[Isolation of periodontal bacteria from blood samples and atheromas in patients with atherosclerosis and periodontitis.]

Rev Med Chil. 2007 Sep;135(9):1118-1124

Authors: Padilla E C, Lobos G O, Jure 0 G, Matus F S, Descouvieres C C, Hasbún A S, Maragaño L P, Núñez F L

Background: Periodontitis is a common oral disease produced by bacterial species that reside in the subgingival plaque. These microorganisms have been associated to atherosclerosis and it is suggested that periodontitis is a cardiovascular risk factor. Aim: To isolate periodontal bacteria from blood and atheroma samples, from patients with atherosclerosis and periodontitis. Material and methods: Twelve patients with periodontitis and a clinical diagnosis of atherosclerosis and 12 patients with periodontitis but without atherosclerosis were studied. Blood samples were obtained immediately before and after scaling and root planing. The samples were incubated in aerobic and anaerobic conditions. One week after scaling, atheromatous plaques were obtained during endarterectomy in the 12 patients with atherosclerosis. These were homogenized and cultured for aerobic and anaerobic bacteria. Microorganisms were identified by means ofPCR. Results: Five patients with and two without atherosclerosis, had bacteremia after scaling and root planing. Bacterial species isolated from blood samples were the same found in periodontic pockets. Four atheromatous plaques of patients with bacteremia yielded positive cultures. The isolated bacteria were the same found in blood samples and periodontal pockets. Conclusions: Bacteremia occurred in seven of 24 patients after scaling and root planing. In four patients, the same species found in periodontic pockets and blood cultures were detected in atherosclerotic plaques obtained one week after the dental procedure.

PMID: 18064365 [PubMed - as supplied by publisher]

Scanning electron microscope assessment of several resharpening techniques on the cutting edges of Gracey curettes.

J Contemp Dent Pract. 2007;8(7):70-7

Authors: Andrade Acevedo RA, Cézar Sampaio JE, Shibli JA

AIM: Treatment of periodontal diseases is based on efficient scaling and root planing (SRP) and adequate maintenance of the patient. The effectiveness of SRP is influenced by operator skill, access to the subgingival area, root anatomy, and the quality and type of instrument used for SRP. The aim of this study was to evaluate the cutting edges of Gracey curettes after manufacturing and after resharpening using several techniques. METHODS AND MATERIAL: The cutting edges of a total of 41 new #5-6 stainless steel Gracey curettes were evaluated blindly using scanning electron microscopy (SEM). The quality of the cutting edges was evaluated blindly by a calibrated examiner using micrographs. Data were analyzed using a Kruskal Wallis test and non-parametric two-way multiple comparisons. RESULTS AND CONCLUSIONS: Different sharpening techniques had significantly different effects on the sharpness of cutting edges (p<0.05). Sharpening by passing the lateral face of curettes over a sharpening stone and then a #299 Arkansas stone produced a high frequency of smooth, sharp edges or slightly irregular edges between the lateral and coronal faces of the curettes. Sharpening by passing a blunt stone over the curette's lateral face produced the poorest quality cutting edge (a bevel). Sharpening of the coronal curette face produced extremely irregular cutting edges and non-functional wire edges. Sharpening with rotary devices produced extremely irregular cutting edges.

PMID: 17994157 [PubMed - in process]

Effects of egg yolk antibody against Porphyromonas gingivalis gingipains in periodontitis patients.

J Oral Sci. 2007 Sep;49(3):201-6

Authors: Yokoyama K, Sugano N, Shimada T, Shofiqur RA, Ibrahim el-SM, Isoda R, Umeda K, Sa NV, Kodama Y, Ito K

Porphyromonas gingivalis gingipains is suspected to be one of the most important causative agents of periodontitis. We postulated that the inhibition of gingipains may reduce the pathogenic nature of P. gingivalis. Anti-P. gingivalis egg yolk antibody (IgY-GP) was isolated from the yolks of hens immunized with purified gingipains. We applied IgY-GP gel subgingivally in periodontitis patients who harbored P. gingivalis in their subgingival flora. Five pairs of contralateral anterior single-rooted teeth were selected. One tooth in each contralateral pair was randomly treated with IgY-GP and subgingival scaling and root planing, whereas the other tooth was treated with SRP alone. The number of P. gingivalis bacteria was assessed by real-time PCR. Bacterial levels were expressed as the percentage of total bacteria. The IgY-GP group had a significant reduction in probing depth. BOP significantly decreased in the IgY-GP group compared to the control group at week 4. The levels of P. gingivalis significantly increased in the control group at week 4, whereas the reduction in the levels of P. gingivalis was sustained in the IgY-GP group. Within the limitations of the present study, IgY-GP was shown to be an effective immunotherapeutic agent in the treatment of periodontitis. (J. Oral Sci. 49, 201-206, 2007).

PMID: 17928726 [PubMed - in process]

Effect of enamel matrix proteins on the treatment of intrabony defects: a split-mouth randomized controlled trial study.

Braz Oral Res. 2007 Jul-Sep;21(3):241-6

Authors: Chambrone D, Pasin IM, Conde MC, Panutti C, Carneiro S, de Lima LA

The objective of this split-mouth, double-blind, randomized controlled trial was to compare the clinical effect of treatment of 2- or 3-wall intrabony defects with open flap debridement (OFD) combined or not with enamel matrix proteins (EMP). Thirteen volunteers were selected with one pair of or more intrabony defects and probing pocket depth (PPD) > or = 5 mm. All individuals received instructions regarding oral hygiene and were submitted to scaling and root planing. Each participant received the two treatment modalities: test sites were treated with OFD and EMP, and control sites received only OFD. After 6 months, a significant reduction was observed in PPD for the EMP group (from 6.42 +/- 1.08 mm to 2.67 +/- 1.15 mm) and for the OFD group (from 6.08 +/- 1.00 mm to 2.00 +/- 0.95 mm) (p < 0.0001), but with no significant difference between groups (p = 0.13). A significant gain in relative attachment level (RAL) was observed in both groups (EMP: from 13.42 +/- 1.88 mm to 10.75 +/- 2.26 mm, p < 0.001; OFD: from 12.42 +/- 1.98 mm to 10.58 +/- 2.23 mm, p = 0.013), but with no significant difference between groups (p = 0.85). Gingival recession (GR) was higher in the EMP group (from 1.08 +/- 1.50 mm to 2.33 +/- 1.43 mm; p = 0.0009) than in the OFD group (from 0.66 +/- 1.15 mm to 1.16 +/- 1.33 mm; p = 0.16), but this difference was not significant (p = 0.06). In conclusion, the results showed that OFD combined with EMP was not able to improve treatment of intrabony defects compared to OFD alone.

PMID: 17710290 [PubMed - in process]

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]

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]

Scanning electron microscopic and profilometric study of different sharpening stones.

