Periodontal bacteria in adult twins.

BACKGROUND: Both environmental and genetic factors are known to influence clinical measures of periodontal disease. The purpose of this study was to determine whether genetic factors similarly influence the presence of specific periodontal bacteria in subgingival plaque. METHODS: Reared-together and reared-apart monozygous (MZ) and dizygous (DZ) adult twins were examined clinically. Demographic and behavioral information was obtained from each subject by questionnaire. Subgingival plaque samples were obtained from the index teeth, and the presence of P. intermedia, P. gingivalis, A. actinomycetemcomitans, E. corrodens, and F. nucleatum was determined using an immunoassay. RESULTS: Microbiological and clinical data were available for 169 twin pairs. The subject-based prevalences of the bacteria in the twin groups ranged from 11% for Porphyromonas gingivalis to 40% for F. nucleatum. For all species examined, the concordance rates were not significantly different (P > 0.05) between MZ and DZ twin groups. These findings were apparent despite similar smoking histories, self-reported oral hygiene practices, and antibiotic use in the twin groups. Furthermore, MZ twins reared together were not more similar than MZ reared-apart twins with respect to any bacterial species examined. CONCLUSIONS: These findings suggest that in a population with access to routine dental care, any effects that host genes and the early family environment have on the presence of specific bacteria in subgingival plaque are not apparent in adulthood. Most twins with disease in this study had early periodontitis. Results from this study may not necessarily be extrapolated to more advanced disease states.

Effect of a non-steroidal anti-inflammatory drug on tissue levels of immunoreactive prostaglandin E2, immunoreactive leukotriene, and pain after periodontal surgery.

The aim of this study was to measure tissue levels of immunoreactive prostaglandin E2 (iPGE2), immunoreactive leukotriene B4 (iLTB4), and pain after periodontal surgery and to evaluate the effect of the non-steroidal anti-inflammatory drug (NSAID), ibuprofen, on these levels. Two contralateral quadrants in each of nine patients were selected to undergo separate surgical procedures, one with ibuprofen (800 mg 1 hour presurgery and 400 mg postsurgery) and one with a placebo. Intra-operatively, a custom-made microdialysis probe, with a 3,000 dalton molecular weight cut-off, was inserted beneath the soft tissue flap and a dialysate collected every 20 minutes for 4 hours after surgery. Pain perception was measured at the same time intervals using two pain scales. Dialysate samples were assayed using two enzyme immunoassays. Mean tissue levels of iPGE2 in the placebo group increased from 74 nM at 40 minutes to a peak of 261 nM at 200 minutes. Mean tissue levels of iLTB4 in the placebo group fluctuated between 0.2 and 0.6 nM. Pain levels in this group increased continuously with time, peaking at 4 hours. Mean tissue levels of iPGE2 in the ibuprofen group were significantly suppressed, exhibiting more than a 95% reduction. This was accompanied by a significant reduction in pain. Ibuprofen had no detectable effect on tissue levels of iLTB4. These data indicate that iPGE2 and iLTB4 are present at relatively high concentrations in the periodontal tissues after surgery. Since these concentrations exceed the Kd values for binding to their respective receptors, PGE2 and LTB4 may be associated with the development of postsurgical pain and inflammation. These data also indicate that ibuprofen can successfully inhibit iPGE2 production in the periodontal tissues and in this way may help reduce postoperative pain and inflammation.

Intrasulcular laser Doppler readings before and after root planing.

