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Trauma and its Effects on Periodontal Tissues
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Foreign bodies may be deposited in the oral cavity either by traumatic injury or iatrogenically. Among the commonly encountered iatrogenic foreign bodies are restorative materials like amalgam, obturation materials, broken instruments, needles, and so forth. The discovery of foreign bodies in the teeth is a special situation, which is often diagnosed accidentally. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, location of the foreign body, and the difficulty involved in its retrieval. It is more common to find this situation in children as it is a well-known fact that children often tend to have the habit of placing foreign objects in the mouth. Sometimes the foreign objects get stuck in the root canals of the teeth, which the children do not reveal to their parents due to fear. These foreign objects may act as a potential source of infection and may later lead to a painful condition. This paper discusses the presence of unusual foreign bodies-a tip of the metallic compass, stapler pin, copper strip, and a broken sewing needle impregnated in the gingiva and their management.
The aim of this retrospective analysis was to determine the age, gender, frequency and distribution of trauma-associated hard tissue and soft tissue lesions of the oral and maxillofacial region in a population from southern Taiwan.
Approximately 10% of the 27,995 biopsy records of patients with history of trauma resulting in lesions who were treated at our institution between 1991 and 2006 were examined for this study.
In the included records, there were 2,762 soft tissue and 26 hard tissue lesions. Mucocele was the most frequent trauma-associated soft tissue lesion (955 cases). The youngest patients were those who presented with mucocele (mean age = 27.3 years), while the oldest patients were those with peripheral giant cell granuloma (58 years). The lower lip was the most frequent site of occurrence of mucocele (676, 64.5%) and was also the predominant site of occurrence of all soft tissue lesions (815, 29.5%), followed by the buccal mucosa (654, 23.4%) and the tongue (392, 14.2%). Trauma-associated hard tissue lesions included only osteoradionecrosis (24 cases) and traumatic bone cysts (2 cases).
As little data of this nature have been reported from populations of Asian developing countries, the findings of this retrospective analysis is valuable for epidemiological documentation of type of traumatic oral lesions as well as for informing the professionals and the layman about the importance of this category of oral lesions.
Injuries to oral soft-tissues can occur due to accidental, iatrogenic, and factitious traumas. Traumatic lesions, whether chemical, physical, or thermal in nature, are among the most common in the mouth. A type of physical injury to the gingival tissues is self-inflicted. Sometimes the lesions are termed gingivitis artefacta. Self-inflicted gingival injuries in children and adolescents can occur as a result of accidental trauma, premeditated infliction, or chronic habits such as fingernail biting, digit sucking, or sucking on objects such as pens, pencils or pacifiers. The purpose of this case report was to illustrate the destructive nature of the habit and to describe the successful treatment of this case. A 14-year-old girl with moderate pain, gingival bleeding and recession in the anterior mandibulary region was admitted to periodontology clinic. Upon questioning, the patient readily admitted traumatizing her gingiva with her fingernail. Treatment consisted of oral hygiene instruction, mechanical debridement, psychological support and surgical periodontal treatment. Postoperatively, complete root coverage, gains in clinical attachment levels, and highly significant increases in the width of keratinized gingiva were observed. This case report shows that it is possible to treat gingival injury and maintain the periodontal health of a patient with destructive habit. Patient compliance, regular dental follow-ups, and psychological support may be useful in stabilizing the periodontal condition of these patients. Dentists must be aware that self-inflicted gingival injury, although thought to be uncommon, is quite widespread.
