Periodontal implications: older adults

Influence of different durations of estrogen deficiency on alveolar bone loss in rats

The purpose of this study was to morphometrically evaluate the influence of different durations of ovariectomy-induced estrogen deficiency on alveolar bone loss associated with ligature-induced bone loss in rats. Sixty female Wistar rats were randomly assigned to ovariectomy (OVX test group) or sham operation (SHAM control group). The OVX and SHAM groups were each distributed into three subgroups of ten rats each according to the duration of estrogen deficiency (30, 60 and 90 postoperative days). In all groups, for the last 30 days of the experimental period, cotton ligatures were placed around the cervix of the right upper second molar; the contralateral tooth was left unligated to serve as a control. The maxillary bones were removed, and the alveolar bone loss was analyzed by measuring the distance between the cementoenamel junction and the alveolar bone crest at the buccal site of the right upper second molar. A comparison between the ligated and unligated groups verified the presence of ligature-induced alveolar bone loss (p < 0.05). No significant differences were observed among the unligated groups (p > 0.05). A significant increase in bone loss was observed when ligation occurred 90 days after ovariectomy compared with the sham group (p < 0.05). These results demonstrate that long-term estrogen deficiency affects ligature-induced alveolar bone loss.

A preliminary assessment of the periodontal status of elderly pensioners in Benin City, Nigeria

AIM

This study was to assess the periodontal status of pensioners in Benin City and obtain baseline data.

MATERIALS AND METHODS

The cross-sectional descriptive study involved 250 subjects selected by systematic random sampling from three clusters of general, university and teaching hospital pensioners examined using the Community Periodontal Index index in four locations within Benin City.

RESULTS

The percentages of the dentate subjects with healthy gingiva, bleeding on probing, calculus, shallow pockets and deep pockets were 2.4, 5.2, 46.8, 38.8 and 6.8%, respectively. Only 2% needed no periodontal treatment; those requiring oral hygiene instructions, scaling and polishing and complex treatment were 52, 39 and 7%, respectively. There were no significant differences in the periodontal status of the pensioners by gender, age or tooth brushing habits.

CONCLUSION

The presence of calculus accounted for the most prevalent periodontal condition among the elderly pensioners followed by shallow periodontal pocketing apparently owing to poor dental attendance or lack of access to care. A comprehensive pensioner's oral health programme is recommended.

Awareness regarding the systemic effects of periodontal disease among medical interns in India

BACKGROUND

Medical curriculum does not provide required space for oral health; hence, many medical interns are unfamiliar with the oral cavity and oral health research.

AIMS

To study the level of awareness regarding systemic effects of periodontal disease among medical interns.

SETTINGS AND DESIGN

A cross-sectional qualitative study recruiting medical interns from two medical institutions affiliated to two different universities in Southern India.

MATERIALS AND METHODS

Study was carried out in two medical institutions affiliated to two different universities in Southern India. A total of 143 interns participated in the study. Each participant was given a self-administered, pre-tested, multiple choice question-type questionnaire to solve on the spot. In order to summarise the awareness level, respondents were graded on a five-level scale as poor, fair, good, very good, and excellent.

STATISTICAL ANALYSIS USED

Percentages, proportions.

RESULTS

A total of 67 respondents (47%) had fair; 60(42%), poor; and 18(11%), good level of awareness regarding the systemic effects of periodontal disease. Only 23(16%), 17(12%), 12(8%), 6(4%) and 4(3%) respondents were aware that the periodontal disease may be the possible risk factor for coronary heart disease, cerebral infarction, diabetes mellitus, hospital-acquired pneumonia, and preterm labour (low birth-weight infants), respectively. Only 12 respondents (8%) would seek dentist's opinion for all patients with systemic diseases related to dental disease.

CONCLUSIONS

Medical interns had inadequate awareness regarding the systemic effects of periodontal disease. Therefore, an integrated teaching of medical and dental sciences is recommended.

Use of enamel matrix protein derivative with minimally invasive surgical approach in intra-bony periodontal defects: clinical and patient-centered outcomes

This case series evaluated the clinical performance and patient-centered outcomes after a minimally invasive surgical technique (MIST) associated with enamel matrix protein derivative (EMD), for the treatment of intra-bony defects. Twelve patients presenting teeth with probing depth >5 mm and bleeding on probing associated with radiographic evidence of intra-bony defect were treated by MIST associated with EMD. Clinical parameters were measured at baseline, 3 and 6 months. Patient perception during the intraoperative period and during the first postoperative week was evaluated. The use of MIST with EDM promoted significant improvements in clinical parameters, minimal pain/discomfort and maximum esthetics satisfaction. Within of limits of the present study, it could be shown that MIST combined with EMD for the treatment of intra-bony defects promotes satisfactory clinical and patient-centered outcomes.

