Comparison of experimental gingivitis with persistent gingivitis: differences in clinical parameters and cytokine concentrations.

BACKGROUND AND OBJECTIVE: Experimental gingivitis has been studied extensively as a well-controlled laboratory model of gingivitis. It is unclear, however, how experimental gingivitis compares with persistent plaque and gingivitis in more naturalistic settings. The present study compares both conditions in a randomized controlled design. MATERIAL AND METHODS: Twenty-six students suffering from plaque and gingivitis were randomly assigned to either a persistent gingivitis or an experimental gingivitis condition. Subjects with persistent gingivitis continued their habitual (i.e. insufficient) oral hygiene behaviour, resulting in persistence of plaque and gingivitis. Experimental gingivitis consisted of initial prophylaxis and subsequent total neglect of oral hygiene. Crevicular interleukin-1beta and interleukin-8 and clinical data were assessed weekly. RESULTS: After 4 wk, subjects with experimental gingivitis showed significantly more plaque accumulation (p = 0.005), higher interleukin-1beta (p = 0.037), and lower interleukin-8 (p = 0.043) concentrations than subjects with persistent gingivitis. Whereas in experimental gingivitis we observed considerable fluctuations in clinical and immunological parameters over the 4-wk period, persistent gingivitis was characterized by little fluctuation, indicating that we were monitoring an inflammatory steady state. CONCLUSION: The data indicate that conditions observed after 4 wk of experimental gingivitis are not comparable with persistent gingival inflammation in a naturalistic setting. Results are discussed with respect to current studies, indicating that chronic inflammation may reflect a stage of down-regulated pro-inflammatory response.

Effects of academic stress on oral hygiene--a potential link between stress and plaque-associated disease?

BACKGROUND: While there seems to be a common belief that psychosocial stress affects oral hygiene behavior, this assumption has rarely been proved. The present study thus aims to analyse stress effects on oral hygiene. MATERIAL AND METHODS: 16 matched pairs of medical students each consisting of 1 student participating in a major academic exam and 1 control without current academic stress, were formed on the basis of baseline plaque levels. At baseline, a professional tooth cleaning was performed. On the last day of exams, students answered questionnaires about oral hygiene during the exams and were afterwards asked to attend for a 2nd dental examination, of which they had no prior knowledge. RESULTS: On the last day of exams, approximately 6 weeks after professional tooth cleaning, 20.9+/-18.3% of control students' sites but only 10.5+/-9.3% of exam students' sites were found to be free of any plaque (p=0.022). Differences were most obvious at oral, as compared to vestibular, sites. Exam students reported a reduction in thoroughness (p=0.019) but not of frequency of oral hygiene behavior. CONCLUSION: The study strongly supports the assumption that psychosocial stress may induce neglect of oral hygiene and increase of plaque accumulation.

Methodological considerations in the assessment of gingival crevicular fluid volume.

In 4 studies on gingival crevicular fluid volume (GCFV) determination, the reliability of measurements, influences of plaque, circadian rhythms and stability over 24 h were examined. Samples were taken at 2 sites with a modified intracrevicular method. Reliability (n=40): repeated GCFV determinations within 5 min revealed good reliability coefficients (r(tt)>0.80). Influences of supragingival plaque (n=80): repeated GCFV determinations within 5 min with plaque removal between measurements in fourty subjects, the other subjects serving as control, revealed no group differences with respect to the differences between measurements. Circadian rhythms (n=20): GCFV was assessed 6x throughout the day. Repeated measures ANOVA revealed no significant time effect. Stability over 24 h under constant clinical conditions (n=20): measures were taken at 16:00 h on 2 consecutive days, several disturbing variables were kept constant. Retest correlations revealed a low stability (i.e., high variability) of GCFV measures under constant clinical conditions (r(tt)=0.38 for tooth 11 and r(tt)= -0.25 for tooth 26). It is concluded that GCFV determination can be done with high reliability, the validity of measurements neither being affected by supragingival plaque nor by diurnal rhythms. The low stability of measurements questions the validity of GCFV for diagnostic purposes.

After-effects of stress on crevicular interleukin-1beta.

