

Outcomes in subjects with diabetes may be improved by chemo-mechanical antiplaque measures after nonsurgical periodontal therapy.

KNOWLEDGE TRANSFER STATEMENT

This study suggests diabetic subjects may benefit from an intensive, at-home, chemical, and mechanical antiplaque regimen to improve nonsurgical periodontal therapy outcomes.

Array comparative genomic hybridisation (aCGH) analysis of premenopausal breast cancers from a nuclear fallout area and matched cases from Western New York

High-resolution array comparative genomic hybridisation (aCGH) analysis of DNA copy number aberrations (CNAs) was performed on breast carcinomas in premenopausal women from Western New York (WNY) and from Gomel, Belarus, an area exposed to fallout from the 1986 Chernobyl nuclear accident. Genomic DNA was isolated from 47 frozen tumour specimens from 42 patients and hybridised to arrays spotted with more than 3000 BAC clones. In all, 20 samples were from WNY and 27 were from Belarus. In total, 34 samples were primary tumours and 13 were lymph node metastases, including five matched pairs from Gomel. The average number of total CNAs per sample was 76 (range 35–134). We identified 152 CNAs (92 gains and 60 losses) occurring in more than 10% of the samples. The most common amplifications included gains at 8q13.2 (49%), at 1p21.1 (36%), and at 8q24.21 (36%). The most common deletions were at 1p36.22 (26%), at 17p13.2 (26%), and at 8p23.3 (23%). Belarussian tumours had more amplifications and fewer deletions than WNY breast cancers. HER2/neu negativity and younger age were also associated with a higher number of gains and fewer losses. In the five paired samples, we observed more discordant than concordant DNA changes. Unsupervised hierarchical cluster analysis revealed two distinct groups of tumours: one comprised predominantly of Belarussian carcinomas and the other largely consisting of WNY cases. In total, 50 CNAs occurred significantly more commonly in one cohort vs the other, and these included some candidate signature amplifications in the breast cancers in women exposed to significant radiation. In conclusion, our high-density aCGH study has revealed a large number of genetic aberrations in individual premenopausal breast cancer specimens, some of which had not been reported before. We identified a distinct CNA profile for carcinomas from a nuclear fallout area, suggesting a possible molecular fingerprint of radiation-associated breast cancer.

Participant characteristics and quality of recall of physical activity in the distant past

Assessment of physical activity in the distant past, usually by recall, is necessary to evaluate its etiologic effects on chronic disease. Few studies have investigated influences on such long-term recall. The authors investigated the association of gender, age, education, marital status, current physical activity, body weight, body mass index, blood pressure, and pulse with the quality of recall of physical activity in a Buffalo Health Study cohort followed since the early 1960s. Comparisons of original, recalled, and current reports of physical activity were made in 137 survivors of the cohort. The quality of recall (the difference between original and recalled reports) values near zero indicated the best recall; positive values, overestimation; and negative values, underestimation. Overestimators had the highest levels, and good recallers lower levels, of current physical activity. Although the authors found differences by gender, age, and education, the evidence did not support better recall by one group compared with the others. Moreover, no association of marital status, body weight, body mass index, blood pressure, or pulse was found with the quality of recall. The results suggest that individual respondent characteristics have little association with recall of past physical activity; however, current physical activity may be a factor to consider in studies of past physical activity and chronic disease.

Periodontal disease and risk of cerebrovascular disease: the first national health and nutrition examination survey and its follow-up study

BACKGROUND

Periodontal disease has been found to be a potential risk factor for coronary heart disease. However, its association with cerebrovascular accidents (CVAs) is much less studied.

METHODS

This study examines the association between periodontal disease and CVA. The study cohort comprises 9962 adults aged 25 to 74 years who participated in the First National Health and Nutrition Examination Survey and its follow-up study. Baseline periodontal status was categorized into (1) no periodontal disease, (2) gingivitis, (3) periodontitis, and (4) edentulousness. All CVAs (International Classification of Diseases, Ninth Revision [ICD-9], codes 430-438) were ascertained by hospital records for nonfatal events and death certificates for fatal events. The first CVA, nonfatal or fatal, was used to define incidence. Relative risks were estimated by hazard ratios from the Cox proportional hazard model with adjustment for several demographic variables and well-established cardiovascular risk factors. Weights were used to generate risk estimates.