Factors of importance for the development of dehiscences during labial movement of mandibular incisors: a retrospective study of adult orthodontic patients

PURPOSE

Labial movement of mandibular incisors has traditionally been considered a risk factor for gingival recession. The aims of this study were to assess changes in prevalence and severity of gingival recession of mandibular incisors during orthodontic treatment of adults in whom the incisors had been moved labially and to identify parameters that could predict recession.

MATERIAL

The sample consisted of 150 adult patients (aged 33.7 +/- 9.5 years, mean +/- SD) treated nonextraction with fixed appliances. Pretreatment overjet, overbite, degree of crowding, presence of tooth rotation, canine relationship, vertical face height, and position of the mandibular incisor to A-pogonion and mandibular lines were registered on study casts and lateral headfilms. Pretreatment gingival recession, width of keratinized gingiva, gingival biotype, gingival inflammation, and visible plaque accumulation were recorded, as was posttreatment gingival recession. Labial movement was determined by measuring pretreatment and posttreatment casts. Descriptive statistics were used to describe gingival recession at baseline and follow-up. Variables to be included in a logistic regression analysis as possible predictors of recession were identified with a bivariate correlation analysis.

RESULTS

No significant increase in the mean gingival recession was observed during treatment. The prevalence of gingival recession greater than 0.1 mm increased from 21% before treatment to 35% after (P < .05). Only 2.8% of the subjects developed recession greater than 2 mm, and 5% of the pre-existing gingival recessions improved. The presence of baseline recession (P < .001), gingival biotype (P < .0179), and gingival inflammation (P < .003) were identified as possible predictors of recession. None of the orthodontic variables was significantly associated with recession.

CONCLUSIONS

Gingival recession of mandibular incisors did not significantly increase during orthodontic treatment. After treatment, fewer than 10% of subjects had gingival recession greater than 2 mm, and, at follow-up, 5% of the pre-existing gingival recession had improved. Thin gingival biotype, visual plaque, and inflammation are useful predictors of gingival recession.

Effect of Restraint Stress on the Progression of Experimental Periodontitis in Rats

BACKGROUND

A hypothesis of an increased risk for destructive periodontal diseases due to psychological stress has long been promoted. However, the research on stress and periodontal disease is still in its infancy. One of the reasons is thought to be that there is no suitable animal model for investigating the relationship.

METHODS

One hundred male Wistar rats were included. A nylon ligature was placed around the second right maxillary molars. The animals were then divided into group S, exposed to a restraint stress for 12 hours/day for up to 10 days, and group N, controls. Ten animals were sacrificed on days 2, 4, 6, 8, and 10. Blood samples were taken, and the blood glucose level and the concentrations of adrenocorticotropic hormone, corticosterone, and adrenaline were measured as the markers of stress. The atrophies of the thymus and the spleen were measured. The furcation area of the second maxillary molars was examined histologically and histometrically.

RESULTS

In group S, all values of stress markers were increased, and the thymus and the spleen were atrophied. Whereas group N showed only slight alveolar bone resorption, a marked alveolar bone resorption occurred in group S between days 8 and 10. An increase in beaded nerve terminals occurred around the vessels in the furcation area of group S.

CONCLUSION

The results of the present study suggest that the restraint stress modulates the progression of periodontal inflammation and that this rat model is suitable for investigating the association between stress and periodontal disease.

