Effect Of Elastomeric Separator On Microbial Count In Gingival Crevicular Fluid

BACKGROUND

The separators are a preliminary step for band insertion, but there is a potential risk of bacteraemia during their placement, particularly in susceptible patients. The objective of the study is to determine the effect of separators on the bacterial count in gingival crevicular fluid (GCF) and to assess the efficacy of chlorhexidine mouth rinse and saline irrigation in the reduction of the bacterial count.

METHODS

This randomized controlled trial was conducted on 51 participants who were divided into three equal g roups randomly (brushing only/control, saline irrigation, and 2% chlorhexidine mouthwash rinse). The inclusion criteria were age between 18-25 years, good oral hygiene, gingival and plaque index <1, no previous orthodontic treatment, and healthy individuals. The bacterial count was obtained from GCF samples after two hours, on the third day, and on the seventh day. Kruskal Wallis test was used to compare the bacterial count among the three groups, and post hoc analysis was done using Dunn's test. Friedman test was applied to see the difference at three-time points in each group.

RESULTS

In both saline and chlorhexidine groups the mean bacterial count decreased significantly from baseline to 3rd day and 7th day after separator placement (p<0.001). For the third day, a significant difference was found in control versus saline and control versus chlorhexidine. No significant difference was found between saline and chlorhexidine on the third day. Similar results were found on the 7 thday. For controls, the bacterial count increased with time and for both saline and chlorhexidine groups the bacterial count decreased. The highest decrease in the bacterial count was found for the chlorhexidine group.

CONCLUSIONS

After the placement of separators, there was an increase in the bacterial count in GCF. Notably, chlorhexidine was found to be more effective than saline irrigation in reducing the bacterial count.

Effects of Kangfuxinye on NF-κB and Inflammatory Cytokines in Gingival Crevicular Fluid of Patients with Orthodontic Gingivitis Caused by Orthodontic Treatment

Explore the Kangfuxinye effection on the expressions of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and inflammatory cytokines (IC) in the gingival crevicular fluid of patients with orthodontic gingivitis caused by orthodontic treatment. 98 patients with orthodontic gingivitis in Qingdao Stomatological Hospital caused by orthodontic treatment were divided into two groups, namely, the control treatment group and the Kangfuxinye treatment group. In this study, the expressions of those proteins and IC in gingival crevicular fluid before and after treatment were analyzed at first, and the correlations of the NF-κB p65 expression with IC were explored. Then the differences in the expressions of those proteins and IC and the efficacy between the control treatment group and the Kangfuxinye treatment group were analyzed. Compared with those before treatment, the expressions of NF-κB-related proteins and IC interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α) and vascular endothelial growth factor (VEGF)] were significantly decreased after treatment (p<0.05). After treatment, the expression of NF-κB p65 was positively correlated with IL-1β, TNF-α and VEGF, but negatively related to IL-4 and IL-10. In addition, compared with the control treatment, Kangfuxinye significantly reduced the expressions of those proteins and their messenger ribonucleic acids (mRNAs) (p<0.05), decreased the expressions of IL-1β, TNF-α and VEGF (p<0.05) but improved the total effective rate of treatment. Kangfuxinye can reduce the NF-κB expressions and IC in the gingival crevicular fluid of patients with orthodontic gingivitis caused by orthodontic treatment and enhance the efficacy.

Treatment of Porphyromonas gulae infection and downstream pathology in the aged dog by lysine-gingipain inhibitor COR388

COR388, a small-molecule lysine-gingipain inhibitor, is currently being investigated in a Phase 2/3 clinical trial for Alzheimer's disease (AD) with exploratory endpoints in periodontal disease. Gingipains are produced by two species of bacteria, Porphyromonas gingivalis and Porphyromonas gulae, typically associated with periodontal disease and systemic infections in humans and dogs, respectively. P. gulae infection in dogs is associated with periodontal disease, which provides a physiologically relevant model to investigate the pharmacology of COR388. In the current study, aged dogs with a natural oral infection of P. gulae and periodontal disease were treated with COR388 by oral administration for up to 90 days to assess lysine-gingipain target engagement and reduction of bacterial load and downstream pathology. In a 28-day dose-response study, COR388 inhibited the lysine-gingipain target and reduced P. gulae load in saliva, buccal cells, and gingival crevicular fluid. The lowest effective dose was continued for 90 days and was efficacious in continuous reduction of bacterial load and downstream periodontal disease pathology. In a separate histology study, dog brain tissue showed evidence of P. gulae DNA and neuronal lysine-gingipain, demonstrating that P. gulae infection is systemic and spreads beyond its oral reservoir, similar to recent observations of P. gingivalis in humans. Together, the pharmacokinetics and pharmacodynamics of COR388 lysine-gingipain inhibition, along with reduction of bacterial load and periodontal disease in naturally occurring P. gulae infection in the dog, support the use of COR388 in targeting lysine-gingipain and eliminating P. gingivalis infection in humans.

Effect of systemic long-term, low-dose aspirin on periodontal status and soluble CD14 in gingival crevicular fluid: a case-control study

AIM

In the present study, we evaluated the effect of systemic long-term, low-dose aspirin on the periodontal status and gingival crevicular fluid (GCF) concentrations of aspirin-triggered lipoxins (ATL) and soluble CD14 (sCD14).

METHODS

The study group consisted of 45 patients who were on long-term, low-dose aspirin therapy, and the control group included patients not on aspirin therapy. Mean bleeding index, plaque index (PI), probing depth (PD), and clinical attachment loss (CAL) were recorded. GCF samples were analyzed for concentrations of ATL, and sCD14 using enzyme-linked immunosorbent assay method.

RESULTS

The means of PI, PD, and CAL were higher for the control group compared to the study group. The mean concentration of ATL was significantly higher for the study group (49.13 ± 37.39 ng/mL). The mean concentration of sCD14 was higher in the control group (5.75 ± 3.91 μg/mL). There was a negative correlation in the study group between concentrations of ATL with PD (r = -0.54) and CAL (r = -0.123). There was a positive correlation between sCD14 and CAL (r = 0.047) in the study group. A negative correlation was also observed between concentrations of sCD14 and ATL (r = -0.134) in the study group.

CONCLUSION

The results indicate better periodontal status among long-term aspirin users compared to non-aspirin users.

Cleavage of host cytokeratin-6 by lysine-specific gingipain induces gingival inflammation in periodontitis patients

BACKGROUND/PURPOSE

Lysine-specific gingipain (Kgp) is a virulence factor secreted from Porphyromonas gingivalis (P. gingivalis), a major etiological bacterium of periodontal disease. Keratin intermediate filaments maintain the structural integrity of gingival epithelial cells, but are targeted by Kgp to produce a novel cytokeratin 6 fragment (K6F). We investigated the release of K6F and its induction of cytokine secretion.

METHODS

K6F present in the gingival crevicular fluid of periodontal disease patients and in gingipain-treated rat gingival epithelial cell culture supernatants was measured by matrix-assisted laser desorption/ionization time-of-flight mass spectrometer-based rapid quantitative peptide analysis using BLOTCHIP. K6F in gingival tissues was immunostained, and cytokeratin 6 protein was analyzed by immunofluorescence staining and flow cytometry. Activation of MAPK in gingival epithelial cells was evaluated by immunoblotting. ELISA was used to measure K6F and the cytokines release induced by K6F. Human gingival fibroblast migration was assessed using a Matrigel invasion chamber assay.

RESULTS

We identified K6F, corresponding to the C-terminus region of human cytokeratin 6 (amino acids 359-378), in the gingival crevicular fluid of periodontal disease patients and in the supernatant from gingival epithelial cells cultured with Kgp. K6F antigen was distributed from the basal to the spinous epithelial layers in gingivae from periodontal disease patients. Cytokeratin 6 on gingival epithelial cells was degraded by Kgp, but not by Arg-gingipain, P. gingivalis lipopolysaccharide or Actinobacillus actinomycetemcomitans lipopolysaccharide. K6F, but not a scrambled K6F peptide, induced human gingival fibroblast migration and secretion of interleukin (IL)-6, IL-8 and monocyte chemoattractant protein-1. These effects of K6F were mediated by activation of p38 MAPK and Jun N-terminal kinase, but not p42/44 MAPK or p-Akt.

