Risk assessment for periodontal diseases

Contesting the conventional wisdom of periodontal risk assessment

Over the years, several reviews of periodontal risk assessment tools have been published. However, major misunderstandings still prevail in repeated attempts to use these tools for prognostic risk prediction. Here we review the principles of risk prediction and discuss the value and the challenges of using prediction models in periodontology. Most periodontal risk prediction models have not been properly developed according to guidance given for the risk prediction model development. This shortcoming has led to several problems, including the creation of arbitrary risk scores. These scores are often labelled as 'high risk' without explicit boundaries or thresholds for the underlying continuous risk estimates of patient-important outcomes. Moreover, it is apparent that prediction models are often misinterpreted as causal models by clinicians and researchers although they cannot be used as such. Additional challenges like the critical assessment of transportability and applicability of these prediction models, as well as their impact on clinical practice and patient outcomes, are not considered in the literature. Nevertheless, these instruments are promoted with claims regarding their ability to deliver more individualized and precise periodontitis treatment and prevention, purportedly resulting in improved patient outcomes. However, people with or without periodontitis deserve proper information about their risk of developing patient-important outcomes such as tooth loss or pain. The primary objective of disseminating such information should not be to emphasize assumed treatment efficacy, hype individualization of care, or promote business interests. Instead, the focus should be on providing individuals with locally validated and regularly updated predictions of specific risks based on readily accessible and valid key predictors (e.g. age and smoking).

Changes in Oral Health Behavior According to Dental Calculus Removal Health Insurance in Korea

BACKGROUND

Periodontal disease is a chronic disease that is increasing year by year. Korea also recognizes the seriousness of periodontal disease and has been applying preventive scaling in the National Health Insurance since 2013 to prevent it. Studies confirming the effectiveness of such insurance coverage are very scarce. Therefore, this study intended to confirm the effect of such policy by comparing and analyzing the oral health characteristics and oral health behavior of the South Koreans before and after the scaling insurance.

METHODS

For all the analyses, complex sampling analysis with the stratification variable, clustering variable, and weight was applied. For a total of 40,945 people, the demographic characteristics, oral health characteristics, dental clinic use, brushing, and use of oral care supplies were compared through chi-square tests.

RESULTS

Scaling insurance showed a positive effect (p < 0.05) on the unemployed and elderly people, who had lost their previous economic status; on smoking and willingness to quit smoking as well as on consultation on drinking problems; on dental-clinic use and oral examination in terms of utilization of dental clinics; and on brushing after lunch, before breakfast, and before sleeping.

CONCLUSIONS

The study results showed that the scaling rate was universalized, and there was a positive effect on willingness to quit smoking and undergo oral examination. An active reimbursement policy for oral health education is needed, however, if a substantial change in oral health behavior is to be achieved.

Interleukin-17 levels in gingival crevicular fluid of aggressive periodontitis and chronic periodontitis patients

Context

Interleukin-17 (IL-17) plays an important function in initiation, progression of any inflammatory condition. It is a pro-inflammatory cytokine and considered to be founding member. Periodontitis being an inflammatory condition of periodontium, IL-17 does have a potential role in periodontitis. The current research has shown positive correlation between the IL-17 and severity of periodontitis. Therefore, this research study aimed to evaluate the levels of IL-17 in aggressive periodontitis (AgP), chronic periodontitis (CP), and "healthy gingival sites."

Materials and Methods

A total of 45 selected subjects (90 samples) were equally divided into three different groups. Group 1 (Healthy gingiva on clinical examination): Subjects with healthy gingiva and no evidence of periodontal attachment level (PAL), probing pocket depth (PPD) <3 mm papillary bleeding index (PBI) <1. Group 2 (AgP): Subjects having age <35 years with at least six permanent teeth apart from the incisors and first molars with PPD and PAL ≥5 mm. Group 3 (CP): It consist of subjects with clinical features of inflammation of gingiva with minimum six teeth in each jaw, with PPD ≥4 mm, PAL ≥4 mm. IL-17 levels were analyzed by using Gingival crevicular fluid (GCF). It was collected from the sulcus of first maxillary molar sites for quantitative analysis.

Results

GCF IL-17 levels in AgP were found to be 1.12 ± 0.29, 1.96 ± 1.71 in CP and 0.64 ± 0.23 in healthy gingival sites. Clinical parameters such as (1) plaque index (Turesky et al., modification of Quigley-Hein), (2) PPD, (3) PBI were higher (significantly) in periodontitis group as compared to healthy gingiva. Positive correlation was found to be significant between levels of IL-17 with PAL and PPD in AgP however in cases of CP, positive correlation of IL-17 levels was found only with PAL but not PPD.

Conclusion

Our study shows that the IL-17 levels were comparatively higher in GCF of AgP, CP in comparison to healthy gingiva, but the GCF IL-17 levels were higher in CP as compared to AgP.

Tropical Oral Disease: Analysing Barriers, Burden, Nutrition, Economic Impact, and Inequalities

Traditionally, a healthy mouth is a good indicator of good general health. Poor oral hygiene reflects the health of the oral cavity and is a risk factor for overall health. Although oral diseases like dental decay and periodontitis are prevalent, awareness of oral diseases is still limited. Oral disorders include a wide range of diseases that may not be confined to the oral anatomical structures but may be manifestations of systemic diseases. Identification of the risk factors of dental and oral diseases, including socio-economic determinants, plays a major role in the type of oral health care, and in the promotion of dental health awareness. This article reviews oral diseases in the Caribbean and aims to raise awareness of this subject while suggesting a research agenda for the region.

Long term comparison of the prognostic performance of PerioRisk, periodontal risk assessment, periodontal risk calculator, and staging and grading systems

BACKGROUND

Clinicians predominantly use personal judgment for risk assessment. Periodontal risk assessment tools (PRATs) provide an effective and logical system to stratify patients based on their individual treatment needs. This retrospective longitudinal study aimed to validate the association of different risk categories of four PRATs (Staging and grading; Periodontal Risk Assessment (PRA); Periodontal Risk Calculator; and PerioRisk) with periodontal related tooth loss (TLP), and to compare their prognostic performance.

