Untreated Periodontal Disease Research Articles

Pro-inflammatory cytokines and antioxidative enzymes as salivary biomarkers of dentofacial infections in children.

Dentofacial infection resulting from untreated dental caries or periodontal disease is a serious disease that can spread to deeper tissues of the face and neck. The present study aimed to analyze the salivary cytokine profile and oxidative stress parameters as potential biomarkers of acute odontogenic infections in children. The prospective study group (DI) consisted of 28 children aged 3-17 years with acute dentofacial infections, and the control group (CG) comprised 52 children aged 4-17 years with uncomplicated dental caries. The cytokine profile was analyzed using the Bio-Plex Pro™ Human Cytokine 27-plex kit. In addition, oxidative stress parameters, such as catalase (CAT), glutathione reductase (GR), superoxide dismutase (SOD), manganese SOD (Mn-SOD), copper-zinc SOD (CuZn-SOD), total antioxidant capacity (TAC), total oxidant status (TOS), and malondialdehyde (MDA), in the saliva of children in both groups were compared. The levels of interleukin 6 (IL-6), macrophage inflammatory protein 1 alpha (MIP-1α) and tumor necrosis factor alpha (TNF-α) were significantly increased in children with dentofacial infections as compared to CG. In contrast, the levels of other pro-inflammatory cytokines, such as IL-1β, IL-1 receptor agonist (IL-Ra), IL-8, monocyte chemoattractant protein 1 (MCP-1), and MIP-1β, did not show statistically significant differences between the 2 groups. Among the measured oxidative stress and antioxidative parameters, only CAT and GR were elevated in children with dentofacial infections as compared to controls. IL-6, MIP-1α, TNF-α, CAT, and GR can serve as selective biomarkers of oral cavity inflammation in children. These biomarkers can be useful in identifying and monitoring the progress and treatment of bacterial infections resulting in dentofacial inflammation.

ANALYSIS OF THE IMPACT OF DIABETES MELLITUS ON PERIODONTAL NETWORK CONDITIONS OF OUTSIDE PATIENTS

Background: diabetes melitus is a chronic disease that affects patients throughout their life. About 80% of diabetes melitus patients have problems with their gums. Uncontrolled diabetes melitus can weaken the immunity of periodontal tissue, on the other hand, untreated periodontal disease will worsen blood sugar balance so that periodontal tissue damage will occur. The purpose of the study: to determine the analysis of the impact of Diabetes melitus on the condition of periodontal tissue in outpatients at UPT Puskesmas Cihurip, Garut Regency. Methodology: the method used is qualitative observational with descriptive analytic design, a population of 30 patients who visited cases of diabetes melitus, sampling using accidental sampling. Data analysis used statistical test with ANOVA test. The results of the study: diabetes melitus in outpatients with type 1 DM classification was 16 people (42.1%) while those including type 2 DM were 22 people (57.9%). Periodontal tissue conditions of outpatients mostly included periodontitis criteria as many as 26 people (68.4%) and criteria with gingivitis as many as 12 respondents (31.6%). Analysis of the impact of diabetes melitus on the periodontal tissue condition of outpatients obtained p-value = 0.000 (p<0.05), meaning that there are differences in diabetes melitus in periodontal tissues including gingivitis and periodontitis. Conclusion: There is an analysis of the impact of diabetes melitus on the condition of periodontal tissue in outpatients. It is recommended for puskesmas, especially dental therapists, to further improve counseling for people with diabetes melitus about the importance of maintaining oral and dental health.

The National Healthy People Initiative:: History, Significance, and Embracing the 2030 Oral Health Objectives.

