Gingival recession in smokers and non-smokers with minimal periodontal disease

An esthetic flap design for surgical endodontics in the anterior zone

OBJECTIVE

To describe an esthetic flap design for surgical endodontics in the anterior zone and to discuss the treatment outcome.

CLINICAL SIGNIFICANCE

Traditional flaps used in apical surgery in the anterior region are created with horizontal and vertical incisions. These incisions do not completely avoid scarring, and may sometimes cause esthetic defects. We describe an envelope flap with no vertical incision for apical surgery in anterior that mainly consists of oblique incision in interproximal papilla. The approach achieve rapid would healing while avoiding scar formation.

CONCLUSIONS

The present report describes successfully treated cases of surgical endodontics in the esthetic zone using an envelope flap that the author recommend in order to achieve better esthetic results.

Effect of a powered and a manual toothbrush in subjects susceptible to gingival recession: A 36-month randomized controlled clinical study

OBJECTIVE

The objective of this long-term clinical study was to evaluate the influence of a newly developed powered toothbrush (PT) on the size and number of pre-existing gingival recessions (GR) in comparison to a manual toothbrush (MT).

METHODS

This was a prospective, single-blind, parallel-group, randomized controlled clinical study. Participants without periodontitis, but with at least two teeth (index teeth) showing GR ≥2 mm were randomized to brush either twice daily with a MT or with a PT with a linear magnetic drive causing the round brush head to produce gentle micro vibrations along with oscillating-rotating movements. Primary outcome parameter was the mean change of GR at the index teeth over 36 months.

RESULTS

Totally 87 out of 92 participants completed the study (MT/PT: n = 42/n = 45). At the 36-month evaluation the mean (standard deviation) change of GR at index teeth differed significantly between MT 0.17 (0.77) and PT -0.10 (0.63) (p = 0.013). Furthermore, the amount of GR sites which improved ≥1 mm or remained stable during the study period did not differ between MT and PT, but the number of sites worsened ≥1 mm was significantly in favour for PT (MT 23 (25.5%) versus PT 10 (10.6%); p = 0.009). A binary logistic regression identified tooth type (OR = 2.991 for pre-/molar (1.096 [95% CI 1.002-8.933]; p = 0.050)) and manual brushing (OR = 3.341 (1.206 [95% CI 1291-8648]; p = 0.013)) as risk factors for recession impairment at the index teeth. There were no differences between groups for adverse events.

CONCLUSION

In a population with pre-existing gingival recessions and consequently a high risk of developing further recession the PT seems to be favourable with regard to further development of GR.

Prevalance and clinical characteristics of gingival recession in Greek young adults: A cross-sectional study

OBJECTIVE

The current cross-sectional study aimed to investigate the prevalence of gingival recession (REC) in a sample of young individuals. In addition, the association with several risk factors was examined.

MATERIALS & METHODS

A 104 subjects, aged 18-30 years old, were randomly enrolled in the study. Participants were requested to fill in a simple structured questionnaire in order to provide information on dental hygiene habits, educational level, smoking and history of orthodontic treatment. Afterwards, all the included individuals were subjected to a thorough clinical periodontal examination including gingival recession (REC), gingival biotype, plaque levels and gingival bleeding index (GBI) assessment.

RESULTS

The mean prevalence of REC in the studied population surpassed 50% with an equal distribution among females and males. The most common teeth associated with REC were the lower left canine and left 1st premolar. Among the examined variables, only the bleeding index was found to be associated with the presence of REC.

CONCLUSIONS

Gingival recession was a prevalent condition among young individuals. Gingival inflammation was found to be the most significant factor affecting the incidence of REC.

