Control Of Periodontal Infection Research Articles

A randomized multi-centre study on the effectiveness of non-surgical periodontal therapy in general practice.

To evaluate the effectiveness of two non-surgical treatment protocols for periodontitis patients in general dental practice. Ninety-five dental hygienists (59 dental clinics) were randomly assigned to one of two treatment protocols: (i) establishment of adequate self-performed oral hygiene prior to a single session of ultrasonic instrumentation (guided periodontal infection control [GPIC]) or (ii) conventional non-surgical therapy (CNST) including patient education and scaling and root planing integrated in multiple sessions. Residual pockets at 3months were retreated in both groups. The primary outcome was pocket closure (probing pocket depth ≤ 4 mm) at 6months. Multilevel models were utilized. Based on data from 615 patients, no significant differences with regard to clinical outcomes were observed between treatment protocols. Treatment-related costs (i.e., chair time, number of sessions) were significantly lower for GPIC than CNST. Smoking and age significantly affected treatment outcomes. No significant differences between the two approaches were observed in regard to clinical outcomes. GPIC was more time-effective. Patient education should include information on the detrimental effects of smoking. gov (NCT02168621).

A person-centred, theory-based, behavioural intervention programme for improved oral hygiene in adolescents: A randomized clinical field study.

AimTo test the effectiveness of a person‐centred and theory‐based educational intervention to increase adolescents′ adherence to adequate oral hygiene behaviour, that is, self‐performed periodontal infection control.Materials and MethodsData were derived from a prospective, multi‐centred, two‐arm, quasi‐randomized field study in which treatment was performed by dental hygienists (DHs) within the Public Dental Service, Västra Götaland, Sweden. Adolescents with poor oral hygiene conditions were invited to participate. The test intervention was based on cognitive behavioural theory and principles, and the DHs used a collaborative communicative approach, inspired by motivational interviewing. The control intervention consisted of conventional information/instruction. Clinical assessments and oral hygiene behaviours were evaluated at 6 months.ResultsThree‐hundred and twelve adolescents were enrolled, of whom 274 followed the treatment to 6‐month follow‐up. There were significant improvements in gingival bleeding and plaque scores for both treatment groups at 6 months, with significantly greater improvements in the test group. Adolescents in the test group brushed their teeth and used interdental cleaning aids more frequently compared to participants in the control group at 6 months.ConclusionA person‐centred and theory‐based oral health education programme is more effective than conventional oral health education in improving adolescents' oral hygiene behaviour and periodontal infection control. ClinicalTrials.gov (NCT02906098).

Patient-reported experiences and outcomes following two different approaches for non-surgical periodontal treatment: a randomized field study

ContextThe current report is part of a prospective, multi-center, two-arm, quasi-randomized field study focusing on the effectiveness in general praxis of evidence-based procedures in the non-surgical treatment of patients with periodontitis.ObjectiveThe specific aims were to (i) evaluate patient-reported experience and outcome measures of treatment following a guided approach to periodontal infection control (GPIC) compared to conventional non-surgical therapy (CNST) and to (ii) identify potential predictors of subjective treatment outcomes and patient’s adherence to self-performed infection control, i.e. adequate oral hygiene.MethodsThe study sample consisted of 494 patients treated per protocol with questionnaire- and clinical data at baseline and 6-months. The GPIC approach (test) comprised patient education for adequate oral hygiene prior to a single session of full-mouth ultra-sonic instrumentation, while the CNST approach (control) comprised education and instrumentation (scaling and root planing) integrated at required number of consecutive appointments. Clinical examinations and treatment were performed by Dental Hygienists, i.e. not blinded. Data were processed with bivariate statistics for comparison between treatment groups and with multiple regression models to identify potential predictors of subjective and clinical outcomes. The primary clinical outcome was gingival bleeding scores.ResultsNo substantial differences were found between the two treatment approaches regarding patient-reported experiences or outcomes of therapy. Patients’ experiences of definitely being involved in therapy decisions was a significant predictor for a desirable subjective and clinical outcome in terms of; (i) that oral health was considered as much improved after therapy compared to how it was before, (ii) that the treatment definitively had been worth the cost and efforts, and (iii) adherence to self-performed periodontal infection control. In addition, to be a current smoker counteracted patients’ satisfaction with oral health outcome, while gingival bleeding scores at baseline predicted clinical outcome in terms of bleeding scores at 6-months.ConclusionsThe results suggest that there are no differences with regard to patient-reported experiences and outcomes of therapy following a GPIC approach to periodontal infection control versus CNST. Patients’ experiences of being involved in therapy decisions seem to be an important factor for satisfaction with care and for adherence to self-performed periodontal infection control.Registered at: ClinicalTrials.gov (NCT02168621).

