Periodontal disease in children and adolescents: introduction and classification

Efficacy of an experimental toothpaste containing sodium bicarbonate, sodium hyaluronate and sodium fluoride on gingivitis

BACKGROUND

Gingivitis is driven by plaque accumulation and, if left untreated, can progress to irreversible periodontitis. For many, the mechanical action of toothbrushing does not achieve adequate plaque control. The aim of this study was to investigate whether twice-daily use of a toothpaste containing 0.2% high molecular weight (HMW) sodium hyaluronate with 67% sodium bicarbonate and 0.221% sodium fluoride (experimental toothpaste) could improve gingival health compared with a regular fluoride toothpaste (negative control). The study also assessed whether the experimental toothpaste could provide additive gingival health benefit over a toothpaste containing only 67% sodium bicarbonate and 0.221% sodium fluoride (positive control).

METHODS

This was a single-center, examiner-blinded, randomized, clinical study in healthy adults with mild-to-moderate gingivitis. At baseline, after abstaining from toothbrushing for 12 h, prospective participants underwent oral soft tissue (OST) and oral hard tissue examination followed by assessments for gingival inflammation (Modified Gingival Index [MGI]), gingival bleeding (Bleeding Index [BI]), and supra-gingival plaque (Turesky Plaque Index [TPI]). Eligible participants were stratified by gender and baseline number of bleeding sites (low: <45; high: ≥45 bleeding sites). Following randomization, participants underwent prophylactic dental treatment. Participants received a full OST examination, MGI, BI and TPI assessments after 3 days, 1, 2 and 6 weeks of product use.

RESULTS

In total, 110 participants were screened for study entry and all were randomized to receive one of three toothpastes (experimental: sodium hyaluronate, sodium bicarbonate, sodium fluoride; positive control: sodium bicarbonate, sodium fluoride; negative control: regular fluoride toothpaste). For all measures, significant improvements were observed in participants receiving either sodium bicarbonate-containing toothpaste (experimental or positive control) compared with the regular fluoride toothpaste (negative control) at week 6. No significant difference was observed in any assessment or visit comparing the experimental toothpaste with the positive control.

CONCLUSIONS

Both the experimental and the positive control toothpastes demonstrated clinically relevant improvements in gingival health compared with a regular fluoride toothpaste (negative control). However, no additional gingival health improvement was observed for the experimental toothpaste compared with the positive control, therefore, no additional gingival health benefit can be attributed to the inclusion of sodium hyaluronate in this formulation.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04737538 (04/02/2021).

The Periodontal Status of Orofacial Cleft Patients: A Systematic Review and Meta-Analysis

Cleft lip and/or palate is the most commonly documented orofacial anomaly and may impact the status of health and disease of adjacent teeth along with their associated supporting structures. The authors performed a systematic review and meta-analysis to assess whether the presence of clefts altered the periodontal status of patients.

The study was registered in PROSPERO (CRD42020210178). A systematic search of literature was performed utilizing unique search strings for PubMed, Scopus, and GoogleScholar as databases including gray literature from April 28, 2020 to October 3, 2020.

Cross-sectional and longitudinal human studies published in the English language, providing information about periodontal disease and its association with cleft lip, alveolus, and palate.

Periodontal outcome measures such as gingival index (GI), clinical attachment level (CAL), plaque index (PI), periodontal probing depth (PPD), and bleeding on probing (BOP) were utilized as the main outcome measures.

Patients with clefts were predisposed to poorer periodontal outcomes. Subgroup analysis revealed compromised periodontal measures for clefts as compared to control sites without cleft which were statistically significant in terms of GI [Z = 2.44, P = .01], CAL [Z = 2.52, P = .01], PI [Z = 2.76, P = .006] and not statistically significant for PPD [Z = 0.27, P = .79] and BOP [Z = 1.47, P = .14].

