Development Of Periodontal Pockets Research Articles

Clinical periodontal diagnosis.

Periodontal diseases include pathological conditions elicited by the presence of bacterial biofilms leading to a host response. In the diagnostic process, clinical signs such as bleeding on probing, development of periodontal pockets and gingival recessions, furcation involvement and presence of radiographic bone loss should be assessed prior to periodontal therapy, following active therapy, and during long-term supportive care. In addition, patient-reported outcomes such as increased tooth mobility, migration, and tilting should also be considered. More important to the patient, however, is the fact that assessment of signs of periodontal diseases must be followed by an appropriate treatment plan. Furthermore, it should be realized that clinical and radiographic periodontal diagnosis is based on signs which may not reflect the presence of active disease but rather represent the sequelae of a previous bacterial challenge. Hence, the aim of the present review is to provide a summary of clinical and radiographic diagnostic criteria required to classify patients with periodontal health or disease.

Unraveling the Etiology of Periodontitis

Across the globe, incidence of oral afflictions like gingivitis and periodontitis are increasing at a very fast pace. Evidencearethere to support the fact that despite of being an oro-dental infection, periodontitis is associated with the systemic diseases too. Different ecological niches of oral cavity can harbor both pathogenic and non-pathogenic micro-organisms. Although the main cause of the disease is the anaerobic or the facultative anaerobic bacteria, other factors such as poor personal hygiene, diet and immune related disorders are also responsible for the progression of the disease. The vicious circle starts from deposition of the bacterial plaque/biofilm on the tooth surface then leading to gingivitis. If left untreated, it progresses to the development of periodontal pockets and ultimately tooth loss. However traditional treatment modalities like high dose of systemic antibiotics are available but antimicrobial resistance and virulence of the periodontal pathogens is the major cause of the treatment failures. This review primarily focuses on the etiology, pathogenesis and microbiology of the periodontitis. It also discusses the virulence and antimicrobial resistance factors of the periodontopathic micro-organisms. It is an attempt to develop the thorough understanding of the disease so that better therapeutic outcomes of periodonto-therapy can be attained.

Effect of smoking on periodontal health and validation of self-reported smoking status with serum cotinine levels

Objective To investigate whether self-reported smoking and serum cotinine levels associate with periodontal pocket development and to determine the accuracy of self-reported smoking using serum cotinine. Materials and methods This 4-year prospective cohort study included data from 294 dentate adults, aged ≥30 years, who participated in both the Health 2000 Survey and the Follow-up Study of Finnish Adults’ Oral Health. Subjectively reported smoking status (daily smokers n = 62, occasional smokers n = 12, quitters n = 49, and never-smokers n = 171), serum cotinine levels, demographic factors, education level, dental behaviours and medical history were collected at baseline. The outcome measure was the number of teeth with periodontal pocketing ≥4 mm over 4 years. Results Self-reported daily smokers had 1.82 (95% CI: 1.32–2.50) higher incidence of deepened periodontal pockets than never-smokers. A positive association was observed between serum cotinine (≥42.0 μg/L) and the development of periodontal pockets. The misclassification rate of self-reported smoking was 6%. Conclusions Both self-reported daily smoking and higher serum cotinine were associated with periodontal pocket development. Self-reported smoking was fairly accurate in this study. However, higher cotinine levels among a few self-reported never-smokers indicated misreporting or passive smoking. Thus, self-reports alone are not enough to assess the smoking-attributable disease burden.

Alcohol use and the development of periodontal pockets: An 11-year follow-up study.

This study investigates whether alcohol use predicts the periodontal pocket development over an 11-year follow-up period. The study participants' periodontal condition was examined both in the Health 2000 and 2011 Surveys (BRIF8901). Participants were aged 30 to 65 years, dentate, periodontally healthy, and did not have diabetes or rheumatoid arthritis in 2000. Periodontal outcome measures in 2011 were the number of teeth with deepened (≥4mm) periodontal pockets and the presence of deepened periodontal pockets. The exposure in 2000 was alcohol use (amount [g/week], frequency [any alcohol or different beverages]). Incidence rate ratios (IRRs) with 95% confidence intervals (CI) were estimated using negative binomial regression model and Poisson regression model with a robust variance estimator. Overall, the amount of alcohol use or use over the risk limit in 2000 was inconsistently associated with the development of periodontal pockets (IRRs varied from 0.6 to 1.0). The frequency of alcohol use (any alcohol or different beverages) had an inconsistent association with the presence of periodontal pockets (IRRs varied from 0.5 to 1.2) while there was an inverse association with the number of teeth with periodontal pockets. Among smokers, there were no clear associations between any of the exposures and either of the outcomes. The same was found among non-smokers except an inverse association was found between frequency of alcohol use and the number of teeth with periodontal pockets. Alcohol use was not consistently associated with the periodontal pocket development over a period of 11 years.

