Periodontal Treatment In Patients Research Articles

Changes in Inflammatory and Metabolic Parameters After Periodontal Treatment in Patients With and Without Obesity

Non-surgical periodontal treatment decreases serum levels of inflammatory cytokines in patients with and without obesity. However, the changes in metabolic parameters in association with these decreases in levels of inflammatory markers by periodontal treatment have not been evaluated in patients with obesity. The aim of this study is to evaluate the short-term changes in systemic inflammatory, lipid, and glucose parameters in the presence of obesity after periodontal treatment. The study included 22 dyslipemic patients with obesity and 24 healthy individuals without obesity with generalized chronic periodontitis. The periodontal parameters, anthropometric measurements, and serum levels of triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and lipoprotein-a, high-sensitive C-reactive protein, fasting blood glucose, insulin, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and leptin were measured. A homeostasis model assessment of the insulin resistance (HOMA-IR) score was calculated before and 3 months after non-surgical periodontal treatment. Both groups responded well to the periodontal treatment in terms of periodontal parameters. The treatment was also associated with a decrease in serum TNF-α and IL-6 levels and HOMA-IR scores in individuals with obesity and with a decrease in IL-6 levels in patients without obesity. Conversely, there were insignificant decreases in lipid profiles and serum fasting glucose of patients with obesity. The non-surgical periodontal treatment causes a decrease in the levels of some circulating proinflammatory cytokines and may be associated with a decrease in insulin resistance in the obese population.

The effect of periodontal treatment in improving erectile dysfunction: a randomized controlled trial

The aim of the study was to evaluate changes in the International Index of Erectile Dysfunction (IIEF) score following periodontal treatment in patients who had severe or moderate erectile dysfunction (ED) and chronic periodontitis (CP). The authors declare that they have no conflict of interest. The study population consisted of 120 patients with severe or moderate ED and CP. The treatment group (n=60) comprised patients who received periodontal treatment, whereas the control group (n=60) comprised patients who did not receive periodontal treatment. The clinical assessments were recorded at baseline, and at 1month (R1) and 3months (R2) after intervention for both groups. The periodontal examination involved assessment of the plaque index, bleeding on probing, probing depth and clinical attachment level. The IIEF questionnaire was used to assess the severity of ED. In the treatment group, the improvement in all clinical periodontal parameters was greater than that in the control group, at both R1 and R2 (p<0.05). The increase in the IIEF scores of the treatment group at R2 was higher than that of the control group (p<0.05), whereas the IIEF scores were similar for both groups at R1 (p>0.05). The findings of the study suggest that periodontal treatment can provide additional benefits in the improvement of ED. However, further studies are needed to understand the mechanisms of interaction between these diseases.

Evaluation of Periodontal Status and Effectiveness of Non‐Surgical Treatment in Patients With Type 2 Diabetes Mellitus in Taiwan for a 1‐Year Period

The periodontal status and effects of non-surgical periodontal treatment in patients with type 2 diabetes mellitus and periodontal disease are assessed. One-hundred patients with type 2 diabetes (mean ± SD hemoglobin (Hb)A1c level: 7.3% ± 0.94%) and periodontal disease were recruited for this study. The group with moderate-to-severe periodontal disease included patients with >1 tooth with a probing depth (PD) ≥5 mm and >2 teeth with a clinical attachment loss (AL) ≥ 6mm, and the group with mild periodontal disease included patients with <1 affected tooth, and >2 affected with a clinical AL ≥ 6mm. Patients (28 patients in the mild group and 72 patients in the moderate-to-severe group) underwent non-surgical periodontal treatments. We analyzed differences in serum concentrations of metabolic parameters (glycated hemoglobin and low-density lipoprotein), inflammatory parameters (interleukin [IL]-1β and C-reactive protein [CRP]), and periodontal parameters between the two groups before treatment and at 3, 6, 9, and 12 months post-therapy. Seventy-five patients with diabetes (21 patients in the mild group and 54 patients in the moderate-to-severe group) completed the study. Significant differences in the plaque index (PI), gingival index (GI), PD, and clinical AL at examination times were observed in the whole cohort (P <0.05). We observed significant differences in the PI, GI, and PD in the moderate-to-severe group (P <0.05), whereas there was only a significant difference in PD in the mild group (P <0.05) between baseline and 12 months post-treatment. Both groups experienced improved glycemic control, but the difference was insignificant. CRP and IL-1β levels were significantly different at examination times for the whole cohort (P <0.05). No significant positive association among metabolic and inflammatory parameters at 12 months post-therapy were found. Non-surgical periodontal treatment improved and maintained the periodontal health of patients with well-controlled diabetes, but no significant reduction of metabolic parameters was observed over a 1-year period.

