Contemporary interpretation of probing depth assessments: diagnostic and therapeutic implications. A literature review

Periodontal disease and emerging point-of-care technologies for its diagnosis

Periodontal disease (PD), a chronic inflammatory disorder that damages the tooth and its supporting components, is a common global oral health problem. Understanding the intricacies of these disorders, from gingivitis to severe PD, is critical for efficient treatment, diagnosis, and prevention in dental care. Periodontal biosensors and biomarkers are critical in improving oral health diagnostic skills. Clinicians may accomplish early identification, tailored therapy, and efficient tracking of periodontal diseases by using these technologies, ushering in a new age of accurate oral healthcare. Traditional periodontitis diagnostic methods frequently rely on physical probing and visual examinations, necessitating the development of point-of-care (POC) devices. As periodontal disorders necessitate more precise and rapid diagnosis, incorporating novel innovations in biosensors and biomarkers becomes increasingly crucial. These innovations improve our capacity to diagnose, monitor, and adapt periodontal therapies, bringing in the next phase of customized and effective dental healthcare. The review discusses the characteristics and stages of PD, clinical treatment techniques, prominent biomarkers and infection-associated factors that may be employed to determine PD, biomedical sensing, and POC appliances that have been created so far to diagnose stages of PD and its progression profile, as well as predicting future developments in this field.

Functional Impairment and Periodontitis in Rheumatoid Arthritis

Background

This study explored the association of functional impairment due to rheumatoid arthritis (RA) and RA disease activity with periodontal disease in patients with RA.

Methods

Ninety-three patients with RA were included. Their RA functional status was assessed using the Steinbrocker classification. The serum level of matrix metalloproteinase-3 (MMP-3) was used as an indicator of RA disease activity. Probing depth (PD) and clinical attachment level (CAL) were used as indicators of periodontal status. We examined the association of RA severity and MMP-3 levels with periodontal status using a generalised linear model (GLM).

Results

In a multivariate GLM, the coefficient for the mean PD was significantly positive in those with RA severity classes III or IV (reference: class I; β = 0.14; 95% confidence interval [CI], 0.03–0.25; P = .02) independent of other confounding variables. In multivariate GLM using the mean CAL as the dependent variable, the coefficient was significant in patients with high MMP-3 levels (10 ng/mL; β = 0.005; 95% CI, 0.001–0.008; P = .02).

Conclusions

Functional impairment due to RA may affect PD, and high serum levels of MMP-3 may affect CAL.

Autologous Dentin Graft after Impacted Mandibular Third Molar Extraction to Prevent Periodontal Pocket Formation-A Split-Mouth Pilot Study

This preliminary study aims to evaluate the efficacy of an autologous dentin graft in preventing periodontal defects after impacted or semi-impacted lower third molars' (M3) surgical extraction. For this purpose, radiographic and periodontal evaluation of post-extractive sockets were performed. Ten patients were enrolled in the study: twenty M3 extraction sockets were treated with a split-mouth modality. After tooth extraction, the experimental sites were filled with autologous dentin graft obtained by the extracted M3, while the control sites were filled with blood clot alone. Flaps were closed by first intention to ensure the stability of the wounds. Post-extractive sites were monitored at days 15, 90 and 180. The healing was not affected by any complications associated with the use of the autologous dentine graft in all cases. The measurements recorded at six months showed a reduction of the probing pocket depth distal to the second lower molar (M2) at both surgical sites, with a greater reduction observed at the experimental sites. Radiographic evaluation also showed a greater amount of bone gain at the grafted sites compared to the control sites. The results of this preliminary study suggest that autologous dentin grafts can be useful in preventing the formation of periodontal defects distal to M2 after M3 surgical extraction.

Periodontal probing on digital images compared to clinical measurements in periodontitis patients

The aim of the study was to compare the supra-alveolar gingival dimension (GD) and the clinical pocket probing depth (PD) by combining data from an intraoral scanner (IOS) and cone-beam computed tomography (CBCT) and identify the clinical features affecting the clinical PD. 1,071 sites from 11 patients were selected for whom CBCT, IOS images, and periodontal charts were recorded at the same visit. CBCT and IOS data were superimposed. GD was measured on cross-sectional images of the probed sites. The level of agreement and correlation between GD and PD were assessed for the entire population and within groups (treated vs untreated, bleeding on probing [BOP] vs no BOP, and PDs of 0-3 mm vs 4-5 mm vs ≥ 6 mm). The mean [± SD] difference between GD and PD was 0.82 [± 0.69] mm, and they were positively correlated (r = 0.790, p < 0.001). The correlations between GD and PD were stronger for untreated sites, sites with BOP, and sites with a larger PD. Within the limitations of this study, the similarity between GD and PD may suggest a possible tendency of overestimation when recording PD.

Periodontitis in Ischemic Stroke Patients: Case Definition Challenges of the New Classification Scheme (2018)

The identification of the associative relationships between ischemic stroke (IS) and risk factors such as advanced age and periodontitis is essential to design real screening protocols and to address them using primary and secondary preventive policies. This study primarily aimed to evaluate the diagnostic performance of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) case definition in detecting periodontitis against the 2012 Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) case definition in a group of IS patients. Secondarily, we report the periodontal status of IS patients and the associative relationship with respect to some risk factors. Patients with their first IS were assessed based on demographic data, medical, oral risk factors and periodontal parameters. The two case definitions were applied to identify the periodontitis burden. The agreement between the two case definition systems, as well as the misclassification ratio, were calculated. A total of 141 patients were included. According to the 2012 CDC/AAP and the 2018 EFP/AAP case definitions, a frequency of periodontitis of 98.5% and 97.8% based on two modalities of inclusion of cases in the severity groups, sensitivity values of 98.54% or 100%, and specificity values of 25% or 14.7% were calculated. Thus, the new case definition system has a higher capacity to detect periodontitis, especially the well-established forms.

The effect of adjunctive systemic antibiotics on microbial populations compared to scaling and root planing alone for the treatment of periodontitis: A pilot randomized clinical trial

AIM

To investigate the microbial shift after periodontitis being treated by scaling and root planing (SRP) with or without adjunctive antibiotics, and to assess the relationship between oral microbiota and systemic factors.

METHODS

A 6-month pilot randomized controlled trial recruited 14 subjects with severe periodontitis, divided into test group and control group to receive full-mouth SRP with or without amoxicillin (500mg) and metronidazole (200mg) (t.i.d. 7d). Clinical examination, collection of subgingival plaque and saliva, and blood tests were performed at baseline pre-treatment, three months, and six months post-treatment. The V3V4 region of 16S DNA was sequenced; taxonomic assignment was based on the Human Oral Microbiome Database.

RESULTS

The periodontal condition significantly improved in both groups; the test group showed a greater improvement in plaque index, probing depth, and bleeding index than the control group. The test group demonstrated significantly lower microbial richness and diversity, and less abundant Porphyromonas than the control group in at three months for both subgingival microbiome and salivary microbiome. However, the microbial differences narrowed within six months. The subgingival and salivary microbiota shifted synergistically. Glucose was positively related to subgingival Porphyromonas; mean platelet volume was positively related to subgingival Leptotrichia.