Braz Dent J. 2006;17(3):237-42

Authors: Andrade Acevedo RA, Cardozo AK, Sampaio JE

Scaling and root planing contribute to the recovery of periodontal health. All periodontal instruments loose their fine cutting angle after use. To maintain this angle, correct sharpening is required using specifically designed stones. The characteristics of sharpening stones can be compared to the blade of the instruments and also transported to root surface during instrumentation. Root smoothness is related to the quality of the blade. Therefore, the purpose of this study was to evaluate the characteristics of 9 sharpening stones by scanning electron microscopic and profilometric analyses. Ceramic and Neumar stones were very fine and both may be recommended to maintain the sharpness of the instruments. Arkansas, Thompson and CE stones presented greater roughness with very regular and round particles, and are suitable for maintenance of the cutting angle. In addition, these stones may be indicated for the routine sharpening of the instruments that are partly dull. Oxide Aluminum, Carborundum and JON stones were the coarsest with large irregular particles and may be indicated for initial sharpening of totally dull instruments with completion of sharpening with finer stones.

PMID: 17262132 [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]

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]

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]

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]

Treatment of cyclosporine-induced gingival overgrowth with azithromycin-containing toothpaste.

Exp Clin Transplant. 2006 Jun;4(1):420-4

Authors: Argani H, Pourabbas R, Hassanzadeh D, Masri M, Rahravi H

OBJECTIVES: Gingival overgrowth is a complication of cyclosporine therapy following organ transplantation. Oral azithromycin is frequently used to treat this complication. This study examined the efficacy of local azithromycin, in the form of toothpaste, against cyclosporine-induced gingival overgrowth. MATERIALS AND METHODS: Twenty stable renal transplanted patients (10 men and 10 women) with gingival hyperplasia were randomly assigned to a test group and a control group. Azithromycincontaining toothpaste had 85 mg azithromycin per gram of toothpaste. Both toothpastes were prescribed b.i.d., each time using 1.5 cm, for 1 month. All participants received scaling, root planing, polishing, and oral hygiene instructions, at least 4 weeks prior to initiation of the study. Gingival overgrowth index, bleeding on probing, blood urea nitrogen, creatinine, and serum cyclosporine levels were measured at baseline, and then again in the second and fourth weeks after tooth brushing. Patient satisfaction with the toothpastes was evaluated by a visual analogue scale. The stability of clinical responses was followed for 3 months after cessation of the toothpastes. RESULTS: Gingival overgrowth index decreased significantly in the azithromycin-containing toothpaste group (from 1.1+/-0.56 to 0.51+/-0.47, P<.001); however, in the control group, this decrease was not significant (P=.22). Bleeding on probing also decreased significantly in patients in the azithromycin-containing toothpaste group compared with controls (P=.001). When compared with baseline levels, trough levels of cyclosporine, blood urea nitrogen, and creatinine did not change in either of the groups. Patients in the control group were more satisfied with the toothpaste than were patients in the test group (53 vs 38). CONCLUSIONS: Azithromycin-containing toothpaste is an effective, simple, and noninvasive treatment for cyclosporine-induced gingival overgrowth.

PMID: 16827637 [PubMed - indexed for MEDLINE]

Effects of periodontal treatment phase I on birth term and birth weight.

J Indian Soc Pedod Prev Dent. 2006 Mar;24(1):23-6

Authors: Sadatmansouri S, Sedighpoor N, Aghaloo M

Considering the high prevalence of preterm birth (PTB) and low birth weight (LBW) and their complications as well as the role played by periodontal disease in their incidence and the lack of any report of periodontal therapy on these problems in Iran, the goal of the present research was to determine the effects of periodontal treatment on PLBW incidence among women with moderate or advanced periodontitis who were referred to Javaheri hospital (2004-2005). This clinical trial research was conducted on 30 pregnant women age ranging from 18-35 years old, with moderate or advanced periodontitis. Fifteen subjects randomly underwent the first phase of periodontal treatment including scaling, root planning and the use of 0.2% chlorhexidine mouth rinse for one week. None of these steps were taken for the controls. After necessary follow ups, the effect of periodontal treatment on birth term and birth weight were analyzed statistically. This research was conducted on 30 subjects, 15 controls and 15 cases in study group. In the control group, the observed rate of PLBW was 26.7% whereas among periodontally treated group, phase I, PLBW infant was not observed (P < 0.05). Infants birth weight were (3059.3-389.7) gms in study group and (3371-394.2) gms in the control group and respectively (P < 0.05). Periodontal therapy, phase I, results in a reduction in PLBW incidence rate. Therefore, the application of such a simple method among periodontally diseased pregnant women is recommended.

PMID: 16582527 [PubMed - indexed for MEDLINE]

The attachment of V79 and human periodontal ligament fibroblasts on periodontally involved root surfaces following treatment with EDTA, citric acid, or tetracycline HCL: an SEM in vitro study.

J Contemp Dent Pract. 2006 Feb 15;7(1):44-59

Authors: Chandra RV, Jagetia GC, Bhat KM

OBJECTIVE: The present in vitro study has been designed to establish and compare the effects of citric acid, EDTA, and tetracycline HCl on human periodontally diseased roots on the structure, attachment, and orientation of V79 (primary Chinese hamster lung fibroblasts) cells and human periodontal ligament fibroblasts (HPDL). MATERIALS AND METHODS: Commercially available V79 cells and HPDL derived from healthy human third molars were used in this study. These fibroblasts were left in solution for seven days in order to attain confluence. Forty single-rooted teeth were obtained from patients diagnosed with periodontitis. The crown part was removed under constant irrigation and the root was split vertically into two equal halves, thus, yielding 80 specimens. Following scaling and root planing, the specimens were washed with phosphate buffered saline (PBS) and kept in 50 microg/ml gentamycin sulphate solution for 24 hours. The root pieces were then treated as follows: citric acid at pH 1, 24% EDTA, or with a 10% solution of tetracycline HCl and were then placed in V79 fibroblast cultures and HPDL cultures. The specimens were harvested after four weeks and were fixed in 2.5% glutaraldehyde in PBS before preparation for scanning electron microscopy (SEM). RESULTS: The behavior of V79 cells was similar to that of human periodontal ligament cells on root conditioned surfaces. V79 and HPDL showed a healthy morphology on root surfaces treated with citric acid and EDTA and a relatively unhealthy appearance on root surfaces treated with tetracycline HCl and distilled water (control group). CONCLUSION: The results suggest the use of citric acid and EDTA as root conditioning agents favorably affects the migration, attachment, and morphology of fibroblasts on human root surfaces, which may play a significant role in periodontal healing and regeneration.

PMID: 16491147 [PubMed - indexed for MEDLINE]

Retention of maxillary molars with Class III furcation involvement utilizing glass-ionomer: two case reports.

