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Microbes, inflammation, scaling and root planing, and the periodontal condition
Abstract
Biofilms are a complex community of microorganisms characterized by the excretion of an adhesive and protective extracellular matrix, microbe-to-microbe attachment, structural heterogeneity, genetic diversity, and complex community interactions. Bacteria growing in dental biofilms display an increased tolerance to antibiotics and antimicrobial agents, including those used in dentifrices and mouthrinses. The microbial challenge associated with the inflammatory periodontal diseases induces an immediate inflammatory and immune response in the host. The nature and magnitude of the response has an impact on the severity and rate of progression of the periodontal disease. It is this host inflammatory-immune response that ultimately leads to the clinical signs and symptoms of gingivitis and chronic periodontitis. The traditional treatment modality of scaling and root planing (SRP) remains the "gold standard" for the non-surgical management of chronic periodontitis. Even clinically successful treatment has a high probability of pocket reinfection. Re-infection of periodontal pockets results from residual biofilms, increased tolerance of microbes within a dense, mature biofilm to antibiotics, reservoirs of bacteria in calculus, and reservoirs of bacteria within the dentinal tubules of infected root surfaces. Thus, for maximum effect, a combination of scaling and root planing and locally delivered antimicrobials should be considered if non-surgical therapy is the treatment of choice.
... The number of Gram-negative anaerobes is increasing in a matured plaque biofilm. [1][2][3] The presence of Gram-negative microbiota could be related to gingivitis. 4 Gingivitis is a reversible inflammatory disease, which occurs as a response of the human organism to plaque bacteria and their products. Gingivitis has a high rate of occurrence (50-90% of adults are affected). ...
... The inflammation is limited to gingival soft tissues and does not result in clinical attachment loss. 2,5,6 There is a substantial body of research focused on the prevalent microbiota in healthy adults 5 , adults with periodontitis 7 , adults with gingivitis 3 , and to our knowledge only one study 8 focuses on adolescents. However, the study was performed on subjects with periodontitis, analyzing samples of subgingival plaque. ...
... were reported as one of the first microbiota isolated in the first stage of development of bacterial biofilm. 2 S. viridans group consisted of S. mutans group, S. salivarius group, S. anginosus group, S. mitis group, S. sanguinis group, and S. bovis. 18 In our study these microorganisms were combined as S. mutans group. ...
Introduction:
In children and adolescents, the most common periodontal disease is the plaque-induced gingivitis.
Aim:
The aim of this study was to reveal the bacterial species associated with supragingival plaque of Bulgarian adolescents diagnosed with plaque-induced gingivitis.
Materials and methods:
Supragingival plaque samples from 70 healthy subjects with moderate plaque-induced gingivitis (37 females and 33 males), aged 12-18 years, were obtained and examined microbiologically.
Results:
A total of 224 microorganisms were isolated. Gram-negative bacteria were predominant compared to Gram-positive [132 (59%) vs. 92 (41%).
Conclusion:
The most frequently isolated microbiota in our study is part of the normal oral bacterial flora. The presence of anaerobes such as.
... Gingivitis is an inflammatory disease, which affects the gingival soft tissues. Peak onset of gingivitis is between 11 and 13 years of age (Novaes Júnior et al., 2004;Cobb, 2008). Poor oral hygiene leads to dental plaque accumulation and subsequently to gingivitis (Gafan et al., 2004). ...
... However, the disease can be reversed and mechanical plaque removal is considered to be the most effective method as long as the patient performs it properly (Franco Neto et al., 2008;Tatikonda et al., 2014). Dental plaque as a biofilm is a complex community that consists of bacteria attached to each other and mostly to the tooth surface (Cobb, 2008;Marsh, 2010). Importantly, the presence of some microbiota inhibits the growth of pathogenic genera and therefore it is of great importance for oral health. ...
... On the other hand, the extracellular matrix produced by bacteria hinders the effect of antimicrobial agents (Cobb, 2008). Efficient treatment of gingivitis could be influenced also by patient compliance. ...
We compared the effect of two therapeutic approaches (marketed toothpaste and addition of Bulgarian propolis extract to the toothpaste) on gingival inflammation, plaque formation and oral microbial flora on Bulgarian adolescents with moderate plaque-induced gingivitis. The participants were divided randomly into two groups of 35 students. The first group was instructed to use marketed toothpaste in their routine oral hygiene. The second group was instructed to add 10 drops of Propolin® to the toothpaste before every brushing. The Gingival index and Plaque index were registered and dental plaque samples were collected on the first visit and on the 20th day of the study. After the treatment, the number of students with Gingival index = 1.1–2.0 in the second group was significantly lower than the respective number in the first group. Neisseria spp. and Streptococcus spp. were present in all samples before and after treatment. The addition of propolis resulted in the complete eradication of Streptococcus mutans, Candida albicans, Fusobacterium varium, Gram-negative cocci, Gram-positive rods, Porphyromonas asaccharolyticus, Prevotella bivia, Prevotella intermedia, Prevotella melani and Streptococcus intermedius. The analyses of Propolin® composition revealed it was a black poplar type propolis and is rich in compounds with pronounced antimicrobial activity. In conclusion, the addition of Bulgarian propolis to the toothpaste improved the gingival health in adolescents with moderate plaque-induced gingivitis and resulted in increased activity against potential periodontal and cariogenic pathogens.
... Dental plaque, a biofilm, coats teeth and can later become dental calculus (Cobb, 2008;Abraham et al., 2007;Hillson, 2005;Carranza and Newman, 1995). The cell walls of bacteria serve as a nucleus for calcium phosphate precipitation (Hillson, 2005). ...
... In addition to the surface biofilm, viable periodontal pathogens have been identified within the calculus matrix. Microbial biofilm is the primary cause of periodontal disease, with calculus being secondary because it acts as a reservoir for bacteria (Cobb, 2008;Socransky and Haffajee, 2005). ...
... Calculus on the root of a tooth confirms the presence of longstanding plaque deposits and the presence of pathogenic bacteria that resulted in the destruction of the soft tissues, including gingiva and periodontal ligaments, and of bone. Thus calculus indicates periodontal disease (Cobb, 2008;Hillson, 2005;Carranza and Newman, 1995). Periodontitis includes a variety of bacterial diseases that, through inflammation, cause destruction to the periodontium (Craig et al., 2007;Gurenlian, 2007;Overman, 2006;Socransky and Haffajee, 2005;Socransky, 1970) (Fig. 1). ...
An incomplete skull of a fossil odontocete from the Monterey Formation of late Miocene age on San Clemente Island, California, USA, includes an incomplete rostrum with an associated tooth. Below its cementoenamel junction, the tooth has a mineral deposit encircling the tooth that thickens apically into a bulge. On the root side of the bulge the deposit becomes thin with a stippled texture. The encircling mineral deposit corresponds anatomically to the gingival line and the circumference of the alveolus. The mineral deposit displays characteristics consistent with dental calculus, an indication of localized periodontal disease, and is believed to be the first documented occurrence of periodontal disease and calculus in a fossil cetacean.
... Innate immunity serves as the initial line of defense against microbial assault in the development of diseases of periodontium [2]. Toll-like receptors (TLRs), which are pathogen related patternrecognizing receptors, have a particular response to the lipopolysaccharides constituent of gram-negative microorganisms [3]. The excessive stimulation of TLRs is thought to be the cause of the damage linked to periodontitis. ...
... Plaque reduction is seen as the key to preventing this long-lasting condition, and nonsurgical as well as surgical approaches have been the mainstays of periodontal illness therapy. Along with mechanical removal of debris, various pharmacological plaque management treatments are utilised as adjuncts [1][2][3][4]. Pharmaceutical plaque control treatments that work as an addition to manual treatment for periodontal disease include substances like triclosan, essential oils, and chlorhexidine (CHX) [4]. The pharmaceutical plaque prevention agent that is currently being studied and implemented the most is CHX [5]. ...
The effect of chlorhexidine (CHX) digluconate, Betadine (BET), curcumin (CUR) on gingival wound healing is of interest to dental practitioners. Hence, we studied the average fibroblast viability % for each of the concentrations of CUR, BET and CHX over various time durations. It was found that mean percentage of viability of fibroblasts is high in CUR and low in CHX at all time periods while the mean percentage of viability of fibroblasts in BET 1% was greater than CHX but lower than CUR at all time periods. Thus, curcumin at a concentration of 0.003% demonstrates the least cytotoxicity for fibroblasts. Hence, it is the most effective bacterial suppression, and the best wound healing.
... [31],Cobb (2008) [32] andApatzidou et al. (2010) [33] postulated that the nonsurgical treatment can result in reduction of inflammation, decrease in pocket depth and gain of attachment. However, mechanical therapy may fail to eliminate the pathogenic bacteria because of their location within gingival tissues or in order areas inaccessible to periodontal instrumentation[34]. ...
... [31],Cobb (2008) [32] andApatzidou et al. (2010) [33] postulated that the nonsurgical treatment can result in reduction of inflammation, decrease in pocket depth and gain of attachment. However, mechanical therapy may fail to eliminate the pathogenic bacteria because of their location within gingival tissues or in order areas inaccessible to periodontal instrumentation[34]. ...
... Gingivitis is an inflammatory disease that affects and is limited to the gingival epithelium and fibrous connective tissues. This disease is a result of the interaction between the human organism and the microbial biofilm [5]. The inflammation, induced by the microbial biofilm (plaque) elicits an immune response in the host, mediated by neutrophils, macrophages/monocytes, and lymphocytes. ...
... The inflammation, induced by the microbial biofilm (plaque) elicits an immune response in the host, mediated by neutrophils, macrophages/monocytes, and lymphocytes. These cells and the resident gingival cells release cytokines, which induce inflammation and disease progression [5,18]. The T helper type 1 cells (Th1) play a critical role in the immune response [18,15]. ...
