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 Periodontal abstracts


1. Implications of Successful Long-Term Tooth Retention After Periodontal Therapy
2. A comparison of two radiographic assessment protocols for patients with periodontal disease
3. Statin Use and Tooth Loss in Chronic Periodontitis Patients
4. A cross-over study on the effect of various therapeutic approaches to morning breath odour
5. Periodontitis and premature death: a 16-year longitudinal study in a Swedish urban population 
6. Periodontal Plastic surgery as an Adjunctive Therapeutic Modality for Esthetic Restorative Dentistry
7. Relationship between human cytomegalovirus transcription and symptomatic apical periodontitis
8. Are bleeding gums a sign of a problem? Not always! 
9.  Effects of Full-Mouth Scaling and Root Planing in Conjunction With Systemically Administered Azithromycin
10. Compare cleaning/disinfecting strategy below to calculus removal/ disinfecting pockets to suppress biofilms!

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Compare cleaning/disinfecting strategy below to calculus removal/ disinfecting pockets to suppress biofilms!

Abstract

The aim of this study was to assess the efficacy of 21
decontamination procedures, for the removal of a multispecies
biofilm.

Experiments were performed on five-day-old biofilms grown
inside silicone tubing, using a reactor system that mimics a dialysis
machine. The treatments were tested on 5cm tubing samples. Effects of
treatment were measured using direct microscopy following staining.
Bacterial viability and endotoxin removal were determined using
conventional microbiological methods following biofilm detachment by
scraping. The 21 procedures were classified into four groups based on
the amount of biofilm removed. The most effective treatment was an
acid pre-treatment, followed by use of a concentrated bleach
solution. Acid pre-treatment removes calcium and magnesium carbonate
crystals that are always found in dialysis biofilms. Treatments
performed at high temperature did not increase the efficacy of
biofilm removal. Most treatments caused at least a 105-fold reduction
in bacterial viability with a few resulting in complete kill.
Autoclaved and bleach-treated samples gave the best results for
viability reduction, with both treatments providing an equally
effective and complete kill. In addition, autoclaving led to a
significant decrease in endotoxin level (removal of 99.99%).

Are bleeding gums a sign of a problem? Not always! 

When examining a patient's gums, dentists and hygienists usually use bleeding on probing (BOP)
as a sign of periodontal disease. Conversely, they use the lack of bleeding as a sign of
periodontal health. Treatment decisions are then based on these findings as well as on other
clinical parameters. But is BOP necessarily an accurate indicator of a problem? What happens
when patients take aspirin to prevent cerebrovascular and cardiovascular diseases? Does aspirin
therapy affect BOP? And in turn, are treatment decisions being made based on a parameter that
is drug-induced? To find answers, a double-blind experiment* studied the effects of short-term
daily aspirin ingestion on BOP.

Methods and materials. Forty-six periodontally healthy patients were included in this study.
Sixteen (16) were given a placebo, 15 were given low-dose aspirin (81mg) and 15 were given a daily
regular-dose aspirin (325 mg). A variety of clinical parameters were measured including BOP before
the experiment began and 7 days after administration of the aspirin or placebo.

Results The patient's percentage of BOP prior to the start of the experiment appeared to
affect the outcome. Patients with <20% BOP sites at baseline did not have a statistically significant
number of bleeding sites (BOP) after aspirin exposure. Most significantly, subjects with >20% BOP
were affected by a daily aspirin (325 mg) but NOT the 81mg dose. Curiously, this result was
independent of the subject's gingival health and oral hygiene.

Discussion and conclusion. Ingesting aspirin (325mg) daily may affect the outcome of BOP,
especially if the patient had >20% bleeding sites prior to beginning this preventive
cardiovascular/cerebrovascular therapy. For these patients, clinicians need to use additional
parameters besides BOP to determine if periodontal intervention is needed.

Comment It would be interesting to know if long-term use of 325mg of aspirin therapy
results in an increase/worsening of a patient's periodontal status. Previously published papers
have noted the benefits of non-steroidal anti-inflammatory drugs on preventing periodontal
breakdown as well as the classic papers of Geiger and Wasserman that demonstrated no correlation
to bleeding and periodontal breakdown. Maybe the importance of BOP needs to be reassessed.

*Schrodi J, Recio L, Fiorellini J, Howell H, Goodson M, and Karimbux N. The effect of aspirin
on the periodontal parameter bleeding on probing. J Perio 73:871-876, 2002.

