Obesity Phenotypes and Dental Calculus in Young Adults: CHIEF Oral Health Study

AIM

The study aimed to examine the association of obesity phenotypes with dental calculus.

BACKGROUND

Obesity has been recognized as a risk factor for kidney and gallbladder stones formation and periodontitis.

OBJECTIVE

We have investigated the association between obesity, metabolic risk factors, and dental calculus, which is a sequela following periodontitis.

METHODS

This study included 5,281 military members, aged 19-45 years, without antihypertensive medications in Taiwan. Obesity was defined as body mass index ≥27.5 kg/m2, and metabolic syndrome (MetS) was defined according to the modified ATP III criteria. Supragingival calculus in any teeth, except for impacted teeth and the third molar, was the outcome of interest. Multiple linear regression analysis with adjustments for age, sex, toxic substance use, brushing teeth frequency, and blood leukocyte counts, was used to determine the association of obesity with dental calculus numbers. Multiple logistic regression analysis was used to assess the association between obesity with or without MetS and the presence of any dental calculus.

RESULTS

BMI was positively correlated to dental calculus numbers [β and confidence intervals (CI) = 0.023 (0.014, 0.032)]. Compared to the obesity(-)/MetS(-) group, there were dosedependent associations for the obesity(-)/MetS(+), obesity(+)/MetS(-), and obesity(+)/MetS(+) groups with the presence of any dental calculus [odds ratios (ORs): 1.08 (0.76, 1.53), 1.31 (1.08, 1.58), and 1.51 (1.20, 1.90), respectively]. Of the metabolic risk factors, abdominal obesity and hypertension were independently associated with dental calculus [ORs: 1.33 (1.13, 1.55) and 1.30 (1.11, 1.52), respectively].

CONCLUSION

This study suggests general obesity as an independent risk factor for dental calculus formation, and MetS, particularly the components of abdominal obesity, and hypertension may also increase the prevalence of dental calculus. Diet control and regular exercise might be preventive measures for the development of both obesity and dental calculus.

The periodontal pocket

Periodontal disease is synonymous with the presence of periodontal pockets, and very often the clinical success of periodontal therapy is based on periodontal pocket depth reduction. Therefore, in the fields of periodontology and implant dentistry, significant research effort has been placed on the etiopathogenesis, diagnosis and treatment of periodontal/peri-implant disease and as a consequence on pocket pathology. In this volume of Periodontology 2000, the in-depth reviews include topics ranging from preclinical models, anatomy and structure of tissues, and molecular and bacterial components, to treatments of pockets around teeth and implants. These reviews aim to provide the readers with current and future perspectives on the different areas of research into the periodontal pocket.

Effect of occlusal calculus utilized as a potential "biological sealant" in special needs patients with gastric feeding tubes: a qualitative in vitro contrast to pit and fissure sealant restorations

The aim of this case report and in vitro investigation was to evaluate the marginal microleakage of intact occlusal calculus of primary molars extracted from a special needs patient who received nutrition via a gastric feeding tube. An adolescent with a history of developmental disturbance presented for routine dental care in a hospital facility. Prophylaxis was performed, and 2 mandibular permanent molars were restored. Five primary molars were extracted due to mobility and delayed retention. Heavy deposits of intact calculus were present on the occlusal surfaces of the primary teeth. The extracted teeth were immersed in methylene blue dye solution, invested in acrylic resin, sectioned into blocks, and photographed at 20× and 40× magnification. Previously photographed calculus-free molars with pit and fissure sealants were reviewed and served as contrasting "restorations." The occlusal calculus on the primary teeth extracted from the patient absorbed the dye, while the comparison teeth containing pit and fissure sealants exhibited varying degrees of marginal dye penetration (microleakage). No marginal microleakage was noted in the calculus specimens, indicating that this substrate may serve as a "natural" occlusal surface sealant and that its removal from occlusal surfaces during routine oral prophylaxis may be unnecessary.

Dental Calculus Links Statistically to Angina Pectoris: 26-Year Observational Study

Objectives

Dental infections, such as periodontitis, associate with atherosclerosis and its complications. We studied a cohort followed-up since 1985 for incidence of angina pectoris with the hypothesis that calculus accumulation, proxy for poor oral hygiene, links to this symptom.

Methods

In our Swedish prospective cohort study of 1676 randomly selected subjects followed-up for 26 years. In 1985 all subjects underwent clinical oral examination and answered a questionnaire assessing background variables such as socio-economic status and pack-years of smoking. By using data from the Center of Epidemiology, Swedish National Board of Health and Welfare, Sweden we analyzed the association of oral health parameters with the prevalence of in-hospital verified angina pectoris classified according to the WHO International Classification of Diseases, using descriptive statistics and logistic regression analysis.

Results

Of the 1676 subjects, 51 (28 women/23 men) had been diagnosed with angina pectoris at a mean age of 59.8 ± 2.9 years. No difference was observed in age and gender between patients with angina pectoris and subjects without. Neither was there any difference in education level and smoking habits (in pack years), Gingival index and Plaque index between the groups. Angina pectoris patients had significantly more often their first maxillary molar tooth extracted (d. 16) than the other subjects (p = 0.02). Patients also showed significantly higher dental calculus index values than the subjects without angina pectoris (p = 0.01). Multiple regression analysis showed odds ratio 2.21 (95% confidence interval 1.17–4.17) in the association between high calculus index and angina pectoris (p = 0.015).

Conclusion

Our study hypothesis was confirmed by showing for the first time that high dental calculus score indeed associated with the incidence of angina pectoris in this cohort study.

Periodontal status and its association with self-reported hypertension in non-medical staff in a university teaching hospital in Nigeria

BACKGROUND

A growing body of evidence suggests a relationship between periodontal disease and non-communicable systemic diseases with rising prevalence in developing countries, Nigeria inclusive.

OBJECTIVES

To determine the periodontal status and its association with self-reported hypertension among non-medical staff in a university teaching hospital in Nigeria.

METHODS

A cross-sectional study was conducted among non-medical staff using self-administered questionnaires and periodontal clinical examination between July and August 2013. Multivariate analysis was explored to determine the independent variables associated with self-reported hypertension. P values < 0.05 were considered statistically significant.