The purpose of this retrospective study was to analyze the cases of traumatic dental injuries involving root fracture and/or periodontal ligament injury (except avulsion) treated at the Discipline of Integrated Clinic, School of Dentistry of Araçatuba, São Paulo State University (UNESP), Brazil, from January 1992 to December 2002. Clinical and radiographic records from 161 patients with 287 traumatized teeth that had sustained root fracture and/or injuries to the periodontal ligament were examined. The results of this survey revealed that subluxation (25.09%) was the most common type of periodontal ligament injury, followed by extrusive luxation (19.86%). There was a predominance of young male patients and most of them did not present systemic alterations. Among the etiologic factors, the most frequent causes were falls and bicycle accidents. Injuries on extraoral soft tissues were mostly laceration and abrasion, while gingival and lip mucosa lacerations prevailed on intraoral soft tissues injuries. Radiographically, the most common finding was an increase of the periodontal ligament space. The most commonly performed treatment was root canal therapy. Within the limits of this study, it can be concluded that traumatic dental injuries occur more frequently in young male individuals, due to falls and bicycle accidents. Subluxation was the most common type of periodontal ligament injury. Root canal therapy was the type of treatment most commonly planned and performed.
A causal relationship between occlusal discrepancies and periodontal disease has been postulated in the past. However, minimal data are available concerning the effect of treatment of occlusal discrepancies on periodontitis.
The records from a private practice limited to periodontics were reviewed to find patients who had complete periodontal examination records, including occlusal analysis, that were recorded at least 1 year apart. Patients who fit these criteria were divided into a group that had none of the recommended treatment (untreated n = 30), those who had only non-surgical treatment (partially treated n = 18), and a control group that had completed all recommended treatment (surgically treated n = 41). The data for each tooth of each patient, including occlusal status, were placed in a database and analyzed using the generalized estimating equations method.
Worsening in overall clinical condition, as measured by worsening in prognosis, indicated that teeth with no initial occlusal discrepancies and teeth with treated initial occlusal discrepancies were only about 60% as likely to worsen in overall clinical condition over time compared to teeth with untreated occlusal discrepancies. Teeth with untreated occlusal discrepancies were also shown to have a significantly greater increase in probing depth per year than either teeth without initial occlusal discrepancies or teeth with treated initial occlusal discrepancies (P < 0.001). In addition, teeth with untreated occlusal discrepancies had a significant increase in probing depth per year (P < 0.001), whereas teeth without initial occlusal discrepancies and teeth with treated initial occlusal discrepancies had no significant increase in probing depth per year (P > 0.05).
This study provides strong evidence of an association between untreated occlusal discrepancies and the progression of periodontal disease. In addition, this study shows that occlusal treatment significantly reduces the progression of periodontal disease over time and can be an important adjunct therapy in the comprehensive treatment of periodontal disease.
Aim:
To review the hypothesis that toothbrushing leads to gingival recession. Gingival recession develops due to anatomical and pathological factors. The prevalence of recession is dependent on the age and characteristic of the population because it usually presents in individuals with periodontal disease or those who practise zealous or improper oral hygiene methods. Gingival trauma and gingival abrasion from toothbrushing is thought to progress directly to gingival recession. Case studies documenting recession from toothbrush trauma are speculative. Short-term studies suggest that gingival trauma and gingival abrasion may result from toothbrushing, but the direct relationship between traumatic home care and gingival recession is inconclusive. Long-term studies remain elusive or do not support the development of recession following toothbrushing. Nevertheless, tooth abrasion may be an integral part in the aetiology of recession. Toothbrush abrasion also may cause wear at the cemento-enamel junction resulting in the destruction of the supporting periodontium leading to recession.
The purpose of the present investigation was to study the nature and frequency of adverse reactions to materials and procedures among orthodontists and their patients.
A questionnaire about this topic was mailed to practicing members of the Norwegian Orthodontic Society, of which 137 (about 75%) responded together with 127 chairside assistants. About half of the orthodontic personnel had experienced adverse reactions. The majority of the problems were dermatoses, comprising dryness, redness, itching, thickening, reduced tactile sensitivity, fissuring, soreness/desquamation and pain of hands and fingers. The residual were respiratory reactions, eye reactions or reactions of a general nature.