A reproducible and sensitive laser Doppler periodontal probe has recently been developed for intrasulcular measurement of gingival blood flow. The specific aims of this investigation were to determine the relation between intrasulcular laser Doppler readings (LDR) and traditional diagnostic criteria as well as to evaluate the response to root planning in terms of LDR and traditional criteria. LDR and clinical measurements (bleeding on probing (BOP), probing depth (PD) and clinical attachment loss (CAL) were obtained from 2 healthy and 2 diseased sites in 30 systemically healthy adult volunteers with localized moderate to advanced periodontitis. All 30 subjects were re-examined 1 month following root planing while 10 subjects were re-examined at approximately 1 year after treatment. Subject-adjusted correlations between pretreatment LDR and PD as well as LDR and CAL were 0.74 and 0.71, respectively. 1 month following root planing, the diseased sites had undergone a significant reduction in LDR and PD with an accompanying gain in CAL. Prior to treatment, 95 of 120 sites (79%) agreed on an ordinal classification (high, low) for LDR and BOP. Mantel-Haenszel common odds ratios for agreement between LDR and BOP were 9.6 pre-treatment and 4.3 one month after treatment. A slight rebound of all measurements was noted in a group of 10 subjects followed for 1 year. It was concluded that the laser Doppler periodontal probe is an unbiased non-invasive method of monitoring the response to periodontal therapy.

An evaluation of laser Doppler readings obtained from human gingival sulci.

A small laser doppler probe with an outside diameter comparable to a conventional periodontal probe (0.5 mm) was developed. The objectives of this investigation were to determine if intrasulcular laser doppler readings (LDR): 1) are reproducible; 2) can detect vascular changes associated with trauma from probe placement; 3) were reproducible when obtained with a stabilizing stent or without a stent; and 4) could detect vascular changes following the injection of a local anesthetic with vasoconstrictor. Nine adult volunteers with clinically healthy gingiva were evaluated for 30 second intervals at 5 sites. Baseline LDR were obtained twice at each site utilizing an acrylic stent to stabilize the probe and once without the stent (trial 1). All LDR were repeated at one month (trial 2) and again two months (trial 3) after baseline. One additional reading per subject was obtained following the administration of a local anesthetic with a vasoconstrictor during the second trial. Inter-trial comparisons found no significant difference in mean LDR between any of the three observation times. However, intra-trial comparison between the first and second LDR revealed an increase of approximately 50% in mean LDR. A 3-fold reduction in mean LDR (P < 0.001) was noted following the administration of a local anesthetic with vasoconstrictor. Intra-class correlation coefficients for stent stabilized LDR were 0.51 (P < 0.01) and 0.63 (P < 0.01) while intra-class correlation for hand held LDR was 0.40 (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

The prevention of localized ridge deformities using guided tissue regeneration.

Healing of extraction sockets where the buccal plate of bone has been destroyed often results in localized ridge deformities. This is most likely due to the ingrowth of extraskeletal connective tissue into the space originally occupied by the tooth which then fills with a combination of bone and soft tissue. Techniques for managing these defects have been described, but it would be preferable to prevent them from occurring at all. Using the principles of guided tissue regeneration, a surgical technique is described that can be applied to post-extraction sites that are deficient in alveolar bone thereby preventing localized ridge deformities. Representative cases are presented illustrating the technique.

Comparison of the distribution of Actinomyces in dental plaque on inserted enamel and natural tooth surfaces in periodontal health and disease.

The distribution of Actinomyces naeslundii, Actinomyces viscosus and Actinomyces odontolyticus in healthy and diseased adult populations was studied in 3 different ways. First, supragingival plaque formation at 2 through 72 h was examined in 12 periodontally healthy adults using a removable pre-measured surface of enamel bonded to molars and premolars. Second, a cross-sectional examination of the composition of both supragingival and subgingival plaque of unknown age was conducted in 205 adults exhibiting periodontal health to moderate disease. Third, the effects of oral hygiene instruction and root planing on the subgingival microflora of a subset of 19 subjects with moderate periodontitis were examined. The evaluation of 12 adults revealed that the predominant species in early plaque formation (2, 4 and 8 h) was A. odontolyticus. A. viscosus and A. naeslundii were present in developing plaques in almost all subjects in 2-h plaque, but absent in half the subjects when 4-, 8- or 24-h plaque was examined. These two species significantly increased in numbers per mm2 enamel surface area in 48- and 72-h plaques. A. odontolyticus was not related to clinical signs of periodontal disease in 205 adults, and its subgingival proportions in plaque did not change following periodontal treatment of 19 individuals. A. naeslundii was found in significantly higher numbers in supragingival than subgingival plaques in the 205 adults examined. The mean proportion of A. naeslundii significantly decreased as the magnitude of probing depth and attachment loss increased. The proportions of A. naeslundii and A. viscosus were found to be significantly increased in subgingival plaques following periodontal treatment.