METHODS

Data on medical history, smoking status, and clinical periodontal parameters were retrieved from patients who received surgical and non-surgical periodontal treatment. A comparison of the rate of TLP and non-periodontal related tooth loss (TLO) within the risk tool classes were performed by means of Kruskal-Wallis test followed by post-hoc comparison with the Bonferroni test. Both univariate and multivariate Cox Proportional hazard regression models were built to analyze the prognostic significance for each single risk assessment tool class on TLP.

RESULTS

A total of 167 patients with 4321 teeth followed up for a mean period of 26 years were assigned to four PRATs. PerioRisk class 5 had a hazard ratio of 18.43, Stage 4 had a hazard ratio of 7.99, and PRA class 3 had a hazard ratio of 6.13 compared with class/stage I. With respect to prognostic performance, PerioRisk tool demonstrated the best discrimination and model fit followed by PRA.

CONCLUSION

All PRATs displayed very good predictive capability of TLP. PerioRisk showed the best discrimination and model fit, followed by PRA.

Collins J, Jones T, Brache M, Toro M, Tumanyan S, Walters C, White S, Elias-Boneta A. The SmoCar Study: A Caribbean-Based Multicenter Study on the Prevalence and Disparities Linked to Smoking and Gingival Health

The aim of the SmoCar (Smoking in the Caribbean) study was to estimate the prevalence of smoking and the disparities in the smoking practices of three regions in the Caribbean: Jamaica, Dominican Republic, and Puerto Rico. The secondary objective was to assess the prevalence and severity of gingivitis in relation to the smoking practices. The study population comprised 1,847 (weighted N = 1,830) individuals (18 years and older) who were volunteer participants from the capitals of Jamaica, Dominican Republic, and Puerto Rico. A structured interview was used to assess the participants’ smoking behaviors. The gingival index was used to determine the extent of gingival inflammation. Polytomous regression was used to estimate the adjusted odds ratios (aORs) for smoking status (current, past, or never), according to risk factors (sex, age-group, education, marital status, tooth-brushing frequency, and city of residence). Logistic regression models were used to assess the associations between different smoking status variables and mild to moderate/severe gingivitis. The majority of the participants were never-smokers, with current smokers being found most commonly in Kingston (33.22%), followed by San Juan (12.76%) and Santo Domingo (8.8%). Both current (aOR = 2.22, 95% confidence interval [1.45, 3.40]) and past (aOR = 1.87, 95% confidence interval [1.19, 2.93]) smoking (vs. never smoking) was strongly associated with severe gingivitis. Smoking was the most prevalent in Jamaicans and the least prevalent in Dominicans. The study population of current smokers was found to have a fourfold increased risk of severe gingivitis and a twofold increased risk of moderate gingivitis.

Potential Effect of Tobacco Consumption through Smoking and Chewing Tobacco on IL1beta Protein Expression in Chronic Periodontitis Patients: In Silico Molecular Docking Study

Detrimental effect of bad oral habits, such as smoking and chewing tobacco, on chronic periodontitis (CP) manifest chronic inflammation of gingival tissues which majorly results in gum bleeding, and teeth loss. A genetic association study of Interleukin 1 beta (IL1β) has been conducted in CP patients having smoking and chewing tobacco habits in regular life style. A molecular docking study has been consequently done to analyze the effect of tobacco on CP progression in depth. All statistical evaluation has been done by using SPSS v16.0. The findings of the study show the significant association of IL1β gene polymorphisms with CP increased susceptibility in combination of oral habits as mentioned earlier. The docking profile has showed the highest binding affinity of IL1β protein with the Nicotine derived Nitrosamine Ketone (NNK), one of the derivatives of nicotine which is in-taken through the habits associated with smoking and chewing tobacco. Nicotine, N-nitrosoanabasine, and N-nitrosonornicotine, the other derivatives, have also demonstrated significant impact over the IL1β protein-caused altered expression. Thus, this study concluded that the harmful effect of tobacco may increase the inflammation in periodontia by inducing the inflammatory active site of the IL1β protein in the CP patients.

Self-perceived oral symptoms and periodontal status among young intravenous heroin addicts: A cross-sectional case-control study

BACKGROUND

It is hypothesized that (a) self-perceived oral symptoms (OSs) are worse in intravenous heroin addicts (IHA) than controls; and (b) clinical periodontal inflammatory parameters (plaque index [PI], bleeding on probing [BOP], PD and clinical attachment loss [AL]), number of missing teeth (MT), and radiographic marginal bone loss (MBL) are higher in IHA compared with controls. The aim was to compare the self-perceived OSs and periodontal parameters among young IHA and controls.

METHODS

Sociodemographic data, self-perceived OSs and duration and daily frequency of intravenous heroin use was gathered using a structured questionnaire. Full-mouth PI, BOP, PD, and clinical AL were measured, and number of MT were recorded. Mesial and distal MBL on all teeth was measured on digital radiographs. Odds ratios (OR) with 95% confidence intervals (CI) were computed for self-perceived OSs and periodontal parameters were assessed using the Mann Whitney U-test and logistic regression analysis. Sample-size was estimated, and level of significance was set at P < 0.05.

RESULTS

OR (95% CI) for self-perceived loose teeth (P < 0.001), pain in teeth (P < 0.001), dry mouth (P < 0.001), burning sensation in mouth (P < 0.001), bleeding gums (P < 0.001) and pain during chewing (P < 0.001) were significantly higher in the test than control group. Number of MT (P < 0.05), PI (P < 0.05), clinical AL (P < 0.05), and mesial (P < 0.05) and distal (P < 0.05) MBL were statistically significantly higher among individuals in the test group compared with the control group.

CONCLUSION

Self-perceived OSs and periodontal inflammatory parameters were worse in IHA than controls.