Research abstract

British Dental Journal 198, 565 - 569 (2005)
Published online: 14 May 2005 | doi:10.1038/sj.bdj.4812304

A comparison of two radiographic assessment protocols for patients with periodontal disease

W M M Jenkins1, L M Brocklebank2, S M Winning3, M Wylupek4, A Donaldson5 & R M Strang6

    * Fifty patients with generalised severe periodontitis were examined to identify which teeth
      required radiographic assessment.
    * Panoramic radiographs were taken and examined. It was decided that, on average,
      4.3 supplementary periapical views would be required for adequate periodontal assessment of
      all the affected teeth and, if teeth requiring dental radiographic assessment were added,
      5.1 supplementary periapical views would be required.
    * This paper demonstrates that the effective radiation dose from a series of periapical
      radiographs of all the affected teeth would, in most cases, have been less than the dose
      from the panoramic-plus-periapicals approach.
    * These conclusions are specific for the equipment and exposure factors used with which,
      therefore, it is difficult to justify the use of panoramic radiography for periodontal assessment.
    * This paper also demonstrates how evidence can be obtained to develop radiographic selection
      criteria of the periodontal tissues.

Abstract

Objective Radiographic assessment of patients with generalised severe periodontitis may be undertaken
with a panoramic view and supplementary periapicals. The purpose of this study was to estimate the
effective radiation dose from this form of radiographic assessment, and to compare it with an estimate
of the dose from a series of periapicals of all the affected teeth.

Design Cross-sectional observational study.

Setting Departments of Periodontology and Radiology, Glasgow Dental Hospital and School.

Method Fifty consecutive patients [were recruited] with sufficiently widespread advanced
periodontitis to require at least seven periapical radiographs. [Following new local guidelines,
a panoramic view was taken.] The adequacy of the image of every affected tooth and the number of
supplementary periapicals required was determined by a panel of four examiners who also calculated
the number of periapicals which would have been taken if panoramic radiography had not been available.
An effective dose of 0.001 mSv for one periapical and 0.007 mSv for a panoramic view was assumed.

Results The panoramic-plus-periapicals approach delivered an estimated additional effective
dose to 86% of patients, in the order of 0.001  0.007 mSv.

Conclusions Within the parameters of this investigation, the anticipated effective radiation
dose from a series of periapical radiographs of all selected teeth would, for the great majority of
patients, have been less than the dose from a panoramic-plus-periapicals approach.

   1. Consultant in Restorative Dentistry, Department of Periodontology,
      Glasgow Dental Hospital and School, 378 Sauchiehall Street, Glasgow G2 3JZ
   2. Senior Lecturer in Oral Radiology, Glasgow Dental Hospital and School,
      378 Sauchiehall Street, Glasgow G2 3JZ
   3. Consultant in Restorative Dentistry, Department of Periodontology,
      Glasgow Dental Hospital and School, 378 Sauchiehall Street, Glasgow G2 3JZ
   4. Superintendent Radiographer, Glasgow Dental Hospital and School,
      378 Sauchiehall Street, Glasgow G2 3JZ
   5. Staff Grade in Restorative Dentistry, Glasgow Dental Hospital and School,
      378 Sauchiehall Street, Glasgow G2 3JZ
   6. Clinical Physicist, Glasgow Dental Hospital and School,
      378 Sauchiehall Street, Glasgow G2 3JZ

Correspondence to: W M M Jenkins1 Department of Periodontology, Glasgow Dental Hospital and School,
           378 Sauchiehall Street, Glasgow G2 3JZ  : e-mail: Bill.Jenkins@northglasgow.scot.nhs.uk