The role of acquired immunity and periodontal disease progression

Our understanding of the pathogenesis in human periodontal diseases is limited by the lack of specific and sensitive tools or models to study the complex microbial challenges and their interactions with the host's immune system. Recent advances in cellular and molecular biology research have demonstrated the importance of the acquired immune system not only in fighting the virulent periodontal pathogens but also in protecting the host from developing further devastating conditions in periodontal infections. The use of genetic knockout and immunodeficient mouse strains has shown that the acquired immune response-in particular, CD4+ T-cells-plays a pivotal role in controlling the ongoing infection, the immune/inflammatory responses, and the subsequent host's tissue destruction. In particular, studies of the pathogen-specific CD4+ T-cell-mediated immunity have clarified the roles of: (i) the relative diverse immune repertoire involved in periodontal pathogenesis, (ii) the contribution of pathogen-associated Th1-Th2 cytokine expressions in periodontal disease progression, and (iii) micro-organism-triggered periodontal CD4+ T-cell-mediated osteoclastogenic factor, 'RANK-L', which is linked to the induction of alveolar bone destruction in situ. The present review will focus on some recent advances in the acquired immune responses involving B-cells, CD8+ T-cells, and CD4+ T-cells in the context of periodontal disease progression. New approaches will further facilitate our understanding of their underlying molecular mechanisms that may lead to the development of new treatment modalities for periodontal diseases and their associated complications.

Mandibular bone remodeling under a choline-deficient diet: a histomorphometric study in rats

BACKGROUND

A deficiency of lipotropic factors in the rat induces renal, hepatic, and/or hematic damage. The aim of the present study was to evaluate the effect of a choline-deficient diet and refeeding on mandibular bone remodeling.

METHODS

Fifty Wistar rats were divided into 5 groups: group 1 (G1): control diet for 15 days; group 2 (G2): choline-deficient diet for 15 days; group 3 (G3): control diet for 30 days; group 4 (G4): choline-deficient diet for 30 days; and group 5 (G5): choline-deficient diet for 15 days and control diet for 15 days. All animals were sacrificed by ether overdose. The mandibles were resected, radiographed, decalcified, processed, and embedded in paraffin. Bucco-lingually oriented sections were obtained at the level of the interradicular bone of the medial roots of the left first molar, and stained with hematoxylin and eosin (H & E). Bone tissue density and bone remodeling were determined histomorphometrically. Body weight, food intake, hematocrit, and hemoglobinemia were also recorded.

RESULTS

Microscopic observation revealed that osteogenesis was lower in rats fed a choline-deficient diet, at both 15 and 30 days, and that this decrease did not revert with a control diet. Histomorphometric evaluation showed 37% and 27% reduction in bone tissue density at 15 and 30 days, respectively, and a 30% decrease in bone formation at 30 days, compared to controls.

CONCLUSION

In this experimental model, a choline-deficient diet led to altered bone remodeling as observed by a marked reduction in osteogenesis.

Periodontal treatment practices of Finnish dentists

OBJECTIVES

To evaluate the treatment practices of Finnish general practitioners (GPs) and dental teachers (DTs) regarding periodontal treatment modalities, and their knowledge of possible contraindications for periodontal surgery.

MATERIAL AND METHODS

A questionnaire on two periodontal cases was mailed to 400 GPs, selected by stratified randomization from the public and private sector, and to 47 DTs. The response rate was 77%. Respondents were asked to choose the optimal treatment for a patient with a bleeding, 8-mm-deep periodontal pocket and to consider the influence on their treatment decision of the six possible contraindications for periodontal surgery presented, two of which were absolute (inadequate oral hygiene and poorly controlled diabetes) and four of which were relative contraindications. The respondents' treatment decisions were compared with recommendations from textbooks and the Consensus Report from the 1996 World Workshop of Periodontology.

RESULTS

The majority of public (65%) and private (70%) dentists and almost all of the DTs chose treatment in agreement with recommendations. Correct answers from dentists were associated with a greater number of days in continuing education (OR = 1.5; p= 0.005). The two absolute contraindications were known by 38% of public and 31% of private sector dentists, and by 29% of DTs. The respective figures for relative contraindications were 40, 58 and 53%.

CONCLUSION

The majority of Finnish dentists followed the recommendations, but elaboration of international guidelines for good clinical practice is still needed to help clinicians to make optimal treatment decisions.

Ante-dependence modeling in a longitudinal study of periodontal disease: the effect of age, gender, and smoking status

BACKGROUND

It is generally accepted that periodontal disease progresses by a series of bursts that are interspersed by periods of stability or even gain of attachment. In order to analyze longitudinal data on a patient's disease experience, it is necessary to use models which accommodate serial dependence. Ante-dependence between the results of a series of periodontal examinations over time can be modeled using a Markov chain. This model describes temporal changes in patients' levels of disease in terms of transition probabilities, which allow for both regression and progression of the disease. The aim of the present study was to demonstrate the use of a Markov chain model to analyze data from a longitudinal study investigating the progression of periodontal disease in an adult population.