CONCLUSION

Kgp degrades gingival epithelial cell cytokeratin 6 to K6F that, on release, induces invasion and cytokine secretion by human gingival fibroblasts. Thus, Kgp may contribute to the development of periodontal disease.

The concentrations of IL-8 and IL-6 in gingival crevicular fluid during nickel-chromium alloy porcelain crown restoration

We explored gum irritation and cytotoxicity caused by nickel-chromium (Ni-Cr) alloy porcelain by interleukin-8 (IL-8), interleukin-6 (IL-6) and gingival crevicular fluid (GCF) volumes at different time points peri-crown restoration. This prospective study was conducted in 60 young adults. The total amount and concentrations of IL-8 and IL-6 per site, GCF volumes, and blood neutrophil counts were performed prior to and at 1 week, 3 months, and 6 months after Ni-Cr alloy-porcelain crown restoration. Thirty male and 30 female subjects, aged 20-35 years old were enrolled. The total amount and concentrations of IL-8 and IL-6 per site, GCF volumes increased after nickel-chromium (Ni-Cr) alloy-porcelain crown restoration, and reached its peak at the third month as the GCF volume increased by 52.20 %, the total amount and concentrations of IL-8 increased by 112.11 and 22.75 %; the total amount and concentrations of IL-6 increased by 77.66 and 17.17 % when compared to baseline. In particular, the increase of IL-8 concentration was found in female patients at 3 months after restoration; while the neutrophil count of the peripheral blood did not change significantly. The increase in the total amount and the concentrations of IL-8 and IL-6 and GCF volume may be related to the cytotoxicity induced by Ni-Cr alloy. The significant increase of IL-8 concentration in females indicates that more attention should be given to women during Ni-Cr alloy porcelain crown restoration.

Efficacy of lycopene as a locally delivered gel in the treatment of chronic periodontitis: smokers vs nonsmokers

OBJECTIVE

The present study was carried out as a multicenter, randomized controlled, split-mouth clinical trial to evaluate the efficacy of locally delivered lycopene on periodontal health and gingival crevicular fluid (GCF) levels of 8-hydroxydeoxyguanosine (8-OHdG) in smokers and nonsmokers compared with periodontally healthy control subjects.

METHOD AND MATERIALS

One hundred ten subjects including 50 smokers, 50 nonsmokers, and 10 controls participated in this study. Subjects in the smoker and nonsmoker groups had contralateral sites treated with lycopene gel and a placebo. Clinical parameters included recording site-specific measures of plaque, gingivitis, probing depth, and clinical attachment level. GCF 8-OHdG values were analyzed using a commercially available ELISA kit.

RESULTS

Compared with the placebo, lycopene-treated sites in smokers and nonsmokers showed significant reductions in probing depths and gain in the clinical attachment levels. However, there was no statistically significant difference in the clinical parameters when lycopene-treated sites in smokers and nonsmokers were compared, except for the reduction in the 8-OHdG levels. The 8-OHdG levels at 1 week and 3 months in sites treated with lycopene in the smoker and nonsmoker group were comparable with those in the periodontally healthy control group.

CONCLUSION

The gel formulation was effective in increasing clinical attachment and reducing gingival inflammation, probing depth, and oxidative injury compared with the placebo in smoking and nonsmoking subjects.

Subgingival delivery of oral debriding agents: a proof of concept

OBJECTIVE

This study is a proof of concept to determine the efficacy of a custom-fabricated tray in placing antimicrobial and debriding agents in the periodontal pockets of persons with active gingival infections. Localized subgingival delivery of antimicrobial and antibiotic agents is routinely employed as adjunctive therapy for the treatment and management ofperiopathogens associated with periodontal disease. Because these delivery techniques often face time constraints and impose temporary restrictions on patient brushing and flossing, a custom-formed prescription dental tray can be used to deliver and maintain medications in periodontal pockets between office visits and without brushing or flossing restrictions. The ability of this tray to maintain sufficient concentrations of medication in the periodontal pockets to have a therapeutic effect is evaluated here with theoretical modeling and practical application.

METHODS

Hydrogen peroxide is an oral debriding agent and oral wound cleanser with antimicrobial properties. The debriding effect of 1.7% hydrogen peroxide gel was tested in vitro on Streptococcus mutans biofilm using glass carriers for collection. Diffusion modeling tested the potential of the customized tray to place hydrogen peroxide gel into the sulcus in the presence of crevicular fluid flow. Changes in periodontal microflora with scanning electron microscopy analysis of in vivo paper point site sampling were analyzed before and after a thin ribbon of 1.7% hydrogen peroxide gel (approximately 0.7 gm) and a subtherapeutic dose (three drops) of Vibramycin (50 mg/5 ml) were placed via Perio Trays into periodontal pockets, ranging from 4-8 mm at daily prescribed intervals for two to five weeks.

RESULTS

In vitro results indicate that 1.7% hydrogen peroxide gel breaks down the exopolysaccharide slime and cell walls ofS. mutans, and begins to debride the cells from glass carriers within 10 minutes. Diffusion modeling indicates that hydrogen peroxide can penetrate into the deeper pockets (9 mm), but also its concentration in these deep pockets will increase over wearing time in the absence of degradation by peroxidases and catalase. Site sampling data confirm diffusion modeling results, with evidence that medication delivered with the prescription tray reduced subgingival bacterial loads and enhanced healing of corresponding oral tissues.

CONCLUSION

The prescription Perio Tray effectively placed medication in the gingival sulcus. Mathematical modeling indicated Perio Tray placement of hydrogen peroxide gel in periodontal pockets with depths up to 9 mm over 15 minutes treatment time was theoretically possible. Pathology reports reveal reductions in subgingival bacterial loads and improvements in pretreatment pocket depths of up to 8 mm after 1.7% hydrogen peroxide and Vibramycin Syrup were prescribed for use with the Perio Tray. The in vitro analysis indicating that hydrogen peroxide is the active and effective oral debriding agent needs to be confirmed with additional studies.

Influence of different retraction techniques on crevicular fluid flow

This study aimed to analyze the influence of different retraction techniques (pure cotton cord, cord impregnated with epinephrine, and chemical retraction [Expa-syl]) on the crevicular fluid flow in vivo. A total of 340 prepared teeth were randomly assigned to one of the retraction procedures. Crevicular fluid flow was measured prior to and immediately after the removal of the respective retraction material. Pure cotton cords led to a significant increase in crevicular fluid flow, whereas impregnated cords and Expa-syl significantly reduced crevicular fluid flow (P < .01). The retraction technique has a high impact on the reduction of crevicular fluid flow in patients. Pure cotton retraction cords should be avoided.

The Effect of Aspirin on Gingival Crevicular Fluid Levels of Inflammatory and Anti-Inflammatory Mediators in Patients With Gingivitis

BACKGROUND

Inflammatory and anti-inflammatory mediators may play a significant role in patients with gingivitis. The purpose of this study was to assess the short-term effects of the systemic administration of two different concentrations of aspirin (81 and 325 mg/day, by mouth) on clinical periodontal parameters and gingival crevicular fluid (GCF) levels of 15-epi-lipoxin A4 (15-epi-LXA4), lipoxin A4, leukotriene B4 (LTB4), prostaglandin E2 (PGE2), and interleukin (IL)-6 and -1beta in a sample of naturally occurring gingivitis patients.

METHODS

At day 0, after initial screening for entry, baseline periodontal parameters, including bleeding on probing (BOP), periodontal probing depths (PDs), and plaque index (PI) were measured, and GCF was sampled from 12 intrasulcular sites with filter paper strips for the measurement of six types of inflammatory and anti-inflammatory mediators using competitive enzyme immunoassay and enzyme-linked immunosorbent assay (prevalues). Forty-seven subjects were assigned randomly to one of three treatment groups: placebo (15 subjects); aspirin, 81 mg (16 subjects); and aspirin, 325 mg (16 subjects) once daily. On day 7, subjects were recalled for the measurement of periodontal parameters and collection of GCF samples for the measurement of six types of mediators (postvalues).