RESULTS

A total of 276 subjects were enrolled into the study. Shallow pockets (CPI code 3) constituted the predominant periodontal disease (46.7%), calculus (CPI code 2) 46%, bleeding gingiva (CPI code 1) in 3.3% and deep pockets ≥ 6mm (CPI code 4) in 2.2%. Self-reported hypertension was the most prevalent self-reported medical condition (18.1%) and found to be associated with periodontitis, increasing age, lower education, and a positive family history of hypertension.

CONCLUSION

Periodontal disease was highly prevalent in this study. Self-reported hypertension was associated with periodontitis, older age, lower education and a positive family history. Periodic periodontal examination and regular blood pressure assessment for non-medical staff is recommended.

Halitosis as a product of hepatic disease

OBJECTIVES

This study evaluated halitosis in patients suffering from hepatic disease.

MATERIAL AND METHODS

Twenty-five patients (12 males and 13 females) aged between 16 and 73 years who had undergone treatment for liver disease were included in this study. Three halimeter recordings were performed to measure methyl mercarptan and hydrogen sulphite. Mean values were calculated and compared with normal values (75-120 ppb). The level of significance was set at P < .05. Results: Thirteen of the 25 subjects (52%) had normal Volatile Sulphur Compound (VSC) values (75-120 ppb). Twelve subjects (48%) recorded values ranging from 132 to 1112 ppb. There was no correlation between hepatic pathology and halitosis. Fifty-two percent of all subjects had poor oral hygiene, strongly correlated with high VSC values (P<0.05) whereas the remaining 48% with good hygiene had normal levels of VSC.

CONCLUSIONS

Within the limitations of this study, high values of VSC were not associated with the presence of hepatic disease.

Drug-induced gingival overgrowth: a case report

A variety of systemic drugs can lead to adverse effects in the oral environment. This article reports the case of a 61-year-old man who had a severe drug-induced gingival overgrowth (DIGO) caused by nifedipine. DIGO is relevant due to severe gingival enlargement, which causes disfigurement and blocks physiological and social functions such as mastication and speaking. Management of DIGO is always a challenge due to the patient's systemic condition. This article shows, step-by-step, how the treatment was executed and how the DIGO was reversed.

Periodontal conditions in patients with oral lichen planus: a pilot study

OBJECTIVE

To evaluate the periodontal status of patients with oral lichen planus and compare it with that of healthy controls. The association between periodontal condition and the extent of disease in oral lichen planus patients was also examined.

METHOD AND MATERIALS

A descriptive clinical study was made of the periodontal condition of 80 consecutive patients with clinically and histologically diagnosed oral lichen planus and 40 healthy controls. Measurements were made of the Gingival Index, Plaque Index, and Community Periodontal Index of Treatment Needs (CPITN).

RESULTS

Mean CPITN scores were significantly higher in oral lichen planus patients (2.8 ± 0.7) than in the healthy controls (1.1 ± 0.8) (P < .001).The patients with oral lichen planus showed no statistically significant difference in CPITN scores according to the extent of the lesions or their clinical form of presentation.

CONCLUSION

The periodontal condition of the oral lichen planus patients was significantly worse than in the control group.

Periodontal health and treatment needs among hospitalized chronic psychiatric patients in Istanbul, Turkey

OBJECTIVE

The aim of the study was to evaluate the periodontal health and treatment needs of chronically hospitalized psychiatric patients in Istanbul, Turkey.

METHOD

The subjects' periodontal health was recorded by the CPI (Community Periodontal Index) method.

RESULTS

Of the 330 patients examined, 179 (52.5%) were males and 151 (47.5%) females. The mean age of the patients was 49.2 +/- 11.7 years. The majority (61.8%) was diagnosed with schizophrenia and 30.6% diagnosed with mental retardation. The mean length of hospitalization was 16.0 +/- 10.9 years. Healthy periodontal tissues (CPI 0) were found in 8.8% of the subjects. Bleeding on probing (CPI 1) was recorded in 6.3%, and dental calculus (CPI 2) in 51.8% of the subjects. These were determined as the worst findings. Altogether, 33% of the subjects had deep periodontal pockets, 14.2% with at least one 4- to 5-mm pocket (CPI 3), and 18.8% with at least one 6-mm pocket (CPI 4). The stepwise logistic regression analysis, between the final CPI score and seven variables including age, gender, psychiatric diagnosis, length of hospitalization, degree of helplessness, tooth brushing habits and smoking, showed that irregular tooth brushing habits and male gender were significant contributors to having a final CPI score of 2 or more. The regression analysis also showed that tooth brushing habits remained as an explanatory variable in CPI 0 coded subjects; helplessness and psychiatric diagnosis (mental retardation) in CPI 2; tooth brushing habits and psychiatric diagnosis (schizophrenia) in CPI 3; and only helplessness in CPI 4.

CONCLUSION

The present study underlines a considerable need for prevention and treatment of periodontal disease among chronic psychiatric patients in Istanbul. Efforts need to be focused above all on raising this population's awareness of the importance of oral hygiene and on early diagnosis of periodontal problems.

Oral hygiene and periodontal treatment needs in children and adolescents with coeliac disease in Greece

AIM

To evaluate the factors that influence the oral hygiene and the periodontal treatment needs of children and adolescents with coeliac disease (CD) in Greece.

METHODS

The sample consisted of 35 children and adolescents, aged 4-18 years. The evaluation included consideration of the detailed medical history, the duration of CD and of gluten-free diet, the history of oral mucosal findings and a dental questionnaire that included information about oral hygiene habits, symptoms of periodontal disease and dental attendance. The clinical dental examination consisted of the simplified gingival index, the oral hygiene index and the periodontal screening and recording index.

STATISTICS

The chi square and logistic regression analysis were performed in order to determine the factors or parameters that had a statistically significant (p ≤ 0.05) impact on oral hygiene and periodontal treatment needs of children and adolescents with CD.

RESULTS

The periodontal treatment need of children and adolescents with CD were high and most of them needed treatment of gingivitis (60.01%) and only a few subjects had a healthy periodontium (34.29%). The periodontal treatment need index, the simplified gingival index and the hygiene index correlated statistically significantly with the presence of a coexisting disease, frequency of tooth brushing, bleeding upon brushing and oral malodor.