The aim of this study was to determine the effect of two treatment approaches on the levels of IL-1β, TNF-α, IL-6, IL-17A, IL-18, and IFN-γ in the gingival crevicular fluid (GCF) in adolescents with moderate gingivitis. The participants were divided randomly into two groups (n = 35) as follows: group A - instructed to use marketed toothpaste, and group AP - instructed to add 10 drops of Propolin® to the toothpaste before every brushing. Samples of GCF were collected at the first visit and on the 20 th day of the study. Enzyme-linked immunosorbent assays (ELISA) were used for the assay of each cytokine concentration. We detected a significant reduction in the levels of IL-1β (p < 0.01), TNF-α (p < 0.01), IL-18 (p < 0.05) and INF-γ (p < 0.01) in group A on the 20 th day in comparison to the initial levels. Participants in group AP registered significantly lower levels of IL-1β (p < 0.001), IL-6 (p < 0.001), TNF-α (p < 0.001), IL-17A (p < 0.05), IL-18 (p < 0.01), IFN-γ (p < 0.001). Comparing the cytokine levels in the groups on the 20 th day of the treatment, we registered significantly lower levels of IL-1β (p < 0.05) and IL-18 (p < 0.05) in group AP when compared to group A. IL-18 and IL-1β could be used as inflammatory biomarkers in adolescents with gingivitis. The addition of propolis to the toothpaste resulted in a reduction of the gingival inflammation in adolescents with moderate gingivitis and greater gingival health improvement than the sole use of a toothpaste. © 2018, Romanian Society for Pharmaceutical Sciences. All rights reserved.
... In our study the prevalence of dental caries was high in the age group less than 16 years (41.7%) ( Table 4), this result was roughly similar to that previously reported in Yemen (49.5%) [11], USA (44%) [12] and France (50%) [13] in children under 16 years old. However, our dental caries rate among children was higher than that documented in the US in recent report (16 to 29%) [14], 2000) and Japan (20.7%) [15]. The high rate of dental caries in children in developing countries including Yemen can be as a result of growing consumption of sugars and inadequate exposure to fluorides [8]. ...
... The variation of periodontitis in different community could be attributed to genetic predisposition, socialcultural-behavioral differences (e.g. smoking, oral hygiene and access to treatment) and nuterional factors [15][16][17]. ...
... In our study the prevalence of dental caries was high in the age group less than 16 years (41.7%) ( Table 4), this result was roughly similar to that previously reported in Yemen (49.5%) [11], USA (44%) [12] and France (50%) [13] in children under 16 years old. However, our dental caries rate among children was higher than that documented in the US in recent report (16 to 29%) [14], 2000) and Japan (20.7%) [15]. The high rate of dental caries in children in developing countries including Yemen can be as a result of growing consumption of sugars and inadequate exposure to fluorides [8]. ...
... The variation of periodontitis in different community could be attributed to genetic predisposition, socialcultural-behavioral differences (e.g. smoking, oral hygiene and access to treatment) and nuterional factors [15][16][17]. ...
Abstract
Objectives: Dental clinic workers (DCWs) in Yemen have an additional risk of getting infected with HBV from their workplace
and till now they are not routinely vaccinated against HBV infection. This study aimed to estimate prevalence of hepatitis B virus
infection and associated risk factors among DCW in selected dental clinics in Sana’a city.
Study design: Data were acquired from a cross sectional survey conducted among DCWs in 2014 at the Faculty of Dentistry,
Sana’a University, in Sana’a city. A proportionate to size random sample was drawn per DCW category. A structured questionnaire
was used to collect data about socio-demographic characteristics and risk factors. ELISA was used to test sera for HBV markers.
Result: The study included 246 dentists and 263 dental assistants, the sero-prevalence of current hepatitis B virus infection was
6.1%; while prevalence of life time exposure to hepatitis B virus infection was 18%. Prevalence of needle stick injuries, exposure
to skin and to mucous membranes were 45.6%, 26.5% and 25.3% respectively. Cuts were also common with 41.1% of participants
reporting a cut in a period of one year preceding the survey. Regular use of gloves, face mask, and glasses were reported by 74.4%,
28.3% and 25.3% of participants respectively. Only 30.1% of respondents were vaccinated against hepatitis B virus infection and
52.1% were susceptible and could potentially be protected through vaccination. Longer duration in service was associated with risk
of infection (OR ranged from 2.2-2.65; P value = 0.002). Being assistant (OR = 1.97; P value = 0.001) was associated with a higher
risk of hepatitis B virus infection.
Conclusion: The prevalence of current and life time exposure to HBV infection was high. Exposure to potentially infectious body
fluids was high and yet only a small percentage of DCW were vaccinated, so there is need to vaccinate all DCWs as a matter of policy
and ensure a safer work environment.
Keywords: HBV, DCWs, Risk factors, Sana’a city, Yemen
... 4 Modalitas perawatan tradisional skeling dan penghalusan akar tetap merupakan "standar emas" untuk penanganan periodontitis secara nonbedahdap. 7 Bukti klinis memperlihatkan rerata penurunan kedalaman poket dan peningkatan perlekatan klinis dapat dicapai dengan penghalusan akar pada daerah dengan kedalaman poket 4-6 mm atau 7 mm lebih. Rata-rata penurunan kedalaman poket adalah 1,29 mm dan 2,16 mm, dan rata-rata peningkatan perlekatan klinis adalah 0,55 mm dan 1,29 mm. ...
... 9 Modalitas perawatan tradisional dari skeling dan penghalusan akar tetap merupakan "standar emas" untuk penanganan non-bedah terhadap periodontitis. 7 Telah digunakan juga laser dalam kedokteran gigi modern selama lebih dari 30 tahun. Penggunaan luas dari laser, seperti CO2, Nd:YAG, dan Er:YAG dalam bidang periodontologi untuk ablasi jaringan lunak dan keras, detoksifikasi permukaan akar, debridement poket, eliminasi bakteri dan berbagai pendekatan bedah. ...
Non surgical periodontal therapy is the first step in periodontal therapy procedure. Elimination of biofilm andmineral deposit from tooth surface is a basic of periodontal therapy. Clinical data showed that the success of longterm periodontal therapy depends on the result of first step compare to spesific surgical therapy. Methods used innon surgical therapy are mechanical instrumentation, ultrasonic debridement, supragingival and subgingivalirigation, localized drugs, systemic antibiotics, and host response modulation. The successful of periodontal therapydepends on the management of negative environment and reduction of bacterial pathogen through a combination ofbetter environment which is less anaerobic for good microorganism to live. The aim of non surgical therapy is toreduce microbial etiology and factors involved in the progression of gingiva and periodontal. The end result is tostop the disease progression and to gain healthy gingiva and tissue condition.
... La periodontitis representa la expresión clínica de una serie de entidades que tienen en común la destrucción de los tejidos de soporte del diente, incluyendo tejido conectivo gingival, ligamento periodontal y hueso alveolar, siendo mediada por la interacción de las biopelículas con los mecanismos de defensa del huésped (1)(2)(3)(4). Sin duda, esta enfermedad se encuentra indiscutiblemente relacionada con la formación y el desarrollo de las biopelículas en cavidad oral, siendo agravada por la presencia del cálculo dental en relación con la encía (5,6). En este sentido, tanto la perdida ósea, como la pérdida de inserción clínica pueden ser variables en diversos modelos propuestos y puede tardar cierto tiempo en progresar (7)(8)(9). ...
... A partir de este fundamento, la evaluación de la lámina dura y del espacio del ligamento periodontal parece evidenciar el riesgo de actividad de periodontitis en lugares interproximales de los dientes (6,25), lo que permite la corroboración de los sitios con salud periodontal. ...
Objective: Determine the concordance and relationship between periodontal clinical attachment level and radiographic examination in patients with chronic periodontitis. Methods: Cross-sectional study of 135 participants over 16 years, randomly selected, diagnosed with chronic periodontitis. Of which 352 were obtained in 1292 periapical interproximal sites. It was measured the height of the ridge with a millimeter ruler. Furthermore, were examined the type of defect, the continuity of the lamina dura and widening of the periodontal ligament space. The data were analyzed using measures of central tendency and dispersion. To quantify the correlation test was used for Kappa and relationships were used odds ratios with confidence intervals of 95%, and was used to establish significance Chi-square test assuming a decision limit of 0.05. Results: There was a statistically significant relationship between attachment levels 4, 5 and 6 mm and radiographic bone loss. For the other relationships were not statistically significant. Regarding the type of defect, the horizontal pattern loss was the most common with 23% of the sites examined. Conclusion: For the diagnosis of chronic periodontitis is not enough with the assessment of radiographic examination, because attachment levels 1, 2 and 3 mm bone loss occurs not visible. It is clear that using only this method of diagnosis would increase the false negative underreported disease.
... 19 The nonsurgical periodontal treatment remains the gold standard for managing the patients with periodontitis. Matthews (2005) 73 , Cobb (2008) 74 and Apatzidou et al. (2010) 75 postulated that the nonsurgical treatment can result in reduction of inflammation, decrease in pocket depth and gain of attachment. However, mechanical therapy may fail to eliminate the pathogenic bacteria because of their location within gingival tissues or in other areas inaccessible to periodontal instrumentation. ...
... 19 The nonsurgical periodontal treatment remains the gold standard for managing the patients with periodontitis. Matthews (2005) 73 , Cobb (2008) 74 and Apatzidou et al. (2010) 75 postulated that the nonsurgical treatment can result in reduction of inflammation, decrease in pocket depth and gain of attachment. However, mechanical therapy may fail to eliminate the pathogenic bacteria because of their location within gingival tissues or in other areas inaccessible to periodontal instrumentation. ...