METHODS

The study population consisted of 504 volunteers; however, only 456 were included in the analysis because the remaining 48 subjects did not give consecutive data. Subjects were examined at baseline, 6 months, and 1, 2, and 3 years. Probing depths (PD) were recorded using an automated probe. Disease was defined as four or more sites with PD > or = 4 mm. Markov chain modeling was used to determine the effect of age, gender, and smoking on the natural progression and regression (healing) of periodontal disease.

RESULTS

Smoking and increasing age had no effect on the progression of disease in this population, but did have a significant effect (P values < or = 0.05) in reducing the regression of disease; i.e., their effect on disease appears to be inhibition of the natural healing process. Gender had no significant effects.

CONCLUSIONS

These results demonstrate how ante-dependence modeling of longitudinal data can reveal effects that may not be immediately apparent from the data, with smoking and increasing age being seen to inhibit the healing process rather than promote disease progression.

Treatment of periodontal disease in older adults

The literature does not indicate that older adults differ from younger individuals in their response to periodontal treatment. However, in older adults, it is more common to find compromised general conditions that may negatively affect the patient's ability to maintain an adequate standard of self-performed plaque control. Although this can be compensated for partly by a carefully designed program for supportive therapy, the prevention and/or elimination of clinical signs of periodontal inflammation may not always be a reachable goal of periodontal therapy in older adults, particularly in those who are frail and functionally dependent. For many patients, a more realistic goal may be the control of disease progression in order to preserve a functional and comfortable dentition throughout life and hence, the decision making process regarding therapeutic levels for the individual patient must include factors such as the amount of remaining periodontal support, the risk for disease progression, demands for oral health and life expectancy.

Epidemiology of periodontal disease among older adults: a review

Although many epidemiological studies have been conducted concerning periodontal disease, the majority were not included in this review because of deficiencies in the measures used. Although it is increasingly common for studies in this field to measure periodontal disease using clinical attachment level, attachment loss or bone loss, the evidence pertaining to prevalence, incidence and risk in older adult populations is limited. Although it is the best indicator to date, characterizing periodontal disease by means of attachment loss has some limitations. Prevalence and incidence rates may vary according to the number of teeth and sites probed and bias and case misclassification may occur because of the healthy survivor effect. Moreover, prevalence data that document lifetime disease experience are of little use in planning for periodontal treatment needs. Problems with sampling or subject selection and idiosyncratic ways of reporting data also limit the quality of the evidence currently available. In order to standardize the collection of data on loss of attachment and to measure it as accurately as possible, Papapanou (63) recommends that studies use full-mouth periodontal examinations and the assessment of clinical attachment level at four sites on each remaining tooth. Given the inconsistencies in and problems with the methods used in the studies reviewed above, only broad conclusions can be drawn concerning periodontal disease in older adults. These confirm the conclusions reached in other reviews of the literature. While moderate levels of attachment loss are to be found in a high percentage of middle-aged and elderly subjects, severe loss is confined to a minority, albeit a substantial one. Severe loss is evident in only a few sites and, in general, affects only a small proportion of sites examined. Nevertheless, approximately one-fifth of older individuals have experienced more generalized severe loss; the rate is much higher in the oldest subjects and subjects from minority groups. Although not universal, severe disease is common in some older populations and some population subgroups. Studies using common approaches are needed to fully elucidate the extent to which disease experience varies across different populations. Similar conclusions can be drawn from prevalence studies measuring bone loss. These show that a minority of subjects accounted for most sites with advanced loss. Studies of incidence suggest that 50-75% of older adults experience additional loss of attachment of 2 or 3 mm or more at a minimum of one site over relatively short periods of time. Rates fall dramatically when more stringent case definitions are used. Moreover, relatively few sites examined show evidence of additional loss so that, although rates are high, extent and severity are low. More detailed analyses of incidence data, although few, indicate that new lesions are more common than progressing lesions, and the pattern of loss tends to support an episodic model of periodontal disease progression.

Assessing dental anxiety, dental care use and oral status in older adults

This study examined associations between dental anxiety and dental care use and oral health status in dentate older adults. Analysis of data from the Piedmont 65+ Dental Study revealed that aspects of dental care use and oral health status were independently associated with high dental anxiety. These results suggest that measures to control dental anxiety may help to improve dental care use and oral health status in older adults.