CONCLUSIONS

Systemic administration of amoxicillin and metronidazole along with SRP had an advantage over SRP alone in clinical improvement and infection control in both the subgingival region and saliva three months post-treatment. Microbial advantage nearly disappeared at six months; however, the clinical advantage lasted longer. The use of antibiotics also has potential benefits for systemic inflammation and glucose. This article is protected by copyright. All rights reserved.

Salivary Pro-Inflammatory Markers and Smoking Status Influences the Treatment Effectiveness of Periodontal Disease Patients with Hypertension

BACKGROUND

Hypertension and periodontal diseases share several risk factors. Inflammation biomarkers in saliva are related to hypertension and periodontal disease. The aim of this study was to explore the role of the salivary inflammatory biomarkers in the treatment effectiveness of patients with hypertension and periodontal disease.

METHODS

This observational study enrolled 160 subjects diagnosed with periodontitis, 40 of which had a history of hypertension. All subjects had completed scaling and root planning therapeutic procedures within four weeks. The clinical periodontal parameters (i.e., bleeding on probing, plaque control record (PCR), and probing depth (PD)) were evaluated before and after the treatment. Pro-inflammatory markers were determined using a commercial kit.

RESULTS

The recovery rate (PD 4-9 mm) in non-hypertensive subjects was significantly higher than in hypertensive subjects (60.47% vs. 52.60%, respectively; p = 0.04). All clinical parameters, excluding PCR, positively correlated with salivary IL-1β at baseline and after completing treatment. Our results showed that increased salivary IL-1β levels were positively associated with decreased PCR (β = -27.65 and p = 0.05) and PD recovery rate (β = -17.05 and p = 0.02) in hypertensive subjects.

CONCLUSIONS

The present study sheds important light on the clinical use of salivary pro-inflammatory cytokines as valuable biomarkers for predicting the treatment effectiveness of patients suffering from hypertension and periodontitis.

Impact of Adjunctive Diode Laser Application to Non-Surgical Periodontal Therapy on Clinical, Microbiological and Immunological Outcomes in Management of Chronic Periodontitis: A Systematic Review of Human Randomized Controlled Clinical Trials

Background

Due to the limitations of scaling and root planing (SRP) in chronic periodontitis (CP) management, research has been focused on utilising additional therapies to enhance conventional treatment methods. The present systematic review is aimed to appraise the accessible scientific evidence of in vivo human studies to establish the effectiveness of adjunctive diode (λ 808- λ 980nm) laser treatment to SRP in CP.

Methodology

This systematic review was conducted following the PRISMA statement guidelines. The review protocol is registered in PROSPERO (CRD 42021227695). The search strategies were based on structured electronic and manual (with appropriate keywords) and were conducted to collect the applicable published data on RCTs studies (in vivo human), spanning over ten years between August 2010 and August 2020. The articles were selected to address the following research focus question: “Does diode laser (λ 808- λ 980nm) therapy have superior effects as an adjunct to SPR, compared to SRP alone, in terms of clinical or microbiological or immunological profiles in the management of CP?”

Results

Fifteen articles met the eligibility criteria and are included in this review. A wide range of discrepancies and inconsistencies were shown in the outcomes of the laser and SPR treatment modality, compared to SRP alone. The data on standardised study protocol, optimal laser parameters and outcome measurements were inconclusive, and a high risk of bias in the majority of the studies observed, which are crucial in establishing a homogenous and reproducible protocol.

Conclusion

In light of the confined evidence-based data and critical evaluation of this systematic review, the efficacy of adjunctive diode laser treatment ranging between 808 and 980nm to SRP remains debatable. The observational quality of the present systematic review was emphasised after scrutinising the available data, and an attempt to propose a laser protocol for future RCTs consideration was a great challenge due to an absence of clear and standardised recommendations in delivering a reliable laser protocol which can be replicable by future investigators. RCTs with robust methodology are warranted.

Effectiveness of Antimicrobial Photodynamic Therapy in the Treatment of Periodontitis: A Systematic Review and Meta-Analysis of In Vivo Human Randomized Controlled Clinical Trials

This systematic review and meta-analysis evaluated antimicrobial photodynamic therapy (aPDT) efficacy in periodontitis. The review protocol was conducted in accordance with PRISMA statements, Cochrane Collaboration recommendations and is registered in PROSPERO (CRD 42020161516). Electronic and hand search strategies were undertaken to gather data on in vivo human RCTs followed by qualitative analysis. Differences in probing pocket depth (PPD) and clinical attachment level (CAL) were calculated with 95% confidence intervals and pooled in random effects model at three and six months. Heterogeneity was analyzed, using Q and I² tests. Publication bias was assessed by visual examination of the funnel plot symmetry. Sixty percent of 31 eligible studies showed a high risk of bias. Meta-analysis on 18 studies showed no additional benefit in split mouth studies in terms of PPD reduction (SMD 0.166; 95% CI −0.278 to 0.611; P = 0.463) and CAL gain (SMD 0.092; 95% CI −0.013 to 0.198; P = 0.088). Similar findings noted for parallel group studies; PPD reduction (SMD 0.076; 95% CI −0.420 to 0.573; P = 0.763) and CAL gain (SMD 0.056; 95% CI −0.408 to 0.552; P = 0.745). Sensitivity analysis minimized heterogeneity for both outcome variables; however, intergroup differences were not statistically significant. Future research should aim for well-designed RCTs in order to determine the effectiveness of aPDT.

Clinical Feasibility of Fully Sintered (Y, Nb)-TZP for CAD-CAM Single-Unit Restoration: A Pilot Study

Fifteen participants (9 male, 6 female) received a total of 15 monolithic single restorations made from fully sintered (Y, Nb)-TZP (tetragonal zirconia polycrystal) block. The restorations were clinically evaluated for survival, success rate, and periodontal probing depths 6 months after the insertion of the restorations. Esthetic, functional, and biological evaluations were also performed over a 6-month follow-up period. The survival and success rates of the single-unit restorations were 100%. The periodontal probing depth values ranged from 1 to 3 mm. No complications with regard to functional and biological properties were observed after 6 months. The postoperative sensitivity was only a transient phenomenon. The fully sintered (Y, Nb)-TZP single-unit restoration showed highly acceptable quality with successful clinical performance over 6 months.

The 2018 EFP/AAP periodontitis case classification demonstrates high agreement with the 2012 CDC/AAP criteria

AIM

To investigate the agreement between the 2018 EFP/AAP periodontitis case classification and the 2012 CDC/AAP criteria.

MATERIALS AND METHODS

This cross-sectional study assessed a population-based sample from a rural area in southern Brazil. A complete periodontal examination was performed at six sites/tooth. The periodontitis case definition was estimated and compared according to the 2018 EFP/AAP classification and the 2012 CDC/AAP criteria (reference). Diagnostic tests included sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and area under ROC curve (AUC).