Periodontitis is a multifactorial infection associated with a variable bacterial pattern. The treatment focuses mainly on the reduction of the total bacterial count. Local delivery of antimicrobials has been investigated as an adjunct to conventional therapy. Tetracycline was proved to inhibit collagenases and was thus proposed to be useful in treating diseases. In recent years, silver nanoparticles have attracted considerable attention for medical applications due to their antibacterial activity. This study aims to evaluate the clinical and the microbiological findings following intrasulcular applications of tetracycline films and silver nanoparticles in periodontal pockets. A total of 48 periodontal pockets were studied. Group (A) received scaling and root planing with tetracycline film application, Group (B): scaling and root planing with silver nanoparticles application and Group (C): scaling and root planing only. The drugs were applied once weekly for three weeks. Clinical parameters were taken at baseline, after one and three months. Samples of gingival crevicular fluid were obtained at baseline and after one month for microbiological analysis. Groups A and B showed a significant decrease in probing depth and clinical attachment level as well as the reduction in the bacterial count compared to Group C. Thus, local application of tetracycline films and silver nanoparticles were effective in improving the clinical outcome and elimination of bacterial infection in periodontal pockets.
... 19 The nonsurgical periodontal treatment remains the gold standard for managing the patients with periodontitis. Matthews (2005) 73 , Cobb (2008) 74 and Apatzidou et al. (2010) 75 postulated that the nonsurgical treatment can result in reduction of inflammation, decrease in pocket depth and gain of attachment. However, mechanical therapy may fail to eliminate the pathogenic bacteria because of their location within gingival tissues or in other areas inaccessible to periodontal instrumentation. ...
... 19 The nonsurgical periodontal treatment remains the gold standard for managing the patients with periodontitis. Matthews (2005) 73 , Cobb (2008) 74 and Apatzidou et al. (2010) 75 postulated that the nonsurgical treatment can result in reduction of inflammation, decrease in pocket depth and gain of attachment. However, mechanical therapy may fail to eliminate the pathogenic bacteria because of their location within gingival tissues or in other areas inaccessible to periodontal instrumentation. ...
Periodontitis is a multifactorial infection associated with a variable bacterial pattern. The treatment focuses mainly on the reduction of the total bacterial count. Local delivery of antimicrobials has been investigated as an adjunct to conventional therapy. Tetracycline was proved to inhibit collagenases and was thus proposed to be useful in treating diseases. In recent years, silver nanoparticles have attracted considerable attention for medical applications due to their antibacterial activity. This study aims to evaluate the clinical and the microbiological findings following intrasulcular applications of tetracycline films and silver nanoparticles in periodontal pockets. A total of 48 periodontal pockets were studied. Group (A) received scaling and root planing with tetracycline film application, Group (B): scaling and root planing with silver nanoparticles application and Group (C): scaling and root planing only. The drugs were applied once weekly for three weeks. Clinical parameters were taken at baseline, after one and three months. Samples of gingival crevicular fluid were obtained at baseline and after one month for microbiological analysis. Groups A and B showed a significant decrease in probing depth and clinical attachment level as well as the reduction in the bacterial count compared to Group C. Thus, local application of tetracycline films and silver nanoparticles were effective in improving the clinical outcome and elimination of bacterial infection in periodontal pockets.
... The human microbiome encompasses all microorganisms inhabiting the skin, mucous membranes, and intestinal tract. The periodontium, a dynamic structure with specialized tissues, vasculature, lymphatics, and nerves, supports the teeth through components like alveolar bone, root cementum, periodontal ligament, and gingival mucosa [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Periodontal disease, a multifactorial inflammatory condition, progressively destroys these tissues, beginning with gingivitis-induced connective tissue degradation and mucosal disintegration [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. ...
Background/Objectives: The aim of this systematic review and meta-analysis was to determine the association between rheumatoid arthritis and periodontal disease. Methods: This systematic review and meta-analysis of the scientific literature was carried out based on the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We analyzed all studies that evaluated the relationship between the chronic inflammatory diseases through the response to non-surgical periodontal treatment, comparing the values of CAL (Clinical Attachment Level) for PD (periodontal disease) and DAS28 for RA. A total of three databases were searched in the literature search: Pubmed, Scopus, and Web of Science. After eliminating duplicate articles and applying certain inclusion criteria, of the 29 articles found, a total of 6 were included in the present study. Results: A statistically significant difference in mean reduction of −0.56 mm was obtained for CAL, with a 95% confidence interval of the difference between −0.82 and −0.31 (z-test = −4.33; p-value = 0.001) in favor of the periodontal treatment group. The heterogeneity of the meta-analysis was slight (I2 = 39% and Q = 8.19; p-value = 0.146). For DAS28, treatment showed a mean reduction of −0.39 DAS points, with a 95% CI between −0.46 and −0.31 (z-test = −10.3; p-value < 0.001) among patients with PD and RA. Conclusions: The present study shows how the control of periodontal disease through non-surgical periodontal treatment can reduce the severity of RA. This finding consistently supports the idea that there is a pathogenic association between these two chronic inflammatory diseases.
... The professional Phase I Therapy includes removal of plaque through scaling and root planning procedures which is considered as Gold Standard among non-surgical treatment modalities in Chronic Periodontitis. [2] The mechanical plaque control is achieved both professionally and by the patient at home. Various mechanical oral hygiene measure includes tooth brushing, interdental cleaning aids and subgingival irrigation performed by patient at home. ...
Periodontitis is an infectious disease that results in inflammation and destruction of the periodontal tissue. The primary goal of periodontal treatment is the elimination or reduction in the number of pathogenic bacteria. SRP does not completely eliminate the residual pockets and periodontopathogenic bacteria. Ozone is a
competitive antimicrobial agent effective against Gram-Positive and Gram-Negative bacteria, fungi, protozoa and viruses. The application of Ozonated olive oil reduces plaque and gingival score and reduces the colony count of streptococcus mutans and lactobacillus. Therefore, the present study was conducted to compare and evaluate the clinical and microbiological outcomes of ozonated olive oil and olive oil as an adjunct to scaling and root planning.
... Scaling and root planing is considered as the "gold standard" among non-surgical treatment modalities in chronic periodontitis. 2 After phase I therapy, there is a significant improvement in gingival inflammation, less bleeding, decreased PPD and increased CAL. Additionally, there were several drawbacks to systemic antibiotic therapy, including the emergence of resistance strains, the prevalence of super infections, and systemic adverse effects that prevented their widespread usage. ...
condition that affects the tissues supporting teeth,
periodontitis is inflammatory and distinguished by a microbial challenge
that triggers the human immune system, which leads to inflammation, the development of periodontal pockets and the final disintegration of the periodontal ligament and alveolar bone. Regenerating the lost periodontal tissues, including as the cementum, periodontal ligament, and alveolar bone, is ultimate objective of periodontal therapy. Numerous locally administered medication delivery strategies, including tetracycline, doxycycline, minocycline, and chlorhexidine, have been
shown to be advantageous. Metformin, an antidiabetic medication, has recently been demonstrated to have osteogenic potential, which encourages the production of new bone and increases osteoblastic differentiation. Therefore, the current study's goal is to assess how well locally delivered 1% Metformin gel works in conjunction with SRP to treat stage I/II with grade A/B periodontitis.
... Scaling typically involves using ultrasonic instruments or manual scalers to break up and remove plaque deposits. Root planing smoothens the rough surfaces of the tooth roots, making it harder for plaque to adhere in the future [44][45][46]. This procedure can be uncomfortable and may require local anesthesia to numb the area. ...
This review explores periodontal disease, a chronic inflammatory condition affecting
the gum tissues and supporting bone. It highlights the concerning prevalence of this
disease, impacting nearly 1 billion adults globally, and emphasizes its association with
various systemic health issues. Following a detailed description of the disease progression from gingivitis to periodontitis, the review examines traditional methods of
diagnosis and treatment. These methods, including clinical examination, X-rays, scaling and root planning, and antibiotics, are effective but often employ a one-size-fits-all
approach. The limitations of this approach in addressing the underlying cause, the
specific bacterial communities within the oral microbiome, are discussed. Finally, the
review introduces the concept of microbial metagenomics as a promising avenue for
personalized diagnosis and treatment of periodontal disease. This technology analyzes the complete genetic fingerprint of the oral microbiome, paving the way for
targeted interventions and potentially revolutionizing the future of periodontal care.
Nevertheless, this advancement of unique technologies does not come without its
own challenges that include high cost which is an obstacle for poor countries, standardization requirements, and ethical issues concerning the personalized medicine
approach.
... Periodontal diseases are a multifactorial inflammatory conditions caused by interaction between oral bacteria organized in complex communities that form biofilms, adhering to dental structure and infecting the tooth supporting tissue and the local host defense response (1) . ...
... Periodontal disease and dental caries are major public health challenges that contribute significantly to the global burden of oral disease [1][2][3]. Dental biofilm is an important etiologic factor in the inception and development of caries and periodontal disease [4]. The essential role of dental biofilm in the etiology of gingivitis is well established and the removal of dental biofilm can reverse this process [5]. ...
Objective
This study aims to evaluate three types of manual toothbrushes [Cross action (CA), Flat trim (FT), and orthodontic type (OT)] in terms of efficacy in plaque removal in patients undergoing fixed orthodontic treatment.
Background
Manual toothbrushes are an essential part of oral hygiene for primary prevention. Plaque control, however, can be influenced by a number of individual and material-related factors. Individual factors include the presence of fixed orthodontic appliances on tooth surfaces, such as brackets and bands, which create difficulties with oral hygiene and lead to plaque formation. The evidence for the effectiveness of advanced bristle designs (multilevel, criss-cross) of the manual toothbrush alone in removing plaque in patients undergoing orthodontic therapy is limited.