Within the limitations of the review, the authors conclude that the presence of orofacial clefts may predispose to periodontal compromise when compared to normal controls. The GRADE rating was moderate.

Treatment of Periodontitis Affecting Human Primary Teeth-A Systematic Review

The aim of this systematic review is to report the treatment options (Intervention) and outcomes (O) for primary teeth affected by periodontitis (Population) and if the treatment of primary teeth can prevent the spread of periodontitis to permanent teeth (Outcomes). The following databases were searched for papers published before December 2022: PubMed, Embase, Web of Science, and Ebscohost. Studies on children affected by periodontitis involving the primary teeth were included and those on children who presented with periodontitis as a manifestation of systemic disease were excluded. Narrative synthesis and methodological quality assessments were performed for the included studies. Three interventional studies (without a control group) that evaluated treatments involving scaling and root planing (SRP with antibiotics) and extraction were included (total n = 60 patients). Additionally, twelve case reports/case series articles (n = 19 patients) were identified. The diagnoses ranged from aggressive periodontitis to juvenile periodontitis and pre-pubertal periodontitis. Based on a limited number of published studies, it was found that the early treatment of periodontitis affecting the primary teeth using SRP and systemic antibiotics resulted in favorable improvements in PD and CAL. Limited evidence suggests that SRP and the extraction of the primary teeth involved have the potential to prevent periodontitis affecting permanent teeth. Future trials are required to standardize the treatment protocols and to confirm these findings.

Antigingivitis efficacy of a sodium bicarbonate toothpaste: Pooled analysis

OBJECTIVE

The objective of this study was to investigate the antigingivitis and antiplaque treatment effect of a toothpaste containing 67% w/w sodium bicarbonate, at the individual tooth site, tooth region and whole mouth (overall) level, by way of a pooled analysis of data from similarly designed clinical trials.

METHODS

Six randomized controlled GSKCH clinical trials, 12-24 weeks in duration, were selected based on pre-specified criteria which included access to patient level data, pre-treatment dental prophylaxis, >20 bleeding sites and mild-moderate gingivitis at screening and use of 67% sodium bicarbonate toothpaste and non-sodium bicarbonate (regular) toothpaste (negative control) for ≥4 weeks. Efficacy outcomes comprised plaque index (TPI), modified gingival index (MGI) and gingival bleeding (bleeding index (BI), number of bleeding sites (BS)). Treatment comparisons were made using ANCOVA for whole mouth (overall) scores and by tooth site region (facial overall, lingual overall; margin/body overall, facial margin/body, lingual margin/body; papillae/interproximal overall, facial papillae/interproximal, lingual papillae/interproximal). Pooled data for BI, MGI, and TPI at individual tooth sites was plotted as a mouthmap to summarize treatment response (change from baseline) by tooth site, at the 24-week timepoint.

RESULTS

For all measures, whole mouth and for all tooth regions at all post-treatment timepoints, significant (p < 0.001) differences in favour of the 67% sodium bicarbonate toothpaste compared with control were observed. At the 24-week timepoint, facial regions demonstrated greater improvements than lingual regions, with the greatest between treatment improvement seen for the facial-papillae regions for bleeding (BS/BI), facial-margin regions for MGI and facial-body regions for TPI. All individual tooth sites demonstrated numerically greater reductions from baseline for the 67% sodium bicarbonate toothpaste than the control toothpaste following 24 weeks use, with the greatest improvements (change from baseline) seen for posterior and papillae tooth sites for bleeding, margin tooth sites for MGI and body tooth sites for TPI.

CONCLUSION

This pooled analysis of patient level-data, limited to GSKCH long-term gingivitis clinical studies, demonstrates that twice daily use of a 67% sodium bicarbonate toothpaste effectively removes plaque from all tooth sites, and results in clinically significant improvements in measures of gingival health, overall and for all the tooth regions investigated, compared with a non-sodium bicarbonate (regular) toothpaste following 24 weeks twice daily use.

