Number Of Periodontal Pockets Research Articles

Estimation of Oral Neutrophil Counts Following Periodontal Therapy in Patients with Chronic Periodontal Disease Utilizing a Standardized Oral Rinse - Interventional Study

Background: Orogranulocytic Migratory Rate (OMR) is defined as the amount of neutrophils move into the oral cavity, through the gingival sulcus. When inflammatory changes occur in the oral cavity, there is an increase in the level of orogranulocytic migratory rate. The oral neutrophil count may be an indicator of the periodontal health status and also it correlates with the severity of periodontal disease. The aim of the study was to assess the relationship of oral neutrophil counts with severity of chronic periodontal diseases and to estimate their levels in response to phase 1 periodontal therapy. Materials and Methods: A total of 66 subjects were selected from the Departments of Periodontics, Annoor Dental College and Hospital, Kerala, India. The subjects were divided into three groups of 22 subjects in each group with two visits. The groups were diagnosed on the basis of gingival index and the number of periodontal pockets. Oral rinse samples of subjects were taken before and 4 weeks after periodontal treatment ((phase 1). Acridine orange was used to stain the cells in the rinse samples. A fluorescence microscope and hemocytometer was used to count neutrophils. Results: There was significant difference in mean value of oral neutrophils before and after treatment for control, moderate periodontitis and severe periodontitis groups. Conclusion: The oral rinse assay was capable to identify a major decrease in oral neutrophil counts in patients who reacted to periodontal treatment (phase 1 therapy). This method is safe, easy, reliable and noninvasive method of quantification of oral neutrophils.

Common complement factor H polymorphisms are linked with periodontitis in elderly patients.

In our recent genome-wide association study, we found that genetic polymorphisms in the complement factor H (CFH) gene and S100A gene region are strongly associated with serum matrix metalloproteinase 8 (MMP-8) concentration and the release of MMP-8 from neutrophils. As MMP-8 is centrally involved in the pathogenesis of periodontitis, we aimed to evaluate the presence of genetic polymorphisms of S100A8/A9/A12, MMP8, and CFH in periodontitis. In addition, we studied whether polymorphisms of these genes affect the concentrations of S100A8, S100A12, MMP-8, or complement activation marker in saliva. We genotyped four single-nucleotide polymorphisms (SNPs, rs1560833 in S100A8/A9/A12, rs11225395 in MMP8, rs800292 in CFH, and rs1061170 in CFH) and measured salivary concentrations of S100A8, S100A12, MMP-8, and terminal complement complex (TCC) in the Parogene cohort (n = 508). The cohort was composed of patients with an indication to coronary angiography and all underwent a clinical and radiographic oral examination. CFH polymorphisms rs800292 and rs1061170 were associated with periodontal parameters. None of the polymorphisms showed association with salivary proteins. However, salivary concentrations of S100A8, S100A12, MMP-8, and TCC were strongly associated with the number of periodontal pockets and alveolar bone loss. Interestingly, genetic variants of CFH, MMP8, and S100A8/A9/A12 gene regions did not affect salivary levels of measured proteins. However, saliva levels of S100A8, S100A12, MMP-8, and TCC, and CFH polymorphisms were associated with clinical and radiographic signs of periodontitis. Our study further supports the observations that any dysregulation of complement may increase the risk of inflammatory disorders, such as periodontitis.

The possible correlation between the chronic esophageal achalasia and periodontal disease - a pilot study.

Achalasia is a very rare disease characterized by the lack of motor coordination in various phases of contraction-relaxation of esophageal muscles. The aim of the study is to determine the correlation between esophageal achalasia and oral diseases. Thirteen esophageal achalasia patients were assessed for the presence of any potential oral symptoms through a questionnaire. 5 volunteered to be included in the study. The oral health status of these 5 patients was assessed by a clinical oral examination. The oral health status of the included cases was compared to the oral health status data from a published observational study on healthy individuals belonging to the same (Italian) population. Our results show that the number of periodontal pockets with Probing Pocket Dept > 4 mm is significantly increased, compared to the average of the Italian population; the Bleeding On Probing (BOP) is not related to the Plaque Control Record (PCR); so we can say that the value of periodontal index is not correlated with the value of oral hygiene index. Considering the limitations of a research based on small numbers, it nevertheless seems advisable to assert that there is a correlation between esophageal achalasia and periodontal disease.

