Recovery of putative pathogens from paper point sampling at different depths of periodontal lesions.

BACKGROUND: The aim of this study was to compare the recovery of three putative periodontal pathogens from periodontal lesions in samples using paper points inserted to different depths of the lesions. METHODS: Twenty 6-8 mm deep periodontal lesions with bleeding on probing were studied. Microbial samples were obtained using paper points inserted to three different depths of the lesions: orifice of lesion; 2 mm into the lesion; and to the base of lesion. Culturing was used for recovery and identification of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia. RESULTS: The recovery of each of the three putative periodontal pathogens was similar following sampling at the various depths of the lesions. CONCLUSIONS: The findings may be explained by the fact that the paper points become saturated as they pass through the orifice of the lesion. Absorption of microorganisms will therefore primarily occur at the orifice. It is also conceivable that the pathogens may be present in similar proportions throughout the various depths of the periodontal lesions.

A training program to improve the ability of periodontal residents to estimate patients' pain experience.

BACKGROUND: The purpose of this study was to determine whether periodontal residents could enhance their ability to assess the pain levels experienced by their patients from probing, using visual analog scale (VAS) to record pain. We hypothesized that with increasing experience by repeated comparisons of the patients' VAS pain ratings with independent ratings by the residents, they would improve their ability to assess their patients' pain experiences. METHODS: For each of three periodontal residents, 40 consecutive patients with periodontal disease were asked to express the degree of pain they experienced during the probing. Independently, the residents rated the pain levels they perceived that the patients experienced. Subsequently, the residents compared the two VAS ratings and discussed differences in ratings with the patients. Descriptive statistics and intraclass correlation coefficients were used to analyze the findings. RESULTS: Differences between patients' and residents' VAS scores gradually became smaller over time for two of the residents. Results for the third resident were less compelling. CONCLUSIONS: This study indicated that the training program improved the residents' ability to estimate the pain experiences of their patients, at least for two of the three participating residents. This training program, using periodontal probing as a model, could serve as an educational tool for students and practitioners who want to improve their sensitivity to their patients' pain experiences.

Pain experienced by patients during periodontal recall examination using thinner versus thicker probes.

BACKGROUND: The aim of the present study, performed during periodontal recall visits, was to compare the levels of pain experienced by patients during periodontal probing using probes with tip diameters of either 0.40 mm or 0.63 mm. METHODS: Three groups of 20 adult patients were examined by three different therapists. Diagonal maxillary/mandibular quadrants were probed with a 0.40 mm and a 0.63 mm probe, respectively. At the completion of probing of each quadrant, the patients were asked to describe their pain using a visual analog scale (VAS). RESULTS: Most patients showed low VAS pain scores for both probes. However, using an arbitrary threshold of VAS > or =40 mm to indicate significant pain, some patients had a painful experience. Lower median pain responses following probing with the 0.63 mm probe compared to the 0.40 mm probe were observed for patients of therapist 1, and for the quartile of all 60 patients that showed the highest VAS scores. For therapist 2 and 3 groups, no differences were found. The pain levels expressed by the three groups of patients varied, confirming results of our previous studies, which also observed differences in patients' pain experiences following probing by different therapists. CONCLUSIONS: The ability to deliver dental care with a minimum of patient discomfort would seem to be an essential part of the skills of individual clinicians. We would like to suggest that dental therapists periodically evaluate this part of their skill by asking patients to express their pain experiences following various procedures using VAS scales.

Ability of examiners to estimate the pain experienced by patients from probing during initial periodontal examination.

BACKGROUND: The aims of the present study were to identify the level of pain experienced by patients from probing during periodontal examination, and to determine to what extent the examining periodontist and the dental assistant could estimate the degree of pain experienced by the patients. METHODS: For each of three periodontists, 20 patients referred for periodontal diagnosis and treatment were selected. The periodontist carried out his examination, which included probing at six sites per tooth. Following probing, the patients rated the pain using a visual analog scale (VAS). The periodontist and the dental assistant who helped out during the examination independently rated the pain level they perceived that each patient experienced, also using a VAS. RESULTS: Most patients showed low pain responses to probing. However, using an arbitrary threshold of VAS > or =40 mm to indicate significant pain, some patients had a painful experience. Differences were observed between the pain levels expressed by the three groups of patients. While two of the three periodontists were able to appraise the pain experienced by their patients, the third was not. CONCLUSIONS: It seems important that the periodontist at the first encounter with the patient should be sensitive to the discomfort the examination may entail. This may influence the patients' decision to accept the required treatment, and may also affect the patients' attitude to and co-operation with the subsequent treatment.