Comparative Analysis of Gene Expression Patterns for Oral Epithelium-Related Functions with Aging

Epithelial cells and functions of the epithelium are critical to the health of the oral cavity. We used a nonhuman primate model to profile the transcriptome of gingival tissues in health across the lifespan and hypothesized that in older animals, epithelial-related transcriptome patterns would reflect epithelial cells that are aggressively responsive to the surrounding environment and less able to modulate and resolve the noxious challenge from the bacteria. Rhesus monkeys (n = 34) with a healthy periodontium were distributed into four groups: ≤3 years (young), 3-7 years (adolescent), 12-16 years (adult), and 18-23 years (aged), and a buccal gingival sample from the premolar/molar region of each animal was obtained. RNA was subjected to a microarray analysis (GeneChip^® Rhesus Macaque Genome Array, Affymetrix), and 336 genes examined that are linked to epithelium and epithelial cell functions categorized into 9 broad functional groups: extracellular matrix and cell structure; extracellular matrix remodeling enzymes; cell adhesion molecules, cytoskeleton regulation; inflammatory response; growth factors; kinases/cell signaling; cell surface receptors; junction associated molecules; autophagy/apoptosis; antimicrobial peptides; and transcription factors. Total of 255 genes displayed a normalized signal >100, and differences across the age groups were observed primarily in extracellular matrix and cell structure, cell adhesion molecules, and cell surface receptor gene categories with elevations in the aged tissues. Keratins 2, 5, 6B, 13, 16, 17 were all significantly increased in healthy-aged tissues versus adults, and keratins 1 and 2 were significantly decreased in young animals. Approximately 15 integrins are highly expressed in the gingival tissues across the age groups with only ITGA8, ITGAM (CD11b), and ITGB2 significantly increased in the aged tissues. Little impact of aging on desmosomal/hemidesmosomal genes was noted. These results suggest that healthy gingival aging has a relatively limited impact on the broader functions of the epithelium and epithelial cells, with some effects on genes for extracellular matrix and cell adhesion molecules (e.g., integrins). Thus, while there is a substantial impact of aging on immune system targets even in healthy gingiva, it appears that the epithelial barrier remains reasonably molecularly intact in this model system.

A randomized controlled trial of a power brush/irrigator/mouthrinse routine on plaque and gingivitis reduction in orthodontic patients

OBJECTIVES

To assess plaque and gingivitis reduction in orthodontic patients after 4 weeks' use of an oscillating-rotating power brush, irrigator, and mouthrinse.

MATERIALS AND METHODS

This was a randomized, examiner-blind, clinical trial comparing plaque and gingivitis outcomes for an experimental power brush/irrigator/mouthrinse oral hygiene routine vs a dental prophylaxis followed by regular manual brushing (positive control). Fifty-one participants with fixed orthodontic appliances in the upper and lower jaw and a minimum of 15 gingival bleeding sites were randomly assigned to experimental or positive control treatment. Both groups were instructed to use their products at least twice daily. At baseline, week 1, and week 4, plaque was evaluated using digital plaque imaging analysis and a conventional subjective index. Gingival inflammation and bleeding were also measured. Analysis of covariance was used to compare groups.

RESULTS

Fifty-one participants (mean age = 13.9 years) were randomized; 50 (25 per group) completed the study. At baseline, group means were not statistically different (P > .1) for gingival inflammation or bleeding. At week 4, the experimental and control groups had a 10.0% to 32.7% and 5.9% to 6.7% reduction vs baseline, respectively, in plaque (across both methods); 12.6% and 8.3% reduction, respectively, in gingival inflammation; and 50.6% and 37.8% reduction, respectively, in bleeding. At week 4, group differences favoring the experimental group were statistically significant (P < .05) for gingival inflammation, gingival bleeding, and plaque (by conventional and digital imaging indexes).