Many of the dermatoses were of moderate severity, attributed to (seasonal) air/ventilation associated problems. Other frequent causes were hand washing procedures, work involving composites and acrylics (orthodontists), or work involving model materials, alcoholic disinfectants, latex gloves, alignates etc. (assistants). For both groups the most severe dermatological reactions were associated with unspecified allergies, acrylics and composites. Non-dermatological reactions also reflected the different working pattern and exposure to materials in orthodontics; acrylic monomer topping the list.
The orthodontists had observed 425 patients with dermal reactions and 67 patients with intraoral/systemic reactions, indicating a prevalence of about 1 per cent. Dermal reactions included redness, eczema, itching and fissuring in facial, neck or perioral areas, mostly attributed to metallic parts of extraoral appliances, with some exceptions (elastics, neck pillows, head caps). Intraoral reactions consisted of redness, soreness and swelling of the oral mucosa, gingiva and/or lips and were associated with metal brackets, labial wires, bonding procedures or acrylic appliances.
In continuation of a series of investigations designed to evaluate codestructive factors in periodontal disease, a single severe mechanical injury was produced subjacent to marginal periodontitis by wedging a toothpick between second and third bicuspids in squirrel monkeys. Marginal periodontitis alone was induced on the contralateral side for the same period of time for comparison of the progression of periodontitis with and without the subjacent traumatic lesion. Statistical analysis of the measurements from the cemento enamel junction to the most apical cell of the junctional epithelium and to the most coronal point of alveolar bone forming the wall of the periodontal ligament showed that the progression of periodontitis was not affected by the presence or absence of the mechanical injury.
OBJECTIVES: Occlusal adjustment as part of periodontal therapy has been controversial for years, mostly because the literature does not provide enough evidence regarding the influence of trauma from occlusion (TfO) on periodontitis. The need for occlusal adjustment in periodontal therapy is considered uncertain and requires investigation. The aim of this systematic review was to identify and analyse those studies that investigated the effects of occlusal adjustment, associated with periodontal therapy, on periodontal parameters. DATA: A protocol was developed that included all aspects of a systematic review: search strategy, selection criteria, selection methods, data collection and data extraction. SOURCES: A literature search was conducted using MEDLINE via PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE. STUDY SELECTION: Three reviewers screened the titles and abstracts of articles according to the established criteria. Every article that indicated a possible match, or could not be excluded based on the information given in the title or abstract, was considered and evaluated. On final selection, four articles were included. CONCLUSIONS: Although the selected studies suggest an association between occlusal adjustment and an improvement in periodontal parameters, their methodological issues (explored in this review) suggest the need for new trials of a higher quality. There is insufficient evidence at present to presume that occlusal adjustment is necessary to reduce the progression of periodontal disease. CLINICAL SIGNIFICANCE: Although it is still not possible to determine the role of occlusal adjustment in periodontal treatment, adverse effects have not been related to occlusal adjustment. This means that the decision made by clinicians whether or not to use occlusal adjustment in conjunction with periodontal therapy hinges upon clinical evaluation, patient comfort, and tooth function.
Abstract The aim of the present experiment was to study the effect of a prolonged period of jiggling force application on the rate of progression of ligature-induced, plaque-associated marginal periodontitis in the beagle dog.
The experiment was performed on eight dogs fed a diet which permitted dental plaque accumulation. On Day 0 a phase of periodontal tissue breakdown was initiated around the mandibular fourth premolars (4P; P4) by the placing of plaque retention ligatures around the neck of the teeth. The ligatures were exchanged once a month throughout the entire study. On Day 60 trauma from occlusion of the jiggling type was produced in the P4 region and maintained for 300 days. The animals were sacrificed on Day 360. Following sacrifice tissue sections comprising 1M, 4P, 4P and P3, P4, M1 were produced and subjected to microscopic analysis.
The experiment revealed that in the dog jiggling forces applied to teeth which are also subjected to ligature-induced and plaque-associated marginal periodontitis, may enhance the rate of destruction of the periodontium.