CONCLUSION

The periodontal treatment need of children and adolescents with CD correlated with factors that related to the presence of a second medical condition and to the personal oral hygiene habits. Additionally, the oral hygiene level and periodontal status of children with CD do not have any specific characteristics but they have similarities to the oral hygiene level and periodontal status of the children of the general population.

Relationship between overweight-obesity and periodontal disease in Mexico

The aim of this study was to examine the association between overweight-obesity and periodontal disease in subjects who attended the clinic of Periodontics, Faculty of Dentistry, San Luis de Potosi, México. This was cross-sectional study involving 88 subjects--60 without overweight-obesity and 28 with overweight-obesity. The following clinical parameters were evaluated: dental bacterial plaque, index of calculus, gingivitis, probing depth and periodontal disease index (PDI). When comparing the group of subjects with overweight-obesity to the control, there were statistically significant differences in the variables calculus (p = 0.0015), gingivitis (p = 0.0050) and periodontal disease (p = 0.0154). Regarding the logistic regression analysis, the dependent variable was subjects with and without overweight-obesity and the independent variables were sex, age and periodontal disease. We found statistically significant differences (p = 0.0162) with OR = 3.16 in periodontal disease. Periodontal disease showed statistically significant differences in the group of subjects with overweight-obesity. The oral health of subjects with overweight-obesity should be supervised and checked in order to prevent oral alterations.

Periodontal status and orthodontic treatment need of autistic children

AIM

To evaluate the periodontal status and orthodontic treatment need of autistic children and compare these findings to nonaffected, same-age individuals.

METHOD

The periodontal status and orthodontic treatment need were evaluated in 32 autistic and 48 nonautistic boys and girls age 8 years to 12 years (mean 9.7 ± 1.2 years and 9.9 ± 1.1 years, respectively). The periodontal status of all subjects was recorded using the Community Periodontal Index of Treatment Need (CPITN) with a slight modification. The orthodontic treatment need was determined using the Dental Aesthetic Index (DAI). Chi-square test and odds ratio were used for statistical analysis.

RESULTS

No significant sex differences were found in the autistic or nonautistic groups. The autistic children presented with a significantly poorer periodontal status than the nonautistic children (P<.05). No significant differences in terms of the various malocclusion categories were found between both groups (P>.05); however, children with autism showed missing teeth, spacing, diastemas, reverse overjets, open bites, and Class II molar relationship tendencies in a higher percentage than nonautistic individuals. In all, autistic children and nonautistic children frequently needed orthodontic treatment.

CONCLUSION

This study suggests that children with autism require special dental management to improve their oral hygiene as well as their dental esthetics. More care from parents, general dentists, and pedodontists/orthodontists should be provided routinely to autistic children.

Microbes, inflammation, scaling and root planing, and the periodontal condition

Biofilms are a complex community of microorganisms characterized by the excretion of an adhesive and protective extracellular matrix, microbe-to-microbe attachment, structural heterogeneity, genetic diversity, and complex community interactions. Bacteria growing in dental biofilms display an increased tolerance to antibiotics and antimicrobial agents, including those used in dentifrices and mouthrinses. The microbial challenge associated with the inflammatory periodontal diseases induces an immediate inflammatory and immune response in the host. The nature and magnitude of the response has an impact on the severity and rate of progression of the periodontal disease. It is this host inflammatory-immune response that ultimately leads to the clinical signs and symptoms of gingivitis and chronic periodontitis. The traditional treatment modality of scaling and root planing (SRP) remains the "gold standard" for the non-surgical management of chronic periodontitis. Even clinically successful treatment has a high probability of pocket reinfection. Re-infection of periodontal pockets results from residual biofilms, increased tolerance of microbes within a dense, mature biofilm to antibiotics, reservoirs of bacteria in calculus, and reservoirs of bacteria within the dentinal tubules of infected root surfaces. Thus, for maximum effect, a combination of scaling and root planing and locally delivered antimicrobials should be considered if non-surgical therapy is the treatment of choice.

Oral health in Brazilian patients with chronic renal disease

BACKGROUND

Poor oral health status may have an impact on the health status of patients with chronic renal failure.

AIM

To describe the oral health status of a group of Brazilian patients with chronic renal failure.

MATERIAL AND METHODS

Retrospective review of the medical records of patients with chronic renal failure, of whom 13 (4.5%) were in a predialysis stage, 158 (55%) were on hemodialysis, 23 (8.4%) were on peritoneal dialysis and 92 (32.1%) were transplanted. General oral health, presence of dental calculus, and halitosis were recorded. The number of decayed, missed and filled teeth was analyzed by means of DMF-T (Decayed, Missed and Filled Teeth) index.

RESULTS

The sample was composed of 152 men (53%) and 134 women (47%), aged 42+/-13 years. Oral health status was considered defective in most patients (83%). Eighty-seven percent had dental calculus and 55% had halitosis. Transplant patients reported significantly less halitosis (40.2%) than the rest of the groups. The DMF-T for the whole population was 20.6 and had a positive correlation with age.

CONCLUSIONS

This group of patients with chronic renal failure presented a poor oral health status. Dental treatment programs for these patients should be implemented to avoid the exposure to dental pathogens.

Caries, periodontal disease and tooth loss in patients with diabetes mellitus types 1 and 2

The aim of this work was to determine the frequency of caries, periodontal disease and tooth loss in patients affected by diabetes mellitus types 1 and 2. It was a cross-sectional study involving 175 subjects distributed in the following groups: (1) 35 patients with diabetes type 1 (glycosylated hemoglobin values from 6.5%-7%), (2) 35 patients with diabetes type 1 (values of glycosylated hemoglobin higher than 7%), (3) 35 subjects without diabetes mellitus type 1, (4) 35 patients with diabetes type 2 and (5) 35 subjects without diabetes mellitus type 2. The following clinical parameters were evaluated for all the subjects who participated in the study: frequency of caries, filled teeth, missing teeth, prosthetic restoration, bacterial dental plaque, calculus index, probing depth and attachment level. On comparing the groups of patients with diabetes type 1 to the control group, there were no statistically significant differences among any of the study variables. On comparing the group of patients with diabetes type 2 to the control group, there were statistically significant differences in the variables missing teeth (p=0.0134), calculus (p=0.0001), probing depth (p=0.0009) and attachment level (p=0.0093). The variable periodontal disease showed statistically significant dIfferences in the group of patients with diabetes type 2. Prevention, supervision and review of the oral health of patients with diabetes (types 1 and 2) are needed in order to prevent oral alterations.

