Gingivitis and gingival recession in adults from high-fluoride and low-fluoride areas

High concentrations of NaF aggravate periodontitis by promoting M1 polarization in macrophages

High-concentration fluoride treatment is commonly used to prevent dental caries in the oral cavity, and fluorine-containing protective paint is used to alleviate common root sensitivity symptoms in patients with periodontitis after periodontal treatment. Recent studies have confirmed its safe use in normal oral environments. However, whether fluoride treatment affects the progression of periodontitis in an inflammatory microenvironment remains unclear. Immunometabolism is crucial for maintaining bone regeneration and repair in periodontitis, and the precise regulation of macrophage polarisation is crucial to this process. Fluoride can influence the immune microenvironment of bone tissue by regulating immune metabolic processes. Herein, we investigated the effects of high concentrations of sodium fluoride (NaF) on periodontal tissues. We examined the expression of osteogenic and M1/M2 macrophage polarisation markers and glucose metabolism in macrophages. RNA sequencing was used to study differentially expressed genes related to M1 polarisation and glucose metabolism in treated macrophages. The results showed that NaF indirectly affects human periodontal ligament cells (hPDLCs), aggravating bone loss, tissue destruction, and submandibular lymph node drainage. Furthermore, NaF promoted glycolysis in macrophages and M1 polarisation while inhibiting osteogenic differentiation. These findings suggest that NaF has a direct effect on hPDLCs. Moreover, we found that high concentrations of NaF stimulated M1 polarisation in macrophages by promoting glycolysis. Overall, these results suggest that M1 macrophages promote the osteoclastic ability of hPDLCs and inhibit their osteogenic ability, eventually aggravating periodontitis. These findings provide important insights into the mechanism of action of NaF in periodontal tissue regeneration and reconstruction, which is critical for providing appropriate recommendations for the use of fluoride in patients with periodontitis.

Prevalence of Dental Fluorosis among Southern Jordanian Population

INTRODUCTION

Jordan is one of the Middle Eastern countries that is classified as a poor water resource country. People in Jordan consume any available water. In the south of Jordan, water resources are limited. The drinking water contains high levels of fluoride, which in turn leads to augmented danger of both skeletal and dental fluorosis.

AIMS

This study is focused on evaluating the pervasiveness of dental fluorosis among patients of Karak City and assessing the degree and distribution of fluorosis.

MATERIALS AND METHODS

This research focuses on 2,512 patients ranging from 12 to 52 years old seeking dental treatment in the Dental Department at "Prince Ali ben Al Houssin Hospital" in Karak City. Dental fluorosis status was assessed by using Modified Dean's Fluorosis Index." The data collected were subjected to statistical analysis.

RESULTS

The dental fluorosis prevalence within our sample was 39.9% in Karak City. Females were more influenced than males, and fluorosis was detected more often in those who drank tap water and was more common in a very mild and localized form.

CONCLUSION

Fluorosis necessitates constant observation, and future study in terms of the intake in Jordan is recommended in terms of all sources. It would not be too soon to note that the supply of drinking water needs to be changed in South Jordan.

A comparative assessment of clinical parameters, sialic acid, and glycosaminoglycans levels in periodontitis patients with and without dental fluorosis: A clinical and biochemical study

Aim:

This study was aimed to evaluate and compare the clinical parameters and the gingival crevicular fluid (GCF) levels of sialic acid (SA) and chondroitin sulfate (CS) in dental fluorosed and nonfluorosed (NF) gingivitis and periodontitis patients.

Materials and Methods:

A total of 100 patients were divided into two control (healthy) and four test (diseased) groups of gingivitis and periodontitis patients with and without dental fluorosis. The GCF-SA and chondrotin sulphate levels were measured using the conventional method and enzyme-linked immuno sorbent assay, respectively.

Results:

The plaque levels (2.9 ± 0.44), gingival bleeding levels (2.75 ± 0.55), and clinical attachment loss (0.44 ± 0.45) between dental fluorosed participants with chronic periodontitis (fluorosed periodontitis [FP]) and NF participants with chronic periodontitis (nonfluorosed periodontitis [NFP]) groups showed no statistically significant difference. Higher probing pocket depth by community periodontal index (CPI) scores of 4 and clinical attachment level CPI score of 1 (75%) was found in FP group when compared to a score of 3 (FP: 24.5% and NFP: 73.5%) of the NFP group. The GCF SA levels (679.05 ± 101.06) were significantly higher in FP group than NFP group (553.80 ± 49.40) (P = 0.048). Similarly, the GCF CS showed highly significant levels in fluorosis periodontitis (48.08 ± 18.13) group than the NFP group (26.95 ± 8.69).