Methods
The experiment followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. This was a three treatment, three-period crossover clinical trial with a single brushing exercise. Thirty subjects were randomized to one of the three treatment sequences of different bristle designs: (CA, FT, and OT). The primary outcome measure was the difference in the plaque scores (baseline minus post-brushing) at each study period, as determined by the Turesky-Modified Quigley–Hein Plaque Index.
Results
Of the thirty-four subjects enrolled in the study, thirty of the subjects met the inclusion criteria and completed all three periods of the study. The mean age was 19.5 ± 1.52 years, with a range of 18–23 years. The differences between treatments in plaque score reduction after brushing were statistically significant ( p -value < .001). The treatment differences were statistically significant ( p -value < .001) favoring the FT toothbrush over the OT and CA types of toothbrush designs. On the contrary, the difference between the OT and CA types was not statistically significant.
Conclusions
Plaque was significantly removed by the conventional FT toothbrush after a single brushing compared to the OT and CA types.
... Periodontal plaque is a biofilm that is both physically and physiologically structured. It is a group of microorganisms that are located on the surface of teeth as a coating and are encased in a framework of polymers that have both microbial and host origins [1]. Plaque on teeth has been defined as the soft, persistent substance present on the surface of the tooth that is difficult to remove with a simple water rinse [2]. ...
Background:
When intraoral orthodontic devices are used, it becomes significantly more difficult to remove plaque effectively. Dentists and orthodontic specialists can come up with more effective preventive strategies while patients are undergoing fixed orthodontic work if they have a deeper understanding of the present scenario. In addition, individuals will become more aware of the importance of good dental hygiene habits as a result of this.
Objective:
To assess and compare the effectiveness of a manual toothbrush, machine-driven toothbrush, and conventional mechanical toothbrush coupled with mouth rinse in removing plaque and maintaining gingival health in patients undergoing fixed orthodontic treatment.
Methods and materials:
In this research, a total of 222 individuals who met the eligibility and exclusion requirements were randomly selected and offered their written consent. There were a total of 74 participants for each of the three different categories. Category A used a physically driven toothbrush. Category B used a motorized toothbrush. Category C used a physically driven toothbrush together with mouthwash containing 0.2% chlorhexidine gluconate. All study participants were assessed at baseline, one-month follow-up, and two-month follow-up to document the preliminary information, including that of the modified papillary bleeding index (MPBI) by Muhlemann, plaque index (PI) introduced by Silness and Loe, and gingival index (GI) introduced by Loe and Silness.
Results:
In this study, the mean PI scores at the one-month and two-month follow-ups were minimum in Category C, while it was maximum in Category A at the two-month follow-up. The mean GI scores at the two-month follow-up were minimum in Category C, while it was maximum in Category A at the two-month follow-up. The mean MPBI scores at the two-month follow-up were minimum in Category C, while it was maximum in Category A. It was observed that participants in this trial who only used a typical mechanical brush experienced an increase in PI and GI scores after one and two months of follow-up. At the one-month and two-month follow-ups, it was noted that the values of PI, GI, and MPBI significantly decreased in the study participants using automated toothbrushes as well as in study participants using manual toothbrushes in conjunction with chlorhexidine mouthwash as compared to baseline values. However, when the three categories were compared, it was found that the research participants utilizing both a manual toothbrush and 0.2% chlorhexidine experienced the highest decreases in PI, GI, and MPBI values.
Conclusion:
The reduction in the scores of PI, GI, and MPBI was maximum in orthodontic patients after two months when they apply manual toothbrushing along with 0.2% chlorhexidine.
... [2,18] SRP is considered as a gold standard in treatment of periodontal disease. [19] It is not only during initial phase of treatment but also as a maintenance therapy to prevent recurrence. [20] Antioxidant activity of Spirulina is due to presence of 2 phycobiliproteins that is phycocyanin and allophycocyanin. ...
Background:
Production of reactive oxygen species (ROS) by polymorpho nuclear neutrophils occurs in chronic periodontitis. These ROS are mainly involved in bacterial destruction. However, extracellular release of same results in destruction of surrounding tissue. Spirulina, a potent antioxidant when administered sub gingivally in pockets can offer improved results in chronic periodontitis patients. This study was conducted to evaluate the effect of Spirulina when delivered sub gingivally in patients with chronic periodontitis.
Methods:
Sixty chronic periodontitis patients were divided into 2 groups. Group I (n = 30) were treated with Scaling and Root planning (SRP) followed by placement of placebo (SRP-P) and in Group II (n = 30) Spirulina microspheres were placed sub gingivally (SRP-S) following SRP. Clinical parameters like bleeding on probing (BOP), clinical attachment level (CAL), gingival index (GI) and probing pocket depth (PPD) were evaluated. Levels of salivary and serum Malondialdehyde (MDA) were estimated using ultra violet spectrophotometer.
Results:
At baseline, in both groups there was no statistically significant difference in clinical and biochemical parameters. Intra group comparisons of parameters from baseline to 90 days were statistically significant in both groups. After 90 days difference in clinical parameters and salivary MDA levels were statistically significant in SRP-S compared to SRP-P group. Though serum MDA levels were reduced in both groups, they were not significant statistically.
Conclusions:
Our study concluded that, local drug delivery of Spirulina adjunctive to SRP has potent antioxidant effect in treatment of chronic periodontitis.
... Ide et al. (2004) reported a clinically significant elevation in serum IL-6 and TNF-α levels after NSPT [54]. Specific studies have highlighted the beneficial aspects of NSPT as transitory and asserted that the clinical inflammatory indicators typically increased 12 months following the treatment [55,56]. Apart from that, NSPT has been observed to improve serum urea and eGFR levels in CKD patients. ...
Chronic kidney disease (CKD) and chronic periodontitis (CP) contribute to the increased level of inflammatory biomarkers in the blood. This study hypothesized that successful periodontal treatment would reduce the level of inflammatory biomarkers in CKD patients. This prospective study recruited two groups of CP patients: 33 pre-dialysis CKD patients and 33 non-CKD patients. All patients underwent non-surgical periodontal therapy (NSPT). Their blood samples and periodontal parameters were taken before and after six weeks of NSPT. The serum level of high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and periodontal parameters were compared between groups. On the other hand, kidney function indicators such as serum urea and estimated glomerular filtration rate (eGFR) were only measured in CKD patients. Clinical periodontal parameters and inflammatory markers levels at baseline were significantly higher (p < 0.05) in the CKD group than in the non-CKD group and showed significant reduction (p < 0.05) after six weeks of NSPT. CKD patients demonstrated a greater periodontitis severity and higher inflammatory burden than non-CKD patients. Additionally, CKD patients with CP showed a good response to NSPT. Therefore, CKD patients’ periodontal health needs to be screened for early dental interventions and monitored accordingly.
... Dental biofilm contributes to the initiation and development of dental caries and periodontitis [1]. The important role that dental biofilm plays in gingivitis etiology has long been established and can be reversed through the removal of dental biofilm. ...
Background
Fixed orthodontic appliances on tooth surfaces, such as brackets and bands, complicate oral hygiene and increase plaque accumulation, contributing to gingivitis, periodontitis, and tooth decay. While manual toothbrushes are an essential part of oral hygiene, there is little clinical evidence to demonstrate how effective manual toothbrushes with novel designs are at removing plaque from orthodontic patients. This study aims to evaluate three types of manual toothbrushes (Pulsar, conventional flat trim (C-TB), and orthodontic type (O-TB)) for their efficacy in plaque removal among patients undergoing fixed orthodontic treatment.
Methodology
The study followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. It was a three-treatment, three-period, examiner-blinded crossover clinical trial conducted with a single brushing exercise. Twenty-four subjects were randomized to one of three different bristle designs (Pulsar, C-TB, and O-TB). The primary outcome measure was the difference (baseline minus post-brushing) in plaque scores assessed using the Turesky-Modified Quigley-Hein Plaque Index during each study period.
Results
Of the 27 subjects enrolled in the study, 24 met the inclusion criteria and completed all three periods of the study. The mean age was 19.58 ± 1.55 years, with a range of 18-23 years. The differences between treatments in plaque score reduction after brushing were statistically significant (p-value <0.001). The treatment differences were statistically significant (p-value <0.001), favoring the C-TB toothbrush and the O-TB over the Pulsar design. On the contrary, the difference between the O-TB and C-TB types was not statistically significant.
Conclusions
C-TB and O-TB remove significantly more plaque than Pulsar toothbrushes after a single brushing exercise. Nevertheless, the C-TB tested in this study was more effective in removing dental plaque than the O-TB in patients wearing fixed orthodontic appliances. Considering the limitations of this study, additional research is required before evidence-based advice concerning the relative performance of the Pulsar toothbrushes in fixed orthodontic patients can be proven.
... The objective of the conventional periodontal therapy is to alter or eliminate the primary microbial etiological factor, plaque and other predisposing factor such as calculus, overhanging restoration and faulty prosthesis. Scaling and root planing is considered as the "gold standard" among non-surgical treatment modalities in chronic periodontitis [2] . However, in clinical cases, the complex anatomy of the root, root concavities, furcation involvement and deep periodontal pockets may hamper the treatment and prevent sufficient reduction of bacterial load. ...