Overcoming behavioral obstacles to prevent periodontal disease: Behavioral change techniques and self-performed periodontal infection control.

It is well established that periodontal infection control, by means of adequate oral hygiene such as daily toothbrushing and interdental cleaning, is essential for prevention of periodontal disease. Evidence suggests that oral health behavioral intervention is more effective if based on a theoretic framework that includes behavioral change techniques based on goals and planning and on feedback and monitoring. This review focuses on factors that influence behavioral changes in oral hygiene measures (both obstacles and facilitators) and a person-centered approach to treatment planning and communication with patients. A person-centered model of oral hygiene is presented that can be integrated into periodontal treatment using different behavioral techniques.

A brief motivational interviewing as an adjunct to periodontal therapy-A potential tool to reduce relapse in oral hygiene behaviours. A three-year study.

To evaluate (ii) whether inclusion of a single motivational interviewing (MI) session, as an adjunct to periodontal therapy, might be beneficial for preventing relapse in oral hygiene behaviours among patients treated for chronic periodontitis and (ii) whether individual and clinical characteristics can be of predictive value for retention of sufficient oral hygiene behaviours. This 3-year follow-up of a previously reported randomized controlled trial (RCT) study of 6-month duration included 26 patients. Patients in the test group had received one MI session by a clinical psychologist before initiation of the periodontal treatment. Otherwise, all patients followed the same treatment protocol for conventional educational intervention and non-surgical periodontal therapy. Efficacy variables assessed for evaluation of the standard of self-performed periodontal infection control were marginal bleeding index (MBI; primary efficacy variable) and plaque score (PI). The patterns of change in MBI and PI scores were similar for test and control groups over the observation period. At 3years, both groups showed a desirable mean full-mouth MBI of 15%, a figure that was comparable to that at the short-term evaluation after active periodontal treatment. The post-treatment MBI was the only variable identified as a predictor of retained adequate oral hygiene behaviours. A single MI session as an adjunct to conventional periodontal therapy could not be proven to be of long-term beneficial additive effect with regard to prevention of relapse in oral hygiene behaviour. Desirable standard of self-performed infection control after active periodontal treatment predicted the retention of sufficient oral hygiene behaviour over time.

Short-term changes on C-reactive protein (CRP) levels after non-surgical periodontal treatment in systemically healthy individuals.

The aim of the present study was to evaluate serum C-reactive protein (CRP) levels in chronic periodontitis patients and periodontally healthy individuals and to assess the effect of non-surgical periodontal treatment on the CRP levels. Twenty-two patients with chronic periodontitis (test group) and 22 periodontally healthy individuals(control group), both groups without any systemic disorder orpotential confounding factors, were included in the study. At baseline, periodontal clinical variables and CRP levels were obtained in both groups. In the test group, oral hygiene instruction and scaling and root planning were carried out; then, after 60days, periodontal clinical variables and CRP levels were reevaluated. The baseline CRP level in the test group was significantly higher than the corresponding value in the control group (1.98±1.55 vs. 1.26±1.05mg/L; p<0.05). After periodontal treatment in the test group, there were improvements in all periodontal clinical variables (p<0.05). The CRP level decreased significantly in those patients with higher baseline levels of CRP (>3mg/L). Chronic periodontitis seemed to promote elevated levels of CRP. Furthermore, non-surgical periodontal treatment significantly decreased the levels of CRP only in patients with high baseline levels of such pro-inflammatory cytokine. Periodontitis may be a potential factor to change the risk of CVD. Thus, the control of periodontal infection performed by health professionals may improve cardiovascular health.