RESULTS

Changes in inflammatory and anti-inflammatory mediator levels were not statistically significant for any of the three treatment groups. However, when pre- and postvalues were compared in the subjects receiving aspirin, 325 mg, there was a negative trend in the relationship between 15-epi-LXA4 and PGE2, whereas the relationship between LTB4 and PGE2 was not as strong. This might indicate that the subjects responding to aspirin-mediated PGE2 suppression effects produced higher 15-epi-LXA4 in GCF than non-responders. No statistically significant differences in PD and PI between pre- and postvalues were found for any of the three treatment groups. However, the results demonstrated a significant increase in BOP when aspirin, 325 mg was compared to placebo (P <0.001) and aspirin, 81 mg (P = 0.001).

CONCLUSIONS

Aspirin can have an affect on BOP in naturally occurring gingivitis patients. Although most of the inflammatory mediators did not show significantly detectable changes after aspirin treatment for 7 days, the trend of aspirin-associated increases of 15-epi-LXA4 implied that this recently discovered aspirin-dependent eicosanoid may be associated with the increased incidence of BOP observed in the subjects who received aspirin therapy.

Effect of systemically administered naproxen sodium on clinical parameters and myeloperoxidase and elastase-like activity levels in gingival crevicular fluid

BACKGROUND

The present study was conducted to determine the possible effect of naproxen sodium on clinical status and the enzymatic profile of gingival crevicular fluid (GCF) when given as adjunct to periodontal treatment.

METHODS

A total of 34 subjects with chronic periodontitis were selected and divided into two groups to receive either naproxen sodium or placebo. At baseline, GCF samples were obtained and probing depths (PD), gingival index (GI), plaque index (PI), and gingival bleeding index (GBI) scores were recorded. In the non-steroidal anti-inflammatory drug (NSAID) group, patients were treated with a protocol consisting of baseline periodontal treatment (scaling, root planing) and naproxen sodium (275 mg) administration daily for 6 weeks. In the placebo group, patients received the same treatment except placebo was given instead of naproxen sodium. At the end of the experimental period, clinical recordings and GCF sampling were repeated. Myeloperoxidase (MPO) and elastase-like enzyme activity (ELA) levels were determined in GCF samples by a spectrophotometric method. GCF enzymatic content was calculated both as total enzyme activity and enzyme concentration.

RESULTS

All of the clinical parameters, except mean GBI, were significantly lower in the experimental group (P <0.05). At baseline and at the end of the experimental period, there were no significant differences between the NSAID and placebo groups regarding GCF MPO and ELA levels in either mode of data presentation (P <0.05). However, in the NSAID group, mean ELA concentration (P = 0.002) and mean total ELA (P = 0.003) presented significant decreases with treatment. Also, with treatment, a general reduction in MPO levels was seen; however, this difference was not significant. Although constant and stable correlations between GCF enzyme levels and clinical parameters could not be found, positive and strong correlations were observed between total enzyme activity and enzyme concentrations.

CONCLUSION

Based on the positive clinical effect and the ELA profile of GCF, it can be suggested that NSAIDs given as an adjunct to baseline periodontal treatment could be beneficial in the outcome of treatment.

The effect of fluoride administration on rat serum osteocalcin expression during orthodontic movement

INTRODUCTION

Osteocalcin is a bone protein that has been used to mark bone turnover. The precise role of this protein in bone remodeling has not been fully elucidated; however, it was shown to be instrumental in the activation of osteoclastic bone resorption via its effect on osteoblasts. Fluoride influences bone growth by acting as a mitogenic agent for osteoblasts. In this study, we used a rodent model to determine the effects of fluoride administration on systemic osteocalcin during orthodontic tooth movement.

METHODS

Thirty-two 8-week-old female Wistar rats were divided into 4 groups. The first experimental group (n = 10) was fed a normal laboratory diet and distilled water (MilliQ). The second experimental group (n = 10) had the same diet with the addition of fluoridated water. All animals in both groups had 100-g nickel-titanium coil springs secured to their mandibular incisors and left first molars to instigate orthodontic tooth movement for 14 days. The third (n = 6) and fourth (n = 6) groups were the controls. These animals did not undergo orthodontic tooth movement and were given fluoridated (100 ppm sodium fluoride) and nonfluoridated water ad libitum. Phlebotomy was performed via the lateral tail vein before placement of the orthodontic appliances, and final blood samples were obtained via cardiac puncture after the rats were killed 2 weeks later. Serum was isolated from the samples after centrifuging at each stage of phlebotomy, and an enzyme-linked immunosorbent assay (ELISA) was subsequently performed to determine osteocalcin levels in the various sample groups.

RESULTS

Orthodontic tooth movement with high, continuous forces was found to have a positive, statistically significant correlation with serum osteocalcin expression in the rodent model. The use of fluoride as a variable was found to increase the mean osteocalcin concentration, but this was not statistically significant.

CONCLUSIONS

Further understanding of the biological implications of increased osteocalcin expression requires additional research into the local expression of this protein in the gingival crevice during orthodontic movement.

Plasma and gingival crevicular fluid phenytoin concentrations as risk factors for gingival overgrowth

BACKGROUND

Gingival enlargement is one of the side effects associated with the administration of phenytoin. The mechanism by which phenytoin induces gingival enlargement is not well understood. This study was conducted to investigate the relationship between plasma and gingival crevicular fluid (GCF) phenytoin concentrations and the degree of gingival overgrowth in patients with similar gingival and plaque indices and also to determine the risk factors for gingival enlargement.

METHODS

Eighteen patients taking phenytoin in regular doses > or =6 months prior to the investigation participated in the study. Gingival enlargement was evaluated with two indices to score vertical and horizontal overgrowth. The gingival index (GI), plaque index (PI), gingival bleeding time index (GBTI), probing depth (PD), and clinical attachment level (CAL) were also evaluated. GCF and plasma phenytoin concentrations were determined by using high-performance liquid chromatography (HPLC).

RESULTS

There was no significant difference between responders and non-responders for PD, CAL, PI, GI, and GBTI. Phenytoin was detected in all of the GCF and plasma samples using the HPLC analysis method. The mean concentration of phenytoin in GCF was significantly greater than the concentration of phenytoin in plasma. No significant difference was observed for the concentration of GCF phenytoin between responders and non-responders. However, the concentration of plasma phenytoin was significantly higher in responders than non-responders.

CONCLUSION

This study showed that plasma phenytoin level appeared to be a risk factor for phenytoin-induced gingival overgrowth.

Gingival temperature measurements with fluoride and nonfluoride elastomeric ligatures

INTRODUCTION

Little is known about the effect of fluoridated elastomerics on gingival health. The aim of this in-vivo study was to compare subgingival temperature measurements near brackets with fluoridated elastomerics with nonfluoridated elastomerics.

METHODS

This was a prospective, longitudinal, crossover study, involving 12 volunteers. Data, including gingival temperature, gingival crevicular fluid volume, and gingival index scores, were collected weekly from the buccal aspects of 8 teeth for 8 weeks (except for a 1-week washout period). A baseline examination was carried out at week 1. This was repeated at week 2, immediately before placement of orthodontic brackets on all 4 first premolars, which were randomly allocated to receive either fluoridated or nonfluoridated elastomerics. Examinations were repeated at weeks 3 and 4, when the elastomerics were removed. After the washout period, the contrary elastomerics (either fluoridated or nonfluoridated) were placed. Examinations were repeated at weeks 5 and 6 when the elastomerics and brackets were removed. A final examination was performed at week 7.

RESULTS

There was a small, but statistically significant, increase in the gingival temperature (P = .002) after placement of the fluoridated elastomerics. There were no other differences in the markers for gingival health.

CONCLUSIONS

The mean increase in gingival temperature with fluoridated elastomers was small (0.3 degrees C) and unlikely to be clinically significant, but the implications are discussed.

Dose-related effects of epinephrine on human gingival blood flow and crevicular fluid production used as a soaking solution for chemo-mechanical tissue retraction

STATEMENT OF PROBLEM

Epinephrine is a frequently used agent for impregnation of the retraction cord. Removal of retraction cord from the gingival sulcus has been shown to elicit a hyperemic response that could be prevented by epinephrine. However, the epinephrine may cause local or systemic adverse effects in the circulation.

