Impact of Patient Compliance on Tooth Loss during Supportive Periodontal Therapy

Periodontal treatment consists of active periodontal therapy (APT) and supportive periodontal therapy (SPT). Regular SPT is recommended to prevent and control the occurrence of periodontal disease following APT. A patient’s compliance with SPT is considered one of the most important factors affecting long-term periodontal status. Tooth loss is generally considered the final outcome of periodontitis. This review aimed to analyze the relationship between patient compliance with regular SPT and tooth loss. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline for systematic reviews was used. A search of articles was conducted using MEDLINE (PubMed) and other databases. Quality assessments of selected studies were performed. To assess the effect of compliance on tooth loss during SPT, pooled risk ratio of tooth loss (RRTL) was used as the primary outcome. Pooled risk difference of tooth loss (RDTL) and weighted mean difference of tooth loss rate (WDTLR) were used as secondary outcomes. Subgroup analysis and meta-regression were conducted to evaluate the effects of different variables. In total, 710 articles were screened. Eight studies, which had a regular-compliance (RC) group and an erratic-compliance (EC) group with at least a 5-y follow-up period, qualified for the meta-analysis. The risk of tooth loss in the RC group was significantly lower than that in the EC group (pooled RRTL: 0.56 [confidence interval (CI): 0.38, 0.82]; pooled RDTL: –0.05 [CI: –0.08, –0.01]). The definition of compliance was a variable significantly related to risk ratio of tooth loss. Patients in the RC group had significantly lower tooth loss rate during SPT than did patients in the EC group (WDTLR: –0.12 [CI: –0.19, –0.05]). Teeth have less risk of being lost if patients are more compliant with supportive periodontal therapy. However, unidentified variables causing data heterogeneity and affecting the risk of tooth loss may have been present. More well-controlled prospective studies are needed in the future.

Innate immune peptide LL-37 displays distinct expression pattern from beta-defensins in inflamed gingival tissue

Anti-microbial peptides produced from mucosal epithelium appear to play pivotal roles in the host innate immune defence system in the oral cavity. In particular, human beta-defensins (hBDs) and the cathelicidin-type anti-microbial peptide, LL-37, were reported to kill periodontal disease-associated bacteria. In contrast to well-studied hBDs, little is known about the expression profiles of LL-37 in gingival tissue. In this study, the anti-microbial peptides expressed in gingival tissue were analysed using immunohistochemistry and enxyme-linked immunosorbent assay (ELISA). Immunohistochemistry revealed that neutrophils expressed only LL-37, but not hBD-2 or hBD-3, and that such expression was prominent in the inflammatory lesions when compared to healthy gingivae which showed very few or no LL-37 expressing neutrophils. Gingival epithelial cells (GEC), however, expressed all three examined anti-microbial peptides, irrespective of the presence or absence of inflammation. Moreover, as determined by ELISA, the concentration of LL-37 in the gingival tissue homogenates determined was correlated positively with the depth of the gingival crevice. Stimulation with periodontal bacteria in vitro induced both hBD-2 and LL-37 expressions by GEC, whereas peripheral blood neutrophils produced only LL-37 production, but not hBD-2, in response to the bacterial stimulation. These findings suggest that LL-37 displays distinct expression patterns from those of hBDs in gingival tissue.

Thickness of palatal masticatory mucosa associated with age

BACKGROUND

The palatal masticatory mucosa is widely used as a donor material in periodontal plastic surgery. However, there are relatively few studies investigating the volume or thickness of the palatal mucosa. The purpose of this study was to determine the thickness of palatal masticatory mucosa in Asian subjects aged 14 to 59 years by a direct clinical technique. The associations of age and gender with the thickness of palatal mucosa were also examined.

METHODS

Sixty-two systemically and periodontally healthy Asians (31 males; 31 females; age range 14 to 59 years) participated in this study. The younger age group (age 14 to 21 years) consisted of 32 subjects with a mean age of 16.8 years, whereas the older age group (age 30 to 59 years) consisted of 30 subjects with a mean age of 38.7 years. A bone-sounding method using a periodontal probe with minimal anesthesia and a prepared clear acrylic stent were utilized to assess the thickness of palatal mucosa at 15 measurement sites defined according to the gingival margin and mid-palatal line. Multiple linear regression analysis was performed to examine the associations of age and gender with the mean mucosal thickness at the subject level. The Wilcoxon test was used to determine the difference in mucosal thickness between the 2 age groups, and between gender at each measurement point.

RESULTS

The mean thickness of palatal masticatory mucosa ranged from 2.0 to 3.7 mm. The younger age group had significantly thinner mucosa (mean 2.8 +/- 0.3 mm) than the older age group (mean 3.1 +/- 0.3 mm). Females had thinner mucosa than males in the same age group, but the difference was not statistically significant. Overall, the thickness of palatal mucosa increased from the canine to second molar areas and in the sites furthest from the gingival margin towards the mid-palate (with the exception of the first molar area, where significantly decreased thickness was observed).

CONCLUSIONS

Within the limits of the present study, the canine and premolar areas appear to be the most appropriate donor site for grafting procedures in both young and adult individuals. The subepithelial connective tissue graft procedure can be considered as a treatment modality in young patients, since a sufficient volume of donor tissue can be obtained from the hard palate area. Other factors that may influence the thickness of palatal mucosa such as racial and genetic factors and body weight need to be further investigated.

Periodontitis in the child and adolescent

Early onset periodontitis (EOP) which affects individuals thirty-five and younger is characterized by a rapid rate of bone loss and disease progression with defects in host response and a specific etiological microbial flora. Within this classification, there are three subsets of the disease: prepubertal periodontitis, juvenile periodontitis, and rapidly progressive periodontitis. The characteristics of each disease are described along with illustrative cases that will help clinicians diagnose EOP in their patients. Currently prescribed treatment modalities and guidelines from the literature are also discussed in this paper. EOP may represent a complex set of diseases that are likely to be reclassified as further advances in microbiological and genetic research are made. Clinicians should be aware of such changes in order to diagnose, treat, and refer their patients for comprehensive care.

A human MSX1 homeodomain missense mutation causes selective tooth agenesis

We demonstrate that a mutation in the homeobox gene, MSX1, causes a common developmental anomaly, familial tooth agenesis. Genetic linkage analyses in a family with autosomal dominant agenesis of second premolars and third molars identified a locus on chromosome 4p, where the MSX1 gene resides. Sequence analyses demonstrated an Arg31Pro missense mutation in the homeodomain of MSX1 in all affected family members. Arg 31 is a highly conserved homeodomain residue that interacts with the ribose phosphate backbone of target DNA. We propose that the Arg31 Pro mutatrion comprises MSX1 interactions, and suggest that MSX1 functions are critical for normal development of specific human teeth.