Study of Bacterial Viability within Human Supragingival Dental Calculus

Subgingival scaling and root planing during minimally invasive periodontal surgery: A randomized controlled split-mouth trial

BACKGROUND

The purpose of this randomized, controlled split-mouth study was to evaluate a videoscope as a visual adjunct to scaling and root planing when utilized in combination with minimally invasive surgery.

METHODS

Twenty-five pairs (89 interproximal surfaces) of periodontally hopeless teeth planned for extraction were scaled and root planed with minimal surgical access using surgical loupes (control) or adjunctive use of a videoscope (test). Teeth were extracted with minimal trauma, stained with methylene blue, and photographed with a digital microscope for analysis. The primary outcome of residual calculus was calculated as a percentage of the total interproximal area of interest. Secondary outcomes included treatment time, as well as residual calculus according to probing depth, tooth location, and treatment date. Data were analyzed using Student's paired t-tests, two-way analyses of variance, and Spearman's correlation tests.

RESULTS

Residual calculus area was 2.61% on control and 2.71% on test surfaces with no significant difference between groups. Subgroup analysis showed no difference in residual calculus between groups at moderate or deep sites. Treatment time per surface was significantly longer in the test group compared to the control group. Treatment order, tooth location, and operator experience did not significantly affect the primary outcome.

CONCLUSIONS

Though the videoscope provided excellent visual access, it did not improve the efficacy of root planing for flat interproximal surfaces during minimally invasive periodontal surgery. Small amounts of calculus remain after instrumentation even with minimal surgical access and when root surfaces appear visually clean and tactilely smooth.

Effect of salivary urea, pH and ureolytic microflora on dental calculus formation and its correlation with periodontal status

Context

Dental calculus, formed by mineralization of plaque predisposes to the development of periodontal disease.

Aim

To evaluate the influence of salivary urea and the presence of ureolytic bacteria on dental calculus formation and periodontal status in patients with good, fair and poor oral hygiene.

Material and methods

An observational cross-sectional study was carried out on 135 patients, 18–60 years of age. Based on the simplified calculus index, patients were divided into three groups, good oral hygiene, fair oral hygiene and poor oral hygiene. Clinical parameters such as plaque index, gingival index, pocket probing depth and clinical attachment level and salivary pH were recorded for each subject. Saliva samples were collected to evaluate the urea levels using autoanalyzer method. Supragingival calculus samples were collected and presence and quantification of ureolytic bacteria were done by gram staining and bacterial culture and confirmed by biochemical reaction. For statistical analysis, test like Shapiro-Wilk test, Kruskal Wallis and Spearman's rho were used.

Results

Increase in salivary pH was associated with increased odds of higher calculus index score (odds ratio = 2.785). There was a non-significant weak correlation between salivary urea and ureolytic bacteria in dental calculus in all the three groups (p > 0.05). Higher calculus index score was associated with increased odds of presence of ureolytic bacteria (odds ratio>1).

Conclusions

Higher level of ureolytic bacteria with increasing calculus index score may breakdown the salivary urea to ammonia resulting in a ureolytic pH rise that facilitate calcium phosphate saturation leading to more calculus formation.

The association between oral health status and the clinical outcome of cirrhotic patients on the waiting list for liver transplantation

Liver transplantation (LT) candidates often present with poor oral hygiene, which could potentially lead to systemic infections and sepsis owing to their cirrhotic state. In this study, we investigated the oral health status of LT candidates and propose guidance for the detection and treatment of encountered oral lesions among these patients. The decayed, missing, and filled teeth (DMFT) index was determined through oral examination. The presence of dental calculus was detected using panoramic radiography and defined by the radiopaque dental calculus (RDC). From January 2011 to August 2018, 56 LT candidates were enrolled with a median follow-up of 39 months. The overall mean numbers of decayed, missing, and filled teeth among these patients were 2.7 ± 2.8, 10.9 ± 8.3, and 5.4 ± 4.5, respectively. Eighteen patients (32.1%) had RDC. The 5-year survival rates of all 56 patients was 57.7%, while that of those who either received LT (23 patients) or not were 82.1% and 39.8%, respectively. A Cox regression model revealed better overall survival of patients after LT (adjusted hazard ratio [aHR] = 0.067, p = 0.001), worse survival among patients with RDC (aHR = 3.468, p = 0.010), at Child-Pugh stages B and C (aHR for stage B = 11.889, p = 0.028; aHR for stage C = 19.257, p = 0.013) compared to patients at Child-Pugh stage A, and those with a model for end-stage liver disease (MELD) score ≥25 (aHR = 13.721, p = 0.018). This study demonstrates that RDC was associated with worse prognosis in LT candidates. We therefore recommend that interprofessional collaboration should be a routine preoperative procedure for the evaluation of oral hygiene among LT candidates.