PURPOSE

The aim of this study was to identify the effective concentration of epinephrine that may prevent the hyperemic response and consequently keep the crevicular fluid production low after cord removal without local or systemic side effects.

MATERIAL AND METHODS

Seventeen healthy human subjects had their crevicular fluid volume and gingival blood flow measured by Periotron and laser Doppler flowmetry, respectively, before and after cord removal at the left maxillary central incisor. The right maxillary incisor served as the control. Retraction cords were presoaked in physiological saline or various concentrations (0.001%, 0.01%, and 0.1% w/v) of epinephrine solution. Double repeated-measures analysis of variance with the Fisher Least Significant Difference post hoc test was used to statistically evaluate the blood flow values (mean +/- SE, alpha=.05), and the Wilcoxon matched pair test was used for crevicular fluid values, given as median (25-75 percentile, alpha=.01).

RESULTS

In the saline group, cord removal resulted in elevated blood flow (140% +/- 11%, P<.001) and crevicular fluid production (300% (130%-470%), P<.05). After cord removal in the 0.01% and 0.1% epinephrine groups, blood flow remained low for the measured period (43%-70%, P<.05). The crevicular fluid production transiently increased in the 0.01% epinephrine group (170% (140%-380%), P<.001), but then returned to baseline level and remained low as for the 0.1% group. No systemic vascular effect was detected in any groups.

CONCLUSION

The prolonged increase in crevicular fluid production and hyperemic response after cord removal can be prevented by application of 0.01% epinephrine solution without systematic changes.

Selective inhibition of Porphyromonas gingivalis growth by a factor Xa inhibitor, DX-9065a

BACKGROUND

Porphyromonas gingivalis is a causative bacterium of adult periodontitis. However, there is no drug specific for P. gingivalis and for its virulence factor.

OBJECTIVES

The objective of this study was to examine the effects of a new selective inhibitor of activated factor X, DX-9065a, on growth of Porphyromonas gingivalis and other periodontopathic bacteria.

METHODS

We incubated P. gingivalis and other periodontopathic bacteria in the presence or absence of DX-9065a and examined the effect of DX-9065a on bacterial growth and trypsin-like activity in its cultures. We also examined the effects of DX9065a on amidolytic activity of purified trypsin-like proteinases (gingipains RgpA and RgpB), from P. gingivalis and on trypsin-like activity in gingival crevicular fluids from patients with adult periodontitis.

RESULTS

DX-9065a selectively inhibited the growth of P. gingivalis and Prevotella intermedia, and its effect on P. gingivalis was bactericidal. Trypsin-like proteinase activity was detected in P. gingivalis, and the activity was strongly inhibited by DX-9065a. DX-9065a even inhibited amidolytic activity of RgpA and RgpB from P. gingivalis. Furthermore, trypsin-like proteinase activity in gingival crevicular fluids was strongly inhibited by DX-9065a.

CONCLUSIONS

DX-9065a inhibits P. gingivalis growth in part through to its ability to inhibit the trypsin-like proteinase activity in P. gingivalis and may be useful for a new drug for treatment of adult periodontitis.

Effects of alendronate and hormone replacement therapy, alone and in combination, on saliva, periodontal conditions and gingival crevicular fluid matrix metalloproteinase-8 levels in women with osteoporosis

OBJECTIVE

To compare the effects of hormone replacement therapy (HRT), alendronate and their combination on oral health of elderly postmenopausal women with osteoporosis.

MATERIALS AND METHODS

Sixty patients, aged 65-80 years (mean 71 years), with a T-score of bone mineral density of -2.5 s.d. or less at either the lumbar spine or the femoral neck, were randomized to receive 2 mg of estradiol plus 1 mg norethisterone acetate (HRT) (n = 20), 10 mg of alendronate (n = 18), or their combination (n = 22) for 2 years. Periodontal and oral status and mouth symptoms were recorded, and salivary analyses made at the beginning and at the end of the study. Gingival crevicular fluid (GCF) matrix metalloproteinase (MMP-8) levels were determined to address destructive events in periodontal tissue.

RESULTS

Resting salivary flow rate decreased by 19% (P < 0.05), and GCF MMP-8 tended to increase in the alendronate group. None of the regimens affected subjective feelings of dry or burning mouth. There were no significant changes in dental or periodontal status, stimulated flow rate or composition of saliva during the study.

CONCLUSIONS

Alendronate decreased resting salivary flow rate but otherwise HRT or alendronate separately or in combination had no effect on oral health in elderly women with osteoporosis.

The clinical application of hyaluronic acid in gingivitis therapy

OBJECTIVE

The efficacy of a topical application of hyaluronic acid (HA) was tested for treating gingivitis.

METHOD AND MATERIALS

Sixty nonsmoking outpatients in good general condition, with clinical signs of gingivitis, were included in the study. Forty patients (HA group, 20 men, 20 women; age: 32.8 +/- 11.3 years) used a spray containing HA 5 times daily over a period of 1 week. The control group consisted of 20 patients (10 men, 10 women; age: 31.3 +/- 9.3 years). The clinical parameters DMF-T (decayed, missed, filled teeth) index, approximal plaque index, sulcus bleeding index, papilla bleeding index, and gingival crevicular fluid were measured at baseline (T1), after 3 days (T2), and after 7 days (T3).

RESULTS

A reduction in the sulcus bleeding index of the HA group (T1: 72.9 +/- 19.5%) to 50.3 +/- 21.1% was noted at T2, and at T3 the sulcus bleeding index was 40.7 +/- 23.0%. The papilla bleeding index values of the HA group were 1.6 at T1, 1.0 at T2, and 0.7 at T3. The gingival crevicular fluid showed significant reductions in the HA group. At T1 the recorded mean value was 16.3, at T2 it was 11.8, and at T3 it was 7.9. Only insignificant changes were observed in the respective indices of the control group. There were no significant alterations in the plaque values of either group throughout the study period.

CONCLUSION

The results obtained by this study demonstrate that the topical application of an HA-containing preparation represents a potentially useful adjunct in the therapy of gingivitis, although its use does not diminish the need for plaque reduction as a primary therapeutic measure.

Effect of Topical Cimetidine Rinse on Gingival Crevicular Neutrophil Leukocyte Function

BACKGROUND

Three coordinated mechanism-of-action clinical studies were conducted to examine the effects of topical cimetidine rinse on neutrophil function in the gingival crevice.

METHODS

The first study was a randomized, double-blind, placebo-controlled, 28-day experimental gingivitis study involving 21 healthy adults, in which subjects rinsed twice a day with placebo or 0.5% cimetidine rinses. At baseline and days 14, 21, and 28, neutrophils were harvested from prespecified gingival sulcular sites, purified, stained, and examined by trifluorochrome phagocytosis and killing microassay. The second and third studies were placebo-controlled, 9-week, three-period (each of 3 weeks' duration), longitudinal studies involving seven and nine adults with moderate periodontitis, respectively. Subjects rinsed twice a day during periods 1 and 3 with placebo and during period 2 with 0.5% cimetidine. At baseline and weekly intervals, neutrophils were harvested from prespecified periodontal pockets, purified, stained, and examined by trifluorochrome phagocytosis and killing microassay in the second study. In the third study, neutrophils were examined spectrophotometrically for superoxide production and in a luminol-enhanced chemiluminescence assay.

RESULTS

In the first study, the mean number of phagocytosing neutrophils was statistically significantly increased (P = 0.016) in the cimetidine group (31.1 cells/subject) versus the placebo group (13.7 cells/subject) at day 28. In addition, a statistically significant increase (P = 0.036) in bacterial killing was observed in the cimetidine rinse group; in the cimetidine group, 63.4% of bacteria in the neutrophils were killed compared to 46.2% in the placebo group. Additional data from the other two studies support these findings.

CONCLUSION

Collectively, these studies provide evidence that topical 0.5% cimetidine oral rinse enhances the antibacterial function of crevicular neutrophils.

