Principles of gene therapy.

Indian J Dent Res. 2007 Oct-Dec;18(4):196-200

Authors: Mammen B, Ramakrishnan T, Sudhakar U,

Genes are specific sequences of bases that encode instructions to make proteins. When genes are altered so that encoded proteins are unable to carry out their normal functions, genetic disorders can result. Gene therapy is designed to introduce genetic material into cells to compensate for abnormal genes or to make a beneficial protein. This article reviews the fundamentals in gene therapy and its various modes of administration with an insight into the role of gene therapy in Periodontics and future percepts and the technical and ethical issues of using gene therapy.

PMID: 17938498 [PubMed - in process]

Dental trauma: restorative procedures using composite resin and mouthguards for prevention.

J Contemp Dent Pract. 2007;8(6):89-95

Authors: Santos Filho PC, Quagliatto PS, Simamoto PC, Soares CJ

AIM: The aim of this article is to describe a step-by-step protocol for emergency care of a patient with a dentoalveolar injury in the anterior region of the mouth as well as the fabrication of a mouthguard to prevent future trauma. BACKGROUND: Dental trauma is one of the most serious oral health problems in active children and adolescents. Care of traumatized patients requires immediate initial emergency treatment followed by integrated procedures to restore damaged oral structures along with a subsequent trauma prevention strategy. Dentoalveolar injuries in the anterior region of the mouth are often characterized by tooth avulsion and coronal fracture. They are managed using procedures such as dental splinting, endodontic therapy with its unique characteristics, and restorative techniques to re-establish function and esthetics as well as protective mouthguards. REPORT: A 16-year-old male presented with avulsion of his maxillary central incisors as a result of a direct, unintentional impact with an opponent during a basketball game. The teeth had been stored in physiological serum immediately following the injury and the patient received immediate care. On clinical examination, the right central incisor was fractured at the incisal third of the crown but no bone fractures were found. The teeth were reimplanted and splinted. The fractured right central incisor was restored following endodontic treatment and a mouthguard was fabricated for the patient. SUMMARY: The dentist must be knowledgeable about the most efficient and suitable treatment for each traumatic scenario in order to provide appropriate care for dental injuries. Coordinated multi-disciplinary action is fundamental in the successful treatment of these injuries. The dental mouthguard is an effective device for protecting the teeth and supportive structures during physical activities and must be part of the protective equipment used by athletes. It is the responsibility of the dental professional to make parents, trainers, and athletic associations aware of the risks associated with physical activities without orofacial protection; this should encourage the proper use of all protective devices to prevent dentoalveolar injuries that compromise oral functions, esthetics, and increase the cost of healthcare.

PMID: 17846676 [PubMed - indexed for MEDLINE]

Periodontal health in mothers of preterm and term infants.

Taiwan J Obstet Gynecol. 2007 Jun;46(2):157-61

Authors: Zadeh-Modarres S, Amooian B, Bayat-Movahed S, Mohamadi M

OBJECTIVE: Recent studies have suggested that chronic periodontitis may induce an inflammatory response which can cause premature delivery. This study was designed to assess the association between periodontal health and preterm labor in Iranian female population. MATERIALS AND METHODS: In this case-control study, 201 pregnant women without systemic disease or other risk factors for preterm labor were chosen. The control group (n = 99) had term labor (infants > or =37 weeks) and the case group (n = 102) had preterm labor (infants < 37 weeks). Bleeding index, pocket depth and debris index were measured. RESULTS: The data of bleeding index (cases, 0.64 +/- 0.38; controls, 0.57 +/- 0.35), probing depth (cases, 2.80 +/- 0.30; controls, 1.63 +/- 0.23) and debris index (cases, 1.38 +/- 0.67; controls, 0.81 +/- 0.38) revealed a statistically significant difference between the two groups (p < 0.05). CONCLUSION: According to the findings of this study, there is a noticeable relationship between periodontal health and duration of pregnancy; periodontal disease could be a risk factor for preterm labor. Oral hygiene is strongly recommended to be included in prenatal care.

PMID: 17638624 [PubMed - indexed for MEDLINE]

Adjunctive effects of systemic amoxicillin and metronidazole with scaling and root planing: a randomized, placebo controlled clinical trial.

J Contemp Dent Pract. 2007;8(5):51-9

Authors: Moeintaghavi A, Talebi-ardakani MR, Haerian-ardakani A, Zandi H, Taghipour S, Fallahzadeh H, Pakzad A, Fahami N

AIMS: The objective of this study was to investigate the effect of the systemic administration of metronidazole and amoxicillin as an adjunct to initial periodontal therapy in patients with moderate to severe chronic periodontitis. METHODS AND MATERIALS: This randomized, double blind, placebo controlled parallel study involved 50 adult patients with untreated periodontitis who were randomly assigned to receive either a full-mouth scaling and root planing along with systemic metronidazole and amoxicillin (T group) or scaling and root planing with a placebo (P group). Clinical measurements including probing depth (PD), clinical attachment levels (CAL), Plaque Index (PI), and Bleeding Index (BI) were recorded at baseline and six to eight weeks after therapy. The deepest pocket was selected and samples for microbiological testing were taken. Patients received coded study medications of either 500 mg amoxicillin in combination with 250 mg metronidazole or an identical placebo every eight hours for seven days following scaling and root planing. RESULTS: There was a significant change in PD (P=0.0001), CAL (P=0.00001), PI (P<0.05), and BI (P<0.05) in the T group compared to the placebo group after therapy. Parallel to the clinical changes, treatment significantly reduced the number of Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and P. intermedia (Pi) compared with baseline in the T group (P=0.003, 0.021 and 0.0001, respectively). However, in the P group only the Pi colony count was reduced significantly (P=0.0001). After therapy, there was a significant difference between the T and P groups in the number of patients negative for Aa, Pg, and Pi (Pv = 0.033). CONCLUSIONS: The significant differences between treatment and placebo groups are in line with other studies and support the considerable adjunctive benefits of the combination of amoxicillin and metronidazole in the treatment of chronic periodontitis.

PMID: 17618330 [PubMed - indexed for MEDLINE]

Periodontal findings and blood analysis of blood donors: a pilot study.

J Contemp Dent Pract. 2007;8(5):43-50

Authors: Ziebolz D, J&#xE4;ger GC, Hornecker E, Mausberg RF

AIM: Before blood donation a medical check-up is mandatory to ascertain the health of the donor and to detect infections clinically. Although gingivitis and periodontitis are also bacterial infections, the oral cavity is only inspected superficially. The purpose of this study was to investigate the periodontal condition of blood donors and whether this affects the results of their blood tests. METHODS AND MATERIALS: A total of 192 blood donors were examined. The investigation included a periodontal examination to determine the Community Periodontal Index (CPI), an analysis of blood chemistry, as well as the determination of hematologic, coagulation, and immune parameters C-reactive protein (CRP), Neopterin, Procalcitonin (PCT), and tumor necrosis factor (TNF-a). Groups were formed according to periodontal status: "healthy" (n=47, mean age 24+/-4 years), "gingivitis" (n=65, mean age 24+/-4 years), and "periodontitis" (n=80, mean age 29+/-8 years). Most parameters of the routine blood test as well as the immune parameters were unremarkable with regard to the periodontal status. The values for SGPT, GGTP, uric acid, triglycerides, total protein (TP), RBC, hemoglobin (Hb) and hematocrit (HC), Eos, and Baso were also within the normal range. Nevertheless, statistical analysis showed some significant differences in these parameters between the "healthy" group and the "periodontitis" group (p=0.05). RESULTS: The results of this study show some blood donors have infections of the gingiva and/or of other periodontal tissues. Whether this is a sufficient reason to exclude them from blood donation, or in which case potential donors should be excluded, is not yet known. Nevertheless, it seems reasonable to integrate a screening method for revealing at least severe periodontitis in the medical check-up of blood donors.

PMID: 17618329 [PubMed - indexed for MEDLINE]

Illinois dental anesthesia and sedation survey for 2006.