The most important goal of periodontal therapy is to reduce or eliminate the subgingival micro-organisms associated with periodontal disease and to maintain periodontal health. Scaling and root planing is the traditional method and has shown effective treatment for chronic periodontitis but it does not necessarily eliminate all the pathogens. Hence, the need for antimicrobial therapy as local drug delivery agents was felt. The objective of the study was to compare and evaluate the effectiveness of Tetracycline fibers (Periodontal Plus ABTM) and Chlorhexidine chip (Periocol – CGTM) as an adjunct to scaling and root planing in the management of chronic periodontitis
... These methods target the removal of sub-and supragingival plaque and calculus (Cobb, 2002;Roberts and Darveau, 2002;Claffey et al., 2004). In some cases, because of deep pocket sites in multirooted teeth, scaling and root planning alone are not sufficient, and additional advanced therapies, such as periodontal surgery and the use of antibiotics, are required (Claffey et al., 2004;Cobb, 2008). ...
Introduction: At the initial part of the gastrointestinal tract, multiple tissues serve the normal function of food delivery. Periodontal structures are integral elements of these. When they deteriorate, it is extremely challenging to regenerate and reconstruct them. The conventional intervention for periodontal disease is scaling and root planning with the aim of reducing pathogenic bacteria. However, periodontal pathogens can rapidly recolonize treated areas. Probiotics have been proposed as novel tools for managing oral health by suppressing pathogenic bacteria through their anti-inflammatory effect, but the available data are controversial.
Aim: Therefore, we performed a meta-analysis to study the effect of probiotics on periodontal pathogenic bacteria.
Methods: The study was registered in PROSPERO under registration number CRD42018094903. A comprehensive literature search from four electronic databases (PubMed, Cochrane CENTRAL, Embase, and Web of Science) yielded nine eligible records for statistical analysis. Studies measuring bacterial counts in saliva and supra- and subgingival plaque were included. Bacterial counts were analyzed using standard mean difference (SMD) and by a random effects model with the DerSimonian–Laird estimation.
Results: The results showed a significant decrease in the overall count of Aggregatibacter actinomycetemcomitans in the probiotic-treated group compared to the control at 4 weeks (SMD: −0.28; 95% CI: −0.56–−0.01; p = 0.045) but not later. Analyzing the bacterial counts in subgroups, namely, in saliva and supra- and subgingival plaque, separately, yielded no significant difference. Probiotics had no significant effect on the overall count of Porphyromonas gingivalis at 4 weeks (SMD: −0.02; 95% CI: −0.35−0.31; p = 0.914) or later. Subgroup analysis also revealed no significant difference between treatment and control groups nor did probiotics significantly decrease the overall and subgroup bacterial counts of Prevotella intermedia, Tannerella forsythia, and Fusobacterium nucleatum.
Conclusion: Our data support the beneficial effect of probiotics in reducing A. actinomycetemcomitans counts, but not of other key periodontal pathogenic bacteria in periodontal disease patients. However, due to the complex mechanism associated with periodontal disease and the limitations of the available studies, there is a further need for well-designed randomized clinical trials to assess the efficacy of probiotics.
... Scaling and root planing (SRP) represents the gold standard therapy for the treatment of periodontal disease, along with the concomitant use of antibiotics and/or antiseptics [5,14]. In order to propose new chemical compounds, the major goal of the present study was to assess the efficacy of subgingival applications of ozone gel in addition to SRP, with respect to SRP plus a conventional chlorhexidine gel. ...
The search for new topical treatments able to display not only antimicrobial properties but also a multiplicity of other beneficial effects while expressing safe cytocompatibility toward host tissues is being progressively developed. Antiseptics represent an aid to the gold standard nonsurgical treatment Scaling-and-Root-Planing (SRP) for periodontal disease. This split-mouth study aims to assess the efficacy of the ozonized gel GeliO3 (Bioemmei Srl, Vicenza, Italy) plus SRP (experimental treatment), with respect to SRP + chlorhexidine gel. Ten participants were treated with SRP + chlorhexidine gel (control sites) and with SRP + ozone gel (trial sites). After 1 (T1) and 3 months (T2) from baseline (T0), patients were revisited. At each time-point, the following indexes were assessed: probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI), plaque index (PI), and bleeding on probing (BoP). It has been assessed that the use of the ozonized gel in addition to SRP did not show significant differences if compared to conventional SRP + chlorhexidine. Chlorhexidine was found to be more effective than ozone in reducing CAL and GI at T2. Ozone deserves consideration for its wide applicability in several clinical fields. In this connection, we also glance at the latest research on ozone therapy.
... The modified Sulcular Bleeding Index (SBI) Mombelli et al. 1987 scores showed a statistically significant reduction in all the groups, which could be attributed to very minimum bleeding on probing due to decreased inflammation after scaling and root planing. This is in accordance with the studies conducted by Charles M Cobb (2008) [13] and Anjani Kumar Pathak et al. (2016) [14] . ...
Aim: This study aimed to compare the effect of low-level laser therapy irradiation with two different wavelengths after osteotomy site preparation on the stability of dental implants. Materials and Methods: The current study is a double-masked, randomized clinical trial. A total of seven patients of age 25 to 55 years were assigned randomly into two groups. Group I: Osteotomy site irradiated with low-level laser therapy of wavelength 940nm. GROUP II: Osteotomy site irradiated with low-level laser therapy of wavelength 660nm. Implant stability was measured after implant placement using the Penguin RFA device. Bone formation was assessed with Cone Beam Computed Tomography. Results: The current trial results showed that low-level laser therapy aided in bone formation around the implants, but there is no significant difference between the two different wavelengths. Conclusion: Implant stability increased in both groups, but no difference is observed among the groups. Hounsfield units indicating bone formation improved in both the groups with no pronounced difference between the groups. All 14 implants were stable, thus indicating that low-level laser therapy aids bone formation, but the wavelength difference had no significant impact. Keywords: Low level laser therapy, Implant Stability, Resonance frequency analysis
... Plaque control can be performed mechanically and chemically. Mechanical plaque control can be performed using conventional methods, such as tooth brushing and dental flossing, however these methods are incapable of removing plaque accumulation on certain parts, such as the gingival sulcus (Cobb, 2008). The disadvantages of conventional methods can be overcome by combining them with chemical methods such as mouth wash (Wolf et al., 2005). ...
Successful of periodontal treatment is to eradicate biofilm of bacteria. Aggregatibacter actinomycetemcomitans is a Gram-negative bacterium that have been suggested to be the main causes of periodontal disease. Theobroma cacao (cacao pod) is a medicinal plant that has a broad range of pharmacological effects. The aim of this study was to assess the antibiofilm effect of cacao pod extract against A. actinomycetemcomitans biofilm in vitro. A. actinomycetemcomitans were cultured in Brain Heart Infusion broth. Crystal-violet staining in biofilm assays were used to evaluate the cacao pod extract effect on A. actinomycetemcomitans ATCC 33384 biofilms and 0.2% chlorhexidine-gluconate was used as a positive control. After 24 hours of incubation, the optical density of each well in microtiter plates was measured. The results showed that the biofilm density after incubation with the cacao pod extract was significantly decreased in all concentrations and all incubation times (p<0.05). The most effective concentration for inhibiting biofilm A. actinomycetemcomitans was 100% cacao pod extract and 3 hrs of incubation time (p<0.05) with a 98.9% reduction of biofilm compared to negative control. Cacao pod extract is effective in inhibiting the growth of A. actinomycetemcomitans biofilm.
... There are several studies that recorded more severe periodontal diseases among pregnant women than control groups (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) . The clinical manifestations of plaque-induced gingival inflammation are modulated by hormonal imbalances that occur during pregnancy (20) . Normal pregnancy is associated with higher metabolic demand and elevated requirements for tissue oxygen that results in increased production of reactive oxygen species and increased oxidative stress (21) . ...
ABSTRACT
Background: There is an increased oxidative stress during pregnancy that might affect their gingival health.
This study was conducted to measure salivary protein carbonyl level of pregnant women and its relation with
gingival health also compared the data obtained with those from healthy married non-pregnant women. Material
and Methods: Thirty pregnant women during third trimester (i.e. study group) and thirty married non-pregnant
women (i.e. control group) were selected from the Primary Health Care Centers in Baghdad city. The age range
of both groups was 25-30 years. Stimulated saliva was collected and salivary protein carbonyl was analyzed
using protein carbonyl assay kit. Plaque index (PlI) was used for measuring dental plaque thickness while
gingival index (GI) was used for diagnosis of gingival disease. Results: The mean values of salivary protein
carbonyl, plaque and gingival indices were highly significantly higher among pregnant than non-pregnant
women (P˂0.01). Person's correlation coefficient showed positive strong highly significant correlation (P˂0.01)
between plaque accumulation and gingivitis among pregnant and non-pregnant women. While non-significant
correlations (P>0.05) were recorded between salivary protein carbonyl levels with both gingival and dental
plaque indices among both pregnant and non-pregnant women. Conclusion: Although dental plaque is the main
etiological factor in pregnancy gingivitis, protein oxidation represented by salivary protein carbonyl level could
play a role in gingival inflammation during pregnancy. Therefore examining the proteomic profile along with
protein oxidation is recommended that helps in early detection and monitoring of periodontal infection during
pregnancy.
Key words: pregnancy, oxidative stress, protein carbonyl, gingival health status
... Thus, antimicrobial agents target the vulnerable microorganisms present in different oral cavity habitats. 2 The success of local antimicrobial agents used in periodontal management rests on delivery of the agent subgingivally, maintenance of active concentrations of the antimicrobial agent, and achieving enough contact time between target microorganisms and the antimicrobial agent. Inability to achieve at least one of these parameters could be the cause for the comparative ineffectiveness of several antimicrobial treatments applied locally in periodontics. ...
... In clinical periodontology and related research, SRP is considered the non-surgical gold standard for the treatment of periodontal diseases such as CP [34]. In order to assess the outcomes or efficacy of SRP, clinical (CAL, GI, PI, and GI) and radiographic (MBL) parameters are traditionally measured before and after NSPT. ...
