Treatment Of Adult Periodontitis Research Articles

Local Delivery of Metronidazole and Chlorhexidine as Toothpaste in Treatment of Adult Periodontitis

Local Delivery of Metronidazole and Chlorhexidine as Toothpaste in Treatment of Adult Periodontitis

Clinical and microbiological evaluation of the effectiveness of the Nd: Yap laser for the initial treatment of adult periodontitis: A randomized controlled study

Clinical and microbiological evaluation of the effectiveness of the Nd: Yap laser for the initial treatment of adult periodontitis: A randomized controlled study

Gingival crevicular fluid collagenase-2 (MMP-8) test stick for chair-side monitoring of periodontitis.

A rapid chair-side test based on the immunological detection of elevated levels of collagenase-2 (matrix metalloproteinase-8, MMP-8) in gingival crevicular fluid (GCF) was developed to identify and monitor the course and treatment of adult periodontitis. MMP-8 was determined in GCF from periodontitis (11 patients, 90 sites), gingivitis (10 patients, 58 sites) and healthy control (8 patients, 59 sites) sites (i) by a test stick incorporating monoclonal antibodies to two epitopes on MMP-8 and (ii) by measuring MMP-8 concentration by a quantitative immunofluorometric assay. Patients with adult periodontitis were treated by scaling and root planing (SRP) and received oral hygiene instructions. GCF MMP-8 testing and clinical measurements were done before and after SRP. MMP-8 GCF levels and chair-side test differentiated periodontitis from gingivitis and healthy control sites. MMP-8 GCF levels > 1 mg/l and positive chair-side test identified especially severe periodontitis sites. A positive and negative test stick result, the outcome of which was rapidly detectable in 5 mins, in GCF correlated well with MMP-8 immunofluorometric assay analysis from the collected GCF samples and the severity of periodontitis. Scaling and root planing reduced the MMP-8 levels in severe periodontitis sites with positive MMP-8 test and gingival probing pocket depth (PD) > 5 mm before treatment. The test stick result and the quantitative assay were discrepant in only 18 of the 207 sites tested, thus agreement was very good (kappa = 0.81). With a threshold of 1 mg/l MMP-8 activity the chair-side test provided a sensitivity of 0.83 and specificity of 0.96 (n = 207). The MMP-8 test can be used to differentiate periodontitis from gingivitis and healthy sites as well as to monitor treatment of periodontitis. A reduction in GCF MMP-8 levels and a change in test stick result provide a means to optimize patient control during maintenance of periodontal treatment.

Pilot study of dietary fatty acid supplementation in the treatment of adult periodontitis

The anti-inflammatory effects of both n-3 and n-6 polyunsaturated fatty acids (PUFA) have been demonstrated in vitro and in many disease states, in particular in the treatment of rheumatoid arthritis. The benefit of n-3 PUFA supplementation has been documented in animal models of periodontal inflammation and a trend towards reduced inflammation has been seen in human experimental gingivitis. The purpose of this study was to examine the potential anti-inflammatory effects of PUFA supplementation, by administration of fish oil as a source of the n-3 PUFA, eicosapentaenoic acid, and borage oil as a source of the n-6 PUFA, gamma-linolenic acid (GLA), to adults with periodontitis. Thirty adult human subjects with periodontitis were administered either fish oil 3000 mg daily; borage oil 3000 mg daily; fish oil 1500 and borage oil 1500 mg daily, or placebo. The modified gingival index, the plaque index (PI), periodontal probing depths and β-glucuronidase levels in gingival crevicular fluid were measured at baseline and after 12 weeks of treatment. Improvement in gingival inflammation was observed in subjects treated with borage oil ( P<0.016), with a trend apparent in subjects treated with fish oil or a combination of PUFA. There was no statistically significant improvement in PI, although a trend was apparent in those receiving borage oil. Improvement in probing depth was seen in those subjects treated with either fish oil alone or borage oil alone, but statistical significance was only seen for the comparison of borage oil and placebo ( P<0.044). No change was seen in gingival crevicular fluid (GCF) β-glucuronidase levels. The use of borage oil supplementation, a source of the n-6 PUFA, GLA, can have beneficial effects on periodontal inflammation. n-6 PUFA supplementation seemed to offer more impressive results than either n-3 PUFA supplementation or the combination of lower doses of the two supplements. Additional studies will be necessary to more fully assess the potential of these agents to favorably affect periodontal inflammation.

Effects of 2% minocycline gel as an adjunct to scaling and root planing on the treatment of adult periodontitis

Effects of 2% minocycline gel as an adjunct to scaling and root planing on the treatment of adult periodontitis

Effects of metronidazole gel as an adjunct to scaling and root planing on the treatment of adult periodontitis

Effects of metronidazole gel as an adjunct to scaling and root planing on the treatment of adult periodontitis

高度な根分岐部病変を伴った成人性歯周炎患者の治療

高度な根分岐部病変を伴った成人性歯周炎患者の治療

Current view of risk factors for periodontal diseases.

