Routine screening of Vitamin D status in patients with Aggressive Periodontitis - A cross sectional clinical study

Background: Periodontal diseases are characterized by the presence of bleeding, inflammation, sensitivity, discomfort, mobility and tooth loss. Plenty of studies supported the assumption that vitamin D deficiency might be a risk factor for periodontal diseases. Our study aimed to investigate the true association between serum vitamin D level and the presence of periodontal disease. Materials and methods: The study evaluated 40 patients (age group 19-35 years) attending the outpatient department, Department of Periodontics and Implantology, Govt. Dental College and Hospital, Srinagar, equally divided into two groups (Group I and Group II) according to the inclusion criteria. Group I included generalized aggressive periodontitis patients while Group II included non periodontitis patients. Clinical parameters and serum 25-hydroxyvitamin D level were assessed. Results: Serum vitamin D levels of periodontitis patients compared to non-periodontitis patients presented non statistically significant differences (p-value = 0.878). Conclusion: Although the serum vitamin D level in aggressive periodontitis patients was lower than the healthy controls but the difference seemed to be statistically insignificant and hence it can be concluded that the serum vitamin D deficiency is not a risk factor for periodontitis.

High-throughput sequencing analysis of the microbiota of subgingival plaque in patients with periodontitis / 口腔疾病防治

Objective @# To detect the composition of the subgingival microbiota in generalized aggressive periodontitis (GAgP) and severe chronic periodontitis (SCP) patients tested by high-throughput sequencing (HTS) technologies, analyze its diversity and function by using bioinformatics, and observe changes in the subgingival microbiota before and after periodontal initial therapy.@* Methods@#Eleven patients with GAgP and 14 patients with SCP who visited the Department of Periodontics in Stomatological Hospital of Kunming Medical University from September 2018 to May 2019 were recruited, and subgingival plaque samples were collected at baseline and 6 weeks after initial therapy. Then, the genomic DNA was distracted and sequenced by the Illumina MiSeq high-throughput sequencing platform. QIIME (quantitative insights in microbial ecology), Mothur, SPSS and other software were used to analyze community information. LEfSe difference analysis (linear discriminant analysis effect size), network analysis, and the KEGG PATHWAY database (https://www.kegg.jp/kegg/pathway.html) were used to predict community function. @* Results @# At baseline, the dominant microbiota of GAgP and SCP patients were similar, including Bacteroidetes, Porphyromonas and Porphyromonas endodontalis. Six weeks after initial therapy, as the periodontal pocket became shallower, the variation trend of the microbiota of GAgP and SCP patients was similar. The relative abundance of gram-negative bacteria, such as Bacteroidetes, Porphyromonas and Porphyromonas endodontalis, decreased, while the relative abundance of gram-positive bacteria, such as Proteobacteria, Actinomyces and Rothia aeria, increased. Actinobacteria were significantly increased biomarkers of the subgingival microbiota in GAgP after treatment. Streptococcus is an important genus that connects the microbiota related to periodontitis and the microbiota related to periodontal health. Community function prediction result showed that initial treatment can reduce the functions of amino acid metabolism, methane metabolism, and peptidase in GAgP and SCP patients.@*Conclusion@#The subgingival microbiota of GAgP and SCP patients are similar. Streptococcus, as an early colonizer, may play an important role in promoting plaque biofilm formation and maturation in the process of subgingival flora from health to imbalance. Initial therapy can change the composition and structure of the subgingival microbiota, reduce community diversity, and reduce the functions of amino acid metabolism, methane metabolism, and peptidase in GAgP and SCP patients.