CONCLUSIONS

Use of a power brush/irrigator/mouthrinse resulted in statistically significantly greater plaque and gingivitis reductions than prophylaxis followed by manual brushing in patients with fixed appliances over 4 weeks.

Artificial neural networks for the diagnosis of aggressive periodontitis trained by immunologic parameters

There is neither a single clinical, microbiological, histopathological or genetic test, nor combinations of them, to discriminate aggressive periodontitis (AgP) from chronic periodontitis (CP) patients. We aimed to estimate probability density functions of clinical and immunologic datasets derived from periodontitis patients and construct artificial neural networks (ANNs) to correctly classify patients into AgP or CP class. The fit of probability distributions on the datasets was tested by the Akaike information criterion (AIC). ANNs were trained by cross entropy (CE) values estimated between probabilities of showing certain levels of immunologic parameters and a reference mode probability proposed by kernel density estimation (KDE). The weight decay regularization parameter of the ANNs was determined by 10-fold cross-validation. Possible evidence for 2 clusters of patients on cross-sectional and longitudinal bone loss measurements were revealed by KDE. Two to 7 clusters were shown on datasets of CD4/CD8 ratio, CD3, monocyte, eosinophil, neutrophil and lymphocyte counts, IL-1, IL-2, IL-4, INF-γ and TNF-α level from monocytes, antibody levels against A. actinomycetemcomitans (A.a.) and P.gingivalis (P.g.). ANNs gave 90%-98% accuracy in classifying patients into either AgP or CP. The best overall prediction was given by an ANN with CE of monocyte, eosinophil, neutrophil counts and CD4/CD8 ratio as inputs. ANNs can be powerful in classifying periodontitis patients into AgP or CP, when fed by CE values based on KDE. Therefore ANNs can be employed for accurate diagnosis of AgP or CP by using relatively simple and conveniently obtained parameters, like leukocyte counts in peripheral blood. This will allow clinicians to better adapt specific treatment protocols for their AgP and CP patients.

Periodontal diseases in children and adolescents: a clinician's perspective part

Contrasting forms of periodontal disease can affect children and adolescents with varying prevalence, severity and extent, leading to a diverse prognosis in these age groups. For an early diagnosis and treatment of periodontal conditions in young patients, it is essential for the dental practitioner to be able to identify and classify the disease correctly at the earliest opportunity, applying basic principles along with understanding of aetiology and risk factors. The first part of this article discusses the classification, plaque-induced and non-plaque-induced gingival diseases, localized and generalized forms of chronic, as well as aggressive, periodontitis.

CLINICAL RELEVANCE

Knowledge of different forms of periodontal diseases affecting children and adolescents may help to distinguish between different forms of diseases and have value in screening and early diagnosis of the disease.

Interrelation between obesity, oral health and life-style factors among Turkish school children

Obesity, dental caries and periodontal diseases are among major public health concerns which may affect children's growth and development. This study seeks any clustering between obesity, oral health and life-style factors among school children in Istanbul, Turkey. A cross-sectional study of children, 10- to 12-year-olds, from a public and a private school was undertaken with questionnaires for children and their mothers and child oral health data, in Istanbul (n = 611). DMFS (number of decayed, missing and filled surfaces of permanent teeth), CPI (Community Periodontal Index), body mass index (BMI) and life-style factors (tooth-brushing frequency, milk consumption at breakfast and bedtimes on school nights) of children were examined. Data analysis included factor analysis, Student's t test and Chi-square tests by cross-tabulation. Public school children were more dentally diseased but less obese than were those in private school (P < 0.001). They more frequently had calculus (62%) and reported non-recommended tooth-brushing (68%) than did those in private school (37%, 56%; P < 0.05). Principal component analysis revealed that DMFS, CPI and BMI shared the same cluster among all children. A need exists for addressing obesity, oral health and nutrition jointly in health promotion strategies to improve children's well-being and empower good life-style factors.