Salivary pH as an improvement parameter in patients with periodontitis: A pilot study

Background: The pH is a chemical parameter of saliva widely studied at present, its normal range is between 6.5 and 7.2. Its alteration has been linked to different oral pathologies, such as periodontal diseases. The purpose of this study was to identify the usefulness of salivary pH measurement as an indicator of improvement in patients with periodontitis and to estimate its possible relationship with the biofilm index and the number of periodontal pockets.
 Methods: A descriptive-comparative pilot study was conducted on forty adult patients; one group was conformed by twenty patients with gingivitis and the second one by twenty patients with chronic periodontitis. In both groups was determined the biofilm index, was performed periodontal probing and a salivary sample was taken for salivary pH measurement, before and after periodontal treatment.
 Results: the results showed that of 20 periodontitis patients evaluated, 6 (30%) had an initial alkaline pH greater than 7,6 and a moderate positive relationship with the biofilm index was observed (r=0.5277). After treatment, 15(75%) periodontitis patients and 14 (70%) gingivitis patients presented a decrease in this parameter.
 Conclusions: there is a variation in the salivary pH after periodontal treatment tending to its restoration, this probably occurs in response to periodontal tissue repair, therefore, pH is a salivary parameter that has potential for monitoring patients with periodontal disease.

Periodontal disease is associated with carotid plaque area: the Malmö Offspring Dental Study (MODS).

Periodontal disease is associated with cardiovascular disease (CVD) but it is unknown if periodontal disease severity is associated with asymptomatic carotid plaque. The aim of the current population-based, observational study was to investigate if signs of periodontal disease are associated with the occurrence of carotid plaque and total plaque area (TPA). The Malmö Offspring Study (MOS) is a population-based study. MOS participants underwent a thorough cardiovascular phenotyping, including carotid ultrasonography. The Malmö Offspring Dental Study (MODS) invited participants of MOS for dental examination, including periodontal charting. Multivariable regression models were used to analyse the presence of carotid plaque and TPA in relation to periodontal parameters. In all, 831 MODS participants were recruited, out of which 495 belonged to the children generation with mean age of 53years, 63% had carotid plaque and 38% had moderate or severe periodontal disease. In models adjusted for CVD risk factors, the OR for having carotid plaque in subjects with vs without periodontal disease was 1.75 (95% CI: 1.11-2.78). In a linear model with TPA as dependent and number of periodontal pockets≥4mm as independent variable, the adjusted beta-coefficient was 0.34 mm2 (95% CI 0.16-0.52). Individuals within the highest quartile of periodontal pockets are expected to have 9mm2 larger TPA compared to those without pockets. Our results suggest that intervention studies addressing periodontal disease could be useful for prevention of CVD.

Predictive factors for tooth loss during supportive periodontal therapy in patients with severe periodontitis: a Japanese multicenter study

BackgroundSupportive periodontal therapy (SPT) must take individual patient risk factors into account. We conducted a multicenter joint retrospective cohort study to investigate the value of modified periodontal risk assessment (MPRA) and therapy-resistant periodontitis (TRP) assessment as predictive factors for tooth loss due to periodontal disease in patients with severe periodontitis during SPT.MethodsThe subjects were 82 patients from 11 dental institutions who were diagnosed with severe periodontitis and continued SPT for at least 1 year (mean follow-up = 4.9 years) between 1981 and 2008. The outcome was tooth loss due to periodontal disease during SPT. The Cox proportional hazards model was used to analyze sex, age, diabetes status, smoking history, number of periodontal pockets measuring ≥6 mm, rate of bleeding on probing, bone loss/age ratio, number of teeth lost, MPRA, and TRP assessment as explanatory variables.ResultsUnivariate analysis showed that loss of ≥8 teeth by the start of SPT [hazard ratio (HR) 2.86], MPRA score indicating moderate risk (HR 8.73) or high risk (HR 11.04), and TRP assessment as poor responsiveness to treatment (HR 2.79) were significantly associated with tooth loss (p < 0.05). In a model in which the explanatory variables of an association that was statistically significant were added simultaneously, the HR for poor responsiveness to treatment and ≥8 teeth lost was significant at 20.17 compared with patients whose TRP assessment indicated that they responded favorably to treatment and who had lost <8 teeth by the start of SPT.ConclusionMPRA and TRP assessment may be useful predictive factors for tooth loss due to periodontal disease during SPT in Japanese patients with severe periodontitis. Additionally, considering the number of teeth lost by the start of SPT in TRP assessment may improve its predictive accuracy.