Adjunctive subantimicrobial dose doxycycline: effect on clinical parameters and gingival crevicular fluid transforming growth factor-beta levels in severe, generalized chronic periodontitis

BACKGROUND

At present there is limited data concerning the efficacy of non-surgical periodontal therapy supplemented with subantimicrobial dose doxycycline (SDD) in the treatment of severe, generalized periodontitis. The purpose of the present study was to evaluate the effect of adjunctive SDD therapy on clinical periodontal parameters and gingival crevicular fluid (GCF) transforming growth factor-beta1 (TGF-beta1) levels in patients with severe, generalized chronic periodontitis over a 6-month period.

METHODS

Thirty-five patients with severe, generalized periodontitis and 11 periodontally healthy subjects were included in the present study. Patients received full-mouth supragingival debridment at baseline and randomized to take either SDD b.i.d. or placebo b.i.d. for 3 months. Patients received root planing and oral hygiene instruction once a week for four consecutive weeks. Clinical measurements including probing depth (PD), clinical attachment level, papilla bleeding index and plaque index and GCF sampling were performed at baseline, 3 and 6 months. The GCF TGF-beta1 levels were analysed by enzyme-linked immunosorbent assay.

RESULTS

Thirteen patients in both study groups completed the 6-month trial. Following scaling and root planing (SRP) plus SDD and SRP plus placebo therapy significant improvements in clinical periodontal parameters of both groups were observed (p<0.025). In the SDD group a significantly higher percentage (%73.4) of deep pockets resolved (PD reduction > or =3 mm from baseline) when compared with placebo group (%49.7) at 6 months (p<0.05). At baseline there were no significant differences in GCF TGF-beta1 levels between three groups. Both total amount and concentration of GCF TGF-beta1 in SDD and placebo groups increased when compared with baseline at 3 months. However, only GCF TGF-beta1 levels of SDD group was significantly higher than baseline (p<0.025) and placebo group (p<0.017) at 3 months. At 6 months GCF TGF-beta1 levels of both groups were similar to baseline levels (p<0.025).

CONCLUSIONS

These data indicate that combination of SDD with non-surgical therapy improves clinical parameters of periodontal disease and increases GCF TGF-beta1 levels together with a decrease in prevalence of residual pockets in patients with severe, generalized chronic periodontitis. Increased GCF TGF-beta1 levels following SDD therapy might suggest a novell pleiotrophic mechanism for tetracyclines to inhibit connective tissue breakdown.

Effectiveness of Adjunctive Low-Dose Doxycycline Therapy on Clinical Parameters and Gingival Crevicular Fluid Laminin-5 γ2 Chain Levels in Chronic Periodontitis

BACKGROUND

Laminin-5 (Ln-5) is involved in the apical migration of epithelial cells during the development of periodontal pockets. Low-dose doxycycline (LDD) can therapeutically modulate the host response with its non-antimicrobial properties. In the present randomized, double-blind, placebo-controlled, parallel arm study, the effectiveness of LDD in combination with non-surgical periodontal therapy on gingival crevicular fluid (GCF) Ln-5 gamma2 chain fragment levels and clinical parameters in patients with chronic periodontitis was examined over a 12-month period.

METHODS

GCF samples were collected and clinical parameters including probing depth (PD), clinical attachment level, gingival index (GI), and plaque index were recorded. Thirty chronic periodontitis patients were randomized either to low-dose doxcycline or placebo groups. LDD group received doxycycline (20 mg, b.i.d.) for 3 months plus scaling and root planing (SRP), while placebo group was given placebo capsules b.i.d. for 3 months plus SRP. The patients were evaluated every 3 months during the 12-month study period. All clinical parameters and GCF sampling were repeated at each visit. GCF Ln-5 gamma2 chain fragment levels were determined by Western immunoblotting using specific antibody and quantitated by computerized image analysis. Friedman test was used for intragroup comparisons followed by Wilcoxon signed rank test to analyze significance of changes over time. The Mann-Whitney test was used to determine differences between both LDD and placebo groups.

RESULTS

Both groups revealed significant improvements in all clinical parameters over the 12-month period (P < 0.0125). LDD group showed a significantly greater reduction in the mean PD scores at 9 and 12 months and in the mean GI scores at all time points than the placebo group (P < 0.05). In the LDD group, GCF Ln-5 gamma2 chain fragment levels were significantly reduced at 3 months (P < 0.0125) and then slightly increased during the rest of the study period. In the placebo group, GCF 45 and 70 kDa Ln-5 gamma2 chain fragments tended to decrease at 3 months compared to baseline, but did not reach significance; these levels continued to increase throughout the remainder of the study period. GCF Ln-5 gamma2 chain fragment levels in LDD group were significantly lower than those of the placebo group during the study period (P < 0.05).

CONCLUSIONS

The present data indicate that LDD therapy in combination with SRP therapy can reduce GCF Ln-5 gamma2 chain fragment levels and improve clinical periodontal parameters in patients with chronic periodontitis. Since matrix metalloproteinases (MMP)-mediated fragmentation of laminin-5 can contribute to pocket formation by stimulating epithelial cell migration, the reduction of Ln-5 gamma2 chain fragment levels could provide a new mechanism by which LDD, adjunctive to SRP, inhibits periodontal disease more effectively than SRP alone. Thus, these results provide extended and additional information about the effectiveness of the LDD therapy as an adjunct to non-surgical periodontal therapy in the long-term management of periodontal disease.

Comparison of some effects of acetylsalicylic acid and rofecoxib during orthodontic tooth movement

The purpose of this study was to examine the effects of 2 different anti-inflammatory drugs on gingival crevicular fluid (GCF) volume and on prostaglandin E(2) (PGE(2)) levels of the GCF during orthodontic tooth movement. A total of 36 extraction patients, aged 17.6 +/- 2.5 years (mean +/- standard deviation), were divided into 3 groups. Acetylsalicylic acid (aspirin) and rofecoxib (Vioxx, Merck, Whitehouse Station, NJ) were used for pain control in the first and second groups; the third group was used as a control. Gingival crevicular fluid was sampled at the beginning of tooth movement and at 24, 48, and 168 hours. An automated enzyme immunoassay was used to measure PGE(2) in GCF. The intragroup differences were evaluated with the Wilcoxon test, and the differences between the groups were determined with the Mann-Whitney U test. Gingival crevicular fluid volumes of the groups did not change significantly during the experimental period. Depending on the variations of fibroblast activation, PGE(2) levels of all the groups increased at 24 and 48 hours and decreased at 168 hours. When the drugs were compared, it was found that the inhibition effect of aspirin on PGE(2) was more than that of rofecoxib. The results suggest that rofecoxib can be used during orthodontic treatment, but further study is recommended.

Effects of sub-antimicrobial dose doxycycline therapy on crevicular fluid MMP-8, and gingival tissue MMP-9, TIMP-1 and IL-6 levels in chronic periodontitis

OBJECTIVE

To investigate whether sub-antimicrobial dose doxycycline (SDD) therapy for 120 d in chronic adult periodontitis patients had significant effects on gingival crevicular fluid (GCF) matrix metalloproteinase-8 (MMP-8) levels, and on gingival tissue MMP-9, tissue inhibitor of matrix metalloproteinases-1 (TIMP-1) and interleukin-6 (IL-6) levels.

BACKGROUND

Tetracycline can significantly inhibit MMP activity in GCF and in gingival tissue, even in much lower dosage then a traditional antimicrobial dosage used in conventional therapy. Sub-antimicrobial dose doxycycline (SDD) therapy has been shown to reduce periodontal disease activity to control MMP and pro-inflammatory cytokines.

METHODS

A total of 32 patients with incipient to moderate (probing pocket depth approximately 4-7 mm) chronic adult periodontitis were included in the study. Subjects were randomly assigned to two groups. After scaling and root planning (SRP), the SRP + SDD group received SDD, 20 mg bid, whereas the SRP + placebo group received placebo, 20 mg bid. In the follow-up, efficacy measures included the change in probing pocket depth (PD), clinical attachment level (CAL), bleeding on probing (BOP) and gingival crevicular fluid MMP-8 levels, gingival tissue MMP-9, TIMP-1 and IL-6 levels from baseline to 120 d.