A re-evaluation of scaling and root planing

BACKGROUND

Extensive reviews on the role of scaling and root planing (SRP) in the treatment of periodontitis have been previously published. This commentary will address the importance of subgingival calculus in the progression and treatment of periodontitis and addresses factors that make the execution of a "definitive" SRP a critical part of therapy.

METHODS

A search for articles, using keywords relevant to the subject , (e.g., periodontitis, dental scaling, root planing, dental calculus, biofilm, inflammation) was conducted using PubMed, Ovid Medline, Cochrane Reviews and the ADA Center for Evidence Based Dentistry data bases. Additionally, references cited in relevant articles were also considered.

RESULTS

Surfaces of subgingival calculus are covered with a biofilm of metabolically active bacteria. Periodontal inflammation is clearly related to the presence of calculus and biofilm. The primary goal of SRP is removal of subgingival calculus and biofilm deposits to create a biologically compatible root surface and reduce the inflammatory burden. Current evidence suggests that inflammation associated with periodontal infections affects both the immediate oral environment and the patient's systemic health.

CONCLUSION

SRP is still critical to the treatment of periodontitis. SRP involving deep probing depths (≥ 5 mm) and root surfaces with anatomical and surface irregularities, regardless of the type of instrumentation, requires time, exceptional skill and perseverance, and patient compliance with periodontal maintenance. Sites with persistent nonresponding probing depths and signs of inflammation following a definitive SRP, should be considered for surgical intervention.

Accuracy of dental calculus detection using digital radiography and image manipulation

BACKGROUND

The aim of this study was to determine if image enhancement improves a clinician's ability to identify the presence of calculus on digital radiographs.

METHODS

Seventy-one hopeless teeth were collected from 34 patients. Teeth were stained with 1% methylene blue, the largest interproximal calculus deposit was scored, and photographs of each interproximal root surface were taken. The surface area of calculus deposit was determined as a percentage of the total interproximal root surface area. Digital radiographs of teeth taken before extraction were modified using the following enhancements: auto-contrast, emboss, invert, and sharpen. Radiographic presence of calculus was determined by two examiners. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each examiner and enhancement. A receiver operating characteristic curve was used to compare differences between the image enhancements in the detection of dental calculus. The kappa statistic was used to compare ratings between examiners.

RESULTS

None of the enhanced images were statistically superior to original images in identifying radiographic calculus (P > 0.05). The average sensitivity of digital radiography was 50%, average specificity was 82.2%, PPV was 94%, and NPV 23.2%. A threshold of >30% of interproximal root surface covered with calculus and increasing size of deposits were associated with improved detection (P < 0.05).

CONCLUSIONS

Digital enhancements do not significantly improve radiographic detection of dental calculus. As area of calculus on the root surface and size of calculus deposits increased, sensitivity of detection also increased.

