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Abdulkareem AA, Al-Taweel FB, Al-Sharqi AJ, Gul SS, Sha A, Chapple IL. Current concepts in the pathogenesis of periodontitis: from symbiosis to dysbiosis. J Oral Microbiol 2023; 15:2197779. [PMID: 37025387 PMCID: PMC10071981 DOI: 10.1080/20002297.2023.2197779] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
The primary etiological agent for the initiation and progression of periodontal disease is the dental plaque biofilm which is an organized aggregation of microorganisms residing within a complex intercellular matrix. The non-specific plaque hypothesis was the first attempt to explain the role of the dental biofilm in the pathogenesis of periodontal diseases. However, the introduction of sophisticated diagnostic and laboratory assays has led to the realisation that the development of periodontitis requires more than a mere increase in the biomass of dental plaque. Indeed, multispecies biofilms exhibit complex interactions between the bacteria and the host. In addition, not all resident microorganisms within the biofilm are pathogenic, since beneficial bacteria exist that serve to maintain a symbiotic relationship between the plaque microbiome and the host’s immune-inflammatory response, preventing the emergence of pathogenic microorganisms and the development of dysbiosis. This review aims to highlight the development and structure of the dental plaque biofilm and to explore current literature on the transition from a healthy (symbiotic) to a diseased (dysbiotic) biofilm in periodontitis and the associated immune-inflammatory responses that drive periodontal tissue destruction and form mechanistic pathways that impact other systemic non-communicable diseases.
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Affiliation(s)
- Ali A. Abdulkareem
- Department of Periodontics, College of Dentistry, University of Baghdad, Baghdad, Iraq
- CONTACT Ali A. Abdulkareem College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Firas B. Al-Taweel
- Department of Periodontics, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Ali J.B. Al-Sharqi
- Department of Periodontics, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Sarhang S. Gul
- College of Dentistry, University of Sulaimani, Sulaimani, Iraq
| | - Aram Sha
- College of Dentistry, University of Sulaimani, Sulaimani, Iraq
| | - Iain L.C. Chapple
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
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Caton JG, Armitage G, Berglundh T, Chapple IL, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Periodontol 2018; 89 Suppl 1:S1-S8. [DOI: 10.1002/jper.18-0157] [Citation(s) in RCA: 316] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Jack G. Caton
- Periodontics; Eastman Institute for Oral Health; University of Rochester; Rochester NY USA
| | - Gary Armitage
- School of Dentistry; University of California San Francisco; San Francisco CA USA
| | - Tord Berglundh
- Department of Periodontology; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Iain L.C. Chapple
- Periodontal Research Group; Institute of Clinical Sciences; College of Medical & Dental Sciences; University of Birmingham; Birmingham UK
| | - Søren Jepsen
- Department of Periodontology; Operative and Preventive Dentistry; University of Bonn; Bonn Germany
| | | | - Brian L. Mealey
- University of Texas Health Science Center; San Antonio TX USA
| | | | - Mariano Sanz
- Facultad de Odontologia; Universidad Complutense Madrid; Madrid Spain
| | - Maurizio S. Tonetti
- Periodontology; Faculty of Dentistry; University of Hong Kong; Hong Kong SAR China
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3
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Chapple IL, Mealey BL, Van Dyke TE, Bartold PM, Dommisch H, Eickholz P, Geisinger ML, Genco RJ, Glogauer M, Goldstein M, Griffin TJ, Holmstrup P, Johnson GK, Kapila Y, Lang NP, Meyle J, Murakami S, Plemons J, Romito GA, Shapira L, Tatakis DN, Teughels W, Trombelli L, Walter C, Wimmer G, Xenoudi P, Yoshie H. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol 2018; 45 Suppl 20:S68-S77. [DOI: 10.1111/jcpe.12940] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/11/2018] [Accepted: 03/12/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Iain L.C. Chapple
- Periodontal Research Group; Institute of Clinical Sciences; College of Medical & Dental Sciences; University of Birmingham; UK
| | - Brian L. Mealey
- University of Texas Health Science Center at San Antonio; USA
| | | | | | - Henrik Dommisch
- Department of Periodontology and Synoptic Dentistry; Charité - Universitätsmedizin Berlin; Germany
| | - Peter Eickholz
- Department of Periodontology, Center for Oral Medicine; Johann Wolfgang Goethe-University Frankfurt; Germany
| | | | | | | | - Moshe Goldstein
- Department of Periodontology; Faculty of Dental Medicine; Hebrew University-Hadassah Medical Center; Jerusalem Israel
| | - Terrence J. Griffin
- Periodontal Department; Tufts University School of Dental Medicine; Boston MA USA
| | - Palle Holmstrup
- Periodontology; Section 1; Faculty of Health and Medical Sciences; University of Copenhagen; Denmark
| | - Georgia K. Johnson
- Department of Periodontology; University of Iowa College of Dentistry; Iowa City IA USA
| | - Yvonne Kapila
- Orofacial Sciences; University of California San Francisco; USA
| | - Niklaus P. Lang
- Department of Periodontology; University of Bern; Switzerland
| | - Joerg Meyle
- Department of Periodontology; University of Giessen; Germany
| | - Shinya Murakami
- Department of Periodontology; Graduate School of Dentistry, Osaka University; Japan
| | - Jacqueline Plemons
- Department of Periodontics; Texas A&M College of Dentistry; Dallas TX USA
| | - Giuseppe A. Romito
- Division of Periodontology; Department of Stomatology; Dental School; University of São Paulo; Brazil
| | - Lior Shapira
- Department of Periodontology; Faculty of Dental Medicine; Hebrew University-Hadassah Medical Center; Jerusalem Israel
| | - Dimitris N. Tatakis
- Division of Periodontology; College of Dentistry; Ohio State University; Columbus OH USA
| | - Wim Teughels
- Department of Oral Health Sciences; Periodontology; KU Leuven & Dentistry; University Hospitals Leuven; Belgium
| | - Leonardo Trombelli
- Research Center for the Study of Periodontal and Peri-Implant Diseases; University of Ferrara; Italy
| | - Clemens Walter
- Department of Periodontology, Endodontology & Cariology; University Centre for Dental Medicine; University of Basel School of Dentistry; Switzerland
| | - Gernot Wimmer
- Department of Prosthodontics; School of Dentistry, Medical University Graz; Austria
| | - Pinelopi Xenoudi
- Orofacial Sciences; School of Dentistry; University of California San Francisco; USA
| | - Hiromasa Yoshie
- Division of Periodontology; Niigata University Graduate School of Medical and Dental Sciences; Japan
