Chronic Periodontal Infection Research Articles

Oral infection, regular alcohol drinking pattern, and myocardial infarction

Oral infections have been associated with an increased risk for myocardial infarction (MI) and other cardiovascular diseases (CVD). Conversely, low, regular alcohol consumption is associated with a lower association of CVD. The objective was to test the novel hypothesis that oral infections are modified by regular alcohol drinking which has the effect of lowering the incidence of MI’s. The effect has been observed where tooth extractions where carried out due to infections and compared with extractions unconnected to infections. Oral infections and in particular periodontal infections impose an infectious load on the health in many people. In its advanced forms (periodontal pockets ⩾6mm) periodontitis affects ∼10–15% of adults. The infection runs a chronic course with exacerbations. The bacteria cause local infection destructive to the supporting tissues of the teeth and have been detected in systemic diseases through bacterial products and bacteria entering the circulation. The often persistent, long term history of chronic periodontal infection in individuals is a challenge to the immune system. Over 700 oral bacteria and other microorganisms have been identified, many of which are virulent. Control of the level of oral microbiota is through well known oral hygiene measures. Alcohol by being bactericidal is a factor that may reduce the bacterial level in the oral cavity. If this effect truly exists, it should be observed through reduction of infections in the mouth. Tooth extraction is the ultimate consequence of periodontal and dental infections and a reduction of tooth extraction due to infections should therefore be observed. The hypothesis was tested using the screening data of the Oslo II-study in a cross sectional analysis. The Oslo-study included men aged 48–67years. The main finding was that the effect of a drinking pattern of 2–7 times per week reduced the risk of MI among men who had a history of tooth extractions due to infections versus tooth extraction for other causes or no extractions. This hypothesis supports an explanation as to why oral infection is a weaker independent risk factor for CVD in some studies. It also gives an indication of the reason for an added benefit by a regular drinking pattern as part of the Mediterranean diet. The important consequence of this hypothesis is the added importance of optimal oral hygiene for the prevention of CVD as well as for the benefit of good oral health.

Low-Level Lasers as an Adjunct in Periodontal Therapy in Patients with Diabetes Mellitus

Diabetes mellitus (DM) increases the risk of periodontitis, and severe periodontitis often coexists with severe DM. The proposed dual pathway of tissue destruction suggests that control of chronic periodontal infection and gingival inflammation is essential for achieving long-term control of DM. The purpose this study is to evaluate the effects of low-level laser therapy (LLLT) by exfoliative cytology in patients with DM and gingival inflammation. Three hundred patients were divided in three equal groups: Group 1 consisted of patients with periodontitis and type 1 DM, Group 2 of patients with periodontitis and type 2 DM, and Group 3 of patients with periodontitis (control group). After oral examination, smears were taken from gingival tissue, and afterward all of the patients received oral hygiene instructions, removal of dental plaque, and full-mouth scaling and root planing. A split-mouth design was applied; on the right side of jaws GaAlAs LLLT (670 nm, 5 mW, 14 min/day) (model Mils 94; Optica Laser, Sofia, Bulgaria) was applied for five consecutive days. After the therapy was completed, smears from both sides of jaws were taken. The morphometric analysis was done using the National Institutes of Health Image software program and a model NU2 microscope (Carl Zeiss, Jena, Germany). Investigated parameters were significantly lower after therapy compared with values before therapy. After therapy on the side subjected to LLLT, there was no significantly difference between patients with DM and the control group. It can be concluded that LLLT as an adjunct in periodontal therapy reduces gingival inflammation in patients with DM and periodontitis.

TWO WAY RELATION OF DIABETES MELLITUS AND PERIODONTITIS - A REVIEW

The association between diabetes and periodontium is complex. Diabetes is a well established risk factor for periodontitis. Periodontitis infection complicates the severity of disease, and the degree of metabolic control of disease. Diabetes is a disease of metabolic dysregulation, primarily of carbohydrate metabolism, characterised by hyperglycemia that results from defects in insulin secretion, impaired insulin action or both. The major efforts should be directed at the prevention of periodontitis in patients at risk of developing diabetes. This proposed dual pathway of tissue destruction suggests that control of chronic periodontal infection is essential for achieving long-term control of diabetes mellitus. This dual relationship of the control of tissue destruction in chronic periodontal infection is essential also for the long term control of diabetes mellitus.