J Contemp Dent Pract. 2005 Nov 15;6(4):160-7

Authors: Reddy KP, Nayak DG, Uppoor AS

Advanced furcation invasion has long been a treatment dilemma for the clinician. The present two case reports used a glass ionomer restorative material as a barrier in the treatment of maxillary Class III furcation defects. One year follow-up results showed a reduction in tooth mobility and probing depths and no bleeding on probing with the use of the glass ionomer. These case reports offer another option in the treatment of a seemingly hopeless periodontally involved maxillary molar.

PMID: 16299618 [PubMed - indexed for MEDLINE]

Products and publishing.

J Am Dent Assoc. 2005 Apr;136(4):436; discussion 436, 438

Authors: Gold SA

PMID: 15884312 [PubMed - indexed for MEDLINE]

Detection of Tannerella forsythia and/or Prevotella intermedia might be useful for microbial predictive markers for the outcome of initial periodontal treatment in Koreans.

Microbiol Immunol. 2005;49(1):9-16

Authors: Kook JK, Sakamoto T, Nishi K, Kim MK, Seong JH, Son YN, Kim DK

A proportion of diseased sites in periodontal disease do not respond to the initial treatment, which might be due in part to the presence of specific microbial pathogens. The aim of this study was to clarify the value of microbial screening for predicting the outcome of periodontal treatment in Koreans using a polymerase chain reaction (PCR). This study enrolled 32 adults with periodontal disease. Microbial and clinical examinations were performed at the baseline and after the initial treatment (professional toothbrushing, scaling, and root planing). Subgingival plaque samples were taken from four sites in each subject (total 128 samples). PCR was used to detect the four putative pathogenic bacteria. There was an improvement in the average of each clinical measurement after the initial treatment. However, approximately half of the sites exhibiting bleeding upon probing (BOP) at the baseline still exhibited bleeding after treatment. There was a close association between the presence of BOP and the presence of Tannerella forsythia (formerly Bacteroides forsythus) and/or Prevotella intermedia. Furthermore, the sites harboring both T. forsythia and P. intermedia at the baseline had a poorer response to treatment than the sites where these two species were not detected. Therefore, microbial screening for T. forsythia and P. intermedia might be useful for predicting the treatment outcome in Koreans.

PMID: 15665448 [PubMed - indexed for MEDLINE]

Quantification and analysis of pain in nonsurgical scaling and/or root planing.

J Am Dent Assoc. 2004 Dec;135(12):1747-54

Authors: Magnusson I, Jeffcoat MK, Donaldson D, Otterbom IL, Henriksson J

BACKGROUND: Three efficacy studies, comprising a database of 337 subjects, were conducted as part of the clinical evaluation of the noninjectable anesthetic gel Oraqix (AstraZeneca, S&#xF6;dertälje, Sweden). The authors discuss some of the challenges encountered when they interpreted the results of the clinical studies and present the results from an alternative analysis of the anesthetic efficacy. METHODS: The three multicenter studies were double-blind, randomized and placebo-controlled. Clinicians applied gel in the subjects' periodontal pockets before scaling and/or root planing, or SRP. Subjects recorded overall pain on a 100-millimeter visual analog scale, or VAS. In the studies, the evaluation of the anesthetic efficacy was based on absolute treatment difference (active-placebo). Investigators used an alternative post hoc approach to evaluate the effect expressed as a ratio (active:placebo). RESULTS: The studies demonstrated consistent and significant lower pain scores for the anesthetic gel versus the placebo gel, with point estimates of absolute treatment difference being 8, 4 and 10 mm. The alternative analysis verified that the estimated treatment effect in terms of a ratio was close to 50 percent in all three studies. CONCLUSIONS: Treatment effects of the anesthetic gel relative to the placebo gel were described more appropriately by means of ratios instead of absolute differences. In this sample of 337 subjects, it was shown that pain was reduced by 50 percent when the anesthetic gel was used compared with when the placebo gel was used. CLINICAL IMPLICATIONS: The authors found that the anesthetic periodontal gel is effective in reducing pain resulting from SRP.

PMID: 15646610 [PubMed - indexed for MEDLINE]

Increase in cariogenic bacteria after initial periodontal therapy.

J Dent Res. 2005 Jan;84(1):48-53

Authors: De Soete M, Dekeyser C, Pauwels M, Teughels W, van Steenberghe D, Quirynen M

This study examined the hypothesis of an intra-oral shift, during initial periodontal therapy, from a periopathogenic to a cariogenic flora. Seventy-one patients with periodontitis were randomly allocated to one of the following treatment strategies: (1) scaling and root planing, quadrant by quadrant, at two-week intervals (NC); (2) full-mouth scaling and root planing within 24 hrs (FRP); or (3) full-mouth disinfection within 24 hrs, including antiseptics [chlorhexidine (CHX) or amine fluoride/stannous fluoride (F) for 2 mos, or CHX for 2 mos followed by F for 6 mos (CHX+F)]. At baseline and after 2, 4, and 8 mos, bacterial samples were taken from supra- and subgingival plaque, saliva, and tongue. The detection frequencies and relative proportions of Streptococcus mutans increased in the NC and FRP groups, but decreased in the F group. In the CHX group, these species disappeared temporarily, but they disappeared for the entire 8 mos in the CHX+F group. These observations were similar for all sample locations. The periopathogens decreased in all groups. This finding confirms the abovementioned hypothesis and indicates a need for caries prophylactic regimens.

PMID: 15615875 [PubMed - indexed for MEDLINE]

The aetiology and treatment of oral halitosis: an update.

Hong Kong Med J. 2004 Dec;10(6):414-8

Authors: Lee PP, Mak WY, Newsome P

Halitosis refers to the condition of offensive mouth odour. More than 90% of cases of halitosis originate from the oral cavity. The implicated bacteria (Fusobacterium nucleatum, Prevotella intermedia, and Tannerella forsythensis) are located in stagnant areas in the oral cavity, such as the dorsal surface of tongue, periodontal pockets, and interproximal areas. These bacteria proteolyse the amino acids releasing volatile sulphur compounds. The management of halitosis involves determining and eliminating the causes, which includes identifying any contributory factors, because certain medical conditions are also associated with characteristic smells. Professional advice should be given on oral hygiene and diet, and treatments should include dental scaling, and root planing of the associated periodontal pockets to reduce the bacterial loading. In addition to the normal oral hygiene practice, tongue cleaning and use of mouthwash are advocated. This paper discusses the common aetiological factors, classification of oral halitosis, and its treatment.

PMID: 15591601 [PubMed - indexed for MEDLINE]

[The effects of non-surgical periodontal treatment on the formation of root-dentin hypersensitivity]

Shanghai Kou Qiang Yi Xue. 2004 Jun;13(3):238-40

Authors: Xu BD, Yang PS

PURPOSE: To study the effects of non-surgical periodontal treatment on the occurrence of root-dentin hypersensitivity and explore its mechanisms through clinical observations. METHODS: 1453 teeth of 52 patients with chronic periodontitis were given scaling and root-planing procedures. 3 months follow-up of these teeth were taken to find root-dentin hypersensitivity after treatment. RESULTS: 432 teeth of 39 patients had different degree of root-dentin hypersensitivity. However,the symptoms disappeared in most patients after active desensitization treatment. CONCLUSION: Subgingival scaling and root-planing can induce the occurrence of root dentin hypersensitivity,therefore, desensitization treatment should be considered as a part of periodontal treatment plan.

