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Journal of Clinical Periodontology Aug 2008Currently, a large variety of classifications is used for periodontitis as a risk factor for other diseases. None of these classifications quantifies the amount of...
BACKGROUND
Currently, a large variety of classifications is used for periodontitis as a risk factor for other diseases. None of these classifications quantifies the amount of inflamed periodontal tissue, while this information is needed to assess the inflammatory burden posed by periodontitis.
AIM
To develop a classification of periodontitis that quantifies the amount of inflamed periodontal tissue, which can be easily and broadly applied.
MATERIAL AND METHODS
A literature search was conducted to look for a classification of periodontitis that quantified the amount of inflamed periodontal tissue. A classification that quantified the root surface area affected by attachment loss was found. This classification did not quantify the surface area of inflamed periodontal tissue, however. Therefore, an Excel spreadsheet was developed in which the periodontal inflamed surface area (PISA) is calculated using clinical Attachment Level (CAL), recessions and bleeding on probing (BOP).
RESULTS
The PISA reflects the surface area of bleeding pocket epithelium in square millimetres. The surface area of bleeding pocket epithelium quantifies the amount of inflamed periodontal tissue. A freely downloadable spreadsheet is available to calculate the PISA.
CONCLUSION
PISA quantifies the inflammatory burden posed by periodontitis and can be easily and broadly applied.
Topics: Epithelial Attachment; Gingival Hemorrhage; Gingival Recession; Humans; Inflammation; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Periodontium; Tooth Root
PubMed: 18564145
DOI: 10.1111/j.1600-051X.2008.01249.x -
Journal of Clinical Periodontology Jul 2018The goal of this study was to evaluate if dental pulp stem cells (DPSCs) delivered into intrabony defects in a collagen scaffold would enhance the clinical and... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
The goal of this study was to evaluate if dental pulp stem cells (DPSCs) delivered into intrabony defects in a collagen scaffold would enhance the clinical and radiographic parameters of periodontal regeneration.
MATERIALS AND METHODS
In this randomized controlled trial, 29 chronic periodontitis patients presenting one deep intrabony defect and requiring extraction of one vital tooth were consecutively enrolled. Defects were randomly assigned to test or control treatments which both consisted of the use of minimally invasive surgical technique. The dental pulp of the extracted tooth was mechanically dissociated to obtain micrografts rich in autologous DPSCs. Test sites (n = 15) were filled with micrografts seeded onto collagen sponge, whereas control sites (n = 14) with collagen sponge alone. Clinical and radiographic parameters were recorded at baseline, 6 and 12 months postoperatively.
RESULTS
Test sites exhibited significantly more probing depth (PD) reduction (4.9 mm versus 3.4 mm), clinical attachment level (CAL) gain (4.5 versus 2.9 mm) and bone defect fill (3.9 versus 1.6 mm) than controls. Moreover, residual PD < 5 mm (93% versus 50%) and CAL gain ≥4 mm (73% versus 29%) were significantly more frequent in the test group.
CONCLUSIONS
Application of DPSCs significantly improved clinical parameters of periodontal regeneration 1 year after treatment.
Topics: Alveolar Bone Loss; Dental Pulp; Follow-Up Studies; Guided Tissue Regeneration, Periodontal; Humans; Periodontal Attachment Loss; Periodontal Pocket; Regeneration; Stem Cells; Treatment Outcome
PubMed: 29779220
DOI: 10.1111/jcpe.12931 -
Journal of Periodontology Dec 2012This report adds a new definition for mild periodontitis that allows for better descriptions of the overall prevalence of periodontitis in populations. In 2007, the...
BACKGROUND
This report adds a new definition for mild periodontitis that allows for better descriptions of the overall prevalence of periodontitis in populations. In 2007, the Centers for Disease Control and Prevention in partnership with the American Academy of Periodontology developed and reported standard case definitions for surveillance of moderate and severe periodontitis based on measurements of probing depth (PD) and clinical attachment loss (AL) at interproximal sites. However, combined cases of moderate and severe periodontitis are insufficient to determine the total prevalence of periodontitis in populations.
METHODS
The authors proposed a definition for mild periodontitis as ≥ 2 interproximal sites with AL ≥ 3 mm and ≥ 2 interproximal sites with PD ≥ 4 mm (not on the same tooth) or one site with PD ≥ 5 mm . The effect of the proposed definition on the total burden of periodontitis was assessed in a convenience sample of 456 adults ≥ 35 years old and compared with other previously reported definitions for similar categories of periodontitis.