Periodontal status and post‐transplantation complications following intensive periodontal treatment in patients underwent allogenic hematopoietic stem cell transplantation conditioned with myeloablative regimen

Evaluation of the periodontal status is necessary prior to management with high-dose chemotherapy before hematopoietic stem cell therapy (HSCT). During medical therapy, pre-existing periodontal conditions may exacerbate and cause local and systemic complications. When possible, maximal oral health should be achieved prior to engraftment. In this study, we aimed to determine the alterations occurred in the periodontal status of the patients after periodontal treatment and allogenic HSCT and evaluate the effect of intensive periodontal approach on the short-term complications of HSCT. The alterations occurred in the periodontal tissues 3-4 weeks after periodontal treatment and after HSCT periods of 3 months for 29 patients treated with full-mouth periodontal treatment completed in 24 h in addition to eradication of dental foci, and oral hygiene status were evaluated using pocket depth measurements, presence of bleeding on probing and plaque and gingival indices. The incidence and severity of acute graft-versus-host disease (GVHD) and oral mucositis (OM) were recorded. Duration of engraftment period and the episode of febrile neutropenia were also evaluated. There were significant improvements in periodontal status after periodontal treatment (P<0.001). There were 14 (48.3%) patients without acute GVHD and 17 (58.6%) patients with no sign of OM. The majority of OM was at grade II level. There was a negative relation that exists between the percentage of BOP (+) sites and presence of OM (r=-0.518, P<0.05). Together with a significant reduction in gingival inflammation and maintenance of the improvement in periodontal health, remarkable decrease in the incidence and severity of OM were observed.

Assessment of the effect of periodontal treatment in patients with coronary artery disease: A pilot survey

Background:Periodontitis is a chronic inflammatory condition believed to cause a low but long lasting systemic inflammatory reaction which in turn contributes to the development of atherosclerosis. Recent data suggests that around 40% cases of coronary artery disease remain unaccounted despite the identification of the classical risk factors.Objectives:To evaluate the efficacy of non surgical periodontal therapy on the levels of serum inflammatory markers in subjects with chronic periodontitis and known coronary artery disease.Materials and Methods:Twenty subjects with known coronary artery disease (CAD) were recruited from the Department of Cardiology, CSM Medical University, Lucknow, India, for this study. Periodontal disease was measured through the clinical parameters bleeding on probing (BOP) and probing depth (PD). All subjects received non surgical periodontal therapy that included oral hygiene instructions and meticulous scaling and root planing. Systemic levels of inflammatory markers such as high-sensitivity C reactive proteins (hsCRP), tumor necrosis factor-α (TNF-α), and white blood cell (WBC) counts were measured prior to and 1 month after periodontal therapy.Results:Subjects experienced significant reductions in bleeding on probing (BOP) and probing depth (PD), indicating improvement in overall periodontal health. In all subjects, high-sensitivity C reactive proteins (hsCRP), and WBC counts were reduced significantly,; however, tumor necrosis factor-α (TNF-α) levels showed no statistically significant reduction.Conclusion:In this study, periodontal treatment resulted in a significant decrease in bleeding on probing (BOP) and probing depth (PD), and this treatment lowered the serum inflammatory markers (hsCRP and WBC counts) in patients with coronary artery disease. This may result in a decreased risk for coronary artery disease in the periodontally treated patients.

Effects of Non‐Surgical Periodontal Treatment on Clinical Response, Serum Inflammatory Parameters, and Metabolic Control in Patients With Type 2 Diabetes: A Randomized Study