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Murakami S, Mealey BL, Mariotti A, Chapple IL. Dental plaque-induced gingival conditions. J Clin Periodontol 2018; 45 Suppl 20:S17-S27. [DOI: 10.1111/jcpe.12937] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/08/2017] [Accepted: 08/19/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Shinya Murakami
- Osaka University; Graduate School of Dentistry-Department of Periodontology; Osaka Japan
| | - Brian L. Mealey
- Department of Periodontics; The University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - Angelo Mariotti
- Division of Periodontology, College of Dentistry; The Ohio State University; Columbus OH USA
| | - Iain L.C. Chapple
- Department of Periodontology; University of Birmingham School of Dentistry; Birmingham UK
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Caton JG, Armitage G, Berglundh T, Chapple IL, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Clin Periodontol 2018; 45 Suppl 20:S1-S8. [DOI: 10.1111/jcpe.12935] [Citation(s) in RCA: 397] [Impact Index Per Article: 66.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Jack G. Caton
- Periodontics; Eastman Institute for Oral Health; University of Rochester; Rochester NY USA
| | - Gary Armitage
- School of Dentistry; University of California San Francisco; San Francisco CA USA
| | - Tord Berglundh
- Department of Periodontology; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Iain L.C. Chapple
- Periodontal Research Group; Institute of Clinical Sciences; College of Medical & Dental Sciences; University of Birmingham; Birmingham UK
| | - Søren Jepsen
- Department of Periodontology; Operative and Preventive Dentistry; University of Bonn; Bonn Germany
| | | | - Brian L. Mealey
- University of Texas Health Science Center; San Antonio TX USA
| | | | - Mariano Sanz
- Facultad de Odontologia; Universidad Complutense Madrid; Madrid Spain
| | - Maurizio S. Tonetti
- Periodontology; Faculty of Dentistry; University of Hong Kong; Hong Kong SAR China
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Chapple IL, Bouchard P, Cagetti MG, Campus G, Carra MC, Cocco F, Nibali L, Hujoel P, Laine ML, Lingström P, Manton DJ, Montero E, Pitts N, Rangé H, Schlueter N, Teughels W, Twetman S, Van Loveren C, Van der Weijden F, Vieira AR, Schulte AG. Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol 2017; 44 Suppl 18:S39-S51. [DOI: 10.1111/jcpe.12685] [Citation(s) in RCA: 223] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Iain L.C. Chapple
- Periodontal Research Group; The University of Birmingham; Birmingham UK
| | - Philippe Bouchard
- Department of Periodontology; Service of Odontology; Rothschild Hospital; AP-HP, Paris 7-Denis Diderot University; U.F.R. of Odontology; Paris France
- EA 2496; Paris 5-Descartes University; U.F.R. of Odontology; Paris France
| | | | - Guglielmo Campus
- WHO Collaboration Centre for Epidemiology and Community Dentistry; Milan Italy
- Department of Surgery, Microsurgery and Medicine Sciences; School of Dentistry; Universita degli Studi di Sassari; Sassari Italy
| | - Maria-Clotilde Carra
- Department of Periodontology; Service of Odontology; Rothschild Hospital; AP-HP, Paris 7-Denis Diderot University; U.F.R. of Odontology; Paris France
- INSERM; U1018; Villejuif; France
| | - Fabio Cocco
- Department of Surgery, Microsurgery and Medicine Sciences; School of Dentistry; Universita degli Studi di Sassari; Sassari Italy
| | - Luigi Nibali
- Centre for Oral Clinical Research; Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University London (QMUL); London UK
| | - Philippe Hujoel
- Public Health Sciences; University of Washington; Seattle WA USA
| | - Marja L. Laine
- Department of Periodontology; Academic Centre for Dentistry in Amsterdam; Amsterdam the Netherlands
| | - Peter Lingström
- Department of Cariology; Institute of Odontology; Gothenburg Sweden
| | - David J. Manton
- Melbourne Dental School; University of Melbourne; Parkville Vic. Australia
| | - Eduardo Montero
- Faculty of Dentistry; Universidad Complutense de Madrid; Madrid Spain
| | - Nigel Pitts
- Dental Innovation and Translation Centre; Dental Institute; Kings College London; London UK
| | - Hélène Rangé
- Department of Periodontology; Service of Odontology; Rothschild Hospital; AP-HP, Paris 7-Denis Diderot University; U.F.R. of Odontology; Paris France
- EA 2496; Paris 5-Descartes University; U.F.R. of Odontology; Paris France
| | - Nadine Schlueter
- Division for Cariology; Department of Operative Dentistry and Periodontology; Center for Dental Medicine; University Medical Center; Albert-Ludwig-University; Freiburg Germany
| | | | - Svante Twetman
- Faculty of Health and Medical Sciences; School of Dentistry; Section of Cariology and Endodontics; University of Copenhagen; Copenhagen Denmark
| | - Cor Van Loveren
- Department of Cariology; Academic Centre for Dentistry Amsterdam; Amsterdam the Netherlands
| | - Fridus Van der Weijden
- Department of Periodontology; Academic Centre for Dentistry in Amsterdam; Amsterdam the Netherlands
| | | | - Andreas G. Schulte
- Department of Special Care Dentistry; Dental School; Witten/Herdecke University; Witten Germany
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Sharma P, Dietrich T, Ferro CJ, Cockwell P, Chapple IL. Association between periodontitis and mortality in stages 3-5 chronic kidney disease: NHANES III and linked mortality study. J Clin Periodontol 2016; 43:104-13. [PMID: 26717883 PMCID: PMC5324563 DOI: 10.1111/jcpe.12502] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Periodontitis may add to the systemic inflammatory burden in individuals with chronic kidney disease (CKD), thereby contributing to an increased mortality rate. This study aimed to determine the association between periodontitis and mortality rate (all-cause and cardiovascular disease-related) in individuals with stage 3-5 CKD, hitherto referred to as "CKD". METHODS Survival analysis was carried out using the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality data. Cox proportional hazards regression was employed to assess the association between periodontitis and mortality, in individuals with CKD. This association was compared with the association between mortality and traditional risk factors in CKD mortality (diabetes, hypertension and smoking). RESULTS Of the 13,784 participants eligible for analysis in NHANES III, 861 (6%) had CKD. The median follow-up for this cohort was 14.3 years. Adjusting for confounders, the 10-year all-cause mortality rate for individuals with CKD increased from 32% (95% CI: 29-35%) to 41% (36-47%) with the addition of periodontitis. For diabetes, the 10-year all-cause mortality rate increased to 43% (38-49%). CONCLUSION There is a strong, association between periodontitis and increased mortality in individuals with CKD. Sources of chronic systemic inflammation (including periodontitis) may be important contributors to mortality in patients with CKD.