Anesth Prog. 2007;54(2):52-8

Authors: Flick WG, Katsnelson A, Alstrom H

This is a 10-year follow-up survey of a 1996 study of all dentists in Illinois holding a permit to administer sedation or general anesthesia. The survey describes the scope of sedation and anesthesia services provided in dental offices in Illinois. A mail survey was sent to 471 dentists who were registered with the department of professional regulation to administer sedation or general anesthesia. Classification by specialty area of practice showed: 63% (84% in 1996) are oral and maxillofacial surgeons, 20% (11% in 1996) general dentists, 6% (5% in 1996) periodontists, 9% (0% in 1996) pediatric dentists, 1% (less than 1% in 1996) dentist anesthesiologists. Advanced cardiovascular life support (ACLS) training was reported by 90% (85% in 1996) of the respondents. The total number of sedations and general anesthetics administered for the year was 115,940. Two mortalities and two cases of long-term morbidity were reported for the 10-year period. Respondents reported that 30 patients required transfer to a hospital but suffered no long-term morbidity. Other practice characteristics were detailed.

PMID: 17579504 [PubMed - indexed for MEDLINE]

A study of the reasons for irregular dental attendance in a private dental college in a rural setup.

Indian J Dent Res. 2007 Apr-Jun;18(2):78-81

Authors: George AC, Hoshing A, Joshi NV

The mouth is regarded as a mirror and the gateway to health. Integration is required between the dental practitioner and the patient, if good dental health is to be attained. Various treatment modalities of late frequently require appointments, which are more than one in number for completion of the entire treatment program. This study was taken up to determine the impact of reported dental attendance patterns of patients on the oral health and treatment quality in teaching hospitals and also on the quality of life in rural areas. AIMS AND OBJECTIVES: 1. To assess the reasons for irregular dental care in the patients attending the clinics in teaching hospitals. 2. To assess the satisfaction of the patient as regards the treatment rendered in the teaching institutes. 3. To correlate the gender of the patient with the regularity in the recall attendance. MATERIALS AND METHODS: A hospital-based cross-sectional study was conducted using a systematic random sampling method and every alternate subject was selected from the patients attending the OPD of Department of Periodontics and Community Dentistry. The data was collected using the interview method with the help of a structured, pretested questionnaire. RESULTS AND CONCLUSION: Out of 288 patients, 94 failed to attend the recall appointments. In these 94 patients, various reasons for not attending recall were assessed and lack of time was found to be the most common reason for non-attendance. Relationship between age and reasons for not reporting was found to be significant (P < 0.01). Patient satisfaction survey showed that 51.54% of the patients were satisfied with the dental treatment rendered. The present study also showed that males are more prompt in attending recall appointments as compared to females. A positive and significant correlation between literacy and patient reporting status was found (P< 0.01).

PMID: 17502713 [PubMed - indexed for MEDLINE]

Assessment of periodontal status in dental fluorosis subjects using community periodontal index of treatment needs.

Indian J Dent Res. 2007 Apr-Jun;18(2):67-71

Authors: Vandana KL, Reddy MS

BACKGROUND: Periodontitis is multifactorial in nature. The various determinants of periodontal disease are age, sex, race, socioeconomic status and risk factors including tobacco usage and oral hygiene status. However, there is inconsistent epidemiological data on the periodontal status of subjects living in high-fluoride areas. The aim of the study was to investigate the effect of dental fluorosis on the periodontal status using community periodontal index of treatment needs (CPITN), as a clinical study. The purpose of this study is to determine the periodontal status using CPITN index in a population aged between 15 and 74 years residing in the high fluoride areas of Davangere district. The possible reasons for the susceptibility of this population to periodontal disease are discussed. MATERIALS AND METHODS: 1029 subjects, aged between 15 and 74 years suffering from dental fluorosis were assessed for their periodontal status. Clinical parameters recorded were OHI-S to assess the oral hygiene status, Jackson's fluorosis index to assess the degree of fluorosis and CPITN index to assess the periodontal status where treatment need was excluded. RESULTS: Gingivitis and periodontitis were more common in females (65.9% and 32.8%,respectively) than in males (75.1% and 24.2%, respectively). Periodontitis was significantly more common in females. As the age advanced from 15 to 55 years and above, gingivitis reduced from 81.0 to 42.9% and periodontitis increased steadily from 18.0 to 57.1%, which was significant. Periodontitis was high in subjects with poor oral hygiene (81.3%), compared to those with good oral hygiene (14.5%), which was significant. As the degree of fluorosis increased, severity of gingivitis reduced and periodontitis increased, i.e, with A degree fluorosis, gingivitis was 89.4% and periodontitis 8.5%, but with F degree fluorosis the former was 64% and the latter 35.8%, which was statistically significant. CONCLUSION: The results suggest that there is a strong association of occurrence of periodontal disease in high-fluoride areas. The role of plaque is well understood in contrast to the effect of fluorides on periodontal tissues. It goes a long way to reason out fluoride as an important etiological agent in periodontal disease.

PMID: 17502711 [PubMed - indexed for MEDLINE]

Greater severity and extent of periodontal breakdown in 136 south Indian human immunodeficiency virus seropositive patients than in normal controls: a comparative study using community periodontal index of treatment needs.

Indian J Dent Res. 2007 Apr-Jun;18(2):55-9

Authors: Ranganathan K, Magesh KT, Kumarasamy N, Solomon S, Viswanathan R, Johnson NW

Apart from the more or less distinctive forms of periodontal disease associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome there remains considerable uncertainty as to whether or not conventional destructive periodontitis is exacerbated in HIV positive individuals. This is especially so in developing countries, from which few studies have been reported. The present study compared the severity and extent of periodontal break down in 136 HIV positive individuals from Chennai, South India, with 136 age-matched controls from the same low socio-economic and ethnic group. All surfaces of all teeth were scored for the community periodontal index of treatment needs (CPITN). Statistical analysis was performed using SPSS package. The results of the present study show that CPITN is a simple, useful technique to assess periodontal status in immunosuppressed patients and that periodontitis is associated with immunosuppression and oral candidiasis. The assessment of periodontal statuscould thus be a useful tool in minimally invasive screening of populations for HIV disease, especially in those parts of the world, like India and Africa, with high prevalence and rising incidence.

PMID: 17502708 [PubMed - indexed for MEDLINE]

Specialty dentistry for the hemophiliac: is there a protocol in place?

Indian J Dent Res. 2007 Apr-Jun;18(2):48-54

Authors: Kumar JN, Kumar RA, Varadarajan R, Sharma N

Restorative dental care for the hemophiliac patient is of paramount importance for the fact that advanced dental conditions and subsequent treatments prove to be more complicated and risky. Quite often, dental health is neglected by hemophiliacs for fear of bleeding during procedures. Surprisingly, even dental specialists avoid these candidates and contribute to the conversion ofa simple dental patient to an oral surgical patient. The complexities involved in diagnosing a bleeding disorder and the rarity of a standardized protocol to handle such patients contribute to this problem. This article prescribes a simple protocol to diagnose bleeding disorders and a modified scheme for endodontic and periodontal therapy in a hemophiliac patient.

PMID: 17502707 [PubMed - indexed for MEDLINE]

Clinical management of an unusual case of gingival enlargement.

J Contemp Dent Pract. 2007;8(4):88-94

Authors: Sumanth S, Bhat KM, Bhat GS

AIM: The purpose of this article is to report a case of conditioned gingival enlargement managed by non-surgical periodontal therapy. BACKGROUND: Hormones are specific regulatory molecules that modulate a host of body functions. Hormonal effects reflect physiologic and pathologic changes in almost all tissues of the body with the periodontium being no exception. Physiologic changes like puberty, the menstrual cycle, and pregnancy cause hormonal variations that may cause inflammation of the gingiva. Oral contraceptives that contain estrogen and/or progesterone are associated with gingival enlargement. REPORT: A 28-year-old female presented with a complaint of swelling of the gingiva with spontaneous bleeding in the maxillary anterior region for a period of one year. The health history documented the use of contraceptives for one year, and a clinical examination revealed the existence of poor oral hygiene and enlarged painful gingival tissues that bled when touched. SUMMARY: This case reaffirms the fact plaque control is the most important procedure in any periodontal therapy. Another factor contributing to the excellent response to therapy is patient compliance. The patient followed home care instructions well and was effective in personal oral hygiene measures.

PMID: 17486192 [PubMed - indexed for MEDLINE]

Association between periodontal disease and acute coronary syndrome.