The occurrence of periodontal diseases and its correlation with different risk factors among a convenient sample of adult Egyptian population: a cross-sectional study

Background: Even though extensive studies on the prevalence of periodontal diseases in various populations worldwide have been carried out, data for the Egyptian population is limited.  The present study was carried out to evaluate the occurrence and the severity of periodontal disease and its correlation with different risk factors. Methods: Periodontal examination was performed on 343 adults attending the outpatient clinics of the Faculty of Dentistry, Cairo University, as well as three private clinics. Socio-demographic data, brushing frequency, body mass index (BMI) and dietary habits were recorded using a questionnaire. Results: It was found that 58.9% of participants had calculus deposits. The occurrence of periodontitis was 89.8%, where 70.8% of participants had stage I and 15.2% had stage II, while only 4.4% and 2.05% suffered from stage III and stage IV, respectively. Calculus was positively correlated with age, grains, and sugar in drinks and negatively correlated with socioeconomic status, education level, brushing frequency and milk. Calculus was not correlated with gender and BMI. Periodontitis was positively correlated with age, carbohydrates other than bread, grains, and crackers, as well as caffeinated drinks, while negatively correlated with gender, socioeconomic status, brushing frequency. Periodontitis was not correlated with BMI or education level. Conclusion: The present study clarifies that age, brushing frequency, carbohydrates and caffeinated drinks consumption are significant factors influencing the occurrence and the severity of periodontal diseases.

The occurrence of periodontal diseases and its correlation with different risk factors among a convenient sample of adult Egyptian population: a cross-sectional study

Background: Even though extensive studies on the prevalence of periodontal diseases in various populations worldwide have been carried out, data for the Egyptian population is limited.  The present study was carried out to evaluate the occurrence and the severity of periodontal disease and its correlation with different risk factors.

Methods: Periodontal examination was performed on 343 adults attending the outpatient clinics of the Faculty of Dentistry, Cairo University, as well as three private clinics. Socio-demographic data, brushing frequency, body mass index (BMI) and dietary habits were recorded using a questionnaire.

Results: It was found that 58.9% of participants had calculus deposits. The occurrence of periodontitis was 89.8%, where 70.8% of participants had stage I and 15.2% had stage II, while only 4.4% and 2.05% suffered from stage III and stage IV, respectively. Calculus was positively correlated with age, grains, and sugar in drinks and negatively correlated with socioeconomic status, education level, brushing frequency and milk. Calculus was not correlated with gender and BMI. Periodontitis was positively correlated with age, carbohydrates other than bread, grains, and crackers, as well as caffeinated drinks, while negatively correlated with gender, socioeconomic status, brushing frequency. Periodontitis was not correlated with BMI or education level.

Conclusion: The present study clarifies that age, brushing frequency, carbohydrates and caffeinated drinks consumption are significant factors influencing the occurrence and the severity of periodontal diseases.

Periodontal Health and Oral Microbiota in Patients with Rheumatoid Arthritis

This study aimed to investigate the periodontal health of patients with established rheumatoid arthritis (RA) in relation to oral microbiota, systemic and oral inflammatory mediators, and RA disease activity. Forty patients underwent full-mouth dental/periodontal and rheumatological examination, including collection of blood, saliva, gingival crevicular fluid (GCF) and subgingival plaque. Composition of plaque and saliva microbiota were analysed using 16S rRNA sequencing and levels of inflammatory mediators by multiplex-immunoassay. The majority of the patients (75%) had moderate or severe periodontitis and the rest had no/mild periodontitis. Anti-citrullinated protein antibody (ACPA) positivity was significantly more frequent in the moderate/severe periodontitis (86%) compared to the no/mild group (50%). No significance between groups was observed for RA disease duration or activity, or type of medication. Levels of sCD30/TNFRSF8, IFN-α2, IL-19, IL-26, MMP-1, gp130/sIL-6Rß, and sTNF-R1 were significantly higher in serum or GCF, and April/TNFSF13 was significantly higher in serum and saliva samples in moderate/severe periodontitis. The microbial composition in plaque also differed significantly between the two groups. In conclusion, the majority of RA patients had moderate/severe periodontitis and that this severe form of the disease was significantly associated with ACPA positivity, an altered subgingival microbial profile, and increased levels of systemic and oral inflammatory mediators.

Association of Childhood Oral Infections With Cardiovascular Risk Factors and Subclinical Atherosclerosis in Adulthood

IMPORTANCE

Severe forms of common chronic oral infections or inflammations are associated with increased cardiovascular risk in adults. To date, the role of childhood oral infections in cardiovascular risk is not known because no long-term studies have been conducted.

OBJECTIVE

To investigate whether signs of oral infections in childhood are associated with cardiovascular risk factors and subclinical atherosclerosis in adulthood.

DESIGN, SETTING, AND PARTICIPANTS

The cohort study (n = 755) was derived from the Cardiovascular Risk in Young Finns Study, an ongoing prospective cohort study in Finland initiated in 1980. Participants underwent clinical oral examinations during childhood, when they were aged 6, 9, or 12 years and a clinical cardiovascular follow-up in adulthood in 2001 at age 27, 30, or 33 years and/or in 2007 at age 33, 36, or 39 years. Cardiovascular risk factors were measured at baseline and during the follow-up until the end of 2007. Final statistical analyses were completed on February 19, 2019.

MAIN OUTCOMES AND MEASURES

Four signs of oral infections (bleeding on probing, periodontal probing pocket depth, caries, and dental fillings) were documented. Cumulative lifetime exposure to 6 cardiovascular risk factors was calculated from dichotomized variables obtained by using the area-under-the-curve method. Subclinical atherosclerosis (ie, carotid artery intima-media thickness [IMT]) was quantified in 2001 (n = 468) and 2007 (n = 489).