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Affiliation(s)
- Praveen Sharma
- Periodontal Research GroupSchool of DentistryUniversity of BirminghamBirminghamUK
| | - Thomas Dietrich
- Periodontal Research GroupSchool of DentistryUniversity of BirminghamBirminghamUK
| | - Charles J. Ferro
- Department of NephrologyUniversity Hospital BirminghamBirminghamUK
| | - Paul Cockwell
- Department of NephrologyUniversity Hospital BirminghamBirminghamUK
| | - Iain L.C. Chapple
- Periodontal Research GroupSchool of DentistryUniversity of BirminghamBirminghamUK
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Borgnakke WS, Madianos PN, Chapple IL, Murakami S, Genco RJ, Papapanou PN, Armitage G, Preshaw PM, Bartold PM, Rahman AU, D’Aiuto F, Sanz M, Eke PI, Slots J, Giannobile WV, Tonetti MS, Kornman KS, Van Dyke TE, Lang NP. WITHDRAWN: The randomized controlled trial (RCT) published by the Journal of the American Medical Association (JAMA) on the impact of periodontal therapy on glycated hemoglobin (HbA1c) has fundamental flaws. J Evid Based Dent Pract 2014. [DOI: 10.1016/j.jebdp.2014.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- I L Chapple
- Periodontal Unit, Birmingham School of Dentistry, Faculty of Medicine and Dentistry, The University of Birmingham
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10
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Chapple IL. Summary and conclusions: Where now? J Dent 2009; 37:S583-4. [DOI: 10.1016/j.jdent.2009.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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McCracken GI, Chapple IL, Milward M, Steen N, DeJager M, Heasman PA. Efficacy of a prototype brush head for a powered toothbrush. A multicentre study. J Clin Periodontol 2002; 29:889-95. [PMID: 12445220 DOI: 10.1034/j.1600-051x.2002.291003.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PRIMARY OBJECTIVE To evaluate a multicentre clinical trial design for testing powered toothbrushes. SECONDARY OBJECTIVE To compare the efficacy of a prototype brush head (N2.3) for the Philips Jordan Sensiflex 2000 powered toothbrush (PTB) to that of Braun Oral-B D15 PTB in removing dental plaque MATERIAL AND METHODS 137 volunteers (ages 18-25 years) were recruited to this 3-centre, 2-week, 2-group, 2-treatment, single-blind trial. Plaque was recorded at screening and again 14 days later at baseline. Stratification of subjects, for gender and screening PI, occurred at baseline. Subjects were then asked to abstain from all oral hygiene measures for 48 h followed by a supervised episode of brushing for 3 min with the allocated PTB. The allocated PTB was used at home for the next 12 days before a second abstinence from all oral hygiene measures for the 48 h prior to a second supervised brushing episode. Plaque levels were scored using a modification of the Quigley & Hein plaque index (PI) at full mouth (FM), interproximal (IP) and smooth surfaces (SS). To enable the means of the within subject differences (pre to postbrushing) to be compared between groups PIs were recorded before and after the supervised brushing episodes, differences between centres, groups and visits were examined. RESULTS No significant differences in PI between groups at screening, baseline or prior to the supervised brushings were detected (P > 0.05 anova). The results of the analysis of variance showed there to be a highly significant difference (P < 0.001) between brushing groups, but, significant differences between centres (P < 0.001) and a significant interaction effect between centre and brushing group (P < 0.001) was also detected. Therefore the difference between groups was not present at all three centres. Further examination of the single centre data showed there to be greater levels of plaque removed by the N2.3 compared to the D15 (FM reduction in PI 1.95 vs. 1.13, respectively) at centre 3 in contrast to the other two centres where no difference was detected. The precise reason for these differences could not be established. CONCLUSIONS A multicentre study design is applicable for evaluating PTBs but a minimum of 3 centres should be included so that differences between centres can be identified. The prototype brush head N2.3 for the Philips Jordan Sensiflex 2000 PTB has comparable plaque removal efficacy to the Braun Oral-B D15 PTB at FM, IP and SS sites.
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Affiliation(s)
- G I McCracken
- Restorative Dentistry, Dental School, University of Newcastle upon Tyne, UK
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Baxter AM, Roberts A, Shaw L, Chapple IL. Localized scleroderma in a 12-year-old girl presenting as gingival recession. A case report and literature review. Dent Update 2001; 28:458-62. [PMID: 11806189 DOI: 10.12968/denu.2001.28.9.458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Scleroderma is a connective tissue disorder that displays considerable clinical heterogeneity. This case describes a 12-year-old girl who presented with a localized form of the disease. The consequences were a severe and progressive localized gingival recession affecting two maxillary incisors, a localized lip defect and scarring of the forehead. The case illustrates the difficulties in diagnosis and management of young patients with localized scleroderma.
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Affiliation(s)
- A M Baxter
- Department of Restorative Dentistry, Birmingham Dental Hospital
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Abstract
Drug therapy and hereditary factors are two of the main causes of gingival overgrowth (GO). Both of these forms of GO are associated with increased extracellular matrix production by fibroblasts. Transforming growth factor beta (TGF-beta) is an important mediator of wound healing and tissue regeneration, which stimulates fibroblasts to produce extracellular matrix materials. The aim of this immunohistochemical study was to determine whether there is any altered expression of TGF-beta isoforms or its receptors in tissue from patients with drug-induced GO (DIGO; n=10) and hereditary gingival fibromatosis (n=10) when compared to non-overgrowth tissue (n=10). Compared to control tissues, significantly more fibroblasts expressed TGF-beta1 in both DIGO and hereditary gingival fibromatosis tissues (P<0.03). Cells expressing TGF-beta2 were present at control levels in DIGO but were significantly reduced in hereditary gingival fibromatosis (P<0.02). By contrast, the number of TGF-beta3-positive cells was the same in overgrowth tissues and controls. However, because of differences in total fibroblast densities between groups, there was a proportional increase in TGF-beta3 as well as TGF-beta1 expressing cells within both overgrowth populations (P<0.0001). Furthermore, representation of the TGF-beta2-positive phenotype was reduced in hereditary gingival fibromatosis (P<0.01) but increased in DIGO (P<0.005) compared to controls. Absorbance measurements of the positive cell populations showed that the level of expression was significantly higher for TGF-beta1 in hereditary gingival fibromatosis (P<0.002) and significantly lower for TGF-beta3 in DIGO (P<0.03). No significant differences in the numbers of TGF-betaRI- or RII-positive cells were detected between overgrowth tissues and controls. However, there were increases in the proportion of receptor-positive cells in the total cell population analysed in overgrowth tissues (P<0.0001). These results indicate qualitative and quantitative differences in TGF-beta isoform and receptor expression by fibroblasts in gingival overgrowth that may contribute to disease pathogenesis.