Investigation of the three-dimensional architecture of the collagen adhesin EmaA of Aggregatibacter actinomycetemcomitans by electron tomography

The periodontal pathogen Aggregatibacter actinomycetemcomitans displays on the bacterial surface a nonfimbrial adhesin, EmaA, which is required for collagen binding. In this study, electron tomography was used to characterize the three-dimensional (3D) architecture of this adhesin. The antenna-like surface appendages, corresponding to EmaA, were found to be composed of an ellipsoidal domain capping a rod-like domain that adopts either a straight or a bent conformation at various positions along the length. The most common flexible point along the length of the EmaA appendage was localized 29.4 nm away from the distal end. One-fifth of the appendages were straight and the remaining showed angles distributed between 140 degrees and 170 degrees at this location. Deletion analysis mapped this bend to amino acids 611 to 640 of the protein sequence. The 3D structure of the collagen binding domain of EmaA was generated by alignment and averaging of 9 subvolumes of the adhesin extracted from tomograms. The structure contains three subdomains: a globular structure with a diameter of approximately 5 nm and a cylindrical domain ( approximately 4.4 nm by 5.8 nm) separated by a linker region with a diameter of approximately 3 nm, followed by a cylindrical domain ( approximately 4.6 nm by 6.6 nm). This is the first 3D structure of a trimeric autotransporter protein of A. actinomycetemcomitans.

The effect of smoking on periodontal health of 15- to 16-year-old adolescents

BACKGROUND

Smoking is a severe risk factor for periodontal health in adults, but data on the effect of smoking on periodontal health in teenage populations are sparse. The aim of this study was to investigate the effect of duration and quantity of smoking on periodontal health in teenagers and possible differences between genders.

METHODS

The oral health of 501 adolescents (15- to 16-year-old boys [n = 258] and girls [n = 243]) was examined. A structured questionnaire about self-reported smoking and health habits was filled out, and bitewing x-rays were taken. Clinical examinations included measuring periodontal indexes, such as visible plaque index, bleeding on probing, root calculus (RC), probing depth, and attachment loss. Results were analyzed by generalized linear logistic regression.

RESULTS

Twenty-five percent of boys and 27% of girls were smokers. The boys and girls who smoked had higher RC values than non-smokers (P <0.001). The adjusted scores for smoking boys and girls were 17.3 (95% confidence interval [CI]: 8.6 to 31.7) and 13.6 (95% CI: 5.5 to 29.7), respectively. The adjusted scores for non-smokers were 10.4 (95% CI: 5.7 to 18.3) and 7.7 (95% CI: 3.3 to 17.3), respectively. Smoking boys and girls also had more periodontal pockets > or =4 mm than non-smokers: the score for boys was 4.6 (95% CI: 2.2 to 9.1), and the score for girls was 5.4 (95% CI: 1.1 to 23.2; P <0.001).

CONCLUSION

Smoking significantly impaired periodontal health in teenagers.

A controlled 6-month clinical trial to study the effects of a stannous fluoride dentifrice on gingivitis

OBJECTIVES

This study was conducted to assess anti-plaque and anti-gingivitis benefits of a stabilized stannous fluoride (SnF(2))/sodium hexametaphosphate (SHMP) dentifrice versus a negative control.

MATERIAL AND METHODS

This was a randomized, 6-month, stratified, single-centre, double-blind, parallel group, clinical study conducted in harmony with the guidelines for evaluating chemotherapeutic products for the control of gingivitis outlined by the American Dental Association. A stabilized 0.454% SnF(2)/SHMP dentifrice was tested against a commercially available negative control dentifrice. Following baseline measurements, subjects received a dental prophylaxis. Subjects were instructed to brush twice daily for 60 s using their assigned product. Efficacy measurements were obtained at baseline, 3 and 6 months post treatment using the Modified Gingival Index, Gingival Bleeding Index and the Turesky Modified Quigley-Hein Plaque Index. Oral tissue examinations were performed at all visits.