Arq Bras Cardiol. 2007 Feb;88(2):185-90

Authors: Rech RL, Nurkin N, da Cruz I, Sostizzo F, Bai&#xE3;o C, Perrone JA, Wainstein R, Pretto D, Manenti ER, Bodanese LC

OBJECTIVE: To evaluate the relationship between PD and ACS and the association of PD and periodontitis in ACS patients. METHODS: Fifty-eight ACS patients and 57 controls with no history of coronary artery disease (CAD) were included in the study. Variables: arterial hypertension, diabetes, dyslipidemia, obesity, history of CAD, cigarette smoking, and interleukin-1beta gene polymorphism. RESULTS: One hundred and fifteen subjects were enrolled in the study. In the ACS group, 58 patients were evaluated, 32 of whom (55.2%) were male and 26 (44.8%), female. In the control group, 57 subjects were evaluated, 32 (56.1%) of whom were male and 25 (43.9%), female. Periodontal disease was diagnosed in 26 (44.8%) ACS patients and 15 (26.6%) control patients (beta2 = 4.43, p = 0.04). In a logistic regression analysis, the odds ratio for association between PD and ACS was 1.8 (95% CI: 1.0-5.0); p = 0.24. The odds ratio for association of periodontitis with ACS was 4.5 (95% CI: 1.3-15.6); p = 0.019. CONCLUSION: No independent association was found between PD and ACS. There was an independent association between periodontitis and ACS.

PMID: 17384836 [PubMed - indexed for MEDLINE]

Hematoma following periodontal surgery with a torus reduction: a case report.

J Contemp Dent Pract. 2007;8(3):72-80

Authors: Mantzikos K, Segelnick SL, Schoor R

BACKGROUND: There are no published case reports that hematomas occur on the floor of the mouth as a result of periodontal surgery. REPORT: These three case reports document post surgical hematoma formation on the floor of the mouth that pose problems with the diagnosis, prognosis, and patient management. All cases involved periodontal surgery where extensive reduction of tori and bony exostoses were required. Two cases resulted in hematomas in the floor of the mouth. However, a change in the post surgical management for a third case demonstrated possible prevention of hematoma formation. SUMMARY: Hematomas in the floor of the mouth can be a resolving post surgical phenomenon or a serious vascular insult to this region of the oral cavity. This report clarifies the diagnosis, prognosis, and the best management protocol through the presentation of three cases.

PMID: 17351684 [PubMed - indexed for MEDLINE]

Prevalence and severity of hypertension in a dental hygiene clinic.

J Contemp Dent Pract. 2007;8(3):13-20

Authors: Thompson AL, Collins MA, Downey MC, Herman WW, Konzelman JL, Ward ST, Hughes CT

AIM: The purpose of this study was to assess the prevalence and severity of hypertension in a dental hygiene clinic and evaluate factors related to the disease. METHODS AND MATERIALS: Records of 615 patients, treated by dental hygiene students during 2003, were reviewed. Data collected included systolic and diastolic blood pressure, presence of diabetes and renal disease, non-modifiers (race, gender, and age), and modifiers (marital status, smoking habits, and occupation). RESULTS: According to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) classification, 154 (25%) of the subjects had normal blood pressure readings, 374 (60.8%) had prehypertension, and 87 (14.1%) had stage 1 hypertension. Statistical analysis showed a significant difference in the JNC7 classification between groups when considering the non-modifiers' race (p=.02) and the modifiers' smoking habits (p=.03) and occupation (p=.01). A statistically significant difference in the JNC7 classification existed between groups with diabetes (p=.00). The majority of patients had blood pressure readings in the prehypertension stage. CONCLUSION: Based on these results, the researchers recommend clinical policy modifications which include: additional documentation for blood pressure readings in the prehypertension stage, lowering the systolic reading from 160 mmHg to 140 mmHg when adding hypertension alert labels, and noting prehypertension/hypertension on the dental hygiene care plan with the appropriate interventions.

PMID: 17351677 [PubMed - indexed for MEDLINE]

The detection of eight putative periodontal pathogens in adult and rapidly progressive periodontitis patients: an institutional study.

Indian J Dent Res. 2007 Jan-Mar;18(1):6-10

Authors: Joshi VM, Vandana KL

PURPOSE: Periodontal disease is a commonly prevalent problem faced alike by both the developed and third world countries but showing wide variations in prevalence and severity across different geographical areas. The purpose was to identify Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Ekinella corrodens (Ec), Campylobacter rectus (Cr), Bacteroides forsythus (Bf), Treponema denticola (Td) and Fusobacterium nucleatum (Fn) in Indian adult periodontitis and rapidly progressive periodontitis patients. MATERIALS AND METHODS: Paper points were used to collect the sample from 28 sites in both adult periodontitis and rapidly progressive periodontitis (8 healthy/20 diseased sites) patients and DNA analysis done. The categorical data was analysed by Fishers exact test and difference in the clinical parameters was tested by Mann-Whitney test. RESULTS: In healthy sites of adult and rapidly progressive periodontitis patients, Aa, Ec, Bf and Aa, Pg, Pi, Td, Fn were detected respectively. However, when diseased and healthy sites were compared in both adult periodontitis and rapidly progressive periodontitis patients respectively, only Pg( P =0.004), Cr( P =0.04), Fn( P =0.014) and Pg( P =0.002), Cr( P =0.02), Fn( P =0.008) were statistically significant. CONCLUSION: The prevalence of the microorganisms correlate with the clinical parameters like probing depth and bleeding on probing as seen in the Japanese and Western periodontitis patients' population.

PMID: 17347537 [PubMed - indexed for MEDLINE]

[Cultural aspects in the understanding of chronic periodontitis: a qualitative study]

Cad Saude Publica. 2007 Mar;23(3):681-90

Authors: Nuto Sde A, Nations MK, Costa Ido C

This study aimed to analyze the concepts, beliefs, attitudes, and explanatory models related to chronic periodontitis among individuals with this disease in order to facilitate communications between dentists and patients and foster conscientious treatment adherence. The study sample consisted of 20 patients from the Periodontics Specialization Courses at Fortaleza University and the Brazilian Dental Association in Fortaleza, Cear&#xE1; State. Data were gathered from October 2004 to January 2005. A qualitative methodological framework was used to interpret the patients' subjective expression. Semi-structured interviews were applied to obtain patients' accounts of their individual experience with the disease condition. Thematic discourse analysis used: empirical categories established within the study itself, simple frequencies and calculated percentages, and refinement of thematic classifications. According to their reports, patients understand the periodontal heath-disease process through the intermediation of both popular and scientific knowledge, involvement of living and work conditions, and access to quality care, i.e., they do not incorporate only the biomedical discourse.

PMID: 17334581 [PubMed - in process]

Treatment of periodontitis and endothelial function.

N Engl J Med. 2007 Mar 1;356(9):911-20

Authors: Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M, Suvan J, Hingorani AD, Vallance P, Deanfield J

BACKGROUND: Systemic inflammation may impair vascular function, and epidemiologic data suggest a possible link between periodontitis and cardiovascular disease. METHODS: We randomly assigned 120 patients with severe periodontitis to community-based periodontal care (59 patients) or intensive periodontal treatment (61). Endothelial function, as assessed by measurement of the diameter of the brachial artery during flow (flow-mediated dilatation), and inflammatory biomarkers and markers of coagulation and endothelial activation were evaluated before treatment and 1, 7, 30, 60, and 180 days after treatment. RESULTS: Twenty-four hours after treatment, flow-mediated dilatation was significantly lower in the intensive-treatment group than in the control-treatment group (absolute difference, 1.4%; 95% confidence interval [CI], 0.5 to 2.3; P=0.002), and levels of C-reactive protein, interleukin-6, and the endothelial-activation markers soluble E-selectin and von Willebrand factor were significantly higher (P<0.05 for all comparisons). However, flow-mediated dilatation was greater and the plasma levels of soluble E-selectin were lower in the intensive-treatment group than in the control-treatment group 60 days after therapy (absolute difference in flow-mediated dilatation, 0.9%; 95% CI, 0.1 to 1.7; P=0.02) and 180 days after therapy (difference, 2.0%; 95% CI, 1.2 to 2.8; P<0.001). The degree of improvement was associated with improvement in measures of periodontal disease (r=0.29 by Spearman rank correlation, P=0.003). There were no serious adverse effects in either of the two groups, and no cardiovascular events occurred. CONCLUSIONS: Intensive periodontal treatment resulted in acute, short-term systemic inflammation and endothelial dysfunction. However, 6 months after therapy, the benefits in oral health were associated with improvement in endothelial function.