Evaluation of Cadmium Levels in Dental Calculus of Male Oral SCC Patients with Betel-Quid Chewing in Hunan Province of China

Cadmium (Cd) is a widespread trace toxic heavy metal with long biological half-life and may induce higher risk of cancer on multiple organs of human body. Recent studies have confirmed that dental calculus has enormous potential for investigation of exposure to Cd in the human mouth by acting as a time capsule. We aimed to examine relationship between Cd levels in dental calculus due to betel-quid chewing and risk of oral cancer. This study included 85 male oral squamous cell carcinoma (SCC) cases with betel-quid chewing and smoking as observation subjects (group A) and 67 healthy people with smoking but without betel-quid chewing as control subjects (group B) in Hunan province of Mainland China. Cd levels in calcified dental calculus samples from all participants were measured by inductively coupled plasma mass spectrometry (ICP-MS). The results of this study indicated that cadmium levels in dental calculus were significantly higher in male oral SCC patients with betel-quid chewing and smoking than that in healthy individuals without habit of betel-quid chewing and with smoking (p < 0.0001). This study gives some evidence to support that there may be a positive relationship between cadmium in dental calculus due to betel-quid chewing and risk of oral SCC.

Cadmium Profiles in Dental Calculus: a Cross-Sectional Population-Based Study in Hunan Province of China

We aimed to investigate whether the cadmium concentrations differ in human dental calculus obtained from the residents with no smoking living in the contaminated area and those with no smoking living in noncontaminated area. In total, there were 260 samples of dental calculus from the adults (n = 50) with no smoking living in contaminated area, the adults (n = 60) with no smoking living in mountainous area, and the adults (n = 150) with no smoking living in low altitude area in Hunan province of China. All samples were analyzed by inductively coupled plasma mass spectrometry (ICP-MS) for cadmium levels. The cadmium levels in dental calculus were significantly higher in the adults with no smoking living in contaminated area than those living in mountainous area and in low altitude area (p < 0.01). The cadmium levels in dental calculus were also higher in the adults with no smoking living in low altitude area than those living in mountainous region (p < 0.01). The results suggested that measuring cadmium levels in dental calculus may be a useful noninvasive method for analysis of environmental exposure to cadmium in the human oral cavity. The low altitude region may have an area contaminated with cadmium in Hunan province of China.

Bacterial Viability within Dental Calculus: An Untrodden, Inquisitive Clinico-Patho- Microbiological Research

INTRODUCTION

Chronic inflammatory periodontal diseases i.e. gingivitis and periodontitis are one of the most common afflictions faced by human beings. Dental plaque, which is a pool of pathogenic microorganisms, remains to be current mainstay in etiopathogenesis. Dental calculus, which is a mineralized product of this plaque remains ignored and is considered merely as an ash heap of minor significance. However, the intriguing array in disease etiopathogenesis bulldozed researchers to suspect the role of calculus in disease chrysalis but still the viability of bacteria inside calculus and thus its pathogenicity remains an intricacy; the answer to which lies in the Pandora's Box.

AIM

The present study was undertaken to investigate the viability of bacteria within dental calculus along with their identification. Also, to classify dental calculus on the basis of mineralization and to observe the variation of viable microflora found in dental calculus with the extent of mineralization and disease severity.

MATERIALS AND METHODS

A total of 60 samples were obtained, by harvesting two samples of supragingival calculus from each patient having chronic inflammatory periodontal disease. These samples were divided into two groups (Group A and Group B). Samples of Group A were kept non-irradiated and samples of Group B were exposed to UV radiation. The samples were categorized into less, moderately and highly mineralized according to the force required for crushing them. All the crushed calculus samples were then divided into three parts. These were used for dark-field microscopy, gram staining and bacterial cultures. Bacterial identification of the cultures obtained was also carried out by performing various biochemical assays.

RESULTS

The present study revealed the presence of motile spirochaetes within the samples under dark-field microscope. Gram staining revealed presence of numerous gram positive cocci and gram negative bacilli. Bacterial cultures showed growth of variety of aerobic and capnophilic microorganisms.

CONCLUSION

The present study concludes the presence of viable aerobic and capnophilic bacteria inside dental calculus which may reside within the lacunae and channels in the calculus.

Dental Calculus Links Statistically to Angina Pectoris: 26-Year Observational Study

Objectives

Dental infections, such as periodontitis, associate with atherosclerosis and its complications. We studied a cohort followed-up since 1985 for incidence of angina pectoris with the hypothesis that calculus accumulation, proxy for poor oral hygiene, links to this symptom.