Prevalence and Associated Factors of Self-Reported Gingival Bleeding: A Multicenter Study in France

Gingival bleeding (GB) is a common sign of gingival inflammation which indicates the presence of periodontal diseases. This cross-sectional multicenter survey aimed to assess the prevalence of self-reported gingival bleeding (SRGB) in French adults and identify the main associated factors. A questionnaire-based interview was randomly proposed to 794 individuals in four French cities (Nancy, Montpellier, Paris, and Rennes). Subjects were recruited in preventive medicine centers (50%), railway stations, and malls (50%). The questionnaire comprised 25 items: SRGB characteristics, socioeconomic variables, oral hygiene habits, use of drugs, and anxiety level. The overall prevalence of SRGB was 63.2% [59.8%; 66.6%], with 58.7% bleeding after toothbrushing and 4.5% spontaneous bleeding. Males reported significantly lower SRGB prevalence than females (p = 0.04). The distribution of SRGB frequency was inversely proportional to age (p < 0.0001). No association between drug use and SRGB was found. The people interviewed in the preventive medicine centers reported the highest frequency of SRGB (p < 0.0001). In the multivariate logistic model, SRGB was significantly related to occupation, smoking status, brushing frequency, and anxiety level. In conclusion, SRGB was prevalent in more than half of the sample and was mainly associated with age, toothbrushing frequency, and anxiety level. Thus, providing information to patients about the importance of this oral manifestation may play an important role in preventing periodontal diseases.

Utility of High-Intensity Laser Therapy Combined with Photobiomodulation Therapy for Socket Preservation After Tooth Extraction

Objective: High-intensity laser therapy (HILT) combined with photobiomodulation therapy (PBMT) using a diode or CO₂ laser was administered after extraction of the left first molar in rats. Effects on socket preservation (preservation of the alveolar bone and healing time after extraction) were evaluated histopathologically.

Background: Irradiation using a diode or CO₂ laser has been shown to hasten wound healing, but the effects remain controversial.

Methods: Five-week-old male Wistar rats that underwent extraction of the left maxillary first molar were divided into three groups: diode laser irradiation (diode group), CO₂ laser irradiation (CO₂ group), and no laser irradiation (control group). HILT (27 J) was performed immediately after tooth extraction to enhance blood coagulation, followed by PBMT (0.7 J) 1 day later to enhance healing. Tissues, including the extraction socket, were removed en bloc 3, 5, 7, 10, and 21 days postextraction to determine the morphological characteristics of wound healing and the distribution of myofibroblasts involved in scar formation.

Results: In the diode and CO₂ groups, new bone formation and cancellous bone maturation were observed at an early stage of wound healing. The number of myofibroblasts was significantly lower in the laser treatment groups than the control (p < 0.001), and both treatment groups had a significantly higher alveolar crest height (p < 0.01), with almost no concavity in the mucosa of the extraction wound.

Conclusions: Combined HILT and PBMT following tooth extraction hastened wound healing and preserved alveolar crest height, suggesting a role in socket preservation.

Electronic Nicotine Delivery Systems (ENDS) and Their Relevance in Oral Health

The number and popularity of electronic nicotine delivery systems (ENDS) and especially e-cigarettes (e-cigs) have been increasing in the last decade. Although ENDS owe their popularity to excluding the harmful chemicals that are present in tobacco smoke, there is a debate whether they are safe, regulated, and as harmless as they are assumed to be and have potential unknown long-term effects. Involvement of cigarette smoking to the progression of periodontal diseases, other adverse oral health outcomes, and its detrimental effects to oral health are well-described. ENDS producer companies claim that these products can improve oral health by providing alternatives to smoking. However, the effect of e-cigs on oral health is not fully understood and is still debated among many scientists and clinicians. The number of studies addressing the potential toxic effect of ENDS or e-cig aerosol on oral cells is limited along with the clinical studies which are still preliminary, and their sample size is limited. The long-term effects of inhaled aerosols and the potential synergistic effect of the e-cigs components are not known. It is essential and of utmost importance to determine whether exposure to ENDS aerosol contributes to the progression of periodontal diseases and how it affects periodontal ligament and gingival cells which are believed to be its first targets. This review briefly summarizes the available evidence about the effects of e-cigs on periodontal health including several pathophysiological events, such as oxidative stress, DNA damage, inflammation, cellular senescence, dysregulated repair, and periodontal diseases.