PMID: 17329698 [PubMed - indexed for MEDLINE]

Physiological features of periodontal regeneration and approaches for periodontal tissue engineering utilizing periodontal ligament cells.

J Biosci Bioeng. 2007 Jan;103(1):1-6

Authors: Benatti BB, Silv&#xE9;rio KG, Casati MZ, Sallum EA, Nociti FH

Experimental studies have shown that the potential of periodontal regeneration seems to be limited by the regenerative capacity of the cells involved. The regeneration of damaged periodontal tissues is mediated by various periodontal cells and is regulated by a vast array of extracellular matrix informational molecules that induce both selective and nonselective responses in different cell lineages and their precursors. In this paper, we first review periodontal ligament tissue and its different cell subpopulations including fibroblasts and paravascular stem cells, and their functions during the development and homeostasis of periodontal tissues. Because conventional periodontal regeneration methods remain insufficient to obtain a complete and reliable periodontal regeneration, the concept of periodontal tissue engineering has been based on the generation of the conditions necessary to improve the healing of periodontal tissues. Additionally, the potential of periodontal ligament cells for use in periodontal tissue engineering to overcome the limitations of conventional periodontal regenerative therapies is discussed, followed by an update of the recent progress and future directions of research utilizing periodontal ligament cells for predictable periodontal regeneration.

PMID: 17298893 [PubMed - indexed for MEDLINE]

Augmentation of keratinized gingiva through bilaminar connective tissue grafts: a comparison between two techniques.

Minerva Stomatol. 2007 Jan-Feb;56(1-2):3-20

Authors: Bertoldi C, Bencivenni D, Lucchi A, Consolo U

AIM: A mucogingival deficiency is considered a potential risk factor for periodontal disease. In particular, mucogingival deficiency can lead to gingival recession, which is a pathological entity per se, due to the increased risk for dental hypersensitivity and root caries. The aim of this study was to evaluate and compare 2 bilaminar grafting techniques normally employed to achieve root coverage. METHODS: Thirty-five patients were divided into 2 groups. Group 1 included 19 patients with 49 gingival recessions treated by Nelson technique (as modified by Harris), while group 2 included 15 patients with 40 recessions treated by Langer technique. Clinical evaluation was performed at preoperative level (T0), after 1 month (T1) and after 1 year (T2). Statistical analysis was performed by means of Friedmann and Wilcoxon test and U-Mann-Whitney test. RESULTS: The statistical analysis did not reveal any significant difference between groups, both in terms of percentage of root coverage and of width of keratinizaed gingiva gain. A significant difference was only observed within each group, for the amount of keratinized gingiva at T1 vs T0 and at T2 vs T1. CONCLUSIONS: This study did not show any statistical difference between the Nelson and the Langer technique as to root coverage and gain in keratinized gingiva.

PMID: 17287702 [PubMed - indexed for MEDLINE]

Evaluation of the marginal gingival health using laser Doppler flowmetry.

Braz Dent J. 2006;17(3):219-22

Authors: Develioglu H, Kesim B, Tuncel A

The purposes of this study were to compare the gingival blood flow (GBF) in test sites (teeth retaining fixed partial dentures) and control sites (contralateral natural teeth) and investigate whether there is any relationship between clinical indices and GBF values. Twelve healthy subjects (6 females and 6 males) aged 20 to 54 years were enrolled this study. The GBF was measured from the middle point of the marginal gingiva in the test and control sites using laser Doppler flowmetry (LDF). Additionally, plaque index, gingival index and probing depth measurements were recorded. Statistically significant difference (p<0.05) was found between the test and control sites for marginal GBF. In contrast, no significant difference (p>0.05) was found between test and control sites with respect to the clinical indices, except for plaque index. The findings of this study suggest that there is a significant relation between resin-bonded fixed partial dentures with margins located subgingivally and marginal GBF. Clinical indices are helpful to collect information about the clinical health status of gingival tissues, but GBF is a good tool to measure gingival tissue blood flow and assess periodontal health. In conclusion, laser Doppler flowmetry can be used together with clinical indices to evaluate the marginal gingival health.

PMID: 17262128 [PubMed - indexed for MEDLINE]

Efficacy of Carisolv as an adjunctive therapy to scaling and root planing on subgingival calculus removal.

Braz Dent J. 2006;17(3):213-8

Authors: Grisi DC, Salvador SL, Marcantonio RA

The purpose of this study was to evaluate the effectiveness of subgingival application of Carisolv gel as an adjunctive therapy to scaling and root planing (SRP) on calculus removal compared to conventional instrumentation. Forty-five teeth requiring extraction due to severe periodontal disease were randomized to the following treatments: 1) SRP alone; 2) placebo gel + SRP; 3) Carisolv gel + SRP. Either test or placebo gel was applied subgingivally for 1 min and then the root were instrumented until a smooth and calculus-free surface was achieved. Instrumentation time and the number of strokes required were recorded. After extraction, the efficacy of root surface instrumentation was measured by percentage of remaining calculus. There was no statistically significant difference (p>0.05) between the treatment groups regarding either time required for instrumentation or the percentage of residual calculus. The subgingival application of Carisolv gel prior to SRP did not provide any additional benefit to root instrumentation compared to scaling and root planing alone.

PMID: 17262127 [PubMed - indexed for MEDLINE]

Densitometric analysis of the autogenous demineralized dentin matrix on the dental socket wound healing process in humans.

Braz Oral Res. 2006 Oct-Dec;20(4):324-30

Authors: Gomes MF, Abreu PP, Morosolli AR, Ara&#xFA;jo MM, Goulart MG

The aim of this study was to evaluate the effects of the autogenous demineralized dentin matrix (ADDM) on the third molar socket wound healing process in humans, using the guided bone regeneration technique and a polytetrafluoroethylene barrier (PTFE). Twenty-seven dental sockets were divided into three groups: dental socket (Control), dental socket with PTFE barrier (PTFE), and dental socket with ADDM slices associated to PTFE barrier (ADDM + PTFE). The dental sockets were submitted to radiographic bone densitometry analysis and statistical analysis on the 15th, 30th, 60th and 90th days using analysis of variance (ANOVA) and Tukey's test (p < or = 0.05). The radiographic analysis of the ADDM + PTFE group showed greater homogeneity of bone radiopacity than the Control group and the PTFE group, during all the observation times. The dentin matrix gradually disappeared from the dental socket during the course of the repair process, suggesting its resorption during the bone remodeling process. It was concluded that the radiographic bone density of the dental sockets treated with ADDM was similar to that of the surrounding normal bone on the 90th day. The ADDM was biocompatible with the bone tissue of the surgical wounds of human dental sockets. The radiographic analysis revealed that the repair process was discreetly faster in the ADDM + PTFE group than in the Control and PTFE groups, although the difference was not statistically significant. In addition, the radiographic image of the ADDM + PTFE group suggested that its bone architecture was better than that of the Control and PFTE groups.

PMID: 17242793 [PubMed - indexed for MEDLINE]

Relationship between maternal periodontal disease and birth of preterm low weight babies.

Braz Oral Res. 2006 Oct-Dec;20(4):318-23

Authors: Alves RT, Ribeiro RA

It has been recently suggested that periodontal disease is an associated factor for prematurity and low birth weight. The aim of this work was to assess the periodontal status of puerperae and determine its possible relationship with preterm low birth weight (PLBW) delivery. The sample included 59 women seen at two maternity hospitals in Juiz de Fora, MG, Brazil. Nineteen mothers had premature and low birth weight babies (gestational age below 37 weeks and birth weight below 2,500 g--group I), and 40 had mature, normal weight babies (gestational age over 37 weeks and birth weight over 2,500 g--group II). The mothers' data were obtained from medical files, interview, and periodontal clinical examination carried out up to 48 hours after delivery. The Periodontal Screening and Recording (PSR) was used for periodontal assessment. The association between periodontal disease and PLBW was expressed as odds ratio (OR). There was a higher rate of periodontal disease in group I (84.21% - 16/19) as compared with group II (37.5% - 15/40). The data also showed a significant association between periodontal disease and PLBW (OR = 8.9 - 95% CI: 2.22-35.65--p = 0.001). It was concluded that maternal periodontal disease was an associated factor for prematurity and low birth weight in this sample.

PMID: 17242792 [PubMed - indexed for MEDLINE]

Periodontal disease as a potential risk factor for acute coronary syndromes.

