Gingivitis Index Research Articles

Changes in the oral streptococcal flora of children undergoing allogeneic bone marrow transplantation

The changes in the oral streptococcal flora of twenty children undergoing allogeneic bone marrow transplant are described. Saliva was collected from each child on four separate occasions: (i) before the conditioning regimen; (ii) 7 days post-transplantation; (iii) when the neutrophil count had risen above 0.5 x 10(9)/l; (iv) 119 days post-transplantation. Indices for dental caries, plaque, gingivitis, herpetic stomatitis and mucositis were also recorded. There was a significant decrease in the total aerobic (P<0.001) and anaerobic counts (P<0.0002) between baseline and 7 days post-transplantation. The proportion of the 'Streptococcus oralis group' (Streptococcus mitis and S. oralis) increased significantly from baseline 12.1% to 48.4% at 7 days post-transplantation (P<0.003). The plaque and gingivitis indices increased significantly from baseline to 7 days post-transplantation (P<0.001). Twenty percent of the children had either positive blood cultures or Hickman line cultures for the 'S. oralis group', and it is possible that the inflamed gingival tissues are a further site of entry for these streptococci. There were no differences in the total anaerobic counts or the proportion of the 'S. oralis group' between baseline and the end of the study in the transplant children, or between the transplant and control children.

Hydrogen peroxide: a review of its use in dentistry.

Several dentifrices that contain hydrogen peroxide are currently being marketed. The increased use of bleaching agents containing (or generating) H2O2 prompted this review of the safety of H2O2 when used in oral hygiene. Daily exposure to the low levels of H2O2 present in dentifrices is much lower than that of bleaching agents that contain or produce high levels of H2O2 for an extended period of time. Hydrogen peroxide has been used in dentistry alone or in combination with salts for over 70 years. Studies in which 3% H2O2 or less were used daily for up to 6 years showed occasional transitory irritant effects only in a small number of subjects with preexisting ulceration, or when high levels of salt solutions were concurrently administered. In contrast, bleaching agents that employ or generate high levels of H2O2 or organic peroxides can produce localized oral toxicity following sustained exposure if mishandled. Potential health concerns related to prolonged hydrogen peroxide use have been raised, based on animal studies. From a single study using the hamster cheek pouch model, 30% H2O2 was referred to as a cocarcinogen in the oral mucosa. This (and later) studies have shown that at 3% or less, no cocarcinogenic activity or adverse effects were observed in the hamster cheek pouch following lengthy exposure to H2O2. In patients, prolonged use of hydrogen peroxide decreased plaque and gingivitis indices. However, therapeutic delivery of H2O2 to prevent periodontal disease required mechanical access to subgingival pockets. Furthermore, wound healing following gingival surgery was enhanced due to the antimicrobial effects of topically administered hydrogen peroxide. For most subjects, beneficial effects were seen with H2O2 levels above 1%.

Clinical Evaluation of the Efficacy and Safety of a New Sonic Toothbrush

The efficacy and safety of a new sonic toothbrush were studied in this single-blind study. The sonic toothbrush combines acoustic vibrations and dynamic fluid activity surrounding the bristles with direct mechanical scrubbing of tooth surfaces. Fifty-one subjects were randomly assigned to either the sonic or the manual toothbrush. Plaque scores were assessed before and after a 2-minute brushing at baseline and 1, 2, and 4 weeks. Gingivitis and sulcular bleeding scores were also taken at each evaluation. To assess long-term safety, 29 subjects returned after 6 months of product use. Repeated measures analysis of variance of the total mean plaque score indicated a significant difference between the devices over time (P < 0.01), with the sonic toothbrush demonstrating a greater level of plaque removal on all tooth surfaces. On average, the plaque reduction from the baseline score for the sonic toothbrush was 3 times greater than the manual brush. However, when broken down by dental region, the sonic toothbrush demonstrated an improved level of plaque removal ranging from 1.5 to 11.9 times better than the manual brush, with the greatest improvement in the interproximal and lingual areas. Both the gingivitis and sulcular bleeding scores exhibited a similar, significant reduction (P < 0.005) over time for both devices with an approximate 17% decrease in the gingivitis index and a 33% decrease in sulcular bleeding sites. Safety assessment after 6 months of use indicated no soft tissue abnormalities which could be attributed to the products.(ABSTRACT TRUNCATED AT 250 WORDS)

