Effect of age on gingival crevicular fluid concentrations of MIF and PGE2.

We used an experimental gingivitis study design to compare crevicular fluid concentrations of Migration Inhibitory Factor (MIF) and Prostaglandin E(2) (PGE(2)) in younger (18 to 30 yrs) and older (46 to 77 yrs) healthy adults. PGE(2) increased after 1 wk in younger participants, whereas it decreased in older individuals after 1 wk of plaque accumulation. A significant interaction between age and time was observed for PGE(2) (p = 0.04). High concentrations of MIF were identified in both age groups at baseline. MIF increased in the younger participants, whereas in the older individuals a decrease over time was observed. MIF concentration was positively correlated with plaque index and gingival index in the older age group. Total counts of bacteria, Parvimonas micra and Prevotella intermedia, were significantly correlated with MIF concentration in older participants. In conclusion, MIF and PGE(2) production in response to bacterial accumulation seems to be modified by age.

The effect of age on prostaglandin-synthesizing enzymes in the development of gingivitis.

BACKGROUND AND OBJECTIVE: The aim of this study was to identify the expression of cyclooxygenase-1, cyclooxygenase-2, cyclooxygenase-3, and microsomal prostaglandin E synthase-1 in young and elderly subjects. MATERIAL AND METHODS: Periodontally healthy subjects were divided into young (18-30 years, n = 7) and elderly (46-77 years, n = 7). A gingival biopsy was taken at baseline. After experimental gingivitis, clinical examination was repeated and a second biopsy was taken. The expression of cyclooxygenase-1, cyclooxygenase-2, cyclooxygenase-3, and microsomal prostaglandin E synthase-1 was analyzed by means of immunohistochemistry. RESULTS: In both healthy age groups, cyclooxygenase-1 and microsomal prostaglandin E synthase-1 were expressed in epithelial cells, endothelial cells and fibroblast-like connective tissue cells. Cyclooxygenase-1 was found in Langerhans' cells of the epithelium. Cyclooxygenase-2 expression was observed in cells exhibiting the morphology of epithelial mitosis cells, and the expression of cyclooxygenase-2 in periodontally healthy elderly subjects was significantly lower (p < or = 0.05). Following experimental gingivitis, cyclooxygenase-1 and microsomal prostaglandin E synthase-1 expression did not change. However, the expression of cyclooxygenase-2 was significantly increased in both age groups (p < or = 0.05). Cyclooxygenase-3 was not detected in any group investigated. CONCLUSION: Cyclooxygenase-1 and microsomal prostaglandin E synthase-1 were expressed constitutively in gingival tissue, and expression was unaffected by age or inflammation states. In contrast, the expression of cyclooxygenase-2 was weaker in elderly subjects. In the course of experimental gingivitis, cyclooxygenase-2 was induced in both age groups.

Osseointegrated implants in patients treated for generalized chronic periodontitis and generalized aggressive periodontitis: 3- and 5-year results of a prospective long-term study.

BACKGROUND: The successful use of osseointegrated implants in periodontally healthy patients has been documented in numerous longitudinal studies in recent years. However, the extent to which these positive results apply to periodontally diseased patients remains unclear. The aim of the present prospective longitudinal study of partially edentulous patients treated for generalized chronic periodontitis and generalized aggressive periodontitis was a clinical, microbiological, and radiographic comparison of teeth and implants and assessment of the implant success rate. METHODS: Five partially edentulous patients treated for generalized aggressive periodontitis (GAgP) and 5 treated for generalized chronic periodontitis (GCP) were enrolled in this study. The GAgP patients received 36 implants, and the GCP patients 12 implants. The teeth were examined 2 to 4 weeks before extraction of the non-retainable teeth (baseline), and 3 weeks after insertion of the final abutments (second examination). All further examinations were performed during a 3-month recall schedule over a 5-year period for the GAgP patients and over a 3-year period for the GCP patients. At each session clinical parameters were recorded at teeth and implants and the composition of the subgingival microflora was determined by dark-field microscopy and DNA analysis. Intraoral radiographs of the teeth and implants were taken for control purposes at baseline; after insertion of the superstructure; and 1, 3, and 5 years later. RESULTS: The clinical findings indicated healthy periodontal and peri-implant conditions in both patient groups throughout the study. However, an increased probing depth and an attachment loss were recorded in the GAgP patients after the third year (P<0.001). The distribution of the microorganisms revealed no significant differences between the patient groups or between implants and teeth. Moderate bone loss at teeth and implants was registered in both groups. The success rates recorded were 100% in the GCP patients and 88.8% (maxilla: 85.7%; mandible: 93.3%) in the GAgP patients. CONCLUSIONS: The 3-year and 5-year follow-ups show that osseointegrated implants may be successful in oral rehabilitation of partially edentulous patients treated for generalized aggressive periodontitis and generalized chronic periodontitis. However, as no significant differences were recorded between conditions at teeth and at implants, progression of the disease cannot be ruled out.