Since 1979, the U.S. Department of Health and Human Services has worked with multiple subject matter experts and the public to develop and issue a set of ambitious, measurable objectives known as "Healthy People." These objectives are aimed at improving the health of the nation issued at the start of each decade, and feature specific targets to be achieved at the end of the decade. The fifth iteration, Healthy People 2030, consists 358 measurable public health objectives associated with evidence-based interventions. Oral health is represented by 11 specific objectives aimed at reducing dental caries in children and adolescents, reducing untreated decay and periodontal disease in adults, and promoting evidence-based prevention strategies, including community water fluoridation, dental sealants, oral cancer screenings, and, most importantly, increasing access to dental services. In fact, access to the oral health care system for children, adolescents, and adults is identified as a Healthy People 2030 Leading Health Indicator - a high-priority Healthy People 2030 objective selected to drive action toward improving health and well-being - for the second straight decade. With the continued promotion of multidirectional integration of oral health and overall health across multiple disciplines, many - including policymakers, oral health professionals, other healthcare professionals, dental and public health organizations, and community advocates - have a role in affecting the outcome of the Healthy People 2030 oral health objectives.

Evaluation of the Oral Health Conditions and Oral Health-Related Quality of Life in a Community-Dwellers Population Aged ≥ 45 Years in the Canton of Bern: A Preliminary Pilot Study.

To evaluate oral health conditions and oral health-related quality of life in community-dwellers aged ≥ 45 years in the Canton of Bern, Switzerland. One hundred subjects (63% males; mean age: 73 years), selected randomly using a cluster procedure within the Canton of Bern, underwent a clinical oral examination after completing questionnaires on socio-economic level, medical history, oral health behaviour, and Geriatric Oral Health Assessment Index (GOHAI). Descriptive analyses and multinomial regression models were applied to investigate the association between oral health diseases (dental caries and periodontitis) and specific participant characteristics. The mean number of decayed, missing, and filled teeth (DMFT) was 0.30, 4.20, and 8.75, respectively; the mean DMFT score = 13.35. Dental caries prevalence (ICDAS > 0) was 15% and periodontitis prevalence was 46%. Logistic regression models revealed that living in an urban area was associated with lower odds (OR 0.03, 95%CI 0.00-0.36) of having periodontal disease. Male gender was associated with lower odds for dental caries (OR 0.31, 95%CI 0.09-1.01) and total lack of professional tooth cleaning was associated with higher odds for dental caries (OR 41.99, 95%CI 0.01-0.38). Ordinal logistic regression revealed that both the presence of dental caries (RR 12.80, 95%CI 1.47-111.20) and periodontal disease (RR 6.91, 95%CI 1.16-84.00) were statistically significantly associated with rheumatoid arthritis. Within the study limitations, untreated dental caries and periodontal disease are prevalent in the Swiss population, despite the high level of self-performed oral hygiene and access to the dental care system.

Oral disorders among older Chileans: prevalence, incidence, and years lived with disability

Objective: Prior epidemiological surveys revealed that Chile experiences a high burden of oral diseases. However, no prior study has reported estimates of untreated dental caries, periodontitis, and edentulism over a three-decade period for the country. Using estimates of the Global Burden of Diseases Study (GBD) 2019, the objective of this study is to report the trends of prevalence, incidence, and years-lived with disability (YLDs) due to untreated dental caries, periodontitis, and edentulism in Chilean older adults between 1990 and 2019. Methods: Estimates of prevalence, incidence, and YLDs due to dental caries, periodontitis, and edentulism were produced for Chile, by age and sex, between 1990 and 2019, using Dismod-MR 2.1. Trends of oral disorders were analyzed using generalized linear regression models applying the Prais-Winsten method. Results: Untreated dental caries and periodontal disease showed an increase in prevalence and YLDs, whereas edentulism prevalence, incidence, and YLDs decreased in all older adults age groups. The incidence of dental caries decreased in the younger groups and increased in the older age groups; while the incidence of periodontal disease increased in the younger and decreased in the older age groups. Conclusions: Overall, the burden of oral diseases in older Chileans increased between 1990 and 2019. This was particularly relevant for untreated caries and periodontal disease. Future estimates of oral diseases burden in Chile require concerted efforts to produce national health surveys that incorporate oral diseases metrics. These estimates are essential to inform policy formulation, implementation and evaluation.