Peridontal diseases are infections, and many forms of the disease are associated with specific pathogenic bacteria which colonize the subgingival area. At least two of these microorganisms, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans, also invade the periodontal tissue and are virulent organisms. Initiation and progression of periodontal infections are clearly modified by local and systemic conditions called risk factors. The local factors include pre-existing disease as evidenced by deep probing depths and plaque retention areas associated with defective restorations. Systemic risk factors recently have been identified by large epidemiologic studies using multifactorial statistical analyses to correct for confounding or associated co-risk factors. Risk factors which we know today as important include diabetes mellitus, especially in individuals in whom metabolic control is poor, and cigarette smoking. These two risk factors markedly affect the initiation and progression of periodontitis, and attempts to manage these factors are now an important component of prevention and treatment of adult periodontitis. Systemic conditions associated with reduced neutrophil numbers or function are also important risk factors in children, juveniles, and young adults. Diseases in which neutrophil dysfunction occurs include the lazy leukocyte syndrome associated with localized juvenile periodontitis, cyclic neutropenia, and congenital neutropenia. Recent studies also point to several potentially important periodontal risk indicators. These include stress and coping behaviors, and osteopenia associated with estrogen deficiency. There are also background determinants associated with periodontal disease including gender (with males having more disease), age (with more disease seen in the elderly), and hereditary factors. The study of risk in periodontal disease is a rapidly emerging field and much is yet to be learned. However, there are at least two significant risk factors-smoking and diabetes-which demand attention in current management of periodontal disease.

Current View of Risk Factors for Periodontal Diseases

Periodontal diseases are infections, and many forms of the disease are associated with specific pathogenic bacteria which colonize the subgingival area. At least two of these microorganisms, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans, also invade the periodontal tissue and are virulent organisms. Initiation and progression of periodontal infections are clearly modified by local and systemic conditions called risk factors. The local factors include pre-existing disease as evidenced by deep probing depths and plaque retention areas associated with defective restorations. Systemic risk factors recently have been identified by large epidemiologic studies using multifactorial statistical analyses to correct for confounding or associated co-risk factors. Risk factors which we know today as important include diabetes mellitus, especially in individuals in whom metabolic control is poor, and cigarette smoking. These two risk factors markedly affect the initiation and progression of periodontitis, and attempts to manage these factors are now an important component of prevention and treatment of adult periodontitis. Systemic conditions associated with reduced neutrophil numbers or function are also important risk factors in children, juveniles, and young adults. Diseases in which neutrophil dysfunction occurs include the lazy leukocyte syndrome associated with localized juvenile periodontitis, cyclic neutropenia, and congenital neutropenia. Recent studies also point to several potentially important periodontal risk indicators. These include stress and coping behaviors, and osteopenia associated with estrogen deficiency. There are also background determinants associated with periodontal disease including gender (with males having more disease), age (with more disease seen in the elderly), and hereditary factors. The study of risk in periodontal disease is a rapidly emerging field and much is yet to be learned. However, there are at least two significant risk factors-smoking and diabetes-which demand attention in current management of periodontal disease. J Periodontol 1996;67:1041-1049.

Natural history of periodontitis and a review of technologies to prevent and treat it

The development of recommendations for what is acceptable clinical practice for patients with adult periodontitis is challenging. First, how much and what type of evidence is needed? This depends very much on the clinical problem, the nature of the evidence that is available, and the potential ill effects that may ensue if the effects of the treatment that is recommended are not what they are hoped to be. All treatments are applied with the implicit assumption that they do more good than harm. Treatments that are expensive, invasive, irreversible, or potentially risky, require more evidence than treatments that are not invasive, have reversible effects, and are without risk. Recall the hierarchy of types of evidence used in the AHCPR pain guidelines ranging from a meta-analysis of RCTs to uncontrolled observations in patients or expert opinion. A randomized controlled trial, or a meta-analysis of RCTs carries more weight than a much larger series of cases because of the great potential for bias when observations are made under uncontrolled conditions. One hundred poorly controlled studies do not provide evidence for optimal clinical decisions. Second, who bears the burden of proof? Certainly, any newly proposed therapy must be proven safe and effective by its proponents. But, what about treatments that have been the standard of practice, can they be grandfathered in, or must evidence be gathered for them? Given changes in understanding of mechanisms of disease pathogenesis, classification, rates of activity, and measurement of outcomes, it may be time to call all clinical dogma regarding treatment of adult periodontitis into question. Reliable evidence is not available for many of the treatments for adult periodontitis. Most of the evidence that is available was collected using methods and an underlying conceptual scheme regarding diagnosis and progression of disease that is very different from current beliefs. One could argue that even for the treatments that have been evaluated in RCTs, disease activity rates were so low by current assessment, that there was no disease to prevent or treat.