TBX21-1993T/C (rs4794067) polymorphism is associated with increased risk of chronic periodontitis and increased T-bet expression in periodontal lesions, but does not significantly impact the IFN-g transcriptional level or the pattern of periodontophatic bacterial infection

Th1-polarized host response, mediated by IFN-γ, has been associated with increased severity of periodontal disease as well as control of periodontal infection. The functional polymorphism TBX21-1993T/C (rs4794067) increases the transcriptional activity of the TBX21 gene (essential for Th1 polarization) resulting in a predisposition to a Th-1 biased immune response. Thus, we conducted a case-control study, including a population of healthy controls (H, n = 218), chronic periodontitis (CP, n = 197), and chronic gingivitis patients (CG, n = 193), to investigate if genetic variations in TBX21 could impact the development of Th1 responses, and consequently influence the pattern of bacterial infection and periodontitis outcome. We observed that the polymorphic allele T was significantly enriched in the CP patients compared to CG subjects, while the H controls demonstrated and intermediate genotype. Also, investigating the putative functionality TBX21-1993T/C in the modulation of local response, we observed that the transcripts levels of T-bet, but not of IFN-γ, were upregulated in homozygote and heterozygote polymorphic subjects. In addition, TBX21-1993T/C did not influence the pattern of bacterial infection or the clinical parameters of disease severity, being the presence/absence of red complex bacteria the main factor associated with the disease status and the subrogate variable probing depth (PD) in the logistic regression analysis.

The novel role of HtrA1 in gingivitis, chronic and aggressive periodontitis.

Proteolytic tissue degradation is a typical phenomenon in inflammatory periodontal diseases. HtrA1 (High temperature requirement A 1) has a serine protease activity and is able to degrade fibronectin whose fragments induce the expression and secretion of several matrix metalloproteinases (MMPs). The aim of this study was to investigate for the first time if HtrA1 has a role in gingivitis and in generalized forms of chronic and aggressive periodontitis. Expression of HtrA1 was investigated in 16 clinically healthy gingiva, 16 gingivitis, 14 generalized chronic periodontitis and 10 generalized aggressive periodontitis by immunohistochemistry and real-time PCR. Statistical comparisons were performed by the Kruskall-Wallis test. Significantly higher levels of HtrA1 mRNA and protein expression were observed in pathological respect to healthy tissues. In particular, we detected an increase of plasma cell HtrA1 immunostaining from gingivitis to chronic and aggressive periodontitis, with the higher intensity in aggressive disease. In addition, we observed the presence of HtrA1 in normal and pathological epithelium, with an increased expression, particularly in its superficial layer, associated with increasingly severe forms of periodontal disease. We can affirm that HtrA1 expression in plasma cells could be correlated with the destruction of pathological periodontal tissue, probably due to its ability to trigger the overproduction of MMPs and to increase the inflammatory mediators TNF-α and IL-1β by inhibition of TGF-β. Moreover, epithelial HtrA1 immunostaining suggests a participation of the molecule in the host inflammatory immune responses necessary for the control of periodontal infection.