Purpose:
The aim of this cross-sectional study was to investigate the effect of scaling and root planing (SRP) on the expression of anti-inflammatory cytokines (interleukin [IL]-4, IL-9, IL-10, and IL-13) in the gingival crevicular fluid (GCF) of electronic cigarette users and non-smokers with moderate chronic periodontitis (CP).
Methods:
Electronic cigarette users and non-smokers with CP were included in the study. Full-mouth plaque and gingival indices, probing depth (PD), clinical attachment loss (CAL), and marginal bone loss (MBL) were assessed. The GCF was collected, and its volume and levels of IL-4, IL-9, IL-10, and IL-13 were assessed. These parameters were evaluated at baseline and 3 months after SRP. The sample size was estimated, and comparisons between groups were performed. P<0.05 was considered to indicate statistical significance.
Results:
Thirty-six electronic cigarette users (47.7±5.8 years old) and 35 non-smokers (46.5±3.4 years old) with CP were included. At baseline, there were no differences in plaque index (PI), PD, CAL, MBL, and GCF IL-4, IL-9, IL-10, and IL-13 between electronic cigarette users and non-smokers. At the 3-month follow-up, there were no significant differences in PI, gingival index (GI), PD, CAL, and MBL in electronic cigarette users compared to baseline, while there were significant reductions in PI, GI, and PD among non-smokers. At the 3-month follow-up, GCF IL-4, IL-9, IL-10, and IL-13 levels were significantly elevated in both groups (P<0.05) compared to baseline. The increases in GCF IL-4, IL-9, IL-10, and IL-13 levels were significantly higher in non-smokers (P<0.05) than in electronic cigarette users at the 3-month follow-up.
Conclusions:
Levels of GCF IL-4, IL-9, IL-10, and IL-13 increased after SRP in electronic cigarette users and non-smokers with CP; however, the anti-inflammatory effect of SRP was more profound in non-smokers than in electronic cigarette users.
... Finally, it is clear that standard nonsurgical therapy of scaling and root planing lowers the microbial burden in periodontitis and decreases inflammation as an approach to controlling the disease (44,62,64). However, while the majority of the population responds well to this treatment, a portion of the population continues to demonstrate disease, with little predictive understanding of who constitutes this "nonresponding" group (70)(71)(72)(73). In humans, it is difficult to implement a prospective periodontitis protocol, and the longitudinal dynamics of the microbiome have generally been defined by comparing disease microbiomes to those posttreatment. ...
This investigation compared the microbiome colonizing teeth during the initiation, progression and resolution of periodontitis in nonhuman primates ( Macaca mulatta ) at different ages. Subgingival plaque samples were collected at baseline, and at 0.5, 1 and 3 months following ligature-induced periodontitis and following naturally-occurring disease resolution at 5 months. Samples were analyzed using 16S amplicon sequencing to identify bacterial profiles across age groups: young (<3 yrs), adolescent (3-7 yrs.), adult (12-15 yrs.) aged (17-23 yrs.). α-diversity of the microbiomes was greater in the adult/aged samples compared to the young/adolescent samples. β-diversity of the samples demonstrated clear age group differences, albeit, individual variation in microbiomes between animals within the age categories was noted. Phyla distribution differed between the young/adolescent group animals and the adult/aged animals at each of the time points showing an enrichment of Spirochetes , Fusobacteria , and Bacteroidetes phyla associated with periodontitis. Major differences in the top 50 OTUs were noted in the young and adolescent microbiomes during the initiation and progression post-ligation compared to the adult and aged animals. A large number of species in the top 50 OTUs were lower at baseline and in resolved disease microbiomes in the young samples, while profiles in adolescent animals were more consistent with the disease microbiomes. Microbiome profiles for resolution for adults and aged animals appeared more resilient and generally maintained a pattern similar to disease. Use of the model can expand our understanding of the crucial interactions of the oral microbiome and host responses in periodontitis.
... Gingivitis is limited to inflammation involving only the gingival soft tissues. Gingivitis has a high prevalence rate and affects 50%-90% of adults worldwide [3,4] In its severest form, periodontitis, initiated by plaque biofilm, results in a loss of periodontal attachment to the root surface and adjacent alveolar bone, which ultimately leads to tooth loss [5,6]. Prevalence rates of periodontitis among people aged 35-44 years are 54% in Taiwan and 47% in the United States [7]. ...
... It is caused due to presence of number of microorganisms, therefore, is of complex nature (2). The treatment of periodontitis begins with reduction of total microbes through surgical and nonsurgical means consisting of mechanical scaling, root planning (3), and often accompanied by antibiotics (4). Therefore these treatments eliminate entire microbial flora by keeping prolonged drug-microbial contact (5,6). ...
The objective of this research was to develop and optimize a controlled release gel (CRG) system for metronidazole benzoate (MZB), poorly water soluble drug using methylcellulose (MC) and hydroxypropyl methyl cellulose (HPMC E15)as a polymer for the treatment of periodontal diseases. The composition was optimized using a Box-Behnken design and 15 formulations were prepared. Gels were characterized by mechanical testing, UV, FTIR, DSC, TEM, appearance, pH, viscosity, clarity, homogeneity, extrudability and antibacterial performance against Staphylococcus aureus (SA) and Bacillus subtilis. (BS). In vitro release of the gel formulations was compared with marketed preparation of metronidazole (Metrogyl® gel) using modified Franz diffusion cell.The results indicate that the MZB gel sustained the release of drug. Kinetics of drug release from the gels was studied by fitting the data to six kinetic models. The results showed Korsmeyer-Peppas, Weibull and Higuchi to be the most appropriate models to describe the release kinetics of MZB from 15 gel formulations.
... The number of the worldwide adult population who suffer from periodontal disease is about 50% (Wahyukundari, 2009). The primary aetiology of periodontal disease is irritation of specific pathogens (Charles, 2008). The secondary aetiology is poor condition of mouth cavity, smoking, education level, socioeconomic status, age, pregnancy, genetic factors and systemic disease (Widyastuti, 2009). ...
This research was done to make the mask that was coated with activated carbon derived from palm
shell as renewable material and impregnated with Titanium Dioxide (TiO2) to prevent it from rapid
saturation. The mask was tested by Photocatalytic Continue Adsorption of CO gas with various
conditions and TiO2 compositions. The BET surface area of AC is 214.451 m2/g. The FESEM-EDX
result showed AC and TiO2 were well coated on the mask filter. The mask worked better if it’s
exposed to the UV light due to activation of TiO2 that oxidize CO gas on AC. The best result obtained
was a mask with composition 5g AC-5% TiO2 that eliminated CO gas from motorcycle exhaust gas
with the average 33.87% of its concentration. The test with the highest CO concentration that has ever
been recorded in Indonesia showed that that the mask could eliminate CO until below the safety limit.
Keywords: activated carbon, adsorption, photocatalysis.
... Thus, the need for follow-up treatment, usually consisting of supra-and subgingival debridement at 3 to 4 month intervals, is necessary to maintain the initially gained beneficial effects " . [52]End-stage renal disease substantially increases the risks of death, cardiovascular disease, and use of specialized health care, but the effects of less severe kidney dysfunction on these outcomes are less well defined. Go AS et al [53] studied these outcomes in a large population and found that the risk of death and hospitalization increased as the GFR decreased below 60 ml/min/1.73m ...
... [4] Scaling root planing (SRP) is considered as the gold standard in improving clinical, microbial, and biochemical parameters of periodontal disease. [5] Various antimicrobials are used as an adjunct to enhance the effects of SRP considering multiple actions of the drug used either in the local drug delivery or systemic form. Administration via AZM buccal patch delivers the sufficient quantity of drug 90% to systemic circulation compared to oral administration of AZM (37%). ...
Aim: This study aims to explore the clinical, microbiological, and biochemical impact of azithromycin (AZM) buccal patch in chronic generalized patients as a monotherapy as well as an adjunct to nonsurgical therapy.
Materials and Methods: A parallel design was used forty periodontitis patients were randomly allocated into five groups, namely Group 1 scaling root planing (SRP) alone, Group 2 (SRP + AZM patch group), Group 3 (SRP + AZM tablet group), Group 4 (AZM patch monotherapy), and Group 5 (AZM tablet as monotherapy). Plaque index, gingival bleeding index, modified gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were assessed at baseline and 21 and 90 days. Subgingival pooled plaque sample was collected to assess periodontopathogens like Porphyromonas gingivalis and Prevotella intermedia (Pi) by anaerobic culture method. Tumor necrosis factor alpha (TNF-α) was also evaluated at baseline and 21 days. Periodontal maintenance was performed in Group 1 until 90th day, and clinical parameter was assessed at the end of 90th day.
Results: SRP + AZM tablets showed greater reduction in clinical parameters (P < 0.05) AZM as monotherapy did not offer clinical benefits over SRP. Baseline data were compared at the end, i.e., 90th day a significant reduction in plaque scores, gingival bleeding, and PPD was observed however no significant gain in the clinical attachment was observed.
Conclusion: The monotherapy resulted in no improvement of periodontal parameters, microbial parameters, and TNF-α level. It is safe to use AZM + SRP as a mode of nonsurgical treatment in periodontitis patients.
... El éxito del tratamiento estaría asociado a la reducción de patógenos periodontales del área subgingival y si bien se han observado profundos cambios en la composición de la microflora, estos serían transitorios, especialmente en los sitios profundos (15,(20)(21)(22)(23)(24)(25) . ...