Genetic contributions to saliva protein concentrations in adult human twins

The heritability of saliva protein concentrations was investigated in stored samples of clarified stimulated whole saliva from adult twins participating in a study of periodontal disease genetics. Saliva was obtained from 29 monozygous and 20 dizygous twin pairs. Visits were scheduled so that both twins in a pair donated saliva at the same time of day. Flow rate was determined, and frozen samples later assayed for lactoferrin, lysozyme, secretory IgA, total peroxidase, myeloperoxidase and total protein. Pairs were always assayed together. Within- and between-pair variances were used to estimate twin intraclass correlations. Pearson correlations were used to estimate associations between saliva variables and clinical indices of gingivitis, dental plaque, periodontal attachment loss, and probing depth. Significant genetic contributions to variance were seen for total protein, lactoferrin, and total peroxidase. Total protein showed a significant positive correlation with gingivitis. There were no other correlations with clinical indices, and intraclass correlations for saliva variables did not change after adjustment for gingivitis. Dizygous twin correlations were higher than monozygous twin correlations for flow rate, lysozyme, and secretory IgA. That may be an artefact due to small numbers of pairs. It seems unlikely that a common environmental factor would strongly affect saliva in twins living apart as adults. Present findings, taken as sib correlations, support a genetic contribution to saliva protein concentrations. Problems with the twin model in saliva might be resolved by longitudinal studies of large numbers of twins.

Short‐term effect of topical application of delmopinol on salivary microbiology, plaque, and gingivitis

The aim of this study was to test a possible dose-response effect of topical application of delmopinol HCl on the salivary microbiology, the healing of a pre-established experimental gingivitis, plaque development, and supragingival plaque composition. Forty-eight healthy subjects were enrolled in an oral hygiene program for 2 wk to upgrade their oral health. After professional tooth cleaning, they abstained from all oral hygiene, but applied 2 ml of a placebo with a soft paintbrush onto their teeth twice daily for 2 wk. At the end of this period, the subjects received tooth cleaning and were then assigned to three treatment groups of 16 individuals each. They applied 2 ml of 0.1%, 0.5%, and 1% delmopinol HCl, respectively, twice daily for the next 2 wk and refrained from all other oral hygiene procedures. At the end of the placebo and delmopinol HCl treatment periods, (1) saliva samples were obtained and cultivated on a series of media, (2) the degree of gingivitis was measured with gingival crevicular fluid (GCF) and gingivitis index (GI), (3) the stainable buccal plaque extension was analyzed planimetrically, and (4) the bacterial morphotypes of plaque adjacent to the gingival margin were analyzed. No changes in the salivary microbiologic counts were detected. The amounts of GCF and GI were reduced in all delmopinol groups, as compared with placebo. Mean plaque extension was reduced by 16% for the 0.1%, 56% for the 0.5%, and 58% for the 1% delmopinol group. Cocci appeared to predominate in bacterial dental plaque when 0.5% and 1% delmopinol were used.(ABSTRACT TRUNCATED AT 250 WORDS)

Periodontal Indices Around Natural and Titanium Abutments: A Longitudinal Multicenter Study

This multicenter prospective study on the use of an implant system involved 9 centers and reports on the periodontal aspects after 3 years of observation. A total of 558 implants in 159 patients with 197 bridges all independent from natural teeth were originally included. Because of failures and patient withdrawals the number of implants was reduced to 460 and bridges to 174. The cumulative success rate for implants, starting from implant placement, is 94.3% after 2 years and 93.9% after 3 years indicating a leveling of implant loss. Failures concentrated in patients with a high plaque index. The loss of marginal bone was during the second and third years only 0.03 mm per year as an average while it was 0.4 mm during the first year. There were no reports of intense gingival inflammation in any of the patients and the plaque and gingivitis index behaved similarly around abutments and teeth. The probing pocket depth was significantly reduced over the observation time. The resistance towards marginal bone loss around these implants confirms the previous studies on fully edentulous patients.