Arq Bras Cardiol. 2006 Nov;87(5):592-6

Authors: Accarini R, de Godoy MF

OBJECTIVE: To investigate whether there is a relationship between active periodontal disease (PD) and acute coronary syndromes (ACS). METHODS: Three hundred and sixty-one patients (57,3% male), ages ranging from 27 to 89 (mean +/- DP = 60.5 +/- 12.2), were admitted to the Intensive Care Unit of a Teaching Hospital with symptoms and complementary examinations consistent with acute coronary syndrome. All the patients had a complete periodontal examination in the ICU setting, and 325 (90.9%) underwent coronary angiography for diagnostic confirmation and/or treatment planning. Periodontal examination included evaluation of all the teeth in the oral cavity and the following parameters: probing depth, clinical attachment level, plaque index, and gingival index. RESULTS: Of the 325 patients, 91 (28%) had coronary arteries free of obstruction or with mild obstructions (< 50% diameter stenosis), and the remaining 72% had severe obstructions. Fisher's exact text yielded a p value of 0.0245 with an odds ratio of 2.571 (95% CI 1.192 to 5.547), meaning that the group with ACS and significant obstructive coronary artery disease was 2.5-fold more likely to have active PD. CONCLUSION: A significant association was found between active periodontal disease and severe obstructive coronary artery in patients with acute coronary syndrome, underscoring the importance of prevention and adequate treatment of periodontal disease, which should be considered as a potential risk factor in the etiology and instability of the atherosclerotic plaque.

PMID: 17221034 [PubMed - indexed for MEDLINE]

Histological analysis of effects of 24% EDTA gel for nonsurgical treatment of periodontal tissues.

J Oral Sci. 2006 Dec;48(4):207-14

Authors: de Vasconcellos LM, Ricardo LH, Balducci I, de Vasconcellos LG, Carvalho YR

The aim of this study was to investigate, by means of histological and histomorphometric analysis, the effects of 24% ethylenediaminetetraacetic acid (EDTA) gel in periodontal tissue when used in combination with conventional periodontal treatment. Periodontitis was induced in the 2nd upper left permanent molars of 45 male Wistar rats by means of ligature. After 5 weeks, this was removed and debridement was performed. The animals were then randomly divided into 3 groups; group 1: mechanical treatment, group 2: mechanical treatment and EDTA gel application for 2 min, and group 3: mechanical treatment and placebo gel application for 2 min. After the treatment, rinsing was done with 0.9% saline solution for 1 min in all cases, followed by root notching in the deepest part of the pocket. After 4, 10, and 28 days the animals were sacrificed. The averages obtained were evaluated by means of test two-way analysis of variance (ANOVA) and Tukey statistical tests (P < 0.05). The results showed that with respect to the type of treatment employed, there were no statistically significant differences in the vitality of the periodontal tissue. It was concluded that 24% EDTA gel did not interfere with periodontal tissue repair when used in combination with conventional periodontal treatment.

PMID: 17220618 [PubMed - indexed for MEDLINE]

Screening of periodontitis with salivary enzyme tests.

J Oral Sci. 2006 Dec;48(4):177-83

Authors: Nomura Y, Tamaki Y, Tanaka T, Arakawa H, Tsurumoto A, Kirimura K, Sato T, Hanada N, Kamoi K

The purpose of this study was to determine the usefulness of salivary biochemical markers for the screening of periodontal disease and examine the agreement between the results of saliva enzyme tests and those of probing depth. The present study included a total of 187 subjects who underwent annual medical check-ups at the Comprehensive Health Care Center, Honjo, Saitama Prefecture, Japan. Periodontal pocket probing was performed with a WHO probe, and various enzymes and biochemical parameters in saliva were measured. For lactate dehydrogenase (LDH), the proportions of the five isoenzymes were calculated. To decide the cut-off point for each enzymatic activity, receiver operating characteristic curves (ROC curves) were constructed and the points of minimum difference between sensitivity and specificity were decided. Among the biochemical markers tested, salivary LDH level had the highest sensitivity and specificity (sensitivity 0.66, specificity 0.67), while salivary levels of aspartate aminotransferase (AST) and blood urea nitrogen (BUN) also had sensitivity and specificity above 0.60. Among the LDH isoenzymes, LDH4 and LDH5 dominated in whole saliva samples. Salivary LDH may be a feasible and useful parameter for the screening of periodontal disease, while salivary AST and BUN also appear to be potentially useful for this purpose.

PMID: 17220614 [PubMed - indexed for MEDLINE]

Dentinal hypersensitivity?--Can this agent be the solution?

Indian J Dent Res. 2006 Oct-Dec;17(4):178-84

Authors: Madhu PS, Setty S, Ravindra S

AIM: To test the efficacy of desensitizing tooth paste containing EMS salts in alleviating dentinal hypersensitivity, reducing plaque accumulation, and reducing gingivitis. METHODS: A randomised, single blind, parallel placebo controlled study was conducted in 40 cases. The cases were randomly assigned to test and control groups. The test group was instructed to use the test tooth paste (containing EMS salts) and control group a placebo tooth paste (without any therapeutic agents) for a period of 6 weeks. The hypersensitivity levels were measured with scratchometer and verbal rating scale. Student t test and wilcoxon's Mann-Whitney test were used to compare the test and control groups. RESULTS AND CONCLUSION: The results indicated that both the test as well as the control toothpastes were effective in alleviating dentinal hypersensitivity as well as reducing gingivitis. However, the test toothpaste was superior in alleviation of dentinal hypersensitivity.

PMID: 17217214 [PubMed - indexed for MEDLINE]

Oral health status and treatment needs in institutionalized psychiatric patients: one year descriptive cross sectional study.

Indian J Dent Res. 2006 Oct-Dec;17(4):171-7

Authors: Kumar M, Chandu GN, Shafiulla MD

BACKGROUND AND OBJECTIVES: Psychiatric patients are one of the special groups requiring attention as they are often neglected. Oral health is an major determinant of general health for psychiatric patients and may have a low priority in the context of mental illness. The present study was conducted to assess the oral health status and treatment needs of institutionalized psychiatric patients of Davangere. METHODS: 220 psychiatric patients admitted in two general hospitals of Davangere during the period of one year were included in the study. The oral health status was evaluated with respect to caries, oral hygiene, and periodontal status. RESULTS: Of the 180 examined with the response rate of 81.8%. 58.3% were males, mean age was 36.7 years, 57.8% had < 1 year of mental illness with a mean of 2.2 years, and 90% were self-sufficient. The multiple logistic regression analysis showed that the mean DMFT (0.92) increased with age, duration of mental illness, and irregularity of oral hygiene habits (P<0.001). Mean OHI-S score was 3.3 and multiple logistic regression analysis showed that the mean OHI-S score increased with age (P<0.001). The multiple logistic regression analysis showed that the CPI score increased with age, duration of mental illness, and degree of helplessness (P<0.001). INTERPRETATION AND CONCLUSION: The findings of this study demonstrates low caries prevalence, poor oral hygiene, and extensive unmet needs for dental treatment.

PMID: 17217213 [PubMed - indexed for MEDLINE]

Long-term uncontrolled hereditary gingival fibromatosis: a case report.

J Contemp Dent Pract. 2007 Jan 1;8(1):90-6

Authors: Seng&#xFC;n D, Hatipoğlu H, Hatipoğlu MG

Hereditary gingival fibromatosis (HGF) is a rare condition characterized by varying degrees of gingival hyperplasia. Gingival fibromatosis usually occurs as an isolated disorder or can be associated with a variety of other syndromes. A 33-year-old male patient who had a generalized severe gingival overgrowth covering two thirds of almost all maxillary and mandibular teeth is reported. A mucoperiosteal flap was performed using interdental and crevicular incisions to remove excess gingival tissues and an internal bevel incision to reflect flaps. The patient was treated 15 years ago in the same clinical facility using the same treatment strategy. There was no recurrence one year following the most recent surgery.

PMID: 17211510 [PubMed - indexed for MEDLINE]

Partial recording protocols for periodontal disease assessment in epidemiological surveys.