OBJECTIVES: To evaluate the microbial composition of deep periodontal pockets at baseline, 1 week, 3 and 12 months after scaling and root planing and the clinical effects of the treatment. METHODS: Clinical parameters were measured and bacterial samples were collected from 44 sites in 11 patients. By means of Polymerase Chain Reaction (PCR) the presence of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythia (Tf) and Prevotella intermedia (Pi) was studied. The patients received mechanical periodontal therapy and were evaluated after 1 week, 3 and 12 months. RESULTS: After treatment all clinical parameters (Plaque, Bleeding on probing, Supuration, Probing Pocket Depth and Clinical Attachment Level) were significantly reduced, and the values obtained were maintained up to the 12 months that the study lasts. At baseline, the most prevalent specie were Pg, present in 66% of the sites, Tf (55%) and Td (41%). The deepest sites were related with the association Tf -Td and Tf- Td- Pi. The reduction in the number of the sites positive for Td, Tf and Pg was significative. CONCLUSIONS: Scaling and root planing resulted on an improvement of both clinical parameters end reduction of Pg, Td and Tf peridontal pathogens occurence in deep periodontal pockets. The results obtained were maintained up to 12 months. No further clinical attachment loss was found in 86% of the sites at 3 months and 79% at 12 months. The sites where the treatment failed in eradicating bacterial species showed, at 12 months, greater probing pocket depths and persistence of periodontal pathogens.
Periodontal disease is a multifactorial pathogenic condition involving microbial infection, inflammation, and various systemic complications. Here, a systematic and comprehensive review discussing key-points such as the pros and cons of conventional methods, new advancements, challenges, patents and products, and future prospects is presented. A systematic review process was adopted here by using the following keywords: periodontal diseases, pathogenesis, models, patents, challenges, recent developments, and 3-D printing scaffolds. Search engines used were “google scholar”, “web of science”, “scopus”, and “pubmed”, along with textbooks published over the last few decades. A thorough study of the published data rendered an accurate and deep understanding of periodontal diseases, the gap of research so far, and future opportunities. Formulation scientists and doctors need to be interconnected for a better understanding of the disease to prescribe a quality product. Moreover, prime challenges (such as a lack of a vital testing model, scarcity of clinical and preclinical data, products allowing for high drug access to deeper tissue regions for prolonged residence, lack of an international monitoring body, lack of 4D or time controlled scaffolds, and lack of successful AI based tools) exist that must be addressed for designing new quality products. Generally, several products have been commercialized to treat periodontal diseases with certain limitations. Various strategic approaches have been attempted to target certain delivery regions, maximize residence time, improve efficacy, and reduce toxicity. Conclusively, the current review summarizes valuable information for researchers and healthcare professional to treat a wide range of periodontal diseases.
Introduction:
Cytokines have a key role in the pathogenesis of both hypertension and periodontitis. Salivary diagnosis is a promising field with numerous clinical applications. Since limited studies have been carried out on how salivary inflammatory cytokines can be determined and how well periodontal disease and hypertension might react to scaling and root planning (SRP). The goal of this study was to identify the pattern of changes in salivary inflammatory cytokines in chronic periodontitis subjects with hypertension after nonsurgical periodontal therapy.
Methods:
It included observational trial recruited 94 chronic periodontitis patients, 44 of whom had hypertension. All subjects have undergone non- surgical periodontal treatment. The clinical periodontal parameters included gingival index (GI), plaque index (PI), and probing of pocket depth (PPD). Unstimulated saliva was collected to determine the inflammatory biomarkers (using a commercial Elisa kit) both before and after SRP.
Results:
In comparison to non-hypertensive participants, the periodontal PPD was significantly higher in hypertensive subjects. All clinical parameters in the first examination, except for PI, were significantly higher in hypertensive than in non-hypertensive subjects. Plaque Index, GI, and PPD parameters at first visit and after finishing treatment positively correlated with salivary IL-1β, excluding pretreatment GI. The current results demonstrate the presence of a positive correlation between diastolic blood pressure and TNF (r = 0.330 and P = 0.029). All patients enrolled in this study showed a significant increase in the salivary levels of IL4 after SRP.
Conclusions:
The current study offer important and valuable information concerning the practical application of pro-inflammatory and anti-inflammatory cytokines as useful biomarkers and indicators for determining the outcome of SRP and progression of chronic periodontitis in patients with hypertension.
Background:
This study tests the effects of scaling and root planing (SRP) versus SRP plus minocycline hydrochloride microspheres (SRP+MM) on 11 periodontal pathogens and clinical outcomes in Stage II-IV Grade B periodontitis participants.
Methods:
Seventy participants were randomized to receive SRP (n = 35) or SRP+MM (n = 35). Saliva and clinical outcomes were collected for both groups at baseline before SRP, 1-month reevaluation, and at 3- and 6-month periodontal recall. MM were delivered to pockets ≥5 mm immediately after SRP and immediately after the 3-month periodontal maintenance in the SRP+MM group. A proprietary saliva test* was utilized to quantitate 11 putative periodontal pathogens. Microorganisms and clinical outcomes were compared between groups using generalized linear mixed-effects models with fixed effects and random effects terms. Mean changes from baseline were compared between groups via group-by-visit interaction tests.
Results:
Significant reduction in Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, Prevotella intermedia, Parvimonas micra, and Eikenella corrodens were identified at the 1-month reevaluation after SRP+MM. Six months after SRP with a re-application of MM 3 months after SRP, Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Eikenella corrodens were significantly reduced. SRP+MM participants had significant clinical outcome reductions in pockets ≥5 mm at the reevaluation, 3- and 6-month periodontal maintenance, and clinical attachment loss gains at the 6-month periodontal maintenance.
Conclusion:
MM delivered immediately after SRP and reapplication at 3 months appeared to contribute to improved clinical outcomes and sustained decreased numbers of Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Eikenella corrodens at 6 months.
The prevalence of periodontal disease poses a significant global health burden. Treatments for these diseases, primarily focused on removal and eradication of dental plaque biofilms, are challenging due to limited access to periodontal pockets where these oral pathogens reside. Herein, we report on the development and characterization of nitric oxide (NO)‐releasing carboxymethylcellulose (CMC) derivatives and evaluate their in vitro bactericidal efficacy against planktonic Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans , two prominent periodontopathogens. Bactericidal exposure assays revealed that three of the synthesized NO‐releasing polymers were capable of reducing bacterial viability of both species by 99.9% in 2 h at concentrations of 4 mg mL⁻¹ or lower, reflecting NO's potent and rapid bactericidal action. The NO‐releasing CMCs elicited minimal toxicity to human gingival fibroblasts at their bactericidal concentrations following 24‐h exposure.
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Background and objective:
Periodontal diseases are a major public health concern leading to tooth loss and have also been shown to be associated with several chronic systemic diseases. Smoking is a major risk factor for the development of numerous systemic diseases, as well as periodontitis. While it is clear that smokers have a significantly enhanced risk for developing periodontitis leading to tooth loss, the population varies regarding susceptibility to disease associated with smoking. This investigation focused on identifying differences in four broad sets of variables, consisting of: (i) host-response molecules; (ii) periodontal clinical parameters; (iii) antibody responses to periodontal pathogens and oral commensal bacteria; and (iv) other variables of interest, in a population of smokers with (n = 171) and without (n = 117) periodontitis.
Material and methods:
Bayesian network structured learning (BNSL) techniques were used to investigate potential associations and cross-talk between the four broad sets of variables.
Results:
BNSL revealed two broad communities with markedly different topology between the populations of smokers, with and without periodontitis. Confidence of the edges in the resulting network also showed marked variations within and between the periodontitis and nonperiodontitis groups.
Conclusion:
The results presented validated known associations and discovered new ones with minimal precedence that may warrant further investigation and novel hypothesis generation. Cross-talk between the clinical variables and antibody profiles of bacteria were especially pronounced in the case of periodontitis and were mediated by the antibody response profile to Porphyromonas gingivalis.
Periodontal diseases have been considered as" infections" in which microorganisms initiate and maintain the destructive inflammatory response. However, the nature of the periodontal disease resulting from dental plaque appears to depend to a large extent on the interaction among the bacterial agent, the environment, and the response of the host's defence mechanisms to the bacterial assault. A thorough understanding of the etiopathogenesis of periodontal disease has provided the clinicians and researchers with a number of diagnostic tools and technique that has widened the treatment options. Periodontitis, a disease involving supportive structures of the teeth prevails in all groups, ethnicities, races and both genders and dental plaque is considered as primary etiologic agent. A complete knowledge of the microbial factors, their pathogenicity as well as host factors are of the essential importance for pathogenesis of periodontal disease. In this way, it could be possible to treat the periodontal patients adequately.
This work aimed to develop new biodegradable in situ forming implants for the treatment of periodontitis, the most common infections in the world. These implants would locally deliver the active ingredient and control its release. One of the prerequisites for these new systems is to provide a good bioadhesion and mechanical properties to prevent premature expulsion from the periodontal pocket. Firstly, new in situ forming implants with promising potential to overcome one of the major drawbacks for the local treatment of periodontitis: limited adhesion to the surrounding tissue were developed. The addition of various concentrations of different types of plasticizers (acetyltributyl citrate, ATBC and dibutyl sebacate, DBS) and adhesive polymers (hydroxypropyl methylcellulose, HPMC) resulted in a significant increase in the adhesion of poly(lactic-co-glycolic acid) (PLGA)-based implants. The systems are formed in situ from N-methyl pyrrolidone (NMP)-based liquid formulations. Importantly, at the same time, good plastic deformability of the implants could be provided and desired drug release patterns could be fine-tuned using several formulation tools. The antimicrobial activity of this new type of in situ forming implants, loaded with doxycycline hyclate, was demonstrated using the agar well diffusion method and multiple Streptococcus strains isolated from the oral microflora of patients suffering from periodontitis.Secondly, a better understanding of the mechanisms of the in situ implant formation was followed using different techniques such as electron paramagnetic resonance (EPR), nuclear magnetic resonance (1H NMR), mass change and drug release measurements under different conditions, optical microscopy, size exclusion chromatography (SEC). The in situ forming implants containing PLGA, ATBC, minocycline hydrochloride, HPMC and NMP were prepared and characterized in detail in vitro. Based on these results, deeper insight into the physico-chemical phenomena involved in implant formation and the control of drug release could be gained. For instance, the effects of adding HPMC to the formulations, resulting in improved implant adherence and reduced swelling, could be explained. Importantly, the in situ formed implants effectively hindered the growth of bacteria present in the patients’ periodontal pockets.Finally, the impact of the composition of the implants on system performance was investigated using advanced characterization techniques, such as EPR analysis. Interestingly, HPMC addition to shorter chain PLGA slightly decreased drug release, whereas in the case of longer chain PLGA the release rate substantially increased. These tendencies could be explained based on the mass transport kinetics during implant formation and the systems’ inner structures. Furthermore, the implants’ antimicrobial activity against microorganisms present in the periodontal pockets of patients suffering from periodontitis was evaluated. Interestingly, these systems more effectively hinder the growth of pathogenic bacteria than of physiological microorganisms. Thus, a re-colonization of the patients’ pockets with healthy flora can be expected to be favored in vivo.