Scientific evidence on the effects of chronic periodontitis on diabetes mellitus remains inadequate and inconclusive. This intervention study is designed to evaluate the effects of periodontal treatment on clinical response, systemic inflammatory parameters, and metabolic control in patients with Type 2 diabetes. A total of 134 patients were randomly allocated into two treatment groups and one control group. Treatment group 1 underwent non-surgical periodontal treatment at baseline and additional subgingival debridement at the 3-month follow-up. Patients in treatment group 2 received non-surgical periodontal treatment and supragingival prophylaxis at the 3-month follow-up, and those in the control group received no intervention throughout the study. All participants were reexamined at 1.5, 3, and 6 months after initial treatment. At each visit, clinical periodontal examinations were conducted and blood samples were taken to evaluate high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-α), glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and lipid profiles. Both treatment groups had a significantly lower hsCRP level after periodontal therapy (P <0.05). Although HbA1c declined significantly in treatment group 2 (P <0.05), the intergroup difference for HbA1c, FPG, TNF-α, and lipid profiles was not statistically significant after therapy (P >0.05). Non-surgical periodontal treatment can effectively improve periodontal and circulating inflammatory status. Despite a lack of strong evidence, trends in some results support improved glycemic control after periodontal treatment in patients with diabetes.

Azithromycin: Author’s Reply

Thank you for the opportunity to reply to Dr Higgins’ letter. I agree that whenever possible, our treatment choices should be informed by evidence. There are in fact 10 controlled clinical studies of azithromycin in the treatment of periodontitis;1-10 the majority of these show a beneficial effect in improving periodontal disease and microbiologic parameters over and above scaling and root planing (SRP). The latest study showed that ‘the adjunctive use of systemic azithromycin in the treatment of P. gingivalis periodontitis demonstrated significant clinical and microbiological benefits when compared with SRP plus placebo’.10 None of these studies was designed to assess periodontal regeneration so the case reports represent the first published evidence that azithromycin could be involved in this outcome. In addition, there are biologically plausible mechanisms to support the use of azithromycin in the treatment of periodontal diseases: the first is its activity against periodontopathogens such as P. gingivalis, A. actinomycemcomitans and other gram negative bacteria; the second being its inherent immune-modulatory properties which exert anti-inflammatory effects. Reduction of inflammation is a primary goal of periodontal therapy, especially since periodontal inflammation has been linked to systemic diseases in recent years.11 Finally, azithromycin is a low-risk drug in terms of adverse effects. Furthermore, the efficacy of azithromycin in reducing cyclosporine-induced gingival overgrowth has been documented in numerous studies since 1996; these papers have been published in the non-periodontal literature but provide another line of evidence that azithromycin has significant long-term periodontal effects after a single course.12-14 Although this effect is scarcely acknowledged in periodontal circles, this should not preclude the use of azithromycin to help patients in a different way than by conventional periodontal therapy (gingival resection, followed frequently by return of the gingival overgrowth if drug substitution is not possible). Regarding Dr Higgins’ opinion that the use of azithromycin for the treatment of periodontal diseases was off-label, I consider that azithromycin is in the same category as amoxil and metronidazole when these are prescribed either individually or in combination for severe/aggressive periodontitis. The prescription of these drugs in the treatment of periodontitis is not ‘off-label’; according to eMims 2010, azithromycin is to be used ‘for mild-moderate infections due to susceptible organisms’. Azithromycin is prescribed for its antibiotic properties in diverse infections for which it received FDA approval, but is also prescribed for its anti-inflammatory and immune-modulating effects to treat asthma, diffuse panbronchiolitis, chronic obstructive pulmonary diseases, and more recently cystic fibrosis and bronchiectasis. Its use in the treatment of advanced periodontal diseases is an application of both its antibiotic and immune-modulating properties; the latter may be an ‘off-label’ use if the drug was only prescribed for these effects in periodontal treatment. According to Bennett, ‘off-label use of drugs by individual physicians is legal and leads to new therapeutic advances’.15 It was made clear in the case report ‘that no definitive conclusions or recommendations about the use of azithromycin should be drawn from them’ and I agree with Dr Higgins’ concerns about the over-prescription of antibiotics in general. On the other hand, extensive clinical observations of the periodontal effects of azithromycin in aggressive periodontitis and in patients who had responded poorly to conventional periodontal treatment (including surgery) show that a single course of the drug improves the clinical outcome for these patients in the long term. Colleagues report similar effects in patients who had previously been ‘written off’ periodontally. Azithromycin’s short treatment regimen (one 500 mg tablet a day for three days) could well minimize the development of bacterial resistance. We do need further evidence from randomized controlled clinical trials and laboratory studies, but in the meantime, it is reasonable to prescribe azithromycin on a case-by-case basis adjunctive to periodontal treatment in patients with severe inflammatory periodontal diseases. It is also timely that azithromycin be included in the Therapeutic Guidelines Oral and Dental.