Alcohol use and periodontal pocket development: findings from a 4-yr longitudinal study.

This study investigated whether alcohol use influences periodontal pocket development during a 4-yr follow-up period. The study included those participants who took part in both the Health 2000 Survey and the Follow-up Study on Finnish Adults' Oral Health. The participants at baseline were aged ≥30yr, periodontally healthy, and did not have diabetes or rheumatoid arthritis. The development of periodontal pockets at follow-up was measured as the number of teeth with periodontal pockets and the presence of periodontal pockets. Alcohol use at baseline was measured as g/wk, frequency, and use over the risk limit. Incidence rate ratios with 95% CI were estimated using negative binomial regression models and Poisson regression models with a robust variance estimator.No consistent association was found between any of the alcohol variables andperiodontal pocket development in the total population or among non-smokers. Among smokers, a positive association was found with the frequency of alcohol use. In general, risk estimates were slightly higher for women than for men. In summary, light-to-moderate alcohol use appears not to be consistently associated with the development of periodontal pockets. The adverse effects on the periodontium seem, to some extent, to be dependent on gender and smoking.

Association between Oral Health Behavior and Development of Periodontal Pockets: A Cohort Analysis Using Data from Japanese Adults who Underwent Routine Dental Checkups in Occupational Settings

Association between Oral Health Behavior and Development of Periodontal Pockets: A Cohort Analysis Using Data from Japanese Adults who Underwent Routine Dental Checkups in Occupational Settings

Prevalence and association of smokeless tobacco use with the development of periodontal pocket among adult males in Dawan Valley, Yemen: a cross-sectional study.

BackgroundThe traditional type of smokeless tobacco used in the Arabian Peninsula, particularly common in Yemen, is called shammah. This study aims to determine the prevalence of shammah use and its association with the development of periodontal pockets. Other associated factors with the development of periodontal pocket were also determined.MethodsThis cross-sectional study included 346 adult males aged 18 years old to 68 years old. Socio-demographic characteristics, oral hygiene practices, and shammah use history were surveyed by using a structured interview questionnaire. The clinical assessment for the presence or absence of periodontal pockets was assessed on the basis of community periodontal index. The chi-square test was used to assess significant differences in study groups in terms of the presence of periodontal pockets. Multivariable logistic regression was selected to assess potential associated factors with the development of periodontal pockets.ResultsAmong the 346 adult males, 248 (71.7 %), 30 (8.6 %), and 68 (19.7 %) males never used shammah, were former shammah users, and were current shammah users, respectively. The significant associated factors with the development of periodontal pocket were age group (30 years old and above) (Adjusted Odds Ratio (AOR) = 2.03, 95 % CI: 1.13, 3.65; P = 0.018), low family income category (AOR = 2.35, 95 % CI: 1.39, 3.99; P = 0.001), former shammah user (AOR = 2.66, 95 %: CI: 1.15, 6.15; P = 0.022), and current shammah user (AOR = 6.62, 95 %: CI: 3.59, 12.21; P = 0.001).ConclusionsThe results revealed that periodontal pockets were significantly associated with age group (30 years old and above), low family income category, former shammah use, and current shammah use. The findings of the current study highlighted the need to develop comprehensive shammah prevention programs and reduce periodontal disease and other shammah-associated diseases.

Effectiveness of Adjunctive Low‐Dose Doxycycline Therapy on Clinical Parameters and Gingival Crevicular Fluid Laminin‐5 γ2 Chain Levels in Chronic Periodontitis