In-situ forming implant formulations based on poly(lactic-co-glycolic acid) (PLGA), acetyltributyl citrate (ATBC), minocycline HCl, N-methyl pyrrolidone (NMP) and optionally hydroxypropyl methylcellulose (HPMC) were prepared and thoroughly characterized in vitro. This includes electron paramagnetic resonance (EPR), nuclear magnetic resonance ((1)H NMR), mass change and drug release measurements under different conditions, optical microscopy, size exclusion chromatography (SEC) as well as antibacterial activity tests using gingival crevicular fluid samples from periodontal pockets of periodontitis patients. Based on these results, deeper insight into the physico-chemical phenomena involved in implant formation and the control of drug release could be gained. For instance, the effects of adding HPMC to the formulations, resulting in improved implant adherence and reduced swelling, could be explained. Importantly, the in-situ formed implants effectively hindered the growth of bacteria present in the patients' periodontal pockets. Interestingly, the systems were more effectively hindering the growth of pathogenic bacterial strains (e.g., Fusobacterium nucleatum) than of strains with a lower pathogenic potential (e.g., Streptococcus salivarius). In vivo, such a preferential action against the pathogenic bacteria can be expected to give a chance to the healthy flora to re-colonize the periodontal pockets.
Copyright © 2015. Published by Elsevier B.V.
Periodontitis is the primary cause of tooth loss in adults and a very wide-spread disease. Recently, composite implants, based on a drug release rate controlling polymer and an adhesive polymer, have been proposed for an efficient local drug treatment. However, the processes involved in implant formation and the control of drug release in these composite systems are complex and the relationships between the systems' composition and the implants' performance are yet unclear. In this study, advanced characterization techniques (e.g., electron paramagnetic resonance, EPR) were applied to better understand in-situ forming implants based on: (i) different types of poly(lactic-co-glycolic acid) (PLGA) as drug release rate controlling polymers; (ii) hydroxypropyl methylcellulose (HPMC) as adhesive polymer; and (iii) doxycycline or metronidazole as drugs. Interestingly, HPMC addition to shorter chain PLGA slightly slows down drug release, whereas in the case of longer chain PLGA the release rate substantially increases. This opposite impact on drug release was rather surprising, since the only difference in the formulations was the polymer molecular weight of the PLGA. Based on the physico-chemical analyses, the underlying mechanisms could be explained as follows: Since longer chain PLGA is more hydrophobic than shorter chain PLGA, the addition of HPMC leads to a much more pronounced facilitation of water penetration into the system (as evidenced by EPR). This and the higher polymer lipophilicity result in more rapid PLGA precipitation and a more porous inner implant structure. Consequently, drug release is accelerated. In contrast, water penetration into formulations based on shorter chain PLGA is rather similar in the presence and absence of HPMC and the resulting implants are much less porous than those based on longer chain PLGA.
Copyright © 2015. Published by Elsevier B.V.
Background:
The aim of this study is to evaluate the expression of human telomerase reverse transcription (hTERT) enzyme in chronic periodontitis (CP) and aggressive periodontitis (AgP) compared with healthy individuals.
Methods:
A total of 79 individuals consented to participate in the study. The study sample comprised healthy individuals (n = 30), patients with CP (n = 30), and patients with AgP (n = 19). Gingival tissue was collected and evaluated for hTERT expression by Western blot and immunohistochemical methods. Reverse transcription polymerase chain reaction was performed using the gingival crevicular fluid (GCF) samples.
Results:
The hTERT messenger RNA (mRNA) and protein expression was significantly higher in AgP compared with CP (P <0.001). In GCF, 53.33% of patients with CP and 68.42% of patients with AgP were showing hTERT mRNA expression, but it was not detected in the control group. The AgP tissue showed higher hTERT expression compared with CP (P <0.001). The hTERT mRNA expression did not show a correlation with gingival index (GI), plaque index (PI), probing depth (PD), and clinical attachment loss (AL) in patients with AgP, whereas hTERT protein expression was strongly correlated with GI, PI, PD, and AL in patients with AgP. The protein expression of hTERT shows significant but moderate correlation with GI and AL in patients with CP.
Conclusion:
High expression of hTERT might be associated with periodontal disease progression, suggesting that hTERT could be a potential prognostic marker.
Many definitions of periodontitis have been used in the literature for population-based studies, but there is no accepted standard. In early epidemiologic studies, the two major periodontal diseases, gingivitis and periodontitis, were combined and considered to be a continuum. National United States surveys were conducted in 1960 to 1962, 1971 to 1974, 1981, 1985 to 1986, 1988 to 1994, and 1999 to 2000. The case definitions and protocols used in the six national surveys reflect a continuing evolution and improvement over time. Generally, the clinical diagnosis of periodontitis is based on measures of probing depth (PD), clinical attachment level (CAL), the radiographic pattern and extent of alveolar bone loss, gingival inflammation measured as bleeding on probing, or a combination of these measures. Several other patient characteristics are considered, and several factors, such as age, can affect measurements of PD and CAL. Accuracy and reproducibility of measurements of PD and CAL are important because case definitions for periodontitis are based largely on either or both measurements, and relatively small changes in these values can result in large changes in disease prevalence. The classification currently accepted by the American Academy of Periodontology (AAP) was devised by the 1999 International Workshop for a Classification of Periodontal Diseases and Conditions. However, in 2003 the Centers for Disease Control and Prevention and the AAP appointed a working group to develop further standardized clinical case definitions for population-based studies of periodontitis. This classification defines severe periodontitis and moderate periodontitis in terms of PD and CAL to enhance case definitions and further demonstrates the importance of thresholds of PD and CAL and the number of affected sites when determining prevalence.
Association studies between maternal periodontitis and an elevated risk for preeclampsia have shown conflicting results. The aims of the present case-control study were: 1) to evaluate the association between maternal periodontitis and preeclampsia before and after matching, assessing confounding and interaction; and 2) to evaluate the influence of the extent and severity of periodontal parameters, bleeding on probing (BOP), probing depth (PD), and clinical attachment loss (CAL), in association with preeclampsia.
Initially, 1,206 Brazilian women were included and divided into a control group (1,042 non-preeclamptic women who gave birth to infants with adequate gestational age and birth weight) and a case group (164 preeclamptic women). Further, 125 preeclamptic women were matched according to age, chronic hypertension, and primiparity to 375 non-preeclamptic women randomly selected from the control group. Maternal periodontitis was defined as PD > or =4 mm and CAL > or =3 mm at the same site in at least four teeth. The effect of variables of interest and confounding were assessed by univariate and multivariate analysis.
After controlling for confounders, maternal periodontitis was included in the multivariate final model (odds ratio [OR] = 1.94; 95% confidence interval [CI]: 1.37 to 2.77; P <0.001) and remained associated with preeclampsia after matching (OR = 1.52; 95% CI: 1.01 to 2.29; P = 0.045). The odds of preeclampsia were associated with an increase in the number of sites with BOP and PD and CAL > or =4 mm.
Maternal periodontitis is a risk factor associated with preeclampsia, emphasizing the importance of periodontal care in prenatal programs.
No abstract available.
Chronic infectious diseases may increase the risk of stroke. We investigated whether periodontal disease, including periodontitis and gingivitis, is a risk factor for cerebral ischemia.
We performed a case-control study with 303 patients examined within 7 days after acute ischemic stroke or transient ischemic attack, 300 population controls, and 168 hospital controls with nonvascular and noninflammatory neurological diseases. All subjects received a complete clinical and radiographic dental examination. The individual mean clinical attachment loss measured at 4 sites per tooth served as the main indicator for periodontitis.
Patients had higher clinical attachment loss than population (P<0.001) and hospital (P=0.010) controls. After adjustment for age, sex, number of teeth, vascular risk factors and diseases, childhood and adult socioeconomic conditions, and lifestyle factors, the risk of cerebral ischemia increased with more severe periodontitis. Subjects with severe periodontitis (mean clinical attachment loss >6 mm) had a 4.3-times-higher (95% confidence interval, 1.85 to 10.2) risk of cerebral ischemia than subjects with mild or without periodontitis (<or=3 mm). Severe periodontitis was a risk factor in men but not women and in younger (<60 years) but not older subjects. Periodontitis increased the risk of cerebral ischemia caused by large-artery atherosclerosis, cardioembolism, and cryptogenic etiology. Gingivitis and severe radiologic bone loss were also independently associated with the risk of cerebral ischemia, whereas caries was not.
Our study indicates that periodontal disease, a treatable condition, is an independent risk factor for cerebral ischemia in men and younger subjects.