Topical metronidazole application as an adjunct to scaling and root planing.

AIM: This study was carried out to investigate the effect of 2 applications of a metronidazole 25% dental gel as adjunctive therapy to subgingival scaling with root planing. METHOD: 59 of the original collective of 64 patients with adult periodontitis were observed for a 9-month period. This randomised single-blind study was carried out in split-mouth design. Each patient had to have at least 2 pockets with a probing depth of > or =5 mm in each quadrant. The clinical parameters, pocket probing depth (PPD), attachment level (AL) and bleeding on probing (BOP), were recorded at all teeth on days 0, 91, 175 and 259; in addition, subgingival plaque samples taken from 45 patients were analysed by means of dark-field microscopy. Therapy comprised subgingival scaling and root planing (SRP) of all quadrants and additional application of metronidazole 25%, dental gel in 2 randomly selected quadrants (SRP+Metro). Treatment was confined to teeth with a baseline PPD of > or =5 mm. Average PPD and AL and the incidence of BOP were computed for all pockets with a baseline PPD of > or =5 mm, and the 2 methods compared. The main efficacy variable for evaluation of the 2 treatments was the difference in PPD on day 259. RESULTS: Comparison of the 2 treatments revealed a statistically significant improvement in the clinical parameters for both treatment methods over the study period. Between baseline and day 259, significant differences in PPD (SRP+Metro: from 6.00 to 4.63 mm, SRP: from 6.02 to 4.83 mm) and BOP (SRP+Metro: from 67 to 31%, SRP: from 64 to 36%) were observed between the 2 treatment groups. Evaluation according to different patient groups demonstrated significant advantages of the combined therapy in previously-untreated patients, especially in female probands. Dark-field microscopy revealed a shift in the bacterial flora towards "healthy conditions". CONCLUSIONS: The results show that only minor advantages are to be gained from the application of a metronidazole 25% dental gel as adjunctive therapy to subgingival scaling. The distinctly better results of combined therapy in previously-untreated patients calls for more thorough investigation.

Guided tissue regeneration in a combined periodontal and orthodontic treatment: a case report.

Periodontal defects in adolescents or young adults are often an incidental finding within an orthodontic treatment. Most of these patients suffer from a special form of periodontal disease: juvenile periodontitis. Guided tissue regeneration offers a technique for long-term therapy in such cases. In the case presented in this report, periodontal problems were aggravated by malpositioning of the affected teeth. Orthodontic and periodontal treatment enabled the correction of malpositioning and regeneration of osseous defects.

An in vitro study of the treatment of implant surfaces with different instruments.

The aim of this in vitro study using implants and abutments was to examine traces left by various cleaning instruments and to determine the quantity of substance removal. The implants and relevant abutments were Screw-Vent implants (Dentsply), titanium plasma-coated full-screw implants (Straumann), and standard Brånemark implants (Nobel Biocare). The instruments used were titanium curettes, Gracey curettes, plastic curettes, rubber cups with Zircate prophy paste, the Cavitron Jet ultrasonic scaler with universal inserts and airpolishing nozzles with Prophy-Jet cleaning powder, and the Densonic sonic scaler with SofTip disposable prophy tips and universal tips. Two test fields (2 x 2 mm) on the respective implant head and abutment underwent standard treatment with each instrument. With the full-screw implants, an additional two test fields were examined from the transition of the titanium plasma coating to the implant head. Untreated implants and abutment surfaces served as controls. The treated and untreated surfaces were examined by scanning electron microscopy for work traces and by optical laser profilometry for substance removal. The results showed that the Cavitron Jet ultrasonic unit, the Densonic sonic scaler with universal tips, and the Gracey curette left pronounced traces and induced high substance removal. The titanium curette and the Densonic sonic scaler with SofTip disposable prophy tips left virtually no traces and removed very little substance. The rubber cup, the plastic curette, and the Cavitron Jet airpolishing system left the implant surfaces unchanged. All instruments apart from the rubber cup and Cavitron Jet airpolishing system left pronounced traces at the transition of the implant head to the titanium plasma coating of the full-screw implants. The Cavitron Jet airpolishing system, the rubber cup, the plastic curette, and, with some reservations, the Densonic sonic scaler with SofTip plastic fittings and the titanium curette, appear to be suitable for cleaning implant surfaces.

