Resolution Of Gingival Inflammation Research Articles

Suspension of oral hygiene practices highlights key bacterial shifts in saliva, tongue, and tooth plaque during gingival inflammation and resolution

Experimentally induced gingivitis is associated with inflammatory and microbiological changes in an otherwise healthy subject, demonstrating the impacts of discontinuing oral hygiene routines. Understanding the bacterial dynamics during the induction and resolution of gingival inflammation will aid in the development of bacterial prognostic tests and probiotics for severe oral disease. We profiled the bacterial community in 15 healthy subjects who suspended all oral-hygiene practices for three weeks. Saliva, tongue, subgingival, and supragingival plaque samples were collected over seven weeks and showed a return to community baseline after oral hygiene practices were resumed. Stronger temporal changes in subgingival and supragingival plaque suggest these sample types may be preferred over saliva or tongue plaque for future prognostics. Taxonomic groups spanning ten phyla demonstrated consistent abundance shifts, including a significant decrease in Streptococcus, Neisseria, and Actinomyces populations, and an increase in Prevotella, Fusobacterium, and Porphyromonas populations. With four distinct oral sites surveyed and results mapped to the Human Oral Microbiome Database reference set, this work provides a comprehensive taxonomic catalog of the bacterial shifts observed during the onset and resolution of gingival inflammation.

Salivary proteotypes of gingivitis tolerance and resilience.

AimThis study aimed to characterize the salivary proteome during the induction and resolution of gingival inflammation in the course of human experimental gingivitis (EG), and to cluster the proteomic profiles based on the clinically defined “slow” and “fast” response patterns.Materials and MethodsA total of 50 unstimulated whole saliva were obtained from the EG model which was induced over 21 days (days 0, 7, 14 and 21), followed by a two‐week resolution phase (day 35). Label‐free quantitative proteomics using liquid chromatography–tandem mass spectrometry was applied. Regulated proteins were subject to Gene Ontology enrichment analysis.ResultsA total of 804 human proteins were quantified by ≥ 2 peptides. Principal component analysis depicted significant differences between “fast” and “slow” responders. Despite gingival and plaque scores being similar at baseline among the two groups, “fast” responders presented with 48 proteins that were at > 4‐fold higher levels than “slow” responders. These up‐regulated proteins showed enrichment in “antigen presentation” and “proteolysis.”ConclusionsTogether, these findings highlight the utility of integrative systems‐level quantitative proteomic approaches to unravel the molecular basis of “salivary proteotypes” associated with gingivitis dubbed as “fast” and “slow” responders. Hence, these differential responses may help prognosticate individual susceptibility to gingival inflammation.

Effect of sulcular green tea extract irrigation on experimental rabbit’s gingivitis (A histopathological study)

Background: Considering the antioxidant, anti-inflammatory, and antimicrobial properties of green tea, this study aimed to evaluate the histopathological effect of the sulcular irrigation of green tea extract in the treatment of experimental gingivitis in rabbit.
 Materials and methods: For this experimental study, 45 male rabbits, separated in two groups, control non- irrigated group (5rabbits) and study group (40 rabbits), gingivitis induced by ligatures was packed subgingivally in the lower right central incisors of the experimental group for seven days. Then, the animals were randomly designated to two irrigated groups (20 rabbits for each) with 50µl/kg of distilled water and 5% green tea extract once daily for seven days starting from the day of ligature removal respectively. Specimens have taken at 1, 3, 7, and 14 days for light microscopical evaluation of inflammatory cellular infiltration.
 Results: Regarding study group (5% of green tea extract), results demonstrated a significant reduction in the mean values of inflammatory cell counts within three days (P≤ 0.05) to reach the amount of control group within seven days (P˃ 0.05). A highly significant difference was detected between control group and study group sprayed with distilled water during all healing periods (P≤ 0.05). Histological examination showed that the resolution of gingival inflammation, re-epithelization, and tissue healing were achieved much quicker in the group of gingival sulcular irrigation with 5% green tea extract.
 Conclusions: In this experimental study, the histopathological analysis demonstrated that the use of 5% extract of green tea as gingival sulcular irrigation might fasten healing after the induction of gingivitis.
 Keywords: green tea, animal model, gingival sulcular irrigation, experimental gingivitis.