Bidirectional association between diabetes mellitus and inflammatory periodontal disease. A review

Diabetes mellitus is a metabolic disorder characterized by hyperglycemia. The abnormal glucose metabolism results from defects in insulin production or insulin action, or both. For decades, it was suspected that diabetes contributed to poorer oral health and the increased frequency of periodontitis. More recently it was found that periodontitis could adversely affect glycemic control in diabetics. This review focuses on the bidirectional relationship between diabetes mellitus and periodontitis. A review of the literature on periodontal disease in diabetes using the following key words: periodontitis/periodontal disease and diabetes mellitus, hyperglycemia/glycemic control. There is strong evidence for an association between diabetes mellitus and inflammatory periodontal disease. Diabetes mellitus increases the risk for and severity of periodontitis, and periodontal diseases can aggravate insulin resistance and affect glycemic control. Periodontal treatment improves glycemic control in type 2 diabetics; control of periodontal infection is not only important for oral health, it may also improve overall health.

Quantification of Subgingival Microflora in a Peri Implantitis Patient Using RTPCR - A Case Report

Background and aims . Peri-implantitis is a chronic progressive marginal infection which is defined as an inflammato-ry reaction affecting the tissues surrounding osseointegrated dental implants resulting in loss of supporting bone. Microflora of patients with implants who are edentulous mainly consists of gram positive facultative cocci and non motile rods. Pre-dominantly, Streptococcus sanguis, Streptococcus mitis while motile rods, Spirochetes, Fusiforms and filaments are infre-quently found in a healthy, stable implant. Microbiota around the failing implant in edentulous patients usually consists of gram negative anaerobic rods. In partially edentulous patients, peri implant microorganisms are increased in proportion of motile rods, Spirochetes and cocci in a stable implant. In a failing implant, in partially edentulous patients high proportions of P.micros, P.intermedia, C.rectus and Fusobacterium species were observed. The concept that the composition of subgin-gival microflora around implants in partially edentulous patients was said to be resultant of composition of flora around the teeth, based on this principle we set out to identify the presence of putative periodontal pathogens on teeth in a predominantly edentulous arch with a metallic coping with periodontitis and a site in the same mouth with peri implantitis site. Materials and methods . Subgingival plaque samples were collected from a partially edentulous patient using a paper point from the periimplantitis lesion with a probing depth of 8-9mm and a tooth with deepest pocket with a probing depth of 6mm and we analyzed the five putative periodontal pathogens namely, P.gingivalis, P.intermedia, P.nigrecens, T.denticola and T.forcythia using Real Time Polymerised Chain Reaction (RTPCR) technique. Results . P.Gingivalis and P.Intermedia , P.Nigrecens had a 3 fold increase and T.Denticola had 1 fold increase when compared to the periodontitis ( teeth) site, and T.Forsythia was found in trace amounts at the peri implantit is site and was completely absent at the periodontitis( teeth) site. Conclusion . Proper periodontal infection control before the placement of dental implants in partially edentulous individ-uals may prevent early bacterial complications and also continuous monitoring of partially edentulous teeth site making it infection free will help in the longevity of the implant. Key words : Dental Implants, Periimplantitis, Subgingival Microflora, Overdenture.

A single session of motivational interviewing as an additive means to improve adherence in periodontal infection control: a randomized controlled trial

To evaluate the effect of a single session of motivational interviewing (MI) on self-performed periodontal infection control. A randomized, examiner masked, controlled clinical trial of 6-month duration was performed involving 44 patients with chronic periodontitis, referred for periodontal treatment. At baseline, all subjects were examined concerning marginal gingival bleeding (MBI) and plaque (PI). Test subjects received a single MI-session before initiation of the periodontal treatment. Otherwise, all patients followed the same treatment protocol for conventional educational intervention and non-surgical periodontal therapy. Efficacy variables for evaluation of self-performed periodontal infection control were MBI (primary variable) and PI. The MI intervention resulted in a negligible decrease (3-4%) in MBI and PI that was not significantly different from the changes observed in the control group without any intervention. Neither was any additive effect of the initial MI-session found on the standard of oral hygiene subsequent to conventional treatment. A desirable MBI score of ≤20% at the end of treatment was associated with being a female patient, whereas high plaque scores at baseline counteracted a corresponding desirable final PI of ≤20%. A single freestanding MI session as a prelude to conventional periodontal treatment had no significant effect on the individuals' standard of self-performed periodontal infection control in a short-term perspective.