Conclusion:

Increased pocket depth score, GCF–SA, and CS levels in the dental fluorosed group were observed when compared with NF group. The diagnostic ability of clinical examination is most often supported by the relevant biochemical parameters that are applicable in this study. The newer diagnostic ability of SA is found to be contributory in this study. The diagnostic ability of CS representing tissue destruction served as an important GCF marker along with SA.

Clinical Relevance:

In dental fluorosis, estimation of SA and CS is recommended in periodontitis patients.

Oestrogen receptor Rsa I gene polymorphism in osteoporosis periodontitis patients with or without dental fluorosis

Background & objectives:

There is a paucity of information on association between dental fluorosis, osteoporosis and periodontitis. The aim of this pilot study was to evaluate oestrogen receptor (ER) Rsa 1 gene polymorphism in osteoporosis periodontitis patients with and without dental fluorosis.

Methods:

Twenty one primary osteoporotic patients suffering from periodontitis with dental fluorosis and 20 primary osteoporotic patients suffering from periodontitis without dental fluorosis participated in this study. Periodontitis was diagnosed based on age, gender T-scores using clinical parameters such as plaque scores, gingival bleeding scores and probing pocket depth, clinical attachment level (CAL) and severity of dental fluorosis. DNA was genotyped at the RsaI RFLP (in exon 5) inside the ER gene to study ER Rsa I gene polymorphism in osteoporosis periodontitis patients with and without dental fluorosis.

Results:

Patients with dental fluorosis had higher degree of osteoporosis than those without fluorosis. CAL was significantly higher (P<0.05) in those with dental fluorosis compared with those without. Rr heterozygote (21.95%) was observed in patients without fluorosis whereas RR mutant homozygote was absent in both the groups. Rr wild homozygote type was seen more in the patients with fluorosis (51.21%). Significant differences were found in distribution of these genotypes between patients with and without dental fluorosis.

Interpretation & conclusions:

This preliminary study showed the presence of ER I gene polymorphism in osteoporosis periodontitis patients without dental fluorosis. Further studies with large sample size are needed to confirm the association shown in this preliminary study.

Outflow Facility in Tube Shunt Fenestration

AIM

Determination of the effect of varying fenestration technique, and simulated patch graft on outflow facility for Baerveldt tube.

MATERIALS AND METHODS

Silicone tubing similar to Baerveldt implant (AMO, Santa Ana, CA) with different fenestrations techniques was connected to a digital manometer in a closed system with a fluid-filled syringe on a stand to adjust pressure. The venting slits included: (A) 4 piercings with 7-0 TG140-8 needle; (B) a 2-mm slit with a 15° blade; (C) 4 piercings with a 15° blade; (D) 9-0 Nylon on CS140-6 needle with suture stenting the fenestration.

RESULTS

For pressures of 10, 20, 30, 40 mm Hg in groups A to D, the average outflow facility (mL/min/mm Hg) were group A: 0.11, 0.20, 0.28, 0.40; group B: 0.30, 0.69, 0.98, 0.93; group C: 0.73, 0.80, 0.81, 0.88; group D: 0.58, 0.65, 0.80, 0.87. For external compression with 10 gram weights at pressures of 10, 20, 30, 40 mm Hg, outflow were group A: 0.0, 0.18, 0.20, 0.53; group B: 0.75, 0.70, 0.97, 1.21. Group C: 0.18, 0.03, 0.57, 0.04. Group D: 0.73, 0.90, 1.13, 0.91.

CONCLUSION

Effectivity of venting slits in maintaining adequate IOP in the early postoperative period for non-valved glaucoma implant is variable, multifactorial and largely intraocular pressure (IOP) dependent.

CLINICAL SIGNIFICANCE

This study explores methods of producing fenestration and the effects on outflow at different pressures in an attempt to determine which fenestration technique has more reproducible results that can be made applicable in clinical practice. This is also the first study to evaluate the effect of external pressures similar to scleral patch graft on the tube fenestrations.