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Affiliation(s)
- H J Wright
- Unit of Oral Biology & Pathology, School of Dentistry, University of Birmingham, UK
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Abstract
BACKGROUND, AIMS Early-onset periodontal diseases (EOP) are a group of inflammatory disorders characterised by a rapid rate of periodontal tissue destruction, in young individuals who are otherwise healthy. There is now substantial evidence to suggest that genetic factors play a rôle in the pathogenesis of EOP but the precise nature of these factors remains unclear. Polymorphisms in cytokine genes which may underpin inter-individual differences in cytokine synthesis and secretion have been associated with other diseases which have an inflammatory pathogenesis, including chronic adult periodontal disease (CAPD). METHOD We therefore investigated the frequency of polymorphisms in the genes encoding interleukin-1 beta (IL-1 beta) and its receptor antagonist (IL-1RA) in 70 EOP patients, including a subgroup of 21 localised EOP (L-EOP) patients and 72 periodontally healthy controls. All subjects were of Caucasian heritage and systemically healthy. A single nucleotide polymorphism (SNP) in exon 5 of the IL-1 beta gene (IL-1 beta+ 3953) was analysed by amplifying the polymorphic region using PCR, followed by restriction digestion with Taq1 and gel electrophoresis. RESULTS The frequency of IL-1 beta genotypes homozygous for allele 1 (corresponding to the presence of a restriction site) of the IL-1 beta+3953 SNP was found to be significantly increased in EOP patients (chi2 test, p = 0.025). Upon stratification for smoking status a significant difference was found in the IL-1 beta genotype distribution between EOP smokers compared to control smokers (F-exact test, p = 0.02), but not between EOP non-smokers and control non-smokers. The IL-1 beta 1/1 genotype occurred at a higher frequency in EOP smokers (odds ratio = 4.9) compared to control smokers. A variable number tandem repeat polymorphism (VNTR) in intron 2 of the IL-IRA gene was analysed by amplifying the polymorphic region using PCR and fragment size analysis by gel electrophoresis. There was no evidence for an association of an IL-1RA genotype with EOP. However the combination of IL-1 beta allele 1 and IL-IRA allele 1 (corresponding to 4 repeats) was associated with EOP (Clump, p = 0.01). CONCLUSIONS These findings suggest that an IL-1 beta genotype in combination with smoking, and a combined IL-1 beta and IL-1RA genotype are risk factors for EOP and support a role for genetic and environmental factors in susceptibility to EOP.
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Affiliation(s)
- J M Parkhill
- Department of Oral Biology, The Dental School, University of Newcastle upon Tyne, UK
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Hennig BJ, Parkhill JM, Chapple IL, Heasman PA, Taylor JJ. Dinucleotide repeat polymorphism in the interleukin-10 gene promoter (IL-10.G) and genetic susceptibility to early-onset periodontal disease. Genes Immun 2000; 1:402-4. [PMID: 11196688 DOI: 10.1038/sj.gene.6363687] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Emerging evidence suggests that certain genetic polymorphisms are associated with various sub-groups of early-onset periodontal diseases (EOP). We determined the genotype with respect to a (CA)n dinucleotide repeat polymorphism in the promoter region of the interleukin-10 gene (IL-10.G) in 72 patients with EOP and in 73 healthy individuals in order to test for possible disease associations. Some differences between the frequency of individual IL.10.G alleles in the patients groups as compared to the healthy controls were detected. For example the frequency of the IL-10.G9 allele in a clinical sub-group of the EOP patients with localised disease (L-EOP, n = 21) was 64.3% as compared to 41.8% in the controls. However, statistical analysis (Monte Carlo simulation) revealed that the differences in IL-10.G allele distribution between the healthy controls and both the EOP group and the L-EOP group were not statistically significant. We conclude that this study provides no evidence for a role of IL-10.G alleles in genetic susceptibility to EOP.
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Affiliation(s)
- B J Hennig
- Department of Oral Biology, Dental School, University of Newcastle upon Tyne, UK
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Affiliation(s)
- I L Chapple
- Unit of Periodontology, School of Dentistry, University of Birmingham
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17
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Abstract
Myelodysplasia syndrome (MDS) presenting as spontaneous gingival hemorrhage is described. Gingival hemorrhage is recognized as a symptom of MDS, a rare group of potentially fatal hematological disorders, but it has not previously been documented as a presenting sign. The diagnostic pitfalls are discussed with the case, and the need for careful interpretation of laboratory findings in conjunction with clinical signs is emphasized. Finally, the MDSs are defined, classified and discussed with respect to their relevance to the clinical periodontist, from a diagnostic, therapeutic, and management standpoint.
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Affiliation(s)
- I L Chapple
- Tissue Injury/Repair Research Group, Birmingham's School of Dentistry, The University of Birmingham, UK
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Abstract
The periodontal tissues and the pulp-dentine complex form an intimate continuum through which pathological changes of either one may lead to infection of the other, and whose management can be fraught with diagnostic and therapeutic difficulty. The purpose of this review paper is to explain the nature of that relationship and to provide pointers which may assist in the diagnostic process and thus enable appropriate management from the outset. Traditional classifications of lesions affecting the periodontal-endodontic complex have caused confusion by attempting to form diagnoses which indicate the putative primary source of infection. We would suggest that the origin of the infection is irrelevant to the management process, and that what is important is whether either, or indeed both, of the tissues are viable or not. Successful therapy will only result from the establishment of an accurate diagnosis, and forming such a diagnosis requires a methodical multi-staged approach.