Desquamative gingivitis and balanitis--linear IgA disease or cicatricial pemphigoid?

A 38-year-old man presented with gingival inflammation together with erosions of the penis. Direct immunofluorescence demonstrated linear deposits of IgA at the basement membrane zone; indirect immunofluorescence and immunoblotting were negative. Linear IgA disease (LAD) was therefore suspected and treatment with dapsone initiated but this was changed to sulfamethoxy-pyridazine and systemic corticosteroids because of methaemoglobinaemia. During 1-year follow-up the lesions continued to wax and wane although they were never as extensive as before. Eighteen months after disease onset there was scarring of the penis together with suspected fibrosis of the inflamed gingival region. In addition the patient was HLA DQ7(3) positive, a haplotype thought to be increased in patients with cicatricial pemphigoid (CP); LAD with scarring or CP with solely linear IgA deposits are possible diagnoses of his condition.

The influence of end abutment and cantilever fixed partial dentures on periodontal health.

The influence of end abutment and cantilever fixed partial dentures on periodontal health was examined in 12 patients with periodontally reduced residual dentition. The prosthetic appliances had been integrated for 4 to 6 years before the first follow-up examination and had no technical defects at baseline. Two follow-up examinations were performed at a 12-month interval to record clinical and microbiologic parameters of 62 abutment teeth, 45 of which were fitted with end abutment fixed partial dentures and 17 with cantilever fixed partial dentures. Both types of fixed partial dentures were represented in all patients. The patients were on a 6 to 8-week recall schedule throughout the study period and had good oral hygiene. At both examinations, subgingival plaque samples were taken at all proximal surfaces and evaluated by dark-field microscopy. The clinical parameters used were Gingival Index, Plaque Index, pocket probing depth, and attachment level. The results showed that both types of fixed partial dentures were compatible with periodontal health subject to optimal oral hygiene. The clinical parameters recorded remained stable at a very low level throughout the study period and were almost identical in both groups. A slight gain in clinical attachment level, with a mean value of 0.19 mm for abutment teeth fitted with cantilever fixed partial dentures and of 0.32 for end abutment fixed partial dentures, was registered during the study period. The composition of the subgingival plaque showed a microflora reflecting virtually health periodontal conditions. The proportion of motile rods and spirochetes was slightly elevated in both groups. In conclusion, it can be stated that both fixed partial denture types display identical characteristics in the periodontally damaged dentition and do not lead to deterioration of the periodontal situation if oral hygiene is closely monitored.

An in vitro study of various instruments for root planing.

Rotating instruments are becoming increasingly significant in the scaling and planing of the root surface. The objective of this in vitro study was to test various root-planing instruments on extracted teeth and then to compare the treated surfaces using scanning electron microscopy. Two manual instruments (scaler and curette) and five mechanically rotating instruments (Desmo-Clean; Perio-Set; Viking-Set; and 40-microns and 15-microns diamond finishers) were investigated. From a total of 42 teeth, six root surfaces were treated with each instrument. The results confirm the clear superiority of the manual instruments (especially the curette). The manual instruments permit good root planing with minimum ablation from the root surface and only a thin smear layer (a compound of grinding dust, dentinal fluid, and water). The best planing results by rotating instruments were achieved with the Desmo-Clean and the 15-microns diamond finisher, whose performance was almost equal to that of the manual instruments. The rotating instruments, however, were associated with higher ablation and a marked smear layer. Manual instruments remain the media of choice on easily accessible root surfaces; however, rotating instruments are of advantage in inaccessible areas (eg, furcations) because of their handling properties.

Topical metronidazole application in recall patients. Long-term results.