Surgical treatment of the residual periodontal pocket.

The ultimate goal of periodontal therapy is to prevent further disease progression in order to reduce the risk of tooth loss. This objective can be achieved through a number of therapeutic modalities comprising both the nonsurgical and surgical phases of periodontal therapy. Nonsurgical periodontal treatment has been shown to control periodontal infection and to arrest progression of the disease in a significant number of cases. However, despite completion of nonsurgical treatment, a number of periodontal pockets, defined as 'residual', often remain. The presence of residual pockets may jeopardize tooth survival and be a risk factor of further disease progression, and ultimately tooth loss. Therefore, the aim of this review is to analyze the knowledge available on the indications for and the performance of periodontal surgical treatment of residual pockets in terms of 'traditional' (clinical, microbiological), patient-based and systemic health outcomes.

PERIODONTAL HEALTH STATUS EVALUATION USING CPITN SCORE, IN A GROUP OF PATIENTS WITH RHEUMATOID ARTHRITIS

Introduction. The relationship between periodontal disease (PD) and rheumatoid arthritis (RA) is currently only partially known, both being chronic multifactorial diseases that may share common pathogenic mechanisms and etiological factors. In a previous meta-analysis we concluded that patients with RA are more commonly affected by PD and develop more severe forms of the disease, compared to the general population. Objectives. The current study aimed to assess the degree of periodontal damage and oral hygiene on a group of patients diagnosed with RA. Methods. The study was conducted on a group of 30 patients, 6 sextants being assessed in each patient (180 potentially evaluable sextants). Establishing the degree of periodontal damage and oral hygiene was achieved by determining the Community Periodontal Index of Treatment Needs (CPITN) and Oral Hygiene Index (IHB, also known as OHI). Results. The mean CPITN score/sextant was 1.92. After clinical examination we found 10 edentulous sextants that could not be evaluated. As a result of the distribution of the scores on all the 170 evaluable sextants, we obtained: CPITN 0 – 11.1%, CPITN 1 – 23.6%, CPITN 2 – 32.4%, CPITN 3 – 27.6%, CPITN 4 – 5.3%. After analyzing the oral hygiene index the mean value we found was 16. Distribution of IHB intervals was: IHB 0-12 (40%), IHB 13-24 (53.3%), IHB 25-36 (6.6%). Discussion and conclusions. Comparing our results to data from the literature, in our group of patients with RA the only CPITN index criteria significantly increased, compared to the healthy population, were gingival bleeding on probing and the number of periodontal pockets with 4-5.5 mm depth.

Periodontal status of type I diabetics compared to non-diabetic participants: a preliminary study

A preliminary group matched comparison study of periodontal status was conducted among Indian participants who had type 1 diabetes mellitus (T1DM) and non-diabetic controls. The mean number of bleeding sites, gigival index score, number of periodontal pocket's and number of clinical loss attachment sites were all significantly higher in cases compared to controls. This study provides evidence that people with type I diabetes mellitus have a higher risk of gingival and periodontal disease.

Tissue response of type 2 diabetics towards non-surgical periodontal therapy: a retrospective, comparative study with non-diabetics - a preliminary investigation

The purpose of this study was to assess the tissue response of Type 2 diabetic subjects towards non surgical periodontal therapy as compared with matched, nondiabetic subjects. This was a retrospective, comparative study using periodontal case notes of 40 subjects attending undergraduates’ periodontal clinics (20 diabetics, 20 nondiabetics), who were selected based on the inclusion and exclusion criteria. Response towards non surgical periodontal therapy was assessed through three clinical periodontal parameters, namely plaque score, gingivitis score and number of periodontal pocket ≥5mm at the baseline and after initial non surgical periodontal therapy. Data obtained was then analyzed by SPSS Version 12. Both diabetic and non-diabetic subjects showed significant improvements (p-value = 0.021; 0.000; 0.001 and 0.010; 0.014; 0.001) in all three parameters after the therapy. However, when comparison was made between the two groups, there was no significant difference (p-value = 0.913; 0.892 and 0.903) in any of the parameters. Periodontal conditions improved clinically in both diabetic and nondiabetic subjects after non-surgical periodontal therapy. Therefore, both groups responded similarly towards the therapy and thus it can be postulated that well-controlled diabetic status does not have a significant effect on the outcome of periodontal therapy.