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Affiliation(s)
- I L Chapple
- University of Birmingham School of Dentistry
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19
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Hennig BJ, Parkhill JM, Chapple IL, Heasman PA, Taylor JJ. Association of a vitamin D receptor gene polymorphism with localized early-onset periodontal diseases. J Periodontol 1999; 70:1032-8. [PMID: 10505806 DOI: 10.1902/jop.1999.70.9.1032] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Early-onset periodontal diseases (EOP) are caused by interactions between host factors, specific microbial pathogens, and environmental factors. It is, therefore, of interest to investigate the nature of host factors as they may provide useful risk markers and reveal important information regarding the disease pathogenesis. Genetic polymorphisms in the vitamin D receptor (VDR) gene are associated with parameters of bone homeostasis and with diseases in which bone loss is a cardinal sign, in particular osteoporosis. Rapidly progressive bone loss is one feature of EOP. We, therefore, sought to determine whether EOP is associated with a polymorphism in the VDR gene. METHODS A restriction fragment length polymorphism (RFLP) for Taq I in exon nine of the VDR gene was analyzed by PCR, followed by restriction digestion with Taq I and gel electrophoresis. We analyzed the genotypes of 69 EOP patients, including 20 patients with unequivocal evidence of localized disease (L-EOP), and 72 controls with no history of EOP. RESULTS The genotype distribution in the L-EOP patient group was 7 (35%), 5 (25%) and 8 (40%) and in the control group 31 (43.1%), 36 (50.0%) and 5 (6.9%) for TT, Tt and tt respectively (where t and T represent the alleles with and without the Taq I RFLP respectively). Chi2 analysis indicated that the distribution of the genotypes between these two groups was highly significantly different (P = 0.001). Allele frequencies were 47.5% and 52.5% for T and t in the L-EOP group; 68.1% and 31.9% in the control group, showing a significant association between the prevalence of the less frequent allele (t) and L-EOP (P = 0.017). There was no significant difference in the genotype distribution or the allele frequencies between the control samples and the larger EOP patient group (n = 69) which included patients with generalized and localized disease. CONCLUSIONS These data indicate that carriage of the less frequent allele of the Taq I RFLP (t) in the VDR gene significantly increases the risk of developing L-EOP. However, VDR genotype may not affect the incidence of all cases of EOP. These findings contribute to our understanding of the genetic basis for periodontal disease and may help define sub-groups of this disease which share common pathogenic factors.
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Affiliation(s)
- B J Hennig
- Department of Oral Biology, The Dental School, University of Newcastle upon Tyne, UK
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20
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Chapple IL, Garner I, Saxby MS, Moscrop H, Matthews JB. Prediction and diagnosis of attachment loss by enhanced chemiluminescent assay of crevicular fluid alkaline phosphatase levels. J Clin Periodontol 1999; 26:190-8. [PMID: 10100046 DOI: 10.1034/j.1600-051x.1999.260310.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The current study aimed to apply a novel enhanced chemiluminescence assay in the analysis of gingival crevicular fluid (GCF) alkaline phosphatase (ALP) levels from patients with untreated adult periodontitis. 3666 sites in 25 patients were monitored prior to and after attachment loss was detected with a Florida disc probe. Parameters assessed were, relative attachment level, probing pocket depth, occurrence of bleeding on probing (single episode), GCF volume (microliter), total ALP levels (microIU/30 s sample time) and ALP concentration (IU/l). After recruiting patients to the study, all measures were taken at baseline and 3 months later, prior to the institution of non-surgical periodontal therapy at active sites. Thresholds for determining attachment loss were calculated using a modification of the tolerance method. The mesio-buccal sites of all teeth had GCF samples collected. The size of individual patient thresholds used to define whether attachment loss had occurred, was dependent upon the discomfort felt by that patient during electronic probing, with a positive correlation existing between discomfort on probing (10 cm visual analogue scale) and threshold size (R = 0.52, p < 0.049). A total of 274 sites (7.5%) experienced attachment loss of which 39 sites had GCF samples available for analysis. Total ALP levels were significantly higher at baseline for sites that progressed to attachment loss than paired controls (p < 0.003), but all other parameters showed no differences (p > 0.1). There were significant increases in total ALP levels and GCF volumes for active sites between baseline and 3 month measures (p < 0.01), but not for control sites or test site ALP concentration (p > 0.8). The diagnostic accuracy for GCF ALP as a predictor of future attachment loss (threshold 900 microIU/30 s) was 64%, with +ve and -ve predictive values of 62% and 68%. When a threshold of 1300 microIU/30 s was selected for ALP as a marker of recent or currently active disease, diagnostic accuracy and +ve/-ve predictive values were 77% and 77%/76%, respectively. These results indicate that total GCF ALP levels may serve as a predictor of future or current disease activity.
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Affiliation(s)
- I L Chapple
- Oral Diseases Research Group, School of Dentistry, University of Birmingham, UK.
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21
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Abstract
This paper reports the detailed calibration of the new Periotron 8000 with different fluids and uses the method of least squares to derive polynomial regression equations up to the 6th order, to investigate the most accurate descriptor of the resulting calibration lines. The use of a 4th order polynomial regression equation (recommended by the manufacturer) provided better coefficients of determination (R2: 0.999) and root mean square errors (RMSE = 1.6) than either linear regression (R2: 0.986, RMSE = 10.9) or quadratic models (R2: 0.998, RMSE = 3.2). Data derived using the manufacturer's MLCONVERT software program lacked accuracy and incurred large errors for volumes > 0.5 microliter. Calibrations performed on one day could be used with accuracy to derive volumes > 0.1 microliter collected on subsequent days, when using the same machine (s.d. for residuals plot = 2.49 Periotron units), but this was not the case for different machines (s.d. = 9.57 Periotron units). Varying serum protein concentration by up to 500% had a negligible effect on calculated volumes above 0.1 microliter. We conclude that the Periotron 8000 is at least as reliable a machine as the Periotron 6000, and that the calibration lines for both machines are best described using 4th order polynomial regression equations and "look-up" tables, rather than quadratic (Periotron 6000) or the manufacturer's software (Periotron 8000). Serum seems to be an acceptable GCF substitute for calibrations, which can be performed 1 day, and used on subsequent days for a given machine and for volumes above 0.1 microliter.
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Affiliation(s)
- I L Chapple
- Oral Diseases Research Group, University of Birmingham, School of Dentistry, UK
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22
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Abstract
Generalized pre-pubertal periodontitis (GPP) is a rare entity that usually affects children with severe systemic diseases. We report the case of a 7-year-old male patient diagnosed with GPP, with no apparent systemic condition, who lost all his primary teeth to periodontal disease. Before extractions, while he was still in mixed dentition the subgingival plaque was collected and analyzed using DNA probes to 40 different microorganisms. Putative periodontopathogens such as Prevotella intermedia, Selenomonas noxia, Fusobacterium nucleatum, and Actinobacillus actinomycetemcomitans could be identified throughout the mouth. More intriguing was the colonization of the sulcus of some secondary teeth by potentially harmful microorganisms found in pockets of diseased adjacent primary teeth.