Terapia periodontal de suporte em paciente com periodontite agressiva generalizada: acompanhamento clínico e radiográfico de 13 anos / Periodontal maintenance therapy in patient with generalized aggessive periodontitis: clinical and radiographic following by 13 years

A terapia periodontal de suporte (TPS) tem como objetivo principal a manutenção dos resultados obtidos durante o tratamento periodontal ativo, sendo a forma mais previsível de controlar a doença periodontal. Essa extensão do tratamento periodontal, pode ocorrer em intervalos de tempo que variam de acordo com a severidade da doença, condição sistêmica do indivíduo, idade, fatores de risco, entre outros. A TPS contribui para a redução da perda dentária e recorrência da doença periodontal, além de possibilitar o diagnóstico de outras doenças bucais. Durante essa etapa, é possível traçar o perfil do paciente, identificar suas dificuldades e estabelecer condutas educativas, preventivas e terapêuticas necessárias para o controle do biofilme e da doença periodontal. Assim, o periodontista deve conscientizar o paciente sobre a importância da TPS, sendo que, a adesão ao tratamento é fundamental para a manutenção da saúde dos tecidos periodontais a longo prazo. O presente relato de caso clínico, demonstra o sucesso da TPS em paciente jovem acometida por periodontite agressiva generalizada. Após a realização da terapia periodontal não cirúrgica, a paciente foi inserida em um programa de manutenção periodontal, há 13 anos atrás, no qual participa ativamente até o presente momento. (AU)

The main objective of the periodontal maintenance therapy (PMT) is to maintain the results achieved during the active periodontal therapy, being the most predictable way of controlling the periodontal disease. This extension of the periodontal treatment may occur at different times, varying according to the aggressiveness of the disease, general health condition of the subject, age and risk factors, among others. The PMT contributes to the reduction of dental loss and prevents the reoccurrence of the periodontal disease, while also allowing the diagnose of other diseases of the mouth. During this phase it is possible to trace the patient's profile, identifying the difficulties and stablishing educational, preventive and therapeutic practices to control oral biofilm and periodontal disease. Thus, the periodontist must raise the patient's awareness to the importance of the PMT, as the patient compliance to the treatment is essential for the long term preservation of the periodontal tissue health. The clinical case here described demonstrates the success of the PMT performed on a young female patient afflicted with generalized aggressive periodontitis. After having performed the non-surgical periodontal therapy, the patient entered a periodontal maintenance program 13 years ago, in which she has been actively participating until the present time.(AU)

Características clínicas y microbiológicas de pacientes con periodontitis agresiva generalizada / Clinical and microbiological characteristics of a patients with generalized aggressive periodontitis

RESUMEN: Objetivo: el objetivo de este estudio es describir las características clínicas y microbiológicas de una muestra de pacientes diagnosticados con periodontitis agresiva generalizada (PAgG). Materiales y métodos: En este estudio de corte transversal, 20 sujetos menores de 30 años con PAgG atendidos en las clínicas odontológicas de la Universidad de Antioquia en Medellín Colombia, fueron invitados a participar entre diciembre del 2015 y marzo del 2017, las muestras microbiológicas fueron analizadas usando técnicas de cultivo y tomadas en los seis sitios más profundos de cada paciente (≥ 5mm). Resultados: Prevotella ssp y F. nucleatum fueron detectados en altos porcentajes, Porphyromonas gingivalis (P.g) fue positivo para la mitad de los sujetos estudiados; además de los microorganismos comúnmente estudiados, el 10% de los pacientes fueron positivos para bacilos entéricos gram-negativos. Conclusiones: se observaron grandes proporciones de microorganismos que incluyeron Prevotella spss y F. nucleatum; el 10% de los pacientes fueron positivos para bacilos entéricos gram-negativos.

ABSTRACT: Aim: The aim of this study is to describe the clinical and microbiological characteristics of a sample of patients diagnosed with generalized aggressive periodontitis (PAgG). Materials and methods: In this cross-sectional study, 20 subjects under 30 years of age with PAgG treated at the dental clinics of the University of Antioquia in Medellín, Colombia were invited to participate between December 2015 and March 2017, the microbiological samples analyzed using culture techniques were taken at the six deepest sites of each patient (≥ 5mm). Results: Prevotella ssp and F. nucleatum were detected in high percentages, Porphyromonas gingivalis (P.g) was positive for half of the studied subjects; In addition to the microorganisms commonly studied, 10% of the patients were positive for gram-negative enteric bacilli. Conclusions: large proportions of microorganisms were observed, including Prevotella spss and F. nucleatum; 10% of the patients were positive for gram-negative enteric bacilli.

