Computational Design of a Multi-Epitope Vaccine Against Porphyromonas gingivalis

Porphyromonas gingivalis is a Gram-negative pathogenic bacterium associated with chronic periodontitis. The development of a chimeric peptide-based vaccine targeting this pathogen could be highly beneficial in preventing oral bone loss as well as other severe gum diseases. We applied a computational framework to design a multi-epitope-based vaccine candidate against P. gingivalis. The vaccine comprises epitopes from subunit proteins prioritized from the P. gingivalis reference strain (P. gingivalis ATCC 33277) using several reported vaccine properties. Protein-based subunit vaccines were prioritized through genomics techniques. Epitope prediction was performed using immunoinformatic servers and tools. Molecular modeling approaches were used to build a putative three-dimensional structure of the vaccine to understand its interactions with host immune cells through biophysical techniques such as molecular docking simulation studies and binding free energy methods. Genome subtraction identified 18 vaccine targets: six outer-membrane, nine cytoplasmic membrane-, one periplasmic, and two extracellular proteins. These proteins passed different vaccine checks required for the successful development of a vaccine candidate. The shortlisted proteins were subjected to immunoinformatic analysis to map B-cell derived T-cell epitopes, and antigenic, water-soluble, non-toxic, and good binders of DRB1*0101 were selected. The epitopes were then modeled into a multi-epitope peptide vaccine construct (linked epitopes plus adjuvant) to enhance immunogenicity and effectively engage both innate and adaptive immunity. Further, the molecular docking approach was used to determine the binding conformation of the vaccine to TLR2 innate immune receptor. Molecular dynamics simulations and binding free energy calculations of the vaccine–TLR2 complex were performed to highlight key intermolecular binding energies. Findings of this study will be useful for vaccine developers to design an effective vaccine for chronic periodontitis pathogens, specifically P. gingivalis.

EVALUATION OF EFFECTIVENESS OF TREATMENT-AND-PROPHYLACTIC COMPLEX IN TOBACCO-ADDICTED PATIENTS WITH CHRONIC GENERALIZED PERIODONTITIS ON THE BACKGROUND OF CHRONIC HYPERACID GASTRITIS

OBJECTIVE

The aim: To evaluate the clinical efficacy of treatment-and-prophylactic complex in patients addicted to tobacco with chronic generalized periodontitis with chronic hyperacid gastritis.

PATIENTS AND METHODS

Materials and methods: 68 patients (men and women) aged 25-44 years were examined. They were distributed into two groups: the main group - 48 patients addicted to tobacco with chronic generalized 1 degree periodontitis and chronic hyperacid gastritis, associated with Helicobacter pylori, the control group - 20 healthy individuals without bad habits. Patients of the main group were distributed at random into 2 subgroups (1.1, 1.2) depending on the chosen therapy. The patients of the subgroup 1.1 received the basic therapy and the developed treatment and prophylactic complex, the subgroup 1.2 received the basic therapy and the ultraphonophoresis procedures with placebo. Assessment of the effectiveness of therapy was carried out by determining hygienic index OHI-S and periodontal indices (PI, PMA index and Muhlemann bleeding index (MBI)).

RESULTS

Results: The usage of the treatment-and-prophylactic complex resulted in improvement of the hygienic index OHI-S and periodontal indices (PI, PMA index and MBI) at the immediate and late observation period.

CONCLUSION

Conclusions: Results of the study confirmed the effectiveness of the proposed treatment-and-prophylactic complex in therapy of chronic generalized 1 degree periodontitis in patients addicted to tobacco smoking with chronic hyperacid gastritis.

[Study of the functional state of the periodontium in older persons and its correction by means of oral hygiene.]