A retrospective study to evaluate the effect of type 2 diabetes mellitus on the severity of periodontal disease. A preliminary investigation.

Aim: A preliminary investigation to assess the relationship in the severity of periodontal disease in diabetics when compared with non-diabetic subjects. Materials and Methods: A retrospective, comparative study using periodontal case notes of 40 subjects (20 Type 2 diabetics, 20 non-diabetics) who were selected based on the inclusion and exclusion criteria. Severity of periodontal disease was assessed through number of periodontal pocket ≥5mm. The results were compared between subjects whose age, gender and plaque scores are matched with the test group. Data obtained was then analyzed by SPSS Version 12. Results: When comparisons were made between test (Type 2 diabetic) and control (non-diabetic) groups, there were no significant difference (p&gt;0.05) in the severity of periodontal disease. However, there was a clinically mean difference between the two groups. Conclusions: This preliminary investigation indicated that the severity of chronic periodontitis, as indicated in periodontal pocketing, increased in diabetic patients when compared to non-diabetics clinically, although it was not statistically significant. The finding of this investigation was thus not conclusive as it was only a retrospective study using patients? case notes. However, the results are now being further investigated with a proper clinical trial which examines periodontal parameters and diabetic status (HbA1c) of the subjects to determine the association between periodontal disease and diabetes mellitus.

Effects of oil drops containing Lactobacillus salivarius WB21 on periodontal health and oral microbiota producing volatile sulfur compounds

The objective of this paper is to evaluate the effects of oil drops containing Lactobacillus salivarius WB21 on periodontal health and oral microbiota producing volatile sulfur compounds (VSCs). For this study, 42 subjects were randomly assigned to receive oil samples containing L. salivarius WB21 or a placebo for two weeks. Oral assessment and saliva collection were performed on days 1 and 15. Bacterial analysis was performed using the real-time polymerase chain reaction and terminal restriction fragment length polymorphism (T-RFLP). In both the experimental and placebo groups, the average probing depth, number of periodontal pockets, and the percentage of bleeding on probing (BOP) decreased while stimulated salivary flow increased on day 15. BOP was reduced in the experimental group compared with the placebo group (P = 0.010). In the experimental group, total bacterial numbers decreased, and the number of L. salivarius increased. The number of Prevotella intermedia, which is correlated with hydrogen sulfide concentration in mouth air, increased in the placebo group and did not change in the experimental group. T-RFLP analysis found that the peak area proportions representing Porphyromonas gingivalis, P. intermedia, Tannerella forsythensis, and Fusobacterium nucleatum decreased in the experimental group, although there was no significant change in the bacterial composition. Thus we observed oil drops containing L. salivarius WB21 improved BOP and inhibited the reproduction of total and VSC-producing periodontopathic bacteria compared with the placebo group, but also showed the limit of its efficacy in controlling VSCs producing and periodontal pathogens.

Modified periodontal risk assessment score: long‐term predictive value of treatment outcomes. A retrospective study

The aim of this study was to evaluate the long-term clinical predictive value of the periodontal risk assessment diagram surface (PRAS) score and the influence of patient compliance on the treatment outcomes. Thirty subjects suffering from periodontitis were re-examined 6-12 years after the initial diagnosis and periodontal treatments. The baseline PRAS score was calculated from the initial clinical and radiograph records. Patients were then classified into a low-to-moderate (0-20) or a high-risk group (>20). Patients who did not attend any supportive periodontal therapy were classified into a non-compliant group. PRAS and compliance were correlated to the mean tooth loss (TL)/year and the mean variation in the number of periodontal pockets with a probing depth (PPD) >4 mm. TL was 0.11 for the low-to-moderate-risk group and 0.26 for the high-risk group (p<0.05); PPD number reduction was 2.57 and 2.17, respectively, and bleeding on probing reduction was 6.7% and 23.3%, respectively. Comparing the compliance groups, the PPD number reduction was 3.39 in the compliant group and 1.40 in the non-compliant group (p<0.05). This study showed the reliability of PRAS in evaluating long-term TL and patient susceptibility to periodontal disease. Our data confirmed the positive influence of patient compliance on periodontal treatment outcomes.