Abstract A series of studies has investigated interactions between periodontal trauma and marginal periodontitis in relation to the initiation, progression and treatment of periodontal disease. Lesions of trauma in the periodontal ligament do not initiate the loss of connective tissue attachment characteristic of marginal periodontitis. Studies conducted in squirrel monkeys and beagle dogs in which jiggling forces were superimposed upon an established marginal periodontitis reported increased loss of alveolar bone, but the accelerated loss of attachment which occurred in the dog model did not occur in the monkey model. In order to clarify the relative importance of inflammation and tooth mobility in the treatment of advanced periodontal disease, periodontal responses were evaluated after removing combinations of traumatic and inflammatory components. Elimination of trauma in the presence of existing marginal inflammation did not reduce tooth mobility or increase bone volume. Osseous regeneration and decreased tooth mobility occurred after resolving both components; however, similar findings occurred after resolving inflammation in the presence of continued tooth mobility. After resolution of inflammation, remaining tooth mobility does not result in increased loss of connective tissue attachment. On a clinical level for periodontal disease treatment, the findings place decreased emphasis upon management of tooth mobility and increased emphasis upon resolution of marginal inflammation.
Orthodontic appliances, designed to tip the maxillary second and third incisors in facial direction, were inserted in 3 dogs. During a 5 month period, the incisors on the left side of the jaw were tipped to a facially displaced position. During a further 5 month period these teeth were moved back to their original position while the two incisors on the right side of the jaw were moved to a position corresponding to that previously reached by the incisors of the left side. The orthodontic appliances were then used to retain the teeth In these positions for 5 months. Teeth in three non-treated dogs served as controls. During the study, the animals were subjected to meticulous plaque control. The animals were sacrificed 15 months after the start of the study. The jaws were removed and buccolingually oriented histological sections of the experimental and control teeth were produced. The study has shown (1) that dehiscences can be produced in the alveolar bone by tipping teeth in facial direction and that bone will reform in such defects when the teeth are moved back to their original position and (2) that such tooth movements are not necessarily accompanied by loss of connective tissue attachment.
Abstract Experiments have been performed in beagle dogs in attempts to evaluate the effect of orthodontic- and jiggling-type trauma on the supporting structures of premolars. The results reported have unanimously demonstrated that in situations where orthodontic or jiggling forces were inflicted on teeth with a normal periodontium, or on teeth with overt signs of gingivitis, the periodontal ligament tissue reacted by transitory signs of inflammation. These phenomena occurred without a concomitant loss of connective tissue attachment and development of pathologically deepened periodontal pockets. If the jiggling trauma was inflicted on teeth with an ongoing plaque-associated, destructive periodontitis, the resulting inflammatory reactions caused enhanced loss of attachment and angular bony defects. Furthermore, orthodontic tilting movements of teeth (intrusion) in a plaque-infected dentition may shift a supragingivally located plaque into a subgingival position resulting in periodontal tissue breakdown.
Data collected as part of an 8–year longitudinal study on periodontal therapy involving 82 patients and 1974 teeth were analyzed to determine if tooth mobility influenced the results of treatment.For each patient, pocket depth, attachment level and tooth mobility were scored clinically at the initial appointment, and once a year for 8 years following periodontal therapy. The treatment consisted of scaling, oral hygiene instruction, occlusal adjustment, periodontal surgery (curettage, modified Widman or pocket elimination), followed by recall prophylaxes every 3 months. Tooth mobility data on a scale of 0–3 were related to changes in attachment levels for three grades of severity of periodontal disease, based on initial pocket depth (1–3 mm, 4–6 mm, and 7+ mm). Mean patient attachment changes were calculated from teeth in the same severity category for each patient. The data were analyzed by one-way analysis of variance and Scheffe's multiple comparison procedure to test the hypothesis of equal effects of tooth mobility on the results of the treatment for the three severity groups over 8 years.The results indicate that there is a statistically significant relationship between original tooth mobility and the change in level of attachment following treatment. Pockets of clinically mobile teeth do not respond as well to periodontal treatment as do those of firm teeth exhibiting the same initial disease severity.