The Influence of Cigarette Smoking on Various Aspects of Periodontal Health

Tobacco is one of the most important risk factors for oral diseases, including oral cancer, oral mucosal lesions and periodontal diseases. There is substantial evidence suggesting that the risk of oral diseases increases with frequent use of tobacco and that quitting smoking results in reduced risk. In this article, the influence of cigarette smoking on the periodontium will be discussed, giving importance to the effects on immune responses, alveolar bone loss, periodontal pathogens and briefly outlining the negative effects of smoking on wound healing and periodontal treatment procedures.

Smoking Related Systemic and Oral Diseases

This article reviewed smoking related systemic diseases and oral diseases. Smoking is related to lung cancer, cardiovascular diseases and many other systemic diseases. Cigarette smoke affects the oral cavity first, so it is evident that smoking has many negative influences on oral cavity, for example, staining of teeth and dental restorations, wound healing, reduction of the ability to smell and taste, and development of oral diseases such as oral cancer, periodontitis, smoker’s palate, smoker’s melanosis, hairy tongue, leukoplakia, oral candidiasis and implant survival rate. The article also discusses the relationship between smoking and dental caries in detail.

Crosstalk between oral and general health status in e-smokers

Electronic cigarette (e-cigarette) simulates the act of tobacco smoking by vaporizing a mixture of propylene glycol, nicotine, and flavoring agents. e-cigarette has been proposed as a product able to aid to stop smoking. The aim of the study is to verify the clinical variations of periodontal health induced by e-cigarettes use and, moreover, to investigate about the awareness of the e-smokers about their health variations and about their hypothetical need to turn back to smoke combustible cigarettes.This clinical observational pilot study involved 110 out of 350 smokers, who switched to e-cigarette. Patients were subjected to oral examinations. A questionnaire to self-assess the variations of some parameters of general health, and to self-assess the need to smoke combustible cigarettes, was distributed to such subjects involved in the study.At the end of the study, we registered a progressive improvement in the periodontal indexes, as well as in the general health perception. Finally, many patients reported an interesting reduction in the need to smoke.In the light of this pilot study, the e-cigarette can be considered as a valuable alternative to tobacco cigarettes, but with a positive impact on periodontal and general health status.

Gingival recession: prevalence and risk indicators among young greek adults

Objectives: The aim of the current research was to assess the prevalence of gingival recession and to investigate possible associations among this condition, periodontal and epidemiological variables in a sample of young Greek adults in a general dental practice. Material and Methods: A total of 1,430 young adults was examined clinically and interviewed regarding several periodontal and epidemiological variables. Collected data included demographic variables, oral hygiene habits and smoking status. Clinical examination included the recording of dental plaque, supragingival calculus presence, gingival status and buccal gingival recession. Multivariate logistic regression analysis model was performed to access the possible association between gingival recession and several periodontal and epidemiological variables as potential risk factors. Results: The overall prevalence of gingival recession was 63.9%. The statistical analysis indicated that higher educational level [OR= 2.12, 95% CI= 0.53-8.51], cigarette smoking [OR= 1.97, 95% CI= 1.48-7.91], frequent tooth brushing [OR= 0.98, 95% CI= 0.56-1.96], presence of oral piercing [OR= 0.92, 95% CI= 0.38-1.58], presence of gingival inflammation [OR= 4.54, 95% CI= 1.68-7.16], presence of dental plaque [OR= 1.67, 95% CI= 0.68-2.83] and presence of supragingival calculus [OR=1.34, 95% CI= 0.59-1.88], were the most important associated factors of gingival recession. Conclusions: The observations of the current research supported the results from previous authors that several periodontal factors, educational level and smoking were significantly associated with the presence of gingival recession, while presence of oral piercing was a new factor that was found to be associated with gingival recession.

Key words:Gingival recession, prevalence, risk factors, young adults.