RESULTS

Five hundred and eighty-eight subjects with ≥6 teeth each were included. Based on the 2018 EFP/AAP classification, 71.1% of the subjects were classified as stage III/IV showing 100% agreement with 2012 CDC/AAP criteria for the severe category. For the moderate and severe classification, the 2018 EFP/AAP SN was 99.8% and 100%, SP 13.6% and 43.6%, PPV 83.4% and 47.4%, and NPV 93.7% and 100%, respectively. The AUC was 0.9059 (95% CI = 0.879-0.933) and the optimal cut-off based on the curve was stage III.

CONCLUSIONS

The 2018 EFP/AAP periodontitis case classification showed high agreement with the 2012 CDC/AAP criteria in a rural sample with high periodontitis occurrence.

Comparative assessment of conventional periodontal probes and CEJ handpiece of electronic probes in the diagnosis and primary care of periodontal disease

Objectives:

Conventional probes (CPs) have been considered acceptable as diagnostic tools to measure probing pocket depth (PPD) and clinical attachment level (CAL) but are affected by multiple variables. Electronic probes (EPs) provide controlled force, digital readout and data storage in computers. The objectives were to compare the reproducibility in the measurement of PPD and CAL by CP and the newly introduced CEJ handpiece of EP and intra-examiner and inter-examiner errors done in two phases.

Methods and Material:

Selected 720 periodontal sites in 1^st molar of 30 persons with chronic periodontitis ≤4 mm and >4 mm pockets were analysed by two trained investigators in two phases at 2 hours difference by CP and CEJ handpiece of EP. Standard deviation, mean difference, correlation coefficient, P value and student 't' test were done to analyse data.

Results:

The intra- examiner and inter-examiner analyses revealed that Pearson's correlation coefficient was above 0.080 and 0.722 in the ≤4 mm and >4 mm pockets, respectively. Mean difference was not statistically significant in both groups except in the intra- examiner findings in the 2^nd phase. Interprobe analysis depicted a standard error of mean of <0.03 in ≤4 mm pockets, whereas it varied from 0.047–0.056 in >4 mm pockets.

Conclusion:

In conclusion, EP is advantageous for research purposes by providing automatic recording and long-term maintenance of data storage without the need of an assistant and patient education and motivation, whereas CP appears to be more useful in routine periodontal examination.

Effectiveness of Photobiomodulation as an Adjunct to Nonsurgical Periodontal Therapy in the Management of Periodontitis- A Systematic Review of in vivo Human Studies

Photobiomodulation therapy (PBMT) has anti-inflammatory, analgesic and regenerative properties. This systematic review aimed to critically appraise the published data of in vivo human randomized clinical trials (RCTs), and present a comprehensive overview of the efficacy of PBMT, as an adjunct to the nonsurgical periodontal therapy (NSPT) in the management of periodontitis. The systematic review protocol is registered in the Prospective Register Of Systematic Reviews (PROSPERO) (www.crd.york.ac.uk/PROSPERO/; ref CRD 42020169108). With the help of the appropriate key words, structured electronic and manual search strategies were applied to gather the relevant published data on in vivo human RCTs based on this topic. Seventeen papers that met the eligibility criteria were included in this review and subjected to a qualitative assessment. Current evidence lacks adequate information regarding the photobiomodulation (PBM) dosimetry, which is fundamental in establishing a standardized and replicable protocol for future researches. Furthermore, substantial discrepancies in the study methodology and a high risk of bias, arising from the majority of the included papers, abet to the inferior quality of these studies. Ultimately, there is an urgent necessity to conduct further well-designed RCTs in order to determine the effectiveness of PBMT, if any, by taking into consideration the abovementioned confounding factors.

Detection of hepatocyte growth factor in oral rinses using water for possible periodontal diagnosis

The aim of this study is to analyze the relationship between Hepatocyte Growth Factor (HGF) levels in oral rinses using water and clinical parameters of periodontitis; and furthermore, to evaluate the potential of a prototype HGF immunochromatographic paper test strip (HGF-TS) for screening of periodontitis, in comparison with a commercially-available occult blood (hemoglobin) test strip (Hb-TS). Clinical periodontal parameters were recorded, and oral rinses were collected, from 125 subjects. Then, the presence of HGF, and hemoglobin (Hb), in each sample was detected using a prototype HGF-TS and an Hb-TS. In addition, the concentrations of HGF and Hb were also determined in each sample is necessary HGF concentrations in oral rinses showed significant correlations with clinical parameters of periodontitis. The positive rate and read value on HGF-TS showed significantly high values in cases of severe periodontitis compared to healthy subjects. Hb-TS showed generally higher positive rates than HGF-TS; however, it showed false positive results in healthy subjects. The concentration of HGF in oral rinses showed close association with the severity of periodontitis, suggesting that the prototype HGF-TS has potential for use in the diagnosis of periodontitis, although further refinement of the test strip is required to increase the sensitivity.

Diagnostic efficacy of and indications for intraoral radiographs in pediatric dentistry: a systematic review

PURPOSE

To systematically evaluate the diagnostic efficacy of intraoral radiographs and evidence supporting the indications for taking of intraoral radiographs in children in the following five clinical categories: caries, pathological conditions (including acute odontogenic infections and periodontal disease), dental/developmental anomalies, dental trauma, and enhancement of comfort/technique for taking radiographs in children. This was carried out to facilitate the updating of existing European Academy of Paediatric Dentistry (EAPD) guidelines on dental radiography in pediatric dentistry.

METHODS

A systematic electronic literature search was conducted on Cochrane Library (1992-24 July 2018), MEDLINE (PubMed, 1946-24 July 2018), EMBASE (Embase.com, 1974-24 July 2018) and Scopus (pre-1970-24 July 2018). Hand search of handbooks and grey literature search was also performed. Study screening and study inclusions were agreed upon by three authors. Data extraction, and methodological quality and risk of bias assessment were carried out in duplicate for each of the included studies.

RESULTS

A total of 9581 papers were identified. Following the primary and secondary assessment process, 36 papers were included in the final analysis. The included studies were further categorized into five main clinical categories for analysis: caries, pathological conditions, dental/developmental anomalies, dental trauma and comfort/technique-related studies. Only one paper was found to be of good quality and at low risk of bias; while, 9 papers were found of be at moderate risk of bias and 26 papers were at high risk of bias. Meta-analysis was not possible for any of the aforementioned clinical situations, and only a narrative synthesis was done.

CONCLUSION

There is insufficient high-quality evidence for the use of intraoral radiographs in pediatric dentistry and current guidelines are based largely on expert opinion. There is a clear need for well-conducted and standardized studies regarding the use of intraoral radiography in pediatric dentistry.

Flowcharts for Easy Periodontal Diagnosis Based on the 2018 New Periodontal Classification

FOCUSED CLINICAL QUESTION

How can a clinician simply and quickly perform a periodontal screening and make a proper periodontal diagnosis using the 2018 proposed new periodontal classification?