The study involved 258 older persons with generalized chronic periodontitis, who were monitored for a month. For an in-depth study of the properties and effectiveness of toothpastes recommended for older and elderly people with preventive anti-inflammatory purpose, tests were conducted to determine the true characteristics and properties of the studied pastes. Periodontal indices PMA and PI were used to study the anti-inflammatory effect of toothpastes. The most pronounced anti-inflammatory effect was revealed in the samples, the active components of which were oat extract, thymol, anise and essential oils of tea tree, as well as eucalyptus. Proper selection of means of individual oral hygiene and the development of «Individual hygienic program of prevention of chronic generalized periodontitis in older and elderly people» can reduce the phenomenon of inflammation in the periodontium, the development of mediators of inflammation and improve dental health of older and elderly people.

Effect of periodontitis on bone mineral density in postmenopausal women: A non-randomized interventional study

OBJECTIVE

Chronic periodontitis (CP) is associated with increased systemic inflammation and osteoporosis. Pro-inflammatory cytokines, implicated in systemic bone loss, are also associated with periodontitis. The impact of control of systemic inflammation by scaling and root planing (SRP) on bone mineral density (BMD) in postmenopausal (PM) osteopenic women with CP was investigated in this study.

METHOD AND MATERIALS

Sixty-eight PM osteopenic women with CP were included. The test group (n = 34) received SRP along with calcium (500 mg) and vitamin D (250 IU) supplementation twice a day for 6 months, while the control group (n = 34) received calcium (500 mg) and vitamin D (250 IU) supplementation twice a day for 6 months. BMD, serum high sensitivity C-reactive protein (hsCRP), and periodontal parameters were recorded at baseline and 6 months.

RESULTS

Improvement in BMD and serum hsCRP showed a statistically significant difference between groups at 6 months (P < .001). Binomial logistic regression analysis revealed that the test group was 4.82 (ORadjusted = 4.82; 95% CI = 1.17-19.71; P = .029) times more likely to exhibit normal BMD at 6 months. The results suggest there is an association of control of systemic inflammation by SRP with improved BMD in PM osteopenic women with generalized severe CP.

Daily Intake of Heat-killed Lactobacillus plantarum L-137 Decreases the Probing Depth in Patients Undergoing Supportive Periodontal Therapy

PURPOSE

Heat-killed Lactobacillus plantarum L-137 (HK L-137) has been shown to activate innate and acquired immunity in humans. The aim of this randomised, double-blind, placebo-controlled clinical trial was to examine the effects of the oral administration of HK L-137 on the outcome of periodontal therapy.

MATERIALS AND METHODS

Thirty-nine patients undergoing supportive periodontal therapy (SPT) were randomly assigned to receive a capsule containing 10 mg of HK L-137 or a placebo capsule daily for 12 weeks. Nineteen patients in the experimental group and 17 patients in the control group were followed-up. Clinical parameters, including plaque index (PI), gingival index (GI), bleeding on probing (BOP), and probing depth (PD) were scored at baseline and weeks 4, 8 and 12 prior to prophylaxis in conjunction with regular SPT visits.

RESULTS

BOP and the number of teeth or sites with PD ≥ 4 mm were significantly reduced in both groups by a successive SPT programme, while there was significantly greater PD reduction (p < 0.05) at teeth with site(s) with PD ≥ 4 mm at baseline in the experimental group than in the control group at week 12.

CONCLUSION

These clinical findings suggest that daily HK L-137 intake can decrease the depth of periodontal pockets in patients undergoing supportive periodontal therapy.

Successful treatment of generalized refractory chronic periodontitis through discontinuation of waxed or coated dental floss use: A report of 4 cases

BACKGROUND AND OVERVIEW

Generalized refractory chronic periodontitis is a periodontal condition that is resistant to conventional therapy. Management of this condition often is frustrating to both the patient and the clinician.

CASE DESCRIPTIONS

The authors present 4 cases of generalized refractory chronic periodontitis characterized by an inflammatory gingival response and progressive bone loss that did not respond to extensive periodontal treatments and regular periodontal care. Histologic examination of affected gingival tissue revealed an abundance of plasma cells, a feature seen in certain oral contact hypersensitivity reactions. The authors suspected that waxed or coated dental floss was the offending contactant, and its removal from the patients' oral hygiene regimens resulted in a dramatic improvement of the periodontal characteristics.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

In cases of periodontal disease as described in this report, dental practitioners should consider the possibility of a contact hypersensitivity reaction to waxed or coated dental floss, whereby the floss exacerbates the condition instead of assisting in its resolution.