Experimental gingivitis in patients with and without altered passive eruption.

Individuals with altered passive eruption (APE) are assumed to be more susceptible to periodontal diseases. To date, this hypothesis has not been sufficiently supported by scientific evidence. The aim of this study, using an experimental gingivitis model, was to examine the development and resolution of gingival inflammation in patients with APE when compared to patients with normal gingival anatomy. A localized experimental gingivitis was induced in 9 patients with APE (test group) and 9 patients without APE (control group) in the maxillary right quadrant. After 21 days, patients were instructed to resume proper home oral hygiene procedures. At baseline (day 0) and at days 7, 14, 21, 28, 35, and 42, plaque index (PlI), gingival index (GI), and gingival crevicular fluid volume (GCF) were evaluated for teeth 6 (canine), 7 (lateral incisor) and 8 (central incisor) of test and control groups. During the experimental gingivitis phase (days 0 to 21), the rate of change in gingival inflammation (GI) was dramatically different between the APE test group and the control group. On day 21, at the time of maximum plaque accumulation, the GI of the APE test group was a 109% greater than the GI of the test group (P ≤ 0.001) despite similar plaque levels (P=0.436). During the resolution of inflammation phase (days 22 to 42), the APE test group continued to exhibit statistically higher GI scores than the control group (P=0.029). In the presence of similar amounts of plaque deposits and plaque accumulation rates, APE patients exhibited differences in the development and resolution of plaque-induced gingival inflammation when compared to controls.

Salivary Total Protease Activity Based on a Broad-Spectrum Fluorescence Resonance Energy Transfer Approach to Monitor Induction and Resolution of Gingival Inflammation.

ObjectiveSalivary total protease and chitinase activities were measured by a broad-spectrum fluorescence resonance energy transfer approach as predictors of induction and resolution of gingival inflammation in healthy individuals by applying an experimental human gingivitis model.MethodsDental biofilm accumulated (21 days, Induction Phase) by omitting oral hygiene practices followed by a 2-week Resolution Phase to restore gingival health in an experimental gingivitis study. Plaque accumulation, as assessed by the Turesky Modification of the Quigley-Hein Plaque Index (TQHPI), and gingival inflammation, assessed using the Modified Gingival Index (MGI), scores were recorded and unstimulated saliva was collected weekly. Saliva was analysed for total protein, albumin, total protease activity and chitinase activity (n = 18).ResultsThe TQHPI and MGI scores, as well as total protease activity, increased until day 21. After re-establishment of oral hygiene, gingival inflammation levels returned to values similar to baseline (day 0). Levels of protease activity decreased significantly, but not to baseline values. Furthermore, ‘fast’ responders, who responded immediately to plaque, exhibited significantly higher proteolytic activity throughout the experimental course than ‘slow’ responders, who showed a lagged inflammatory response.ConclusionThe results indicate that differential inflammatory responses encompass inherent variations in total salivary proteolytic activities, which could be further utilised in contemporary diagnostic, prognostic and treatment modalities for periodontal diseases.

Regulation of PGLYRP1 and TREM-1 during Progression and Resolution of Gingival Inflammation.