Terapia antibiótica como adjuvante à terapia mecânica para o tratamento de periodontite agressiva generalizada / Antibiotic therapy as adjunctive to mechanical therapy for the treatment of generalized aggressive periodontitis ­ a literature review

O objetivo deste estudo foi avaliar os protocolos de antibióticos propostos em pacientes com periodontite agressiva generalizada (PAgG). Sessões de raspagem supragengival e polimento, instrução de higiene oral e quaisquer outros procedimentos de adequação foram realizados para alcançar um índice de placa < 20%. A raspagem e alisamento radicular (RAR) ou debridamento periodontal (associado ou não à desinfecção com clorexidina), e o debridamento periodontal ultrassônico em sessão única foram adotados. A azitromicina (AZT), a doxiciclina (DOX), o metronidazol (MET), a clindamicina, e a moxifl oxacina (MOX) foram alguns dos medicamentos testados. Alguns protocolos de antimicrobianos mostraram benefícios clínicos (redução do NS e PS, com ganho do NIC). Baseado na ação contra o Aa, a associação AMX + MET parecem ser a de eleição. No entanto, efeitos adversos, como o desconforto gastrointestinal, mal-estar geral, sonolência, náusea, dor de cabeça, gosto metálico ou eventos mais severos (erupção cutânea grave) foram observados. Por outro lado, apenas 0,7% dos pacientes relataram reações adversas com o AZT, que pode ser usado por um período menor (três dias). O uso do MET em concentrações menores (250 mg) não é efetivo. A MOX (apenas um comprimido por dia, custo reduzido) tem boa biodisponibilidade, longa meia-vida, boa penetração tecidual, e excelente tolerabilidade, parecendo tão efi ciente quanto o AMX+MET, e motivando a realização de novos protocolos de tratamento. Embora a análise microbiológica tenha demonstrado que a terapia medicamentosa foi superior em reduzir e/ou suprimir a carga microbiana subgengival, há tendência de recolonização bacteriana, ressaltando a necessidade da terapia periodontal de suporte.

The aim of this study was to evaluate the antibiotic protocols proposed to treat aggressive generalized periodontitis (AgGP) patients. Supragingival scaling and root planing, oral hygiene instructions, and other aid tools were performed to reach < 20% plaque score. The root scaling and planning or periodontal debridement (associated or not to chlorhexidine), and the ultrasonic periodontal debridement (single session) were adopted. The azithromycin (AZT), doxycycline (DOX), metronidazole (MET), clindamycin, and moxifl oxacin (MOX) were some of the investigated agents. Some antimicrobial protocols demonstrated clinical benefi ts (BoP and PD reductions, as well as CAL improvements). Based on the action against Aa, the AMX + MET association seems to be the therapy of choice. However, adverse effects, such as gastrointestinal discomfort, malaise, numbness, nausea, headache, metallic taste, or more severe reactions (cutaneous rash) were observed. On the other hand, only 0.7% of patients reported unpleasant symptoms with AZT, which can be used by a shorter period (three days). The use of MET in lower concentrations (250 mg) is not effective. The MOX (1 tablet once a day, reduced cost) seems to be as effi cient as AMX + MET, motivating the generation of new treatment protocols. Although the microbiological analysis had demonstrated that the antibiotic therapy was superior in reducing and/or eliminate the subgingival bacterial load, there is a trend for microbial recolonization, which emphasizes the need for periodontal supportive therapy.