Hemostasis in Periodontally Treated Patients on Oral Antithrombotic Therapy may be Possible

Hemostatic management for periodontal treatments in patients on oral antithrombotic therapy: a retrospective study. Morimoto Y, Niwa H, Minematsu K. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108(6):889-96. Walter A. Bretz, DDS, PhD. The authors attempted to evaluate hemostatic management of periodontal treatment in patients on oral antithrombotic therapy. Information not available. Retrospective case series Level 3: Other evidence. Not applicable.

Relationship of Porphyromonas gingivalis with glycemic level in patients with type 2 diabetes following periodontal treatment

The aim of this study was to assess the relationship between serum glycemic levels and subgingival microbial profile alteration following periodontal treatment in patients with type 2 diabetes mellitus. We studied 30 periodontitis patients with type 2 diabetes mellitus who received full-mouth subgingival debridement by analyzing their subgingival microbial profiles using a polymerase chain reaction method at baseline and various time-points for 12 months following treatment. Concurrently, probing pocket depth, bleeding on probing, and metabolic parameters, including glycated hemoglobin A1c (HbA1c), blood sugar level, C-reactive proteins, total cholesterol, triglyceride, and high-density and low-density lipoprotein cholesterol, were recorded. Periodontal conditions were significantly improved after treatment, and the occurrence rates of periodontal bacterial species, including Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, and Prevotella intermedia, were also reduced. Interestingly, P. gingivalis was detected more frequently in subjects with increased HbA1c values after periodontal treatment than in those patients with decreased HbA1c values. Furthermore, P. gingivalis with type II fimbriae was detected only in HbA1c-increased subjects, while improvements in HbA1c values were observed only in subjects without type II clones. These results suggest that glycemic level in diabetes is affected by the persistence of P. gingivalis, especially clones with type II fimbriae, in periodontal pockets.

Photodynamic therapy as adjunct to non-surgical periodontal treatment in patients on periodontal maintenance: a randomized controlled clinical trial

Recent preclinical and clinical data have suggested the potential benefit of photodynamic therapy (PDT) in the treatment of periodontitis. However, currently, there are very limited data from controlled clinical trials evaluating the effect of PDT in the treatment of periodontitis. The aim of the present study was to evaluate the clinical and microbiological effects of the adjunctive use of PDT in non-surgical periodontal treatment in patients receiving supportive periodontal therapy. Twenty-four patients receiving regularly supportive periodontal therapy were randomly treated with either subgingival scaling and root planing followed by a single episode of PDT (test) or subgingival scaling and root planing alone (control). The following parameters were evaluated at baseline and at 3 months and 6 months after therapy: full mouth plaque score (FMPS), full mouth bleeding score (FMBS), bleeding on probing (BOP) at experimental sites, probing pocket depth (PPD), gingival recession (REC), and clinical attachment level (CAL). Primary outcome variables were changes in PPD and CAL. Microbiological evaluation of Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Tannerella forsythensis (T.f.), Treponema denticola (T.d.), Peptostreptococcus micros (P.m.), Fusobacterium nucleatum (F.n.), Campylobacter rectus (C.r.), Eubacterium nodatum (E.n.), Eikenella corrodens (E.c.), and Capnocytophaga species (C.s.) was also performed at baseline and at 3 months and 6 months after therapy, using a commercially available polymerase chain reaction test. No differences in any of the investigated parameters were observed at baseline between the two groups. At 3 months and 6 months after treatment, there were no statistically significant differences between the groups in terms of PPD, CAL and FMPS. At 3 months and 6 months, a statistically significantly higher improvement of BOP was found in the test group. At 3 months after therapy, the microbiological analysis showed a statistically significant reduction of F.n. and E.n. in the test group. At 6 months, statistically significantly higher numbers of E.c. and C.s. were detected in the test group. The additional application of a single episode of PDT to scaling and root planing failed to result in an additional improvement in terms of PPD reduction and CAL gain, but it resulted in significantly higher reduction of bleeding scores than following scaling and root planing alone.

A critically severe gingival bleeding following non‐surgical periodontal treatment in patients medicated with anti‐platelet

Only a few dental procedures have been reported to cause life-threatening bleeding. All of these cases followed surgical intervention. In this paper, we report a case of severe bleeding following non-surgical periodontal procedures in a patient treated with a dual anti-platelet regimen post-coronary stent insertion. Her medical history included ischaemic heart disease, hypertension and diabetes mellitus. Haemostasis was achieved at the conclusion of the non-surgical periodontal treatment. However, several hours later, the patient arrived at the emergency room and was diagnosed with hypovolemic shock. This case should raise the clinician's awareness of bleeding complications in non-surgical procedures as well as the risk for bleeding when a dual anti-platelet regimen is administered. The importance of patient monitoring and the use of local haemostatic agents is demonstrated in these cases.