Microbial-associated oral lichenoid reactions

OBJECTIVE

The objective of the present study was to compare a new type of symptomatic lichenoid reaction, specifically located on the mucosal side of the lips, and associated with microorganisms, with a matched group presenting with reticular oral lichen planus (OLP) of the buccal mucosa.

PATIENTS AND METHODS

The mean age for both groups was 66 years with a predominance of women (62%). The lichenoid reaction group (n = 25) presented with a reticular reaction pattern embracing various degrees of erythema. Patients presenting with OLP had similar lesions confined to the buccal mucosa but not on the mucosal side of the lips.

RESULTS

In both groups, 80% were on any type of medication. However, 56% of the patients with lichenoid reactions medicated with more than three drugs compared with 29% (P < 0.05) in the OLP group. The former group more often used medicaments prescribed for cardiovascular diseases (48%vs 25%). Twenty-two of the patients with lichenoid reactions were treated with chlorhexidine. In 80% of these patients (n = 18), the lesions improved or completely healed, indicating a microbial association.

CONCLUSION

Lichenoid reactions present on the mucosal side of the lips may be initiated by microbial plaque precipitated on the buccal surfaces of the anterior teeth.

A combination of alleles 2 of interleukin (IL)-1A(-889) and IL-1B(+3954) is associated with lower gingival bleeding tendency in plaque-induced gingivitis in young adults of Arabic heritage

The aim of this study was to investigate the possible association of a distinct combination of polymorphisms in the interleukin (IL)-1 gene cluster on gingival bleeding tendency in young adult Arabs with plaque-induced gingivitis. Fifty otherwise healthy, nonsmoking volunteers, 19-28 years of age, participated. Clinical examinations included periodontal probing depth, bleeding on probing, and plaque index. Probing was done with a pressure-controlled probe at about 1.27 MPa. Examinations were repeated after 2 and 4 weeks. Polymorphisms in the IL-1 gene cluster were assessed using a reverse hybridization assay. A subject carrying alleles 2 at IL-1A ( -889 ) and IL-1B ( +3954 ) was designated genotype-positive. Twenty-six subjects were genotype-positive (52%). A repeated measures two-level (occasion, subject) model of the proportion of sites bleeding on probing, which was adjusted for gender, average plaque index, probing depth, and calculus, revealed a significantly lower proportion of bleeding sites in genotype-positive subjects (estimate -0.050, standard error 0.025, p < 0.05). Biserial correlations of bleeding proportions were high (0.71-0.78), confirming the steady-state plaque environment. It was concluded that inflammatory responses to dental plaque were considerably dampened in genotype-positive, nonsmoking young adults of Arabic heritage.

Periodontitis and Gestational Diabetes Mellitus: Exploring the Link in NHANES III

OBJECTIVES

The authors hypothesized that women with a history of gestational diabetes mellitus (GDM) during pregnancy would exhibit more severe periodontal disease than controls without a history of diabetes during pregnancy.

METHODS

Data from NHANES Ill provided information for 4,244 women ages 20-59. One hundred and thirteen had a history of GDM (GDM+), while 4,131 had no history of diabetes before or during their pregnancies (GDM-). Women were further classified by the presence or absence of diabetes mellitus (DM+ or DM-) at the time of their NHANES Ill examination. Periodontal disease (PD) was defined as one or more teeth with one or more sites with probing depth > or = 4mm, loss of attachment > or = 2mm, and bleeding on probing.

RESULTS

The PD prevalence among women who were GDM+DM- was 9.0% and 4.8% for those who were GDM-DM-. PD prevalence for women who were GDM+DM+ was 30.5% and 11.6% for GDM-DM+ subjects, respectively. A logistic regression model, controlling for age, calculus, smoking, and income estimated women who were GDM+DM+ were more likely to have periodontal disease than women who were GDM-DM- and women who were GDM-DM+. The GDM+DM- group also tended to be more likely to have PD than the GDM-DM- and GDM-DM+ groups. However, the odds ratios were not statistically significant.

CONCLUSIONS

These results support the hypothesis that women with gestational diabetes mellitus (GDM) during pregnancy may be at greater risk for developing more severe periodontal disease than pregnant women without GDM.

Oral health status in individuals with dementia living in special facilities

AIM

The aim of this review was to retrieve data describing the oral health status of individuals with dementia living in special facilities.

MATERIALS AND METHODS

A literature search on the MEDLINE database (Entrez PubMed) was performed. The literature search yielded 208 papers, of which seven publications were selected for evaluation.

RESULTS

From the available studies poorer oral hygiene, decreased saliva flow rates and a higher caries incidence were reported in individuals with dementia living in special facilities when compared with healthy individuals. Oral health problems were more pronounced in the severe stage of the disease.

CONCLUSIONS

There is limited scientific data describing the oral health status of individuals with dementia living in special facilities. However, available data indicate that individuals with dementia living in special facilities have more oral health problems than individuals without dementia.

Oral malodor-related parameters in the Chinese general population

OBJECTIVES

To estimate the prevalence of halitosis in the Chinese population and to assess the relationships between halitosis and oral health, social and behavioural factors.

METHODS

The correlation between the incidence of oral malodor and oral health was surveyed in a sample of 2000 individuals (1000 males and 1000 females) aged 15-64 years residing in urban and rural areas. Malodor was measured with both organoleptic measurements and with a portable sulphide monitor. Assessment of oral health included decayed, missing and filled teeth (DMFT), periodontal status, dental plaque, and tongue coating. Behavioural and social factors related with oral health or halitosis were also investigated.