HOW TO CITE THIS ARTICLE

Olayanju J, Borras T, Qaqish B, Fleischman D. Outflow Facility in Tube Shunt Fenestration. J Curr Glaucoma Pract 2018;12(3):113-118.

Fluorosed fibroblast attachment on fluorosed and nonfluorosed teeth after SRP and EDTA root biomodification

BACKGROUND

Fluorosis causes mineralization changes in the tooth and can lead to morphologic alterations of fibroblasts. To understand the effect of fluorosis on periodontal healing, the initial step during healing, such as fibroblast attachment to the root surface, needs to be evaluated. Hence, the objective of the present study was to study the attachment of fluorosed fibroblasts on the fluorosed and nonfluorosed root fragments.

MATERIALS AND METHODS

A total of 56 fluorosed and nonfluorosed, periodontally healthy and diseased tooth roots were obtained and allotted to eight groups: Fluorosed and nonfluorosed healthy controls (FH and NFH, respectively), fluorosed and nonfluorosed diseased controls (FD and NFD, respectively), fluorosed and nonfluorosed roots treated with scaling and root planing (FD + S and NFD + S, respectively), and similar groups treated with scaling and root planing and 24% ethylenediaminetetraacetic acid (EDTA) gel application for 2 min (FD + SE and NFD + SE, respectively). After the respective treatment, the root fragments were incubated in the human periodontal ligament fibroblast cells obtained and cultured from freshly extracted healthy human fluorosed premolar tooth root.

RESULTS

In the nonfluorosed roots category, greater attachment was found in the untreated nonfluorosed diseased (P = 0.036) and SRP-treated nonfluorosed diseased groups (P = 0.008) as compared to the nonfluorosed healthy group. While in the fluorosed roots category, no significant difference was observed in FL-FA (P > 0.05) within the group. However, no attachment was observed in EDTA-treated fluorosed root fragments. When fluorosed groups were compared to nonfluorosed groups, no significant changes were noted between the groups.

CONCLUSION

SRP proves to be a standard requirement for fibroblast attachment to occur both in fluorosed and nonfluorosed roots. Although there was no significant difference in attachment between SRP and SRP + EDTA among fluorosed roots, EDTA does not seem to be a promising agent for root biomodification in fluorosed roots in a given concentration and time of treatment.

Fluoride profiles in the cementum and root dentine of human permanent anterior teeth extracted from adult residents in a naturally fluoridated and a non-fluoridated area

OBJECTIVES

To determine the effect of water fluoride concentration on the fluoride profile across the entire thickness of the cementum and root dentine of human permanent anterior teeth in adults.

SUBJECTS

Twenty-eight human permanent anterior teeth from individuals aged from 30 to over 60 years were studied.

SETTING

Teeth were obtained from a natural high-fluoride area (West Hartle-pool, UK; 1.0-1.3 ppm F in drinking water, WHP) and the other from a non-fluoridated naturally low fluoride area (Leeds, UK; 0.1 ppm F in drinking water, LDS).

DESIGN

Cementum and root dentine were sampled using an abrasive micro-sampling technique from the cementum surface to the pulpal surface of root dentine.

RESULTS

Fluoride concentration was higher in tooth roots (the cementum and dentine) taken from the naturally fluoridated area (WHP) than from the non-fluoridated area (LDS). Age and average fluoride concentration showed a positive correlation in WHP dentine, middle region of the root (r = 0.78, P < 0.001) and in the apical region of the root (r = 0.61, P < 0.05). WHP cementum had the strongest fluoride concentration correlation with age in the cervical region of the root (r = 0.67, P < 0.01). An analysis of variance (ANOVA) showed that the area (water fluoride content), age and number of years lived in the area combined with total age were significant.

CONCLUSIONS

The fluoride content of cementum and root dentine in adult residents is related to fluoride content in drinking water.

Fluoridation effects on periodontal disease among adults

Numerous studies report that water fluoridation reduces caries in children, but little current evidence exists about fluoridation's effects on the periodontal health of adults. To address this issue, we estimated fluoridation effects on periodontal disease among 1066 Washington state employees and their spouses, aged 20 to 34, with current residences divided evenly between fluoridated and nonfluoridated communities. Subjects were interviewed by telephone to collect residence histories, personal characteristics and other data. Each subject's lifetime years of fluoridation exposure (YFE) was calculated from the person's residence history and the U.S. Centers for Disease Control's Fluoridation Census. Oral assessments were conducted to measure the extent of periodontal disease. Relative to adults with no exposure, continuous lifetime exposure reduced the probability of attachment loss from 0.87 to 0.72. Similar benefits were obtained for bleeding gingiva and calculus. The estimates of fluoridation's benefits were not influenced by selection bias due to subjects' nonparticipation in the oral assessments.