SUMMARY

The 2018 periodontal classification has been released, however, it is challenging for clinicians especially for the dental students to apply the published information in practice. A diagnostic flowchart was created for three of the most common periodontal conditions: health, gingivitis, and periodontitis. Additionally, flowcharts were proposed for the diagnosis of periodontitis severity and risk of progression by staging and grading. Probing depth was the first clinical parameter to categorize the type of diseases. Subsequently, bleeding on probing, radiographic bone loss/clinical attachment loss, and history of periodontal treatment were further added for making a proper diagnosis. Three clinical cases were given to demonstrate the use of the simplified proposed flowcharts.

CONCLUSIONS

The proposed diagnostic flowcharts are the user-friendly tool to assist clinicians to perform an initial screening and diagnosis based on the 2018 newly proposed periodontal disease classification.

A graphical model for skewed matrix-variate non-randomly missing data

Epidemiological studies on periodontal disease (PD) collect relevant bio-markers, such as the clinical attachment level (CAL) and the probed pocket depth (PPD), at pre-specified tooth sites clustered within a subject's mouth, along with various other demographic and biological risk factors. Routine cross-sectional evaluation are conducted under a linear mixed model (LMM) framework with underlying normality assumptions on the random terms. However, a careful investigation reveals considerable non-normality manifested in those random terms, in the form of skewness and tail behavior. In addition, PD progression is hypothesized to be spatially-referenced, i.e. disease status at proximal tooth-sites may be different from distally located sites, and tooth missingness is non-random (or informative), given that the number and location of missing teeth informs about the periodontal health in that region. To mitigate these complexities, we consider a matrix-variate skew-$t$ formulation of the LMM with a Markov graphical embedding to handle the site-level spatial associations of the bivariate (PPD and CAL) responses. Within the same framework, the non-randomly missing responses are imputed via a latent probit regression of the missingness indicator over the responses. Our hierarchical Bayesian framework powered by relevant Markov chain Monte Carlo steps addresses the aforementioned complexities within an unified paradigm, and estimates model parameters with seamless sharing of information across various stages of the hierarchy. Using both synthetic and real clinical data assessing PD status, we demonstrate a significantly improved fit of our proposition over various other alternative models.

Periodontal Health of Pre-Dialysis Chronic Kidney Disease Patients in a Northeast Peninsular Malaysia Tertiary Hospital

Introduction

Chronic kidney disease (CKD) is associated with periodontal disease due to its hyperinflammatory state. Limited studies have explored the prevalence of periodontal disease among CKD patients in Malaysia.

Objective

To assess the periodontal status of pre-dialysis CKD patients in Hospital Universiti Sains Malaysia.

Methods

A total of 46 pre-dialysis CKD patients who attended the nephrology clinic at Hospital Universiti Sains Malaysia were enrolled in this study. Periodontal examination was performed using the periodontal probing depth (PPD), clinical attachment loss (CAL) and plaque index.

Results

The majority of the CKD patients were Malay (95.7%) and 80.4% were males. The mean age of the patients was 58.5 years. Using PPD measurement, 37 (74.0%) of the patients had mild periodontitis, 9 (20.0%) had moderate periodontitis and 3 (6.0%) had no periodontitis. Based on CAL measurement, 12 (26%) patients had mild periodontitis, 29 (63.0%) had moderate periodontitis and 5 (11%) had severe periodontitis. The mean (standard deviation [SD]) value of mild and moderate-to-severe periodontitis by PPD measurement were 4.26 (0.26) and 5.24 (0.36), respectively. The mean of mild and moderate-to-severe periodontitis by CAL measurement were 2.66 (0.62) and 4.98 (0.73), respectively. There was no correlation between the periodontal parameters and estimated glomerular filtration rate (PPD: r = −0.160, P = 0.914; CAL: r = −0.135, P = 0.372; plaque index: r = 0.005, P = 0.974).

Conclusion

This study revealed a greater prevalence and severity of chronic periodontitis among CKD patients. Thus, the periodontal health of CKD patients’ needs to be screened and monitored.

Evaluation of trabecular bone changes in patients with periodontitis using fractal analysis: A periapical radiography study

BACKGROUND

The present study was aimed to evaluate the trabecular bone changes between healthy individuals and periodontitis patients with fractal dimension analysis on digital periapical radiographs.

METHODS

Data from 35 healthy and 35 individuals with periodontitis were confirmed from the database of our faculty and included in the study. Two regions of interest (ROI) were selected belonging to mesial and distal region of mandibular first molar on periapical radiographs. The mean fractal dimension (FD) values of two regions were calculated with using box-counting method. Student t test was used for the comparison of the FDs.

RESULTS

The mean FD of individuals with periodontitis was 0.97, whereas it was 1.04 for the healthy group. The mean FD values were significantly higher in the healthy group (P < 0.05). In the periodontitis group, as the FD of mesial interdental bone increased, the FD of distal interdental bone increased significantly (P < 0.05).

CONCLUSION

Because of FD numerically showing changes in bone trabeculation, changes in the alveolar bone can be detected quantitatively.

Plaque-induced gingivitis: Case definition and diagnostic considerations

OBJECTIVE

Clinical gingival inflammation is a well-defined site-specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a "gingivitis site") is completely different from defining and grading a "gingivitis case" (GC) (i.e. a patient affected by gingivitis), and that a "gingivitis site" does not necessarily mean a "GC". The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque-induced gingivitis and to propose a set of criteria to define GC.

IMPORTANCE

A universally accepted case definition for gingivitis would provide the necessary information to enable oral health professionals to assess the effectiveness of their prevention strategies and treatment regimens; help set priorities for therapeutic actions/programs by health care providers; and undertake surveillance.

FINDINGS

Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%) CONCLUSIONS: A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.

Semiparametric Bayesian latent variable regression for skewed multivariate data

For many real-life studies with skewed multivariate responses, the level of skewness and association structure assumptions are essential for evaluating the covariate effects on the response and its predictive distribution. We present a novel semiparametric multivariate model and associated Bayesian analysis for multivariate skewed responses. Similar to multivariate Gaussian densities, this multivariate model is closed under marginalization, allows a wide class of multivariate associations, and has meaningful physical interpretations of skewness levels and covariate effects on the marginal density. Other desirable properties of our model include the Markov Chain Monte Carlo computation through available statistical software, and the assurance of consistent Bayesian estimates of the parameters and the nonparametric error density under a set of plausible prior assumptions. We illustrate the practical advantages of our methods over existing alternatives via simulation studies and the analysis of a clinical study on periodontal disease.

Investigation of a Novel Predictive Biomarker Profile for the Outcome of Periodontal Treatment

BACKGROUND

An ability to predict the response to conventional non-surgical treatment of a periodontal site would be advantageous. However, biomarkers or tests devised to achieve this have lacked sensitivity. The aim of this study is to assess the ability of a novel combination of biomarkers to predict treatment outcome of patients with chronic periodontitis.