RESULTS

The prevalence of halitosis was 27.5% according to the organoleptic score. The level of volatile sulphur compounds (VSCs) in mouth air was significantly lower in males and in some of the age groups after lunch. Age and location of residence (rural or urban areas) did not influence the VSCs concentration in mouth air. The amount of tongue coating played the most important role in increasing VSCs concentration in mouth air, followed by periodontal status and plaque index values. DMFT, social, and behavioural factors did not contribute to halitosis.

CONCLUSIONS

Tongue coating score, modified sulcus bleeding index and calculus index were factors significantly related to oral malodor in this study.

Risk factors for periodontitis

This review presents a selected overview of the literature concerning risk factors for periodontitis. That in some individuals gingivitis develops into periodontitis is still a matter of extensive research. Cross-sectional studies of clinical and microbiological factors can be meaningful. Longitudinal studies of the natural history allow analysis of potential factors and conditions that may have an impact on the disease process. At present, several possible risk factors for the initiation and progression of periodontitis have been identified: age, gender, plaque, calculus, existing attachment loss. A consistent finding appears to be genetic predisposition for the development of the disease. In terms of microbiology, several micro-organisms have been identified. The results of the Java Project on natural development of Periodontal Disease clearly pinpoint Actinobacillus actinimycetemcomitans as being associated with the onset of disease. The presence of subgingival calculus was found to be associated with onset and dental plaque with progression of disease. Consistent with literature males are more susceptible to disease. The presence of pockets > or = 5 mm appear to be a useful tool, since it was found to be a prognostic factor for disease progression.

Diabetes and Periodontal Disease: A Case-Control Study

BACKGROUND

Periodontitis is often associated with diabetes and might be considered one of the chronic complications of diabetes mellitus, both in Type 1 (T1DM) and Type 2 (T2DM). This case-control study was designed to evaluate the possible association between non-insulin-dependent diabetes (T2DM) and clinical and microbiological periodontal disease among adult Sardinians.

METHODS

A total of 212 individuals participated in this study: 71 T2DM patients aged 61.0 +/- 11.0 years and 141 non-diabetic controls in good general health aged 59.1 +/- 9.2 years. All subjects were given a clinical periodontal examination for probing depth, attachment level, presence of calculus, bleeding on probing, and assessment of plaque. Subgingival plaque samples were obtained, and P. gingivalis, P. intermedia, and T. forsythensis were identified using multiplex polymerase chain reaction.

RESULTS

T2DM patients showed a significantly lower number of teeth present (P = 0.002); a significant increase in number of probing depths >4 mm, and percent of pocket depths >4 mm (P = 0.04 and P = 0.05, respectively); periodontitis (P = 0.046); bleeding on probing (P = 0.02); and plaque index (P = 0.01). A significant association with diabetes was detected for plaque (X2= 4.46; P <0.05) and bleeding on probing (X2= 3.60; P <0.05). Concerning bacteria prevalence, a positive association was detected for P. gingivalis (X2= 2.80; P <0.05) and T. forsythensis (X2= 3.87; P <0.05). Presence of plaque was positively associated with case status (odds ratio [OR] = 1.3; 95% confidence interval [CI]: 1.2, 3.6) and with prevalence of P. gingivalis and T. forsythensis (OR = 1.2, 95% CI: 1.3, 2.2; and 1.2, 95% CI: 1.2, 1.8, respectively).

CONCLUSION

Patients with T2DM undoubtedly have a susceptibility for more severe periodontal disease.

Rare and abnormal massive dental calculus deposit: an investigative report

An unprecedented case is presented involving a massive calculus buildup on the mandibular incisors. The clinical and radiographic findings were reviewed, probable causes were investigated, and results were outlined and discussed. The composition, origin, and formation of dental calculus and its interrelationship with dental plaque and saliva were highlighted. The role of dental calculus in the pathogenicity of periodontal diseases, in view of epidemiological data, research, and clinical study findings, is discussed. Both the case management and the benefit of total calculus removal for resolving periodontal disease are underlined.

Cross-sectional analysis of different variables of patients with non-insulin dependent diabetes and their periodontal status

The periodontal condition of 72 non-insulin dependent diabetes patients was compared with that of 92 nondiabetic individuals. Plaque Index (PII), Calculus Index (CI), Gingival Index (GI), and attachment loss (AL) were measured on four surfaces of six teeth in each subject. All four parameters were significantly higher in the diabetic group. No significant difference in the frequency of toothbrushing was found between the groups. For all age groups, GI and AL were higher in the diabetic group. In each group, GI was not changed with age, while AL increased with age. Classification of the groups based on PII showed that the diabetic group's GI was higher than the nondiabetic group for low, medium, or high PII values. The diabetic group showed higher AL for only the medium and high PII groups. Classification by CI revealed that the diabetic group's GI and AL were significantly higher than those of the nondiabetic group for subjects with low, medium, or high values of CI. Multiple regression analysis revealed that the main factor affecting GI was the presence or absence of diabetes. PII and CI both showed a significant relationship with GI; age was the second most significant factor. The most significant factors influencing AL were CI and the presence or absence of diabetes; age was the second most significant factor. Patients who had had diabetes for more than 10 years had a higher AL than those who had suffered from diabetes for less than 10 years. Patients with average HbA1c values > or = 10% had more serious mean GI values than those with HbA1c values < 10%. In patients with diabetes, age, plaque accumulation, and calculus formation have more detrimental effects on the periodontal apparatus than in healthy individuals.

Analysis of etiologic factors and periodontal conditions involved with 309 abfractions

OBJECTIVES

Non-carious cervical lesions (NCCL), also termed abfractions, have long been thought to be produced by excessive brushing. Nearly 20 years ago an occlusal etiology was proffered (Lee & Eagle 1984). Controversy still exists concerning these two concepts. The present work was carried out to verify the occurrence of signs of excessive brushing or occlusal disturbances associated with abfractions.

MATERIAL AND METHODS

All first consultants were screened for the presence of abfractions during one trimester. NCCL were found in 61 patients who consequently received a thorough examination searching for clinical evidence of excessive brushing or occlusal disturbances. The presence of plaque, calculus, periodontitis, or mobility was also noted. Simple frequency and percentage were used to describe the occurrence of different clinical signs in association with the presence of abfractions.