The triggering receptor expressed on myeloid cells 1 (TREM-1) signaling pathway is stimulated by bacteria and, together with its putative ligand peptidoglycan recognition protein 1 (PGLYRP1), propagates proinflammatory responses. We aimed to evaluate the TREM-1/PGLYRP1/interleukin (IL)-1β regulation in response to biofilm accumulation and removal in an experimental human gingivitis model. The study (n = 42 participants, mean age: 23.8 ± 3.7 y) comprised a recruitment step (day -14) followed by experimentally induced biofilm formation (induction [I] phase, day 0 to +21) and a 2-wk resolution (R) phase (day +21 to +35). Plaque was recorded by the Modified Quigley and Hein Plaque Index (TQHPI), while records of gingival inflammation were based on the Modified Gingival Index (MGI). Unstimulated whole saliva supernatants (n = 210, 5 time points) were tested for TREM-1, PGLYRP1, and IL-1β by enzyme-linked immunosorbent assay. During the I-phase, concentrations of all analytes showed a tendency for downregulation at day +7 compared to day 0. TREM-1 (P = 0.019) and PGLYRP1 (P = 0.007) increased significantly between day +7 and day +21. Although all analyte levels decreased during the R-phase, the difference was not significant except TREM-1 being at borderline significance (P = 0.058). Moreover, TREM-1, PGLYRP1, and IL-1β showed significant positive correlations (P < 0.0001) with each other. The study participants were grouped into "fast" and "slow" responders based on clinical gingival inflammation scores. At each time point, fast responders showed significantly higher concentrations of TREM-1 (P < 0.025), PGLYRP1 (P < 0.007), and IL-1β (P < 0.025) compared to slow responders. Mixed-effects multilevel regression analyses revealed that PGLYRP1 (P = 0.047) and IL-1β (P = 0.005) showed a significant positive association with the MGI scores. The study demonstrated that TREM-1 and PGLYRP1 are regulated in response to biofilm accumulation and removal, and fast responders demonstrated higher levels of these analytes compared to slow responders. The results of this study demonstrated the suitability of salivary TREM-1 and PGLYRP1 to reflect biofilm accumulation and removal and PGLYRP1 to monitor the progression and resolution of inflammation in gingivitis-susceptible individuals (fast responders). Combined with conventional risk factors, the molecular toolbox proposed here should be further validated in future studies to confirm whether it can be used for population-based monitoring and prevention of gingivitis.

Local and Systemic Inflammatory Responses to Experimentally Induced Gingivitis

This study profiled the local and systemic inflammatory responses to experimentally induced gingivitis. Eight females participated in a 21-day experimental gingivitis model followed by a 14-day resolution phase. Bleeding on probing and plaque index scores were assessed before, during, and after resolution of gingival inflammation, and samples of saliva, GCF, and plasma were collected. Samples were assessed for biomarkers of inflammation using the BioPlex platform and ELISA. There were no significant changes in GCF levels of cytokines during the experimental phase; however, individual variability in cytokine profiles was noted. During resolution, mean GCF levels of IL-2, IL-6, and TNF-α decreased and were significantly lower than baseline levels (P = 0.003, P = 0.025, and P = 0.007, resp.). Furthermore, changes in GCF levels of IL-2, IL-6, and TNF-α during resolution correlated with changes in plaque index scores (r = 0.88, P = 0.004; r = 0.72, P = 0.042; r = 0.79, P = 0.019, resp.). Plasma levels of sICAM-1 increased significantly during the experimental phase (P = 0.002) and remained elevated and significantly higher than baseline levels during resolution (P < 0.001). These results support the concept that gingivitis adds to the systemic inflammatory burden of an individual.

Periodontal disease in a Rubinstein–Taybi syndrome patient: case report

Rubinstein-Taybi syndrome (RTS) is a rare disorder affecting 1 of 300,000 people, characterized by growth, mental and motor retardation, small stature, broad thumbs and toes, characteristic face, high-arched palate, and recurrent respiratory infections. The present report describes the periodontal and immunological status of a 14-year-old female patient with RTS. Probing depth, clinical attachment level, bleeding on probing, and radiographic evaluation were performed. Periodontal examination revealed severe attachment loss in incisors and molars and generalized bleeding on probing. Periodontal treatment consisted of scaling and root planing and oral hygiene instructions. Periodontal treatment resulted in resolution of gingival inflammation and pocket depth reductions. The association of periodontal disease and RTS is previously undescribed. This case report underscores the importance of periodontal clinical diagnosis and the possibility of successful periodontal treatment in RTS patients.

No difference between ultrasonic/sonic and manual debridement for the treatment of chronic periodontitis?