Periodontal treatment needs in populations of high- and low-fluoride areas of Morocco

The purpose of this study was to determine the periodontal status and treatment needs, using the CPITN index, in a population aged 7 to 60 years residing in the fluorosis area of Khouribga and the non-fluorosis area of Beni-Mellal, Morocco. A total of 2378 subjects was studied. In the youngest age groups, more subjects and sextants from Khouribga than from Beni-Mellal were free of periodontal diseases. Conversely, in Beni-Mellal, subjects in the youngest age groups presented a higher mean number of sextants with calculus than those from Khouribga. In combining the 2 areas, 1.3% of the 2319 dentate subjects examined needed no treatment and 98.7% needed at least oral hygiene instructions (TN1). The present study, based on the CPITN index, demonstrated in both areas a high prevalence of gingivitis, and a relatively low prevalence of deep pocketing, occurring on the average in less than half a sextant in the total populations.

The effects of airborne fluorides on oral conditions in Morocco

The purpose of this study was to determine the prevalence and severity of dental caries and dental fluorosis, as well as various other oral conditions, in 2378 subjects (ages seven to 60) living in the fluoridated area of Khouribga and the non-fluoridated area of Beni Mellal, Morocco. The community index of dental fluorosis (CFI) ranged from 1.99 to 2.80 in the high-fluoride area: Over 90% of the population was affected, and more than one-third of the subjects showed moderate dental fluorosis. However, in Beni Mellal, more than 96% of the dentate subjects examined were free of dental fluorosis, and the CFI of 0.02 was considered not significant. Significant differences were observed between the two areas with respect to caries prevalence. DMFT and DMFS indices were markedly lower in the fluorosis area of Khouribga. The oral conditions of subjects appeared to be better in Khouribga, where the gingival and calculus indices were significantly lower than in Beni Mellal. The analyses of covariance showed no significant differences in plaque accumulation (PI) between the Khouribga and Beni Mellal samples. However, a close statistical correlation was found between PI and GI in Beni Mellal and Khouribga.

Periodontal disease as a function of life events stress

Studies relating stress and oral pathology have been limited to animal experiments or clinical studies of personality and psychological health that have ignored the role of specific life events. The present study related measurements of life events stress to measurements of periodontal disease. Subjects were fifty male volunteers recruited from a pool of dental patients from the Brooklyn VA Outpatient Dental Clinic. Oral examinations were given to determine the degree of periodontitis and gingivitis. Evidence of other somatic symptomatology was assessed by the somatization subscale of the Brief Symptom Inventory. The degree of life events stress was assessed with the Life Experience Survey. Measurements of life events stress were found to be significantly correlated with measures of periodontal disease. Periodontal disease was more severe and widespread as stressors increased. Subjects were found whose general physical health was unrelated to their life situation.

Occurrence of dental caries and gingivitis in low, medium and high fluoride areas in Finland

The study was performed on a material of 365 Finnish schoolchildren aged 13--15 years. One-third of the children were from Jyväskylä, with 0.2 parts/10(6) fluoride in the drinking water, one-third from Kuopio, with an artificially corrected 1.0 parts/10(6) fluoride content since 1959, and one-third from Hamina, where the natural fluoride content of the drinking water varies between 2.5 and 5.0 parts/10(6). All the children were scored for the Visible Plaque Index (VPI), the Gingival Bleeding Index (GBI) and for past caries experience (DFS). With increasing fluoride content of the drinking water the DFS scores were found to decrease significantly. No such difference was observed with regard to the VPI scores. The prevalence of gingival bleeding was found to be highest in Hamina (2.5 parts/10(6)). A highly significant positive correlation was found between individual VPI and GBI scores in all three towns. No corresponding correlations were found between the individual VPD and DFS scores. The latter finding is in desagreement with the generally accepted view that oral hygiene is an efficient caries-preventive measure.