Cad Saude Publica. 2007 Jan;23(1):33-42

Authors: Vettore MV, Lamarca Gde A, Le&#xE3;o AT, Sheiham A, Leal Mdo C

The objective of the present study was to compare the reliability of four partial-mouth protocols for assessing shallow, moderate, and deep sites for periodontal pocket depth and clinical attachment levels. Periodontal pocket depth and clinical attachment level measurements were recorded for 156 subjects (age > or = 30). The four models of partial-mouth protocols compared were: Model I: all sites per tooth in the random half-mouth protocol randomly selecting one maxillary and mandibular quadrant, Model II: buccal sites in a full-mouth protocol, Model III: buccal sites in the random half-mouth protocol randomly selecting one maxillary and mandibular quadrant, Model IV: all sites per tooth using Community Periodontal Index teeth. In comparison with full mouth examination, Model I did not show significant differences for periodontal pocket depth and clinical attachment level parameters. Models II and III were different for some periodontal pocket depth means, and Model IV significantly overestimated all clinical parameters related to periodontal disease. Model I appears to be adequate to substitute for the full-mouth examination to assess the prevalence and severity of chronic periodontal disease in adults.

PMID: 17187102 [PubMed - indexed for MEDLINE]

Association of psychological well-being with oral conditions in Japanese workers.

J Occup Health. 2006 Nov;48(6):487-93

Authors: Ide R, Hoshuyama T, Wilson D, Takahashi K, Higashi T

Although the effect of disorders on psychological well-being is well-known, there are few studies focusing on oral conditions at the worksite. The present study examined the association between psychological well-being and oral conditions of Japanese workers. A cross-sectional study was performed using data from 1381 Japanese civil service officers aged 20-59 yr old. Psychological well-being was measured with the 12-item version of the General Health Questionnaire (GHQ-12) in a comprehensive health questionnaire, while measures for oral condition included self-rated oral health, oral symptoms and clinical indicators: dental caries, periodontal status and number of missing teeth. The mean GHQ scores according to the levels of each oral condition were estimated by analysis of variance, separately for males and females. Higher scores corresponded to poorer psychological well-being. Age, gender, smoking and type of occupation were adjusted in a multivariate analysis. Psychological well-being was not associated significantly with dental caries, periodontal status or number of missing teeth. The adjusted means of the GHQ scores for ;conscious of appearance of mouth' were significantly different among the categories for both genders (male: p<0.001, female: p=0.018). For five of six oral symptoms, the adjusted means of GHQ scores were lowest for those respondents who rated their oral symptoms as ;never or hardly ever.' Our results did not show that psychological well-being was associated with oral conditions measured by clinical indicators. However, an association was found between some oral symptoms and psychological well-being. Absence of oral symptoms seems to be related to better psychological well-being.

PMID: 17179642 [PubMed - indexed for MEDLINE]

Root coverage with free gingival autografts--a clinical study.

Indian J Dent Res. 2006 Jul-Sep;17(3):126-30

Authors: Deepalakshmi D, Arunmozhi U

AIM: To assess the percentage of root coverage with autogenous free gingival grafts. MATERIALS & METHODS: Ten non-smoking patients with Miller's class I or class II recessions were included in the study. The clinical parameters such as recession depth, recession width, probing pocket depth, clinical attachment level and width of the keratinized gingiva were recorded at the baseline, at the end of 1 month, 3 months, and 6 months after the surgical procedure. Autogenous free gingival grafts harvested from the palatal mucosa were used to cover the denuded roots. RESULTS: Four out of ten sites showed 100% root coverage. A mean percentage of 80.3% of root coverage was achieved.

PMID: 17176829 [PubMed - indexed for MEDLINE]

Assessment of full-time dental hygiene faculty participation in clinical practice.

J Dent Educ. 2006 Dec;70(12):1298-307

Authors: Kiser JR, Wilder RS, Fleming DE, George MC

The purpose of this research project was to determine how many U.S. dental hygiene (DH) programs had full-time (FT) faculty members who provided direct patient care unrelated to the curriculum. Questions in this project also assessed attitudes and opinions of DH directors regarding clinical practice and opportunities for salary supplementation. A questionnaire of twenty open-ended and closed-ended questions was designed on Survey Monkey, an online survey engine. After IRB approval and pilot testing, 278 U.S. DH program directors received two emails with the survey link requesting their participation. A response rate of 69.1 percent (n=192) was achieved. Results revealed that 14.2 percent of the programs required FT DH faculties to participate in clinical practice settings unrelated to the curriculum, while 67 percent of the programs had faculties who also participated in clinical practice. Eighty-three percent of respondents reported faculties who participated in clinical practice were financially compensated. The majority (95.4 percent) of directors indicated maintaining clinical skills was an advantage to clinical practice, while 48 percent of directors indicated participation takes time away from being an educator. Overall, the majority of DH programs did not require FT faculties to participate in clinical practice; however, respondents were generally in favor of allowing faculties the opportunity to practice and thought that it enhanced their competency as clinical instructors.

PMID: 17170320 [PubMed - indexed for MEDLINE]

Oral condition and health status of elderly 8020 achievers in Aichi Prefecture.

Bull Tokyo Dent Coll. 2006 May;47(2):37-43

Authors: Hashimoto M, Yamanaka K, Shimosato T, Ozawa A, Takigawa T, Hidaka S, Sakai T, Noguchi T

The purpose of this study was to investigate differences in oral condition and health status between persons with 20 or more teeth at the age of 80 (8020 elderly) and persons of the same age with less than 20 teeth (non-8020 elderly). This study was conducted by a team belonging to the Aichi Dental Association. Number of remaining teeth, Community Periodontal Index of Treatment Needs (CPITN), salivary blood test, masticatory ability, bone mineral density (BMD), grip strength, balance test (length of time one can stand on one leg with eyes open), height, weight and body mass index (BMI) were all examined. The percentages of CPITN code 0, 1 and 2 were 68% in the 8020 male elderly and 72% in the 8020 female elderly. The positive percentage in the salivary blood test in the 8020 elderly was lower than that in the non-8020 elderly. Masticatory ability was 1.55 g in the 8020 male elderly, and 1.53 g in the 8020 female elderly. Relative masticatory ability in the 8020 female elderly was 20% higher than that in the non-8020 female elderly. BMD in the 8020 female elderly was significantly higher than that in the non-8020 female elderly. Grip strength in the 8020 elderly was also significantly higher than that in the non-8020 elderly. The duration of balance test in the 8020 male elderly was 2.2 times longer than that in the non-8020 male elderly. The 8020 elderly showed good oral condition and health status was found to be better in the 8020 elderly than in the non-8020 elderly.

PMID: 17167218 [PubMed - indexed for MEDLINE]

The effect of tool handle shape on hand muscle load and pinch force in a simulated dental scaling task.

Appl Ergon. 2007 Sep;38(5):525-31

Authors: Dong H, Loomer P, Barr A, Laroche C, Young E, Rempel D

Work-related upper extremity musculoskeletal disorders, including carpal tunnel syndrome, are prevalent among dentists and dental hygienists. An important risk factor for developing these disorders is forceful pinching which occurs during periodontal work such as dental scaling. Ergonomically designed dental scaling instruments may help reduce the prevalence of carpal tunnel syndrome among dental practitioners. In this study, eight custom-designed dental scaling instruments with different handle shapes were used by 24 dentists and dental hygienists to perform a simulated tooth scaling task. The muscle activity of two extensors and two flexors in the forearm was recorded with electromyography while thumb pinch force was measured by pressure sensors. The results demonstrated that the instrument handle with a tapered, round shape and a 10 mm diameter required the least muscle load and pinch force when performing simulated periodontal work. The results from this study can guide dentists and dental hygienists in selection of dental scaling instruments.

PMID: 17156742 [PubMed - indexed for MEDLINE]

Are veneers conservative treatment?

J Am Dent Assoc. 2006 Dec;137(12):1721-3

Authors: Christensen GJ

PMID: 17138718 [PubMed - indexed for MEDLINE]

Periodontal treatment does not reduce the risk of preterm delivery, study finds.

J Am Dent Assoc. 2006 Dec;137(12):1642-3

Authors: Garvin J

PMID: 17138706 [PubMed - indexed for MEDLINE]

Musculoskeletal disorders.

J Am Dent Assoc. 2006 Dec;137(12):1638; author reply 1639-40

Authors: Hamann CP, Rodgers PA, Sullivan KM

PMID: 17138704 [PubMed - indexed for MEDLINE]

Treatment of periodontal disease and the risk of preterm birth.