In this study, the hypothesis was adopted that fatigue destruction may develop on the cementum of the root surface because of the repeated occlusal stresses loaded on the tooth as in the case of prolonged occlusal trauma. The purpose of this study is to clarify whether cemental fatigue destruction occurs when repeated stresses are loaded on the occlusal surface of a tooth.
The teeth used were five human mandible premolars from individuals 14 to 22 years of age. The teeth were freshly extracted in orthodontic treatment. They were free of decay and fillings, and their roots were straight. One half of the root was embedded in cold curing acrylic resin, and a compressive load of 5.0 kgf was repeatedly applied along the tooth axis in water 1 million times with a speed of one time per second. Changes in the tooth surface were observed by taking photographs with a stereoscopic microscope and a digital camera after every 100,000 loadings. Cracks were dyed with 2% methylene blue solution, and crack areas were measured using gray-scaled and binary-processed photographs. Data were analyzed using image analysis software.
It was confirmed that cracks significantly developed on the buccal, mesial, and distal surfaces but not on the lingual surface; crack areas showed a tendency to significantly increase after 500,000 loadings; extension of the crack from the cemento-enamel junction to the root apex increased with time, and the average extension was 0.67 +/- 0.12 mm after 1 million loadings.
This study revealed that cementum cracks developed in the cervix by repeated loadings and extended toward the root apex with time, suggesting that repeated stresses by occlusion or strong stresses such as by bruxism may trigger the development of site-specific attachment loss, which is one of the potential factors inducing periodontal diseases.
(1) The production of traumatic occlusion by inserting raised fillings in the teeth of monkeys is described. The fillings were inserted in three adjoining posterior teeth, one being left higher than the others. In one monkey an upper central incisor was the only tooth treated and on this was fixed a raised metal crown.(2) Experiments were terminated after varying periods of time, from ten to forty-three weeks. The jaws containing the teeth in which raised fillings were inserted, the opposing teeth, and the controls, were sectioned. Some sections were cut mediodistally and others faciolingually.(3) Results. These were judged from a histological examination of the sections.(a) Seven monkeys were treated. (b) In three monkeys very definite changes analogous to parodontal disease were produced. (c) In three monkeys less extreme changes were seen. (d) In one monkey there was no change. (e) in each animal the pathological changes were usually observed in only the one tooth which took the greatest stress of the three that were filled and the opposing one with which it articulated. (f) Of the 39 teeth subjected to trauma eleven showed pathological changes in the subgingival tissues.(4) The clinical evidence in man is considered.(5) The conclusion is reached that traumatic occlusion is an ætiological factor in the production of that variety of parodontal disease in which there is vertical pocket formation associated with one or a varying number of teeth.
Few studies have longitudinally investigated the relationship between periodontal disease progression and occlusal factors in individual subjects during the maintenance phase of periodontal therapy. The aim of this cohort study was to investigate the relationship between biting ability and the progression of periodontal disease in the maintenance phase.
A total of 194 patients were monitored for 3 years during the maintenance phase of periodontal therapy. The subjects with disease progression (Progress group) were defined based on the presence of >or= 2 teeth demonstrating a longitudinal loss of proximal attachment of >or= 3 mm or tooth-loss experience as a result of periodontal disease during the study period. The subjects with high occlusal force were diagnosed as men who showed an occlusal force of more than 500 N and women who showed an occlusal force of more than 370 N. The association between biting ability and the progression of periodontitis was investigated using logistic regression analysis.
There were 83 subjects in the Progress group and 111 subjects in the Non-progress group. A backward, stepwise logistic regression model showed that the progression of periodontal disease was significantly associated with the presence of one or more teeth with a high clinical attachment level (CAL) of >or= 7 mm (odds ratio: 2.397; 95% confidence interval: 1.306-4.399) ( p = 0.005) and low occlusal force (odds ratio: 2.352; 95% confidence interval: 1.273-4.346) ( p = 0.006).