Antibacterial susceptibility patterns of Porphyromonas gingivalis isolated from chronic Periodontitis patients

To test the antimicrobial sensitivity of Porphyromonas gingivalis to a panel of eight orally administrable antibiotics in chronic periodontal diseases and to evaluate factors associated with periodontitis in adult patients. A total of fifty strains of P. gingivalis were isolated from one hundred and twenty adult patients with chronic perio-dontitis. Identification of bacteria was carried out by anaerobic culture and biochemical tests. Selected colonies of P. gingivalis were used to evaluate the antibacterial activities of penicillin, metronidazole, amoxicillin, amoxicillin/clavulanic acid, clindamycin, doxy-cycline, ciprofloxacin and azithromycin. Most of the patients were female, age ranging between 40 to 50 years. Majority of the patients frequently had scaling and depths of periodontal pockets in infected teeth were 5-8 mm and most of them had hemorrhage during sampling. Susceptibility testing revealed a sensitivity of 100% of P. gingivalis to azithromycin, doxycycline and amoxicillin/clavulanic acid but lower susceptibilities were found for the rest of antibiotic agents evaluated. Frequent scaling in women aged between 40-50 years had positive correlation with chronic periodontitis. The application of antibiotics in conjuction with mechanical debridation, may reflect in the level of resistance of P. gingivalis in patients with chronic periodontal infections. This could suggest periodical antibiotic susceptibility testing is necessary to determine the efficacy of antimicrobial agents if the perfect curing of chronic periodontal diseases after mechanical debridation is meant. Further clinical studies are required to confirm the in vitro results. The only limitation in this study was identification of bacteria to species rather than subspecies level.

PENGARUH PERIODONTITIS TERHADAP KESEHATAN BAYI YANG DILAHIRKAN : INFLUENCE OF PERIODONTITIS ON THE HEALTH OF BABIES BORN

Periodontal disease is characterised by low-grade infection of the gums and tooth support structures by Gram-negative, predominantly anaerobic bacteria. Periodontitis may cause preterm birth by causing low-grade bacteraemia, which lodges in the decidua, chorion and amnion or by releasing endotoxin into the maternal circulation, which triggers intrauterine inflammation and preterm birth. Approximately 25% of PLBW cases occur without any of the known risk factors, which have prompted continuation of the search for other possible causal factors. Collectively, the studies summarized in this paper suggest a model wherein chronic periodontal infection, serving as a reservoir for bacterial products (such as LPS) or various inflammatory mediators (or both), may play an important role in the development of PLBW. On that basis, the authors felt the need for further review on the effect of periodontitis on the health of babies born, and is expected to provide insight into the influence of periodontitis on the health of babies born so the dentist can be more critical and increasing role in preventing and improving maternal health pregnancy and abortion standarizations. As conclusion, the poor health of periodontium during pregnancy is one of the risks of preterm and low birth weight

Systemic endotoxin levels in chronic indolent periodontal infections

Periodontal disease has been linked with an increased risk of various systemic diseases. A plausible biologic explanation for this link includes the opportunity for oral pathogens to translocate to the circulation as a result of breakdown in integrity of the oral epithelium. This study refined a methodology used to detect endotoxin activity in the serum of subjects with indolent periodontal infections. The QCL Kinetic Chromogenic Assay (Cambrex) is a kinetic measure of endotoxin activity. Sera from 211 pregnant women with periodontitis enrolled in the Obstetrics and Periodontal Therapy Trial were used to develop the assay further and to evaluate the detection of endotoxin activity that might accompany a low-level bacteremia in chronic periodontitis. We optimized the system to increase the sensitivity and reproducibility of the assay. The refined system was able to detect endotoxin activity in serum at > 0.0125 EU/mL. At baseline (13-16 wk of gestation), 35.5% of the women were positive for endotoxin activity (1.62 +/- 2.21; range: 0.38-15 EU/mL). This report describes a sensitive measure of endotoxin activity in serum. The procedure allowed us to document levels of this microbial virulence factor in serum of individuals with indolent infections such as periodontal disease.