Effects of systemic sitafloxacin on periodontal infection control in elderly patients

To evaluate the microbiological and clinical effects of the systemic administration of sitafloxacin (STFX) on periodontal pockets in elderly patients receiving supportive periodontal therapy (SPT). Periodontitis is a risk factor for atherosclerosis. Better periodontal health contributes to reduce atherosclerosis-related diseases in elderly population. Forty-four patients undergoing SPT were randomly assigned to two groups: a test group took 100 mg/day of STFX for five consecutive days, or a control group received scaling and root planing (SRP) under local anaesthesia. Microbiological and clinical parameters were examined at baseline and at 1 and 3 months after therapy. The presence of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia was significantly reduced at 1 month after treatment in both groups. The median reductions of the bacteria between the baseline and 1 month were 3.08 and 2.54% in the STFX- and SRP-treated groups, respectively. Both treatments significantly decreased the probing depth at 1 and 3 months compared to the baseline. The systemic administration of STFX is effective at improving periodontal health during SPT and could be an alternative to SRP for elderly patients who cannot undergo anaesthesia or are at risk of tissue injury.

Criteria periodontal initial therapy is effective weapon for control of periodontal infection

牙龈炎和牙周炎是最常见的牙周疾病,也是人类较常见的感染性疾病之一.不仅危害牙周健康和口腔健康,而且与全身健康和疾病有着密切关系.有文献报道亚洲人易患牙周炎,中国是牙周病的高发国家,80%～90%的成人患有不同程度的牙周疾患。

Full-mouth treatment vs. the conventional staged approach for periodontal infection control

Full-mouth treatment vs. the conventional staged approach for periodontal infection control

Full‐mouth treatment vs. the conventional staged approach for periodontal infection control

Full‐mouth treatment vs. the conventional staged approach for periodontal infection control

Experimental periodontitis in mice selected for maximal or minimal inflammatory reactions: increased inflammatory immune responsiveness drives increased alveolar bone loss without enhancing the control of periodontal infection

Inflammatory immune reactions that occur in response to periodontopathogens are thought to protect the host against infection, but may trigger periodontal destruction. However, the molecular and genetic mechanisms underlying host susceptibility to periodontal infection and to periodontitis development have still not been established in detail. In this study, we examined the mechanisms that modulate the outcome of Aggregatibacter (Actinobacillus) actinomycetemcomitans-induced periodontal disease in mice mouse strains selected for maximal (AIRmax) or minimal (AIRmin) inflammatory reactions. Our results showed that AIRmax mice developed a more severe periodontitis than AIRmin mice in response to A. actinomycetemcomitans infection, and this periodontitis was characterized by increased alveolar bone loss and inflammatory cell migration to periodontal tissues. In addition, enzyme-linked immunosorbent assays demonstrated that the levels of the cytokines interleukin-1beta, tumor necrosis factor-alpha and interleukin-17 were higher in AIRmax mice, as were the levels of matrix metalloproteinase (MMP)-2, MMP-13 and receptor activator of nuclear factor-kappaB ligand (RANKL) mRNA levels. However, the more intense inflammatory immune reaction raised by the AIRmax strain, in spite of the higher levels of antimicrobial mediators myeloperoxidase and inducible nitric oxide synthase, did not enhance the protective immunity to A. actinomycetemcomitans infection, because both AIRmax and AIRmin strains presented similar bacterial loads in periodontal tissues. In addition, the AIRmax strain presented a trend towards higher levels of serum C-reactive protein during the course of disease. Our results demonstrate that the intensity of the inflammatory immune reaction is associated with the severity of experimental periodontitis, but not with the control of A. actinomycetemcomitans periodontal infection, suggesting that the occurrence of hyperinflammatory genotypes may not be an evolutionary advantage in the complex host-pathogen interaction observed in periodontal diseases.