from AAP 2005 research abstracts.......booyah  ;-) - FRED

Implications of Successful Long-Term Tooth Retention After Periodontal Therapy
Bryan Frantz, D.M.D., Scranton Background: A basic tenet of periodontal therapy is long-term retention of teeth in comfort and function. There has been a recent trend in therapy to extract periodontitis-affected teeth and replace with implants because of apparent unpredictable treatment outcomes in the private practice environment. The purpose of the present study was to try and clarify this situation by analyzing tooth retention outcomes in a large data base with a minimum of ten years post-periodontal treatment. The therapeutic approach had been directed primarily at resolution of inflammation. Methods: The population comprised 150 patients, 105 females, 45 males, age ranges 27-75 yrs, mean 48.2 yr. Active treatment comprised oral hygiene instruction, scaling, reevaluation of responses, and surgical therapy utilized a variety of different techniques. After active treatment, patients went on a maintenance program of professional examination and scaling every 3 months, and appointments were alternated between the periodontal and referring dentist office. Nine cases were AAP type II, 88 were type III, and 53 type IV. The average follow-up period was 12.6 years, ranging 10.1- 16.1years. The total number of teeth entering into initial treatment were 3,738, mean per patient 24.9. During treatment, 56 teeth were extracted, average extraction per patient = 0.37. Thus, number of teeth remaining after treatment was 3,682, mean per patient 24.5. Results: Over the 12-year maintenance period in these 150 patients, the total number of teeth lost was 239. Sixty-three were lost for non-periodontal reasons; the 176 lost for periodontal reasons were because of terminal bone loss (110 teeth), exfoliation (1 tooth), furcation breakdown (34 teeth), and endo-perio (31 teeth). The 176 teeth lost due to periodontal disease represented 4.7 % of the total 3,682 teeth at risk (meaning 95.3% tooth retention), with an average tooth loss per patient of 1.2. Seventy-five patients lost teeth, and 10 patients lost 3 or more teeth indicating that some were at greater risk. Clinical and radiographic data across time showed that almost all patients had changed very little since completion of treatment. Conclusions: Rate of tooth loss after therapy was extremely slow with over 95% tooth retention after 12 years. This rate of retention seems overall more favorable than implant success rates over a similar period of time. Also, a stable periodontal condition over 12 years meant that all treatment planning options were still available to the patient. Finally, this approach toward tooth retention may be economically more beneficial to the patient. Acknowledgments: Drs. Alan M. Polson, University of Pennsylvania and Alexis Gearhart, Scranton participated in this
research. giddyup ;-)) - KendelG When people under-respond to inflammatory stimuli (ADDX genotype 4) they are much more at risk to lose a tooth..... If they smoke / diabetic and under-respond to inflammatory stimuli they have a huge risk of perio. anybody familiar with www.addx.us and read some of the literature. They claim the only defense would be that DNA-PCR testing ---- so new that the dentists don't know about it. - joe Statin Use and Tooth Loss in Chronic Periodontitis Patients J. Cunha-Cruz,*? ­B. Saver,? ­G. Maupome,§ and ­P.P. Hujoel*­ *Department of Dental Public Health Sciences, University of Washington, Seattle, WA. †Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil. ‡Department of Family Medicine, University of Washington. §Currently, Oral Health Research Institute, Indiana University School of Dentistry, Indianapolis, IN; previously, Center for Health Research, Kaiser Permanente, Portland, OR. Correspondence to: Correspondence: Dr. Philippe P. Hujoel, Department of Dental Public Health Sciences, B509, University of Washington, 1959 N.E. Pacific St., Box 357475, Seattle, WA 98195-7475. Fax: 206/685-4258; e-mail: hujoel@u.washington.edu. Background: Statins have anti-inflammatory and bone stimulating properties that may positively affect chronic periodontitis. Our objective in this study was to evaluate whether statin use by chronic periodontitis patients had a beneficial impact on tooth loss. Methods: In a retrospective cohort study (N patients = 1,021; mean follow-up = 7.1 years), dental records were merged with pharmacy data. Any statin use during 3 years, statin use during each of 3 consecutive years (regular use), and any statin use during the first 3 years after the initial periodontal exam were evaluated as predictors of tooth loss using negative binomial regression models with adjustment for potential confounding factors. Results: Any statin use during 3 years was not associated with tooth loss rate in the year subsequent to the 3-year period (rate ratio [RR] = 1.00; 95% confidence interval [CI] = 0.56 to 1.81). Regular statin use during 3 years was associated with a non-significant 37% reduced tooth loss rate in the year subsequent to the 3-year period (RR = 0.63; 95% CI = 0.32 to 1.25). Any statin use during the first 3 years after the initial periodontal exam was associated with a 48% decreased tooth loss rate in year 4 and subsequent years (RR = 0.52; 95% CI = 0.29 to 0.95). Conclusions: Our findings were mixed for an association of statin use with