RESULTS
Addition of mild periodontitis increases the total prevalence of periodontitis by ≈31% in this sample when compared with the prevalence of severe and moderate disease.
CONCLUSION
Total periodontitis using the case definitions in this study should be based on the sum of mild, moderate, and severe periodontitis.
Topics: Adult; Aged; Aged, 80 and over; Europe; Female; Humans; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Population Surveillance; Prevalence; Terminology as Topic; United States
PubMed: 22420873
DOI: 10.1902/jop.2012.110664 -
Frontiers in Immunology 2021The subgingival biofilm attached to tooth surfaces triggers and maintains periodontitis. Previously, late-onset periodontitis has been considered a consequence of... (Review)
Review
The subgingival biofilm attached to tooth surfaces triggers and maintains periodontitis. Previously, late-onset periodontitis has been considered a consequence of dysbiosis and a resultant polymicrobial disruption of host homeostasis. However, a multitude of studies did not show "healthy" oral microbiota pattern, but a high diversity depending on culture, diets, regional differences, age, social state etc. These findings relativise the aetiological role of the dysbiosis in periodontitis. Furthermore, many late-onset periodontitis traits cannot be explained by dysbiosis; e.g. age-relatedness, attenuation by anti-ageing therapy, neutrophil hyper-responsiveness, and microbiota shifting by dysregulated immunity, yet point to the crucial role of dysregulated immunity and neutrophils in particular. Furthermore, patients with neutropenia and neutrophil defects inevitably develop early-onset periodontitis. Intra-gingivally injecting lipopolysaccharide (LPS) alone causes an exaggerated neutrophil response sufficient to precipitate experimental periodontitis. Vice versa to the surplus of LPS, the increased neutrophil responsiveness characteristic for late-onset periodontitis can effectuate gingiva damage likewise. The exaggerated neutrophil extracellular trap (NET) response in late-onset periodontitis is blameable for damage of gingival barrier, its penetration by bacteria and pathogen-associated molecular patterns (PAMPs) as well as stimulation of Th17 cells, resulting in further neutrophil activation. This identifies the dysregulated immunity as the main contributor to periodontal disease.
Topics: Animals; Bacteria; Biofilms; Dysbiosis; Extracellular Traps; Gingiva; Humans; Inflammation Mediators; Neutrophil Activation; Neutrophils; Pathogen-Associated Molecular Pattern Molecules; Periodontal Pocket; Periodontitis; Signal Transduction
PubMed: 34899756
DOI: 10.3389/fimmu.2021.788766 -
Medical Hypotheses Jan 2021COVID-19 is the emerging health emergency ruining the well being of individuals and devastating the global economies. Sustained research focusing on the virus has been...
COVID-19 is the emerging health emergency ruining the well being of individuals and devastating the global economies. Sustained research focusing on the virus has been on throughout the world. However, no definitive remedies have yet been derived in the containment of the virus. Steady knowledge on the pathogenesis of the virus has revealed certain consistent features specific to the disease which includes massive destruction of the lung due to the presence of excessive angiotensin-converting enzyme receptors (ACE2) which are essential for the viral entry inside the host. Once, access is gained multiplication occurs resulting in suppressing the immune response of the body against the virus. Henceforth, the equilibrium of the host is disrupted leading to manifestation of the disease. The Periodontal pocket also presents with pathology very much similar to COVID-19 and a possibility of dual role can be thought of pertaining to aspects of Periodontal Medicine.
Topics: Angiotensin-Converting Enzyme 2; COVID-19; Cytokines; Host Microbial Interactions; Humans; Models, Dental; Models, Immunological; Periodontal Pocket; Receptors, Virus; Risk Factors; SARS-CoV-2
PubMed: 33183854
DOI: 10.1016/j.mehy.2020.110355 -
BMC Oral Health Dec 2014Relevant benefits of adjunctive medication of antibiotica after conventional root surface debridement in terms of enhanced pocket depth (PD) reduction have been shown.... (Review)
Review
BACKGROUND
Relevant benefits of adjunctive medication of antibiotica after conventional root surface debridement in terms of enhanced pocket depth (PD) reduction have been shown. However, means and standard deviations of enhanced reductions are difficult to translate into clinical relevant treatment outcomes such as pocket resolution or avoidance of additional surgical interventions. Accordingly, the aim of this systematic review was to calculate odds ratios for relevant cut-off values of PD after mechanical periodontal treatment with and without antibiotics, specifically the combination of amoxicilline and metronidazol, from published studies. As clinical relevant cut-off values "pocket closure" for PD ≤ 3mm and "avoidance of surgical intervention" for PD ≤ 5 mm were determined.