Dentists’ Knowledge, Attitude and Practices Regarding Dental Care for Children with Special Healthcare Needs in Saudi Arabia

Introduction: Despite advancements in dentistry, children with special needs continue to have poor oral health, with a higher prevalence of untreated dental caries and periodontal disease. Many treating dentists and the parents of these children encounter difficulty managing these children, and the quality of their oral health will be determined by this. Hence, identifying and overcoming the barriers of managing children with Special Healthcare Needs (SHCN) can be assessed as important step in addressing their treatment needs. Aim: The study investigated the perceptions of general and Paediatric dentists in Saudi Arabia, regarding the treatment needs and challenges posed while providing dental care to children with special needs. Materials and Methods: A cross-sectional, questionnairebased study was conducted among 447 general dentists and 76 Paediatric dentists in Saudi Arabia during five-month period between 15th October 2021 to 15th March 2022. A prevalidated questionnaire consisting of 18 close-ended questions assessing the knowledge, attitude, and practices of the dentists related to children with SHCN was emailed to each dentist. The data was analysed using the IBM Statistical Package for Social Sciences (SPSS) 22.0 version (IBM, Chicago, USA). The threshold for significance was established at 5%. The significance of study variables was determined utilising Chi-square test. Results: Most Paediatric dentists and general dentists were of the opinion that mental/behavioural/cognitive disability was the most difficult to manage (p<0.001). Out of the total, 66.2% of the dentists were aware of the dental home concept in managing children with SHCN. The knowledge related factors that were significantly associated, included type of impairment most difficult to manage (p<0.001) and awareness of the dental home concept (p<0.001). Regarding attitude, both general and Paediatric dentists agreed that providing oral care is as important as providing medical care and that they were confident in treating these children (p<0.001). The practices related factors that were significantly associated included supporting staff's comfort in treating these children (p=0.004), accessibility of clinic (p<0.001), the availability of equipment to treat (p=0.02), and the techniques most commonly used for managing the behaviour of SHCN children (p<0.001). Conclusion: The two most significant challenges to a SHCN child receiving dental care were a lack of access to a dentist who can provide oral care and limitations in the child’s cooperation during the procedure. The unmet treatment needs of these children can be considerably reduced by improving parental awareness, facilitating approaches that enhance patient compliance, and providing convenient access to dental care.

Hemisection with crown splinter in perforation mesial canal wall first molar mandible: a case report

Background: Untreated progressive inflammatory periodontal disease can affect attachment loss until bifurcation or trifurcation of multirooted teeth. Hemisection in multirooted is removal of compromised root preserve the good one then restorative coronal part with a fixed prosthesis. It is the treatment option for preserving the remaining part of healthy root who having sound periodontium. The study aimed to describe a case of a hemisection is presented for a tooth where only the mesial root of a mandibular molar was affected.Case presentation: a 22 years old female comes to RSGM Prof. Soedomo with moderate pain and gum swelling. Perforation in mesial root canal wall in the objective examination. In radiograph, there were radiolucent in mesial root, bifurcation and fracture instrument left in mesial apical root canal. The conditions that can't approach in non-surgical treatment such as fracture instrument, severe vertical bone loss, caries, internal or external resorption in furcation or one root, and furcation lesion, can be treated with surgical approach hemisection as alternative before axtraction teeth. Hemisection treatment includes root canal treatment of the remaining roots, intracanal retention with fiber post then restorative the coronal part use restorative material and splinting with the adjacent tooth to decrease the risk of displacement. Fixed prosthodontic prosthesis to maintain the occlusal balance.Conclusion: hemisection is a feasible treatment option because more practical and conservative for periodontal-endodontic lesions rather than extraction teeth.

The Reasons for Primary Tooth Extraction in Primary School-age Children in RSGM Baiturrahmah