The aim of this randomised study in split-mouth design, in which 24 patients from the recall programme of Marburg University Department of Periodontology were enrolled, was to compare topical application of a metronidazole 25% dental gel with subgingival scaling. The clinical parameters used were pocket probing depth (PPD) and bleeding on probing (BOP); these were recorded at baseline and 1, 3, 6, 14, 18 and 24 months after completion of treatment. In addition, plaque samples were taken from all mesial pockets for evaluation by dark-field microscopy. All patients had at least one tooth in each quadrant with a PPD of 5 mm or more showing BOP when they entered the study. The treatment consisted of 2 applications of dental gel in 2 randomly selected quadrants (on days 0 and 7) as well as subgingival scaling of the remaining quadrants. Statistical evaluation of all sites with a baseline PPD of 5 mm or more showed that both methods led to a significant reduction in PPD and BOP in the first 6 months. The average reduction in PPD was 1.3 mm in the gel group and 1.5 mm in the scaling group, with the tendency to bleeding being reduced by ca. 50% in both groups. After 24 months, improvements of 0.6 mm and 0.5 mm respectively were observed in PPD. The tendency to bleeding had undergone a slight increase but was still below baseline values. No statistically significant differences were observed between the two methods, although the results recorded with subgingival scaling were slightly better. Dark-field microscopy revealed a shift in the composition of the bacterial flora, suggesting a more physiological situation, which was maintained for 6 months before reverting consistently after 18 months to the baseline values of the plaque composition. Overall, application of a metronidazole 25% dental gel led in recall patients to an improvement in the investigated clinical and microbiological parameters comparable with subgingival scaling. After 24 months, the clinical parameters still displayed a very slight improvement over baseline values; after 18 months the microflora had reverted to its baseline composition.

Osseointegrated implants in patients treated for generalized severe adult periodontitis. An interim report.

This study presents oral rehabilitation with osseointegrated implants in partially edentulous patients treated for generalized severe adult periodontitis. Five female patients aged between 31 and 44 received a total of 36 implants and were observed for 1 year after insertion of the superstructure. Three months before implantation, venous blood samples were taken from the patients and five periodontally healthy controls, and the serum examined with highly sensitive ELISA test kits for interleukin 1 beta (IL-1 beta) and interleukin 6 (IL-6). Clinical examination covered the plaque index (PI) and gingival index (GI) at teeth and implants plus probing depth (PD) and clinical attachment level (CAL) at the teeth. Microbiological evaluation of teeth and implants was performed by dark-field analysis, and DNA analysis was performed in addition 1 year after insertion of the superstructure. Radiological controls of the teeth were carried out with standard single-tooth films in the 2 years preceding implantation and at baseline. Following implantation, further controls of the teeth and implants were undertaken immediately after insertion of the superstructure and 1 year thereafter. The immunological examination revealed that the IL-1 beta (0.22 +/- 0.2 pg/ml) (means +/- SD) and IL-6 (2.27 +/- 2.8 pg/ml) level was slightly, but not significantly, higher in the patients than in the control group (IL-1 beta: 0.06 +/- 0.06 pg/ml and IL-6: 0.64 +/- 0.2 pg/ml) (P > 0.05). The clinical results show that the GI at the teeth rose slightly from 0.0 to 0.2, and at the implants from 0.3 to 0.4. The PI rose slightly from 0.3 to 0.7 at the teeth and from 0.2 to 0.9 at the implants. Neither the GI nor the PI revealed any significant difference between teeth and implants. Clinical attachment loss at the teeth was minimal at 4.7 to 4.8 mm. Comparison between the teeth and the implants revealed no essential difference in bacterial flora; neither Actinobacillus actinomycetemcomitans nor Porphyromonas gingivalis was recorded at any location. Small quantities of Prevotella intermedia were detected at the teeth and implants of one patient. Radiological evaluation 1 year after insertion of the superstructure revealed a mean bone loss of 0.62 mm at the implants. The bone loss at the teeth during the same period was 0.3%, whereas it had been 1.5% in each of the 2 previous years. These results suggest that there is only a slight difference between the periodontal and peri-implant areas in patients with generalized severe adult periodontitis. The full potential for implants in these patients, however, needs to be shown in controlled longitudinal studies.

Periodontal status of a subject sample of Yemen.