Observations on dentine hypersensitivity in general dental practices in the United Arab Emirates

Dentine hypersensitivity is a common clinical finding with a wide variation in prevalence values and etiological factors. The objective of this cross-sectional study was to investigate the prevalence and some etiological factors of dentine hypersensitivity of Emirati patients visiting general dental clinics in the United Arab Emirates (UAE) over a period of three calendar months.

MATERIALS AND METHODS

Six general dental practitioners examined 204 Emirati patients over a period of three calendar months and patients who had dentine hypersensitivity diagnosed were questioned further about their smoking habits and the frequency, severity, and duration of their pain. Furthermore, cervical tooth surface loss was noted.

RESULTS

A total of 55 patients were diagnosed as having dentine hypersensitivity, giving a prevalence figure of 27%. The most common teeth affected were the lower anterior teeth.

CONCLUSIONS

The prevalence of dentine hypersensitivity in Emirati patients visiting a general dental clinic in the UAE was 27%. The most common etiology appeared to be the loss of cervical tooth surface structure.

Scaffold-free microtissues: differences from monolayer cultures and their potential in bone tissue engineering

OBJECTIVES

Cell-based therapies for bone augmentation after tooth loss and for the treatment of periodontal defects improve healing defects. Usually, osteogenic cells or stem cells are cultivated in 2D primary cultures, before they are combined with scaffold materials, even though this means a loss of the endogenous 3D microenvironment for the cells. Moreover, the use of single-cell suspensions for the inoculation of scaffolds or for the direct application into an area of interest has the disadvantages of low initial cell numbers and susceptibility to unwanted cellular distribution, respectively.

MATERIALS AND METHODS

We addressed the question whether an alternative to monolayer cultures, namely 3D microtissues, has the potential to improve osteogenic tissue engineering and its clinical outcome.

RESULTS

By contrast, to monolayer cultures, osteogenic differentiation of 3D microtissues is enhanced by mimicking in vivo conditions. It seems that the osteogenic differentiation in microtissues is enhanced by strong integrin-extracellular matrix interaction and by stronger autocrine BMP2 signaling. Moreover, microtissues are less prone to wash out by body fluids and allow the precise administration of large cell numbers.

CONCLUSION

Microtissue cultures have closer characteristics with cells in vivo and their enhanced osteogenic differentiation makes scaffold-free microtissues a promising concept in osteogenic tissue engineering.

CLINICAL RELEVANCE

Microtissues are particularly suitable for tissue engineering because they improve seeding efficiency of biomaterials by increasing the cell load of a scaffold. This results in accelerated osteogenic tissue formation and could contribute to earlier implant stability in mandibular bone augmentation.

Scaffold-free microtissues: differences from monolayer cultures and their potential in bone tissue engineering

Objectives

The paper’s aim is to review dentin hypersensitivity (DHS), discussing pain mechanisms and aetiology.

Materials and methods

Literature was reviewed using search engines with MESH terms, DH pain mechanisms and aetiology (including abrasion, erosion and periodontal disease).

Results

The many hypotheses proposed for DHS attest to our lack of knowledge in understanding neurophysiologic mechanisms, the most widely accepted being the hydrodynamic theory. Dentin tubules must be patent from the oral environment to the pulp. Dentin exposure, usually at the cervical margin, is due to a variety of processes involving gingival recession or loss of enamel, predisposing factors being periodontal disease and treatment, limited alveolar bone, thin biotype, erosion and abrasion.

Conclusions

The current pain mechanism of DHS is thought to be the hydrodynamic theory. The initiation and progression of DHS are influenced by characteristics of the teeth and periodontium as well as the oral environment and external influences. Risk factors are numerous often acting synergistically and always influenced by individual susceptibility.

Clinical relevance

Whilst the pain mechanism of DHS is not well understood, clinicians need to be mindful of the aetiology and risk factors in order to manage patients’ pain and expectations and prevent further dentin exposure with subsequent sensitivity.