RESULTS

Abfractions often exist in mouths presenting plaque (40.1%), calculus (41.7%), or periodontitis (20.4%). Ulceration of the gingiva is a rare finding (1.6%). However, subgingival apical limits were frequent (32.5%). NCCL coexist almost systematically with occlusal wear facets (94.5%). Lack of canine disclusion (77.2%) was also closely associated with the presence of abfractions. Conversely, mobility was seldom found (1.9%).

CONCLUSIONS

Clinical signs of excessive brushing were lacking, whereas signs of occlusal disturbance were very consistent with the presence of abfractions.

The possibility of detecting subgingival calculus by laser-fluorescence in vitro

The aim of the present study was to investigate laser-fluorescence effects on the root surface. The possibility of detecting subgingival calculus should be evaluated to control complete calculus removal after scaling and root planing. Twenty freshly extracted human teeth, partially covered with calculus on the root surface, were fixed on a translation stage. The specimens were irradiated by light from a laser source (diode laser, <1 mW) with a wavelength of 655 nm using the Diagnodent trade mark -system. To simulate the conditions in a periodontal pocket during the measurement procedure, the teeth were covered by a layer of physiological saline solution or blood in order to determine the influence of different inflammatory fluids. The root surface was scanned on a line of about 1 cm in steps of 0.5 mm. The start and end was marked by a notch. The results of the laser-fluorescence detection were compared to clinical and histological findings. Clinically apparent calculus on the root surface was always accompanied with a statistically significant increase of laser-fluorescence values ( p < 0.05). These values were not influenced by the different fluids ( p < 0.05). The laser-fluorescence values were reproducible ( p > 0.05). After scaling, when no debris remained at the root surface, laser-fluorescence values decreased significantly ( p < 0.05). The histological findings supported the clinical results. In conclusion, the present study indicates that laser-fluorescence values on the root surface are strongly correlated to the presence of calculus. This fluorescence effect can basically be used to develop a new detecting system for subgingival calculus in periodontal pockets.

Oral hygiene, gingivitis, and periodontitis in persons with Down syndrome

This study was conducted to determine and compare the prevalence, severity, and extent of gingivitis and periodontitis in patients with Down syndrome and patients who did not have Down syndrome. The authors also assessed the relationship of these conditions and compared them to the age, gender, and oral hygiene profiles in both groups. Using a case-control study design, the authors examined 32 individuals with Down syndrome (DS) and matched each with a participant from the control group (CG) according to age and gender. Researchers determined the Simplified Oral Hygiene Index, Gingival Index, and measured the level of gingival attachment for each participant. The authors found that the relationship between the presence of dental plaque and the severity of gingivitis was moderate among participants with DS. While the overall characteristics of the periodontal and gingival health status were not markedly different between the two groups, the extent and severity of gingivitis and the extent of periodontitis were greater in the group with DS than in the CG.

The relationship between periodontal disease attributes and Helicobacter pylori infection among adults in the United States

OBJECTIVES

We investigated the relationship between Helicobacter pylori infection and abnormal periodontal conditions.

METHODS

Data from the first phase of the third National Health and Nutrition Examination Survey were used. A total of 4504 participants aged 20 to 59 years who completed a periodontal examination and tested positive for H. pylori antibodies were examined.

RESULTS

Periodontal pockets with a depth of 5 mm or more were associated with increased odds of H. pylori seropositivity (odds ratio [OR] = 1.47; 95% confidence interval [CI] = 1.12, 1.94) after adjustment for sociodemographic factors. This association is comparable to the independent effects of poverty on H. pylori (OR = 1.54; 95% CI = 1.10, 2.16).

CONCLUSIONS

Poor periodontal health, characterized by advanced periodontal pockets, may be associated with H. pylori infection in adults, independent of poverty status.

Dental findings in 4-, 14-, and 25-to 35-year-old Hong Kong residents with mental and physical disabilities

This study was designed to collect baseline data on dental status of 4-, 14- and 25- to 35-year-old Hong Kong residents who were mentally impaired and physically disabled. Participants were randomly selected from figures derived from a pilot survey, and dentally examined. The mean dmft/DMFT scores were 1.25, 2.27, and 5.23 (Missing component of 3.02), respectively. There was no correlation between caries experience and physical mobility, mental impairment, or sex in any age group. No visible plaque was found in 85.1% of 4 year olds (n = 309), 52.3% 14 year olds (n = 174), and 36.2% 25 to 35 year olds (n = 264). Visible plaque was recorded for 13.6% 4 year olds, 30.5% 14 year olds, and 47% 25 to 35 year olds. Abundant plaque was detected in 1.4% 4 year olds, 17.2% 14 year olds, and 15.8% 25 to 35 year olds. No calculus was observed in the 4 year olds, but 20.2% of 14 year olds had calculus as did 56.3% of the 25 to 35 year olds.

The extent and correlates of gingival recession in non-institutionalised Thai elderly

The purpose of this study was to describe the extent and distribution of gingival recession in Thai elderly. As part of a longitudinal geriatric oral health study, 453 community-dwelling dentate subjects, 51-92 years of age, were examined at baseline in 1999. All remaining teeth were measured on four periodontal sites to assess the amount of gingival recession. The percentage of sites with recession increased with age from 49.6% in 51-59 years of age to 72.0% in 70+ years of age (P < 0.001). Males exhibited greater levels of recession than females (P < 0.001). Regression analysis for the percentage of buccal sites with recession showed that recession was associated with age, gender, cervical abrasion, and amount of calculus (R2 = 0.15, P < 0.001). However, the regression model for the percentage of all sites with recession did not find an association between recession and cervical abrasion. Hence, it appears that gingival recession on different locations may involve different processes.