reduced tooth loss in chronic periodontitis patients. Lack of control for some potential confounders, particularly smoking, and evaluation of different patterns of statin usage hamper the interpretation of the results. Exploration of these findings in additional epidemiological studies may be worthwhile. Journal of Clinical Periodontology Volume 33 Page 555 - August 2006 doi:10.1111/j.1600-051X.2006.00955.x Volume 33 Issue 8 A cross-over study on the effect of various therapeutic approaches to morning breath odour Marcelo Faveri1,2, Mitsue F. Hayacibara1,3, Giselle Cancine Pupio1, Jaime A. Cury3, Claudia Ota Tsuzuki2 and Roberto M. Hayacibara1 Faveri M, Hayacibara MF, Pupio GC, Cury JA, Tsuzuki CO, Hayacibara RM. A cross-over study on the effect of various therapeutic approaches to morning breath odour. J Clin Periodontol 2006; 33: 555– 560. doi: 10.1111/j.1600-051X.2006.00955.x. Abstract Objective: The aim of this study was to investigate the effect of tongue scraping and inter-dental flossing on morning bad breath in periodontally healthy subjects. Methods: A four-step blind, cross-over study was conducted in 19 volunteers, divided into four groups: Group I: tooth brushing; Group II: tooth brushing and inter-dental flossing; Group III: tooth brushing and tongue scraping; and Group IV: tooth brushing, inter- dental flossing and tongue scraping. The volunteers performed these oral hygiene procedures three times a day for 7 days. Seven-day wash- out intervals were observed. Morning mouth breath was assessed organoleptically and by volatile sulphur compound concentrations. Results: The highest mean organoleptic and volatile sulphur compound measurement values were found in the treatment groups in which tongue scraping was not performed and there were statistical differences between the two groups (p<0.05). In the organoleptic evaluation (p>0.05), inter-dental flossing did not show any statistical improvement in the effect of tongue hygiene on morning bad breath, but it significantly reduced the concentration of volatile sulphur compounds (p<0.05). Conclusion: The findings suggest that tongue scraping appears to be the most important hygienic procedure to reduce morning bad breath in periodontally healthy subjects. Journal of Periodontal Research Volume 42 Issue 4 Page 361Issue 4 - 366 - August 2007 To cite this article: B. Söder, L. J. Jin, B. Klinge, P.-Ö. Söder (2007) Periodontitis and premature death: a 16-year longitudinal study in a Swedish urban population Journal of Periodontal Research 42 (4), 361–366. doi:10.1111/j.1600-0765.2006.00957.x Abstract Periodontitis and premature death: a 16-year longitudinal study in a Swedish urban population B. Söder11Institute of Odontology, Karolinska Institutet, Huddinge, Sweden , L. J. Jin22Faculty of Dentistry, University of Hong Kong, Hong Kong, China , B. Klinge11Institute of Odontology, Karolinska Institutet, Huddinge, Sweden , P.-Ö. Söder11Institute of Odontology, Karolinska Institutet, Huddinge, Sweden 1Institute of Odontology, Karolinska Institutet, Huddinge, Sweden and 2Faculty of Dentistry, University of Hong Kong, Hong Kong, China Birgitta Söder, Karolinska Institutet, Institute of Odontology, Box 4064, 141 04 Huddinge, Sweden Tel: + 46 8 524 8 82 41 Fax: + 46 8746 79 15 e-mail: birgitta.soder@ki.se Söder B, Jin LJ, Klinge B, Söder P-Ö. Periodontitis and premature death: a 16-year longitudinal study in a Swedish urban population. J Periodont Res 2007; 42: 361–366. © 2007 The Authors. Journal compilation © 2007 Blackwell Munksgaard Abstract Background and Objective: Growing experimental evidence implicates chronic inflammation/infection due to periodontal diseases as a risk factor for death. The objective was to evaluate the role of periodontitis in premature death in a prospective study. Methods: The causes of death in 3273 randomly-selected subjects, aged 30–40 years, from 1985 to 2001 were registered. At baseline, 1676 individuals underwent a clinical oral examination (Group A) and 1597 did not (Group B). Mortality and causes of death from 1985 to 2001 were recorded according to ICD-9-10. Results: In Groups A (clinically examined group) and B, a total of 110 subjects had died: 40 subjects in Group A, and 70 in Group B. In Group A significant differences were present at baseline between survivors and persons who later died, with respect to dental plaque, calculus, gingival inflammation and number of missing molars in subjects with periodontitis (p < 0.001). The multiple logistic regression analysis results of the relationship between being dead (dependent variable) and several independent variables identified periodontitis with any missing molars as a principal independent predictor of death. Conclusions: Young individuals with periodontitis and missing molars seem to be at increased risk for premature death by life-threatening diseases, such as neoplasms, and diseases of the circulatory and digestive systems. Periodontal Plastic surgery as an Adjunctive Therapeutic Modality for Esthetic Restorative Dentistry Kirk L. Pasquinelli, DDS This paper summarizes the field of periodontal plastic surgery and its applicability as an adjunctive treatment modality in the delivery of esthetic restorative dentistry. sthetic dental problems are often multifactorial in nature and may not be satisfactorily resolved by restorative treatment alone. An interdisciplinary approach to these situations