Lip buccal mucosa traumatic overgrowth due to sucking habit - a 10-year follow-up of a non-surgical approach: a combination of behavioural and myofunctional therapy

OBJECTIVE

Traumatic lesion of the lip buccal mucosa may develop due to a repetitive lip sucking habit, secondary to a dental space which opened in the dental in adult patients. The non surgical treatment approach is based on increasing of patient's awareness to the sucking habit along with the creation of a change in the oral and dental surrounding tissues. The following case included a failure to identify a traumatic habit of lower lip sucking, resulting in a buccal mucosa overgrowth. Combined conservative periodontal and orthodontic approach will be presented to address this clinical issue without any need for surgical intervention.

MATERIAL AND METHODS

56 year old female patient presented with a complaint of unaesthetic appearance of the intraoral right buccal mucosa of the lower lip at rest position due to an intensive repetitive sucking habit of the right lower lip segment. We initiated a non surgical treatment approach including increasing the patient's awareness to the sucking habit, controlling the periodontal disease and orthodontic treatment to align and level the dental arch and to close the residual space.

RESULT

The soft tissue overgrowth on the lip buccal mucosa almost completely subsided spontaneously as a result of conservative dental and behavioral management without the need for any oral surgery intervention. A 10 years follow-up revealed no repetitive oral mucosa overgrowth, no spaces reopening and no sucking habit redevelopment.

CONCLUSION

Implementation of a morphological correction will assist the patient in breaking the habit and creating an environment that may effectively prevent the reoccurrence of the habit.

Programme guidelines for promoting good oral health for children in Nigeria: a position paper

BACKGROUND

The objective of this paper is to draw attention to the oral health needs of children in Nigeria, and promote the use of appropriate interventions for disease prevention in the population. It also evaluates the value of the ongoing twice-daily tooth brushing campaign, which focuses on promoting good periodontal health and its relevance for children in Nigeria.

DISCUSSION

The main oral health burden for children in Nigeria is untreated dental caries, attributable to low utilization of oral health facilities. While there is a strong association between oral hygiene status and caries occurrence, no research had established an association between frequency of tooth brushing and caries in children in Nigeria. Prevalence of caries and gingivitis is low, despite the fact that a majority of children brush once a day and most of them have fair oral hygiene. Campaigns that promote twice daily brushing to prevent chronic periodontitis in children are not driven by evidences supporting the local epidemic, and therefore cannot be considered as efficient use of the limited resources available.

SUMMARY

Existing evidences show that the main oral health need of children in Nigeria is the management of untreated caries. Promoting the treatment of caries should be the primary focus of oral health programmes for children in Nigeria, as this would reduce further risks of developing new carious lesions. Public health campaigns should focus efforts at creating demand for oral health care services, for both preventive and curative purposes.

The significance of motivation in periodontal treatment: the influence of adult patients' motivation on the clinical periodontal status

Motivation plays an important role in the treatment process of chronic diseases, as treatment requires behavioural change and lifelong adherence to medical recommendations. Periodontitis is a good example of such health condition as to maintain good periodontal health patients have to adhere to a strict oral hygiene regimen.

OBJECTIVE

To examine whether the motivation of patients suffering from chronic periodontitis influences their clinical periodontal condition.

BASIC RESEARCH DESIGN

Cross sectional study.

CLINICAL SETTING

Department of Periodontology and Oral Medicine, Dental University Clinic, Jagiellonian University, Krakow, Poland.

PARTICIPANTS

199 adult periodontal patients, aged 20-78 years.

INTERVENTIONS

Questionnaire concerning patients' medical and dental history, modified Zychlińscy motivation assessment questionnaire, clinical periodontal examination.