From August to October 1991, the periodontal status of 1001 Yemenis representing the age groups 12-14, 15-19, 20-24 and 35-44 years was recorded and evaluated with reference to the CPITN, the calculus index and clinical attachment levels. The impact of chewing khat, the leaves of a cultivated, alkaloid shrub, and of using the traditional miswak chewing stick for oral hygiene purposes were investigated. The results show that 6.9% of the juvenile probands (15-19 years) had healthy periodontal tissue (CPITN 0), whereas bleeding on probing and calculus (CPITN 1 + 2) were registered in 86.2%. In the 35-44 year age group, 1.7% were periodontally healthy, whereas 84.5% displayed plaque retention or shallow pocketing (CPITN 2 + 3) and 12.5% deep pocketing (CPITN 4). The treatment needs in all age groups are confined primarily to calculus removal and instruction in oral hygiene. The clinical attachment level and the calculus index revealed age-related attachment loss and calculus formation, primarily among male probands. The higher khat consumption among the male population is reflected in its detrimental effect on the periodontal tissue, especially among younger probands. Oral hygiene aids have also an influence on periodontal status, with a toothbrush proving more efficient than the miswak. WHO efforts directed towards prophylactic programs need to be intensified but can be staffed by dental hygienists.

Comparative study of plaque and gingivitis prevention by AmF/SnF2 and NaF. A clinical and microbiological 9-month study.

This comparative clinical 9-month study was designed to examine the efficacy of amine/stannous fluoride (AmF/SnF2) (Meridol) and sodium fluoride (NaF). 150 probands with chronic gingivitis or early signs of periodontitis were divided into 3 randomised groups. Group 1 was given a NaF toothpaste and an NaF mouthrinse, group 2 AmF/SnF2 toothpaste and mouthrinse, and group 3 AmF/SnF2 toothpaste and NaF mouthrinse. The probands were examined at intervals (0, 1, 3 and 9 months) under conditions of a clinical double-blind study. The parameters recorded were the plaque index (PlI), the approximal plaque index (API), the gingival index (GI) and the mod. sulcus bleeding index (SBI). The probing depths (PD) were also measured. The composition of the supragingival plaque was evaluated by dark-field microscopy. A highly significant reduction in all clinical parameters was recorded in all 3 groups in the course of the study. The most pronounced reduction in PlI, API, SBI and PD was recorded in group 2. In the group comparison, however, no significant differences were recorded. Microbiological examination revealed a highly significant increase in cocci and a decrease in rods in all 3 groups. There was also a significant reduction in spirochetes, filaments and fusiforms in groups 2 and 3. In group 1, there was a significant fall only in fusiforms and small spirochetes. Overall, no significant difference in clinical parameters was recorded in the group comparison. However, the use of AmF/SnF2 toothpaste and mouthrinse (group 2) and, to a lesser degree, the combined use of AmF/SnF2 toothpaste and NaF mouthrinse display a favorable microbiological effect. The results from the present double-blind study reveal a reduction in gingival inflammation and supragingival plaque accumulation with a positive change in plaque flora in all groups. The reduction in potentially gingivopathogenic bacteria was slightly higher in the amine/stannous fluoride group.

Topical metronidazole application compared with subgingival scaling. A clinical and microbiological study on recall patients.

The aim of this study was to compare the topical application of a metronidazole 25% dental gel with subgingival scaling. 30 patients from the recall program participated in this open randomised study with split-mouth design. Pocket probing depths (PPD) and bleeding on probing (BOP) were measured before and 2, 12 and 24 weeks after the end of the treatment period. In addition, subgingival plaque samples were taken from all mesial sites and analysed with dark-field microscopy. All patients had at least 1 tooth in each quadrant with a PPD of 5 mm or more that should bleeding on probing, when entering the study. The treatment consisted of 2 applications of the dental gel in 2 randomly selected quadrants (on days 0 and 7) as well as simultaneous subgingival scaling of the remaining quadrants. Oral hygiene instruction was given on day 21. The average PPD and the average frequency of BOP were calculated for all sites with an initial PPD of 5 mm or more and continued at each examination, using the same sites. The statistical analyses showed that both treatments were effective in reducing PPD and BOP over the 6-month period. At the end of the follow-up period, the mean reduction in PPD was 1.3 mm after gel treatment and 1.5 mm after subgingival scaling. BOP was reduced by 35% and 42%, respectively. No significant differences between the 2 treatments were detected. Dark-field microscopy showed a shift toward a more healthy microflora for both treatment modalities; this persisted throughout the 6-month period. Application of a 25% metronidazole dental gel on recall patients seems to be as effective on the investigated clinical and microbiological parameters as subgingival scaling.