Periodontal status in smokers and nonsmokers: a clinical, microbiological, and histopathological study

A case-control study was done to assess the influence of smoking on clinical, microbiological, and histopathological parameters. Methods. Two hundred dentate male patients (100 smokers and 100 nonsmokers) ranging between 25 and 50 years were enrolled in the study. Periodontal parameters were recorded. Plaque samples were collected for microbial analysis for BANA test. Gingival biopsies were obtained from selected site for assessing histopathological changes. Results. Both groups showed almost similar plaque levels (P=0.258), but smokers had reduced gingival (0.62 ± 0.31) and bleeding indices (28.53 ± 17.52) and an increased calculus index (1.62 ± 0.36). Smokers had an increased probing depth of 4-7 mm (P=0.009) and overall increased CAL. No difference in microbiota was found between the two groups. Histopathologically smokers showed a decreased blood vessel density (8.84 ± 0.96) and inflammatory cells (52.00 ± 9.79). Conclusions. It is quite possible that many of the pathogenic mechanisms involved in tissue degradation in periodontitis in smokers could be quite different from those in nonsmokers.

The association of orthodontic treatment and fixed retainers with gingival health

BACKGROUND

The use of postorthodontic fixed retainers made of wire and composite resin bonded to the lingual/palatal tooth aspect is a common practice that can affect gingival health. The purpose of this study was to evaluate the association of orthodontic treatment and fixed retainers with gingival health.

METHODS

The study included 92 consecutive subjects who arrived for routine dental examination at a military dental clinic between May and August 2007. Plaque and gingival indices, gingival recession, probing depth, and bleeding on probing were measured at the anterior sextants. When a fixed retainer was present, the distance was measured between the retainer and incisal edge and to the cemento-enamel junction. Past orthodontic treatment and smoking habits were self-reported. Postorthodontic patients were sorted by the presence or absence of fixed retainers.

RESULTS

The mean probing depth was 1.90 +/- 0.2 mm, and gingival recession was 0.06 +/- 0.02 mm; 20.8% of all sites exhibited bleeding on probing. Current smoking was reported by 20 (21.7%) patients. Labial gingival recession was significantly greater in treated (0.13 +/- 0.2 mm) patients compared to non-treated patients (0.05 +/- 0.2 mm; P = 0.03). Localized lingual gingival recession was significantly greater in teeth with fixed retainers (0.09 +/- 0.2 mm) compared to teeth with no fixed retainers (0.01 +/- 0.1 mm; P = 0.0002), as were plaque and gingival indices and bleeding on probing. Plaque on the lingual/palatal aspect showed a weak, positive correlation with lingual gingival recession (r = 0.16; P = 0.033).

CONCLUSION

Orthodontic treatment and fixed retainers were associated with an increased incidence of gingival recession, increased plaque retention, and increased bleeding on probing; however, the magnitude of the difference in recession was of low clinical significance.

Gingival recession in young adults: occurrence, severity, and relationship to past orthodontic treatment and oral piercing

INTRODUCTION

Gingival recession can be localized or generalized and associated with at least 1 tooth surface. As a result, gingival recession leads to root surface exposure, often causing esthetic impairment, fear of tooth loss, increased susceptibility for root caries, and dentin hypersensitivity. The prevalence, extent, and severity of gingival recession in a young adult Israeli population were evaluated, and the relationship between orthodontic therapy and other potential risk indicators and gingival recession was assessed.

METHODS

Our cohort included 303 consecutive healthy patients who had routine dental examinations at a military dental center. Information was collected regarding age, smoking habits, oral piercing, oral hygiene habits, and past orthodontic treatment. Clinical examination included visible gingival inflammation, visible dental plaque, and gingival recession on the facial aspects of all teeth.

RESULTS

Gingival recession was found in 14.6% of the subjects and in 1.6% of all examined teeth. The prevalence, extent, and severity of recession correlated with past orthodontic treatment. A negative correlation was found between plaque on the buccal tooth aspect and gingival recession. There was no correlation between gingivitis or smoking habits and recession. Prevalence was related to oral piercing.

CONCLUSIONS

Gingival recession is not uncommon in young adults and is related to past orthodontic treatment and oral piercing. Patients undergoing orthodontic treatment or about to pierce the tongue or lips should be advised regarding these findings.