Background: Tooth extraction is an important measure in determining oral health status because it generally reflects untreated periodontal tissue disease and caries. Tooth extraction can also be used as a measure of people's knowledge and motivation in maintaining their teeth. The higher the revocation rate, the lower the community's knowledge and motivation. Purpose: The aim of this study is to see the main reasons for tooth extraction in children who are in the pedodontics of the RSGM Baiturrahmah. Material and Methods: This type of research is quantitative with analytic descriptive methods. The target population of this study were students of coass Lab Paedodonti RSGM Baiturrahmah in October-December 2019, with a sample of 76 people. The research was conducted at the Paedodonti Lab RSGM Baiturrahmah in October-December 2019 using a questionnaire. Data analysis using SPSS program with chi square analysis. Results: The distribution of reasons for deciduous tooth extraction is presented, it is found that most of the reasons for extracting deciduous teeth in primary school children are physiological mobility, as many as 53 people (69.7%). In addition, there were 19 people (25%) of the reasons for removal because of excessive retention of 1 person (1.3%), and because of the request of patients / parents as many as 3 people (3.9%). Conclusion: The main reason for the extraction of deciduous teeth in elementary school children at the Lab Paedodonti RSGM Baiturrahmah, was physiological mobility, with the teeth that were often extracted were the mandibular incisors in the 7 year age group.

REGENERATION WITH AUTOGENOUS BONE GRAFT IN ANGULAR DEFECT

Untreated periodontal disease destroys the attachment apparatus and tooth supporting tissues, resulting in tooth loss. Periodontal treatment aims to stop the progression of periodontal disease while also regenerating periodontal tissues that have been lost due to periodontal disease. Periodontal regeneration appears to occur after treatment with autogenous bone grafts, according to data from clinical and histological research. Because it contains cells that engage in osteogenesis, autogenous bone possesses osteogenic potential. Autografts are also bioabsorbable (they are eventually replaced by the patient's own bone), nonallergenic (they produce little tissue reaction without an immunological reaction), simple to utilize, and inexpensive. Around autogenous bone graft particles, rapid revascularization occurs, and the graft can release growth and differentiation agents. When compared to open flap debridement, autogenous cancellous bone from the jaw is not suited for repairing intrabony periodontal abnormalities. An autogenous cortical bone (ACB) graft derived from the surgical site close to the intraosseous defect is beneficial because it eliminates the requirement for a second surgical site for repairing intraosseous periodontal deficiencies. For tissue regeneration, many therapeutic techniques are employed. Various grafting materials, such as autografts, allografts, xenografts, and alloplasts, have been used and therapeutically utilized among them. A case report on periodontal regeneration employing autogenous bone in the treatment of a periodontal intra-bony defect in the lower left molars is presented in this study.

Infrastructure and management quality of private dental practices in Khartoum, Sudan. The dental practitioners' perspective.

Background: The oral health status of the Sudanese population shows a high prevalence of untreated carious lesions, periodontal disease, and lifestyle-related risk factors. With the deteriorated and limited public dental services, the private dental sector became the main dental care provider in Khartoum. Evaluation of the private dental sector and discovering the challenges that facing the dentists are necessary to correct the defects and assure an optimal service quality. Methods: A cross-sectional questionnaire-based study was performed on a sample of 190 practicing dentists in Khartoum. The questionnaire was developed to gathers information about the dentist’s general information that reflects their professional experience in private clinics and toward some common issues related to private clinics. Their perspective toward their clinic’s readiness and their basic clinical dental skills were assessed using a satisfaction rating questions. Data were analyzed using SPSS 22.0 and Microsoft Office Excel 2010 software. Results: From a total of 136 clinics, 190 dentists participated and approached to fill the questionnaire (71.1% females and 28.9% males). The overall average of the clinics' settings assessment is as follows; 3.7% ‘poor’, 18.6% ‘fair’, 50.3% ‘good’, and 27.3% ‘excellent’ while clinics materials and equipment average scores were 6.3% ‘poor’, 19.8% ‘fair’, 48.1% ‘good’, and 25.7% ‘excellent’. The average results of dentists’ skills evaluation of all disciplines were; ‘excellent’ (20.4%), ‘good’ (35.2%), ‘fair’ (13.5%), ‘poor’ (4.1%), and ‘unfamiliar’ (26.8%). The most common reasons that render dentists to quit a good dental clinic were low payment compared with the clinic’s income and transportation difficulties. Participating dentists considered that insufficient training and poor materials and instrument quality as the main factors of suboptimum treatment results. 57% of the participants agreed that dental insurance improved the quality of dental service. Conclusions: As a whole, the clinic settings and equipment which are evaluated as ‘good’ and ‘excellent’ are more than those evaluated as ‘poor’ and ‘fair’. The participants reported more proportion of ‘excellent’ to ‘good’ results in providing simple and common procedures. Many dentists were ‘unfamiliar’ with advanced or expensive procedures. From the practitioner's perspective; insufficient training and poor materials and instrument quality are the main reasons for suboptimal treatment results. Low payment compared with the clinic’s income and transportation difficulties were the major factors that affect the dentists' job continuation in particular private practice. 43.2% of the participants did not agree that dental insurance improved the quality of dental service. Keywords: Private Practices, Dental services, Quality of materials and instruments, Treatment Quality, Dental insurance, Sudan.