Lactoferrin in the gingival crevice as a marker of polymorphonuclear leucocytes in periodontal diseases.

This study examined lactoferrin (LF) levels in gingival crevicular fluid (GCF) and set out to test the hypothesis that LF could act as a marker of crevicular polymorphonuclear leucocytes (PMN). Therefore, 2 experiments were conducted: (a) to quantify total LF (ng/30 s sample) in GCF; (b) to correlate LF levels (ng/microliters) and PMN numbers (PMNs/microliters) in gingival crevicular washings (GCW). GCF was collected from 71 sites in a total of 22 patients. These sites were classified on the basis of clinical indices of gingivitis (GI) and pocket depth (PD) into three clinical groups: 'healthy', 'gingivitis' and 'periodontitis'. GCWs were obtained from an additional 63 sites in 21 patients. LF in GCF and GCWs was assayed by a sandwich ELISA. Total leucocyte and differential counts were performed on the GCWs. GCF LF (ng/30 s) correlated positively with GI (r = 0.418, p < 0.001), PD (r = 0.415, p < 0.001) and GCF volume (r = 0.624, p < 0.001). Gingivitis (n = 21) and periodontitis sites (n = 24) demonstrated significantly higher (p < 0.05) total GCF LF than healthy (n = 26) sites. In GCWs LF (ng/microliters) showed stronger correlations with clinical indices (GI: r = 0.452, PD: r = 0.513, p < 0.001) than did PMN numbers (PMNs/microliters) (GI: r = 0.279, PD: r = 0.388, p < 0.05). LF correlated strongly with PMNs in GCWs (r = 0.531, p < 0.001) and provides a simple and effective marker of crevicular PMN numbers.

Quantification of periodontal attachment at multi-rooted teeth.

The purpose of the present study was to estimate the lost attachment surface area (LAS) and the remaining attachment surface area (RAS) of molars from a combination of clinical and radiographic measurements. Clinical and radiographic measurements on 32 maxillary and 26 mandibular molars were correlated with the post-extraction measurements of LAS and RAS. The results indicate that linear models may increase the precision of the estimate of LAS by a factor of 1.2 for maxillary molars and 1.4 for mandibular molars when compared to estimates of LAS using only attachment level measurements. A diagnostic model for RAS predicts the square root of the remaining attachment surface area with the information obtained from the remaining radiographic attachment area and a gingivitis index. It is concluded that modeling of periodontal data may provide a method for predicting lost and remaining periodontal attachment area of molar teeth.

Periodontal aspects of osseointegrated fixtures supporting an overdenture

196 Brånemark implants in 86 consecutive patients rehabilitated by means of overdentures (6 upper jaws, 80 lower jaws) were observed longitudinally. In each jaw, only 2 implants were used to anchor the overdenture. 2 implants in the lower jaw showed some mobility at the abutment installation and were removed immediately. During the loading period (mean loading time 19.1 months ranging from 4 to 48 months), none of the implants showed any signs of non-integration. The marginal tissue reaction and plaque accumulation were monitored using conventional indices. Clinical methods and standardized radiographs were used to evaluate the bone level and density. The numbers of approximal surfaces without plaque (40%) or with gingival inflammation (55%) were almost constant throughout the study. The probing pocket depths remained within the range of 2.7 to 3.2 mm during the observation time, whereas the distance of the gingival margin from the top of the abutment clearly increased (from 1.8 to 2.9 mm). For loaded lower jaw implants connected to each other with a straight bar, a radiographic bone loss of 0.8 mm was observed during the first postsurgical year followed by a mean annual bone loss of less than 0.1 mm. For the "sleeping" fixtures, 50% less bone loss was recorded. For loaded but not interconnected implants in the upper jaw, the bone loss during the first 6 months reached 2.0 mm. The loss in marginal bone height did not clearly correlate with parameters such as the plaque index, the gingivitis index, the presence or absence of gingiva around the abutment, or the implant length. The present data, with an observation time up to 4 years, showed that the failure rate for Brånemark implants supporting overdentures in the lower jaw can be limited to 1%. However, the use of 2 unconnected fixtures in the upper jaw cannot presently be advocated since considerable bone loss was observed.