RESULTS

A total of 140 subjects were enroled and 128 completed the study. RESULTS after 6 months showed the SnF(2) dentifrice delivered a 16.9% reduction in gingivitis (p<0.001), a 40.8% reduction (p<0.001) in gingival bleeding, and an 8.5% reduction in plaque (p=0.001) versus the negative control. Both treatments were well tolerated.

CONCLUSIONS

Twice daily use of the SnF(2)/SHMP dentifrice over 6 months provided statistically significant anti-plaque and anti-gingivitis benefits relative to a negative control.

Periodontal Disease Progression Among Young Subjects With No Preventive Dental Care: A 52-Month Follow-Up Study

BACKGROUND

The aim of the present study was to assess the incidence, severity, and extension of periodontal disease among young subjects.

METHODS

Three hundred sixty subjects from a public school in Belo Horizonte, Brazil were examined. Forty-four subjects with bone loss (BL) and/or clinical attachment loss (CAL) > or = 4 mm, and no dental care during the following 52 months, were considered the reference sample and were recalled for a second examination. At both examinations, statistical analyses were performed for CAL and BL for subject, tooth, and site. Comparisons of CAL at subject, tooth, and site levels were performed with the Wilcoxon test for matched samples. Comparisons of BL at subject, tooth, and site levels were performed with the McNemar and Student t tests for dependent samples.

RESULTS

Findings indicated an increase in the number of sites with CAL >4 mm from baseline to follow-up. Sites that exhibited BL increased from 2.14% at baseline to 7.5% at follow-up (P <0.001). The severity of periodontitis was characterized by increased CAL values at affected sites at both examinations (P <0.001) and an increase in BL over time (mean BL at 35 affected sites was 2.6 mm at baseline and 3.5 mm at follow-up; P = 0.001). In addition, a 34% incidence of BL was verified.

CONCLUSIONS

The incidence, severity, and extension of CAL and BL were significant findings. They indicate the importance of early detection of the disease and the need for preventive health care programs geared toward young subjects.

Distribution ofPorphyromonas gingivalis fimAGenotypes in Japanese Children and Adolescents

BACKGROUND

Porphyromonas gingivalis is considered to be one of the most important pathogens in periodontal disease and its fimA genes have been classified into six variants (types I through V and Ib). A majority of the P. gingivalis organisms isolated from periodontitis patients are type II, followed by type IV, while type I is prevalent in healthy adults.

METHODS

A total of 650 saliva samples were taken from 464 children (3 to 18 years of age), who visited Osaka University Dental Hospital. Genomic DNA was extracted from each sample and analyzed using a polymerase chain reaction (PCR) method with P. gingivalis-specific primers, followed by an additional PCR assay to determine the fimA genotypes for P. gingivalis- positive subjects.

RESULTS

Fifteen (3.23%) of the subjects were P. gingivalis-positive and none of those samples showed a positive reaction to the type II fimA-specific primers, while four, one, and two subjects were shown to be positive for the type I, Ib, and III genotypes, respectively. In addition, the type IV genotype was detected in three subjects in the older age group.

CONCLUSIONS

Our findings suggest that a limited number of children harbor P. gingivalis, and that the distribution of type II and IV fimA genotypes is extremely low. Further, some adolescents were found to possess the type IV fimA genotype which has been shown to be possibly related to adult periodontitis, in contrast to types I, III, and V.

Anti-gingivitis efficacy of a stabilized 0.454% stannous fluoride/sodium hexametaphosphate dentifrice. A controlled 6-month clinical trial

OBJECTIVE

Stannous fluoride is a broad-spectrum anti-microbial agent that has been used in dentistry as a chemical adjunct to prevent dental caries and gingivitis. The objective of this study was to assess the anti-gingivitis efficacy of a stabilized 0.454% stannous fluoride/sodium hexametaphosphate dentifrice relative to a negative control.