PMID: 15269873 [PubMed - indexed for MEDLINE]

Effectiveness of antimicrobial adjuncts to scaling and root-planing therapy for periodontitis.

Evid Rep Technol Assess (Summ). 2004 Jan;(88):1-4

Authors: Bonito AJ, Lohr KN, Lux L, Sutton S, Jackman A, Whitener L, Evensen C

PMID: 15164672 [PubMed - indexed for MEDLINE]

Changes in oral microbial profiles after periodontal treatment as determined by molecular analysis of 16S rRNA genes.

J Med Microbiol. 2004 Jun;53(Pt 6):563-71

Authors: Sakamoto M, Huang Y, Ohnishi M, Umeda M, Ishikawa I, Benno Y

Terminal RFLP (T-RFLP) analysis was used to investigate changes in the oral microbiota in saliva and subgingival plaque samples from one patient with aggressive periodontitis (subject A) and two patients with chronic periodontitis (subjects B and C) before and 3 months after periodontal treatment. Substantial changes in the T-RFLP patterns of subgingival plaque samples of subjects B and C were noted after 3 months of improved oral hygiene and full-mouth supra- and subgingival scaling and root planing. However, there was little change in the subgingival microbiota of subject A. Although the proportions of terminal restriction fragments (T-RFs) larger than 1000 bp were notable in the T-RFLP patterns generated after digestion with HhaI of the samples from two subjects before treatment (subject B, 35.5 %; subject C, 29.6 %), the proportions of these T-RFs were significantly reduced or not detected after treatment (subject B, none; subject C, 4.1 %). Real-time PCR showed a significant change in the proportions of target bacteria in subgingival plaque samples of subject B. After 3 months, the Porphyromonas gingivalis population was markedly reduced (3.1 x 10(-3) %), whereas the proportion of Porphyromonas gingivalis before treatment was 7.6 %. The proportions of Tannerella forsythensis, Treponema denticola and Treponema socranskii were also markedly diminished after treatment. Similarly, the proportion of the T-RF presumed to represent Porphyromonas gingivalis was 5.9 % and became undetectable after 3 months. Analysis of 16S rRNA gene clone libraries from subgingival plaque samples of subject B before and after treatment showed a notable change in the subgingival microbiota. These results were in agreement with the T-RFLP analysis data and showed that the T-RFs larger than 1000 bp represent Peptostreptococcus species. Our results indicate that T-RFLP analysis is useful for evaluation of the effects of medical treatment of periodontitis.

PMID: 15150339 [PubMed - indexed for MEDLINE]

A comparative evaluation of the clinical effects of systemic and local doxycycline in the treatment of chronic periodontitis.

J Oral Sci. 2004 Mar;46(1):25-35

Authors: Akalin FA, Baltacio&#x11F;lu E, Sengün D, Hekimoğlu S, Taşkin M, Etikan I, Fişenk I

In this study, the clinical efficacies of systemic doxycycline (SD) and local doxycycline (LD) in the treatment of chronic periodontitis were compared. Forty-five patients were studied in 3 main groups with 5 treatments: SD alone, SD+scaling-root planing (SD+SRP), LD alone, LD+SRP and SRP alone. Antibiotic-treated patients were given doxycycline treatment alone in 1 quadrant of their upper jaws, and doxycycline+SRP was given in the contralateral quadrant. The areas included at least 4 teeth with > or = 5 mm pockets. Probing depth (PD), clinical attachment level, gingival index, sulcular bleeding index and plaque index values were recorded at baseline and the 7th week. The results were statistically analyzed. All of the clinical parameters were significantly reduced by all treatments (P < or = 0.05). The SD and LD treatments alone provided significant clinical healings. The significant differences among the groups were only in PD at the 7th week. The LD treatment provided significantly higher PD reduction than the SD treatment (P < or = 0.05). No significant difference was found between the SD+SRP and the LD+SRP treatments. There was no significant difference between SD+SRP and SRP alone treatment (P > 0.05). The SD group showed lower PD reduction than SRP group (P < or = 0.05), while no significant difference was found between LD and SRP treatments. The LD alone treatment seemed more effective than SD alone treatment on PD reduction, but no significant difference was found between them when combined with the SRP. LD may be more preferable than SD as an adjunct to mechanical treatment since LD seems more effective than SD on PD reduction and does not have the side effects of SD.

PMID: 15141721 [PubMed - indexed for MEDLINE]

Comparison of the effects of various periodontal rotary instruments on surface characteristics of root surface.

J Oral Sci. 2004 Mar;46(1):1-8

Authors: Kishida M, Sato S, Ito K

The efficacy of scaling and root planing using various periodontal rotary instruments was examined. Eighty extracted human teeth with a history of periodontal disease were divided into four groups of 20 and subjected to one of the following procedures: Use of 1) a Root Burnisher, 2) a Perio Planing Bur (both rotating instruments for contra angle handpieces), 3) a Tooth Planing Bur (rotating instrument for use with an air turbine), or 4) a Gracey Scaler. In each case, the time required for cleaning was measured. Twenty healthy extracted human teeth were used as untreated controls. After treatment, the surface roughness of 10 specimens out of each group were measured using a profilometer and observed by scanning electron microscopy (SEM). Half of the samples were then incubated in dishes with a suspension of fibroblasts. After counting the number of attached cells, the attachment of fibroblasts was observed by SEM. The root surfaces treated with the rotary instruments appeared smooth and there were no significant differences between groups. From the SEM observations, smooth root surfaces with different surface textures were evident and a tight attachment of fibroblasts was observed. The results of this study suggest that use of rotary instruments is superior for periodontal scaling and root planing.

PMID: 15141717 [PubMed - indexed for MEDLINE]

Computer-controlled delivery versus syringe delivery of local anesthetic injections for therapeutic scaling and root planing.