Gingival enhancement in fixed prosthodontics. Part I: Clinical findings

This study assessed the efficacy of a 0.12% chlorhexidine gluconate (CHX) rinse on the enhancement and maintenance of gingival health in patients receiving fixed prosthodontic treatment. Thirty patient participants in this examiner blind study were randomly assigned into two groups, one control and another group using CHX 15 ml b.i.d. in addition to normal oral hygiene. The medication was used for 2 weeks prior to crown preparation, 3 weeks during provisional crown placement, and 2 weeks after definitive crown cementation. Plaque and gingivitis indices were measured initially and at the three aforementioned points during the 7-week period. The plaque index for the control group decreased by 0.26 units; CHX decreased by 0.63 units at 7 weeks. The gingival index of the control group decreased by 0.37 units; CHX decreased by 0.87 units. Adjunctive use of chlorhexidine with fixed prosthodontic procedures significantly reduced plaque levels and significantly improved gingival health compared with the control patients. Fixed prosthodontic procedures alone decreased plaque levels and increased gingival health.

Langerhans cells in human chronic gingivitis and phenytoin-induced gingival hyperplasia

Langerhans cell numbers in oral epithelium increase as dental plaque accumulates. The anti-convulsant drug phenytoin predisposes to gingival hyperplasia in certain patients who take this medication for epilepsy and who also have poor oral hygiene. In this study 7 patients with phenytoin-induced gingival hyperplasia were compared with 5 subjects with chronic marginal gingivitis. On initial examination and on completion of the hygiene phase of periodontal therapy (a period ranging from 3.0 to 4.25 months), clinical indices of plaque and gingivitis were recorded and biopsies were taken from the lower anterior labial gingiva. Frozen sections were stained by an immunoperoxidase technique using the monoclonal antibody OKT6, and the number of Langerhans cells in a defined cross-sectional area was counted. In phenytoin-induced gingival hyperplasia there was a marked increase in Langerhans cells (13.8 ± 0.45) when compared with chronic gingivitis (7.7 ± 0.31; p < 0.05). Both groups showed marked reductions in their plaque and gingival indices and numbers of Langerhans cells once treatment had been completed. However, levels of Langerhans cells in the drug-induced hyperplasia remained significantly higher (3.5 ± 0.26) than in chronic gingivitis (1.5 ± 0.22; p < 0.05).

Diabetes mellitus and periodontal disease in an Irish population

The prevalence of periodontitis was studied in a population of 157 insulin dependent diabetes mellitus patients aged 8-78 years attending the outpatients diabetic clinic of a large general hospital in Cork, Ireland. Every third diabetic patient attending the clinic was selected for examination. The dental parameters measured were plaque index (PI), gingivitis index (GI), periodontal pocket depth (PD) and periodontal attachment loss (PAL). Diabetic control was measured by estimating percentage haemoglobin glycolysation (% Hb Alc) known duration of diabetes (KDD) and insulin dependence. It was found that none of the diabetic measurements showed any consistent pattern in relation to any of the periodontal measurements. The findings are in agreement with other studies which suggest that no significant correlation between diabetic parameters and periodontal disease can be demonstrated. When the diabetic patient suffered periodontitis it was due to factors (such as genetic predisposition) other than impaired glucose metabolism.

Quantification of periodontal attachment at single-rooted teeth.