METHODS

This was a randomized, 6-month, double-blind, parallel-group gingivitis study conducted according to the guidelines for evaluating chemotherapeutic products for the control of gingivitis outlined by the American Dental Association. A stabilized 0.454% stannous fluoride/sodium hexametaphosphate dentifrice was tested against a commercially available negative control dentifrice. Following baseline measurements, subjects received a dental prophylaxis. Subjects were then instructed to brush twice daily for 60 s using their assigned product. Oral soft-hard-tissue examinations and clinical examinations using the Modified Gingival Index, Gingival Bleeding Index, and the Turesky modification of the Quigley-Hein Plaque Index were performed at baseline, 3 and 6 months post-treatment.

RESULTS

A total of 143 subjects were enrolled and 130 of them completed the 6-month study. After 6 months of product usage, the experimental group had 21.7% less gingivitis (p<0.001), 57.1% less bleeding (p<0.001), and 6.9% less plaque (p=0.01) on average compared with the negative control group. No adverse oral soft-hard-tissue effects or extrinsic tooth staining was observed in the study.

CONCLUSION

The results demonstrate that use of the stabilized 0.454% stannous fluoride/sodium hexametaphosphate dentifrice over a 6-month period provided statistically significant reductions in gingivitis, gingival bleeding, and plaque when compared with a negative control dentifrice.

The Comparative Efficacy of Stabilized Stannous Fluoride/Sodium Hexametaphosphate Dentifrice and Sodium Fluoride/Triclosan/Copolymer Dentifrice for the Control of Gingivitis: A 6-Month Randomized Clinical Study

BACKGROUND

Antimicrobial agents such as stannous fluoride and triclosan have been incorporated into dentifrice formulations and have been shown to be effective in reducing gingivitis. The objective of this study was to compare the anti-gingivitis efficacy of a 0.454% stannous fluoride/sodium hexametaphosphate dentifrice to a positive control triclosan/copolymer dentifrice.

METHODS

This was a 6-month, randomized, double-masked, parallel-group study conducted according to the American Dental Association guidelines for evaluating chemotherapeutic products for the control of gingivitis. A 0.454% stannous fluoride/sodium hexametaphosphate dentifrice was tested against a commercially available positive control dentifrice (0.30% triclosan/2.0% Gantrez copolymer). Following baseline measurements, subjects received a dental prophylaxis. Subjects were then instructed to brush twice daily for 60 seconds using their assigned product. Tooth brushing was supervised for 3 days of each week. Clinical examinations using a gingival index were performed at baseline and at 3 and 6 months.

RESULTS

A total of 199 subjects were enrolled and 186 completed the 6-month study. Average baseline gingivitis and bleeding scores were similar for the two treatment groups. After 6 months, the experimental group had statistically significantly less gingivitis (25.8%) and statistically significantly less bleeding (27.4%) on average compared to the control group. Neither adverse oral soft tissue effects nor tooth staining were reported.

CONCLUSION

Within the limits of the study protocol, the results demonstrated superior therapeutic benefits for the stabilized 0.454% stannous fluoride/sodium hexametaphosphate dentifrice in reducing gingivitis compared to the triclosan/copolymer control in this partially supervised study.

The influence of tobacco smoking on the onset of periodontitis in young persons

This paper reviews the evidence for cigarette smoking as a risk factor for the development of severe destructive periodontal disease in young adults. A high prevalence of cigarette smoking has been identified among young individuals with aggressive periodontitis and tobacco usage increases the risk of periodontal destruction most significantly in young populations. The effect appears to be dose related and is independent of levels of plaque accumulation. Young smokers have more alveolar bone loss and attachment loss than non smoking equivalents. Prolonged and heavy smoking can reduce gingival bleeding and therefore mask the clinical marker of bleeding on probing often used by dentists to monitor periodontal health. This has implications for potential misdiagnosis and failure to detect periodontitis at an early stage. Nicotine metabolites concentrate in the periodontal tissues and can have local effects as well as the potential to affect the systemic host response. Dentists are well placed to assess the smoking status of their young patients and have a role to play in the delivery of smoking cessation advice especially as it pertains to periodontal health. In this way the dental profession can also make a significant contribution to the general health and well being of our youth and future generations.