RESULTS

After 120 d, PD and CAL improved significantly in the SRP + SDD group. Initial MMP-8 levels for the SRP + SDD group and the SRP + placebo group were 407.13 +/- 114.45 ng/ml and 378.71 +/- 189.39 ng/ml, respectively, with no statistical difference between the two groups. MMP-8 levels for the SRP + SDD group and the SRP + placebo group were: 235.35 +/- 134.58 ng/ml and 364.04 +/- 219.27 ng/ml at 30 d; 157.50 +/- 95.95 ng/ml and 236.60 +/- 186.16 ng/ml at 60 d; 102.70 +/- 67.64 ng/ml and 208.56 +/- 124.54 ng/ml at 90 d; and 63.77 +/- 53.33 ng/ml and 229.13 +/- 168.09 ng/ml at 120 d, respectively. The amount of decrease in MMP-8 levels for the SRP + SDD group was statistically significant compared to that for the SRP + placebo group, especially apparent at 120 d (p < 0.05). TIMP-1 levels in both groups increased from the baseline to 120 d with statistical significance (p-value < 0.05), but there was no significant difference between the two groups. Changes in MMP-9 and IL-6 levels were not statistically significant.

CONCLUSION

Adjunctive SDD therapy can improve the clinical parameters and this clinical improvement is reflected by controlled level of MMP-8 in chronic adult periodontitis after the therapy.

Improvement of periodontal status by green tea catechin using a local delivery system: a clinical pilot study

The purpose of this study was to determine the usefulness of green tea catechin for the improvement of periodontal disease. The minimum inhibitory concentration (MIC) and bactericidal activity of green tea catechin against black-pigmented, Gram-negative anaerobic rods (BPR) were measured. Hydroxypropylcellulose strips containing green tea catechin as a slow release local delivery system were applied in pockets in patients once a week for 8 weeks. The clinical, enzymatic and microbiological effects of the catechin were determined. Green tea catechin showed a bactericidal effect against Porphyromonas gingivalis and Prevotella spp. in vitro with an MIC of 1.0 mg/ml. In the in vivo experiment, the pocket depth (PD) and the proportion of BPR were markedly decreased in the catechin group with mechanical treatment at week 8 compared with the baseline with significant difference. In contrast, PD and BPR were similar to the baseline and the value at the end of the experimental period in the placebo sites of scaled groups. The peptidase activities in the gingival fluid were maintained at lower levels during the experimental period in the test sites, while it reached 70% of that at baseline in the placebo sites. No morbidity was observed in the placebo and catechin groups without mechanical treatment. Green tea catechin showed a bactericidal effect against BPR and the combined use of mechanical treatment and the application of green tea catechin using a slow release local delivery system was effective in improving periodontal status.

Effects of pre-soaked retraction cords on the microcirculation of the human gingival margin

In the direct treatment of cervical lesions and to improve the impression-making procedure prior to fabricating indirect restorations, exposure of the gingival sulcus and control of hemorrhage or gingival fluid seepage are a prerequisite. For gingival displacement, cords impregnated with medicaments are widely used. In this investigation, the authors first studied in vitro the time course of fluid absorption by retraction cords immersed in test solutions. Thereafter, in a clinical trial, they examined the microcirculatory responses of the gingival margin after subgingival insertion and removal of retraction cords pre-soaked in solutions containing saline, AlCl3, Fe2(SO4)3 or epinephrine. Blood flow was recorded using laser Doppler technique. Blood perfusion fell markedly upon inserting the retraction cord, and this response was invariably present with all the compounds tested. After five-minutes, the decrease became less apparent with cords that were impregnated with physiological saline, AlCl3 or Fe2(SO4)3. Removing the cord elicited a prompt, marked and sustained increase in gingival microcirculation. However, removal of the cord impregnated with 0.1% epinephrine failed to reverse the decreased perfusion, and blood flow to the gingival margin remained low over an additional 20-minute observation. The results of this study indicate that with the exception of epinephrine, all retraction substances tested produced gingival hyperemia for operative procedures. Only epinephrine exhibited sustained vasoconstrictor response. It is anticipated that using laser Doppler flowmetry may be a suitable technique to evaluate the appropriate concentration of epinephrine that would elicit topical vasoconstriction.

Local application of n-3 or n-6 polyunsaturated fatty acids in the treatment of human experimental gingivitis

BACKGROUND

Polyunsaturated fatty acids have the potential to attenuate inflammation by the synthesis of mediators of the 15-lipoxygenase pathways, which show opposite effects to the pro-inflammatory arachidonic acid metabolites such as leukotriene B4 (LTB4).

AIMS

The aim of this clinical study was to evaluate the effects of topical application of n-6 or n-6 polyunsaturated fatty acids in patients with experimental gingivitis.

METHODS

In each subject, similar teeth served as experimental and control over a 21-day non-hygiene phase and a 9-day resolving phase. Efficacy assessment was based on the bleeding on probing frequency (BOP) and the gingivocrevicular fluid volume (GCF). GCF was determined by inserting a filter paper strip for 30 s and measurements were performed on a Periotron 8000. The LTB4 concentration was analyzed by reversed-phase high-pressure liquid chromatography.

RESULTS

After 21 days of plaque growth, the BOP, GCF and LTB4 levels were significantly increased in all groups, with no differences between the control and experimental side. Rinsing of an area with established gingivitis for a 9-day period significantly reduced the GCF in the n-6 group (71.9 (18.7) versus 47.4 (11.4) Periotron Units, median (inter quartile range)).

CONCLUSION

The topical application of n-6 or n-6 fatty acids failed to inhibit the development of experimental gingivitis. Rinsing with n-6 fatty acids could reduce the level of GCF in established experimental gingivitis.

Controlled local delivery of tetracycline with polymer strips in the treatment of periodontitis

BACKGROUND

Several antibacterial agents have been studied as a means to produce bactericidal or bacteriostatic activity as an adjunct to mechanical treatment of periodontal disease. The primary purpose of this study was to evaluate the efficacy of tetracycline strips administered singly or in multiples in conjunction with root planing, versus root planing alone, or to an untreated control. Secondary purposes were to compare gingival crevicular fluid (GCF) volume and GCF concentrations of tetracycline in pockets treated with strips; to evaluate strip insertion time; and to compare ease of placement for single or multiple strips.

METHODS

Using a 4-quadrant design, 4 test teeth in 24 patients were treated with either root planing and single strip application; root planing and multiple strip application; root planing alone; or an untreated control.

RESULTS

Single and multiple strip placement resulted in a significant reduction in probing depth (P = 0.033) compared to root planing and untreated groups. The multiple strip group significantly decreased bleeding on probing (P = 0.05) compared to all other treatment groups. There was no treatment effect on GCF; however, there was a significant reduction in the GCF volume over time (P = 0.001). The time required for placement was, on average, 1.9 minutes for single strips and 3.25 minutes for multiple strips.

CONCLUSIONS

Our data suggest that multiple strips are superior to a single strip in reducing bleeding on probing, and that local delivery of tetracycline is superior to root planing alone in reducing probing depth.

Evaluation of transforming growth factor-beta 1 level in crevicular fluid of cyclosporin A-treated patients

BACKGROUND

The aim of the present study was to investigate the level of transforming growth factor-beta 1 (TGF-beta 1) in gingival crevicular fluid (GCF) samples of cyclosporin A (CsA)-treated patients and to compare the results with control groups.

METHODS

Fourteen renal transplant patients exhibiting severe CsA-induced gingival overgrowth, 10 patients with chronic gingivitis, and 10 subjects with clinically healthy periodontium were included in the study. In CsA-treated patients, GCF samples were harvested from sites exhibiting gingival overgrowth (CsA GO+) and sites not exhibiting gingival overgrowth (CsA GO-). The TGF-beta 1 levels in a total of 96 GCF samples from the 34 participants were analyzed by enzyme-linked immunosorbent assay. The results were expressed in terms of total amount (pg/2 sites) and concentration (ng/ml).

RESULTS

TGF-beta 1 total amounts in CsA GO+ and CsA GO- sites were similar and significantly higher than that of healthy sites (P < 0.02 and P < 0.01, respectively). The total amount of TGF-beta 1 was also higher in gingivitis sites compared to the healthy sites, but the difference was not statistically significant (P > 0.05). CsA GO+ and CsA GO- sites exhibited higher total amount and concentration of TGF-beta 1 than that of gingivitis sites, but the differences were insignificant (P > 0.05).