The measurement process of attachment loss has been criticized in recent years. Problems with clinical interpretation, precision of the measurement, and statistical manipulation of the obtained data, are some of the problems associated with the present methodology. The purpose of the present study was to propose an alternative measurement process which addresses some of the existing problems by estimating the lost attachment surface area (LAS) and the remaining attachment surface area (RAS) from a combination of clinical measurements. The results show that a linear combination of several sources of clinical information can be used to predict RAS and LAS. A diagnostic model for LAS (R2 = 81.5%) predicts the square root of LAS with information obtained from bucco-lingual attachment level measurements, the radiographic lost attachment area, the gingivitis index and the radiographic tooth length. This model increases the precision of the estimate of LAS by a factor of 1.86 when compared to the estimate of LAS using only attachment level measurements. A diagnostic model for RAS (R2 = 75.5%) predicts the square root of RAS with the information obtained from the remaining radiographic attachment area, the gingivitis index and the mobility index. Both linear inference models are constructed with measurements of anatomical landmarks to avoid the discrepancy between anatomical and clinical measurements in the produced estimates. It is concluded that modeling of periodontal data provides a simple, inexpensive, and precise diagnostic tool for predicting the lost and the remaining periodontal attachment of single-rooted teeth. Measurement processes of this type could provide a convincing basis for the evaluation of clinical decisions and research questions.

The concentration of salivary steroid hormones and the prevalence of gingivitis at puberty.

Gingival conditions of 1323 junior high schoolchildren aged 12-15 were examined, and 132 children who had either healthy gingivae or severe gingivitis were called to the clinic. More precise examination of gingivitis was performed by assessment of Jackson's gingivitis index (G.I.), probing depth (P.D.), and bleeding on probing. Whole saliva was collected, and the salivary concentrations of estradiol, progesterone, and testosterone were determined by radioimmunoassay. Subgingival bacterial plaque was sampled from 36 children, and total bacterial counts and morphological differentiation were performed under a phase-contrast microscope. For statistical analysis, both males and females were divided into two groups according to the concentration of each sex hormone and subgrouped by the results of clinical examinations. Chi-square analysis using 2-by-2 tables was performed to determine the relation between salivary steroid hormone levels and gingival inflammation. The results suggest that unbalanced secretion of certain hormones might be one of the factors promoting gingivitis at puberty.

Relationships of serum opsonins and complement in human experimental gingivitis.

This study assessed the phagocytosis of polymorphonuclear neutrophils and the opsonic capacity of serum in experimental human gingivitis. Relationships were sought among these two measurements, clinical indices of gingivitis and complement-related opsonins. Measurements of chemiluminescence provided an index of phagocytosis and of opsonic capacity. Test group Plaque Index scores were higher than the control group on Days 7, 14, and 21, while the Gingival Index of the test group was elevated only on Day 21. Phagocytosis of test subjects' PMNs and opsonic capacity of their sera were no different from that of the controls'. Levels of C3 in both nonactivated and activated sera of the test group were significantly lower than that of the control group only on Day 14. In the test group, differences of per cent C3 conversion occurred between Days 14 and 21, and Plaque Index scores were inversely correlated with the order of per cent C3 data on these same days. Our results also indicate that complement contributes significantly to the serum opsonic capacity. The levels of developing plaque and subsequent gingival inflammation are apparently related to the degree of complement activation.

Assessment of susceptibility of plaque bacteria to chlorhexidine after six months' oral use

Changes in the susceptibility of plaque bacteria to chlorhexidine treatment were investigated by determining the minimum inhibitory concentration (MIC) of chlorhexidine on two kinds of bacteria commonly found in supragingival plaque. Streptococci and actinomyces were isolated from plaque samples collected from subjects participating in a clinical trial comparing a 0.12% chlorhexidine gluconate mouthrinse to a placebo mouthrinse. The isolates were inoculated onto media containing varying concentrations of chlorhexidine to determine the MIC of chlorhexidine during the six‐month treatment period and three months after cessation of treatment. While significant differences in the sensitivity of these two bacterial strains to chlorhexidine were seen sporadically, no consistent pattern of resistance emerged. It was concluded that prolonged use of a 0.12% chlorhexidine gluconate mouthrinse did not alter the composition of the oral microflora toward organisms less sensitive to chlorhexidine. This conclusion was further supported by the clinical findings in this trial that showed chlorhexidine's effects on plaque and gingivitis indices were maintained throughout the six‐month treatment period. Three months after the mouthrinse was discontinued, the MIC's of chlorhexidine on isolates from placebo‐treated and chlorhexidine‐treated subjects were the same as pretreatment values. Thus, no residual change in resistance was observed nor were there any adverse changes in the microbial profile.