[The GTR technic within the framework of combined periodontal-orthodontic treatments. A case report]. / GTR-Technik im Rahmen einer kombinierten parodontal-kieferorthopädischen Behandlung. Eine Fallbeschreibung.

Periodontal defects in adolescents or young adults are often an incidental finding within the framework of orthodontic treatment. Often these patients are suffering from a special form of periodontal disease, juvenile periodontitis. Guided tissue regeneration (GTR) offers a technique for long-term therapy in such cases. In the case presented here, the periodontal problems were aggravated by malpositioning of the affected teeth. Orthodontic and periodontal treatment enabled the malpositioning to be corrected and the osseous defects to be largely regenerated. Controls on regular bases up to now revealed a stable status over 2 years.

An in vitro study of oscillating instruments for root planing.

The objective of this in vitro study was to test PER-IO-TOR instruments on the Profin Directional System angle piece (Dentatus-Sweden), using extracted human teeth. In the 1st part of the study, 6 root surfaces were treated with the instruments TOR 1, TOR 2, TOR 3 and TOR 4. For comparison purposes, half the samples treated with each instrument were then subjected to further treatment with a Gracey curette. All samples were then examined by SEM. In the 2nd part of the study, 4 root surfaces were given standardized treatment with each PER-IO-TOR instrument and the amount of substance removed was determined with a mechanical profilometer. For this purpose, the treated root surface was scanned with a microneedle and the profile depth recorded. The study showed that the PER-IO-TOR instruments were efficient with respect to surface planning and protective abrasion. Instrument TOR 3 (spatula with eyelet) in particular yielded similar results to those obtained with a curette. The overall results confirm that the PER-IO-TOR instruments have similar planing properties to manual instruments, causing minimum abrasion from the root surface. They thus represent an alternative to manual instruments, not only in inaccessible areas but also on smooth tooth surfaces.

Experiences with guided tissue regeneration in the treatment of advanced periodontal disease. A clinical re-entry study. Part I. Vertical, horizontal and horizontal periodontal defects.

The aim of this study was to evaluate the predictability of guided tissue regeneration (GTR), using ePTFE-membranes (Gore-Tex) in the treatment of advanced periodontal disease. The study presents long-term results for 88 teeth in 23 patients at least 9 months after membrane surgery. The periodontal lesions included severe horizontal and/or vertical bone loss. The bone level (BL and BL') and the tissue level (TL), a new parameter between cemento-enamel junction and coronal margin of the tissue in the defect, were recorded during surgery: immediately before application of the membrane (BL), after membrane removal (TL) and during a re-entry procedure (BL') 9 to 12 months later. The average tissue gain in the periodontal defect (BL-Tl) at membrane removal was 65.7% (p < 0.001) and the average gain in mineralized tissue at re-entry (BL-BL'), 30.4%, meaning more than 46% of the gained tissue at removal was mineralized at re-entry. The decreased amount of mineralized tissue at re-entry in relation to the tissue gain at membrane removal might be due to formation of a so-called long connective tissue attachment or to mineralization-induced shrinkage of the new tissue and some surgical difficulties in coverage of the newly formed tissue. Nevertheless, an absolute gain of 31% mineralized tissue after GTR can provide a marked improvement in the prognosis of a periodontally severely damaged tooth.

Periodontal health of the population in eastern Germany (former GDR).

The periodontal status of 1688 inhabitants of eastern Germany (former GDR) was investigated between July 1991 and March 1992, using the CPITN. The results show that only 1.4% of those examined have a healthy periodontal apparatus, whereas 40.1% had some signs of severe periodontitis (CPITN 4). This implies a very high therapy requirement in all age-groups, with 93.1% of 15- to 19-year-olds in need of peridontal treatment (CPITN 1 + 2 + 3 + 4). A comparison between educational qualifications and frequency of brushing or routine dental checks reveals a better level of prophylaxis in the more educated classes. As expected, the CPITN code with good oral hygiene and regular dental checks was significantly lower than with poor oral hygiene and infrequent dental checks. The high prevalence of periodontal disease lends urgency to the development of an extensive prevention concept introduced in childhood.