N Engl J Med. 2006 Nov 2;355(18):1885-94

Authors: Michalowicz BS, Hodges JS, DiAngelis AJ, Lupo VR, Novak MJ, Ferguson JE, Buchanan W, Bofill J, Papapanou PN, Mitchell DA, Matseoane S, Tschida PA,

BACKGROUND: Maternal periodontal disease has been associated with an increased risk of preterm birth and low birth weight. We studied the effect of nonsurgical periodontal treatment on preterm birth. METHODS: We randomly assigned women between 13 and 17 weeks of gestation to undergo scaling and root planing either before 21 weeks (413 patients in the treatment group) or after delivery (410 patients in the control group). Patients in the treatment group also underwent monthly tooth polishing and received instruction in oral hygiene. The gestational age at the end of pregnancy was the prespecified primary outcome. Secondary outcomes were birth weight and the proportion of infants who were small for gestational age. RESULTS: In the follow-up analysis, preterm birth (before 37 weeks of gestation) occurred in 49 of 407 women (12.0%) in the treatment group (resulting in 44 live births) and in 52 of 405 women (12.8%) in the control group (resulting in 38 live births). Although periodontal treatment improved periodontitis measures (P<0.001), it did not significantly alter the risk of preterm delivery (P=0.70; hazard ratio for treatment group vs. control group, 0.93; 95% confidence interval [CI], 0.63 to 1.37). There were no significant differences between the treatment and control groups in birth weight (3239 g vs. 3258 g, P=0.64) or in the rate of delivery of infants that were small for gestational age (12.7% vs. 12.3%; odds ratio, 1.04; 95% CI, 0.68 to 1.58). There were 5 spontaneous abortions or stillbirths in the treatment group, as compared with 14 in the control group (P=0.08). CONCLUSIONS: Treatment of periodontitis in pregnant women improves periodontal disease and is safe but does not significantly alter rates of preterm birth, low birth weight, or fetal growth restriction. (ClinicalTrials.gov number, NCT00066131 [ClinicalTrials.gov].).

PMID: 17079762 [PubMed - indexed for MEDLINE]

Clinical evaluation of an ionic tooth brush on oral hygiene status, gingival status, and microbial parameter.

Indian J Dent Res. 2006 Apr-Jun;17(2):74-7

Authors: Deshmukh J, Vandana KL, Chandrashekar KT, Savitha B

It has long been recognised that the presence of dental plaque leads to gingivitis and periodontal disease, as well as dental caries. Today tooth brushing is the most widely accepted method of removing plaque. Hence this present clinical study was undertaken to evaluate the effectiveness of an ionic toothbrush on oral hygiene status. For this study, 20 dental students in the age group of 18-20 years were included. All the subjects after undergoing dental prophylaxis were then provided with ionic toothbrushes, either active (equipped with lithium battery) or inactive (without lithium battery). Plaque index and gingival bleeding index were examined at 7th, 14th, and 21st day. Microbial assessment was done for detection of colony forming units (CFU) from the plaque samples which were collected on 0 day and 21st day, both before brushing and after brushing. Results shown a significant reduction in all the parameters and the reduction was more significant in active and inactive ionic toothbrush users. It was concluded that both active and inactive ionic toothbrushes reduced the plaque index and gingival bleeding index scores significantly and active ionic tooth brushes were more effective as compared to inactive ionic toothbrushes. There was no soft tissue trauma following the use of both type of toothbrushes, which showed that ionic toothbrushes were equally safe for regular long-term use.

PMID: 17051872 [PubMed - indexed for MEDLINE]

Study of the clinical usefulness of a dental drug system for selective reduction of mutans streptococci using a case series.

J Oral Sci. 2006 Sep;48(3):111-6

Authors: Tamaki Y, Nomura Y, Takeuchi H, Ida H, Arakawa H, Tsurumoto A, Kumagai T, Hanada N

The aim of this study was to evaluate the clinical efficacy and safety of a dental drug delivery system (3DS) for the selective reduction of mutans streptococci. Twenty patients with high levels of mutans streptococci in saliva participated. The efficacy of 0.2% chlorhexidine (CHX) delivered by 3DS in reducing the salivary levels of mutans streptococci compared with total streptococci and lactobacilli was investigated. Each subject was treated by professional mechanical tooth cleaning (PMTC) and subsequently individual trays with CHX for 5 min. Salivary bacterial samples were taken at the baseline and weeks 1-12. A significant reduction in the colony count of mutans streptococci was observed during the first 4 weeks compared with the baseline count, while no significant decrease in the count of total streptococci or lactobacilli was found during 12 weeks. In particular, the proportion of mutans streptococci in total streptococci remained low after 12 weeks. Our results indicate that the new 3DS used in combination with PMTC appears to be a promising intraoral drug delivery system which, when used with a low CHX concentration selectively, effectively reduces mutans streptococci in the oral cavity with no adverse effects.

PMID: 17023742 [PubMed - indexed for MEDLINE]

Effect of platelet-rich plasma in the treatment of periodontal intrabony defects in humans.

Chin Med J (Engl). 2006 Sep 20;119(18):1511-21

Authors: Ouyang XY, Qiao J

BACKGROUND: Platelet-rich plasma (PRP) is a kind of natural source of autologous growth factors, and has been used successfully in medical community. However, the effect of PRP in periodontal regeneration is not clear yet. This study was designed to evaluate the effectiveness of PRP as an adjunct to bovine porous bone mineral (BPBM) graft in the treatment of human intrabony defects. METHODS: Seventeen intrabony defects in 10 periodontitis patients were randomly treated either with PRP and BPBM (test group, n = 9) or with BPBM alone (control group, n = 8). Clinical parameters were evaluated including changes in probing depth, relative attachment level (measured by Florida Probe and a stent), and bone probing level between baseline and 1 year postoperatively. Standardized periapical radiographs of each defect were taken at baseline, 2 weeks, and 1 year postoperatively, and analyzed by digital subtraction radiography (DSR). RESULTS: Both treatment modalities resulted in significant attachment gain, reduction of probing depth, and bone probing level at 1-year post-surgery compared to baseline. The test group exhibited statistically significant improvement compared to the control sites in probing depth reduction: (4.78 +/- 0.95) mm versus (3.48 +/- 0.41) mm (P < 0.01); clinical attachment gain: (4.52 +/- 1.14) mm versus (2.85 +/- 0.80) mm (P < 0.01); bone probing reduction: (4.56 +/- 1.04) mm versus (2.88 +/- 0.79) mm (P < 0.01); and defect bone fill: (73.41 +/- 14.78)% versus (47.32 +/- 11.47)% (P < 0.01). DSR analysis of baseline and 1 year postoperatively also showed greater radiographic gains in alveolar bone mass in the test group than in the control group: gray increase (580 +/- 50) grays versus (220 +/- 32) grays (P = 0.0001); area with increased gray were (5.21 +/- 1.25) mm(2) versus (3.02 +/- 1.22) mm(2) (P = 0.0001). CONCLUSIONS: The treatment with a combination of PRP and BPBM led to a significantly favorable clinical improvement in periodontal intrabony defects compared to using BPBM alone. Further studies are necessary to assess the long-term effectiveness of PRP, and a larger sample size is needed.

PMID: 16996004 [PubMed - indexed for MEDLINE]

Scanning electron microscopic analysis of the effect of Carisolv gel on periodontally compromised human root surfaces.

Braz Dent J. 2006;17(2):110-6

Authors: Grisi DC, Theodoro LH, Sampaio JE, Grisi MF, Salvador SL

The aim of this study was to analyze, under scanning electron microscopy (SEM), the morphologic characteristics of root surfaces after application of Carisolv gel in association with scaling and root planing (SRP). Sixty periodontally compromised extracted human teeth were randomly assigned to 6 groups: 1) SRP alone; 2) passive topical application of Carisolv + SRP; 3) active topical application of Carisolv + SRP; 4) multiple applications of Carisolv + SRP; 5) SRP + 24% EDTA; 6) topical application of Carisolv + SRP + 24% EDTA. Carisolv gel was applied to root surfaces for 30 s, followed by scaling and root planing, consisting of 50 strokes with Gracey curettes in an apical-coronal direction, parallel to the long axis of the tooth. The only exception was group 4, in which the roots were instrumented until a smooth, hard and glass-like surface was achieved. All specimens were further analyzed by SEM. The results showed that the treatment with Carisolv caused significant changes in root surface morphology of periodontally compromised teeth only when the chemical agent was actively applied (burnishing technique). Carisolv failed to remove the smear layer completely, especially with a single application, independently of the method of application. Multiple applications of Carisolv were necessary to achieve a smear layer reduction comparable to that obtained with 24% EDTA conditioning.