The Oral Health status of Vegetarians and Non-Vegetarians (Omnivores) in Mysore City

Objectives : To know the oral health status of vegetarians and non vegetarians in Mysore city. Methods: 583 vegetarians and 599 omnivores were examined from different wards of Mysore city selected through systematic random sampling method. Data were recorded using WHO modified performa. Data was analyzed using SPSS version 10.0. Results: The mean DMFT was mores among vegetarians compared to omnivores and periodontal status was poor among omnivores presenting with more number of periodontal pockets and loss of attachment Vegetarians showed high prevalence of malocclusion compared to omnivores. Erosion was more among vegetarians where as attrition was more among omnivores. Omnivores had more number of fluorosis compared to vegetarians.

Oral Health in Women With Coronary Heart Disease

Over the last few decades, oral diseases including periodontitis, have been discussed as a possible risk factor for cardiovascular disease. The purpose of this study was to compare the oral health of age-matched women with or without coronary heart disease (CHD). A total of 143 consecutive women, aged 43 to 79 years, with diagnosed CHD underwent a thorough dental examination including a panoramic radiograph and were compared to 50 women, aged 45 to 77 years without CHD. The number of remaining teeth and pathological periodontal pockets (> or =4 mm) between the groups differed. The women with CHD had 18.9 +/- 8.5 remaining teeth versus 23.4 +/- 6.3 teeth in the control group (P < 0.001). The CHD group had more pathological periodontal pockets compared to the controls, 14.2 +/- 12.4 versus 9.6 +/- 13.3 (P = 0.002), respectively. The mean marginal bone level assessed on radiographs was the same in both groups, while the number of vertical bone defects differed (P = 0.022). Dentures were more frequent in the CHD group than in the controls (27% versus 6%, P = 0.022), as was edentulousness, 10.5% versus 0% (P = 0.017), respectively. Multiple regression analysis adjusted for age, smoking, body mass index (BMI), diabetes, education, and place of birth showed a relation between the number of periodontal pockets and CHD with an odds ratio (OR) of 3.8 (1.68 to 8.74), and a tendency between dentures and CHD, with an OR of 4.6 (0.99 to 21.28). This study indicates that women with CHD have worse oral health than those in a comparable group with no history of CHD.

Correlation between TNFa in gingival crevicular fluid and body mass index in obese subjects

The aim of this study was to investigate the relationship between body mass index (BMI kg/m[Formula: See Text]), the inflammatory mediator tumor necrosis factor α (TNFα), and interleukin-8 (IL-8) in gingival crevicular fluid (GCF) from 32 obese subjects aged between 13 and 24 years. Gingival inflammation (GBI %), pathological pocket depths, and alveolar bone loss diagnosed on radiographs were recorded. The GCF was collected from six sites per subject using periopaper, and the volume was determined using Peritron 8000. The levels of TNFα and IL-8 were determined using ELISA kits. Within the whole group, there was no significant relationship between BMI and the variables age, GBI %, number of periodontal pockets, smoking, and the levels of TNFα or IL-8. In subjects with BMI ≥40, however, there was a statistically significant correlation (r=0.74, P<0.01) between the level of TNFα in GCF and BMI. The correlation coefficient between BMI and TNFα in subjects with BMI ≥40 differed significantly (P<0.05) compared to that between subjects with BMI <40. The level of TNFα in GCF was positively correlated (P<0.05) with BMI in subjects with no periodontal pathological pocket. No significant correlation was found between the level of IL-8 and BMI. The results indicate that BMI positively correlates with TNFα in GCF in the group of young subjects with BMI ≥40 as well as in the subjects with no pathological periodontal pocket (≥4 mm) and that TNFα in GCF may be affected by the obese condition through a systemic effect.