The relation between apical periodontitis and root‐filled teeth in patients with periodontal treatment need

To investigate a number of clinical and treatment variables that might have influenced the prevalence of apical periodontitis in root-filled teeth in a population of periodontally compromised patients. This investigation was a retrospective cross-sectional study on data collected from periodontal charts in addition to intra-oral full-mouth radiographs from patients attending the Department of Periodontology of the Dental School of the Ghent University Hospital. Periodontal parameters (clinical attachment loss and the lowest marginal bone level, the history of periodontal treatment), endodontic treatment (length, homogeneity and overall quality of the root filling) and the quality of coronal restorations were related to the prevalence of apical periodontitis. A total of 272 root-filled teeth in 94 patients were evaluated. The periapical condition was significantly influenced by the quality of the root filling and the coronal filling (P < 0.05). More apical periodontitis was seen when the coronal level of the root filling exceeded the marginal bone level (P < 0.005). The marginal periodontal condition seemed to influence the periapical status. Teeth with apical periodontitis were associated with significantly more extended marginal bone loss (P < 0.001). Significantly less apical periodontitis was seen in patients that had received marginal periodontal treatment (P < 0.005), compared with untreated periodontal patients. Signs of periodontal disease, as reflected by marginal bone loss, are of importance for the periapical condition of root-filled teeth. Efforts should be taken in preventing spread of infection through the periodontal-endodontic pathway by periodontal infection control and a high quality of root filling and coronal filling. Care should also be taken to seal the coronal cavity up to the level of the root filling, where it is advisable to reduce the coronal level of the root filling below or at least at the level of the surrounding marginal bone.

Periodontal infection control: current clinical concepts

The main objective of the treatment of patients with periodontitis is to establish adequate infection control in the dentogingival area. Pocket/root instrumentation (scaling and root planing), combined with effective self‐performed supragingival plaque control measures, constitute the basic treatment modalities, but also locally applied antiseptics and antibiotics may be utilized. The purpose of this article is to give an overview of current clinical concepts on periodontal infection control.

Early colonization of dental implants by putative periodontal pathogens in partially edentulous patients.

There is limited scientific information available on the early colonization of the peri-implant pockets in partially edentulous individuals. Knowledge about this process is one step in better understanding the etiology and pathogenesis of peri-implantitis. In this study, the early colonization of the peri-implant pockets by putative periodontal pathogens was studied in 20 partially edentulous individuals using anaerobic culture techniques. At baseline, the presence and levels of putative periodontal pathogens in the microflora of periodontal pockets and saliva were established. Immediately after loading of the titanium implants and after 6 and 12 months the presence and levels of selected putative periodontal pathogens were determined in periodontal and peri-implant pockets. A second aim was to detect bacterial contamination of the implant site and the inside of the implant. At baseline, the most frequently isolated species from the periodontal pockets were Fusobacterium nucleatum, Prevotella intermedia and Peptostreptococcus micros. Bacteroides forsythus, Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were isolated from 9, 2 and 3 patients respectively. Six months after placing of the bridges, the majority of the implant sites had detectable levels of most periodontal bacterial species with the exception of A. actinomycetemcomitans which could not be isolated from any of the peri-implant samples during the experimental period, although 2 patients had this organism at baseline. In 2 patients with detectable subgingival P. gingivalis at baseline this species was found after 12 months in the peri-implant sites. One of these patients lost 2 implants which was associated with a high proportion of P. gingivalis in the peri-implant pockets. A second patient developed 2 fistulas around 2 implants at 8 months and this event was also associated with the presence of P. gingivalis. It is concluded that proper periodontal infection control before installment of dental implants in partially edentulous patients may prevent early bacterial complications.