METHODS

Gingival crevicular fluid (GCF) and subgingival plaque were collected from 77 patients at three representative sites, one healthy (probing depth [PD] ≤3 mm) and two diseased (PD ≥6 mm), at baseline and at 3 and 6 months after treatment. Patients received standard non-surgical periodontal treatment at each time point as appropriate. The outcome measure was improvement in probing depth of ≥2 mm. Concentrations of active enzymes (matrix metalloproteinase [MMP]-8, elastase, and sialidase) in GCF and subgingival plaque levels of Porphyromonas gingivalis, Tannerella forsythia, and Fusobacterium nucleatum were analyzed for prediction of the outcome measure.

RESULTS

Using threshold values of MMP-8 (94 ng/μL), elastase (33 ng/μL), sialidase (23 ng/μL), and levels of P. gingivalis (0.23%) and T. forsythia (0.35%), receiver operating characteristic curves analysis demonstrated that these biomarkers at baseline could differentiate healthy from diseased sites (sensitivity and specificity ≥77%). Furthermore, logistic regression showed that this combination of these biomarkers at baseline provided accurate predictions of treatment outcome (≥92%).

CONCLUSION

The "fingerprint" of GCF enzymes and bacteria described here offers a way to predict the outcome of non-surgical periodontal treatment on a site-specific basis.

Epidemic trend of periodontal disease in elderly Chinese population, 1987-2015: a systematic review and meta-analysis

Periodontal disease is a common oral health problem in the elderly population. The prevalence varied substantially due to absence of a universal diagnostic criteria. We conducted a systematic review to identify the epidemiological characteristics of periodontal diseases among Chinese elderly people. A total of 19 articles were included. The pooled detection rates for three indicators, including bleeding on probing (BOP), pocket depth (PD) and clinical attachment loss (CAL), were 53.9% (95% CI: 43.8-63.9%), 57.0% (50.8-63.2%), and 70.1% (65.4-74.8%), respectively. No significant differences in these indicators between urban and rural population. When stratified by gender, BOP (+) detection rates did not show any differences, but the detection rates of PD ≥ 4 mm and CAL ≥ 4 mm were significantly higher in males than in females (59.3% [53.4-65.2%] versus 50.8% [43.5-58.0%], RRPD = 1.13 [1.01-1.26]; 73.8% [70.0-77.7%] versus 65.2% [60.2-70.2%], RRCAL = 1.21 [1.11-1.32]). No statistically significant differences were observed between CAL ≥ 4 mm and PD ≥ 4 mm (RR = 1.12, [0.83-1.50]). A geographical map based on available data during 1987-2015 showed wide variations of periodontal disease across the mainland China. Some factors such as heterogeneity of case definitions, no specific diagnosis of periodontitis, and variable quality of the included studies could affect the final results. Hence, further high-quality epidemiological studies with standardized diagnostic criteria are needed.

Reduced Bone Stiffness in Women Is Associated with Clinical Attachment and Tooth Loss

The authors evaluated the association of reduced bone stiffness of the calcaneus with clinical attachment loss (CAL) and tooth loss. The authors analyzed data from 4,678 subjects (2,384 women), aged 20 to 88 y, from the second follow-up of the population-based Study of Health in Pomerania (SHIP-2) and the baseline examination of the SHIP-Trend cohort. Bone stiffness, characterized by the stiffness index (SI) and the osteoporotic fracture risk (OFR), was assessed by quantitative ultrasound of the heel. SI and OFR were significantly associated with the mean CAL in women. While 1) the SI showed a significant association with the mean CAL and 2) the OFR with the median number of teeth in just the postmenopausal women, the OFR showed a significant association with mean CAL for both pre- and postmenopausal women. In postmenopausal women, a 10-unit increase in the SI was associated with a decrease in the mean CAL of 0.05 mm (95% confidence interval [CI]: –0.10 to 0.00; P = 0.046). Moreover, the adjusted median number of teeth was 21.4 (95% CI: 20.9 to 21.9) among the postmenopausal women with a low OFR, while it was 19.1 (95% CI: 17.8 to 20.3; P = 0.001) among the postmenopausal women with a high OFR. For the premenopausal women with a low OFR, the mean CAL was 1.60 mm (95% CI: 1.53 to 1.66), while for the premenopausal women with a high OFR, it was 2.24 mm (95% CI: 1.78 to 2.69; P = 0.006). Reduced bone stiffness was associated with clinical attachment and tooth loss in women but not in men.

Peri-implantitis. Part 3: current modes of management

Peri-implantitis is an inflammatory condition fuelled by the presence of bacteria on the implant surface. As such, in a similar manner to periodontal disease management, the removal of biofilm from the implant surface should result in regression of the disease process. The optimal manner with which this is achieved has yet to be realised. This may be unsurprising due to the relative surface complexity of the implant surface when compared to natural tooth root. Other management strategies include surface decontamination, the removal of implant threads known as implantoplasty, and in severe cases the need to explant. Favourable defects can be reconstructed utilising guided bone regeneration techniques. The current review appraises some of the techniques for the management of peri-implantitis.

The association between dental health and nutritional status in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) and periodontitis are chronic inflammatory systemic diseases with common risk factors (smoking and aging). In COPD, poor periodontal health could result in inadequate nutrition, potentially causing loss of muscle volume. The purpose of this case-control study was to examine our hypothesis that COPD patients have poorer periodontal health and poorer nutritional status than non-COPD patients. Periodontal status was assessed using bleeding on probing (BOP), pocket depth (PD), and plaque-control ratio (PCR). Nutritional status was assessed using body mass index, lean body mass, and serum albumin levels. The COPD group ( n = 60) had fewer remaining teeth, greater BOP, greater PD, and lower serum albumin levels compared with smokers without COPD ( n = 41) and nonsmokers ( n = 35; p < 0.001). COPD was an independent risk factor for poor periodontal health, demonstrated by fewer remaining teeth (relative risk (RR), 5.48; p = 0.0024), BOP (RR, 12.8; p = 0.0009), and having >30% of remaining teeth with a PD ≥ 4 mm (RR, 4.82; p = 0.011). A significant negative correlation existed between the number of teeth with a PD ≥ 4 mm and serum albumin level ( r² = 0.127; p = 0.013). We demonstrated that poor periodontal health was associated with hypoalbuminemia, suggesting poor nutritional status and inflammation in COPD.

Differentiation of oral bacteria in in vitro cultures and human saliva by secondary electrospray ionization - mass spectrometry

The detection of bacterial-specific volatile metabolites may be a valuable tool to predict infection. Here we applied a real-time mass spectrometric technique to investigate differences in volatile metabolic profiles of oral bacteria that cause periodontitis. We coupled a secondary electrospray ionization (SESI) source to a commercial high-resolution mass spectrometer to interrogate the headspace from bacterial cultures and human saliva. We identified 120 potential markers characteristic for periodontal pathogens Aggregatibacter actinomycetemcomitans (n = 13), Porphyromonas gingivalis (n = 70), Tanerella forsythia (n = 30) and Treponema denticola (n = 7) in in vitro cultures. In a second proof-of-principle phase, we found 18 (P. gingivalis, T. forsythia and T. denticola) of the 120 in vitro compounds in the saliva from a periodontitis patient with confirmed infection with P. gingivalis, T. forsythia and T. denticola with enhanced ion intensity compared to two healthy controls. In conclusion, this method has the ability to identify individual metabolites of microbial pathogens in a complex medium such as saliva.

