Advanced Attachment Loss Research Articles

Impact of Smoking on Oral Health-related Quality of Life

The aim of this study was to assess smoking impact on oral health-related quality of life (OHRQoL). A cross-sectional study was carried out with smokers and non-smokers patients scheduled at a Faculty of Dentistry in Brazil. Sociodemographic data were collected and oral problems impact on quality of life were assessed through “Oral Health Impact Profile-14” (OHIP-14) questionnaire. The World Health Organization criteria were used to assess dental caries and periodontal disease. Data analysis was performed by descriptive and inferential statistics. Two hundred and seven individuals participated in the study, 112 non-smokers and 95 smokers. Most smokers were males (54.25%), the average smoking time was 24.74 ± 14.84 years and 54.72% of them reported smoking more than 11 cigarettes/day. Smokers scored higher values in OHIP-14 (p = 0.026) and in dimensions “functional limitation” (p < 0.001), “psychological discomfort” (p = 0.024) and “psychological disability” (p = 0.047). In addition, smokers had higher percentages of sextants with periodontal pockets (p < 0.001) and moderate to advanced attachment loss (p = 0.029). In short, smokers suffered a greater impact on OHRQoL, in addition to a worse periodontal condition compared to non-smokers.

Combined Periodontal and Orthodontic Treatment of Severely Compromised Teeth in Stage IV Periodontitis Patients: How Far Can We Go?

This retrospective study evaluated the effect of combined periodontal-orthodontic treatment in terms of clinical, radiographic, and patient-reported outcomes in 40 stage IV periodontitis patients with advanced attachment loss and pathologic migration of anterior teeth. Full-mouth periodontal parameters were recorded at baseline (after diagnosis; T0), at the end of active periodontal therapy (APT; T1), at completion of orthodontic tooth movement (OTM; T2), and at the last supportive periodontal care (SPC) visit (T3). Radiographic analysis was performed at T0, T2, and T3. A total of 115 teeth were lost during APT, including 5 molars at T2 (used as orthodontic anchorage) and 10 premolars at T3 (due to root fracture). All anterior migrated teeth were in function at T3 (mean duration: 9.5 years). Significant mean probing pocket depth reduction (1.5 ± 1.1 mm) and attachment level gain (0.9 ± 1.0 mm) were observed after APT, whereas OTM and SPC were associated with furthering small changes. The alveolar bone level at T3 was slightly increased from T0 values. Patient-reported outcome measurements significantly improved in terms of esthetics and masticatory function. OTM should be considered an essential part of the comprehensive treatment plan to change the prognosis of severely compromised teeth in stage IV periodontitis patients.

Long-Term Prognosis of Severely Compromised Teeth Following Combined Periodontal and Orthodontic Treatment: A Retrospective Study.

This retrospective study evaluated the long-term response of periodontal tissues and survival rate of teeth with advanced attachment loss and pathologic migration in 21 periodontitis patients treated with combined periodontal and orthodontic treatment. All anterior migrated teeth were in function at the end of 10 to 15 years of maintenance. Residual probing depths and clinical attachment levels improved after treatment and remained stable through the follow-up. A total of 55 hopeless teeth were lost during active therapy, as well as 6 molars over the course of the supportive periodontal therapy (for nonperiodontal reasons). In highly compliant patients, all migrated teeth with initial unfavorable prognosis showed long-term clinical stability.

Osteoporosis, fragility fracture, and periodontal disease

Osteoporosis and periodontitis are common disorders that affect aging populations. It has been hypothesized that both conditions may be related. The aim of this study was to evaluate the relationship between osteoporosis and periodontitis using vertebral fragility fracture as a real marker of osteoporosis and periodontal clinical examination to define periodontitis. Six hundred thirty-four women aged 55 to 70 years, with fragility spine fractures, and living in the same healthcare region of Seville, Spain, were invited to take part in this cross-sectional study conducted from 2008 to 2010. All the women included in the study were referred to undergo spine radiological examination, spinal densitometry, and full-mouth periodontal assessment. With the exception of number of teeth (19 in the fractured postmenopausal group and 23 in the control group; P < 0.007) and sites with a clinical attachment level lower than 7 mm (P < 0.048), there were no significant differences in clinical and periodontal parameters among women in the fractured postmenopausal group and the control group. In short, fractured postmenopausal women have lost more teeth with more advanced attachment loss (clinical attachment level >7 mm). None of the definitions of periodontitis used resulted in significant differences between groups. The relationship between periodontitis and osteoporosis remains unclear, and further studies considering fragility fracture as a real marker of osteoporosis are warranted to clarify the exact role and effect of one condition on the other and the corresponding clinical implications.