MAIN OUTCOME MEASURES

The extent of motivation. Periodontal status evaluated with the use of periodontal indices (API, BOP, CPITN).

RESULTS

The mean motivation score was 57.4. The mean API and BOP values were 55.7% and 46.4%, respectively. For most of the patients the recorded CPITN value was 3. Correlations were observed between motivation and both API and BOP, and between API and BOP.

CONCLUSION

Periodontal patients with greater motivation having better oral health (lower API and BOP) suggests an influence on the quality of their self-management of the disease (i.e. adherence to their oral hygiene regimen).

Tooth loss assessment during periodontal maintenance in erratic versus complete compliance in a periodontal private practice in Shiraz, Iran: a 10-year retrospective study

BACKGROUND

Several studies have demonstrated the efficacy of periodontal maintenance (PM), but there are conflicting data regarding tooth loss following patient compliance.

METHOD

Seventy-two periodontal patients (52 women, 20 men), 86% of whom had been diagnosed with chronic moderate to severe periodontitis, were included in this retrospective study. Clinical variables such as tooth loss, bleeding on probing (BOP), plaque index and probing depth were collected from patients after 10 years of PM. The periodontal status of regular compliers (RCs) and erratic compliers (ECs) were compared in a private practice.

RESULTS

The statistical analysis showed that clinical variables were not significant between RCs and ECs except for BOP (p = 0.038). During PM, 24 teeth (a mean of 1.5 teeth per participant) were lost in the RC group, and 80 teeth (a mean of 1.43 teeth per participant) were lost in the EC group. Molars were the most frequently lost teeth and canines the least. In general, those patients with less BOP lost fewer teeth (p = 0.002) and attended more recall visits (p = 0.001).

CONCLUSIONS

In the present sample, RCs and ECs did not show significant differences in rates of tooth loss. However, a significant difference between RCs and ECs in regard to BOP was observed at the final examination (p = 0.038). There was also a strong relationship between BOP and recall visits: the patients with less BOP attended more recall visits (p = 0.001).

Supportive periodontal treatment and full-mouth ultrasonic debridement: a randomised controlled clinical trial

PURPOSE

To evaluate the effect of different maintenance recall intervals in patients with chronic periodontitis treated by full-mouth ultrasonic debridement.

MATERIALS AND METHODS

Twenty-eight patients participated in the study and were divided into two groups: group 1 (n = 14) underwent full-mouth ultrasonic debridement followed by monthly supportive periodontal therapy; group 2 (n = 14) underwent full-mouth ultrasonic debridement followed by supportive periodontal therapy delivered at 3-month intervals. Plaque index (PI), bleeding on probing (BOP), pocket probing depth (PD), gingival recession (GR) and clinical attachment level (CAL) were evaluated at baseline and after 3 and 6 months.

RESULTS

Subjects in group 1 had statistically significantly lower PI scores than did subjects in group 2 at six months. However, no differences in BOP, PPD, GR and CAL were observed between groups at any of the time points evaluated. Nonetheless, while full-mouth BOP and PPD scores progressively decreased over time in group 1, the same parameters were significantly reduced at 3 months in group 2, but remained stable thereafter. The proportion of moderate and deep pockets decreased progressively over time in the group of monthly recalls, while the proportion of moderate to deep sites decreased significantly in group 2 only at 3 months; no additional reductions were seen at 6 months.

CONCLUSION

Supportive periodontal therapy both at one- and three-month intervals promotes short-term stability of clinical improvements obtained after full-mouth ultrasonic debridement in patients with chronic periodontitis.

The impacts of adenotonsillar hypertrophy on periodontal health in children: a prospective controlled pilot study

OBJECTIVES

To evaluate the impacts of obstructive adenotonsillar disease on periodontal health and to assess the efficacy of adenotonsillectomy in the prevention of chronic periodontitis in children.