The effect of periodontal therapy on glycaemic control in a Hispanic population with type 2 diabetes: a randomized controlled trial

OBJECTIVE

In the Mexican-American population, the prevalence of Type 2 diabetes mellitus (T2DM) is as high as 50% of the population. This randomized controlled clinical trial was designed to elucidate how treatment of periodontal disease affects HbA1c values in this population.

MATERIALS AND METHODS

One hundred and fifty-four T2DM patients with periodontal disease were enrolled in the study. The test group was treated with scaling and root planing (SRP); the control group received oral hygiene instructions. At baseline and 4-6 weeks after therapy, a complete periodontal examination was performed. Blood was collected at baseline and 4 months later for HbA1c levels.

RESULTS

One hundred and twenty-six individuals completed the study. Baseline mean ± SD HbA1c for the test and control groups were 9.0 ± 2.3% and 8.4 ± 2.0% respectively. Non-significant difference in HbA1c reductions (0.6 ± 2.1% and 0.3 ± 1.7%) was found between test and control groups at 4 months. Comparisons of the periodontal clinical parameters between the test and control groups found significant differences with improved results in the test subjects.

CONCLUSIONS

No statistically significant differences were found in the changes of HbA1c levels between test and control groups. Non-surgical periodontal therapy improved the magnitude of change in periodontal parameters as compared to the control subjects. ClinicalTrials.gov Identifier: NCT01128374.

Nitrite and nitrate levels of gingival crevicular fluid and saliva in subjects with gingivitis and chronic periodontitis

OBJECTIVES

Nitrosative stress plays an essential role in the pathogenesis of periodontal disease. The aim of this study is to analyze the gingival crevicular fluid and saliva nitrite and nitrate levels in periodontally healthy and diseased sites.

MATERIAL AND METHODS

A total of 60 individuals including, 20 chronic periodontitis and 20 gingivitis patients and 20 periodontally healthy controls participated in the present study. Probing depth, clinical attachment level, bleeding on probing, gingival index and plaque index were assessed, gingival crevicular fluid (GCF) and saliva samples were obtained from the subjects, including 480 GCF samples and 60 unstimulated whole saliva samples. Nitrite and nitrate were analyzed by Griess reagent.

RESULTS

Total GCF nitrite levels were higher in gingivitis and periodontitis groups (1.07 [SD 0.62] nmol and 1.08 [SD 0.59] nmol) than the control group (0.83 [SD 0.31] nmol) (P < 0.05) but did not differ significantly between gingivitis and periodontitis groups (P > 0.05). The difference in GCF nitrate level was not significant among the control, gingivitis and periodontitis groups (7.7 [SD 2.71] nmol, 7.51 [SD 4.16] nmol and 7.38 [SD 1.91] nmol). Saliva nitrite and nitrate levels did not differ significantly among three study groups. Saliva nitrate/nitrite ratios were higher in periodontitis and gingivitis groups than the control group. A gradual decrease in nitrate/nitrite ratio in GCF was detected with the presence of inflammation.

CONCLUSIONS

It may be suggested that nitrite in gingival crevicular fluid is a better periodontal disease marker than nitrate and may be used as an early detection marker of periodontal inflammation, and that local nitrosative stress markers don't show significant difference between the initial and advanced stages of periodontal disease.

Comparative evaluation of accuracy of periodontal probing depth and attachment levels using a Florida probe versus traditional probes

BACKGROUND

The current interest in the assessment of Clinical attachment level (CAL) has stimulated recent introduction of novel periodontal probes. CAL is currently the gold standard for diagnosis and monitoring of periodontal disease. The errors inherent to the use of a periodontal probe are variation in probing force, visual errors in identifying the cemento-enamel junction (CEJ), relative attachment level landmarks, fluctuations in gingival inflammation and misrecording measurements. The present study has been undertaken to compare the accuracy of measuring probing depth (PD) and CAL using Florida probe and Williams probe.

METHODS

After random selection of sixty subjects PD and CAL were measured at mandibular first molars region using Williams probe, Florida probe and CEJ probe by two different examiners. The measurements recorded by using three probes were subjected to statistical analysis for comparison of accuracy and reproducibility.

RESULTS

Difference in mean PD with Williams probe and Florida probe were statistically significant with p value of .000. Similarly the CAL measurement achieved by Williams probe and CEJ probe showed significant different results. More consistent results were seen with Florida probe and CEJ probe when the measurements of PD and CAL were done by two different examiners.

CONCLUSION

Florida probe and CEJ probe have been shown to be more accurate and were found to be more consistent which were reproducible by two independent examiners.

Risk factors for periodontal changes in adult patients with banded second molars during orthodontic treatment

OBJECTIVE

To identify the risk factors for periodontal changes in adult patients during orthodontic treatment by evaluating the periodontal status of banded second molars using the gingival index (GI).

MATERIAL AND METHODS

The sample consisted of 100 adult patients divided into two groups: the Orthodontics group, undergoing corrective treatment with fixed appliances and bands cemented to the four second molars, and the Control group, with no prior history of orthodontic treatment, age and sex matched. Group GI values were compared using the Wilcoxon test. Additionally, a multivariate logistic regression was performed to study the risk factors for increases in the GI.

RESULTS

Individuals in the Orthodontics group showed a significantly higher GI than those in the Control group. Logistic regression revealed that among the risk factors found to increase GI, the following proved significant (in order of importance): plaque index, subgingival encroachment of the cervical margins of bands, probing depth, and length of orthodontic treatment.

CONCLUSIONS

Banded second molars of adult patients during orthodontic treatment showed more clinical signs of gingival inflammation than those of untreated individuals. Moreover, major risk factors identified included the presence of plaque and the presence of subgingival band margins.

Periodontitis and diabetes associations with measures of atherosclerosis and CHD

OBJECTIVE

Diabetes has been linked with more severe periodontal disease and with coronary heart disease (CHD). The purpose of this study was to determine if periodontal infection was a significant modifier in the risk that diabetes poses for increased carotid artery intimal-medial wall thickness (IMT) and more advanced atheroma lesions as reflected in atherosclerotic plaque calcification measured by acoustic shadowing.

METHODS AND RESULTS

Comparisons for analyses of cardiovascular outcomes were performed based upon periodontitis and diabetes status. Periodontitis was measured using pocket depth and attachment loss at six sites per tooth. Cross-sectional data on 6048 persons aged 52-74 years were obtained from the Dental Atherosclerosis Risk in Communities Study. Participants without diabetes (n=5257) were compared to those with diabetes (n=791). Dependent variables were thick IMT (>1 mm), presence of acoustic shadowing, and prevalent CHD. All models were adjusted for the following covariates: gender, age, race/center, LDL and HDL cholesterol, BMI, triglycerides, hypertension, smoking, income and education. For multivariate model building, all non-normally distributed variables were transformed and multivariable logistic regression analyses were performed to evaluate the relationship between periodontal infection, diabetes, and cardiovascular outcomes. Individuals with diabetes and with severe periodontitis were found to be significantly more likely to have IMT>1 mm [OR=2.2, (1.4-3.5)], acoustic shadowing [OR=2.5, (1.3-4.6)], and CHD [OR=2.6, (1.6-4.2)] compared to those without diabetes or periodontal disease.