Oral Health Status of the Refugee Population in Utah

A refugee is a person that “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his or her nationality and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country” [1]. Among refugees, one of the most common health problems reported by US organizations after initial screening is oral healthrelated [2]. Previous research reported high levels of untreated caries, periodontal disease, orofacial disease and disabilities among refugees [2-4].

Attitude of Physicians towards Periodontal Disease and Diabetes Mellitus Screening in Dental Clinics in Thailand.

Background: Diabetes mellitus (DM) is one of the top causes of death in many places of the world. Diagnosing DM in the early stage is necessary to avoid severe cases and death. Objectives: To evaluate the knowledge of association between DM and periodontal disease (PD) among Thai physicians and assess their attitudes towards DM screening in dental clinics in Thailand. Methods: Online survey of currently practicing physicians in Thailand was conducted on voluntary basis using the newly developed questionnaire. Result: We received 403 responses that are statistically sufficient to represent the entire population of currently practicing physicians in Thailand. A total of 97.3% of all responses indicate that Thai physicians have knowledge about the association between DM and PD. More than 90% know that DM has an effect on PD; however, 70% know about the effect of untreated PD in DM patients. Most of physicians think that DM screening in dental clinics is important (79.1%) and are ready to accept referred cases for definite DM diagnosis from a dentist (84.1%). The concerned issues among the participants were the accuracy of the test results in DM screening (73%) and ability of a dentist to perform the screening (71.5%). Conclusions: The majority of participating physicians have adequate knowledge about the bidirectional relationship between DM and PD. They have a positive attitude towards DM screening in dental setting. The collaboration between physicians and dental professionals should be established to reduce the number of undiagnosed DM patients and enhance the medical care of DM patients.

Effects of non-surgical periodontal therapy on inflammatory markers of psoriasis: A randomized controlled trial.

The purpose of this randomized controlled clinical study was to evaluate the effect of non-surgical mechanical periodontal therapy on the inflammatory status and severity of psoriasis in subjects with psoriasis. The study population consisted of 92 periodontitis patients with psoriasis vulgaris suffering from an untreated periodontal disease. Two randomized groups were formed from these patients: immediate periodontal therapy (test group, n=46) and delayed periodontal therapy (control group, n=46). Periodontal clinical measures, on salivary interleukin 2, interleukin 6 and secretory immunoglobulin A levels and the Psoriasis Area and Severity Index (PASI) scores were evaluated at baseline and on the 8th week in control and test groups. Eight weeks after completion of non-surgical periodontal therapy (test group) or initial examination (control group), a significant decrease was observed in interleukin 2, interleukin 6 level and in PASI score, whereas a significant increase was observed in secretory immunoglobulin A levels in the test group (p<.05). Within the limits of this study, the results suggest that effective periodontal therapy improves the psoriasis condition in patients afflicted by both diseases.

Long-term regular dental attendance and tooth retention among British adults: A cross-sectional analysis of national survey data.