Methods

In our Swedish prospective cohort study of 1676 randomly selected subjects followed-up for 26 years. In 1985 all subjects underwent clinical oral examination and answered a questionnaire assessing background variables such as socio-economic status and pack-years of smoking. By using data from the Center of Epidemiology, Swedish National Board of Health and Welfare, Sweden we analyzed the association of oral health parameters with the prevalence of in-hospital verified angina pectoris classified according to the WHO International Classification of Diseases, using descriptive statistics and logistic regression analysis.

Results

Of the 1676 subjects, 51 (28 women/23 men) had been diagnosed with angina pectoris at a mean age of 59.8 ± 2.9 years. No difference was observed in age and gender between patients with angina pectoris and subjects without. Neither was there any difference in education level and smoking habits (in pack years), Gingival index and Plaque index between the groups. Angina pectoris patients had significantly more often their first maxillary molar tooth extracted (d. 16) than the other subjects (p = 0.02). Patients also showed significantly higher dental calculus index values than the subjects without angina pectoris (p = 0.01). Multiple regression analysis showed odds ratio 2.21 (95% confidence interval 1.17–4.17) in the association between high calculus index and angina pectoris (p = 0.015).

Conclusion

Our study hypothesis was confirmed by showing for the first time that high dental calculus score indeed associated with the incidence of angina pectoris in this cohort study.

Dental calculus is associated with death from heart infarction

Objectives. We studied whether the amount of dental calculus is associated with death from heart infarction in the dental infection—atherosclerosis paradigm. Materials. Participants were 1676 healthy young Swedes followed up from 1985 to 2011. At the beginning of the study all subjects underwent oral clinical examination including dental calculus registration scored with calculus index (CI). Outcome measure was cause of death classified according to WHO International Classification of Diseases. Unpaired t-test, Chi-square tests, and multiple logistic regressions were used. Results. Of the 1676 participants, 2.8% had died during follow-up. Women died at a mean age of 61.5 years and men at 61.7 years. The difference in the CI index score between the survivors versus deceased patients was significant by the year 2009 (P < 0.01). In multiple regression analysis of the relationship between death from heart infarction as a dependent variable and CI as independent variable with controlling for age, gender, dental visits, dental plaque, periodontal pockets, education, income, socioeconomic status, and pack-years of smoking, CI score appeared to be associated with 2.3 times the odds ratio for cardiac death. Conclusions. The results confirmed our study hypothesis by showing that dental calculus indeed associated statistically with cardiac death due to infarction.

Resolution of Localized Chronic Periodontitis Associated with Longstanding Calculus Deposits

This report, which is based on nonstandardized serial radiographs obtained over a period of 15 years, documents a case of localized chronic periodontitis associated with progressive deposition of calculus on the distal aspect of a mandibular second molar. The site was treated by scaling and root planing, followed by a course of adjunctive systemic azithromycin. Treatment yielded favorable reductions in probing depth and clinical inflammation, leaving only few isolated sites with pockets no deeper than 4 mm. Two years after completion of active treatment, there was radiographic evidence of increased bone density distal to the second molar.

Clinical and microbiological evaluation of one-stage full-mouth disinfection: a short-term study

INTRODUCTION: Patients seem to adhere better to short-term periodontal treatment schemes. Besides, time-reduced treatments are more cost-effective. However, the degree of benefits related to this type of treatment still requires additional investigations. AIM: The present short-term study evaluated clinical and microbiological outcomes, from baseline to 3-months, of chronic periodontitis subjects treated by the one-stage full-mouth disinfection protocol. MATERIAL AND METHOD: Sixteen chronic periodontitis subjects (mean-age 49.87 ± 8.22) who met inclusion/exclusion criteria were included. A calibrated examiner measured whole-mouth plaque and gingival indices, periodontal pocket depth and clinical attachment level at baseline and at 3-months. Subgingival samples were also collected from the 5 most diseased periodontal sites to determine total bacterial load and levels of P. gingivalis and S. oralis by real time qPCR. Periodontal treatment consisted of full-mouth manual debridement plus wide intraoral use of chlorhexidine in gel and solution. Additionally, after debridement, individuals rinsed 0.12% chlorhexidine at home twice a day for the following 2 months. Data monitored were compared by paired Student-t test (p<0.05). RESULT: Statistical analysis revealed that, in general, one-stage full-mouth disinfection treatment provided significant clinical and microbiological improvements at 3-months. Total bacterial load showed one of the most pronounced reductions from baseline to 3-months (p=0.0001). Also, subgingival levels P. gingivalis and S. oralis reduced overtime. CONCLUSION: After a short period of monitoring, chronic periodontitis subjects showed clinical and microbial improvements following one-stage full-mouth disinfection treatment.