Gingival Recession: Epidemiology and Risk Indicators in a Representative Urban Brazilian Population

BACKGROUND

Gingival recession is a common manifestation of periodontal disease, but it is also associated with other risk factors. A few studies have investigated the epidemiology and risk factors of this condition. This study describes the epidemiology of gingival recession in a representative, urban Brazilian population and assesses various risk indicators.

METHODS

A representative sample of 1,460 subjects was selected using a multi-stage, probability, cluster sampling strategy. The subjects were interviewed using a structured questionnaire and had a full-mouth clinical examination in a mobile examination center.

RESULTS

More than half (51.6%) and 22.0% of the individuals and 17.0% and 5.8% of teeth per individual showed gingival recession > or = 3 mm and > or = 5 mm, respectively. The prevalence, extent, and severity of recession correlated with age. Recession showed a nonlinear relationship with age, with 25 to 50 year olds showing the highest level of recession. Males aged > or = 30 years showed significantly higher prevalence and extent of gingival recession than females. The percentage of teeth with recession was significantly higher in the lower socioeconomic groups irrespective of age, and in subjects > or = 30 years of age with irregular dental care than in subjects with regular care. Using a multivariable model, cigarette smoking and presence of supragingival calculus were the factors most significantly associated with localized and generalized recession, whereas gender, dental visits, and socioeconomic status were not significant risk indicators.

CONCLUSIONS

The high level of gingival recession in this Brazilian population may be primarily related to destructive periodontal disease and is significantly associated with a high level of supragingival dental calculus and cigarette smoking. Population-based programs aimed at the prevention of periodontal diseases may reduce the prevalence of severe gingival recession in this and similar populations.

A cross-sectional study of buccal cervical sensitivity in UK general dental practice and a summary review of prevalence studies

AIM

The initial aim of this study was to establish the prevalence of dentine hypersensitivity (DH) in a cross-sectional study of patients visiting general dental practitioners in the UK over a period of one calendar month.

METHODS

Eighteen dental practitioners examined 5,477 patients over a period of one calendar month, and patients who were diagnosed with DH were questioned further about their occupation and smoking habits. The amount of buccal gingival recession associated with the sensitive teeth was also recorded, as was the presence of periodontal disease.

RESULTS

One hundred and fifty-two patients were diagnosed as having DH, giving a prevalence figure of 2.8%. The commonest teeth affected were the first molars and premolars, and the commonest initiating factor was cold drinks. A tendency for a greater number of DH teeth was also found for patients with periodontal disease who also smoked. There was also a tendency for the patients with DH teeth to come from higher social groups.

CONCLUSION

At the time of conducting this study, the European Federation of Periodontology had not recommended that sensitive teeth associated with periodontal disease and treatment be termed root sensitivity (RS). The title of this paper was therefore chosen to reflect this decision, and the data represent teeth both within and between subjects with DH and RS.

The prevalence of dentine hypersensitivity in a hospital clinic population in Hong Kong

OBJECTIVES

Dentine hypersensitivity is a common clinical finding with a wide variation in prevalence values. The aim of this study was to establish the prevalence of dentine hypersensitivity and to examine some associated aetiological factors in a cross-sectional study of patients visiting the Periodontology and Oral Hygiene Clinic at Prince Phillip Dental Hospital, Hong Kong over a three-week period.

METHODS

226 patients were examined over a three-week period using a triple syringe to administer a blast of cold air to confirm the diagnosis of dentine hypersensitivity. Additional factors such as smoking habits, initiating stimuli, gingival recession and cervical tooth surface loss were noted.

RESULTS

153 patients were diagnosed as having dentine hypersensitivity, giving a prevalence figure of 67.7%. The commonest teeth affected were the lower incisors and the commonest initiating factor was cold drinks.

CONCLUSIONS

The prevalence of dentine hypersensitivity in a hospital periodontology clinic population in Hong Kong was 67.7%.