Clinical responses to subgingival application of a metronidazole 25% gel compared to the effect of subgingival scaling in adult periodontitis

A newly developed metronidazole 25% dental gel was compared with subgingival scaling in the treatment of adult periodontitis. 206 patients in 9 centres participated in the study. Probing pocket depth (PPD) and bleeding on probing (BOP) were recorded before treatment and 2, 6, 12, 18, and 24 weeks after the treatment. All patients had at least 1 tooth in each quadrant with a PPD of 5 mm or more. The treatments consisted of 2 applications of dental gel (days 0 and 7) in 2 randomly selected quadrants (split mouth design) and 2 sessions of subgingival scaling (1 quadrant on day 0, and 1 quadrant on day 7). Instruction in oral hygiene was given 2 weeks after completed treatment. The average PPD and the average frequency of BOP were calculated over all sites with initial PPD of 5 mm or more. PPD and BOP were thus, at each examination, calculated from the same sites. The mean PPD was 5.9 mm before gel application and 5.8 mm before scaling (p = 0.31). BOP was 88% in both treatment groups. 24 weeks after the treatment, PPD and BOP were significantly reduced in both groups and for both parameters (p < 0.01). PPD was reduced by 1.3 mm after gel application and 1.5 mm after scaling; BOP was reduced by 32% and 39%, respectively. The difference between the treatments was statistically significantly, but considered as clinically unimportant.

Clinical and microbiologic effects of single-dose metronidazole or scaling and root planing in treatment of adult periodontitis.

Sites affected with adult periodontitis were observed for 3 months to compare their clinical and microbiologic responses to a single 2 g dose of metronidazole, scaling and root planing, or no treatment. 2 sites with probing depths greater than or equal to 5 mm in each of 18 female subjects (6 in each treatment group) were evaluated clinically (plaque and bleeding indices, probing depth, attachment loss) and microbiologically (%s of cocci, motile rods, non-motile rods and spirochetes, and of obligate anaerobic colony-forming units, black-pigmented Bacteroides, Fusobacterium and Actinobacillus actinomycetemcomitans in subgingival plaque). No significant differences in these variables existed between the 3 groups at baseline. The no-treatment (control) group showed no substantial clinical or microbiologic changes during the study. After 1 month, scaling and root planing had effected significant clinical improvement and significant shifts in the subgingival flora to a pattern more consistent with periodontal health; these changes were still evident at 3 months. In contrast, 1 month after metronidazole, there was some clinical improvement and a significant increase in cocci and a decrease in motile rods, but at 3 months these changes were no longer evident. The results show that the benefits of scaling and root planing are sustained for at least 3 months. However, the benefits of a single 2 g dose of metronidazole are both few and transient, indicating that this regimen, while effective against anaerobic infections in other organ systems, is not clinically or microbiologically effective in the treatment of adult periodontitis.

Relationship between some subgingival bacteria and periodontal pocket depth and gain or loss of periodontal attachment after treatment of adult periodontitis

We studied the association between post-treatment periodontal disease activity and subgingival Bacteroides gingivalis, Bacteroides intermedius, spirochetes and motile rods. 20 adults, 22-62 years, with moderate-to-severe periodontitis participated in a split-mouth treatment study. All individual quadrants received supragingival cleaning and in addition, subgingival scaling and a NaHCO3-NaCl-H2O2 slurry, subgingival scaling alone, slurry alone, or no subgingival treatment. Post-treatment periodontal disease status was determined over a period of 12 months by changes in probing periodontal pocket depth and probing periodontal attachment level. Subgingival specimens obtained by paper point-sampling were evaluated for B. gingivalis and B. intermedius using indirect immunofluorescence and for spirochetes and motile rods using bright light phase contrast microscopy. A total of 142 periodontitis lesions representing all 4 quadrants of the 20 subjects were studied. The relationship between clinical data and bacteria was analyzed using logistic regression. The probability of the study organisms being present in subgingival sites at 3 to 6 months after treatment increased with increased residual pocket depth. The presence of B. gingivalis showed a strong positive association (p less than 0.004) with loss of periodontal attachment. A significant association was also found for spirochetes (p less than 0.008) but not for motile rods (p greater than 0.35) or B. intermedius (p greater than 0.13). Similar results were obtained at 12 months after therapy, except that the presence of motile rods was significantly associated with loss of periodontal attachment (p less than 0.03). Caution must be exercised when using B. gingivalis or spirochetes to evaluate treatment efficacy. If the presence of these organisms was utilized to indicate progressing periodontitis, many active lesions could be identified, and only 1 to 17% and 13 to 43% of sites in remission at 3-6 months after therapy would be expected to harbor B. gingivalis and spirochetes, respectively. The consequences of treating periodontal sites in remission would mainly be limited to cost and inconvenience. However, since several active periodontitis lesions did not reveal the organisms, treatment decisions based solely on the absence of the organisms may result in the omission of needed therapy. As a practical consideration, periodontal treatment should be continued as long as B. gingivalis and maybe spirochetes are detectable in the subgingival microflora. In the absence of these organisms, and until additional periodontal pathogens have become known, the decision to continue or conclude periodontal therapy must b