Viability of bacteria in dental calculus - A microbiological study

Aim:

The aim of this study was (1) To investigate the viability of bacteria within supragingival and subgingival calculus, (2) To examine motility of bacteria, and (3) To identify bacterial morphotypes in calculus.

Materials and Methods:

Supra and subgingival calculus were harvested from 30 subjects having clinical evidence of chronic inflammatory periodontal disease and were divided into two groups. Samples from both groups were immediately transported to the Department of Microbiology for gram staining, acridine orange staining, bacterial culture and to the Department of Oral Pathology for dark field microscopy.

Results:

Gram staining revealed presence of bacteria within the samples.Dark field microscopic examination revealed presence of filamentous organisms, spirochetes, and motile short bacilli. Acridine orange fluorescent stain showed that the viable bacteria appeared apple green. Bacterial culture revealed presence of a variety of aerobic organisms.

Conclusion:

From the results, it appeared that viable bacteria were present within calculus especially within internal channels and lacunae.

Characteristics of subgingival calculus detection by multiphoton fluorescence microscopy

Subgingival calculus has been recognized as a major cause of periodontitis, which is one of the main chronic infectious diseases of oral cavities and a principal cause of tooth loss in humans. Bacteria deposited in subgingival calculus or plaque cause gingival inflammation, function deterioration, and then periodontitis. However, subgingival calculus within the periodontal pocket is a complicated and potentially delicate structure to be detected with current dental armamentaria, namely dental x-rays and dental probes. Consequently, complete removal of subgingival calculus remains a challenge to periodontal therapies. In this study, the detection of subgingival calculus employing a multiphoton autofluorescence imaging method was characterized in comparison with a one-photon confocal fluorescence imaging technique. Feasibility of such a system was studied based on fluorescence response of gingiva, healthy teeth, and calculus with and without gingiva covered. The multiphoton fluorescence technology perceived the tissue-covered subgingival calculus that cannot be observed by the one-photon confocal fluorescence method.

The Effectiveness of Subgingival Scaling and Root Planing: An Evaluation of Therapy With and Without the Use of the Periodontal Endoscope

BACKGROUND

A fiber-optic periodontal endoscope was developed to aid in the visualization of subgingival structures and to improve the diagnosis and management of periodontal diseases. The purpose of this study was to determine whether use of the periodontal endoscope with scaling and root planing (SRP) resulted in a decrease in residual calculus compared to SRP alone.

METHODS

Fifteen subjects with 50 tooth pairs participated in this study. Each tooth per pair was randomized to receive SRP with or without the endoscope. Teeth were extracted, and a stereomicroscope and digital image analysis was used to determine percent residual calculus present in a masked fashion.

RESULTS

There was 2.14% (P < 0.001) more residual calculus at control versus test sites. At buccal/lingual and interproximal surfaces, mean differences in residual calculus were 1.30% (P <0.015) and 2.93% (P < 0.001), respectively. Test treatment time decreased significantly as operator experience increased. There were no statistically significant differences between residual calculus for test and control teeth at shallower probing depths; however, at deeper probing depths, the use of the endoscope resulted in significantly less residual calculus.

CONCLUSIONS

The use of the periodontal endoscope resulted in a statistically significant overall improvement in calculus removal during SRP, which was most evident in deeper probing depths. The clinical significance of this level of improvement is unknown.