Oral bacteria induce a differential activation of human immunodeficiency virus‐1 promoter in T cells, macrophages and dendritic cells

The human immunodeficiency virus (HIV) can integrate into T cells, macrophages and dendritic cells resulting in a latent infection. Reports have also demonstrated that various microbial and host cell factors can trigger HIV reactivation leading to HIV recrudescence, potentially undermining highly active antiretroviral therapies. This study evaluated the capacity of oral bacteria associated with chronic periodontal infections to stimulate HIV promoter activation in various cell models of HIV latency. T cells (1G5) challenged with oral bacteria demonstrated a dose-response of HIV promoter activation with a subset of the bacteria, as well as kinetics that were generally similar irrespective of the stimuli. Direct bacterial challenge of the T cells resulted in increased activation of approximately 1.5- to 7-fold over controls. Challenge of macrophages (BF24) indicated different kinetics for individual bacteria and resulted in consistent increases in promoter activation of five fold to six fold over basal levels for all bacteria except Streptococcus mutans. Dendritic cells showed increases in HIV reactivation of 7- to 34-fold specific for individual species of bacteria. These results suggested that oral bacteria have the capability to reactivate HIV from latently infected cells, showing a relationship of mature dendritic cells > immature dendritic cells > macrophages > or = T cells. Expression of various pattern recognition receptors on these various cell types may provide insight into the primary receptors/signaling pathways used for reactivation by the bacteria.

Porphyromonas gingivalis gingipains cause G1 arrest in osteoblastic/stromal cells

The program for mammalian cell growth and division consists of four successive phases; G(1), S, G(2), and M. Porphyromonas gingivalis may manipulate the host cell cycle to benefit bacterial virulence expression, which likely causes the cell and tissue tropism observed in chronic periodontal infections. We examined P. gingivalis for its effects on cell-cycle modulation in mouse ST2 osteoblastic/stromal cells. Synchronized ST2 cells were infected with P. gingivalis ATCC33277 (wild-type, WT), gingipain-mutants [KDP136 (DeltargpADeltargpBDeltakgp), KDP129 (DeltargpADeltargpB), and KDP133 (Deltakgp)], and a fimbria-deficient mutant (KDP150) for 24 h, then the cell cycle was evaluated using flow cytometry. Cell-cycle-related molecule expression was examined with a microarray, as well as with quantitative real-time polymerase chain reaction and Western blotting assays. Both the WT and KDP150 strains significantly inhibited cellular proliferation and arrested the cell cycle in the G(0)/G(1) phase, while the expression levels of the cell-cycle regulatory molecules cyclin D and cyclin E were also decreased. In contrast, KDP136 did not show any effects. G(1) arrest was also clearly induced by KDP129 and KDP133, with KDP129 being more effective. The present findings suggest that P. gingivalis gingipains reduce cyclin expression and cause early G(1) arrest, leading to the inhibition of cellular proliferation.

Prevalence of Enterococcus faecalis in subgingival biofilm and saliva of subjects with chronic periodontal infection

Background and aims Enterococci are increasingly associated with nosocomial and opportunistic infections in humans. The role of the oral cavity as a reservoir for this species is unclear, particularly in the presence of oral infection. This study investigated the prevalence of Enterococcus faecalis in subgingival biofilm and saliva of patients with periodontal disease. Methods Samples were obtained from 56 periodontally healthy and 169 chronic periodontitis subjects. DNA was extracted from the samples and detection of E. faecalis was carried out by polymerase chain reaction. Results In general, E. faecalis was detected in 34.9% of all samples evaluated. No significant difference in the prevalence of this species between subgingival biofilm (34.6%) and saliva (35.1%) samples was observed. E. faecalis was detected significantly more often in saliva and subgingival samples of periodontitis patients (40.5% and 47.8%, respectively) compared to controls (14.6% and 17.1%, respectively; p < 0.05). Moreover, significant positive correlations were observed between the presence of E. faecalis and clinical parameters of probing depth, clinical attachment level, bleeding on probing and plaque accumulation ( p < 0.001). Conclusion The present data showed that E. faecalis is frequently detected in the oral microbiota of periodontitis patients suggesting that periodontal infection may favour the colonization by this species. Close attention should be given to these patients regarding the risk for development of E. faecalis infection in other sites of the body.

Immediate Placement of Dental Implants Into Debrided Infected Dentoalveolar Sockets

To describe a protocol for the immediate placement of endosseous implants into debrided infected dentoalveolar sockets. A total of 30 implants were immediately placed into debrided infected sites in 20 patients. The pathology at the receptacle dentoalveolar sockets varied, and included subacute periodontal infection, perio-endo infection, chronic periodontal infection, chronic periapical lesion, and a periodontal cyst. The immediate placement protocol emphasized the meticulous debridement of the infected tissues in combination with peripheral ostectomy of the alveoli. Guided bone regeneration was accomplished to support bony healing of alveolar defects surrounding the implantation site. Pre- and postsurgical antibiotic therapy was administered. All implants but 1 were osseointegrated and functional when followed up after 12 to 72 months. One implant was mobile after its immediate restoration and was removed. Complications were related to the use of guided bone regeneration. Deficiency of the attached gingiva was noted in 1 case. The treatment approach is illustrated in 2 anterior maxilla cases with 3-year follow-up. Successful immediate implantation in debrided infected alveoli depends on the complete removal of all contaminated tissue and the controlled regeneration of the alveolar defect. With this proposed clinical approach, experienced clinicians may consider immediate implants as a viable treatment option in patients presenting with dentoalveolar infections.