The presence of one or more teeth with a high CAL of >or= 7 mm and low occlusal force might be possible risk factors for periodontal progression in the maintenance phase of periodontal therapy.
Aim: This study evaluates relationships in humans between various occlusal contacts and the presence of deeper probing depths, reduced width of keratinized tissue, and less than favourable initial prognosis.
Materials and Methods: The tooth level relationship between various occlusal contacts and pocket probing depths, width of keratinized gingiva, and prognosis at the time of initial examination was evaluated (multivariate model) in a group of patients (85 patients, 2219 teeth) with active periodontal disease.
Results: The following were noted to be associated with significantly deeper pocket probing depths: premature contacts in centric relation (0.89 mm, p<0.0001), posterior protrusive contacts (0.51 mm, p<0.0001), balancing contacts (1.01 mm, p<0.0001), combined working and balancing contacts (1.13 mm, p<0.0001), and the length of slide between centric relation and centric occlusion. Protrusive contacts on anterior teeth were significantly associated with shallower probing depths (−0.18 mm, p=0.0076) and a wider zone of keratinized tissue (0.16 mm, p=0.0065). Balancing contacts with and without working contacts and centric prematurities were all associated with an increased incidence of a less than “Good” prognosis
Conclusions: Multiple types of occlusal contacts were shown to be associated with deeper probing depths and the increased assignment of a less than “Good” initial prognosis.
ABSTRACT The role of occlusion in periodontal disease has always been a challenging topic. A good understanding of the current status of the relationship of occlusion and periodontitis is of paramount importance in order for dental clinicians to provide adequate and comprehensive periodontal treatment in patients presenting with traumatic occlusion. This article reviews the literature regarding the relationship between occlusion and periodontitis and presents recommendations for clinical practice based on available evidence. Clinical cases illustrating the complexity of this relationship and their management are presented.
The aim of the present study was to assess the influence of traumatic forces causing a gradually increasing tooth mobility on an ongoing destructive periodontitis.
The experiments were performed in five dogs fed a diet which permitted dental plaque accumulation. Periodontal breakdown was induced around the mandibular third and fourth premolars (4P, 3P and P3, P4) by the placement of plaque retention ligatures around the neck of the teeth. After 330 days, when approximally 50 % of the supporting tissues had been lost, mucoperiosteal flaps were raised around the four premolars and notches prepared in the buccal root surfaces at the marginal termination of the alveolar bone. The notches served as landmarks for measurements to be made in histological sections. The flaps were resutured and new plaque retention ligatures placed around the roots of all four teeth.
One week later (Day 0), P3 and P4 (test teeth) were subjected to jiggling forces in a bucco-lingual direction with the use of an elevator. The jiggling procedure which had a duration of 30 seconds, was repeated on Days 4, 8, 12 and 16, and was guided in such a way that the tooth mobility gradually increased during the experimental period. The animals were sacrificed on Day 26, and sections of 4P,3P and P3, P4 were prepared for light microscopic examination.
The results of the study demonstrated that jiggling forces, resulting in a progressive increase of tooth mobility, mediated an enhanced rate of destruction of the supporting apparatus in dogs with an ongoing process of periodontal tissue breakdown.
The purpose of the randomized clinical trial was to test; (1) the influence of occlusal adjustment (OA) in association with periodontal therapy on attachment levels, pocket depth, and tooth mobility, (2) whether OA was of greater significance in non-surgically treated periodontal defects, and (3) whether initial tooth mobility or disease severity had an affect on post-treatment attachment levels following OA. After hygienic-phase therapy, 50 patients received OA/No OA according to random assignment; 22 patients received an OA and 28 were not adjusted. 2 months after OA, either modified Widman flap surgery or scaling and root planing by a periodontist were done according to random assignment within each patient in a split-mouth design. Following active treatment patients were maintained with prophylaxis done every 3 months and scored annually. For the analysis of this two-year data, a repeated measures analysis of variance was performed using attachment level change and pocket depths as outcome indicators. There was significantly greater gain of clinical periodontal attachment in patients who received an OA compared to those who did not. Both the surgically and non-surgically treated sides of the mouth responded similarly to OA. There was no affect of OA on the response in pocket depth, nor did initial tooth mobility or initial periodontal disease severity influence the response to OA.