METHODS

This prospective and controlled clinical study was conducted between August 2012 and February 2013 with 35 pediatric patients who had permanent anterior dentition. The study group included twenty patients (n = 20) who had complaints of chronic mouth breathing and snoring and were diagnosed with obstructive adenotonsillar disease. These patients underwent adenoidectomy with or without tonsillectomy. We performed periodontal examinations to assess the periodontal health status in these children before and two months after surgery. The periodontal measures included plaque index (PI), pocket depth (PD) and gingival index scores (GI). Subsequently, these periodontal measures were compared with healthy control group who had no adenotonsillar disease (n = 15).

RESULTS

Among the study group six patients underwent adenoidectomy and 14 patients underwent adenoidectomy combined with either tonsillectomy or tonsillotomy. The preoperative PI, PD and GI scores of the study group were 1.27 ± 0.39, 1.34 ± 0.31 and 0.97 ± 0.37 respectively. These scores were significantly higher compared to the control group (p < 0.001). These periodontal index scores were significantly improved after surgery (p = 0.008 for PI and p < 0.001 for both PD and GI). In addition, we found no difference in postoperative values of PD and GI between the study group and control group.

CONCLUSION

We concluded that obstructive adenotonsillar disease adversely affects periodontal health in children and surgical management of obstruction improves the clinical findings. However, more comprehensive research is required to elucidate the association between adenotonsillar hypertrophy and periodontal disease.

[Comparative analysis of the relationship between of chronic periodontitis patients' compliance and clinical efficacy]

OBJECTIVE

To evaluate the effect of patients' compliance on clinical parameters in patients with chronic periodontitis during periodontal maintenance therapy period.

METHODS

Chronic periodontitis patients who had completed non-surgical periodontal basic treatment were incorporated into the periodontal maintenance therapy(PMT). Clinical examination was performed in the baseline and each quarterly recall, over 3-year period. Clinical parameters including number of teeth, probing depth(PD), attachment loss(AL) level and bleeding on probing(BOP), were recorded. According to the number of PMT visit, the patients were classified into three groups:regular complier(RC); erratic complier(EC); non-complier(NC). The final parameters(three years later) were obtained by outpatient follow-up and telephone interviews. The data were calculated for the pecentage of sites with PD 4-5 mm, PD ≥ 6 mm, AL 4-5 mm, AL ≥ 6 mm, BOP, and the number of tooth loss per patient and the rates of progression of periodontitis.Statistical analyses including ANOVA test and Chi-square test were performed by SPSS 16.0 software package.

RESULTS

The percentage of clinical parameters in RC [AL 4-5 mm :(14.8 ± 5.0)%, AL ≥ 6 mm: (9.3 ± 3.1)%, BOP: (22.8 ± 4.2)%] were significantly decreased compared with that at baseline [AL 4-5 mm:(19.0 ± 6.0)%, AL ≥ 6 mm: (10.6 ± 3.1)%, BOP:(30.3 ± 5.6)%] (P < 0.01). There was significant difference between RC and NC [AL 4-5mm:(43.3 ± 1.3)%, AL ≥ 6 mm:(31.3 ± 1.7)%, BOP (91.5 ± 5.4)%] (P < 0.01), and between RC and EC[AL 4-5 mm: (18.9 ± 6.7)%, AL ≥ 6 mm: (12.6 ± 5.4)%, BOP:(38.4 ± 5.2)%] (P < 0.05). The progression rate of periodontitis [19.1% (4/21) at subject level, 0.7% (434/61 362) at site level] and tooth loss (1.0) was significantly lower in RC compared with EC and NC patients.

CONCLUSIONS

Regular periodontal maintenance enables the patients with chronic periodontitis to maintain long-term efficacy.