CONCLUSION

Results from this study suggest that among people with diabetes, periodontal disease may increase the likelihood of subclinical atherosclerotic heart disease and CHD.

Contemporary concepts in the diagnosis of periodontal disease

Periodontitis is an inflammatory disease of bacterial origin that results in the progressive destruction of the tissues that support the teeth, specifically the gingiva, periodontal ligament, and alveolar bone. The diagnosis of periodontal disease currently relies almost exclusively on clinical parameters and traditional dental radiography. In this article, the authors review current diagnostic techniques and present new approaches and technologies that are being developed to improve assessment of this common condition.

Immunoglobulin G (IgG) class, but Not IgA or IgM, antibodies to peptides of the Porphyromonas gingivalis chaperone HtpG predict health in subjects with periodontitis by a fluorescence enzyme-linked immunosorbent assay

Chaperones are molecules found in all cells and are critical in stabilization of synthesized proteins, in repair/removal of defective proteins, and as immunodominant antigens in innate and adaptive immunity. Subjects with gingivitis colonized by the oral pathogen Porphyromonas gingivalis previously demonstrated levels of anti-human chaperone Hsp90 that were highest in individuals with the best oral health. We hypothesized that similar antibodies to pathogen chaperones might be protective in periodontitis. This study examined the relationship between antibodies to P. gingivalis HtpG and clinical statuses of healthy and periodontitis-susceptible subjects. We measured the humoral responses (immunoglobulin G [IgG], IgA, and IgM) to peptides of a unique insert (P18) found in Bacteroidaceae HtpG by using a high-throughput, quantitative fluorescence enzyme-linked immunosorbent assay. Indeed, higher levels of IgG class anti-P. gingivalis HtpG P18 peptide (P < 0.05) and P18alpha, consisting of the N-terminal 16 amino acids of P18 (P < 0.05), were associated with better oral health; these results were opposite of those found with anti-P. gingivalis whole-cell antibodies and levels of the bacterium in the subgingival biofilm. When we examined the same sera for IgA and IgM class antibodies, we found no significant relationship to subject clinical status. The relationship between anti-P18 levels and clinical populations and individual subjects was found to be improved when we normalized the anti-P18alpha values to those for anti-P18gamma (the central 16 amino acids of P18). That same ratio correlated with the improvement in tissue attachment gain after treatment (P < 0.05). We suggest that anti-P. gingivalis HtpG P18alpha antibodies are protective in periodontal disease and may have prognostic value for guidance of individual patient treatment.

Macrophage inflammatory protein-1alpha: a salivary biomarker of bone loss in a longitudinal cohort study of children at risk for aggressive periodontal disease?

BACKGROUND

Periodontitis develops in a time-dependent manner. Cross-sectional studies document one moment in time but fail to capture the progressive nature of disease. Radiographic measures of bone loss are relatively insensitive but are reliable markers of irreversible disease. Longitudinal studies are needed to identify biomarkers that can precede radiographic evidence of bone loss and, thus, mark the period prior to clinical evidence of irreversible disease. A longitudinal study of students susceptible to localized aggressive periodontitis (LAgP) was conducted to evaluate chemokines/cytokines found in saliva derived from periodontally healthy children who subsequently developed alveolar bone loss.

METHODS

Students were screened, sampled for Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans [Aa]), and divided into a cohort of Aa+ and Aa- students. Ninety-six periodontally healthy Aa+ and Aa- students were recalled every 6 to 9 months following screening. Examinations, saliva collections, and radiographs were performed. After seven students developed bone loss, the levels of 21 cytokines were assessed and matched to saliva from seven Aa+ and seven Aa- students who remained healthy for > or =1 year. Subsequently, saliva from an additional 27 students who remained healthy was analyzed.

RESULTS

Nineteen cytokines were not detected or were detected at low levels. Macrophage inflammatory protein (MIP)-1alpha was elevated 50-fold in seven Aa+ students who developed disease 6 to 9 months prior to radiographic detection of bone loss compared to levels in 21 Aa+ and 20 Aa- students who remained healthy (P <0.001). Interleukin (IL)-1beta was also elevated (P = 0.01). MIP-1alpha had a specificity of 96.8% and a sensitivity of 100%, whereas IL-1beta showed 90.3% specificity and 85.7% sensitivity relative to bone loss. MIP-1alpha levels were also related to increasing probing depth and the number of pockets >6 mm.

CONCLUSION

The superior sensitivity and specificity of MIP-1alpha, which correlated well with probing depths and the onset of bone loss, suggested that it could be used as an early biomarker for LAgP.

Case definitions for use in population-based surveillance of periodontitis

Many definitions of periodontitis have been used in the literature for population-based studies, but there is no accepted standard. In early epidemiologic studies, the two major periodontal diseases, gingivitis and periodontitis, were combined and considered to be a continuum. National United States surveys were conducted in 1960 to 1962, 1971 to 1974, 1981, 1985 to 1986, 1988 to 1994, and 1999 to 2000. The case definitions and protocols used in the six national surveys reflect a continuing evolution and improvement over time. Generally, the clinical diagnosis of periodontitis is based on measures of probing depth (PD), clinical attachment level (CAL), the radiographic pattern and extent of alveolar bone loss, gingival inflammation measured as bleeding on probing, or a combination of these measures. Several other patient characteristics are considered, and several factors, such as age, can affect measurements of PD and CAL. Accuracy and reproducibility of measurements of PD and CAL are important because case definitions for periodontitis are based largely on either or both measurements, and relatively small changes in these values can result in large changes in disease prevalence. The classification currently accepted by the American Academy of Periodontology (AAP) was devised by the 1999 International Workshop for a Classification of Periodontal Diseases and Conditions. However, in 2003 the Centers for Disease Control and Prevention and the AAP appointed a working group to develop further standardized clinical case definitions for population-based studies of periodontitis. This classification defines severe periodontitis and moderate periodontitis in terms of PD and CAL to enhance case definitions and further demonstrates the importance of thresholds of PD and CAL and the number of affected sites when determining prevalence.

A community study on the relationship between stress, coping, affective dispositions and periodontal attachment loss

BACKGROUND

Psychological factors may increase the risk for periodontal diseases. Contemporary conceptualization of the stress process supports the evaluation of stress at three levels: stressors, moderating and mediating factors, and stress reactions.

OBJECTIVE

This study was undertaken to investigate the relationship of periodontal disease in terms of clinical attachment level (CAL) to psychosocial stress, making reference to the major components of stress process.

METHODS

A cross-sectional study of 1000 subjects aged 25-64 years in Hong Kong was conducted. Subjects were asked to complete a set of questionnaires measuring stressors including changes, significant life event and daily strains, stress reactions including physiological and affective responses, and coping and affective dispositions. CAL was assessed.