RESULTS

This study included 755 participants, of whom 371 (49.1%) were male; the mean (SD) age at baseline examination was 8.07 (2.00) years. In this cohort, 33 children (4.5%) had no sign of oral infections, whereas 41 (5.6%) had 1 sign, 127 (17.4%) had 2 signs, 278 (38.3%) had 3 signs, and 248 (34.1%) had 4 signs. The cumulative exposure to risk factors increased with the increasing number of oral infections both in childhood and adulthood. In multiple linear regression models, childhood oral infections, including signs of either periodontal disease (R2 = 0.018; P = .01), caries (R2 = 0.022; P = .008), or both (R2 = 0.024; P = .004), were associated with adulthood IMT. The presence of any sign of oral infection in childhood was associated with increased IMT (third tertile vs tertiles 1 and 2) with a relative risk of 1.87 (95% CI, 1.25-2.79), whereas the presence of all 4 signs produced a relative risk of 1.95 (95% CI, 1.28-3.00). The associations were more obvious in boys: if periodontal disease were present, the corresponding estimate was 1.69 (95% CI, 1.21-2.36); if caries, 1.46 (95% CI, 1.04-2.05); and if all 4 signs of oral infections, 2.25 (95% CI, 1.30-3.89). The associations were independent of cardiovascular risk factors.

CONCLUSIONS AND RELEVANCE

Oral infections in childhood appear to be associated with the subclinical carotid atherosclerosis seen in adulthood.

Contextual and Individual Determinants of Root Caries in Older People

The aim of this study was to identify the association of the presence of root caries in older people with contextual and individual determinants using a multilevel model. Data from the National Survey of Oral Health collected in Brazil were used. A sample of older Brazilians (aged 65-74 years) was included and selected through multistage probability cluster sampling, using probability proportional to size. Contextual variables of municipalities and individual variables of older people were included. Descriptive, bivariate, and multilevel analyses were conducted. Of the 3,926 older people included in the study, 934 (21.8%) had at least 1 tooth with root caries. There seemed to be no pattern of involvement between the anterior and posterior teeth in the dental arches. Multilevel analysis showed a higher presence of root caries among older people resident in municipalities that were noncapital cities (OR = 1.50), who were over 70 years of age (odds ratio, OR = 1.22), had nonwhite skin color (OR 1.35), had coronal caries (OR = 5.58), were dissatisfied with their teeth and mouth (OR = 1.47), and had self-perceived dental treatment needs (OR = 1.33). Contextual and individual determinants were associated with the occurrence of root caries in older people. Lesion presence demonstrated a profile of social inequality.

Detection of a new species of torque teno mini virus from the gingival epithelium of patients with periodontitis

We describe a novel species of torque teno mini virus called TTMV-204, which was isolated from the gingival epithelium of patients with periodontitis and characterized using viral metagenomics. The sequence of the full genome is 2824 nt in length. Phylogenetic analysis and genetic analyses show classic Betatorquevirus species organization with less than 40% amino acid similarity in ORF1. The prevalence of TTMV-204 in the periodontitis patient population was 18.75% (15/80), which was higher than in periodontally healthy individuals (10.00%, 10/80). However, the difference of the TTMV-204 prevalence between two groups was not statistically significant (p = 0.115). Further investigation is required to determine whether this new virus is associated with inflammation.

Awareness of periodontal disease and its management among medical faculty in Guntur district: A questionnaire-based study

Aim:

The aim of this study was to assess the awareness of periodontal disease, its influence on general health, and attitude toward periodontal disease management among medical faculty in Guntur district.

Materials and Methods:

In this cross-sectional study, 150 medical faculty members from different specialties in Guntur district were included in the study. A self-administered questionnaire was prepared based on knowledge, attitude, and practice surveys to assess the awareness of periodontal disease and its management.

Results:

Majority of the study participants (82%) had a previous dental visit. Only 31.3% believed that plaque is the major cause for periodontal disease. 56.7% responded that the relation between periodontal disease and systemic diseases is bidirectional. Only 39.3% were aware that periodontal disease is a risk factor for preterm low-birth weight infants. 52.6% of the medical faculty thought that scaling causes loss of enamel. 54.7% were aware that light amplification by stimulated emission of radiation is used in the periodontal treatment. Medical professionals who visited specialist in their previous dental visit obtained mean periodontal score (5.35 ± 1.686) greater than those who had visited general dentist and the difference is statistically significant (0.024).

Conclusion:

This study clearly demonstrates that medical practitioners had fair knowledge about various aspects of periodontal disease. This was particularly evident among those who have had a previous visit to a dentist. It was also found that young professionals with limited experience in the profession had better knowledge.

A novel species of torque teno mini virus (TTMV) in gingival tissue from chronic periodontitis patients

A new species of torque teno mini virus, named TTMV-222, was detected in gingival tissue from periodontitis patients using a viral metagenomics method. The 2803-nucleotide genome of TTMV-222 is closely related to TTMV1-CBD279, with 62.6% overall nucleotide similarity. Genetic analyses of the new virus genome revealed a classic genomic organization but a weak identity with known sequences. The prevalence of TTMV-222 in the periodontitis group (n = 150) was significantly higher than that in the healthy group (n = 150) (p = 0.032), suggesting that the new virus may be associated with inflammation in chronic periodontitis patients. However, this finding requires further investigation.

Association between Polymorphisms in Interleukins 4 and 13 Genes and Chronic Periodontitis in a Han Chinese Population

Chronic periodontitis (CP) is one of the most common chronic inflammatory diseases and cytokines play a pivotal role in the regulation of immune response. Interleukin-4 (IL-4) and interleukin-13 (IL-13) are anti-inflammatory cytokines and several polymorphisms of them have been proved involved in periodontal disease. This study aimed to evaluate whether three single nucleotide polymorphisms (SNPs), rs2070874 and rs2243248 from IL4 and rs1800925 from IL13, are associated with CP in a Han Chinese population consisting of 440 moderate or severe CP patients and 324 healthy controls. Genomic DNA extracted from buccal epithelial cells of the included participants were genotyped using a matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry method. No significant association between rs2070874 or rs1800925 and CP was found, while the frequencies of rs2243248 and two haplotypes C-G-T and C-T-T showed significant differences between the two groups. The results suggest that the polymorphism rs2243248 and haplotypes C-G-T and C-T-T may be associated with CP susceptibility in the present Han Chinese population.