Effect of different frequencies of preventive maintenance treatment on dental caries: five-year observations in general dentistry patients.

A long-term study in adults at a public dental clinic in Sweden was initiated to evaluate the relative effectiveness of prophylactic treatments on the progression of dental caries and periodontal discase. With treatments scheduled every 3rd, 6th, 12th or 18th month, this report presents results on caries for the 3-month, 6-month and 18-month groups, and evaluates the impact of various caries-related risk factors. Caries increment over approximately 5 years was determined by adding clinical and radiographic findings of manifest primary and secondary caries during the study. Overall caries activity among all 105 participating individuals was low to moderate. No significant differences for caries on any of the various tooth surfaces or for total caries were observed among the three groups. Multiple regression analysis with 5-year caries increment as dependent variable showed that the following factors had a statistically significant association with caries increment: percentage filled surfaces at baseline examination, dietary score, plaque score, and number of mutans streptococci and lactobacilli in saliva. Non-significant factors included number of preventive treatments provided during the 5-year interval. The results of this long-term trial suggest that preventive treatments as often as every 3 6 months may not be justified in the case of patients with low to moderate caries activity.

Pain experienced by patients during periodontal maintenance.

BACKGROUND: The aims of this study were to determine: 1) the degree of pain experienced by patients during probing and debridement; 2) whether the treating hygienists could estimate the degree of pain experienced by the patients; and 3) whether the patients' pain responses could be predicted by factors such as the patients' age, gender, number of residual periodontal lesions, and answers to a questionnaire on dental anxiety. METHODS: Prior to periodontal maintenance procedures, two groups of 20 adult patients to be treated by two hygienists completed an anxiety questionnaire. Subsequently, measurements of probing depths were performed, followed by pain ratings by each patient using a visual analog scale (VAS). The hygienists also completed a VAS, estimating the pain level they perceived their patient to have experienced. The same protocol was repeated for instrumentation (debridement). RESULTS: Most patients showed low pain responses to both probing and instrumentation. However, using an arbitrary threshold of VAS > or = 40 mm, 20% to 33% of the patients had a significant pain experience. The hygienists were quite accurate in their relative estimates of their patients' pain experiences. Regression analyses disclosed that significant portions of the pain responses could be predicted by the patients' answers to one of the dental anxiety questions. CONCLUSIONS: Recognition of patients who are likely to experience significant pain during periodontal treatment may be facilitated by the use of one question on dental anxiety. During treatment, the ability to gauge and respond to patients' pain experiences would seem to be an important component of a therapist's clinical skills.

Treatment of peri-implant infections: a literature review.

OBJECTIVES: The purpose of the present paper is to review available information on the treatment of peri-implant mucositis and peri-implantitis. MATERIALS AND METHODS: The results of animal research and human studies are presented. Proposed strategies for the treatment of peri-implantitis presented in the literature are also included. RESULTS: Most of the information accessible at this time derives from case reports. The reports provide evidence that efforts to reduce the submucosal infection may result in short-term improvements of the peri-implant lesion. They also indicate that regenerative procedures in intrabony peri-implant defects can result in the formation of new bone. CONCLUSIONS: Several uncertainties remain regarding the treatment of peri-implantitis. Properly conducted long-term follow-ups of consecutively treated cases would seem to be a realistic avenue for accumulation of more information. This may assist in establishing the predictability, magnitude and stability of improvements that can be achieved.

Pain experienced by patients during periodontal maintenance treatment.