Protective effect of oral Lactobacilli in pathogenesis of chronic periodontitis

The study aimed at evaluation of IL-17 and TNF-α levels and at analysis of oral lactobacilli in patients with chronic periodontitis (CP) in the context of their protective effect on a course of the disease. The study was conducted on 14 patients with moderate CP (group 1) and 14 patients with severe CP (group 2). Control group (group 3) included 15 individuals with gingivitis. Levels of IL-17 and TNF-α were estimated using an ELISA. Strains of Lactobacillus were isolated in Rogosa agar, H(2)O(2)-production was determined in TMB-Plus agar. In group 1, the mean content of IL-17 was 19.66±6.1 pg/ml, and that of TNF-α was 4.95±0.91 pg/ml, in group 2 IL-17 content was 34.7±6.65 pg/ml, and that of TNF-α was 6.94±0.78pg/ml, in group 3 content of IL-17 was 0.65±0.58pg/ml, content of TNF-α was 0.17±0.14pg/ml. Analysis of lactobacilli manifestation in the control group and in the group with moderate CP in most of the persons demonstrated presence of H(2)O(2)-producing Lactobacillus, while in the group with severe CP presence of Lactobacillus was demonstrated in only 5 patients.

CONCLUSIONS

development of CP is linked to persistent excessive cytokine response of Th17 cells, the intensity of which may affect clinical course of the disease; in parallel, H(2)O(2)-producing oral lactobacilli may prevent against progression of CP, most probably reducing secretory activity of Th17 cells and restricting growth of periodontopathogens.

Education as a predictor of chronic periodontitis: a systematic review with meta-analysis population-based studies

BACKGROUND

The impact of socioeconomic inequalities on health is well-documented. Despite the links of periodontal disease with cardiovascular diseases, adverse pregnancy outcomes and diabetes, no meta-analysis of socioeconomic variations in periodontal disease exists. This meta-analytic review was conducted to determine the extent to which education attainment influences risk of periodontitis in adults aged 35+ years in the general population.

METHODS

The authors searched studies published until November 2010 using EMBASE and MEDLINE databases. References listed were then scrutinised, our own files were checked, and, finally, we contacted experts in the field. The authors included only general population-based studies conducted in adults aged 35 years and more. All articles were blind reviewed by two investigators. In the case of disagreement, a third investigator arbitrated. Using PRISMA statement, two reviewers independently extracted papers of interest.

RESULTS

Relative to the higher education group, people with low education attainment experience a greater risk of periodontitis (OR: 1.86 [1.66-2.10]; p<0.00001). The association was partially attenuated after adjustment for covariates (OR: 1.55 [1.30-1.86]; p<0.00001). Sensitivity analyses showed that methods used to assess periodontitis, definition of cases, study country and categorization of education are largely responsible for the heterogeneity between studies. No significant bias of publication was shown using both the Egger (p = 0.16) and rank correlation tests (p = 0.35).

CONCLUSIONS

In the studies reviewed, low educational attainment was associated with an increased risk of periodontitis. Although this evidence should be cautiously interpreted due to methodological problems in selected studies, efforts to eliminate educational inequalities in periodontitis should focus on early life interventions.

Effect of smoking on the results of a chlorhexidine digluconate treatment extended up to 3 months after scaling and root planing-a pilot study

The aim of the study was to evaluate the impact of smoking on a prolongated chlorhexidine digluconate regimen after scaling and root planing. Forty-two smokers (test group) and 85 nonsmoking patients (control group) with generalized chronic periodontitis were examined for clinical attachment level (CAL), probing depth (PD), bleeding on probing (BoP), and Plaque Index (Pl) at baseline and after 1 and 3 months. During scaling and root planing, a 0.2% chlorhexidine digluconate solution and a 1% chlorhexidine digluconate gel were used. The subjects used a 0.2% chlorhexidine digluconate solution twice daily for 3 months. The Mann-Whitney U and Wilcoxon tests were used for statistical analysis. There were significant improvements of all studied variables after 1 and 3 months in both groups. After 3 months, the mean improvement in the test group was 1.62 mm for CAL, 2.85 mm for PD, and 48% for BoP; in the control group, the values were 2.18 mm for CAL, 2.81 mm for PD, and 47% for BoP. Only the maximum changes of CAL between 1 and 3 months (test group, 0.32 mm vs 0.69 mm in the control group) and PD (test group, 0.47 mm vs 0.76 mm in the control group) were significantly different between the groups (P < .05 and P = .05, respectively). The present data appear to suggest that the use of chlorhexidine digluconate twice daily during a period of 3 months following nonsurgical periodontal therapy may result in significant clinical improvements in smokers and nonsmokers.