CONCLUSIONS

The results of the present study support the theory that CsA increases the synthesis of TGF-beta 1 in GCF. However, since the difference between CsA GO+ and CsA GO- sites was not statistically significant, it seems unlikely that GCF TGF-beta 1 level is the sole factor responsible for the CsA-induced gingival overgrowth. Complex interactions between various mediators of inflammation and tissue modeling are possibly involved in the pathogenic mechanisms of this side effect.

Effects of SCN-/H2O2 combinations in dentifrices on plaque and gingivitis

OBJECTIVES

A 10-week, double-blind, placebo-controlled clinical study on 140 male subjects was conducted to determine the effect on plaque and gingivitis of 5 dentifrices containing various thiocyanate (SCN-)/hydrogen peroxide (H2O2) combinations.

MATERIALS AND METHODS

The dentifrices consisted of a gel base without any detergents or abrasives (placebo, group A) to which SCN- and/or H2O2 were added as follows: 0.1% SCN- (group B), 0.5% SCN- (group C), 0.1% SCN-/0.1% H2O2 (group D), 0.5% SCN-/0.1% H2O2 (group E) and 0.1% H2O2 (group F). A baseline examination was performed in which the Silness and Löe Plaque Index (PI), the Mühlemann and Son Sulcus Bleeding Index (SBI), and the amount of gingival crevicular fluid (GCF) were recorded using the Periotron 6,000 on teeth 16, 12, 24, 36, 32, and 44. The subjects were randomly assigned to either the placebo group (n = 40) or one of the test groups (n = 20) and used their respective dentifrices over a period of 8 weeks. Finally, each group used the placebo for another 2 weeks (wash-out). Re-examinations were performed after 1, 4, and 8 weeks and the 2-week wash-out period employing the clinical parameters used at baseline. Intragroup changes were analyzed with the Wilcoxon signed-ranks test, using the baseline and wash-out points as references. The Mann-Whitney U test was used for comparisons between the treatment groups and the placebo group.

RESULTS

At the 8-week examination, the plaque index in group E (p = 0.017) and group F (p = 0.032) was lower than in the placebo group. The Sulcus Bleeding Index in group F after 1 week was increased (p = 0.023) and the SBI in group E after 8 weeks was reduced (p = 0.047) as compared to the placebo group.

CONCLUSION

The results demonstrated that a dentifrice containing 0.5% SCN- and 0.1% H2O2 but no detergents or abrasives inhibited plaque and decreased gingivitis.

Effects of hormonal contraceptives on the periodontium, in a population of rural Sri-Lankan women

AIMS

Women using hormonal contraceptives can be considered to be a 'risk group' for periodontal disease, due to prolonged, sustained serum levels of oestrogens and progesterone. This investigation aims to study the effects of hormonal contraceptives on periodontal tissues.

METHODS

32 women using hormonal contraceptives for less than 2 years, 17 for 2-4 years and a matched control group of 39 non-users were selected for the study. They were clinically examined for plaque levels (plaque index: PLI), gingival condition (gingival index: GI) and loss of periodontal attachment (LA).

RESULTS

Contraceptive users of less than 2 years and 2-4 years duration (n=32, n= 17 respectively) and non-users (n=39) had similar oral hygiene levels; yet the contraceptive users had a significantly higher level of gingival inflammation, compared to the non-users (p<0.001; 1-way ANOVA). Usage of hormonal contraceptives for 2-4 years (n= 17) caused a significantly higher LA (p<0.001) compared to that of controls (n=39).

CONCLUSIONS

Usage of contraceptive preparations containing oestrogen and progesterone resulted in hormonal changes similar to those seen in pregnancy, associated with increased prevalence of gingivitis. There was significantly higher LA with prolonged usage of hormonal contraceptives, compared with controls.

Effects on the clinical indices and gingival crevicular fluid enzyme activities of the cyclical regimen of low-dose doxycycline therapy for adult periodontitis

The purpose of this study was to determine the effect of cyclic regimen of low dose doxycycline (20 mg) or placebo therapy following scaling and root planing on clinical parameters and crevicular fluid alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase and elastase activities. Fifteen adults (13 males, 2 females) with moderate to advanced adult periodontitis were recruited for the study. The LDD-treated group (n = 8 subjects) self administered low dose doxycycline b.i.d. (20 mg, p.o.) from time (treatment) to 2 months and then no drug from 2 to 4 months and finally low-dose doxycycline b.i.d. from 4 to 6 months (i.e. "cyclical" regimen). The placebo-treated group (n = 7 subjects) was asked to take placebo capsules (containing inactive filler; i.e. starchflour) b.i.d. according to the same "cyclical" regimen. No differences were found between LDD- and placebo-treated groups regarding any of the clinical parameters and gingival crevicular fluid enzyme activities. The relative attachment gain was significantly improved in both groups. The "cyclical" regimen of low-dose doxycycline was not found to reduce alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase and elastase activities in gingival crevicular fluid of the adult periodontitis patients over a 6-month time period.

GCF levels of MMP-3 and MMP-8 following placement of bioresorbable membranes

Matrix metalloproteinases (MMPs) are responsible for remodeling and degrading extracellular matrix and basement membrane components. MMP-3 and -8 levels were assessed in this study during the early healing phase following a guided tissue regeneration (GTR) procedure. 32 patients, having 2 or 3 walled intrabony defects of PD > or =6 mm, were stratified into 2 groups on the basis of age, sex, smoking status and disease severity. All intrabony defects were treated using the resorbable Guidor membrane but only 1 group of patients was given a pre-operative dosage of antibiotic (3 g amoxycillin). GCF samples for the quantification of MMP-3 and -8 levels were obtained from the intrabony site where a membrane was placed (membrane site), from the non-adjacent site on the adjacent tooth which was involved in the surgical flap (surgical control site), and from a healthy site (healthy) on the contralateral side. The GCF samples taken at baseline, 1 week, 4 weeks and 3 months after surgery were analyzed using an enzyme linked immunoabsorbent essay (ELISA) for MMP-3 and using a time-resolved immunofluorescence assay (IFMA) for MMP-8. MMP-3 was detected in a very low % of sites at baseline while relatively high levels of MMP-8 were detected at all 3 types of sites at baseline. MMP-8 levels increased for all sites at week 1, and this was statistically significant for the membrane site, but at week 4, the levels decreased for both the membrane and the surgical sites. There was no statistically significant difference between the levels of MMP-3 and -8 in the antibiotic and non-antibiotic group. Collagen remodelling occurs during the early wound healing period following surgical and regenerative procedures. The levels of MMP-3 and -8 in GCF appear to reflect these processes. Interestingly, the presence of the membranes appeared to increase the levels of MMP-3 and -8 and may relate to the resorption of the resorbable membrane by host systems.

The effect of ammonium glycopyrrolate (Robinul)-induced xerostomia on oral mucosal wetness and flow of gingival crevicular fluid in humans

The antisialogogue, ammonium glycopyrrolate (Robinul), was used to reduce the salivary flow rate in healthy individuals with normal salivary function to determine whether the dry-mouth symptoms and reduced amounts and patterns of oral mucosal wetness found previously in hyposalivators could be induced by this means. After baseline measurements, the drug was given to 10 healthy volunteers and their resting whole-saliva flow rate was measured at 0, 15, 60, 105 and 150 min thereafter. At the same times, the thickness of the layer of residual mucosal saliva (a measure of residual mucosal wetness) at each of 22 intraoral sites was also determined. The saliva flow rate fell from a mean of 0.45 +/- 0.07 ml/min to a mean of 0.05 +/- 0.02 ml/mm by 1 h and slowly thereafter to a mean of 0.02 +/- 0.01 to 0.03 +/- 0.01 ml/min for the remainder of the experiment. Onset of dryness symptoms was observed approx. 30 min after giving the drug. Simultaneously, the residual saliva at each of the 22 sites teted decreased to a thickness level previously found in patients with hyposalivation and who exhibited an intense feeling of dry mouth. Despite these decreases in thickness, the pattern of residual mucosal wetness throughout the mouth remained more or less unchanged. As in earlier studies, wetness was least on the hard palate and highest on the posterior dorsum of the tongue. An altered taste of the residual saliva in the mouth and an increased feeling of roughness as the tongue was passed over labial and buccal mucosal surfaces were noted. The amount of gingival crevicular fluid (GCF) in 12 gingival sites in each of the participants was also measured. Unlike the reduction in salivary flow, changes in GCF over the 150 min of the study were negligible. From this it was concluded that GCF could contribute much more to the oral fluids in dry-mouth than in normal individuals, especially when there is greater gingival inflammation.