Current status of indices of gingivitis.

Gingival indices are used to describe the relative status of the degree of either health, disease, or both, of the gingival tissues. Most of the indices incorporate a graduated scale with definite upper and lower limits. All gingival indices rely on one or more of the following criteria: color, contour, bleeding, extent of involvement, crevicular fluid flow. Some indices have shown a correlation between the various criteria used and histologic signs of inflammation, particularly in the case of bleeding and visual signs of inflammation. In this paper, a number of indices to assess gingival health have been reviewed; their sensitivity varies and the type of index used will be dependent on the objective of the study to be conducted.

A procedure for evaluating the reliability of a gingivitis index

A methodology is presented for assessing the reliability of an ordinarily-scaled index and is illustrated by using data from a clinical trial in which gingival inflammation was assessed with the PMGI index, independently, by 5 examiners. One of the examiners was an experienced examiner, the others newly trained. All subjects were evaluated by each examiner initially and at the end of the study period. The reliability of the average score per subject, maximum score per subject, and the % of affected sites per person are estimated by the intraclass correlation coefficient. Procedures are presented that utilize various forms of the weighted kappa statistic for dissecting patterns in examiner agreement for specific sites, types of site, all sites, and for the individual components and categories of the index. It is shown how these procedures can be useful for training and calibrating multiple examiners, who will be using such an index in a clinical study, so that adequate reliability levels can be realized.

A clinical study on mixed salivary leukocytes and occult blood in patients with periodontal disease (author's transl)

Severity of gingival and periodontal disease was evaluated by counting the numbers of leukocytes in mouth-rinsing saline and measuring the salivary occult blood with urine test kits.The results were as follows:1. Salivary leukocytes counts were correlated with the degrees of periodontal inflammation, especially with Dunning's X-ray bone scores and the degrees of tooth mobility. There were more salivary leukocytes in adult patients with complaints of viscous saliva and bad taste than in adults without periodontal complaints or in children.2. The levels of salivary occult blood were correlated with clinical gingival bleeding scores, but were not correlated with other clinical scores. Except for gingival bleeding scores, salivary occult blood levels showed greater correlation coefficient with gingival redness scores than with other clinical scores. Salivary occult blood levels had little correlation with salivary leukocytes counts.3. Salivary occult blood levels and salivary leukocytes counts showed statistically significant decrease after scaling of salivary donors.4. The measurement of salivary leukocytes counts by estimation of peroxidase activity in saliva, failed because of the lack of correlation between these parameters.It was suggested that salivary leukocytes counts and occult blood levels were available for indices of periodontitis and gingivitis respectively.

National statistics on caries and oral hygiene derived from the Danish Child Dental Health recording system.

ABSTRACT The new recording system for the Danish Child Dental Services is based on registrations of clinical examination findings for all children receiving public dental care in pursuance of the Act on Child Dental Health. During the school year 1972/73, dental information was derived from about 84,000 children in 127 municipalities. Recordings applying to the children in the first grade were obtained from all participating dental services, some of which also reported the findings for earlier age groups or higher grades. National statistics, comprising def‐s and DMF‐S indices and plaque and gingivitis indices are presented. Similar statistics applying to the individual dental services have been made available to the participating services, and certain applications of this annual documentation are emphasized. No working time in the dental services was used solely for the purpose of obtaining the statistics, the examination findings for the individual children being used routinely in the clinic.