Prevalence of Actinomyces spp. in patients with chronic periodontitis

This study investigated the prevalence of Actinomyces spp. in shallow, deep and very deep pockets of patients with chronic periodontitis compared to healthy controls and correlated the results with clinical status. Twenty patients with chronic periodontitis and 15 healthy subjects were enrolled in this study. Clinical indices were recorded in a six-point measurement per tooth. From each patient samples of supra and subgingival plaque were taken separately from teeth with shallow, deep and very deep pockets. Samples of supragingival plaque and sulcular microflora were collected from the healthy subjects. All the samples were cultivated on different media at 37̊C in an anaerobic atmosphere for 7 days. All the suspect colonies were identified using a rapid ID 32 A system (bioMèrieux) and MALDI-TOF-MS analysis using an Autoflex II Instrument (Bruker Daltonics) together with in house developed identification software and a reference spectra database. A total of 977 strains were identified as Actinomyces. Actinomyces naeslundii/oris/johnsonii (430 isolates) was the most prevalent species and was found in all patients and in almost all of the healthy subjects. Significant differences (p=0.003) between the groups were found for Actinomyces odontolyticus/meyeri and Actinomyces israelii which were associated with periodontitis patients. Actinomyces dentalis was found in higher percentage (p=0.015) in the periodontitis group. Actinomyces gerencseriae and Actinomyces massiliensis were significantly more often found supragingivally than subgingivally (p=0.004, p=0.022, respectively) in the periodontitis group. Whether some Actinomyces species, definitely important plaque formers, are actively involved in the pathogenicity of chronic periodontitis needs further investigation.

Assessment of the prevalence of periodontal diseases and treatment needs: A hospital-based study

Background:

The periodontal diseases are the most prevalent oral diseases worldwide especially in developing countries like India. The objective of this cross-sectional survey was to determine the prevalence of periodontal diseases and treatment needs (TNs) in a hospital-based population.

Materials and Methods:

Totally, 500 men and women (15-74 years) were recruited and periodontal status of each study subject and sextant was evaluated on the basis of community periodontal index of TNs, and thereafter TN for each subject and sextant was categorized on the basis of the highest code recorded during the examination.

Results:

A total of 500 subjects (59% males and 41% females) was divided into seven age groups, that is, 15-19, 20-24, 25-34, 35-44, 45-54, 55-64, and 65-74 years and sextants were included from the 486 subjects. Healthy periodontium, bleeding on probing, calculus, shallow pockets, and deep pockets were found in 3.9%, 6.58%, 50.61%, 20.98%, and 17.90% subjects, respectively. Males were more affected with shallow and deep pockets as compared to females. Periodontal diseases in the early stages were more prevalent in the younger age groups, whereas advanced stages were more prevalent in older age groups. 17.90% subjects and 11.48% sextants need complex treatment. About 77.98% subjects and 73.15% sextants require either oral hygiene instructions or oral hygiene instructions and oral prophylaxis. Only 3.9% subjects and 15.36% sextants were healthy and needed no treatment.

Conclusions:

Periodontal diseases were found to be 96.30% in the study population and the results indicate that majority of the population need primary and secondary level of preventive program to reduce the chances of initiation or progression of periodontal diseases thereby improving their systemic health overall.

Association between alcohol consumption and periodontal disease among older Nigerians in plateau state: a preliminary study

OBJECTIVE

To report the periodontal status of older adults in Plateau State, Nigeria, and determine its Association with alcohol consumption.

BACKGROUND

Periodontal disease is common among Nigerians, and the prevalence increases with age. The role that alcohol consumption plays in the occurrence of the disease among Africans is uncertain.

MATERIALS AND METHODS

Sample selection was performed using a multistage cluster sampling technique among older adults in Plateau State, Nigeria. Interviews, using structured questionnaires, were conducted for each of the participants. Clinical examinations were then carried out to determine the occurrence of periodontal disease, assessed by clinical attachment loss and probing depth.

RESULTS

The prevalence of periodontal disease was 79%, being severe in 46% of the population. Almost half of the participants (46.7%) examined were still actively consuming alcohol, among which 48% reported a history of intoxication. There was no statistically significant relationship between periodontal disease and the frequency of alcohol consumption, or quantity consumed on each occasion. However, alcohol consumption was highly correlated with periodontal disease among those who reported intoxication from the drink (r = 0.095; p = 0.033). A history of intoxication with alcohol was the only significant predictor of periodontal disease, after adjusting for age and gender.

CONCLUSION

Periodontal disease was highly prevalent among older Nigerians in this study. Apart from those who reported intoxication from alcohol, there was no statistically significant relationship between the prevalence of periodontal disease and the frequency of alcohol consumption or the quantity consumed on each occasion.

Crosstalk between hormones and oral health in the mid-life of women: A comprehensive review

Oral health is constantly shaped by the cross-talk between behavioral, biological, and social forces. Menopause is that time in a woman's life when menstrual cycles cease by reduced secretion of the ovarian hormones, such as, estrogen and progesterone. Diseases of the mouth itself are the most common reasons for pain and discomfort in the mouth. However, there are certain situations where oral symptoms are caused as a result of systemic diseases. This review article has emphasized on the diverse oral presentations of postmenopausal women by descriptive analysis of various underlying mechanisms associated with these conditions. Dentists should be aware of the possible association of menopause and various oral health problems.

Association between mental well-being, depression, and periodontal attachment level among young adults of the postwar Sebha city, Libya: A pilot study

OBJECTIVES

The present study was aimed to investigate the association of mental well-being and depression with periodontal clinical attachment loss among young adults in postwar urban population of Sebha city, Libya.

MATERIALS AND METHODS

Mental well-being and depression were assessed using Arabic versions of World Health Organization (WHO) five well-being index and major depression inventory (ICD-10), respectively. Random sample of 149 subjects were studied. Degree of periodontal attachment was measured at six sites per tooth using a rigid manual periodontal probe.