J Am Dent Assoc. 2004 Mar;135(3):358-65

Authors: Loomer PM, Perry DA

BACKGROUND: The authors conducted a study to compare administration of local anesthetic using a computer-controlled delivery device with an aspirating syringe for therapeutic scaling and root planing. The anterior middle superior alveolar, or AMSA, injection was compared with other maxillary injections. METHODS: Twenty healthy adults with moderate periodontal disease participated in this single-blind crossover study. Subjects were evaluated by a trained examiner and were treated by experienced dental hygienists. Subjects provided written and verbal pain ratings via a visual analog scale, or VAS, and a verbal rating scale, or VRS. AMSA injections were compared with syringe-delivered injections--greater palatine, or GP, and nasopalatine, or NP, blocks, and anterior superior alveolar and middle superior alveolar injections--in maxillary quadrants. Bleeding and changes in attachment were evaluated after one month. RESULTS: VAS and VRS scores for AMSA were significantly lower for computer-controlled delivery when compared with NP injections and combined maxillary injections (VAS scores) and with GP and combined maxillary injections (VRS scores). Mean injection times were similar for both groups. Mean gains in attachment were equal, 0.19 millimeters for quadrants anesthetized using computer-controlled injections and 0.22 mm for syringe injections. CONCLUSIONS: Subjects reported having less pain with GP and NP injections delivered using the computer-controlled device, and total injection time was similar to that required for syringe injections. Both techniques provided adequate anesthesia for therapeutic scaling and root planing. Clinical Implications. The two anesthetic delivery techniques were therapeutically equivalent for mandibular injections, and the AMSA injection has clinically significant advantages for maxillary injections.

PMID: 15058627 [PubMed - indexed for MEDLINE]

[Observations of the non-surgical treatment response on diabetic patients with chronic periodontitis]

Shanghai Kou Qiang Yi Xue. 2004 Feb;13(1):6-9

Authors: Yang YZ, Sun Z, Jin LJ, Liang HQ, Hu CZ, Yang YG, Corbet EF

PURPOSE: To observe the non-surgical treatment response on diabetic patients with chronic periodontitis. METHODS: Moderate to advanced chronic periodontitis was studied in 36 Diabetes Mellitus (DM) patients classified as 20 cases with high and fluctuating blood glucose level (DM-H) and 16 cases with relatively low and stable blood glucose level (DM-L). 28 non-DM patients with chronic periodontitis served as control (Non-DM). Plaque Index (PlI), Gingival Index (GI), Bleeding on Probing (BOP), Probing Depth (PD) and Clinical Attachment Loss (AL) of all patients were recorded at 6 sites on each tooth at the baseline and in the first, the third, the sixth month after oral hygiene instrument (OHI), scaling and root planing. RESULTS:It was found that the short-term effect of non-surgical periodontal procedure had resulted in significant resolution of gingival inflammation and pronounced reduction in pocket depth and gain of attachment loss in all patients. The treatment response was similar in both DM and Non-DM patients with chronic periodontitis. CONCLUSIONS:Non-surgical periodontal treatment allowed for favorable treatment responses in a group of diabetic patients with chronic periodontitis and that their various profiles of blood glucose did not influence the short-term healing response to the treatment.

PMID: 15007470 [PubMed - indexed for MEDLINE]

[The curative effects of ultrasonic scaling device used in root planing: comparison with universal subgingival scaling]

Shanghai Kou Qiang Yi Xue. 2002 Sep;11(3):271-2

Authors: Chen F, Zhou Y, Tian Y

PMID: 14983271 [PubMed]

Atypical localized deep pocket due to a cemental tear: case report.

J Contemp Dent Pract. 2003 Aug 15;4(3):52-64

Authors: Marquam BJ

A 71-year old patient with a history of minimal periodontal attachment loss presented with an asymptomatic, non-bleeding, isolated deep pocket on the mesio-facial of a central incisor. Such localized, deep pockets are most frequently associated with a root fracture or an abscess, but in this case an atypical ledge-like projection determined to be a cemental tear was detected at the base of the 6 mm pocket. Periodontal flap surgery revealed a partial detachment of the cementum. Uneventful resolution of the pocket was achieved following root planing to remove the cemental fragment and placement of a bone graft and resorbable membrane. This article reviews the nature, predisposing factors, causes, clinical significance, and treatment of cemental tears.

PMID: 12937596 [PubMed - indexed for MEDLINE]

Analysis of multiple 2x2 tables with site-specific periodontal data.

J Dent Res. 2003 Jul;82(7):514-7

Authors: Panageas KS, Begg MD, Grbic JT, Lamster IB

Periodontal data typically consist of observations made at multiple sites within each patient. Observations within a patient tend to be positively correlated; hence, standard statistical techniques that assume independence are invalid. Regression techniques for correlated data have been proposed; communicating results from these models, however, is difficult, due to their inherent complexity. Simpler statistical approaches have also been proposed, but many of these methods can be applied only when covariates are specific to the subject, and do not vary from site to site within a subject. In this paper, we present two methods for the analysis of multiple 2x2 tables containing site-specific periodontal data. The methods presented are modifications of the well-known Mantel-Haenszel methods. We illustrate these methods using a subset of data from a clinical trial examining the effects of scaling and root planing on levels of interleukin-1 beta.

PMID: 12821710 [PubMed - indexed for MEDLINE]

Bioerodible injectable poly(ortho ester) for tetracycline controlled delivery to periodontal pockets: preliminary trial in humans.

AAPS PharmSci. 2002;4(4):E20

Authors: Schwach-Abdellaoui K, Loup PJ, Vivien-Castioni N, Mombelli A, Baehni P, Barr J, Heller J, Gurny R

The semisolid consistency of poly(ortho esters) (POEs) containing tetracycline free base allows direct injection in the periodontal pocket and shows sustained and almost constant in vitro release in phosphate buffer, pH 7.4 at 37 degrees C, for up to 14 days. Total polymer degradation concomitant with drug release was obtained. Formulations containing 10% or 20% (wt/wt) tetracycline were evaluated in a panel of 12 patients suffering from severe and recurrent periodontitis. In the first trial including 6 patients, single-rooted teeth and molar teeth with furcations were treated immediately after scaling and root planing. Patients tolerated both formulations well, experienced no pain during application, and showed no signs of irritation or discomfort during the observation period. However, retention of the formulation was minimal in this first study. An improved clinical protocol followed in the second study (stopping bleeding after scaling and root planning) prolonged the retention of the formulations in the inflamed periodontal pockets. For up to 11 days, tetracycline concentrations in the gingival crevicular fluid were higher than the minimum inhibitory concentration of tetracycline against most periodontal pathogens.

PMID: 12645992 [PubMed - indexed for MEDLINE]

For the dental patient...Treating periodontal disease: scaling and root planing.

J Am Dent Assoc. 2003 Feb;134(2):259

Authors:

PMID: 12636131 [PubMed - indexed for MEDLINE]

Morphologic analysis, by means of scanning electron microscopy, of the effect of Er: YAG laser on root surfaces submitted to scaling and root planing.