Data sources Data sources were Medline, the Cochrane Controlled Trials Register, Biosis, EMBASE, Health Devices Alerts, Meditec, Russmed articles and Scisearch dated up to April 2001, and reference lists from relevant articles. Study selection Randomised controlled trials were selected if they had at least 6 months’ follow-up and compared machine-driven instruments with hand instruments for the treatment of chronic periodontitis. Data extraction and synthesis Information regarding the quality and characteristics of studies was extracted independently by two reviewers. Kappa scores determined their agreement. Prevention of tooth loss was the primary outcome, with secondary outcomes of prevention of disease progression, resolution of anatomical defects and resolution of gingival inflammation also considered. Efficiency was assessed as the mean time needed to treat one tooth. Qualitative synthesis was conducted for all outcomes except time needed to treat one tooth, where a meta-analysis was performed. Results Thirteen studies were included in the review. No study reported on the selected primary outcome variables. Using the outcome variables of clinical attachment gain, probing pocket-depth reduction or bleeding on probing-reduction, there appeared to be no differences between ultrasonic/sonic and manual debridement. No major differences in the frequency or severity of adverse effects were found. Ultrasonic/sonic debridement was found to take significantly less time, ie, 36.6% of the time for debridement using hand instruments. Conclusions Ultrasonic/sonic subgingival debridement requires less time than use of hand instruments. The data did not indicate a difference between ultrasonic/sonic and manual debridement for the treatment of chronic periodontitis for single-rooted teeth but the evidence is not very strong. High quality trials are needed to assess the efficacy of machine-driven subgingival debridement. Clinical outcome variables that have a tangible benefit to the patients should be used.

Changes in Hemoglobin Concentration and Oxygen Saturation in Human Gingiva With Decreasing Inflammation

The purpose of this study was to determine if functional changes in the human gingival vasculature were reversible following the resolution of gingival inflammation. Ten patients with 40 inflamed gingival sites were evaluated before and 2 weeks after the completion of treatment. We determined the hemoglobin concentration and the oxygen saturation of hemoglobin at each site by tissue reflectance spectrophotometry. With the use of treatment including motivation, oral hygiene instruction, and scaling, clinical parameters such as the gingival and plaque indices, the Periotron score, and the probing depth were altered toward a healthier state. With the resolution of gingival inflammation, the increased hemoglobin concentration and decreased oxygen saturation in the inflamed gingiva were restored to normal levels. These findings suggest that reversible changes in the local hemoglobin concentration and oxygen saturation are associated with decreasing gingival inflammation in human subjects.

Blood flow in healed and inflamed periodontal tissues of dogs.

The objectives of this study were to determine if increased blood flow associated with gingivitis would decrease following resolution of gingival inflammation in dogs with periodontitis; if increased blood flow in inflamed gingiva was associated with changes in the blood flow of alveolar bone, and if blood flow in gingiva and alveolar bone increased if periodontitis was reactivated by ligating teeth. Regional blood flow was measured in dogs with pre‐existing periodontitis, using radioisotope‐labelled, plastic microspheres. In the first experiment on 4 adult Beagle dogs, teeth in the left jaws were treated to resolve the periodontitis, while teeth in the right jaws were not treated. Gingival and bone blood flow were measured after 12 wk. Blood flow was significantly (p&lt;0.05) lower in non‐inflamed healed gingiva (32.1±2.7 ml/min/100 g) than in inflamed gingiva (46.1±5.3 ml/min/100 g). No differences in the blood flow of alveolar bone underlying inflamed or non‐inflamed gingiva were present. In the second experiment, the right mandibular teeth of 5 dogs were treated to resolve periodontitis while teeth in the other quadrants were ligated for 4, 10 or 12 wk. The duration of ligation did not alter blood flow. Gingival blood flow around ligated maxillary and mandibular teeth was comparable and approximately 54% higher than around non‐ligated teeth (p±0.03). The difference in blood flow between gingiva with G.I. ± 1 and gingiva with G.I.±2 was significant (p±0.04). Blood flow in bone was not altered by changes in the inflammatory status of the overlying gingiva. The findings suggest that changes in blood flow associated with inflammation are reversible and that blood flow in alveolar bone is regulated independently of gingival blood flow.

The development of physiologic gingival contours by gingivoplasty

While the elimination of periodontal pockets with resolution of gingival inflammation and the establishment of physiologic function to the tooth are essential requisites for successful periodontal therapy, the achievement of a self-cleansing ability by a physiologic gingival architectural form will aid materially in the maintenance of health. This must, however, in no way discourage the patient's participation in a home care routine to aid in the cleansing. In fact, because of the achieved topography of the gingivae the patient is better able to perform the advocated toothbrush techique.