RESULT AND CONCLUSION

A total of 59.11% of the studied samples had healthy mental well-being state, whereas 40.81% had poor mental well-being. The severity of depression was stronger in males than in females. In the present study mental well-being, depression, and all its categories did not have any significant effect on periodontal attachment loss. Further studies and health interventions can be planned based on this data.

Different treatment strategies are applied to patients with the same periodontal status in general dentistry

OBJECTIVE

To analyse how general dental practitioners (GDPs) and dental hygienists judge and plan to treat patients with different periodontal conditions.

MATERIALS AND METHODS

Seventy-seven GDPs and 50 dental hygienists in a Swedish county, Halland, participated in a questionnaire study. The response rate was 94%. The questionnaire consisted of four simulated patient cases and an attached answer sheet. The patient cases had different periodontal status, ranging from healthy to moderate bone loss with general inflammation. The clinicians judged the periodontal status as healthy or diseased. If judged as diseased the clinicians suggested a diagnosis, selected treatment options and estimated the number of treatment sessions for each patient case. The clinicians were compared to each other regarding their judgement, as healthy or diseased, diagnostics and treatment.

RESULTS

Three out of four patients were judged both as healthy and diseased by different clinicians. If judged as diseased the patients were diagnosed as having gingivitis or periodontitis. Regardless of the clinicians' former judgement and diagnostics there were no differences (p > 0.05) in the selected treatment options but there was a difference (p < 0.05) in the suggested number of treatment sessions.

CONCLUSIONS

Clinicians' judgement of the same periodontal condition, as healthy or diseased, varies, which partly results in different treatment decisions considering the number of treatment sessions. The suggested number of treatment sessions varied also between clinicians even if they judged and diagnosed the condition likewise. The willingness to treat and suggested treatment options were not influenced by the variation in judgement and diagnostics.

Variations in inflammatory genes are associated with periodontitis

BACKGROUND

Periodontitis is a multi-factorial disease and several risk-factors such as infections, inflammatory responses, oral hygiene, smoke, aging and individual predisposition are involved in the disease. Pathogens trigger chronic inflammation with cytokines release which in turn leads to the destruction of the connective and the teeth supporting bone. The identification of genetic factors controlling oral inflammation may increase our understanding of genetic predisposition to periodontitis.Single nucleotide polymorphisms in the promoter region of Vascular Endothelial Growth Factor, Alpha-1-Antichymotripsin, hydroxy-methyl-glutaryl CoA reductase, Interferon alpha, Interleukin-1 Beta, Interleukin 10, Interleukin 6 and Tumor Necrosis Factor- alpha genes from a case/control study were investigated.

RESULTS

The C allele of Vascular Endothelial Growth Factor, A allele of Interleukin 10 and GG genotype of Tumor Necrosis Factor-α were individually associated with chronic periodontitis. However, the concomitant presence of the three genetic markers in the same subjects appeared to play a synergistic role and increased several folds the risk of the disease.

CONCLUSIONS

Our findings offer new tools to implement the screening of unaffected subjects with an increased susceptibility of periodontitis and increase our understanding regarding the genetic inflammatory background related to familiarity of the disease.

Socioeconomic disparities of periodontitis in Koreans based on the KNHANES IV

OBJECTIVES

The aim of this study was to identify the socioeconomic factors associated with the prevalence of periodontitis in Koreans.

METHODS

Cross-sectional data from 12 763 subjects, 15 years old and above, who underwent periodontal examinations were obtained from the Korean National Health and Nutrition Examination Survey IV (2007-209). Multivariate linear and logistic regression analyses were applied to estimate the association between socioeconomic indicators and prevalence of periodontitis.

RESULTS

A significant association was found between increasing age and periodontitis. Participants with higher income were less likely to have periodontitis (aOR = 0.9 and 95% CI = 0.78-0.98, and aOR = 0.7 and 95% CI = 0.60-0.80 in the middle and highest quintiles of monthly household income, respectively). In addition, participants living in rural areas were less likely to have periodontitis (aOR = 0.9 and 95% CI = 0.81-0.99), and current smokers were more likely to have periodontitis (aOR = 1.7 and 95% CI = 1.49-1.89). The analysis of comorbidities revealed that individuals with diabetes mellitus (DM) were significantly more likely to have periodontitis (aOR = 1.4 and 95% CI = 1.18-1.68).

CONCLUSIONS

In a rapidly increasing Korean population, the lower socioeconomic groups as well as individuals with DM were significantly more likely to present with periodontitis.

Age-related changes of fibroblast density in the human periodontal ligament

Objective

Recently, research has focused intensely on age-related tissue changes, not only in the field of dermatology but also in dental sciences. Although many new insights into age-related morphological, ultrastructural and biochemical changes in the periodontal ligament tissue have been gained, the basic question of whether there is a quantitative change in cell number remains unanswered or, at least to date, unpublished. Thus, the aim of this study was to detect age-related changes of the periodontal ligament regarding fibroblast density.

Material and methods

33 lateral tooth-bearing segments of the maxilla were obtained from deceased human individuals of different age, ranging from 7 to 63 years. The buccal segment of the periodontal ligament of the mesiobuccal root of the first maxillary molar was evaluated histomorphometrically to obtain the fibroblast density.

Results

The results clearly indicate a steady and statistically significant decline of fibroblast number with age.

Conclusion

It may be concluded that fibroblast density in the physiological human periodontal ligament tissue decreases with age, thus causing an initial delay in physiological, pathological or externally induced processes that require remodeling of the periodontal ligament, e.g. traumatic occlusion or orthodontic tooth movement. It may be assumed that an orthodontic tooth movement in elderly patients requires more time in the initial treatment phase and should be done with lighter forces.

A comparative study of the oral hygiene status of smokers and non-smokers in Ibadan, Oyo state

AIMS

The aim of this study was to assess the effect of tobacco smoking on gingival health and the oral hygiene status of respondents.

MATERIALS AND METHODS

A cross-sectional survey of 213 adults from three communities in the Ibadan North local government was carried out. Respondents were divided into two groups comprising of 117 smokers (cases) and 96 non-smokers (control). Intra oral examination was done using the Simplified Oral Hygiene Index (OHI-S) and Gingival index (GI).