RESULTS

Periodontitis is a significant risk factor for total CVA and, in particular, nonhemorrhagic stroke (ICD-9, 433-434 and 436-438). Compared with no periodontal disease, the relative risks (95% confidence intervals) for incident nonhemorrhagic stroke were 1.24 (0.74-2.08) for gingivitis, 2.11 (1.30-3.42) for periodontitis, and 1.41 (0.96-2.06) for edentulousness. For total CVA, the results were 1.02 (0.70-1.48) for gingivitis, 1.66 (1.15-2.39) for periodontitis, and 1.23 (0.91-1.66) for edentulousness. Increased relative risks for total CVA and nonhemorrhagic stroke associated with periodontitis were also seen in white men, white women, and African Americans. Similar results were found for fatal CVA.

CONCLUSION

Periodontal disease is an important risk factor for total CVA and, in particular, nonhemorrhagic stroke.

Adapting the cognitive interview to enhance long-term (35 years) recall of physical activities

The cognitive interview (CI) was modified for use in an epidemiological study in which respondents were asked to recall their daily physical activities from the distant past (35 years ago). In comparison to a traditional epidemiological interview, the CI elicited many more responses and also more precise responses. Several practical costs, however, were incurred by the CI: additional time to train interviewers and to conduct interviews and difficulties in coding the responses. The costs and benefits of conducting the CI are addressed, along with conceptual and methodological challenges. The article ends with an existential question: Is the CI a singular technique if it can be modified so radically for different settings?

Examination of the relation between periodontal health status and cardiovascular risk factors: serum total and high density lipoprotein cholesterol, C-reactive protein, and plasma fibrinogen

Using data from the Third National Health and Nutrition Examination Survey (1988-1994), the authors examined the relation between periodontal health and cardiovascular risk factors: serum total and high density lipoprotein cholesterol, C-reactive protein, and plasma fibrinogen. A total of 10,146 participants were included in the analyses of cholesterol and C-reactive protein and 4,461 in the analyses of fibrinogen. Periodontal health indicators included the gingival bleeding index, calculus index, and periodontal disease status (defined by pocket depth and attachment loss). While cholesterol and fibrinogen were analyzed as continuous variables, C-reactive protein was dichotomized into two levels. The results show a significant relation between indicators of poor periodontal status and increased C-reactive protein and fibrinogen. The association between periodontal status and total cholesterol level is much weaker. No consistent association between periodontal status and high density lipoprotein cholesterol was detectable. Similar patterns of association were observed for participants aged 17-54 years and those 55 years and older. In conclusion, this study suggests that total cholesterol, C-reactive protein, and fibrinogen are possible intermediate factors that may link periodontal disease to elevated cardiovascular risk.

Reliability of recall of physical activity in the distant past

Substantial data exist supporting the role of physical activity in the etiology of several chronic diseases. Many chronic diseases begin developing 20-30 years before they become clinically evident. Since researchers often must rely on recall to characterize the long term habits of study participants, the accuracy of recall of physical activity is an important methodological issue in etiologic studies. The purpose of this study was to examine the quality of recall of physical activity in the distant past in a cohort of western New York residents followed since 1960. Paired t tests and intraclass correlation coefficients (ICCs) were used to compare "original" (1960) and "recalled" (1992-1996) reports of weekday (occupational) and free-day (leisure time) physical activity. Results showed that the recalled reports underestimated past weekday activities when overall activity was examined; estimates closer to the originals were found when levels of activity were examined. Recall was best for weekday light (ICC = 0.43) and weekday moderate (ICC = 0.45) activity in both sexes and free-day hard activity in females (ICC = 0.45). Most participants underestimated past free-day activity, but males overestimated free-day hard activity. Correlations for free-day activity were highest for summer sports in females (ICC = 0.29) and winter sports in both sexes (ICC = 0.39) and were low for walking and "other activity." Considering the length of time between the original interviews and the recall interviews, the correlations found here are remarkable and close to those found in other studies where recall intervals were 10 years or less.