RESULTS

Individuals with high mean CAL values had higher scores on the job and financial strain scales than periodontally healthy individuals (P < 0.05), after adjusting for age, gender, cigarette smoking and systemic disease. Depression, anxiety trait, depression trait, problem-focused coping, and emotion-focused coping were also related to CAL. Logistic regression analysis indicated that all these factors were significant risk indicators for periodontal attachment loss, except problem-focused coping, which reduced the odds of CAL. Individuals who were high emotion-focused copers, low problem-focused copers, trait anxious, or trait depressive had a higher odds of more severe CAL.

CONCLUSION

Chronic job and financial strains, depression, inadequate coping, and maladaptive trait dispositions are significant risk indicators for periodontal attachment loss. Adequate coping and adaptive trait dispositions, evidenced as high problem-focused coping and low anxiety/depression trait, may reduce the stress-associated odds.

Suppression of overt gingival inflammation in tobacco smokers - clinical and mechanistic considerations

Gingivitis is a reversible inflammatory disease of the periodontal tissues. Periodontitis, in addition, involves destruction of the supporting structures of teeth. Diagnoses of gingivitis and periodontitis are predominantly dependent on clinical measurements of key inflammatory indices. Smokers are more susceptible to developing periodontal diseases, yet smoking masks overt signs of inflammation, presenting dental professionals with a clinical conundrum. We review the evidence that tobacco smoke may (i) cause acute periodontal vasoconstriction, (ii) inhibit periodontal angiogenesis in response to inflammatory stimuli, and/or (iii) suppress the production of pro-inflammatory mediators. It is clear that the mechanisms by which cigarette smoking dampens the periodontal inflammatory response are not yet fully understood. Further research into inflammatory suppression is warranted and should point to improved methods of diagnosis, not only in smokers, but also in non-smokers.

Oral health-related quality of life and periodontal status

BACKGROUND

As patient-centered approaches become more popular, increasing attention is being given to assess the effects of various human health situations on an individual's overall quality of life (QoL). Measures have been used in dentistry to study the effects of orthodontic treatment and oral surgery, but so far little has been reported about the effects of periodontal disease.

OBJECTIVE

This study assessed the impact of periodontal health status on QoL.

METHODS

A subsample of 767 subjects were selected from a community study (n=1000) which investigated the association between psychological factors and clinical periodontal attachment level (CAL). The sample included subjects with full-mouth mean CAL<or=2 mm (healthy/low periodontal attachment loss group), and subjects with full-mouth mean CAL>3 mm (high/severe periodontal attachment loss group). The subjects were requested to complete the Chinese short-form version of Oral Health Impact Profile (OHIP-14S) and a checklist of self-reported periodontal symptoms during the previous 12 months.

RESULTS

A total of 727 subjects (95%) completed the questionnaire. The OHIP-14S and subscale scores were significantly associated with six of seven of the self-reported periodontal symptoms. A comparison of the mean OHIP-14S scores of the healthy/low and the high/severe periodontal attachment loss groups revealed significant differences in respect of the subscales of functional limitation, physical pain, psychological discomfort, physical and psychological disabilities.

CONCLUSION

This study demonstrates a significant association between oral health-related QoL and periodontal disease.

A doença periodontal na comunidade negra dos Arturo's, Contagem, Minas Gerais, Brasil

Trata-se de um estudo seccional transversal em uma comunidade da raça negra. A amostra foi constituída por 104 indivíduos acima de 13 anos de idade, sendo 63 mulheres e 41 homens. Foram examinados todos os dentes presentes, com exceção dos terceiros molares. Cada dente foi sondado em seis sítios para registrar a profundidade de sondagem e a perda de inserção e em quatro sítios para registrar sangramento após sondagem e presença de cálculo. Observou-se que, do total dos dentados, o sangramento à sondagem foi detectado em 97,9%, a profundidade de sondagem (PS) > 4mm foi observada em 43,3%, a perda de inserção (PI) > 4mm verificou-se em 63,5% e em 81,2% observou-se a presença de cálculo. De 46 a 60 anos, identificou-se uma PI de 8,3mm (±4,27), a maior média, e também PS de 4,6mm (±3,5). A doença acometeu 9,6% dos participantes em sua forma grave (PS > 7), valor dentro dos padrões conhecidos no Brasil e no mundo, não havendo um diferencial por ser um povo negro. Faixa etária, escolaridade e uso de tabaco foram indicadores de risco relacionados com a doença.

Position Paper: Diagnosis of Periodontal Diseases

At the present time, the diagnosis and classification of periodontal diseases are almost entirely based on traditional clinical assessments. Supplemental quantitative and qualitative assessments of the gingival crevicular fluid and subgingival microflora can potentially provide useful information about the patient's periodontal disease. In certain situations, these supplemental risk-assessment tests may be particularly valuable in establishing the endpoint of therapy prior to placing patients on a periodontal maintenance program. Although the clinical utility of none of these tests has been validated, their further development is warranted. A genetic test for susceptibility to periodontitis has become commercially available. How best to use this and future host-based tests in clinical practice remains to be determined. Probing depth and clinical attachment loss measurements obtained with periodontal probes are practical and valid methods for assessing periodontal status. Computer-linked, controlled-force electronic periodontal probes are commercially available and are currently in use by some practitioners. Many of the logistical problems associated with subtraction radiography are being overcome and this powerful diagnostic tool may soon come into widespread use. Future developments in this and other imaging techniques are likely to have a profound effect on our approach to the diagnosis of periodontal diseases.

Diagnostic value of the use of lateral and occlusal radiographic views in comparison with periodontal probing for the assessment of periodontal attachment of the canine teeth in dogs

OBJECTIVE

To determine the diagnostic value of 2 intraoral bisecting angle radiographic views in comparison with periodontal probing for the assessment of periodontal attachment of the canine teeth in dogs.

STUDY POPULATION

466 canine teeth from 117 dogs.

PROCEDURE

Periodontal probing measurements were recorded, and clinical attachment levels (CAL) were calculated at the mesial, buccal, distal, and lingual (or palatal) surfaces on each canine tooth. Occlusal and lateral radiographs of the canine teeth were obtained. Alveolar margin height (AMH) was measured at the same 4 surfaces. Values for AMH and CAL were compared on the basis of tooth surface, dental arch, and radiographic view.

RESULTS

The AMH at the mesial and distal surfaces of the mandibular canine teeth was measurable on the lateral view and was significantly correlated with CAL. Similar results were found for the mesial and distal surfaces of the maxillary canine teeth. Buccal and lingual AMH were measured on the mandibular occlusal radiographic view, and values were significantly correlated with CAL, but only the buccal AMH could be assessed on the occlusal radiographic view of the maxilla with values that correlated significantly with CAL.

CONCLUSIONS AND CLINICAL RELEVANCE

The lateral radiographic view is suitable for evaluating periodontal attachment at the mesial and distal surfaces of the canine teeth in dogs. The occlusal radiographic view is suitable for assessing buccal surfaces as well as the lingual surface of mandibular canine teeth but not the palatal surface of maxillary canine teeth in dogs.