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Affiliation(s)
- S Dibart
- Department of Periodontology & Oral Biology, Boston University Goldman School of Dental Medicine, and Children's Hospital, MA 02118, USA
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23
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Chapple IL, Mason GI, Garner I, Matthews JB, Thorpe GH, Maxwell SR, Whitehead TP. Enhanced chemiluminescent assay for measuring the total antioxidant capacity of serum, saliva and crevicular fluid. Ann Clin Biochem 1997; 34 ( Pt 4):412-21. [PMID: 9247675 DOI: 10.1177/000456329703400413] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This paper reports the development of an enhanced chemiluminescent (ECL) assay for measuring the total antioxidant (AO) capacity of serum, saliva and a fluid collectable from the gum margin called gingival crevicular fluid (GCF). The theory behind the assay is explained, and the optimum conditions for the assay, and for storage of reagents and clinical samples is described. Calibration lines were linear (R > or = 0.99; P < 0.0001) and the within batch coefficient of variations for a water soluble vitamin E analogue (Trolox), serum and saliva samples were < 5%. In saliva and GCF, a characteristic AO response not seen in serum of the same patients, was identified. Total peripheral (serum) and local (saliva) AO capacities (mumol/L Trolox) were investigated in patients with (n = 18) and without (n = 16) adult periodontitis. Serum AO status did not differ between groups. Salivary total AO concentrations were lower in the peridontitis (P) group [175 (53) mumol/L] than in the non-periodontitis (NP) group [254 (110) mumol/L1: P < 0.01], as were saliva:serum AO ratio's [0.37 (0.11) versus 0.5 (0.18): P < 0.01]. Periodontitis patients may have a reduced salivary AO concentration, which could result from, or predispose to, the damaging effects of reactive oxygen species (ROS). The potential for ROS production in the oral and periodontal environment may explain the presence of a specific antioxidant in oral fluids that is not detectable in serum. The ECL assay described provides a rapid, simple and reproducible method of measuring total antioxidant defence in small volumes of biological fluids.
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Affiliation(s)
- I L Chapple
- Department of Dentistry, University of Birmingham, Edgbaston, UK
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24
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Abstract
This paper aims to review the rôle of free radical-induced tissue damage and antioxidant defence mechanisms in inflammatory diseases that involve pathogenic processes similar to the periodontal diseases. There is a clearly defined and substantial role for free radicals or reactive oxygen species (ROS) in periodontitis, but little research has been performed in this area. This paper reviews the considerable data available relating ROS activity and antioxidant defence to inflammatory diseases and attempts to draw parallels with periodontitis, in an effort to stimulate more periodontal research in this important area. The recent discovery of the transcription factor nuclear factor kappa B (NF-kappa B) is reviewed and several potential pathways for cytokine-induced periodontal tissue damage, mediated by NF-kappa B1 are discussed. Emphasis is placed on cytokines that have been studied in periodontitis, principally TNF-alpha, IL-1, IL-6, IL-8 and beta-interferon. The link between cellular production of such important mediators of inflammation and the antioxidant (AO) thiols, cysteine and reduced glutathione (GSH), is discussed and it is hypothesised that NF-kappa B antagonists may offer important therapeutic benefits.
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Affiliation(s)
- I L Chapple
- Oral Disease Mortrers Group, University of Birmingham School of Dentistry, UK
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25
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Abstract
OBJECTIVES This manuscript attempts to critically review traditional and currently employed methods of periodontal diagnosis, in the light of current knowledge about individual patients and sites at risk of progressive periodontal attachment loss. DATA SOURCES Articles published over the last decade from international research journals, have demonstrated that existing methods of periodontal disease diagnosis are seriously deficient with respect to accuracy, their ability to predict ongoing or future disease activity and their ability to determine the current activity status of historically diseased sites. STUDY SELECTION Longitudinal studies have questioned the rationale behind traditional treatment regimes and underlined the importance of site-directed therapy to avoid potentially damaging instrumentation of quiescent or healthy sites. The recent explosion in local, less invasive chemotherapies for periodontal disease management has aimed at addressing the site-specific nature of this group of diseases, but the true benefits of such novel therapies cannot be realised until more accurate and specific diagnostic techniques become available. CONCLUSIONS The manuscript concludes that the range of clinical information collected by experienced periodontists using currently available technology is probably sufficient to manage mild-to-moderate chronic adult periodontitis. However, those patients at risk from more aggressive attachment loss, and those individuals that appear refractory to traditional therapies, require the development of more accurate diagnostic tests to compliment the revolution in site-specific therapies. A diagnostic model is presented, which attempts to draw together current and future diagnostic methods for managing the majority of periodontal disease types, and it is suggested that current diagnoses should include some assessment of "risk'.
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Affiliation(s)
- I L Chapple
- Unit of Periodontology, School of Dentistry, University of Birmingham, UK
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26
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Chapple IL, Socransky SS, Dibart S, Glenwright HD, Matthews JB. Chemiluminescent assay of alkaline phosphatase in human gingival crevicular fluid: investigations with an experimental gingivitis model and studies on the source of the enzyme within crevicular fluid. J Clin Periodontol 1996; 23:587-94. [PMID: 8811480 DOI: 10.1111/j.1600-051x.1996.tb01829.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to investigate how levels of gingival crevicular fluid (GCF) alkaline phosphatase (ALP) change in relation to levels of plaque and gingival inflammation in 20 adults during a 21 day period of experimental gingivitis. The source of ALP within GCF was also investigated using a repeat sampling protocol; by determining enzyme levels derived from 30 putative periodontal pathogenic and non-pathogenic species; and by examining inhibition profiles from a variety of host and bacterial ALP isoenzymes. Total 30-s GCF ALP levels increased significantly (p < 0.002) during experimental gingivitis and preceded an increase in gingival index (GI) by approximately 7 days. Enzyme levels correlated with GCF volume (R = 0.7; p < 0.0001), but repeat sampling indicated that entry of ALP into the gingival crevice was independent of the rate of fluid flow. Only 5 of the bacterial species investigated produced clearly detectable levels of ALP in culture supernatants, these were P. gingivalis (381), P. intermedia (581), P. nigrescens (8944), Dentin P. gingivalis (TW 471: clinical isolate) and C. ochracea (25). Levamisole inhibition and studies on suspensions of washed plaque demonstrated that host-derived ALP contributed to > 80% of the enzyme in GCF. We conclude that elevated 30-s GCF ALP levels measured using the chemiluminescent assay reported, are detectable before increases in gingival indices and appear to be a better marker of gingival inflammation than ALP concentrations. The major source of ALP within GCF is host derived and in early inflammatory disease is likely to be of polymophonuclear leukocyte origin.
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Affiliation(s)
- I L Chapple
- Department of Dentistry, Birmingham School of Dentistry, University of Birmingham, UK
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27
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Chapple IL. Periodontal diseases in children and adolescents: classification, aetiology and management. Dent Update 1996; 23:210-6. [PMID: 8948184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The human periodontal diseases are a complex group of disorders that span the entire length of the human life cycle. They are infective in nature, but are mediated by host parasite interactions that are influenced not only by the nature of the pathogens present but also by a variety of underlying immunological and connective tissue anomalies. Thus, on occasion they may reflect systemic disorders that have previously been undiagnosed. As such abnormalities frequently present in childhood or adolescence, knowledge of the potential implications of this broad group of diseases is important. This paper reviews the current classification of childhood periodontal disease and outlines the clinical presentation and management of the more common disorders.