RESULTS

The mean age of the smokers was 31.2 ± 12.6 years and that of the non-smokers 32.8 ± 9.5 years. The mean Simplified Oral Hygiene Index (OHI-S) was 1.15 ± 0.51 for the non-smokers and 2.19 ± 0.62 for the smokers (P < 0.05). The mean GI was 1.06 ± 0.55 for the non-smokers and 1.62 ± 0.58 for the smokers (P < 0.05).

CONCLUSION

The study shows that smoking is associated with increased severity of gingival disease. It is, therefore, recommended that smokers should be encouraged to visit a dentist for preventive procedure more regularly than the non-smokers and better still, smokers should be encouraged to quit smoking as gingival disease is not without consequences if allowed to persist.

Stress and periodontal disease: The link and logic!!

Stress is an equated response to constant adverse stimuli. At one point or another everybody suffers from stress. Stress is compatible with good health, being necessary to cope with the challenges of everyday life. Problems start when the stress response is inappropriate to the intensity of the challenge. Psychological stress can down regulate the cellular immune response. Communication between the central nervous system and the immune system occurs via a complex network of bidirectional signals linking the nervous, endocrine, and immune systems. Stress disrupts the homeostasis of this network, which in turn, alters immune function. Direct association between periodontal disease and stress remains to be proven, which is partly due to lack of an adequate animal models and difficulty to quantifying the amount and duration of stress and also there are many factors influencing the incidence and severity of periodontal disease. Nevertheless, more recent studies indicate that psychosocial stress represents a risk indicator for periodontal disease and should be addressed before and during treatment. This paper discusses how stress may modulate host response to bacteria and influence the course and progression of periodontal disease.

Oral hygiene behaviour change during the nonsurgical periodontal treatment phase

The purpose of the present study was to investigate the frequency of smoking cessation and the use of proximal tooth cleaning routines after a nonsurgical periodontal treatment phase in a Specialist clinic of Periodontology and to evaluate if these behaviour changes had any influence on the periodontal healing results. The investigation was conducted as a retrospective longitudinal study on a randomly selected population of 100 patients referred for periodontal treatment. The variables were registered from the dental records and the radiographs. Forty-six individuals declared that they were smokers at baseline and one individual of those quitted smoking during the nonsurgical treatment period. The percentage of individuals who performed proximal tooth cleaning daily was significantly increased from 56% to 72% during the treatment period. The patients practising proximal tooth cleaning daily had significantly lower Plaque index before as well as after the nonsurgical periodontal treatment phase compared to those without the routine. The subjects who did not perform tooth cleaning daily before the treatment and who did not introduce this routine had significantly deeper periodontal pockets compared to those who performed inter-dental cleaning daily before treatment or who had adopted the routine during the treatment phase. However, there were no significant differences according to number of deepened periodontal pockets after nonsurgical treatment irrespective of proximal cleaning routines. In the future, motivational interviewing may be a more effective method to achieve a behaviour change if an extended education of dental hygienists within this area will be implemented.

Estimation of the costs of smoking-related oral disease: a representative South Korean study

OBJECTIVES

The objectives of this study were to estimate the socioeconomic and psychological costs associated with smoking-related oral disease (SROD) with the aim of generating objective data that could be used in smoking cessation counselling by dental care providers and could also serve as data with which to set standards and criteria for use in dental health insurance.

METHODS

Patients were sourced from the 11 dental hospitals associated with dental schools in South Korea. A total of 1,288 of 10,080 patients with SROD were selected to participate in the study for a period of 2 years from January 2009 to March 2011. Data collected were analysed using spss Version 17.0.

RESULTS

Among the SRODs, the most common was periodontal disease (40.7%). Periodontal disease accounted for the highest social and economic costs. Mouth cancer accounted for the highest psychological cost.

CONCLUSIONS

In order to reduce associated socioeconomic and psychological costs, dental care providers and government should provide more proactive and more efficient smoking cessation programmes.

A cross-sectional study on the relationship between behavioral variables and economic status in periodontal disease among elderly individuals

OBJECTIVES

The objectives of this study were to examine the relationship between behavioral variables, such as smoking and level of income on the periodontal disease among older South Indian adults.

MATERIALS AND METHODS

Data pertaining to participants aged 55 years and above from the Outpatient Department of MR Ambedkar Dental College and Hospital were used. A total of 209 elderly subjects were selected by convenient sampling and a complete evaluation of their periodontal status was carried out.

RESULTS

Our study showed that patients belonging to the lower income group and smokers had more severe disease compared to other groups. They were found to have higher plaque scores, higher calculus scores, deeper pockets and attachment loss compared to the subjects of the other groups.

CONCLUSION

Variables, such as smoking, gender and low income are associated with the severity of periodontal disease in older adults.

Serum levels of long-chain polyunsaturated fatty acids in patients with periodontal disease

BACKGROUND

Long-chain polyunsaturated fatty acids omega-3 and omega-6 (LC-PUFA n-3 and n-6) can function as important inflammatory modulators and also have a strong effect in the proresolving inflammatory processes. The aim of the authors is to analyze the serum levels of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and arachidonic acid (AA) in patients with generalized chronic periodontitis (GCP) and compare these results with serum levels of patients with gingivitis only.

METHODS

Twenty-one patients with untreated GCP (mean age: 46.0 ± 8.8 years) and 16 patients with gingivitis only (mean age: 31.5 ± 7.5 years) were investigated. The clinical examination included probing depth (PD), clinical attachment level, bleeding on probing, and plaque index. Blood samples were analyzed for the presence of DHA, EPA, DPA, and AA using gas chromatography.

RESULTS

Significantly higher levels of DHA, DPA, EPA, and AA were observed in patients with GCP when compared with patients with gingivitis (P = 0.007, P = 0.004, P = 0.033, and P = 0.001, respectively). The differences were still significant even after the adjustments for age and sex. The PD showed a significant positive correlation with DHA (r = 0.5; P = 0.003), DPA (r = 0.6; P <0.001), and AA (r = 0.6; P <0.001).