Burns of the oral cavity may be caused by prolonged use of certain drugs by the patient or by incorrect use of caustics by the dentist. Unwillingly-acquired self-inflicted injuries are also encountered, such as caustic ingestion (out of curiosity or by accident), excessive consumption of fresh fruit and fresh fruit juice, and wrong oral hygiene practice. Our experience with six infrequent and unfamiliar types of oral burns, caused by various components and material, is described and discussed.
The aim of this experiment was to achieve support for the hypothesis that bone resorption, induced by jiggling forces, leaves a component within the supracrestal soft tissue with a capacity of reforming bone. The maxillary lateral incisors and first premolars and the mandibular second premolars in two monkeys were used in the study. Using metal pins inserted into the neighboring teeth as retainers, orthodontic elastics were stretched and placed alternately around the buccal and lingual surfaces of each experimental tooth in order to produce jiggling forces. After 5 months of continuous jiggling, when bone dehiscences were produced on the buccal aspect of the teeth, the elastics were removed. After repositioning of the teeth a split thickness flap was raised. On one side of the jaw the soft tissue within the bone dehiscences was removed. At the contralateral teeth a sham operation was performed maintaining the soft tissue within the bone dehiscences. The monkeys were sacrificed 6 months after surgery. Tissue blocks containing test and control specimens were dissected free and prepared for microscopic analysis. The length of the supracrestal connective tissue attachment and the amount of coronal bone regeneration were assessed in the histological sections. It was found that buccal alveolar bone, reduced in height by jiggling forces, regenerated after discontinuation of the forces. When the soft tissue within the buccal bone dehiscences produced by the jiggling forces was surgically removed, the coronal regeneration of the alveolar bone was markedly reduced. These observations suggest that bone resorption, induced by jiggling forces, leaves a soft tissue component with a capacity of forming bone.
Conflicting results have been reported regarding the effect of periodontal trauma upon progression of periodontitis. In these studies, different initial pocket morphologies were present. This study investigated the effect of trauma superimposed upon existing intrabony pockets. Localized intrabony pockets were produced adjacent to the mesial and distal surfaces of the mandibular third bicuspids in 10 squirrel monkeys. Two animals were killed after 10 weeks of periodontitis. In four (experimental) of the remaining eight animals, mesio-distal jiggling of the third bicuspid was begun 10 weeks after induction of periodontitis, and continued for another 10 weeks. The other four animals (control) were killed 20 weeks after initiation of periodontitis. Step-serial histologic sections were selected from experimental and control specimens and analyzed for loss of connective tissue attachment, loss of crestal alveolar bone and percentage of bone in the coronal interproximal periodontium. When corresponding dimensions from experimental and control surfaces were compared statistically, there were no differences in loss of connective tissue attachment but a greater loss of bone had occurred in specimens with the combination of periodontitis and trauma. In addition, there was a marked difference in osseous morphology between the experimental and control specimens. It was concluded that trauma superimposed upon existing intrabony pockets increased loss of alveolar bone and altered osseous morphology, but did not affect the loss of connective tissue attachment.
Attachment level at two sites on each tooth in 22 untreated subjects with existing periodontal pockets was measured every month for 1 year. Regression analysis was then applied to the data from each periodontal site to determine if statistically significant trends in attachment level change could be detected. 82.8% of the sites monitored did not significantly change during the year. 5.7% of the sites became significantly deeper and 11.5% of the sites became significantly shallower (P less than 0.01) during the period. Among those sites in which pocket depth increased, approximately half exhibited a cyclic deepening followed by spontaneous recovery to their original depth. In 15 of the subjects, sites were found which became significantly deeper while other sites within the same subject became significantly shallower. In six subjects, who might be considered to have an arrested form of periodontal disease, virtually no sites became deeper during the monitoring period whereas 11-36% of their sites became significantly shallower. The results of this investigation suggest that a dynamic condition of disease exacerbation and remission as well as periods of inactivity may be characteristic of periodontal disease.