Appearance of Multidrug‐Resistant Opportunistic Bacteria on the Gingiva During Leukemia Treatment

Dentists generally recognize the importance of periodontal treatment in patients with leukemia, with the most attention paid to preventing the development of odontogenic infection. For physicians, the worst type of infection is one caused by multidrug-resistant bacteria. Here, we report a patient with an abnormal increase in multidrug-resistant opportunistic bacteria in the gingiva during hematopoietic cell transplantation (HCT). A 53-year-old woman receiving HCT for leukemia had an insufficient blood cell count for invasive periodontal treatment before HCT. Even brushing caused difficulties with hemostasis. Therefore, frequent pocket irrigation and local minocycline administration were performed. The multidrug-resistant opportunistic bacterium Stenotrophomonas maltophilia was detected first in phlegm 2 days before HCT, and it was detected in a gingival smear and a blood sample 7 and 11 days after HCT, respectively. The patient developed sepsis on day 11 and died 14 days after HCT. Frequent irrigation and local antibiotic application were ineffective against S. maltophilia on the gingiva. Inflammatory gingiva without scaling and root planing showed bleeding tendency, and this interfered with the eradication of this bacterium. The gingiva in patients undergoing leukemia treatment acts as sites of proliferation and reservoirs for multidrug-resistant opportunistic bacteria. Severe systemic infection by multidrug-resistant bacteria in such patients with leukemia also may involve the gingiva. To prevent abnormal increases in such bacteria on the gingiva, scaling and/or root planing before chemotherapy, which reduces bleeding on brushing during the neutropenic period caused by chemotherapy, may contribute to infection control in such patients, although it was impossible in this case.

Treatment of periodontitis and endothelial function

Conclusion: Acute short-term systemic inflammation and endothelial dysfunction results from intensive periodontal treatment. Six months after this treatment, there is improvement in endothelial function. Summary: Atherosclerosis is an inflammatory disease. Some believe periodontitis can be a source of chronic systemic inflammation underlying atherosclerosis. Periodontitis is associated with elevated C-reactive protein and other inflammatory biomarkers (Arch Intern Med 2003;163:1172-9). Endothelial dysfunction may serve as a common pathway through which inflammation mediates atherogenesis. The authors sought to evaluate the treatment of periodontitis on endothelial function. Of 120 patients with severe periodontitis, 59 were assigned randomly to community-based periodontal care and 61 to intensive periodontal treatment. Endothelial function was assessed by brachial artery flow–mediated dilatation. Markers of coagulation and endothelial activation and inflammatory biomarkers were evaluated before treatment and at 1, 7, 30, 60, and 180 days after treatment. Flow-mediated dilatation was significantly lower 24 hours after treatment in the intensive treatment group compared with the control treatment group (absolute difference, 1.4%; 95% confidence interval [CI], 0.5 to 2.3; P = .002). Higher levels of C-reactive protein, endothelial-activation markers, and inflammatory markers were found in the intensive treatment group at 24 hours (P < .05 for all comparisons). At 60 days after therapy, however, flow-mediated brachial artery dilatation was greater in the intensive treatment group. The plasma levels of soluble E-selectin were lower at 60 days in the intensive treatment group than in the control group (absolute difference in brachial artery flow-mediated dilatation 0.9%; 95% CI, 0.1 to 1.7; P = .02) and also at 180 days after therapy (difference 2.0%; 95% CI, 1.2 to 2.8; P < .001). Improvement in brachial artery dilatation and inflammatory markers was associated with improvement in measures of periodontal disease (r = 0.29 by Spearman rank correlation; P = .003). Comment: The severity of periodontitis present in the subjects of this study is likely present in no more than 0.5% to 1% of the adult United States population. Atherosclerosis is obviously considerably more common. It would be interesting to see if future studies can demonstrate improvement in endothelial function with periodontal treatment in patients with lesser degrees of periodontitis.