offers the greatest potential for an outstanding treatment result. The better versed the restorative dentist is in adjunctive therapeutic modalities available from the dental specialties, the greater will be their ability to deliver a superior result. Periodontal plastic surgery may be utilized in the interdisciplinary solution to many esthetic clinical challenges.1 Periodontal plastic surgery deals with the cosmetic reconstruction, reshaping, or removal of the dentoalveolar tissues.2 The procedures common to the field include: root coverage, ridge augmentation, ridge preservation, preprosthetic ridge alteration, and esthetic crown lengthening. The ultimate goals of periodontal plastic surgery procedures are to provide the patient with their desired esthetic outcome while maintaining the health of the teeth and periodontium.Through a series of case reports, the objective of this paper is to help restorative dentists further their knowledge of periodontal plastic surgery as it pertains to the planning and delivery of sound biologic dental therapy that optimizes esthetics. Relationship between human cytomegalovirus transcription and symptomatic apical periodontitis in Iran Yazdi KA, Sabeti M, Jabalameli F, Eman eini M, Kolahdouzan SA, Slots J. Relationship between human cytomegalovirus transcription and symptomatic apical periodontitis in Iran. Oral Microbiol Immunol 2008: 23: 510–514.© 2008 The Authors. Journal compilation. © 2008 Blackwell Munksgaard. ABSTRACT Background/aims: Apical periodontitis of endodontic origin may develop as a result of cooperative interactions among herpesviruses, specific pathogenic bacteria and tissue-destructive inflammatory mediators. This study sought to identify the presence of Epstein–Barr virus (EBV) and human cytomegalovirus (HCMV) transcripts in symptomatic and asymptomatic periapical lesions of individuals living in Iran. Material and methods: Fifty endodontic patients (28 with symptomatic periapical lesions and 22 with asymptomatic periapical lesions) were included in the study. In each study subject, a microbiological periapical sample was collected using a curette in conjunction with periapical surgery. A reverse transcription–polymerase chain reaction assay was used to identify transcripts of EBV and HCMV. Results: Human cytomegalovirus transcript was detected in 15 of the 28 (53.6%) symptomatic and in six of the 22 (27.3%) asymptomatic periapical study lesions (significant difference between symptomatic and asymptomatic lesions; P = 0.03, chi-square test). Epstein–Barr virus transcript was identified in one symptomatic and in two asymptomatic periapical lesions. Conclusion: This study establishes that HCMV transcription is common in apical periodontitis and is most frequent in symptomatic lesions. The high frequency of active herpesvirus infections in severe apical periodontitis changes the pathogenic paradigm of the disease and may also have preventive and therapeutic implications. Effects of Full-Mouth Scaling and Root Planing in Conjunction With Systemically Administered Azithromycin Abstract Journal of Periodontology 2007, Vol. 78, No. 3, Pages 422-429 (doi:10.1902/jop.2007.060247) Kazuhiro Gomi,* ­Akihiro Yashima,* ­Takatoshi Nagano,* ­Mikimoto Kanazashi,* ­Nobuko Maeda,? and ­Takashi Arai*­ *Department of Periodontics and Endodontics, Tsurumi University, School of Dental Medicine, Yokohama, Japan. †Department of Oral Bacteriology, Tsurumi University, School of Dental Medicine. Correspondence: Dr. Kazuhiro Gomi, Department of Periodontics and Endodontics, Tsurumi University, School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama 230-8501, Japan. Fax: 81-45-583-8401; e- mail: gomi-k@tsurumi-u.ac.jp. Background: One-stage full-mouth disinfection (FMD), in which full- mouth scaling and root planing (SRP) is performed with adjunctive use of chlorhexidine, was introduced in 1995. There have been several reports on the effectiveness of this treatment protocol. However, FMD was reported to induce pyrexia frequently. We examined the effects of full-mouth SRP in conjunction with azithromycin administered orally before SRP to control the number of bacteria. The purpose of this study was to compare the effects of full-mouth SRP using azithromycin with conventional SRP. Methods: Thirty-four subjects (17 in the test group and 17 in the control group) with severe chronic periodontitis were selected. The subjects of the test group had azithromycin 3 days before full-mouth SRP. Clinical parameters (probing depth [PD], gingival index [GI], bleeding on probing [BOP], and gingival crevicular fluid [GCF]), total number of bacteria, and number of black pigment-producing rods (BPRs) were evaluated at baseline and 5, 13, and 25 weeks after baseline. Results: All clinical parameters improved in the test group more than in the control group. In the bacteriologic examination, the total number of bacteria did not change during the examination. In the test group, BPRs were not detected until 13 weeks. However, BPRs were detected in the control group by 13 weeks. Conclusion: It was shown that full-mouth SRP using systemically administered azithromycin was a clinically and bacteriologically useful basic periodontal treatment for severe chronic periodontitis. KEYWORDS: Azithromycin, bacteria, dental scaling, oral administration, root planing, periodontitis

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