PMID: 16924336 [PubMed - indexed for MEDLINE]

A modified double pedicle graft technique and other mucogingival interceptive surgeries for the management of impacted teeth: a case series.

Indian J Dent Res. 2006 Jan-Mar;17(1):35-9

Authors: Sunil S, Avinash BS, Prasad D, Jagadish L

Maxillary canine is one of the most common teeth that are impacted. This accounts for 1-2% of all patients who attend orthodontic treatment. The key to achieve maximal eruption of these teeth is their surgical exposure and the role of periodontist in such situations is to provide a functional and satisfactory width of attached gingiva on the labial surface. There are different techniques to surgically expose the impacted teeth, namely--gingivectomy technique, apically positioned flap, closed eruption technique, modified apically positioned flap, double pedicle flap and free gingival graft. Selection of the procedure is dependent on the positioning of the tooth in relation to mucogingival junction and attached gingiva. In the present case series we describe three different techniques for uncovering of impacted teeth, which are apically positioned flap, closed eruption technique and a modified double pedicle graft specially planned for the situation. These procedures when selected diligently using sound selection criteria will create adequate width of attached gingiva which minimizes or eliminates the future mucogingival problems.

PMID: 16900893 [PubMed - indexed for MEDLINE]

Evaluation of physiological and behavioral measures in relation to dental anxiety during sequential dental visits in children.

Indian J Dent Res. 2006 Jan-Mar;17(1):27-34

Authors: Rayen R, Muthu MS, Chandrasekhar Rao R, Sivakumar N

Anxiety is a special variety of fear, experienced in anticipation of threatening stimuli. While some research workers have said that the response of a child improves with the number of visits, many have felt otherwise. The present study is yet another effort to find the patterns of anxiety in children during sequential dental visits. The main aim was to determine the physiological and behavioral variations during sequential dental visits and its impact on age and sex. The study was conducted at the outpatient Department of Pedodontics and preventive dentistry, Meenakshi Ammal Dental College and Hospital, Chennai to evaluate the physiological and behavioural measures of stress and anxiety in children. One hundred and fifteen children, between four and eleven years of age who reported for dental treatment were selected for the study.

PMID: 16900892 [PubMed - indexed for MEDLINE]

Detection and measurement of oral malodour in periodontitis patients.

Indian J Dent Res. 2006 Jan-Mar;17(1):2-6

Authors: John M, Vandana KL

BACKGROUND & OBJECTIVES: Malodour has been correlated with the concentration of volatile sulphur compounds produced in the oral cavity by metabolic activity of bacteria colonizing the periodontal sites and the dorsum of the tongue. The aim of this study was to detect malodour in mouth air organoleptically and using a portable sulphide monitor and to correlate it with the clinical parameters, halitosis linked toxins and BANA, using tongue and subgingival plaque samples. The halitosis grading is also correlated with the microbial colonies of the subgingival plaque sample. METHODS: 20 patients with chronic periodontitis with 5-7 mm pocket depth, radiographic evidence of bone loss and presence of oral malodour participated in this study. Assessment of mouth air was done organoleptically and by using a portable sulphide monitor. The clinical parameter, plaque index (PI), gingival index (GI), gingival bleeding index (BI), were obtained from all the areas. Samples for BANA and to detect halitosis linked toxins were taken from the dorsal surface of the tongue and periodontal pockets ranging 5-7 mm. Halitosis related microbial colonies were identified using anaerobic culturing from the subgingival plaque. RESULTS: The scores of PI, GI, BI and sample that tested positive for halitosis linked toxins and with the halitosis grading were not significant. The presence of tongue coating and the halitosis grading and toxin levels were significant. BANA has shown to be non contributory due to technical problems. Anaerobic culture has shown to identify Streptococcus, Bacteroides, Fusobacterium, Porphyromonas and Prevotella colonies. INTERPRETATION & CONCLUSION: The results confirmed that there was no correlation between the clinical parameters, halitosis linked toxins and halitosis grading. The microbial colonies have shown to correlate with the presence of oral malodour.

PMID: 16900888 [PubMed - indexed for MEDLINE]

Efficacy of a herbal toothpaste on patients with established gingivitis--a randomized controlled trial.

Braz Oral Res. 2006 Apr-Jun;20(2):172-7

Authors: Ozaki F, Pannuti CM, Imbronito AV, Pessotti W, Saraiva L, de Freitas NM, Ferrari G, Cabral VN

The aim of this randomised, double blind controlled trial was to verify the efficacy of a herbal dentifrice on the reduction of plaque and gingivitis. Forty eight volunteers with established gingivitis were randomly assigned to either a test group (herbal dentifrice) or positive control group (dentifrice with triclosan and fluoride). The dentifrices were distributed in plain white tubes by an independent pharmacy, which revealed the contents of each tube only after the experimental period. Plaque and gingivitis assessments were carried out on baseline and after 28 days of product use. All examinations were conducted by the same calibrated investigator. Subjects were instructed to brush their teeth three times daily using their assigned dentifrice for 28 days. There was a significant reduction in plaque levels in both the test and control groups. However, there was no significant difference between the groups. A significant reduction in gingivitis was observed in both groups, although there was no significant difference between them. No adverse reactions were reported. The authors concluded that both dentifrices were effective in reducing plaque and gingivitis in subjects with established gingivitis.

PMID: 16878213 [PubMed - indexed for MEDLINE]

Veneer mania.

J Am Dent Assoc. 2006 Aug;137(8):1161-3

Authors: Christensen GJ

PMID: 16873334 [PubMed - indexed for MEDLINE]

The effects of periodontal instrument handle design on hand muscle load and pinch force.

J Am Dent Assoc. 2006 Aug;137(8):1123-30; quiz 1170

Authors: Dong H, Barr A, Loomer P, Laroche C, Young E, Rempel D

BACKGROUND: In comparison with people in other occupations, dentists and dental hygienists are at increased risk of developing work-related musculoskeletal disorders, including carpal tunnel syndrome. An important risk factor in dental practice is forceful pinching, which occurs during dental scaling. Ergonomically designed dental instruments may help reduce the prevalence of MSDs among dental practitioners. METHODS: In the authors' study, 24 dentists and dental hygienists used 10 custom-designed dental scaling instruments with different handle diameters and weights to perform a simulated scaling task. The authors recorded the muscle activity of two extensors and two flexors in the forearm with electromyography, while thumb pinch force was measured by pressure sensors. RESULTS: Handle designs of periodontal instruments had significant (P < .05) effects on hand muscle load and pinch force during a manual scaling task. The instrument with a large diameter (10 millimeters) and a light weight (15 grams) required the least amount of muscle load and pinch force. There was a limit to the effect of handle diameter, with diameters larger than 10 mm having no additional benefit; however, the study did not identify a limit to the effect of reducing the weight of the instrument, and therefore instruments lighter than 15 g may require even less pinch force. CLINICAL IMPLICATIONS: The results from this study can guide dentists and dental hygienists in selection of dental scaling instruments.

PMID: 16873329 [PubMed - indexed for MEDLINE]

Osteonecrosis of the jaw and oral bisphosphonate treatment.

J Am Dent Assoc. 2006 Aug;137(8):1115-9; quiz 1169-70

Authors: Nase JB, Suzuki JB

BACKGROUND: Bisphosphonates are becoming recognized increasingly as having a significant impact on dental therapies. This case report describes adverse clinical sequelae and successful treatment following periodontal surgery in a dental patient receiving bisphosphonate treatment. CASE DESCRIPTION: A 78-year-old woman experienced a nonhealing interproximal wound subsequent to a minor periodontal procedure performed to facilitate restoration of an adjacent tooth. Her medical history revealed that she had been taking an oral bisphosphonate every day for the previous five years for treatment of osteoporosis. After three months of periodic d&#xE9;bridement and meticulous oral home care, one of the authors recovered a large piece of necrotic bone. The wound healed after the author performed surgery at the site. CLINICAL IMPLICATIONS: Dentists should exercise caution when considering surgical procedures for patients with a history of oral bisphosphonate use. Thorough treatment of nonhealing wounds in these patients can lead to favorable outcomes.

PMID: 16873327 [PubMed - indexed for MEDLINE]