Pesqui Odontol Bras. 2002 Oct-Dec;16(4):308-12

Authors: Theodoro LH, Garcia VG, Haypek P, Zezell DM, Eduardo Cde P

The purpose of this study was to morphologically evaluate, by means of scanning electron microscopy, the effects of Er:YAG laser on the treatment of root surfaces submitted to scaling and root planing with conventional periodontal instruments. Eighteen root surfaces (n = 18), which had been previously scaled and planed, were assigned to 3 groups (n = 6). The control Group (G1) received no further treatment; Group 2 (G2) was irradiated with Er:YAG laser (2.94 mum), with 47 mJ/10 Hz, in a focused mode with air/water spray during 15 s and with 0.57 J/cm of fluency per pulse; Group 3 (G 3) was irradiated with Er:YAG laser (2.94 mum), with 83 mJ/10 Hz, in a focused mode with air/water spray during 15 s and with 1.03 J/cm2 of fluency per pulse. We concluded that the parameters adopted for Group 3 removed the smear layer from the root surface, exposing the dentinal tubules. Although no fissures, cracks or carbonized areas were observed, an irregular surface was produced by Er:YAG laser irradiation. Thus, the biocompatibility of the irradiated root surface, within the periodontal healing process, must be assessed.

PMID: 12612768 [PubMed - indexed for MEDLINE]

Amplified crevicular leukocyte activity in aggressive periodontal disease.

J Dent Res. 2002 Oct;81(10):716-21

Authors: Buchmann R, Hasilik A, Van Dyke TE, Lange DE

Exaggerated neutrophil responses are a critical component in the pathogenesis of periodontal disease. We investigated whether leukocyte activity in aggressive periodontitis (AP) is increased compared with that in chronic periodontitis (CP) by gingival crevicular fluid (GCF) analysis of myeloperoxidase (MPO), beta-N-acetyl-hexosaminidase (beta-NAH), cathepsin D (CD), and elastase-alpha-1-proteinase inhibitor complex (alpha-1-EPI) before and 6 months after therapy. Initial AP neutrophil responses were significantly amplified compared with those in CP (MPO, 3.2-fold; beta-NAH, 37.5-fold; CD, 2.2-fold; alpha-1-EPI, 1.4-fold; p < 0.05). Surgical therapy resulted in a significant reduction of GCF markers compared with non-surgical treatment. However, the changes in clinical parameters were not different between AP and CP (P > 0.05). Analysis of the results suggests that the local inflammatory response in AP is characterized by increased release of inflammatory mediators of neutrophil origin into the GCF. Analysis of the data further suggests that surgical therapy is a more predictable method for removal of the pro-inflammatory etiology.

PMID: 12351672 [PubMed - indexed for MEDLINE]

SEM study on the effect of two different demineralization methods with saturated tetracycline hydrochloride on diseased root surfaces.

J Contemp Dent Pract. 2001 May 15;2(2):25-35

Authors: Babay N

The scanning electron microscope was used to evaluate the dentin surface of diseased teeth subjected to two methods of conditioning with tetracycline hydrochloride (TTC) for 1 and 4 minutes respectively. Five groups of twelve specimens each received root planing (control); were immersed in TTC for 1 and 4 minutes; and burnished in TTC for 1 and 4 minutes. Control specimens exhibited an amorphous irregular surface smear layer. TTC, irrespective of the method used, was effective in removing the smear layer. Immersion in TTC for 1 minute revealed obstructed dentinal tubules, while burnishing for 1 minute revealed the presence of collagen fibrils. The 4-minute application of TTC, irrespective of the conditioning method used, showed wide exposed dentinal tubules. No significant difference between Groups III, IV, and V was noted (p>0.05).

PMID: 12167931 [PubMed - indexed for MEDLINE]

Antimicrobial approach.

J Am Dent Assoc. 2002 Jul;133(7):812, 814

Authors: Wolner SZ

PMID: 12148672 [PubMed - indexed for MEDLINE]

The nonsurgical treatment of patients with periodontal disease: results after five years.

J Am Dent Assoc. 2002 Mar;133(3):311-20

Authors: Loesche WJ, Giordano JR, Soehren S, Kaciroti N

BACKGROUND: In a previous study involving patients seen at the dental clinic of the Detroit Receiving Hospital, the authors found that 87 percent of teeth initially recommended for surgery or extraction were spared those treatments by a combination of debridement and short-term usage of antimicrobial agents. The objective of the present study was to determine how long the surgery-sparing benefits of less invasive treatment would persist. METHODS: Ninety of these patients were scheduled for maintenance therapy at three-month intervals over a five-year period. They were evaluated periodically for surgical needs by a clinician who was not aware of the nonsurgical periodontal treatment the patient had received. RESULTS: The initial treatment benefits were sustained, as the number of teeth needing periodontal surgery or extraction was 0.06 teeth per patient after 1.1 year, 0.22 after 2.3 years, 0.51 after 3.6 years and 0.86 after 5.1 years. CONCLUSIONS: A noninvasive treatment regimen for an anaerobic infection in teeth seriously compromised by periodontal disease resulted in a reduced need for surgery or tooth extraction for at least five years after completion of the initial treatment.

PMID: 11934186 [PubMed - indexed for MEDLINE]

A systematic review of complication risks for HIV-positive patients undergoing invasive dental procedures.

J Am Dent Assoc. 2002 Feb;133(2):195-203

Authors: Patton LL, Shugars DA, Bonito AJ

BACKGROUND: This systematic literature review determined the strength of evidence regarding whether patients with human immunodeficiency virus, or HIV, are at higher risk of developing complications from invasive oral procedures than similar patients without HIV. TYPES OF STUDIES REVIEWED: MEDLINE and EMBASE searches of the English literature from the early 1980s through April 2000 yielded five articles meeting the inclusion and exclusion criteria: original research, concurrent treatment of HIV-positive and HIV-negative subjects, presence of complications (for example, local or systemic infection, bleeding, alveolitis, delayed healing) resulting from extractions, orthognathic surgery, periodontal therapy, endodontic therapy, placement of dental implants, prophylaxis, or scaling and root planing. RESULTS: The authors found no studies involving orthognathic surgery, periodontal therapy, dental implants, prophylaxis, or scaling and root planing, and only one study reporting few immediate endodontic therapeutic complications. Thus, the evidence is insufficient with respect to any additional risk associated with these procedures among people with HIV/AIDS. Because of the few studies, low overall complication rates and variability in results from different analytic approaches, the authors consider the evidence to be too poor to rule in or out a meaningful relationship between HIV status and complications from tooth extractions. CLINICAL IMPLICATIONS: Limited published scientific evidence is available to guide clinicians in regard to possible increased risks of invasive oral procedures associated with the HIV status of the patient.

PMID: 11868838 [PubMed - indexed for MEDLINE]

The mandibular molar class III furcation invasion: a review of treatment options and a case report of tunneling.