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Affiliation(s)
- I L Chapple
- University of Birmingham School of Dentistry
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28
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Abstract
Ultrasonic scalers may be operated at different power settings which may influence the final therapeutic result. The displacement amplitude of the scaling tip may affect scaling efficiency or the degree of root surface damage. This investigation aimed to determine whether there was any difference in periodontal healing, as assessed by standard clinical methods, when an ultrasonic scaler was operated at full or half power in patients suffering from mild to moderate adult periodontitis. Seventeen patients with chronic adult periodontitis were entered into the study and a split mouth design utilized. Quadrant allocation was randomized, 2 quadrants being treated at full power and 2 at half power. At baseline, probing attachment levels, bleeding and plaque indices (BI and PI) were recorded and oral hygiene instruction given. Two weeks later all measurements were repeated and further recordings made at 1, 3, and 6 months post-therapy. Statistical analysis demonstrated no differences between groups at baseline (P > 0.3) for all parameters. At the post-oral hygiene stage, there were significant attachment gains for both experimental groups (P < 0.04), but no differences were found between the groups (P > 0.6). At 6 months, mean attachment gains for the half power and full power groups over baseline measures were 0.5 +/- 0.5 mm and 0.4 +/- 0.3 mm, respectively (P < 0.002), and there were no significant differences between the groups (P > 0.5). The results show that the use of the half power setting was as effective as using the ultrasonic scaler at full power.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- I L Chapple
- School of Dentistry, University of Birmingham, UK
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29
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Abstract
The Periotron 6000 fluid analyser has become widely used as a diagnostic tool for a variety of oral diseases and recent work has questioned its reliability. This paper investigates for the first time, the detailed calibration curves of 2 Periotron 6000 machines across a range of 23 different fluid volumes. Within and between machine reliability is analyzed and the shape of the calibration line determined. The measurement errors incurred by using a single fluid sample, as opposed to mean values of triplicate samples are also determined. We conclude that there are 3 sections to the calibration line, 2 linear and a quadrilateral zone, and that 2 separate regression equations should be used; from 0-0.1 microliter and from 0.1-1.0 microliter. Within machine calibration errors were only 3.2 +/- 7.5%, but values for volumes below 0.2 microliter were as high as 18.7%. Using a single fluid sample rather than mean values of multiple samples, incurred a further 4 +/- 4% error, which was as high as 7% for volumes lower than 0.12 microliter. Whilst significant differences in volume reading existed between different machines (p < 0.0004) and between the same volumes of different fluids (p < 0.00001), individual Periotron calibrations were extremely reproducible and reliable. We conclude that the Periotron 6000 is a reliable and convenient instrument for measuring fluid volumes greater than 0.2 microliter. For volumes lower than 0.2 microliter errors in measurement may be too high for some investigations, but this is likely to be due to problems with evaporation and with measurement technique, rather than errors directly due to the Periotron itself. Finally, for optimum accuracy, the digital display should be re-set to zero after each sample is measured.
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Affiliation(s)
- I L Chapple
- Department of Dentistry, University of Birmingham Dental School, England
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30
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Abstract
The sonic scaler operates at frequencies of 2 to 6 kHz and is powered by pressurised air from the dental unit. Variables likely to affect how these instruments perform include the air pressure input and load applied by the operator. Other variables include the brand of scaler used and the clinical technique of the operator. The aim of this study was to investigate differences in instrument performance within a dental teaching hospital. Light microscopy was used to measure the displacement amplitudes in air of 32 Sonic scalers which were in regular clinical use in three departments (Periodontal Unit, Restorative Unit and School of Hygiene). During operation, the air pressure was kept at a constant 2.8 kg cm-2 and measurements were made on each instrument with three scaling tips (universal, sickle and periodontal). The periodontal scaling tip exhibited the greatest vibration although this was not significant (p > 0.1). There was a significant difference in performance between the different clinical environments where the scalers were used (p < 0.01). 4 new sonic scaling instruments made by different manufacturers were selected for displacement amplitude measurements. One brand of sonic scaler demonstrated a significantly greater displacement amplitude in comparative measurements between instruments (p < 0.01). This study demonstrated differences in the oscillation of sonic scalers which should be recognised by clinicians when using these instruments, since they may influence clinical performance.
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Affiliation(s)
- S Shah
- School of Dentistry, University of Birmingham, UK
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31
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Chapple IL, Glenwright HD, Matthews JB, Thorpe GH, Lumley PJ. Site-specific alkaline phosphatase levels in gingival crevicular fluid in health and gingivitis: cross-sectional studies. J Clin Periodontol 1994; 21:409-14. [PMID: 8089243 DOI: 10.1111/j.1600-051x.1994.tb00738.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Using a recently developed chemiluminescent assay enabling alkaline phosphatase (ALP) quantification in nanolitre volumes of gingival crevicular fluid (GCF), we have investigated GCF ALP levels in health and in the presence of gingivitis. In gingival health, there was a site-specific pattern of ALP concentration with higher enzyme concentrations around the upper and lower anterior teeth. Furthermore, clinically normal sites that had been subjected to different levels of plaque control produced significantly different ALP levels, (p < 0.03). This indicates that biochemical components of GCF may be used to measure subclinical inflammatory status. The ratio of GCF to serum ALP varied from 6:1 to 11:1, suggesting that a major source of the enzyme is through local production. The main cross-sectional study of 30 patients with gingivitis (276 sites) demonstrated that total GCF ALP levels, collected over a 30-s sampling time were higher for a gingival index of 1 than of 0 (p < 0.014). There was no significant relationship between total GCF ALP and plaque levels of the enzyme, and analysis of plaque within the study group demonstrated very low levels of ALP, indicating that the enzyme is likely to be largely derived from the periodontal tissues. The ratio of GCF ALP levels to those of saliva within individuals was 530:1, thereby eliminating saliva contamination as a risk, when total GCF ALP is being measured.
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Affiliation(s)
- I L Chapple
- Department of Dentistry, University of Birmingham, UK
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32
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Abstract
Hypophosphatasia is rare enzymopathy that normally presents within the first few years of life and often has profound effects upon the periodontium. It is a heritable disorder characterised by defective mineralisation of the skeletal and dental structures of the body and a deficiency in the liver/bone/kidney (L/B/K) isoenzyme of alkaline phosphatase (ALP). There has been a tremendous advance in our knowledge of this condition over the last decade due to the advent of highly specific DNA probes and novel microanalytical techniques. This paper aims to review current literature about hypophosphatasia with special reference to the dental aspects of the condition and to shed light upon the controversial area of its mode of genetic inheritance. It is concluded that hypophosphatasia may result from the existence of 2 defective alleles, which alone or in combination may cause the condition. One allele is expressed in an autosomal dominant manner producing milder phenotypic characteristics, whilst the other is expressed in an autosomal recessive manner producing the more severe clinical form that often results in neonatal death. The milder phenotypes may go undiagnosed and the consequence of this in genetic counselling terms is extremely important.