Aggressive periodontitis in children: a 14–19‐year follow‐up

The objective was to assess the recurrence of disease in subjects with a history of localized aggressive periodontitis (LAP). Initially, 11 children (7-13 years) with LAP were examined. Samples from the subgingival microbiota and soft tissue biopsies were obtained. Non-surgical periodontal therapy was performed and the affected deciduous and two permanent molars were extracted. The subjects were enrolled in a recall programme within the public dental services. Fourteen to 19 years after the initial examination, the subjects were recalled for clinical and radiographic examinations. The re-examination disclosed that two of the subjects exhibited recurrence of disease with probing pocket depth > or = 6 mm and bone loss of 3-4 mm at several teeth, while another two subjects presented a limited number of sites with the disease. While bleeding on probing was a general finding in the group, no further loss of attachment was detected in seven subjects. Advanced attachment loss at the deciduous teeth as well as the presence of Aggregatibacter actinomycetemcomitans and its specific clone JP at the initial examination did not correlate with the recurrence of disease at the 14-19-year follow-up. Children treated for LAP do not always exhibit recurrence of periodontitis in the absence of supportive periodontal therapy over periods of 14-19 years.

Periodontal Disease in Hispanic Americans With Type 2 Diabetes

Diabetes is a major risk factor for the development of periodontal disease in certain populations. The prevalence of type 2 diabetes is increased in Hispanic Americans, but its impact on the extent and severity of periodontal disease in this population has not been determined. Sixty-three Hispanic Americans, aged 33 to 72 years, from South Texas were grouped based on the presence or absence of type 2 diabetes. Past medical histories, including smoking, were obtained. Periodontal status was evaluated by measuring probing depth (PD), clinical attachment level (CAL), plaque, bleeding on probing, visual gingival inflammation, and calculus. Type 2 diabetes was associated frequently with major medical complications in this population. Diabetes was associated with significantly more calculus formation and tooth loss and an increased extent and severity of periodontitis. Subjects with diabetes had nearly three times the mean CAL and frequency of PD >6 mm than subjects without diabetes and nearly twice the frequency of moderate to advanced attachment loss (> or =3 mm). Smoking and diabetes had significant independent effects on mean CAL and the frequency of deep pockets. Diabetes and smoking combined were associated with a significantly higher frequency of sites with CAL > or =3 mm compared to healthy non-smokers, healthy smokers, and non-smokers with diabetes. Hispanic Americans with type 2 diabetes had more supra- and subgingival calculus, an increased extent and severity of periodontal destruction, and an increased frequency of tooth loss due to periodontitis. An additive/synergistic contribution of type 2 diabetes and smoking for increasing the extent of periodontal disease was observed.

Periodontal condition in patients with rheumatoid arthritis

The purpose of this clinical study was to investigate if periodontal disease and rheumatoid arthritis (RA) are associated. The study included 39 RA patients (test group) and 22 age- and gender-matched healthy individuals (control group). Questionnaires on general and oral health were applied and a complete periodontal exam, including visible plaque, marginal bleeding, attachment loss (AL) and number of teeth present, was also performed by a single calibrated examiner. Diabetes mellitus patients and smokers were excluded. RA patients had fewer teeth, higher prevalence of sites presenting dental plaque and a higher frequency of sites with advanced attachment loss. Although the prevalence of dental plaque was higher in the test group (Chi-square test, p = 0.0006), the percentage of sites showing gingival bleeding was not different (Fishers exact test, p > 0.05). Based on our results, we suggest that there is an association between periodontal disease and RA.

Cytomegalovirus‐Associated Periodontitis and Guillain‐Barré Syndrome

Guillain-Barré syndrome (GBS), an autoimmune disorder of the peripheral nervous system, is characterized by rapidly ascending neural paralysis, hyporeflexia, and areflexia. The polyneuropathy of the GBS affects one to four humans per 100,000 of the population annually throughout the world (adults and children). The pathogenesis of GBS remains unclear. However, there are increasing indications that the disease is triggered by a preceding well-established febrile infection by cytomegalovirus (CMV). The present report describes active CMV within the periodontium of a 37-year-old patient affected by GBS. Real-time reverse transcriptase-polymerase chain reaction (real-time RT-PCR) was performed to detect CMV, Epstein-Barr virus-1 (EBV-1), herpes simplex 1 (HSV-1) and 2 (HSV-2) virus, and enteroviruses (polio-, coxsackie-, echo-, and enteroviruses 68 and 71) from periodontal sites demonstrating advanced attachment loss. Healthy sites and sites with inflamed gingival tissue were not included in the study. Anaerobic bacterial culture determined the occurrence of potential major periodontal pathogens. Real-time RT-PCR and microbiologic analysis revealed the presence of a dual infection of CMV and specific bacterial plaque. CMV, Porphyromonas gingivalis, Tannerella forsythensis, and Campylobacter species were associated with periodontitis active sites, loss of attachment, and gingival bleeding. Furthermore, periodontal sites infected by active CMV had no visible radiographic crestal lamina dura. The periodontium may serve as a reservoir for CMV and a source of viral replication. However, further research is needed to test whether viral replication in the periodontium precedes the GBS symptoms.