One-year effects of vitamin D and calcium supplementation on chronic periodontitis

BACKGROUND

A previous study reported by this group found that patients in periodontal maintenance programs taking vitamin D and calcium supplementation had a trend for better periodontal health compared to patients not taking supplementation. The objective of the present study is to determine, for the same cohort of subjects, whether such differences persist over a 1-year period.

METHODS

Fifty-one patients enrolled in maintenance programs from two dental clinics were recruited. Of these, 23 were taking vitamin D (≥400 IU/day) and calcium (≥1,000 mg/day) supplementation, and 28 were not. All subjects had at least two interproximal sites with ≥3 mm clinical attachment loss. For mandibular-posterior teeth, gingival index, plaque index, probing depth, attachment loss, bleeding on probing, calculus index, and furcation involvement were evaluated. Photostimulable-phosphor, posterior bitewing radiographs were taken to assess alveolar bone. Daily vitamin D and calcium intakes were estimated by nutritional analysis. Data were collected at baseline, 6 months, and 12 months.

RESULTS

Total daily calcium and vitamin D intakes were 1,769 mg (95% confidence interval, 1,606 to 1,933) and 1,049 IU (781 to 1,317) in the taker group, and 642 mg (505 to 779) and 156 IU (117 to 195) in the non-taker group, respectively (P <0.001 for both). Clinical parameters of periodontal health improved with time in both groups (P <0.001). When clinical measures were considered collectively, the differences between supplement takers and non-takers had the following P values: baseline (P = 0.061); 6 months (P = 0.049); and 12 months (P = 0.114). After adjusting for covariates, the P values for the effect of supplementation were as follows: baseline (P = 0.028); 6 months (P = 0.034); and 12 months (P = 0.058).

CONCLUSIONS

Calcium and vitamin D supplementation (≤1,000 IU/day) had a modest positive effect on periodontal health, and consistent dental care improved clinical parameters of periodontal disease regardless of such supplements. Our findings support the possibility that vitamin D may positively impact periodontal health and confirm the need for randomized clinical trials on the effects of vitamin D on periodontitis.

Full-Mouth Disinfection

Full-mouth disinfection is a relatively new technique for the management of patients, especially those with moderate to severe chronic periodontitis. In this paper, the technique is reviewed and efficacy evaluated. The methodology and possible outcomes are illustrated with a case report.

[Update on current care guidelines: prevention, early diagnosis and treatment of chronic periodontitis]

Periodontitis is common in the adult Finnish population. Due to the lack of pain and other symptoms, affected patients seldom seek dental care but require attention through the health care system. A careful periodontal screening, including risk assessment, should form part of regular dental check-ups. Individual brushing and interdental cleaning instructions, as well as tobacco counselling, are important in both the prevention and treatment of periodontitis. When detecting early signs of periodontitis, periodontal treatment, including the necessary maintenance visits, is crucial in preventing the severe form of the disease and its harmful consequences for the patient's dentition and general health.

[Artificial crowns influence upon edge parodontium status]

With the aim of prosthetic treatment efficacy increase study of edge parodontium tissue reaction upon different types of artificial crowns was done and methods of chronic localized parodontitis prevention were developed. Changes of the main gingival fluid characteristics (amount, acidity, interleukine-1beta concentration) and indicators of microcirculation in edge parodontium of the teeth under the artificial crowns influence were disclosed. There were developed methods of chronic localized parodontitis prevention produced by artificial crowns edge.

Cross-sectional study of vitamin D and calcium supplementation effects on chronic periodontitis

BACKGROUND

A low dietary intake of vitamin D and calcium hastens bone loss and osteoporosis. Because vitamin D metabolites may also alter the inflammatory response and have antimicrobial effects, we studied whether the use of vitamin D and calcium supplements affects periodontal disease status.