Oral health in the elderly with non-insulin-dependent diabetes mellitus

Non-insulin-dependent diabetes mellitus (NIDDM) is a common endocrine disease affecting the elderly in particular. Long-term complications involve the vasculature; vision, renal, and neural function; and the periodontium. Knowledge about the oral health of the elderly and the effects of NIDDM is limited. The objective of this study was to compare the oral health of patients aged 60+ years, who have NIDDM, with patients who do not have NIDDM. To evaluate oral health, we recorded retention and condition of the teeth, periodontal health, and condition of the oral mucosa. We also assessed oral hygiene, smoking history, regularity of dental checkups, and medication use. The study group was selected from among patients who came to the ambulatory care clinic at University of Medicine and Dentistry, New Jersey, Center for Aging with a diagnosis of NIDDM. The control group, which did not have NIDDM, was selected from among the same patient group and was matched for age and gender. Patients with severe dementia, those having fewer than 10 teeth or those who were in need of antibiotic prophylaxis were excluded from the study. Patients underwent a short interview and a clinical evaluation. Our study involved 32 elderly adults with NIDDM and 40 elderly adults who did not have NIDDM. Both groups had similar oral hygiene levels and regularity of professional dental care. In addition, the plasma glucose levels among the study group were well controlled. This study did not show statistically significant differences in oral health parameters between participants with diabetes and those in a control group.

Relationship of clinical depression to periodontal treatment outcome

BACKGROUND

Depression has been associated with periodontal disease; however, its relationship to periodontal treatment outcome (PTO) has not been investigated.

METHODS

Data were obtained by chart abstraction and computer databases on 1,299 health maintenance organization (HMO) patients aged 30 to 64 who had concurrent medical, dental, and pharmacy benefits, and who had an initial periodontal examination during 1996, 1997, or 1998. Depression (yes/no) was the main independent variable and was determined by presence of any diagnosis code for depression on the patient record. PTO was determined by the difference in percent of sites with probing depth (PD) > or = 5 mm between the initial and 1-year post-treatment periodontal exams. Sub-median periodontal treatment outcome (SMPTO) was defined as a reduction in fewer than the median percent of sites (7.33%) with PD > or = 5 mm. Information on sociodemographics, periodontal therapy, calculus and plaque, number of remaining teeth, smoking, antidepressant medications, and diabetes were collected.

RESULTS

A total of 697 patients had a periodontal exam at both baseline and follow-up. Of these, 12.2% had depression. In a multivariable logistic model, depression (odds ratio [OR] 2.16, 95% confidence interval [Cl] 1.12 to 4.16) and 4-month recall treatment (OR 2.34, Cl 1.46 to 3.75) were associated with SMPTO, while percent of sites at baseline with PD > or = 5 mm (OR 0.93, Cl 0.91 to 0.94), number of remaining teeth at baseline (OR 0.94, Cl 0.89 to 0.99), and number of teeth lost during the study period (OR 0.75, Cl 0.58 to 0.96) were negatively associated. Periodontal surgery, age, gender, smoking, plaque, calculus, diabetes, and antidepressant medication were not significant in the model.

CONCLUSION

Clinical depression may have a negative effect on periodontal treatment outcome in this group model HMO population.

Pathologic migration--spontaneous correction following periodontal therapy: a case report

Periodontal disease is often associated with pathologic migration, which becomes an esthetic concern. A 17-year-old girl developed increasing gaps among her maxillary incisors. She had gingival enlargement in the palatal maxillary anterior region. The central incisors had pathologically migrated, resulting in a 2-mm diastema. Periodontal treatment was planned and completed. Following periodontal treatment, there was "spontaneous" repositioning of the central incisors. The 6-month follow-up revealed no change or deterioration of the periodontal condition. The patient was referred for orthodontic closure of the remaining diastema between the central and lateral incisors.

Oral self-care and periodontal health indicators among adults with diabetes in Finland

We assessed the effects of oral self-care on periodontal health indicators among adults with diabetes. The sample consisted of 120 dentate individuals, all of whom were regular patients at the Salo Regional Hospital Diabetes Clinic in southwest Finland. Clinical periodontal examination included identification of visible plaque, the presence of calculus, and use of the Community Periodontal Index of Treatment Needs (CPITN). A questionnaire focused on self-treatment, self-prevention, and self-diagnosis of oral diseases, utilization of dental services, and patients' knowledge and attitudes towards oral health. The New Century model of oral health promotion was used as a theoretical framework for analysis of determinants of oral self-care. Although individuals aged 40 years or older were more frequent interdental cleaners, significantly better oral health indicators were found among younger patients. Women reported brushing their teeth more frequently, and differences in plaque and calculus indices were significantly lower than those of men. Self-reported good oral condition was strongly associated with frequent dental visits and less plaque and calculus. No missing teeth and age less than 40 years were predictors of lower plaque, calculus, and CPITN scores. A significant association was found only between frequent dental visits and reduced amount of calculus. Self-reported frequency of oral health habits among adults with diabetes seemed to have little effect on periodontal health indicators. Adults with diabetes should benefit from comprehensive oral self-care, and more attention is needed for improving the quality and outcome of these habits.

Bleeding on probing in smokers and non-smokers in a steady state plaque environment

An altered gingival inflammatory response to supragingival plaque in smokers had been claimed by several authors. Relatively limited information exists with regard to the consistency of naturally occurring plaque and bleeding upon probing within the oral cavity under usual oral hygiene measures. The aims of the present study were to describe the distribution of tooth surfaces covered by supragingival plaque and gingival units bleeding upon probing in a steady state environment of no dental intervention. In addition relative consistency of plaque and bleeding was investigated. 65 volunteers, 14 women and 51 men in the age range of 19 to 30 years, participated. 33 volunteers were heavy smokers and 32 non-smokers. Clinical examinations revealed mild, plaque-induced gingivitis with no overt destructive periodontitis. Within a 6-month period. presence and amount of plaque, calculus and gingival bleeding was site-specifically assessed four times, i.e., every 8 weeks. Well-defined, symmetric and consistent patterns of plaque and calculus distribution within the oral cavity were observed, which were rather identical in smokers and non-smokers. Smokers had evenly more plaque in all regions of the oral cavity. In contrast, there was no obvious pattern of bleeding upon probing. Consistency of observations was considerably lower than for plaque scores. This was particularly true for smokers, where the association between bleeding scores was generally smaller than in non-smokers. A large portion of the variation of gingival bleeding may be due to presently unknown factors other than plaque and calculus with considerable consequences for preventive programmes.