J Am Dent Assoc. 2002 Jan;133(1):55-60

Authors: Vandersall DC, Detamore RJ

BACKGROUND: The predictable management of a mandibular molar that has lost all of its interradicular periodontal support-in other words, that has experienced a Class III furcation invasion, or FI-often is a frustrating and disappointing process for both clinician and patient. The strategic value of retaining such a periodontally involved tooth must be determined by both the patient and dentist before a treatment option is selected. In this article, the authors present and describe various therapeutic plans available for Class III FIs in mandibular molars, discussing the advantages and disadvantages of each approach. They focus particularly on a surgical technique called "tunneling," which is performed to d&#xE9;bride the remaining soft and hard tissues in the furcal area; this, in turn, allows access for effective oral hygiene and maintenance. CASE DESCRIPTION: The authors report on the 23-year result of a case involving tunneling. The procedure facilitated the retention of a mandibular molar with a Class III FI in a manner acceptable to both the patient and the clinician. CLINICAL IMPLICATIONS: Tunneling, in a properly selected patient who is motivated to perform careful oral hygiene, can result in comfortable, functional, healthy retention of the affected tooth, with a minimal commitment of time and financial outlay.

PMID: 11811743 [PubMed - indexed for MEDLINE]

An economic evaluation of a chlorhexidine chip for treating chronic periodontitis: the CHIP (chlorhexidine in periodontitis) study.

J Am Dent Assoc. 2001 Nov;132(11):1557-69

Authors: Henke CJ, Villa KF, Aichelmann-Reidy ME, Armitage GC, Eber RM, Genco RJ, Killoy WJ, Miller DP, Page RC, Polson AM, Ryder MI, Silva SJ, Somerman MJ, Van Dyke TE, Wolff LF, Evans CJ, Finkelman RD

BACKGROUND: The authors previously suggested that an adjunctive, controlled-release chlorhexidine, or CHX, chip may reduce periodontal surgical needs at little additional cost. This article presents an economic analysis of the CHX chip in general dental practice. METHODS: In a one-year prospective clinical trial, 484 chronic periodontitis patients in 52 general practices across the United States were treated with either scaling and root planing, or SRP, plus any therapy prescribed by treating, unblinded dentists; or SRP plus other therapy as above but including the CHX chip. Economic data were collected from bills, case report forms and 12-month treatment recommendations from blinded periodontist evaluators. RESULTS: Total dental charges were higher for SRP + CHX chip patients vs. SRP patients when CHX chip costs were included (P = .027) but lower when CHX chip costs were excluded (P = .012). About one-half of the CHX chip acquisition cost was offset by savings in other charges. SRP + CHX chip patients were about 50 percent less likely to undergo surgical procedures than were SRP patients (P = .021). At the end of the trial, periodontist evaluators recommended similar additional procedures for both groups: SRP, about 46 percent; maintenance, about 37 percent; surgery, 56 percent for SRP alone and 63 percent for SRP + CHX chip. CONCLUSIONS: Adjunctive CHX chip use for general-practice patients with periodontitis increased costs but reduced surgeries over one year. At study's end, periodontists recommended similar additional surgical treatment for both groups. CLINICAL IMPLICATIONS: In general practice, routine use of the CHX chip suggests that costs will be partially offset by reduced surgery over at least one year.

PMID: 11806071 [PubMed - indexed for MEDLINE]

Evaluation of a transoral delivery system for topical anesthesia.

J Am Dent Assoc. 2001 Dec;132(12):1714-9

Authors: Carr MP, Horton JE

BACKGROUND: The development of bioadhesives has allowed for the creation of a novel transoral topical anesthesia delivery system used to alleviate pain by needlestick injections and select dental procedures. METHODS: Sixty subjects evaluated the effectiveness of a lidocaine-containing bioadhesive patch, or L-BP, to alleviate pain caused by needlesticks, or Ns, with or without injection, and with scaling and root planing, or Sc/RP, instrumentation. The authors topically administered a commonly used benzocaine-containing gel, or B-G, preparation to analogous sites for direct comparison. Subjects rated their degree of pain/discomfort using verbal pain score, or VPS, measurements. RESULTS: Paired t tests and signed ranked tests revealed that the subjects' perception of pain was significantly reduced after the application of L-BP with placebo (P < .01) for both Ns and Sc/RP but was not significantly reduced by B-G with placebo. L-BP also significantly reduced the subjects' perception of pain caused by Ns and Sc/RP when compared directly with B-G (P < .01). The resultant tissue anesthesia by L-BP significantly reduced pain to Ns with or without anesthetic injection using 25- and 27-gauge needles. However, Ns in conjunction with anesthetic injections generated significantly greater pain than that caused by Ns alone (P < .01). VPS score differences between 25- and 27-gauge needles were not found. CONCLUSIONS: This study found that a lidocaine-containing bioadhesive system delivering topical anesthesia was highly effective in alleviating pain/discomfort arising from Ns, with and without concomitant injection, and select Sc/RP procedures. CLINICAL IMPLICATIONS: A new topical delivery system that effectively anesthetizes oral tissues may prove highly useful in allaying patient anxieties about and fear of select dental procedures.

PMID: 11780993 [PubMed - indexed for MEDLINE]

Decrease of sulfate-reducing bacteria after initial periodontal treatment.

J Dent Res. 2001 Jul;80(7):1637-42

Authors: Langendijk-Genevaux PS, Hanssen JT, van der Hoeven JS

Sulfate-reducing bacteria (SRB) are associated with periodontitis, but it is unknown if elimination of these potential pathogens accompanies clinical improvement. This longitudinal study examined the occurrence of SRB and clinical effects following scaling and root planing. In this study, the presence of periodontal SRB was determined in 38 selected patients before and six months after mechanical therapy. SRB were detected by the enrichment culture technique. Mechanical periodontal treatment resulted in elimination of SRB in 89% of the patients, and 95% of the sites (n = 76). SRB were significantly reduced in patients with progressive, adult, and refractory periodontitis. The elimination of SRB was accompanied by clinical improvement. The mean gain of attachment of these pockets was 3 mm (p < 0.001). The reductions in pocket depth (p < 0.001) and bleeding were significant (p < 0.001). Persistence of SRB correlated with the initial pocket depth (p < 0.02) and attachment level (p < 0.02), and with bleeding of the site after treatment (p < 0.05). In conclusion, mechanical debridement is generally effective for the elimination of SRB.

PMID: 11597024 [PubMed - indexed for MEDLINE]

Accuracy questioned.

J Am Dent Assoc. 2001 Jul;132(7):858, 860, 862

Authors: Golub LM

PMID: 11480638 [PubMed - indexed for MEDLINE]

Efficacy of subantimicrobial dosing with doxycycline. Point/counterpoint.