BACKGROUND: The aims of this study were to assess the degree of pain experienced by patients during probing and debridement and to determine whether the pain responses could be predicted by the patient's age, gender, percentage of sites > or = 4 mm deep, and responses to a questionnaire on dental anxiety. METHODS: Prior to the maintenance procedures, 26 adult patients completed an anxiety questionnaire. Subsequently, measurements of probing depths were performed. The patients activated a tallying device at each probe entry that evoked pain (pain frequency). Pain levels for each quadrant were also assessed with a visual analog scale (VAS). Following probing, the same protocol was repeated during instrumentation (debridement). RESULTS: Most patients showed low pain responses to both probing and instrumentation as evaluated by both methods of measurement. However, using arbitrary thresholds of pain frequency > or = 50% and VAS > or = 40 mm, approximately 15% of the patients had a painful experience. Stepwise multiple regression analyses disclosed that significant portions of the pain levels could be predicted by gender and the patients' answers to 2 of the dental anxiety questions. CONCLUSIONS: Recognition of patients who are likely to experience pain during periodontal treatment can be facilitated by the use of 2 questions on dental anxiety and the VAS response to probing during examination.

La efectividad del tratamiento quirúrgico comparado con el tratamiento no quirúrgico de la enfermedad periodontal: II zona de las furcaciones: estudio de 24 meses / Effectiveness of surgical treatment versus non surgical treatment of periodontal disease: II zone of forcations: 24 months study

La respuesta al tratamiento y mantención periodontal en un período que se extendió hasta 24 meses fue estudiado en 17 pacientes portadores de la enfermedad periodontal. Se comparó los efectos de la instrumentación radicular sola, versus la instrumentación radicular mas la técnica quirúrgica de colgajo como un medio de mejorar el acceso, en furcaciones con compromiso de clase I y II según clasificación de Staffileno. Un total de 123 sitios fueron estudiados en relación al índice de placa, frecuencia de hemorragia gingival, profundidad de saco y nivel de inserción clínica. Los resultados sometidos al análisis de regresión lineal demostraron que con aquellos sitios con compromiso de furcación y con lesiones de profundidad 0-3 mm o 4 - 6 mm a los 24 meses al igual que en las caras planas, hubo un mejoramiento en todos los parámetros clínicos estudiados independiente de la modalidad de tratamiento inicial efectuada. Sin embargo, en aquellos sitios cuyas lesiones tenían profundidad inicial de 7 o mas mm., sólo en los casos tratados quirúrgicamente hubo una evolución favorable de la profundidad del saco hasta los 24 meses, ya que el resto de los parámetros clínicos y muy especialmente el nivel de inserción clínica, experimenta un progresivo deterioro independiente de la modalidad de tratamiento empleado. De los resultados de este estudio, se concluye que los compromisos de furcaciones clase I y II de Staffileno con lesiones periodontales profundas, no existe aún una modalidad de tratamiento habitual, que determine en el largo plazo, mejoramiento y mantención de la salud periodontal, hecho que podría estar determinado, por la verdadera regeneración de los tejidos periodontales

La efectividad del tratamiento quirúrgico comparado con el tratamiento no quirúrgico de la enfermedad periodontal: I. Superficies planas de molares; estudio de 24 meses / Effectivity of surgical treatment compared with non surgical treatment in periodontal disease

La respuesta al tratamiento y mantención periodontal durante un período de 24 meses fue estudiado en 17 pacientes portadores de enfermedad periodontal comparando los efectos del pulido radicular sólo versus el pulido radicular más la técnica quirúrgica de colgajo efectuadas en las caras planas de raíces de molares. Un total de 443 sitios fueron controlados en relación al índice de placa, frecuencia de hemorragia gingival, profundidad del saco y nivel de inserción clínica. Los resultados analizados mediante el análisis de regresión lineal, demostraron que en aquellos sitios que inicialmente tienen lesiones de una profundidad de 0 - 3 mm ó 4 - 6 mm., a los 24 meses hubo un mejoramiento clínico evidente de la condición de los tejidos periodontales, independiente de cual sea la modalidad de tratamiento. En los sitios que inicialmente tenían lesiones de 7 ó más mm., de profundidad su situación sin embargo es diferente, ya que si bien el índice de placa y la profundidad del saco se reducen considerablemente, el nivel de inserción clínica y la frecuencia de hemorragia no experimentan una evolución positiva en aquellos casos tratados con pulido radicular sin técnica quirúrgica