The effects of periodontal therapy on vascular endothelial function: A pilot trial

Chronic periodontal infection is associated with an increased risk of coronary heart disease. Although the mechanism responsible for the relationship between periodontal disease and cardiovascular events is not fully understood, it is hypothesized that the chronic inflammatory burden of periodontal disease may lead to impaired functioning of the vascular endothelium. Twenty-two otherwise healthy adults with moderate to severe periodontitis who underwent complete mouth disinfection were evaluated to determine if periodontal therapy would result in improved endothelial function and a decrease in serum inflammatory markers. Subjects had measurements of periodontal disease severity, flow-mediated (endothelium-dependent), and nitroglycerin-mediated (endothelium-independent) dilation of the brachial artery, serum C-reactive protein (CRP) and interleukin 6 (IL-6), and serum total and high-density lipoprotein cholesterol levels on 2 baseline visits separated by 1 month and, again, 1 month after treatment. There were no significant changes in clinical periodontal measures, flow-mediated dilation, nitroglycerin-mediated dilation, CRP, IL-6, total cholesterol, or high-density lipoprotein cholesterol between the repeated baseline measurements. Periodontal treatment, however, resulted in significant improvements in periodontal pocketing, flow-mediated dilation, and serum IL-6, as well as a trend toward reduction in serum CRP; there were no significant changes in nitroglycerin-mediated dilation or in cholesterol levels. These results represent proof of concept that improvement in endothelial function, as measured by flow-mediated dilation of the brachial artery, may be possible through near-elimination of chronic oral infection and suggest that the conduct of a larger controlled trial is justified.

Fimbria-dependent activation of pro-inflammatory molecules in Porphyromonas gingivalis infected human aortic endothelial cells

Epidemiological studies support that chronic periodontal infections are associated with an increased risk of cardiovascular disease. Previously, we reported that the periodontal pathogen Porphyromonas gingivalis accelerated atherosclerotic plaque formation in hyperlipidemic apoE-/- mice, while an isogenic fimbria-deficient (FimA-) mutant did not. In this study, we utilized 41 kDa (major) and 67 kDa (minor) fimbria mutants to demonstrate that major fimbria are required for efficient P. gingivalis invasion of human aortic endothelial cells (HAEC). Enzyme-linked immunosorbent assay (ELISA) revealed that only invasive P. gingivalis strains induced HAEC production of pro-inflammatory molecules interleukin (IL)-1beta, IL-8, monocyte chemoattractant protein (MCP)-1, intracellular adhesion molecule (ICAM)-1, vascular cellular adhesion molecule (VCAM)-1 and E-selectin. The purified native forms of major and minor fimbria induced chemokine and adhesion molecule expression similar to invasive P. gingivalis, but failed to elicit IL-1beta production. In addition, the major and minor fimbria-mediated production of MCP-1 and IL-8 was inhibited in a dose-dependent manner by P. gingivalis lipopolysaccharide (LPS). Both P. gingivalis LPS and heat-killed organisms failed to stimulate HAEC. Treatment of endothelial cells with cytochalasin D abolished the observed pro-inflammatory MCP-1 and IL-8 response to invasive P. gingivalis and both purified fimbria, but did not affect P. gingivalis induction of IL-1beta. These results suggest that major and minor fimbria elicit chemokine production in HAEC through actin cytoskeletal rearrangements; however, induction of IL-1beta appears to occur via a separate mechanism. Collectively, these data support that invasive P. gingivalis and fimbria stimulate endothelial cell activation, a necessary initial event in the development of atherogenesis.