J Am Dent Assoc. 2001 Apr;132(4):457-66

Authors: Greenstein G, Lamster I

BACKGROUND: This article addresses the role of subantimicrobial dosing with doxycycline, or SDD, in the treatment of chronic periodontitis. The authors discuss and debate 10 issues with regard to SDD's utility as an adjunct to scaling and root planing. TYPES OF STUDIES REVIEWED: The authors reviewed reports of controlled clinical trials that assessed the efficacy of SDD. The main focus of this article is data from the U.S. Food and Drug Administration's phase 3 clinical trial that evaluated the efficacy of SDD in terms of alterations of probing depth, clinical attachment levels and disease progression. RESULTS: The authors compared data from test groups, which underwent root planing plus SDD, with data from control groups, which underwent root planing alone. The mean data suggest that SDD provides a defined but limited improvement of periodontal status when used in conjunction with scaling and root planing. Furthermore, several in vivo studies indicated that a nine-month course of SDD did not cause development of drug-resistant bacterial strains or alteration of the subgingival microbiota. CLINICAL IMPLICATIONS: Some patients may benefit from SDD. However, there are several issues that should be clarified before widespread use of SDD is recommended for patients with chronic periodontitis. The evidence indicates that suppression of the bacterial challenge, which reduces the host response, is the most efficient way to control periodontal diseases.

PMID: 11315376 [PubMed - indexed for MEDLINE]

Nonsurgical periodontal therapy in 2000: a literature review.

J Am Dent Assoc. 2000 Nov;131(11):1580-92

Authors: Greenstein G

BACKGROUND: This article addresses the advantages and limitations of nonsurgical periodontal therapies to treat patients with mild-to-moderate chronic periodontitis. TYPES OF STUDIES REVIEWED: Controlled clinical trials were selected that assessed the efficacy of the following treatment methods: mechanical instrumentation, ultrasonic d&#xE9;bridement, supragingival irrigation, subgingival irrigation, local drug delivery, administration of systemic antibiotics and host-response modulation. Evidently, data with regard to alterations of probing depth, clinical attachment levels and inflammatory status were evaluated. RESULTS: Comparison of the data from test and control groups revealed the following results. Manual and ultrasonic débridement can be used to treat most patients with mild-to-moderate chronic periodontitis. Patients who do not practice optimal plaque control can enhance their personal hygiene procedures by using supragingival irrigation. Subgingival irrigation usually does not provide any benefit beyond that achieved with root planing. Systemic and locally delivered antimicrobial agents appear to be most beneficial among patients who do not respond to conventional treatment. Host modulation may enhance root planing modestly. CLINICAL IMPLICATIONS: The data indicate that most patients with mild-to-moderate periodontitis can be treated with nonsurgical therapies. However, clinicians need to be aware of the limitations of each technique with regard to the magnitude of improvement that it can induce at specific sites.

PMID: 11103577 [PubMed - indexed for MEDLINE]

Photoactive porphyrin derivative with broad-spectrum activity against oral pathogens In vitro.

Antimicrob Agents Chemother. 2000 Dec;44(12):3364-7

Authors: Rovaldi CR, Pievsky A, Sole NA, Friden PM, Rothstein DM, Spacciapoli P

Photodynamic therapy (PDT) has historically been used as a means to treat cancerous tumors but has recently been used to kill bacterial cells through the use of targeted photosensitizers. PDT is a potential adjunct to scaling and root planing in the treatment of periodontal disease. However, the effectiveness of porphyrin derivatives against microorganisms has been limited because some gram-negative bacteria are refractory to photodynamic treatment with these agents. We have designed a porphyrin derivative conjugated to a pentalysine moeity that endows the molecule with activity against gram-positive and gram-negative bacteria. Whereas the porphyrin, chlorin e6, showed in vitro activity against a limited spectrum of bacteria, chlorin e6 conjugated to pentalysine showed in vitro activity against all oral microorganisms tested, including Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Campylobacter rectus, Eikenella corrodens, Fusobacterium nucleatum subsp. polymorphum, Actinomyces viscosus, and the streptococci. Potent antimicrobial activity (>/=5-log-unit reduction in the numbers of CFU per milliliter) was retained in the presence of up to 25% whole sheep blood. The use of potent, selective agents such as this chlorin e6-pentalysine conjugate to more effectively reduce the pathogenic bacteria in the periodontal pocket may be a significant tool for the treatment of periodontal disease.

PMID: 11083641 [PubMed - indexed for MEDLINE]

Trends in surgical and nonsurgical periodontal treatment.

J Am Dent Assoc. 2000 Jun;131 Suppl:31S-38S

Authors: Drisko CH

BACKGROUND: New research is demonstrating that a person's total health is indeed related to his or her oral health. Elimination of all oral infections, including gingivitis and periodontis, is important to overall health. CLINICAL IMPLICATIONS: This article reviews recent evidence on the systemic and oral connection and discusses these findings as they relate to patient care. The article examines trends in nonsurgical and surgical therapy that will successfully arrest periodontal infections. Opportunities for early diagnosis and prevention will play an increasing role in dental practice in the future as patients understand the importance of oral health to overall health.

PMID: 10860343 [PubMed - indexed for MEDLINE]

Managing pain.

J Am Dent Assoc. 2000 Mar;131(3):289-90

Authors: Dunsky JL

PMID: 10715916 [PubMed - indexed for MEDLINE]

Limiting sensitivity after quadrant scaling and root planing.

J Am Dent Assoc. 2000 Feb;131(2):221-2

Authors: McArdle BF

PMID: 10680390 [PubMed - indexed for MEDLINE]

The cost-effectiveness of a new chlorhexidine delivery system in the treatment of adult periodontitis.

J Am Dent Assoc. 1999 Jun;130(6):855-62

Authors: De Lissovoy G, Rentz AM, Dukes EM, Eaton CA, Jeffcoat MK, Killoy WJ, Finkelman RD

BACKGROUND: Periodontal treatment is costly. The authors assessed the potential economic impact of a new periodontal chemotherapeutic, testing the hypothesis that its adjunctive use would result in reduced periodontal surgical needs. METHODS: An economic model estimated treatment needs following two clinical trials of the adjunctive use of a chlorhexidine, or CHX, -containing chip compared with scaling and root planing, or SRP, alone. Needs were based on periodontal status at nine months and a probabilistic algorithm; costs were assigned on the basis of a national dental survey and an average wholesale price of the CHX chip. RESULTS: The base case model projected significantly more maintenance procedures and significantly fewer periodontal surgical procedures for patients treated with SRP and the CHX chip compared with patients who were treated with SRP alone (54.4 percent vs. 46.4 percent, P = .014; 29.2 percent vs. 35.5 percent, P = .015, respectively). Average total costs of care for patients treated with SRP and CHX chip were $737 +/- $244 compared with $734 +/- $239 for patients treated with SRP alone. Sensitivity analyses to account for variations in practice patterns did not appreciably alter the results. When data were analyzed after only three or six months of treatment, the significant differences in treatment needs disappeared. CONCLUSIONS: The CHX chip is a new, apparently cost-effective treatment option for non-surgical periodontal therapy. Adjunctive use of the CHX chip could reduce periodontal surgical needs significantly at little or no additional cost. CLINICAL IMPLICATIONS: Results suggest that incorporating the CHX chip into routine practice requires a new algorithm for management of periodontal disease. To obtain full clinical benefit, treatment needs to be continued for nine months.

PMID: 10377645 [PubMed - indexed for MEDLINE]