The changes in T lymphocyte subsets following periodontal treatment in patients with chronic periodontitis

The aim of this study was to determine whether there was any change in T-lymphocyte subsets in patients with chronic periodontitis after applying different periodontal treatment methods. Twenty-four patients with chronic periodontitis were included in the study. In every phase of the treatment (pretreatment, initial treatment, curettage and flap operations) the biopsy samples were taken from the gingival tissues at sites of chronic periodontitis. Then CD4(+) and CD8(+) lymphocyte and CD4(+)/CD8(+) ratio values were determined using flow cytometry in the biopsy samples. At the same time, gingival pocket depth, Löe-Silness gingival index, and Silness-Löe plaque index scores were recorded to assess the periodontal status in patients. To determine the correlation between the clinical measurements and the laboratory results obtained before the treatment, after initial treatment, after curettage and after flap operations, we conducted an analysis using a paired t-test. Flow cytometry findings in the patients with chronic periodontitis showed that CD4(+) and CD8(+) lymphocyte values before treatment were under the normal value and the CD4(+)/CD8(+) ratio was within the normal distribution interval. The CD4(+)/CD8(+) ratio decreased postcurettage and postflap operation. This decrease was statistically significant (p < 0.001). The CD4(+) and CD8(+) lymphocyte values were increased postcurettage and postflap operation. This increase was also statistically significant (p < 0.001). These findings suggest that local immune response was poor in the patients with chronic periodontitis. CD4(+) and CD8(+) T-lymphocytes could play a significant role in chronic periodontitis pathobiology.

Bisphosphonate Therapy Improves the Outcome of Conventional Periodontal Treatment: Results of a 12‐Month, Randomized, Placebo‐Controlled Study

Bone loss in periodontitis results from inflammatory reactions that stimulate osteoclastic bone resorption. Bisphosphonates inhibit bone resorption and increase bone mass. This study evaluated the effect of bisphosphonate therapy as an adjunct to non-surgical periodontal treatment in patients with moderate to severe chronic periodontitis. Patients were randomized (2:1) to one of two bisphosphonate therapies or placebo for 1 year. All patients received non-surgical periodontal treatment (scaling, root planing) and periodontal maintenance therapy every 3 months. Clinical assessments at baseline and 6 and 12 months included clinical attachment level (CAL), probing depth (PD), and bleeding on probing (BOP). Periodontal bone mass was assessed by dental radiographs at baseline and 12 months using fractal analysis and digital subtraction radiography (DSR). Seventy patients were randomized, 43 to the bisphosphonate group and 27 to the placebo group. Bisphosphonate therapy significantly improved CAL, PD, and BOP relative to the placebo group during the 6- to 12-month period (CAL, P = 0.0002; PD, P = 0.0156; BOP, P = 0.0079). There was no difference in the change in periodontal bone mass between the bisphosphonate and placebo groups as measured by fractal analysis and DSR. These data suggest that bisphosphonate treatment improves the clinical outcome of non-surgical periodontal therapy and may be an appropriate adjunctive treatment to preserve periodontal bone mass.

Periodontal treatment of patients with Papillon–Lefèvre syndrome: a 3‐year follow‐up

Conventional mechanical periodontal treatment of Papillon-Lefevre syndrome (PLS) has often been reported to fail. This study describes the outcome of a non-surgical periodontal therapy including antimicrobial treatment of nine patients diagnosed with PLS. The patients originate from a total of 15 children and adolescents with PLS for which clinical characteristics are presented. Clinical examination including conventional periodontal measurements. Initial treatment including oral hygiene instruction, scaling and root planing and systemic amoxicillin-metronidazole therapy for 6 weeks. After that the patients were enrolled in a 3-month recall maintenance program. In addition to this mechanical supportive maintenance treatment, tetracycline was prescribed and used continuously for 1.5 years. On five patients who were showing acceptable standard of oral hygiene and also compliance with the antibiotic medication, development of periodontitis on erupting teeth was prevented and disease activity on the previously periodontally involved teeth controlled during a 3-year period. Poor results of treatment were observed for three patients, all siblings. These patients failed to comply with the medication and also failed to improve their oral hygiene.

Tooth loss during maintenance following periodontal treatment in a periodontal practice in Norway.