Periodontal Infection and Preterm Birth: Results of a Prospective Study

Evidence from past studies suggests that chronic periodontal infection (chronic periodontitis) may be associated with preterm birth. Odds ratios as high as 7.9 are reported for mothers of preterm, low-birth-weight infants. The present prospective study correlated the presence of periodontitis at 21 to 24 weeks' gestation with subsequent preterm birth in 1313 women. Women requiring antibiotic prophylaxis for any reason were excluded. A team of specially trained dental hygienists obtained duplicate estimates of probe depth and attachment level in eight moderately affected nonpregnant patients and were accepted as study participants if their error did not exceed 0.5 mm. Significantly more periodontal disease was found in African American women than in white women. Unadjusted odds ratios for generalized periodontal disease increased with increasing prematurity, but this relationship did not take into account other known risk factors. Odds ratios adjusted for smoking, parity, race, and age disclosed that the risk of preterm birth associated with generalized periodontitis was approximately 4 to 7 times higher than in patients with good periodontal health. Women with severe or generalized periodontitis had an adjusted odds ratio of 4.45 for delivery before 37 weeks' gestational age, 5.3 for delivery before 35 weeks', and 7.1 for delivery before 32 weeks'. These findings support an association between preexisting maternal periodontal disease and preterm birth. A controlled interventional study will be needed to firmly establish a causal link.

Osteoporosis and periodontitis: discussion, conclusions, and recommendations.

1). Osteopenia is a condition of compromised bone strength that predisposes an individual to a risk of fracture. The paper accompanying this discussion by Dr. Charles Chesnut elegantly underscores that bone fragility has 2 components: bone density and bone quality.2 The density of the bone is extensively monitored in osteoporotic conditions, with dual energy xray absorptiometry being the gold standard; however, a reliable standard to measure bone quality has not been established. The line between osteoporosis and osteopenia has largely been a statistical one defined by the World Health Organization as 2.5 standard deviations below the mean for young white women. This is similar to determining a diagnosis of periodontitis solely on the presence of a site with 5 mm of attachment loss. Clearly a standard like this makes categorizing patients easier but provides little information on who needs treatment or preventive intervention. Moreover, can the standard be generalized to other ethic groups, men, or children? For these reasons, both osteoporotic and periodontal diseases are often clinically diagnosed and treatment sequenced on the basis of risk indicators for disease. In a comparison of the risk factors associated with osteoporosis and periodontal diseases, illustrated in the accompanying paper by Dr. Jean WactawskiWende, it seems clear that there are multiple similarities between the 2 disease processes.3 The diseases are associated in general with advancing age, with the vast majority of patients being over the age of 35, and a higher incidence in the later decades. A patient with a history of loss of alveolar bone support is at risk for future progression of periodontitis. Likewise, a patient with systemic bone loss or osteoporosis is at risk for osteoporosis. A history of previous bone loss is a common risk indicator for both periodontitis and osteoporosis. Systemic disease and certain medications (such as chronic corticosteroids) may worsen both periodontitis and osteoporosis. Smoking seems to be a significant risk indicator for severity and a risk factor for progression in both conditions. In addition, the pathophysiology of both diseases appears to have a hereditary or, at least, familial component. HEALTH CONSEQUENCES OF OSTEOPOROSIS Osteoporosis was once thought of as a natural part of the aging process in women, much the same way that tooth loss was thought to be related to age rather than chronic periodontal infection. Today, osteoporosis is no longer considered age or gender dependent. Approximately 10 million people in the United States have osteoporosis and almost twice that number have low bone mass or osteopenia. Currently, a patient experiencing a hip fracture has a 1 in 6 likelihood of mortality, a 1 in 5 likelihood of being non-ambulatory, and a 1 in 3 likelihood of needing dependent care. The estimated cost of osteoporosis fractures annually is $20 billion, not including subsequent complications of pressure sores, pneumonia, urinary tract infections, and depression.1 If one considers the rapidly expanding population group older than 65 years of age, the impact of osteoporosis on health care becomes readily apparent. In the year 2000, the world population had approximately 350 million people over the age of 65; by the year 2050, it is estimated that 1.5 billion people will be older than 65 years of age.1 The impact of this aging population will have dramatic effects on the number of fractures related to osteoporosis. In 2000, there were approximately 1.7 million fractures related to osteoporosis in adults 35 years of age or older. The number of osteoporotic fractures, in the same age group, is projected to reach 6.2 million by 2050.1 Without intervention or a better understanding of the disease process, this will have a devastating result on the health care system. Whether this potential progression in osteoporosis will have an equal effect on oral bone loss may require a better understanding of the interrelationship between osteoporosis and periodontitis.