METHODS
The databases PubMed, Embase and Central were searched for randomized clinical studies assessing the beneficial effect of the combination of amoxicillin and metronidazole after non-surgical mechanical debridement. Titles, abstracts and finally full texts were scrutinized for possible inclusion by two independent investigators. Quality and heterogeneity of the studies were assessed and the study designs were examined. From published means and standard deviations for PD after therapy, odds ratios for the clinically relevant cut-off values were calculated using a specific statistical approach.
RESULTS
Meta-analyses were performed for the time points 3 and 6 month after mechanical therapy. Generally, a pronounced chance for pocket closure from 3 to 6 months of healing was shown. The administration of antibiotics resulted in a 3.55 and 4.43 fold higher probability of pocket closure after 3 and 6 months as compared to mechanical therapy alone. However, as the estimated risk for residual pockets > 5 mm was 0 for both groups, no odds ratio could be calculated for persistent needs for surgery. Generally, studies showed a moderate to high quality and large heterogeneity regarding treatment protocol, dose of antibiotic medication and maintenance.
CONCLUSION
With the performed statistical approach, a clear benefit in terms of an enhanced chance for pocket closure by co-administration of the combination of amoxicillin and metronidazole as an adjunct to non-surgical mechanical periodontal therapy has been shown. However, data calculation failed to show a benefit regarding the possible avoidance of surgical interventions.
Topics: Aggressive Periodontitis; Amoxicillin; Anti-Bacterial Agents; Chronic Periodontitis; Combined Modality Therapy; Dental Scaling; Drug Combinations; Humans; Metronidazole; Periodontal Pocket; Root Planing
PubMed: 25529408
DOI: 10.1186/1472-6831-14-159 -
Swiss Dental Journal Feb 2018
Review
Topics: Decision Trees; Dental Prophylaxis; Follow-Up Studies; Long-Term Care; Periodontal Pocket; Periodontitis; Risk Factors
PubMed: 29533057
DOI: No ID Found -
Frontiers of Oral Biology 2012Periodontitis is an inflammatory disease of the oral cavity initiated by a microbial biofilm (or 'dental plaque'). Subgingival biofilms in periodontal pockets are not... (Review)
Review
Periodontitis is an inflammatory disease of the oral cavity initiated by a microbial biofilm (or 'dental plaque'). Subgingival biofilms in periodontal pockets are not easily analyzed without the loss of structural integrity. These subgingival plaques are structured communities of microorganisms with great phylogenetic diversity embedded in a self-produced extracellular polymeric matrix. For almost three decades, knowledge of the structure of plaque located below the gingival margin has been limited to landmark studies from the 1970s that were unaware of the breadth of microbial diversity we appreciate now. Only recently has technical progress - combining histology, confocal scanning fluorescent microscopy and fluorescent in situ hybridization to localize the most abundant species from different phyla and species associated with periodontitis - provided new insights into the architecture of subgingival biofilms. This review focuses on the structure and composition of subgingival biofilms and discusses current knowledge on the nature of the extracellular matrix. We describe further structural aspects of 'subgingival' biofilms produced in vitro that are gaining considerable interest as we search for models to investigate biofilm development, resistance to antibiotics, extracellular polymeric matrix composition and function, and reciprocal host-cell-to-biofilm interactions.
Topics: Bacteria; Biodiversity; Biofilms; DNA, Bacterial; Dental Plaque; Extracellular Matrix; Humans; In Situ Hybridization, Fluorescence; Metabolome; Microbial Consortia; Microscopy, Confocal; Periodontal Pocket; Periodontitis; RNA, Ribosomal, 16S; Signal Transduction; Tooth Root
PubMed: 22142954
DOI: 10.1159/000329667 -
Journal of Clinical Periodontology Jul 2020Position paper on endpoints of active periodontal therapy for designing treatment guidelines. The question was as follows: How are, for an individual patient, commonly...