Periodontal management of an adolescent with Down's syndrome--a case report

A case of periodontitis in a young adolescent Japanese girl with Down's syndrome is presented in this report. The patient received a monthly preventive course of dental care consisting of mechanical plaque control and oral hygiene instruction. After 2.5 years she recovered from progression of periodontal disease both clinically and microbiologically. The importance of clinical care for periodontitis in Down's syndrome patients is discussed.

The Application of Multilevel Modeling in the Analysis of Longitudinal Periodontal Data – Part I: Absolute Levels of Disease

BACKGROUND

Statistical analyses of periodontal data that average site measurements to subject mean values are unable to explore the site-specific nature of periodontal diseases. Multilevel modeling (MLM) overcomes this, taking hierarchical structure into account. MLM was used to investigate longitudinal relationships between the outcomes of lifetime cumulative attachment loss (LCAL) and probing depth (PD) in relation to potential risk factors for periodontal disease progression.

METHODS

One hundred males (mean age 17 years) received a comprehensive periodontal examination at baseline and at 12 and 30 months. The resulting data were analyzed in two stages. In stage one (reported here), the absolute levels of disease were analyzed in relation to potential risk factors; in stage two (reported in a second paper), changes in disease patterns over time were analyzed in relation to the same risk factors. Each approach yielded substantially different insights.

RESULTS

For absolute levels of disease, subject-level risk factors (covariates) had limited prediction for LCAL/PD throughout the 30-month observation period. Tooth position demonstrated a near linear relationship for both outcomes, with disease increasing from anterior to posterior teeth. Sites with subgingival calculus and bleeding on probing demonstrated more LCAL and PD, and supragingival calculus had an apparently protective effect. Covariates had more "explanatory power" for the variation in PD than for the variation in LCAL, suggesting that LCAL and PD might be generally associated with a different profile of covariates.

CONCLUSION

This study provides, for a relatively young cohort, considerable insights into the factors associated with early-life periodontal disease and its progression at all levels of the natural hierarchy of sites within teeth within subjects.

Clinical course of chronic periodontitis

AIM

The purpose of this study was to assess the initiation and progression of periodontal disease during adult life.

MATERIALS AND METHODS

In a 26-year longitudinal investigation of the initiation and progression of chronic periodontitis that started in 1969 and included 565 men of Norwegian middle class, 223 who had participated in some, but not all, intermediate examinations presented at the last survey in 1995. Fifty-four individuals were available for examination in all seven surveys.

RESULTS

Covering the age range from 16 to 60 years, the study showed that at 16 years of age, 5% of the participants had initial loss of periodontal attachment (ILA > or = 2 mm) at one or more sites. Both the subject incidence and the site incidence increased with time, and by 32 years of age, all individuals had one or more sites with loss of attachment. As age progressed, new lesions affected sites, so that as these men approached 60 years of age approximately 50% of all available sites had ILA. An assessment of the intraoral distribution of the first periodontal lesion showed that, regardless of age, molars and bicuspids were most often affected. At and before the age of 40 years, the majority of ILA was found in buccal surfaces in the form of gingival recession. By 50 years, however, a greater proportion of sites presented with attachment loss attributed to pocket formation or a combination of pocket formation and gingival recession. As individuals neared 60 years of age, approximately half of the interproximal areas in posterior teeth had these lesions.

CONCLUSION

This investigation has shown that, in a well-maintained population who practises oral home care and has regular check-ups, the incidence of incipient periodontal destruction increases with age, the highest rate occurs between 50 and 60 years, and gingival recession is the predominant lesion before 40 years, while periodontal pocketing is the principal mode of destruction between 50 and 60 years of age.