The natural history of periodontal disease in man. Risk factors for progression of attachment loss in individuals receiving no oral health care

BACKGROUND

Few investigations have reported on risk factors for periodontal attachment loss over time in subjects with no home or professional dental care. The purpose of this report was to identify potential risk factors for progression of periodontal attachment loss among male Sri Lankan tea laborers who participated in a 20-year investigation of the natural history of periodontal disease.

METHODS

Data for this report were obtained from the 154 subjects who participated in the 1970 baseline and the final 1990 examinations and included data from their interim examinations performed in 1971, 1973, 1977, 1982, and 1985. Oral health assessments included: 1) attachment levels in millimeters on mesial and mesio-buccal surfaces of all but third molar teeth; 2) plaque index (PI); 3) gingival index (GI); 4) calculus index (CI); 5) caries index (DMFS); and 6) presence or absence of teeth. Other variables included age, history of smoking, and/or use of betel nut. Statistical analyses used multivariate repeated measures analysis of variance (ANOVA).

RESULTS

The final adjusted model indicated that attachment loss increased significantly with age (X2 = 74.0; df = 1), GI (X2 = 45.5; df = 1), CI (X2 = 52.7; df = 1) and follow-up time (X2 = 219.8; df = 6, P<0.0001 for all variables).

CONCLUSIONS

Age, GI, CI, and time were significantly associated with mean attachment loss over 20 years. Neither PI, history of smoking, or history of betel nut use were significantly associated with attachment loss over time.

Oral health status of heroin users in a rehabilitation centre in Hubei province, China

OBJECTIVE

To report on the oral health of heroin users and to determine risk factors for oral health status.

DESIGN

All heroin users at one rehabilitation camp received an interview using a pre-tested questionnaire from one of three trained interviewers and a dental examination using World Health Organization recommended procedures from one of three calibrated dentists.

SETTING

Interviews and examinations were carried out at Hubei Province camp.

PARTICIPANTS

All 520 resident heroin users at the camp participated in the study.

OUTCOME MEASURES

Oral hygiene expressed using the Debris Index; caries status by DMFT; periodontal status by percentage with bleeding, pocketing and calculus; mucosal status using standard World Health Organization criteria.

RESULTS

One hundred (19%) of the heroin users were caries free; their mean DMFT was 4.2. The majority (92%) of the DMFT was decay and only a small proportion (8%) was treatment related. The proportion of heroin users with bleeding, calculus, shallow pocketing and deep pocketing was 42%, 95%, 42% and 8% respectively. The mean Debris Index score was 3.2. Mucosal lesions were present in 31 subjects (6%). Using multivariate analysis, duration of heroin use and education were risk factors for DMFT, route of drug administration was a risk factor for calculus and gender was a risk factor for deep pocketing.

CONCLUSIONS

There are indications of poorer periodontal health as well as higher caries experience in this group when compared to provincial dental epidemiological data. Mucosal lesions were not widely prevalent. Both social factors and characteristics of drug use were related to oral health in this group.

Peripheral giant cell granuloma: a case report

The peripheral giant cell granuloma is a reactive lesion of the soft tissue of the oral cavity. Clinical appearance ranges from normal tissue coloration to dark red or purplish. These are elevated lesions generally 5-15 mm in diameter. Etiology is considered to be chronic irritation. To decrease the risk of clinical recurrence, treatment is complete excision to include the underlying periosteum. Histologic features of the peripheral giant cell granuloma include multinucleated giant cells with a stroma that may contain osteoblasts, myofibroblasts, macrophages, and Langerhans cells. A case report is presented.

Periodontal diseases in children and adolescents

The predominant form of periodontal disease in children and adolescents is gingivitis, which is a nonspecific inflammatory reaction of the marginal gingiva. The inflammatory reaction in the tissue, initiated by dental plaque accumulation, starts early during infancy and reflects the bacterial challenge to the host. In most children, the process of gingival inflammation remains superficial. In some cases, however, the balance between the microbial challenge and the host response is disrupted, leading to an inflammatory process that may result in loss of attachment. Genetic factors that modify the host response to the bacterial challenge are major determinants of susceptibility to the development of EOP, and many systemic diseases have been reported to predispose children and adolescents to periodontal disease. It is important to take a complete medical history of the patient and assess if there is a hereditary trend for periodontitis within the family. Dental professionals should rely on clinical and radiographic criteria of the disease for early identification of children at risk, with special focus on the presence of subgingival calculus. Children with overt gingival inflammation, subgingival calculus, or early signs of alveolar bone loss should be considered as periodontitis-risk patients and should be included in a preventive program as early as possible.

[Periodontal infection in pregnant women and low birth weight babies]

Among several factors in preterm low birth weight, we can find pre-conceptional causes and others depending on pregnant women's behaviour. In 1996 a scientific team composed by periodontists, gynaecologists and epidemiologists found that 18% of preterm low birth weight in 250,000 babies are due to periodontal infection. In our survey we used 113 pregnant women in gynaecological clinic in university hospital. By using Community Periodontal Index Treatment Needs (CPITN) in pregnant woman and by weighting babies as soon as accouchement done. In spite of percentage of preterm low birth weight, we registered 33.9% babies of normal birth weight with mother's CPITN under 1.

An unusual case of a relationship between rosacea and dental foci

Rosacea is a chronic disorder affecting the facial convexities, characterized by frequent flushing, persistent erythema, and telangiectases. During episodes of inflammation, additional features are swelling, papules, and pustules. The exact etiology of this dermatitis is unknown, and theories abound. Infectious foci, especially dental foci, seem to be rarely associated with the onset and progression of this disease. Dermatologic treatments are determined by the severity of the disease. But eradication of infectious foci, and in this case eradication of dental foci, may generate a significant improvement and may lead to a recovery.

Shifting paradigms in periodontal disease. Implications for prevention in the elderly

Our understanding of periodontal diseases has evolved considerably. No longer are the notions of universal susceptibility to plaque and calculus with automatic reliance on mechanical debridement valid. The interplay between specific bacteria and the immune response within a complex context of risk factors forms the new paradigm of periodontal disease pathogenesis. New approaches to treatment and prevention and their implications in the elderly will be discussed.