The role of the BDJ is to inform its readers of ideas, opinions, developments and key issues in dentistry - clinical, practical and scientific - stimulating interest, debate and discussion amongst dentists of all disciplines.
Patients who have undergone irradiation for head and neck tumors commonly have xerostomia. Loss of the protective constituents normally found in saliva leaves patients at greater risk for development of significant dental pathologic disorders, including gingival and periodontal disease. Periodontal disease and tooth extractions are currently accepted as etiologic factors for the development of osteoradionecrosis. This double-blind crossover trial was conducted to assess the efficacy of a dentifrice containing salivary peroxidase elements in the reduction of gingivitis in a population of patients with irradiated cancer. Subjects were instructed to brush with the dentifrice provided. Plaque and gingival index values were obtained and statistically compared with baseline values. A weak positive effect was found between use of the dentifrice and a reduction in gingival inflammation. Patient compliance was a limiting factor in this treatment effect. The results suggest possible efficacy for the dentifrice in augmenting traditional measures of postradiation oral health maintenance.
Burns of the oral mucosa can be caused by heat, cold, radiation, electricity and mechanical or chemical stimuli. Acids, alkalis and salts can cause considerable damage to the oral mucosa, membranes and lips. Most damage is found in the oropharynx, besides the pharynx and tonsils, the alveolar mucosa of the tongue and the masticatory mucosa of the palate or gingiva show localized or diffused damage. The clinical appearance depends on the severity of the tissue damage and the destructive properties and mode of application of the causative agent. We present an illustrative case of central palatal burn associated with the eating of microwaved pizzas and discuss similar mechanisms of injury.
Self-inflicted gingival injuries have been known to occur in children and adolescents secondary to a number of causes, including accidental trauma; fingernail biting; digit sucking; or sucking on objects such as pens, pencils, thread, or toothpicks. Of these causes, the one documented as the most common cause is habitual fingernail biting or onychophagia. This case report describes the gingival injury caused by habitual fingernail biting and the findings noted at the time of periodontal surgery. The potential ramifications of fingernail biting are discussed, and the steps necessary to ensure and preserve the dental health of the patient are identified.
The following report describes an unusual iatrogenic contact burn from a heated dental instrument. The potential hazard of inflicting a contact burn using a glass bead sterilizer must be kept in mind.
De Bruyne MAA, De Moor RJG, Raes FM. Necrosis of the gingiva caused by calcium hydroxide: a case report. International Endodontic Journal, 33, 67–71, 2000.
Case report The present case demonstrates the possible detrimental effect of an overextension of a calcium hydroxide intracanal dressing into the periradicular and soft tissue after iatrogenic buccal root perforation of a maxillary central incisor.
At first this perforation was not recognized by the dentist, which resulted in the introduction of a large amount of non-setting calcium hydroxide paste under the gingival tissues through a dehiscence on the buccal side of the root.
This report describes the consequences and management of the necrosis of the buccal gingiva and mucosa, and the subsequent treatment and follow-up of the root perforation.
Periodontal disease does not directly affect the occluding surfaces of teeth, consequently some may find a section on periodontics a surprising inclusion. Trauma from the occlusion, however, has been linked with periodontal disease for many years. Karolyi published his pioneering paper, in 1901 'Beobachtungen uber Pyorrhoea alveolaris' (occlusal stress and 'alveolar pyorrhoea'). (1) However, despite extensive research over many decades, the role of occlusion in the aetiology and pathogenesis of inflammatory periodontitis is still not completely understood.