Laminin-5 (Ln-5) is involved in the apical migration of epithelial cells during the development of periodontal pockets. Low-dose doxycycline (LDD) can therapeutically modulate the host response with its non-antimicrobial properties. In the present randomized, double-blind, placebo-controlled, parallel arm study, the effectiveness of LDD in combination with non-surgical periodontal therapy on gingival crevicular fluid (GCF) Ln-5 gamma2 chain fragment levels and clinical parameters in patients with chronic periodontitis was examined over a 12-month period. GCF samples were collected and clinical parameters including probing depth (PD), clinical attachment level, gingival index (GI), and plaque index were recorded. Thirty chronic periodontitis patients were randomized either to low-dose doxcycline or placebo groups. LDD group received doxycycline (20 mg, b.i.d.) for 3 months plus scaling and root planing (SRP), while placebo group was given placebo capsules b.i.d. for 3 months plus SRP. The patients were evaluated every 3 months during the 12-month study period. All clinical parameters and GCF sampling were repeated at each visit. GCF Ln-5 gamma2 chain fragment levels were determined by Western immunoblotting using specific antibody and quantitated by computerized image analysis. Friedman test was used for intragroup comparisons followed by Wilcoxon signed rank test to analyze significance of changes over time. The Mann-Whitney test was used to determine differences between both LDD and placebo groups. Both groups revealed significant improvements in all clinical parameters over the 12-month period (P < 0.0125). LDD group showed a significantly greater reduction in the mean PD scores at 9 and 12 months and in the mean GI scores at all time points than the placebo group (P < 0.05). In the LDD group, GCF Ln-5 gamma2 chain fragment levels were significantly reduced at 3 months (P < 0.0125) and then slightly increased during the rest of the study period. In the placebo group, GCF 45 and 70 kDa Ln-5 gamma2 chain fragments tended to decrease at 3 months compared to baseline, but did not reach significance; these levels continued to increase throughout the remainder of the study period. GCF Ln-5 gamma2 chain fragment levels in LDD group were significantly lower than those of the placebo group during the study period (P < 0.05). The present data indicate that LDD therapy in combination with SRP therapy can reduce GCF Ln-5 gamma2 chain fragment levels and improve clinical periodontal parameters in patients with chronic periodontitis. Since matrix metalloproteinases (MMP)-mediated fragmentation of laminin-5 can contribute to pocket formation by stimulating epithelial cell migration, the reduction of Ln-5 gamma2 chain fragment levels could provide a new mechanism by which LDD, adjunctive to SRP, inhibits periodontal disease more effectively than SRP alone. Thus, these results provide extended and additional information about the effectiveness of the LDD therapy as an adjunct to non-surgical periodontal therapy in the long-term management of periodontal disease.

Mineral status of skeleton and advanced periodontal disease

Studies of the effect of general bone loss on periodontal condition and on development of periodontal pockets suggest that there is no clear correlation between periodontal health or number of teeth and the general mineral status of the skeleton. In some reports, however, deep periodontal pockets have been correlated with good mineral status in the jawbones and skeleton. The purpose of this study of 227 healthy postmenopausal women aged 48 to 56 years was to determine whether advanced alveolar bone loss, diagnosed by panoramic radiographs, and periodontal probing depths or number of remaining teeth were correlated with the bone mineral status of the skeleton and cortical bone in the mandible. The results suggest that individuals with high mineral values in the skeleton seem to retain their teeth with deep periodontal pockets more easily than those with osteoporosis. This finding may especially motivate treatment of persons suffering from advanced periodontal disease but having good mineral status.

Evidence of alveolar bone loss in rats fed an atherogenic diet.

Normal Wistar rats, aged four and six month, were fed an atherogenic diet and the resulting periodontal changes were determined after six and eight weeks using histological, histochemical and histometrical methods. The changes of the alveolar bone remodelling adjacent to incisor teeth were compared with those around molar teeth. A diminished formation of new bone and an increased osteoclastic resorption were found in the alveolar bone of the rats fed the atherogenic diet. In addition gingival inflammation and the development of periodontal pockets were observed. Using histometrical evaluation it could be demonstrated that these alveolar bone changes were significantly more pronounced in the incisor teeth than in the molars. It is supposed that the latter finding is due to the more intense remodelling of the alveolar bone in the constantly growing teeth of rodents.

Evidence of alveolar bone loss in rats fed an atherogenic diet

Normal Wistar rats, aged four and six month, were fed an atherogenic diet and the resulting periodontal changes were determined after six and eight weeks using histological, histochemical and histometrical methods. The changes of the alveolar bone remodelling adjacent to incisor teeth were compared with those around molar teeth.A diminished formation of new bone and an increased osteoclastic resorption were found in the alveolar bone of the rats fed the atherogenic diet. In addition gingival inflammation and the development of periodontal pockets were observed.Using histometrical evaluation it could be demonstrated that these alveolar bone changes were significantly more pronounced in the incisor teeth than in the molars. It is supposed that the latter finding is due to the more intense remodelling of the alveolar bone in the constantly growing teeth of rodents.

Observations on the Development of Periodontal Disease in Hill Sheep and the Effect of Selenium Injections

SUMMARY One hundred and forty Blackface ewes were used to study the development of a periodontal disease (broken-mouth) on a Scottish hill farm over a period of 3 years. The teeth were examined every 3 months and half the sheep were given injections of sodium selenate and some were given x-tocopherol. The severity of the disease was found to increase in the late summer and autumn and to be static or even to decrease during the winter and spring. Forward movement of the teeth in relation to the dental pad occurred concurrently with development of periodontal pockets. Selenium and α-tocopherol had no effect on broken-mouth in this experiment.