Periodontal therapy coupled with careful maintenance has been shown to be effective in maintaining periodontal health; however, a small number of teeth are still lost because of progressive periodontitis. To investigate factors associated with tooth loss due to periodontal reasons during maintenance following periodontal treatment in patients in a Norwegian specialist periodontal practice. The study also examined how initial prognosis related to actual outcome as measured by periodontal tooth loss. Hundred consecutive patients (68 females, 32 males) who had comprehensive periodontal treatment and attended for 9.8 (SD: 0.7), range: 9-11 years of maintenance care, were studied. All teeth classified as being lost due to periodontal disease over the period were identified. Only 36 (1.5%) of the 2436 teeth present at baseline were subsequently lost due to periodontal disease. There were 26 patients who lost at least one tooth. Logistic regression analysis showed that tooth loss was significantly related to male gender (p=0.049; adjusted odds ratio: 2.8; confidence interval (c.i.): 1.0-8.1), older age, i.e.>60 years (p=0.012; adjusted odds ratio: 4.0; c.i.: 1.3-12.0) and smoking (p=0.019; adjusted odds ratio: 4.2; c.i.: 1.4-13.8). The majority 27 (75%) of the teeth lost due to periodontal disease had been assigned an uncertain, poor or hopeless initial prognosis; however, nine teeth (25%) lost had been assigned a good prognosis at baseline. The prognosis for 202 teeth was judged to have worsened over the period of the study. Compliance with maintenance following periodontal treatment was associated with very low levels of tooth loss in a referral practice in rural Norway. Male gender, older age (>60 years) and smoking were predictors of tooth loss due to progressive periodontitis.

Use of antimicrobial agents during supportive periodontal therapy

Individual susceptibility to periodontal breakdown involves an interplay of genes, periodontal pathogens and other modulating factors. Anti-infective treatment, which includes oral hygiene measures, mechanical debridement, pharmacologic intervention and surgery, has been shown to be effective in arresting the progression of periodontal disease. Nevertheless, due to the chronic nature of the disease, susceptible individuals who are not maintained in a supervised recall program subsequent to the active treatment phase, show signs of recurrent destruction. Supportive periodontal therapy (SPT) is an integral part of periodontal treatment for patients with history of periodontitis, and is needed to prevent recurrence of disease in susceptible individuals. To prevent re-infection with periodontal pathogens, SPT includes elimination of dental plaque and bacteria from the oral cavity, thereby preventing the recurrence of pathogens into the gingival area. For individuals at risk of developing periodontitis, SPT should combine self-performed and professional anti-infective therapy, using mechanical and pharmacological means. The existing evidence suggests that the adjunctive use of antimicrobial pharmacologic therapy during SPT may enhance the results of mechanical debridement. The use of antimicrobials varies between patients, and is dependent on risk assessment and longitudinal monitoring of the clinical status of the periodontium.

Evaluation of gingival and periodontal conditions following causal periodontal treatment in patients treated with nifedipine and diltiazem.

It is established that phenytoin, cyclosporin and some calcium antagonists produce gingival overgrowth, but it is not known how this condition may respond to causal periodontal treatment. In order to find out, a longitudinal study was carried out, over a year, comparing a group of patients who were given nifedipine (NG, n = 18) and another group who were given diltiazem (DG, n = 13) with 2 others: one comprised cardiopathic patients who took no calcium antagonists (CG, n = 12) and the other contained patients who were medically healthy, with moderate periodontitis (HG, n = 12). On their basal visit, they were examined and instructed in oral hygiene, and then given causal periodontal treatment, being seen again at 4 and 8 months, when hygiene instructions were reinforced. They were seen for the last time at 12 months, when they were again examined. Groups NG and DG, on their basal visit, showed larger gum size than groups HG and CG, which was statistically significant; on their final visit, these differences remained only at the interproximal level. The number of patients with gingival overgrowth-taking the average of group HG as a minimal value-was much higher in groups CG (92%), DG (100%) and NG (89%) on the basal visit; on the final visit, the differences remained only in groups DG (85%) and NG (83%). The probing pocket depth reduction was much greater in groups HG and CG than in DG and NG, basically due to a greater gaining on clinical attachment level. The % of sites in which the pocket depth improved by more than 2 mm was 39.8% in HG, 54.5% in CG, 23.7% in DG and 28.7% in NG. The % of sites where the attachment gain by more than 2 mm was 46.2% in HG, 55.5% in CG, 22.8% in DG and 21.4% in NG. The amount of plaque and bleeding on probing, which was similar in all groups on the basal visit, decreased throughout the study, especially between the basal and 2nd visit in groups HG and CG. We have demonstrated that patients that take nifedipine and diltiazem show a larger gum size and their response to causal periodontal treatment is poorer than in the healthy and the cardiac groups.