To explore the association between long-term pattern of dental attendance and tooth retention among British adults. This study analysed data from 2970 dentate adults who participated in the Adult Dental Health Survey. Data were collected through home interviews and clinical examinations. Individuals were categorized into four trajectories according to their responses to three questions on dental attendance over their life span. The four trajectories were always, current, former and never regular attenders. Tooth retention was measured as the number of natural teeth retained and having a functional dentition (20 or more teeth). Associations were examined in regression models adjusted for demographic (sex, age and country of residence), socioeconomic (education, equivalized household income and social class) and clinical factors (untreated caries and periodontal disease). Never and former regular attenders had fewer teeth retained (rate ratios with 95% confidence interval: 0.93 [0.89-0.97] and 0.97 [0.96-0.99], respectively) and lower odds of having functional dentition (odds ratios with 95% CI: 0.36 [0.22-0.60] and 0.53 [0.34-0.83], respectively) than always regular attenders after adjusting for demographic, socioeconomic and clinical characteristics. However, no differences in number of teeth retained or having a functional dentition were found between always and current regular attenders. Long-term regular dental attendance was associated with greater tooth retention. Never and former regular attenders had fewer teeth retained than always regular attenders. No difference in tooth retention was found between always and current regular attenders.

History of periodontal treatment and risk for intrauterine growth restriction (IUGR)

BackgroundTo explore the hypothesis that maternal periodontitis is associated with increased risk for Intrauterine Growth Restriction (IUGR), we examined the risk of IUGR in relation to periodontal treatment before, during and after pregnancy.MethodsWe conducted a retrospective cohort analysis of insurance claims data from 2009 to 2012 for women who delivered a singleton live birth (n = 32,168). IUGR was examined as a function of type and timing of dental treatment, adjusting for potential confounders in logistic regression. Sensitivity analysis evaluated the potential effects of unmeasured confounding.ResultsWomen who received periodontal treatment after delivery, indicating the presence of untreated periodontal disease during pregnancy, had significantly higher odds of IUGR compared to women who received no periodontal treatment (adjusted OR 1.5, 95% CI 1.2, 1.8).ConclusionsPeriodontal treatment provided in the immediate postpartum period, a proxy for periodontitis during gestation, was associated with increased risk of IUGR.

Moving from advocacy to activism? The fourth WHO global forum on human resources for health and implications for dentistry

As we debate shaping the future oral health workforce within the UK, to meet the needs of current and future populations, it is helpful to take an international perspective on this very important issue. Globally, there is a strong recognition that human resources for health (HRH) are fundamentally important to deliver effective care, accessible to all people. This paper reviews the outcome of the fourth global forum held by the World Health Organisation (WHO) in Dublin which highlighted the urgency for action. The main objectives of the forum were to advance the implementation of (i) the WHO Global Strategy on HRH 2030 and (ii) the United Nations High-Level Commission's Health Employment and Economic Growth recommendations. From an oral health perspective, the global burden of oral disease remains huge with untreated dental caries, periodontal disease and tooth loss ranking among the most prevalent conditions worldwide. Major considerations are how dental education, practice delivery and/or oral health systems as a whole could and should innovate to accommodate the growing needs of the population. As dental professionals, it also becomes necessary for us to engage and play a proactive role in this change process. Due to growing differences between population needs and available services, it is necessary for oral health personnel to work more closely with the broader health workforce so as to identify solutions that are in the best interests of the patients and populations at large.

Nutritional and dental issues in patients with intellectual and developmental disabilities

BackgroundPeople with intellectual and developmental disabilities are among the most disadvantaged and underserved groups of dental patients. Considerable health care disparities for this population have been identified, particularly oral and dental health as well as access to dental care services. People with Down syndrome and cerebral palsy have a variety of nutritional and dental considerations. ConclusionsThese people have a higher prevalence of untreated caries and periodontal disease than the general population and may have higher rates of obesity, edentulism, and chronic oral and systemic diseases. Diet choices may affect the oral health and may play an important role in the systemic health of these people. Suggestions to improve and affect dietary intake are provided. Clinical ImplicationsHealth issues within this population require a holistic approach to care. Concerns about oral health and diet must be addressed to support optimal health.

Is gingival bleeding a symptom of type 2 and 3 von Willebrand disease?