Periodontal status and preterm low birth weight: a case control study

Previous studies have suggested that periodontal disease may be an important risk factor for preterm low birth weight. However, the link between periodontal health status of pregnant women and preterm low birth weight is contentious, as recent studies found no association between periodontitis and pregnancy outcome. The aim of this study was to investigate this potential link in a German Caucasian population. Fifty-nine pregnant women with a high risk for a preterm low birth weight infant (suffering from preterm contractions, cases, group 1) as well as 42 control women with no preterm contractions during pregnancy and having an infant appropriate for date and weight (>or= 37 weeks gestation, >or= 2500 g, group 2) were examined. Clinical periodontal status was recorded on a full mouth basis. Subgingival plaque samples were taken and periodontal pathogens were identified by polymerase chain reaction. Additionally, interleukin-1 beta level in gingival crevicular fluid was analysed. The mean percentage of sites showing moderate to advanced attachment loss (>or=3 mm) was low in all study groups (group 1: 9.9 +/- 11.2%; group 2:10.6 +/- 14.1%, respectively). No significant differences between the groups in any aspects of the studied periodontitis parameters could be detected. Using a logistic regression model controlling for known preterm low birth weight risk factors, no periodontitis-associated factors increased risk for preterm contractions or preterm low birth weight. The odds ratio (OR) was 1.19 for preterm contractions, the 95% confidence interval (CI) 0.46; 3.11 and 0.73 for preterm low birth weight; 95% CI: 0.13; 4.19, respectively. In this population, periodontitis was not a detectable risk factor for preterm low birth weight in pregnant women.

Clinical Response of Azithromycin as an Adjunct to Non‐Surgical Periodontal Therapy in Smokers

Antibiotic therapy can be used in very specific periodontal treatment situations such as in refractory cases of periodontal disease found to be more prevalent in smokers. This study was designed to determine the efficacy of azithromycin (AZM) when combined with scaling and root planing (SRP) for the treatment of moderate to severe chronic periodontitis in smokers. Thirty-one subjects were enrolled into a 6-month randomized, single-masked trial to evaluate clinical, microbial (using benzoyl- DL-arginine naphthylamine [BANA] assay), and gingival crevicular fluid (GCF) pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) levels in response to SRP alone or SRP + AZM. At baseline, patients who smoked > or =1 pack per day of cigarettes who presented with at least five sites with probing depths (PD) of > or =5 mm with bleeding on probing (BOP) were randomized into the test or control groups. At baseline and 3 and 6 months, clinical measurements (probing depth [PD], clinical attachment loss [CAL], and bleeding on probing [BOP]) were performed. GCF bone marker assessment (Ctelopeptide [ICTP] as well as BANA test analyses) were performed at baseline, 14 days, and 3 and 6 months. The results demonstrated that both groups displayed clinical improvements in PD and CAL that were sustained for 6 months. Using a subject-based analysis, patients treated with SRP + AZM showed enhanced reductions in PD and gains in CAL at moderate (4 to 6 mm) and deep sites (>6 mm) (P <0.05). Furthermore, SRP + AZM resulted in greater reductions in BANA levels compared to SRP alone (P <0.05) while rebounds in BANA levels were noted in control group at the 6-month evaluation. No statistically significant differences between groups on mean BOP and ICTP levels during the course of the study were noted. The utilization of AZM in combination with SRP improves the efficacy of non-surgical periodontal therapy in reducing probing depth and improving attachment levels in smokers with moderate to advanced attachment loss.

Treatment of periodontal disease may significantly reduce susceptible women's risk of delivering preterm low-birthweight babies

Summary Subjects The subjects were 400 healthy pregnant women of low0689 socioeconomic class, aged 18 to 35, with a history of a single gestation and periodontal disease. The women were between 9 and 21 weeks of gestation. Age and gestation history were chosen as a means to control for other known risk factors for preterm low birthweight (PBLW). Exposure All subjects received nonsurgical periodontal therapy0689 and daily 0.12% chlorhexidine rinses. Women with advanced attachment loss also received metronidazole and amoxicillin. Treatment was completed before 28 weeks gestation, and the periodontal health was maintained by visits every 2 to 3 weeks until gestation. Main outcome measure Preterm birth, as defined by spontaneous delivery before 0689 week 37, and low birthweight, as defined by Main results Untreated periodontal disease was an independent risk0689 factor for PLBW in this group of women: odds ratio = 5.99 (1.70 – 20.6; P = .001 ). Treatment of periodontal disease significantly reduced the risk for PLBW; 1.84% of the women in the treatment group, versus 10.11% in the control group, delivered PBLW babies ( P = .003 ).