BACKGROUND: In a previous study, we found stress to increase crevicular interleukin-1beta (Il-1beta) secretion induced by supragingival plaque. While in that study, stress and plaque were presented concomitantly, we now wondered whether a consecutive presentation of these 2 factors would still exert stress effects. METHOD: 39 medical students participated in the study; 18 took part in a major exam while the remaining 21 served as controls. From the day after the last exam, students neglected oral hygiene in 2 antagonistic quadrants for 21 days (experimental gingivitis), while they maintained perfect hygiene at the remaining sites. Crevicular fluid samples were taken at days 0, 5, 8, 15, 18, and 21 of experimental gingivitis. RESULTS: A significant effect of pre-exposure to academic stress on crevicular Il-1beta concentration was found (area under the curve: p=0.042), the effect size, however, being smaller than in our previous study when stress and plaque were presented concomitantly. CONCLUSIONS: It is concluded that pre-exposure to stress may persistently alter the immunological effects of microbial challenge to the periodontium.

Increase of crevicular interleukin 1beta under academic stress at experimental gingivitis sites and at sites of perfect oral hygiene.

This study analyses the effects of academic stress on crevicular interleukin-1beta(I1-1beta) both at experimental gingivitis sites and at sites of perfect oral hygiene. I1-1beta is thought to play a predominant role in periodontal tissue destruction. 13 medical students participating in a major medical exam (exam group) and 13 medical students not participating in any exam throughout the study period (control group) volunteered for the study. In a split-mouth-design, they refrained from any oral hygiene procedures in two opposite quadrants for 21 days (experimental gingivitis) while they maintained perfect hygiene levels at the remaining sites. Crevicular fluid was sampled for further I1-1beta analysis at teeth 5 and 6 of the upper jaw at days 1, 5, 8, 11, 14, 18 and 21 of the experimental gingivitis period. Exam students showed significantly higher I1-1beta levels than controls both at experimental gingivitis sites (area under the curve, exam group: 1240.64+/-140.07; control group: 697.61+/-111.30; p=0.004) and at sites of perfect oral hygiene (exam group: 290.42+/-63.19; control group: 143.98+/-42.71; p = 0.04). These results indicate that stress might affect periodontal health by increasing local I1-1beta levels especially when oral hygiene is neglected.

Increase in gingival inflammation under academic stress.

Several correlational questionnaire studies have observed a positive relationship between psychological stress and periodontal diseases. This paper analyses the effects of academic stress on periodontal health in a prospective quasi-experimental design. 26 medical students participating in a major exam and the same number of medical students not participating in any exam throughout the study period volunteered for the study. Bleeding on probing was assessed 4 weeks prior to the exam period (baseline) and at the last day of the exam. Severe deterioration in gingival health from baseline to the last exam day were observed more frequently in exam students than in controls (p=0.014). 6 exam students but only 1 control person developed a severe gingivitis at at least one formerly healthy tooth throughout the study period. These results further support the hypothesis that psychological stress is a significant risk factor for periodontal inflammation. Future studies should examine factors mediating this relationship.

Papillon-Lefèvre syndrome--successful treatment with a combination of retinoid and concurrent systematic periodontal therapy: case reports.

Papillon-Lefevre syndrome is a rare autosomal-recessive congenital differentiation disorder; the external signs are hyperkeratosis of the palms and soles. Intraorally, the most salient manifestations are dystrophic periodontal problems that affect both the primary and permanent dentitions and frequently lead to premature tooth loss. Two children were treated with acitretin 0.5 mg/kg of body weight per day from November 1992 to November 1993, and another child since October 1993. Concurrently, the children received professional oral hygiene care (scaling, root planing, and curettage). The combination of retinoid therapy and periodontal treatment improved the dermatologic and periodontal conditions.

[Root fractures and tooth luxations. 1]. / Wurzelfrakturen und Luxationen von Zähnen--I. Teil.

Root fractures and subluxation of teeth often play only a minor role in the discussion of the therapy of traumatic tooth defects. This contribution discusses possible therapeutic approaches as well as prognosis and long-term results in cases of tooth root fractures and partially dislocated teeth. The primary aim of the therapy is to avoid further damage to the developing teeth of the first set, and to keep the permanent teeth in a proper condition for the maximum time possible.