[The treatment of periodontal diseases using Diplen-Denta films with chlorhexidine (a clinico-laboratory study)]

Diplen-Denta biopolymer adhesive film with chlorohexidine-was used in the treatment of periodontal inflammations of different severity. The efficacy of treatment of gingivitis and periodontitis is assessed from changes in the clinical parameters and in the activity of neutrophil elastase in the gingival liquid. The new treatment is highly effective in patients with catarrhal gingivitis and generalized periodontitis of light and medium severity.

Effect of a chlorhexidine/thymol-containing varnish on prostaglandin E2 levels in gingival crevicular fluid

The aim was to study the effect of a chlorhexidine/thymol-containing varnish (Cervitec) on the levels of prostaglandin E2 (PGE2) in gingival crevicular fluid (GCF). The material consisted of 25 adolescents and young adults with fixed orthodontic appliances exhibiting gingival inflammation. Four buccal sites, adjacent to bands and brackets, were selected on each patient and randomly treated with either a varnish containing chlorhexidine diacetate (1% w/w) and thymol (1% w/w) or a placebo varnish without active ingredients. After baseline registration, the varnishes were applied twice within 3 d. Follow-up examinations were performed after 3, 8 and 30 d. The gingival inflammation was assessed by bleeding on probing, volume of GCF with a Periotron 8000 and PGE2 level in GCF by using a radioimmuno assay. Compared with baseline, a statistically significant reduction in the volume of GCF was recorded at the chlorhexidine/thymol treated sites in contrast to the placebo. The mean PGE2 levels were significantly reduced after the test varnish treatment compared with baseline and differed significantly from placebo after 8 d. The findings suggest that treatments with the antibacterial varnish result in reduced gingival inflammation and may thus be beneficial for patients with fixed orthodontic appliances.

Medications as risk factors for periodontal disease

As the United States population ages, people will be taking more medications which may benefit their general health but not necessarily their periodontal health. The effects of medications have been grouped into six categories as follows: behavioral alteration of oral hygiene methods, alteration of plaque composition, effect on gingival tissues, effect on alveolar bone, effect on gingival crevicular fluid, and effect on salivary flow. Although most medications discussed in this paper increase the risk for periodontal disease, a few may actually decrease the risk. These include the effect of phenytoin on alveolar bone, the antibacterial effect of antibiotics, the anticollagenolytic effects of tetracyclines, and the effect of non-steroidal anti-inflammatory drugs on decreasing alveolar bone resorption.

Clinical studies on marginal gingiva around abutment tooth (Part 3). Effect of tannin-fluoride preparation on gingival health

It was examined whether the tannin-fluoride preparation (HY preparation), which might have a caries-reductive, plaque inhibiting and astringent action, could reduce the incidence of gingival inflammation around abutment teeth. Zinc oxide eugenol cement mixed with the HY preparation was packed in the cavity prepared in the resin base facing the abutment tooth. Gingival crevicular fluid (Periotron units:GCF), gingival index (GI), plaque index (PlI) and probing depth around the abutment teeth were measured over a 3 month period. The following results were obtained: 1. GCF decreased at month 1 and showed low values at months 2 and 3. 2. GI showed a decreasing tendency. 3. PlI and probing depth did not show obvious changes. These results indicate that the tannin-fluoride preparation reduces gingival inflammation around abutment teeth.

Effects of chlorhexidine and four antimicrobial compounds on plaque, gingivitis, and staining in beagle dogs

Solutions containing 0.2% of a bis-biguanide, chlorhexidine (positive control), and four bis-amidinourea antimicrobial agents were tested in beagle dogs in a 12-week study. The five agents significantly reduced clinical plaque and gingivitis scores, and gingival fluid volumes in treated dogs, compared with water. All compounds reduced the stain area scores compared to water controls. Stain intensity scores were higher for chlorhexidine than for the four new antimicrobial agents and the water controls. There were no overt behavioral changes. Histological examination of oral tissues revealed no irritation.

[Effect of the propellants O2 and CO2 on the efficacy of oral irrigation]

The therapeutical results obtained with oral irrigations when O2 or CO2 was used as a propellant air compared with those achieved with compressed air. The assessment of the therapeutical success was based on the periodontal disease index according to Kötzschke and the exsudate heights according to Egelberg. A significant improvement in the periodontal condition was stated in all three groups of patients. Though only the exsudate values for the O2 group were significantly better than those for the compressed air group, being the only difference between the groups which was significant, the greater efficiency of the O2 and CO2 application (compared to compressed air application) is, nevertheless, obvious and interpretable. The therapeutical results obtained permit the statement that a technically perfect device and the further increase of the partial pressure of O2 or CO2 in the irrigation fluid will lead to even better therapeutical results, for which purpose the suggestions given should be considered in establishing the indication. The favourable results achieved with compressed air testify to the beneficial action of each irrigation or spray treatment.

Considerations in the management of patients taking oral contraceptives

Among the undesirable effects associated with the use of oral contraceptives are an increased incidence of thromboembolic events, an increased risk of myocardial infarction, and, in certain users, a significant elevation in blood pressure. An altered fibrinolytic activity may have a direct effect on the occurrence of localized osteitis, "dry sockets." It is also possible that gingival inflammation and loss of attachment may occur even under conditions of adequate plaque control. Salivary changes and alterations in the bony trabecular pattern of the mandible have been observed, but the clinical significance is as yet undetermined (Illustration).

The effect of folic acid on gingival health

On days 0 and 30 of a double blind study, two groups of 15 subjects each were evaluated using a plaque index, a gingival index, a gingival exudate flow and fasting plasma folic acid levels. Group I received 2 mg of folic acid twice daily for 30 days while Group II received a placebo. Results of the study seem to indicate that folic acid supplemented to the diet may increase the resistance of the gingiva to local irritants and thus lead to a reduction in inflammation.

Effect of brushing the teeth with a fluoride-containing and fluoridefree dentifrice on the gingiva of dogs

The effect of brushing the teeth with a fluoride-containing or fluoridefree dentifrice on gingivitis induced by a soft diet was studied in four dogs. Changes in the gingival status were recorded at different stages of the experiment by the gingival indexes, which are a reflection of the external appearance, and by the amount of gingival fluid that is influenced by the pocket depth. The two factors appeared to be directly related although the range of the gingival index was much narrower than that of the amount of gingival fluid. No evident retardation in the improvement of the gingival condition occurred after brushing the teeth with a dentifrice that contained fluoride as compared with using a fluoridefree dentifrice or saline.

The effect of chlorhexidine mouthrinse on healing after gingivectomy

The purpose of this investigation was to evaluate the effect of 0.2% chlorhexidine gluconate mouthrinse following gingivectomy on plague under the dressing and on healing. Twenty-eight patients with indications for gingivectomy were selected. Coe-Pak was used as surgical dressing. In addition to unsual home care, the patients rinsed twice daily with chlorhexidine or placebo for 21 d after surgery. The study followed a cross-over double-blind design. Gingival exudate was assessed and Pl I and G I were registered at 7, 14, and 21 d postsurgically. The study indicated that chlorhexidine did not influence the amount of plaque under the dressing, and it was uncertain whether chlorhexidine had any effect on the healing process when the surgical area was covered by Coe-Pak. However, (1) after the surgical dressing was removed, the chlorhexidine maintained plaque scores at the same low level as under the dressing, (2) healing was was promoted when chlorhexidine was used, and (3) the presence of a dressing in one side of the mouth did not prevent the patient from maintaining good oral hygiene.