AIM
Position paper on endpoints of active periodontal therapy for designing treatment guidelines. The question was as follows: How are, for an individual patient, commonly applied periodontal probing measures-recorded after active periodontal therapy-related to (a) stability of clinical attachment level, (b) tooth survival, (c) need for re-treatment or (d) oral health-related quality of life.
METHODS
A literature search was conducted in Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily <1946 to 07 June 2019>.
RESULTS
A total of 94 papers were retrieved. From the literature search, it was found that periodontitis patients with a low proportion of deep residual pockets after active periodontal therapy are more likely to have stability of clinical attachment level over a follow-up time of ≥1 year. Other supporting literature confirms this finding and additionally reports, at the patient level, that probing pocket depths ≥6 mm and bleeding on probing scores ≥30% are risks for tooth loss. There is lack of evidence that periodontal probing measures after completion of active periodontal treatment are tangible to the patient.
CONCLUSIONS
Based on literature and biological plausibility, it is reasonable to state that periodontitis patients with a low proportion of residual periodontal pockets and little inflammation are more likely to have stability of clinical attachment levels and less tooth loss over time. Guidelines for periodontal therapy should take into consideration (a) long-term tangible patient outcomes, (b) that shallow pockets (≤4 mm) without bleeding on probing in patients with <30% bleeding sites are the best guarantee for the patient for stability of his/her periodontal attachment, (c) patient heterogeneity and patient changes in immune response over time, and (d) that treatment strategies include lifestyle changes of the patient. Long-term large population-based and practice-based studies on the efficacy of periodontal therapies including both clinical and patient-reported outcomes (PROs) need to be initiated, which include the understanding that periodontitis is a complex disease with variation of inflammatory responses due to environment, (epi)genetics, lifestyle and ageing. Involving people living with periodontitis as co-researchers in the design of these studies would also help to improve their relevance.
Topics: Female; Humans; Male; Periodontal Pocket; Periodontitis; Quality of Life; Tooth Loss
PubMed: 31912527
DOI: 10.1111/jcpe.13253 -
Nigerian Journal of Clinical Practice Sep 2023Neutrophils continuously migrate into the oral cavity from various sources like gingival crevicular fluid and saliva both in health and in inflammation. The migration of...
BACKGROUND
Neutrophils continuously migrate into the oral cavity from various sources like gingival crevicular fluid and saliva both in health and in inflammation. The migration of the neutrophils into the various tissues and into the oral cavity occurs when the host microbial interplay tips the balance favoring the initiation of the inflammatory and immune reactions which depending on the amount of the microbial load results in the development of acute and chronic infections in the susceptible host.
AIM
The present study was designed to quantify and compare the oral salivary neutrophil levels in patients with gingivitis and chronic and aggressive periodontitis as well as in healthy controls, before and after scaling and root planing (SRP) and to compare the difference within the selected study groups.
MATERIALS AND METHODS
Forty subjects were classified into four groups, that is, healthy controls, gingivitis, and chronic and aggressive periodontitis. Oral rinse samples were collected using Hank's balanced salt solution from each patient before and after phase I periodontal therapy. Cells in the rinse samples were stained with Acridine orange, and neutrophil counts were carried out using a fluorescence microscope and a hemocytometer.
RESULTS
Baseline oral salivary neutrophil levels were maximum in the chronic periodontitis group followed by the aggressive group and then the gingivitis group. Oral salivary neutrophil levels also positively correlated to probing pocket depth, plaque index, calculus index, and gingival index in all four study groups. Maximum reduction in the oral salivary neutrophil levels after phase I periodontal therapy was seen in the gingivitis group.
CONCLUSION
From our study, we conclude that the oral salivary neutrophil levels decreased significantly after SRP. Estimation of changes in the oral salivary neutrophil levels has the potential to aid in monitoring treatment outcomes. Thus, it suggests that it could be used as a simple, noninvasive laboratory technique to monitor the periodontal status and disease progression.
Topics: Humans; Neutrophils; Periodontal Pocket; Aggressive Periodontitis; Chronic Periodontitis; Gingivitis
PubMed: 37794540
DOI: 10.4103/njcp.njcp_3_23