BackgroundVon Willebrand disease (VWD) is the most common inherent bleeding disorder. Gingival bleeding is a frequently reported symptom of VWD. However, gingival bleeding is also a leading symptom of plaque-induced gingivitis and untreated periodontal disease. In type 1 VWD gingival bleeding was not increased compared to controls. Thus, this study evaluated whether type 2 and 3 VWD determines an increased susceptibility to gingival bleeding in response to the oral biofilm.MethodsTwenty-four cases and 24 controls matched for age, sex, periodontal diagnosis, number of teeth and smoking were examined hematologically (VWF antigen, VWF activity, factor VIII activity) and periodontally (Gingival Bleeding Index [GBI]), bleeding on probing [BOP], Plaque Control Record [PCR], periodontal inflamed surface area [PISA], vertical probing attachment level).ResultsBOP (VWD: 14.5±10.1%; controls: 12.3±5.3%; p = 0.542) and GBI (VWD: 10.5±9.9%; controls: 8.8±4.8%; p = 0.852) were similar for VWD and controls. Multiple regressions identified female sex, HbA1c, PCR and PISA to be associated with BOP. HbA1c and PCR were associated with GBI. Number of remaining teeth was negatively correlated with BOP and GBI.ConclusionType 2 and 3 VWD are not associated with a more pronounced inflammatory response to the oral biofilm in terms of BOP and GBI.

Natural history of periodontitis: Disease progression and tooth loss over 40years.

To assess long-term attachment and periodontitis-related tooth loss (PTL) in untreated periodontal disease over 40years. Data originated from the natural history of periodontitis study in Sri Lankan tea labourers first examined in 1970. In 2010, 75 subjects (15.6%) of the original cohort were re-examined. PTL over 40years varied between 0 and 28 teeth (mean 13.1). Four subjects presented with no PTL, while 12 were edentulous. Logistic regression revealed attachment loss as a statistically significant covariate for PTL (p<.004). Markov chain analysis showed that smoking and calculus were associated with disease initiation and that calculus, plaque, and gingivitis were associated with loss of attachment and progression to advanced disease. Mean attachment loss <1.81mm at the age of 30 yielded highest sensitivity and specificity (0.71) to allocate subjects into a cohort with a dentition of at least 20 teeth at 60years of age. These results highlight the importance of treating early periodontitis along with smoking cessation, in those under 30years of age. They further show that calculus removal, plaque control, and the control of gingivitis are essential in preventing disease progression, further loss of attachment and ultimately tooth loss.

Impact of Docosahexaenoic Acid Therapy on Subgingival Plaque Microbiota.

Oral docosahexaenoic acid (DHA) + aspirin therapy has been shown to reduce periodontal probing depth (PD) and local inflammatory mediators in gingival crevicular fluid (GCF) among patients with untreated chronic periodontal disease. Whether DHA + aspirin therapy influences specific bacterial burden in this setting is unknown. Thus, the aim of this study is to evaluate the impact of DHA with low-dose aspirin therapy on periodontal bacterial profile in patients with periodontitis. Fifty-five adults with moderate-to-severe periodontitis were enrolled in a randomized, 3-month double-masked, placebo-controlled trial of daily 2 g DHA or placebo capsules enriched with 81 mg aspirin; 46 enrollees completed the trial. In addition to clinical measurements and GCF sampling, subgingival plaque samples were collected from four posterior sites in all participants and analyzed by the checkerboard DNA-DNA hybridization technique. Presence of 40 periodontal bacterial species at baseline and 3 months was semiquantitatively estimated. Despite broad improvements in clinical parameters, total bacteria and individual species counts in dental plaque did not differ significantly between baseline and 3 months in either group (P >0.1 for all). A modest effect of DHA + aspirin on Porphyromonas gingivalis counts was associated with 14% (95% confidence interval: 3% to 35%) of the observed benefit of DHA on PD. DHA + aspirin had no significant effect on individual plaque bacterial counts in unadjusted models or those adjusted for age, sex, and race (P >0.1 for all). This pilot randomized, controlled trial suggests that DHA + aspirin therapy improves periodontitis largely by modulating host inflammatory response. Changes in individual species levels in subgingival plaque microbiota were not detectable; however, a small portion of the benefit appears to stem from changes in P. gingivalis levels in the DHA + aspirin treatment group. Whether this change in P. gingivalis levels leads to biofilm alteration with reversal of dysbiosis requires further longitudinal and more specific investigations.