METHODS

A cohort of 51 subjects receiving periodontal maintenance therapy was recruited from two dental clinics; 23 were taking vitamin D (>or=400 IU/day) and calcium (>or=1,000 mg/day) supplementation, and 28 were not taking such supplementation. All subjects had at least two interproximal sites with >or=3 mm clinical attachment loss. Daily calcium and vitamin D intake (from food and supplements) were estimated by nutritional analysis. The following clinical parameters of periodontal disease were recorded for the mandibular posterior teeth: gingival index, probing depth, cemento-enamel junction-gingival margin distance (attachment loss), bleeding on probing, and furcation involvement. Posterior photostimulable-phosphor bitewing radiographs were taken to determine cemento-enamel junction-alveolar crest distances (alveolar crest height loss). Data were analyzed with a repeated-measures multivariate analysis of variance.

RESULTS

Compared to subjects who did not take vitamin D and calcium supplementation, supplement takers had shallower probing depths, fewer bleeding sites, lower gingival index values, fewer furcation involvements, less attachment loss, and less alveolar crest height loss. The repeated-measures analysis indicated that collectively these differences were borderline significant (P = 0.08).

CONCLUSIONS

In these subjects receiving periodontal maintenance therapy, there was a trend for better periodontal health with vitamin D and calcium supplementation. More expanded longitudinal studies are required to determine the potential of this relationship.

Systematic cognitive behavioral approach for oral hygiene instruction: a short-term study

OBJECTIVE

Determine whether a six-step behavioral cognitive method is more effective than traditional oral hygiene instruction.

METHODS

Thirty-eight patients with chronic periodontitis were randomly assigned to two groups. The control group was given traditional oral hygiene instruction for 20 min. The intervention group received counseling by Farquhar's six-step method for 10 min after traditional oral hygiene instruction. In both groups, oral hygiene instruction was given once a week, and performed three times in total for 3 weeks. Clinical characteristics, deposition of dental plaque, frequency and duration of brushing, frequency of interdental cleaning and scores based on scale of "self-efficacy for brushing of the teeth" were compared in both groups.

RESULTS

There were no differences between the two groups in clinical, demographic, behavioral and self-efficacy characteristics at the baseline examination. However after the third visit, the intervention group had a significantly higher self-efficacy, lower plaque index, longer brushing duration and higher frequency of inter-dental cleaning than those of the control group. Multiple regression analysis showed significant association of toothbrushing duration with self-efficacy for brushing of the teeth (p<0.001).

CONCLUSION

The six-step method might be more effective for enhancing self-efficacy and behavioral change of oral hygiene than traditional oral hygiene instruction alone.

PRACTICE IMPLICATIONS

Dentists and dental hygienists can use the six-step method for effective oral hygiene instruction.

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

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

[Guidelines for maintenance care of chronic periodontitis in Belgium]

The importance of maintenance care for controlling periodontitis and preventing disease recurrence is well-documented. Supportive periodontal therapy is essentially based on periodontal risk assessment, oral hygiene reinforcement and professional cleaning. As most of the referred periodontal patients return to the general practitioner at some point, supportive periodontal therapy should be continued in general practice. This manuscript offers the clinician, in particular the general practitioner, a number of guidelines to organize maintenance care.

[Peri-implantitis]

Millions of partially or fully edentulous patients worldwide have been treated by means of dental implants ever since the description of the osseointegration process by PI Brånemark. Despite high success rates, different biological and mechanical complications do occur. Peri-implantitis is a chronical infection around dental implants with irreversible crestal bone loss. Like periodontitis, peri-implantitis is a multifactorial disease caused by pathogenic species in a sensitive host. Today treatment of peri-implantitis is highly unpredictable, hence regular follow-up and prevention seems warranted. As the number of patients rehabilitated with dental implants is growing, the incidence will certainly increase. Guidelines about diagnostics, prevention and treatment of peri-implantitis are mentioned in this article based on current scientific evidence.