Observations on temperature and temperature patterns of the gingiva. II. Estimations of the error in measurement

Clinical instruments and methods for assessing physical oral health: A systematic review

OBJECTIVE

This study aimed at exploring available clinical instruments and methods for assessing physical oral health, and at identifying those with sufficient diagnostic performance.

METHODS

A systematic literature search was conducted in Embase and MEDLINE. Identified instruments and methods were critically appraised, and quality of diagnostic performance was rated by two independent reviewers as A (sufficient diagnostic performance), B (either sufficient reliability or validity) or C (insufficient quality, or empirical results unsatisfactory and/or inconsistent). For all A-rated instruments and methods, an in-depth literature search was conducted to supplement and verify their effectiveness and accuracy.

RESULTS

A total of 141 instruments and methods were identified. Only 12 methods with sufficient diagnostic performance could be rated as A, 72 were rated as B, and 34 received a C-rating. Further 23 instruments and methods could not be rated due to lack of available information on diagnostic performance. Of all A-rated instruments, six were designed for tooth structure, two for periodontium, one for endodontium and three for temporomandibular joints and muscles.

CONCLUSION

Even though some instruments and methods exhibited good to excellent reliability and validity and can be recommended for research and clinical practice, they do not allow assessing all components of physical oral health. There is a need to identify and define standard instruments, and for components of physical oral health where methods with sufficient diagnostic performance are lacking, further research is required.

Sulcus temperature distributions in the absence and presence of oral hygiene

In this study we investigated the possibility of using sulcus temperature measurements as an early indicator for the beginning of gingival inflammation. Sulcus temperature distributions over the arches appeared to obey a quadratic polynomial. With a test group of 10 volunteers, all dental students, small changes in temperature were measured after subjects refrained from all oral hygiene: A slight but significant tendency for the frontal temperature to increase after 14 days of no oral hygiene was, however, present. The quality of a quadratic polynomial fit of the temperature distributions over the arches decreased significantly, already after 3 d of non-oral hygiene. This indicates that the coefficient of quadratic correlation for the temperature distributions over the arches is a measure for the oral hygiene of patients and for changes in the physiology of gingival tissues. Furthermore, as its decrease was concurrent with an increase in plaque and gingival indices, it might serve as an early indicator for the beginning of gingival inflammation. However, further development work is needed in order to make this approach useful as a clinical tool.

In situ lymphocyte subpopulations from active versus stable periodontal sites

The purpose of this study was to evaluate lymphocyte subset densities and distributions within gingival biopsies from active sites (greater than or equal to 2 mm clinical attachment loss within three months of biopsy) versus clinically similar but stable or healthy sites. Small interproximal gingival biopsies representing at least one of each of the above categories were obtained from each of 20 periodontal maintenance patients. Serial cryostat sections displaying a cross section of the gingiva were labeled with monoclonal antibodies for (1) pan T cells, (2) T cytotoxic/suppressor cells, (3) T helper/inducer cells and (4) pan B cells and were developed using an avidin-biotin-peroxidase system. Lymphocyte populations were enumerated in repeatable fields from the sulcular, middle and oral one-third of each section. Relative proportions of the same lymphocyte subsets were analyzed in peripheral blood samples from the same patients using direct immunofluorescence. Pan B cells were significantly more prevalent in infiltrates from active sites than in stable (P less than 0.05) or healthy (P less than 0.01) sites. The T/B cell ratio was also significantly lower in active than stable biopsies (P less than 0.05), and in active biopsies versus blood (P less than 0.05). The T helper/T suppressor cell ratio did not vary significantly between blood and any gingival tissue disease group or location, but a trend toward lower relative numbers of T helper cells in the sulcular infiltrates of active sites was noted. These results support the premise that active periodontal sites display elevated B cell populations and abnormal immune regulation possibly involving the T helper cell subset.

Measuring and interpreting increases in probing depth and attachment loss

Increases in probing depth and attachment level measurements are used by clinicians and clinical scientists for assessing the periodontal status and/or change in status of patients. Interpretation of these measurements has implications with respect to our understanding of periodontal disease, treatment of patients and the implementation of clinical investigations. Measurements of probing depths and attachment loss were made on 204 teeth in 34 patients. The measurements were repeated after short periods of time by different examiners as well as the same examiners. Using these data, sensitivities and specificities of several potential diagnostic thresholds were calculated. It is concluded that observing an increase of probing depth greater than 1 mm serves as a diagnostic test with high sensitivity and specificity.