The gingival bleeding time index

A stereomicroscopic and immunohistochemical study of vasculature in gingiva bleeding after probing

This study investigated the stereomicroscopic appearance of gingival sulcular surfaces and the histologic alterations of subepithelial vasculature of gingiva bleeding after probing. Sixty-four pairs of gingival biopsies from 49 patients were obtained and the results of stereomicroscopically visible vasculature were observed in half of the specimens. The number of biopsies showing that the vasculature of bleeding gingiva was significantly greater than those of non-bleeding gingiva. The immunohistochemical marker UEA-1 was used to identify endothelial cells on the vascular walls of 34 gingival biopsies from 15 patients. Following stereomicroscopic examination, tissue preparation with routine and UEA-1 stainings was performed. Volumetric and numerical analyses of vasculature in 6 divided portions of subepithelial connective tissue were measured. The results showed that significantly greater numbers of UEA-1 staining vessels were found within the apico-superficial portion of bleeding gingiva than those of non-bleeding gingiva. However, there was no specific correlation between the UEA-1 positive vessels within gingival tissue and stereomicroscopic visibility of vasculature on the surface appearance. It is suggested that increased vascularity in gingiva may be responsible for bleeding on clinical probing.

Detection of high-risk groups and individuals for periodontal diseases. Clinical assessment of the periodontium

The fundamental concepts of measuring periodontal diseases and the interpretation of such information as an historical record of disease, rather than disease activity, emphasises the need for improved diagnostic and prognostic tests. Criteria for an indicator of disease activity were suggested and an index fulfilling these should allow sites to be categorised as "active", quiescent or healing, and enable one to predict the risk of future disease activity. The ability of current measurements and indices, routinely used during clinical assessments of periodontal diseases, to fulfill the suggested criteria was considered and rejected in all cases. It is concluded that clinical parameters are only capable of identifying disease retrospectively, indicating the need for longitudinal, rather than cross-sectional studies in the search for clinical and laboratory markers of disease activity and susceptibility.

Clinical and microbiologic effects of local tetracycline irrigation on periodontitis

This investigation was conducted on seven individuals referred for treatment of moderate adult periodontitis. Twenty-eight sites with an average probing depth of 5.6 +/- 0.9 mm were evaluated. One tooth per jaw quadrant was randomly assigned to receive one of the following treatments: (I) no treatment, i.e., control; (II) saline irrigation; (III) tetracycline irrigation and (IV) scaling and root planing (SC/RP). A plaque control program was instituted one week prior to the experimental period and reinforced throughout the eight-week study. Irrigation was performed every 48 hours during the first two weeks of the experiment for Groups II and III, and the single treatment of SC/RP was carried out immediately following the baseline examination for Group IV. Clinical and microbiologic changes were monitored every two weeks using plaque and gingival indices, gingival fluid flow, probing depths, bleeding on probing and dark-field microscopic examination of the subgingival microbial flora. The tetracycline and SC/RP treatment modalities resulted in statistically significant clinical and microbiological improvements when compared with the control. Tetracycline irrigation alone and SC/RP alone had a similar effect in changing the subgingival microflora from one associated with disease to one associated with health. Thus, these treatment modalities are effective methods of producing statistically significant alterations in the subgingival microflora. The property of substantivity may contribute to the sustained duration of the effect of locally delivered tetracycline.

Lactate dehydrogenase, beta-glucuronidase and arylsulfatase activity in gingival crevicular fluid associated with experimental gingivitis in man

Experimental gingivitis provides a useful model for studying the initiation of periodontal disease in man. This study evaluated over a 4-week period the Plaque Index (PLI), Gingival Bleeding Time Index (GBTI), and gingival crevicular fluid (GCF) for resting and flow volume as well as the concentration and total activity of three enzymes in the GCF (lactate dehydrogenase--LDH, beta-glucuronidase--BG and arylsulfatase--AS) from the maxillary right quadrant of eight subjects with healthy gingiva. After rising sharply during the 1st week, the PLI continued to increase during the 2nd week but remained constant during the 3rd and 4th weeks. The GBTI, and the resting and flow GCF volumes, increased steadily throughout the study. LDH concentration in GCF varied minimally during the experiment, while total LDH activity rose slightly over the 4-week period. BG concentration and total activity in GCF rose steadily from baseline to the 3rd week and then either fell or leveled off during the 4th week. AS concentration in GCF rose from baseline to the 2nd or 3rd week and then fell. AS total activity in GCF rose from baseline to the 2nd week and then remained constant. These data suggest that while clinical signs of inflammation increased over the 4 weeks of the experiment, a homeostatic mechanism in the crevicular environment may control ground substance-degrading enzyme activity during experimental gingivitis in man.

Periodontal diagnosis. Current status and future needs

This literature relating to current methods of periodontal diagnosis is reviewed. There exists a future need for objective diagnostic techniques which reflect the dynamics of periodontal disease activity.

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

Assessment of bleeding upon probing is an integral part of a periodontal examination. Recent investigations have indicated that bleeding reflects histological, clinical and bacteriological alterations associated with periodontal disease. Furthermore, clinical and histologic data suggest that bleeding is an earlier sign of gingivitis than visual signs of inflammation (redness and swelling). The current literature referring to the role of bleeding upon probing in the diagnosis of periodontal disease is reviewed, and its limitations as a clinical parameter are discussed.

The effects of topical steroidal and systemic nonsteroidal anti-inflammatory drugs on experimental gingivitis in man

Retrospective studies in man and prospective studies in animals have indicated that systemically administered anti-inflammatory drugs may decrease plaque-induced inflammation and loss of attachment. The purpose of the present double blind study was to determine the effects of a systemically administered nonsteroidal anti-inflammatory drug and a topically applied steroidal anti-inflammatory drug on experimentally produced gingivitis. Eighteen dental students were brought to a state of optimal gingival health and then divided into three groups. One group received placebo gel to apply topically and placebo capsules. A second group received placebo gel and capsules containing sulindac, a nonsteroidal anti-inflammatory drug. The third group received a topical steroidal gel and placebo capsules. All subjects refrained from home care for 22 days in the maxillary right quadrant. Results of the study indicate that the topical steroidal drug significantly inhibited gingival inflammation while the systemically administered nonsteroidal drug had no apparent effect.

Evaluation of periodontal probing forces

The purpose of this study was to evaluate interexaminer and intraexaminer probing force variations in various regions of the mouth and adjacent to different tooth surfaces. Fifty-eight dental clinicians composed of 13 periodontists, 15 general dentists, 15 hygienists and 15 senior dental students probed the facial surfaces of periodontally healthy volunteers with a modified pressure-sensitive periodontal probe. The forces used during probing were calculated and analyzed by analysis of variance and t-statistics. There was wide variation in probing forces used by individuals within each clinician group. No statistical differences between the groups in mean probing force or absolute range of probing force could be detected. When pooled data were analyzed, it was found that the clinicians: (1) used probing forces ranging from 5 to 135 g, (2) probed in posterior regions with greater force than in anterior regions, and (3) probed midfacial, mesial and distal gingival units with different force. Midfacial regions were probed with the lightest force and distal regions with the heaviest force.