Periodontal infection and preterm birth: Results of a prospective study

Previous studies have suggested that chronic periodontal infection may be associated with preterm births. The authors conducted a prospective study to test for this association. A total of 1,313 pregnant women were recruited from the Perinatal Emphasis Research Center at the University of Alabama at Birmingham. Complete periodontal, medical and behavioral assessments were made between 21 and 24 weeks gestation. After delivery, medical records were consulted to determine each infant's gestational age at birth. From these data, the authors calculated relationships between periodontal disease and preterm birth, while adjusting for smoking, parity (the state or fact of having born offspring), race and maternal age. Results were expressed as odds ratios and 95 percent confidence intervals, or CIs. Patients with severe or generalized periodontal disease had adjusted odds ratios (95 percent CI) of 4.45 (2.16-9.18) for preterm delivery (that is, before 37 weeks gestational age). The adjusted odds ratio increased with increasing prematurity to 5.28 (2.05-13.60) before 35 weeks' gestational age and to 7.07 (1.70-27.4) before 32 weeks' gestational age. The authors' data show an association between the presence of periodontitis at 21 to 24 weeks' gestation and subsequent preterm birth. Further studies are needed to determine whether periodontitis is the cause. While this large prospective study has shown a significant association between preterm birth and periodontitis at 21 to 24 weeks' gestation, neither it nor other studies to date were designed to determine whether treatment of periodontitis will reduce the risk of preterm birth. Pending an answer to this important question, it remains appropriate to advise expectant mothers about the importance of good oral health.

Idiopathic resorption of teeth A report of three cases

External resorption of teeth is a condition typically associated with etiologic factors within the adjacent alveolar bone, such as chronic periapical or periodontal infections, neoplasms, erupting permanent teeth, orthodontic movement, or trauma to the jaws. When none of these causes are present, resorption of teeth at the cementoenamel junction has been termed “idiopathic resorption of teeth.” Three cases of idiopathic resorption of teeth are reported, the literature on previous cases is reviewed, and hypotheses as to causes and a new theory are postulated regarding the possible mechanism for osteoclastic resorption of teeth.

Evaluation of autotransplantations of completely developed maxillary canines

Transplantation of 28 maxillary canines was followed up in 22 patients with an average age of 25.2 s.d. 9.9 years. The root was fully developed. The mean immobilization time was 6.6 weeks and the mean follow-up period 17.8 months. Results seemed to be better in the age group of 13-20 years than in 21-30 and 31-47 years. Statistically significant better results were found in the youngest than in the older groups in the return of vitality, vertical bone resorption, periodontal space and in the lamina dura. Four of the 28 teeth were extracted because of great mobility caused by poor bone regeneration and vertical resorption of the alveolar bone: three in the middle age group and one in the oldest. Pulp extirpation was performed on nine teeth: six in the oldest group and three in the middle group. Vitality returned in only three teeth, all of which belonged to the youngest group. Root resorption was observed in all age groups; in 76 % of the cases it occurred in the apical third, and was generally inflammatory. The causes of the failure of transplantation were considered to include damage of the transplant during removal from deep palatal malposition, poor regeneration of the bone around the transplant and chronic periodontal infection. The prognosis for transplantation was found to be fairly good for patients under 20 years of age but poorer for older age groups.

Evaluation of periapical radiolucencies found in cadavers

There has been a recent resurgence of interest in investigative roentgenography. Bender and Seltzer1 showed that intrabony lesions often may not be detected roentgenographically unless there is per­ foration or considerable resorption of the overlying cortical bone. They also pointed out that there may be extensive bone dis­ ease without roentgenographic evidence. The findings of Shackman and Harrison2 confirm this, as they were able to demon­ strate microscopically visible but roent­ genographically invisible metastases in vertebrae and long bones. Goldman, Millsap, and Brenman,3 in 1957, removed the entire buccal and lingual plates of jaw bones and concluded that “ . . . only the density of the radiograph was affected when the buccal and lingual plates were removed.” Limited observations of peri­ apical pathoses studied roentgenographi­ cally and microscopically were made by Kronfeld.4 Perhaps the most complete account of oral bone pathosis found in cadavers was recorded by Thoma in 1918.5 He pre­ sented photographs of several cadaver specimens with bone lesions resulting from chronic periapical and periodontal infection. Unfortunately, this work was not accompanied by roentgenograms. In the literature a void seems to exist con­ cerning the “ naturally occurring” oral pathoses that are available for study in cadavers. The following investigation was instigated to compare the findings of others using experimental lesions with actual pathologic conditions found in cadavers studied roentgenographically and by subsequent dissection.