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Affiliation(s)
- I L Chapple
- Department of Dentistry (Periodontology), Birmingham Dental School, St. Chads Queensway, UK
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33
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Chapple IL, Matthews JB, Thorpe GH, Glenwright HD, Smith JM, Saxby MS. A new ultrasensitive chemiluminescent assay for the site-specific quantification of alkaline phosphatase in gingival crevicular fluid. J Periodontal Res 1993; 28:266-73. [PMID: 8336246 DOI: 10.1111/j.1600-0765.1993.tb02093.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The search for markers of periodontal disease activity and progression has accelerated over the last decade, in an effort to replace existing subjective clinical measures of periodontal health status. Research is being aimed at establishing more objective and quantitative methodology, capable of rapid diagnosis prior to the appearance of clinical signs of destructive disease. Such tests need to be sensitive enough to evaluate individual periodontal sites in health as well as disease states. We report the development of a new chemiluminescent assay for the enzyme alkaline phosphatase, that is capable of quantifying the enzyme in sub-microliter volumes of gingival crevicular fluid and serum. The technique will measure alkaline phosphatase (ALP) whilst immobilised on paper strips, without the need for an elution stage. It is simple, versatile and amenable to chair-side use. We discuss in detail the assay procedure and have examined levels of ALP in 11 adult volunteers with clinically healthy periodontal tissues. The mean ALP concentration was 2135 IU/L for GCF and 183 IU/L for serum, a 12-fold difference. There also appeared to be an "oral pattern" of enzyme distribution in healthy periodontal sites, with levels being higher in the anterior region of the mouth and highest in the lower anterior region.
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Affiliation(s)
- I L Chapple
- Department of Periodontology, University of Birmingham, England
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34
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Chapple IL, Thorpe GH, Smith JM, Saxby MS, Glenwright HD, Green A, Perry GM, Grundy M, Shaw L, Matthews JB. Hypophosphatasia: a family study involving a case diagnosed from gingival crevicular fluid. J Oral Pathol Med 1992; 21:426-31. [PMID: 1432739 DOI: 10.1111/j.1600-0714.1992.tb01033.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hypophosphatasia is an inherited disorder characterized by defective mineralization of the skeletal and dental structures of the body and deficient liver/bone/kidney alkaline phosphatase (L/B/K ALP) activity. There has been a tremendous advance in our knowledge of this condition over the last decade due to the advent of highly specific DNA probes and novel microanalytic techniques. The purpose of this paper is threefold: to review the dental aspects of current literature about this rare condition; to present a case (and family study) that was diagnosed in a 5-yr-old boy from 0.14 microliters of gingival crevicular fluid, using a new ultrasensitive chemiluminescent assay for the enzyme alkaline phosphatase; and to provide strong evidence for an autosomal dominant mode of inheritance.
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Affiliation(s)
- I L Chapple
- Department of Dentistry, Birmingham Dental School, England
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35
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Abstract
This study examines the effect of a chlorhexidine irrigant during ultrasonic scaling and root planning and compares clinical results with those obtained using a water irrigant. The irrigant was delivered either through a conventional or a recently-introduced ultrasonic scaler, which allows the irrigant solution to be passed through the inside of the scaler tip. The study utilizes a split-mouth design and contrasts the effectiveness of both instruments in improving periodontal health, as measured by standard clinical indices. A preliminary investigation of patient tolerance to treatment performed throughout the clinical trial was also undertaken. Statistical analysis at the 3 and 6 month post-treatment stage revealed no significant differences between the 4 experimental groups in respect of probing attachment levels (P > 0.5), bleeding index (P > 0.1), or plaque index (P > 0.05). Clinical attachment gain assessed by probing ranged from 0.6 to 0.9 mm. Chlorhexidine increased patient tolerance in 77% of cases and the new model ultrasonic scaler was favored over the traditional model in 70% of cases. The magnitude of the tolerance differences was however not statistically significant. The possible potential of the new scaler and of chlorhexidine as an irrigant to reduce patient discomfort is worthy of further investigation than was possible in this study.
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Affiliation(s)
- I L Chapple
- Department of Restorative Dentistry, Dental School, Birmingham, UK
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36
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Chapple IL, Rout PG, Basu MK. Gingival Kaposi's Sarcoma: the first indication of HIV infection. Dent Update 1992; 19:296, 298-301. [PMID: 1303366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article presents a case of gingival Kaposi's sarcoma that initially mimicked an acute periodontal infection, but was the first clinical sign of HIV infection in a 38-year-old male homosexual patient. The clinical features and treatment of oral Kaposi's sarcoma are discussed and the variable histopathology of the lesion is demonstrated.
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Affiliation(s)
- I L Chapple
- Department of Restorative Dentistry, The Dental School, Birmingham, UK
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37
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Chapple IL, Manogue M. Management of a recurrent follicular ameloblastoma. Dent Update 1991; 18:309-12. [PMID: 1810789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Millett DT, Chapple IL, Hirschmann PN, Corrigan AM. Septic osteoradionecrosis of the mandible associated with pathological fracture: report of two cases. Clin Radiol 1990; 41:408-10. [PMID: 2383956 DOI: 10.1016/s0009-9260(05)80602-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Osteoradionecrosis of the mandible is a recognised pathological sequel to radiotherapy in the cervico-oro-facial region. Two cases of septic osteoradionecrosis which progressed to pathological fracture are described along with their subsequent clinical management.
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Abstract
Patent nasopalatine ducts are a rare entity, only 12 cases being reported in the English literature. Four new cases are presented, the world literature is reviewed, and possible mechanisms of formation are discussed.
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Affiliation(s)
- I L Chapple
- Department of Oral and Maxillofacial Surgery, Sunderland District General Hospital, Tyne, United Kingdom
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Heasman PA, Jacobs DJ, Chapple IL. An evaluation of the effectiveness and patient compliance with plaque control methods in the prevention of periodontal disease. Clin Prev Dent 1989; 11:24-8. [PMID: 2598578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The study was designed to evaluate the effectiveness of plaque control recommendations 6 months following active treatment of moderately advanced periodontal disease in 100 patients. The compliance of the patients to the use of different numbers of plaque control aids was also assessed. Our observations suggest that oral hygiene standards deteriorate during periods of unsupervised maintenance, and this is unrelated to either the number of aids recommended or the number of treatment visits. The reasons for patients failing to comply with professional recommendations were determined.
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