CONCLUSION

The present findings suggest that serum levels of LC-PUFA n-3 and n-6 may be affected by the severity of periodontal disease.

Role of high endothelial postcapillary venules and selected adhesion molecules in periodontal diseases: a review

Periodontitis is accompanied by the proliferation of small blood vessels in the gingival lamina propria. Specialized postcapillary venules, termed periodontal high endothelial-like venules, are also present, and demonstrate morphological and functional traits similar to those of high endothelial venules (HEVs) in lymphatic organs. The suggested role of HEVs in the pathogenesis of chronic periodontitis involves participation in leukocyte transendothelial migration and therefore proinflammatory effects appear. Recent observations suggest that chronic periodontitis is an independent risk factor for systemic vascular disease and may result in stimulation of the synthesis of acute phase protein by cytokines released by periodontal high endothelial cells (HECs). However, tissue expression of HEV-linked adhesion molecules has not been evaluated in the gingiva of patients with chronic periodontitis. This is significant in relation to potential therapy targeting expression of the adhesion molecules. In this review, current knowledge of HEV structure and the related expression of four surface adhesion molecules of HECs [CD34, platelet endothelial cell adhesion molecule 1, endoglin and intercellular adhesion molecule 1 (ICAM-1)], involved in the key steps of the adhesion cascade in periodontal diseases, are discussed. Most studies on the expression of adhesion molecules in the development and progression of periodontal diseases pertain to ICAM-1 (CD54). Studies by the authors demonstrated quantitatively similar expression of three of four selected surface markers in gingival HEVs of patients with chronic periodontitis and in HEVs of reactive lymph nodes, confirming morphological and functional similarity of HEVs in pathologically altered tissues with those in lymphoid tissues.

Analysis of IL-1α(-889) and IL-1B(+3953) Gene Polymorphism in Syrian Patients with Aggressive Periodontitis: A Pilot Study

Polymorphisms in IL-1 gene have been suggested to influence transcription of IL-1α and IL-1B and thereby the pathophysiology of periodontitis. Using genotyping IL-1 test, a pilot study was conducted on 32 Syrian patients with aggressive periodontitis (AgP) and 35 healthy controls to investigate the association between the IL-1α(−889), IL-1B(+3953) gene polymorphisms and AgP among schoolchildren. The results revealed a similar distribution of genotypes between patients and controls, and did not support an association between IL-1 gene polymorphisms and AgP, however, the association was significant in male patients only. To determine and confirm any susceptible or resistant genes for AgP, future studies should use many target genes and well-defined related periodontal outcomes.

Evaluation of periodontal risk assessment model among adults aged 30-60 years attending KLE Dental College, Belgaum: A hospital-based study

Aim:

The aim of the present study was to evaluate the periodontal risk of individuals using the modified periodontal risk assessment model.

Materials and Methods:

Adult subjects aged 30-60 years attending the out patient department of Institute of Dental Sciences, Belgaum in a week’s period were screened and 30 among those who met the criteria were included in the study. Complete history and examination of the oral cavity was done using mouth mirror and community periodontal index probes. Periodontal status was recorded using community periodontal index. Systemic conditions like hypertension and diabetes was assessed by suitable investigations. All the risk factors were plotted on a model using Microsoft excel and periodontal risk was assessed based on the findings and categorized as low, moderate and high risk.

Results:

Among 30 patients 13 were in low risk group, 10 in moderate risk group, and 7 in high risk group identified by proposed model given by Vishwa Chandra whereas 20 patients were in low risk group, 5 in moderate risk group and 5 in high risk group when identified Lang and Tonetti model (2003).

Conclusion:

In conclusion the use of risk assessment tool would result in reduction of complex therapies and would prevent the future effects of periodontal disease such as bone and tooth loss.

Toothbrushing and smoking among adolescents--aggregation of health damaging behaviours

AIM

The aim of this study was to determine whether an association exists between daily smoking and infrequent toothbrushing habits among adolescents.

MATERIALS AND METHODS

Nationally representative samples of 14-, 16- and 18-year-old Finns (N=5643) took part in the survey. A 12-page structured questionnaire was posted to the adolescents, asking them to complete it and return it in an enclosed pre-paid envelope. The χ(2)-test and a logistic regression model were used for analyses.

RESULTS

At the age of 14 years, 8.5% reported smoking daily, at 16 years 25.0% and at 18 years 33.2%. Only 28.3-54.7% of the adolescents reported brushing their teeth more than once a day. Among 14-year-olds, 6.5% of the adolescents reported both smoking daily and brushing less than twice a day. The respective figures were 17.7% for the 16-year-olds and 21.6% for the 18-year-olds. Among the 14-year-olds, the strongest association with smoking daily and brushing less than twice a day was found with low school performance (OR=8.2), and among 16- and 18-year-olds school career (studying at a vocational school, OR=3.4).

CONCLUSION

Daily smoking and infrequent toothbrushing are strongly associated in adolescence.

Prediction of future marginal bone level: a radiographic study

AIM

The aim of the study was to predict the marginal bone level at a 5-year follow-up based on the information available from an initial radiographic examination and to evaluate the precision of the prediction by comparing the predicted bone levels with those actually observed at the follow-up.

MATERIALS AND METHODS

In 1997, 616 randomly selected dentate individuals underwent a full-mouth radiographic survey. In 2003, 473 of those individuals (77%) participated in a second radiographic examination. Marginal bone level, caries lesions, fillings, crowns, root fillings and periapical status were recorded on all teeth. On the basis of data available from the first examination, a linear mixed model regression analysis with the tooth as the unit of analysis was used to predict the marginal bone level 5 years later.

RESULTS

Number of teeth, smoking, and also presence of apical periodontitis and crowns were associated with bone loss and could be used as predictors of future marginal bone level.

CONCLUSION

The analysis of all teeth showed that the number of tooth- and person-specific factors at the first examination influenced the prediction of the marginal bone level at the 5-year follow-up examination. However, the performance of the combined prediction model was less satisfactory.