Self-perception of generalized aggressive periodontitis symptoms and its influence on the compliance with the oral hygiene instructions: a pilot study

Aim: Patient’s adherence to the periodontal treatment is fundamental to the success of the therapy.Lack of response to the clinician’s instructions is influenced by various factors, including gender,age and psychosocial profile. The aim of the present study was to evaluate the relationship between self-perceived symptoms of generalized aggressive periodontitis and compliance with the oral hygiene instructions. Methods: Twenty-six subjects presenting a generalized aggressive form of periodontal disease were selected. The subjects answered a questionnaire to rate the perceived symptoms of periodontal disease with a sensitivity scale, in which a numeric score is attributed to each mentioned symptom. The percentage of sites with pocket probing depth (PPD)e” 5mm as well as the plaque index (PI) and gingival index (GI) were evaluated and the patients received a full mouth prophylaxis. One month later, the patients were re-evaluated for PI, GI, and PPD, and their percent reductions were correlated with the numeric score attributed to the aggressive periodontitis symptoms. Spearman’s correlation and Wilcoxon’s test were used with as ignificance level of 5%. Results: The greater the self-perception of some of the symptoms, the greater the adherence to the oral hygiene instructions. A positive correlation was observed between the reduction of GI and self perception of bleeding on tooth brushing (p=0.04, r=0.27)and redness and swelling of gums (p=0.04, r=0.26). Conclusions: The self-perception of symptoms of generalized aggressive periodontitis could have an influence on the patient’s response to the oral hygiene instructions.

Full mouth fixed implant rehabilitation in a patient with generalized aggressive periodontitis

BACKGROUND: Generalized aggressive periodontitis (GAP) is a destructive periodontal disease that can develop in young age. Only a few cases of full mouth rehabilitation, using dental implants, have been reported in a patient with aggressive periodontitis. CASE DESCRIPTION: This clinical report describes the treatment procedures and results of full mouth rehabilitation in a patient with aggressive periodontitis. After all teeth were extracted, 6 implants were placed in the maxilla and mandible, respectively. Fixed detachable implant prostheses were made. The patient was satisfied with the final results. She was followed for 10 months postloading. CLINICAL IMPLICATION: For a long-term success, continuous maintenance care is critical, as the contributing factors of the disease (such as immune factors or periodontal pathogens) may not be controlled adequately.

IL-10 gene promoter polymorphisms in Korean generalized aggressive periodontitis patients / 대한치주과학회지

Genetic polymorphisms associated with aggressive periodontitis have previously been reported. Interleukin-10 is an immunoregulatory cyto ine that plays a role in the patho genesis of periodontitis. Individual capacity for IL-10 production appears to be under genetic influence. The aim of present investigation was to explore possible genetic association of IL-10 gene promoter polymorphisms with generalized aggressive periodontitis. The study population consisted of 37 generalized aggressive periodontitis patients from the Department of Periodontology, Chonnam National University Hospital and 27 control subjects, all the subjects were non-smokers. Genomic DNA was obtained from buccal swab. The IL-10 promoter -597, -824, -1082 positions were genotyped by amplifying the polymorphic regions using polymerase chain reaction (PCR), followed by restriction enzyme digestion and gel electrophoresis. IL-10-597 C (allele 1) to A (allele 2) and IL-10-824 C (allele 1) to T (allele 2) and IL-10-1082 G (allele 1) to A (allele 2) polymorphisms were examined. The results were as follows. 1. In patients, the distribution of genotypes C/C, C/A and A/A at Il-10-597 was determined to be 13.5%, 37.8% and 48.7%, respectively and the distribution of genotypes at IL-10-824 was the same as that of IL-10-597. The distribution of genotypes G/G, G/A and A/A at IL-10-1082 was found to be 2.7%, 16.2% and 81.4%, respectively. No statistical difference in genotype distribution was found between the patient and control groups. 2. Allele 2 carriage rate at the three position of the IL-10 promoter region was higher in the control group than the patient group. 3. Allele 2 frequencies at IL-10-597 and -824 positions were higher in female group than male group and its difference was statistically significant(p<0.05). No significant difference in genotype distribution between the control and patient groups. Allele frequency between control and patient groups was not significantly different although allele 2 frequency at the three positions in the IL-10 promoter region appeared to be higher in control group. In conclusion, no clear association between IL-10 gene promoter polymorphisms and generalized aggressive periodontitis in Korean was observed.