Periodontal findings in adult twins.

Gingivitis and periodontitis are among the most common diseases known to man. Although bacterial plaque is generally accepted as the primary etiologic agent, little information is available concerning the influence that host genetic factors have on these diseases. The purpose of the present study was to examine the relative contribution of environmental and host genetic factors to clinical measures of periodontal disease through the study of both reared-together twins and monozygous twins reared apart. Probing depth, clinical attachment loss, gingivitis, and plaque were assessed from the Ramfjord teeth in 110 pairs of adult twins (mean age 40.3 years), including 63 monozygous and 33 dizygous twin pairs reared together and 14 monozygous twin pairs reared apart. Bootstrap sampling was used to estimate and provide confidence limits of between-pair and within-pair variances, intraclass correlations and heritability. Based on ratios of within-pair variances or heritability estimates, a significant (P less than 0.05) genetic component was identified for gingivitis, probing depth, attachment loss and plaque. Heritability estimates indicated that between 38% to 82% of the population variance for these periodontal measures of disease may be attributed to genetic factors. While there is general agreement that bacteria are important in the pathogenesis of the periodontal diseases, future etiologic studies should consider the role of host genetic influences.

Phenytoin and 5-(p-hydroxyphenyl)-5-phenylhydantoin do not alter the effects of bacterial and amplified plaque extracts on cultures of fibroblasts from normal and overgrown gingivae.

Local irritation of gingival tissue by plaque is among the factors which affect development of gingival overgrowth in patients undergoing chronic phenytoin (PHT) therapy. Variability in the cytotoxicity of plaque components or of plaque substances plus PHT and/or its metabolites toward gingival fibroblasts may relate to whether gingival overgrowth forms in a particular patient. Fibroblasts from healthy and overgrown gingivae were incubated with (a) PHT and its major human metabolite, 5-(p-hydroxyphenyl)-5-phenylhydantoin (HPPH), (b) microbial and "amplified" plaque extracts, and (c) microbial and "amplified" plaque extracts plus PHT and HPPH. Cell numbers and cell-associated protein were determined for each incubation preparation. A wide range in cytotoxic response to a particular microbial or plaque extract occurred among cell strains. Plaque extracts from different subjects had variable cytotoxicity toward a cell strain. The differences among fibroblast strains in response to an extract and the variability in cytotoxicity of different plaque extracts toward a cell strain were not related to their source from normal or overgrown gingivae. Cell numbers and cell-associated protein were similar for incubation mixtures containing extracts with and without PHT and HPPH. These data do not show differences among cytotoxicity levels of plaque extracts, the response of particular gingival fibroblast strains to plaque components, or interaction between drugs and certain plaque samples which explain development of gingival overgrowth in some subjects receiving chronic PHT therapy.

Hospital periodontics. A survey of hospital utilization by American Academy of Periodontology members.

A survey of American Academy of Periodontology members was conducted to determine: the number of Academy members with hospital staff privileges, the frequency with which Academy members use hospital facilities, and the amount of training Academy members have had in physical evaluation and assessment of medical risk. The results indicate that over half of all Academy members have hospital staff privileges, with the majority of these being active Academy members. One third of the 945 Academy members who perform dentistry in a hospital operating room treat only one to two cases a year. Fewer than one fifth of the questionnaire respondents who perform dentistry in an operating room treat more than 12 cases per year. Approximately 95% of Academy members believe that periodontal training programs should include a course in physical evaluation and assessment of medical risk. The amount of formal training in physical evaluation and assessment of medical risk varies widely among Academy members. Over one third of 1,144 questionnaire respondents have had no formal training in physical evaluation and assessment of medical risk, while fewer than one tenth have had over 80 hours of formal training.

Repair of alveolar cleft defects with autogenous bone grafting: periodontal evaluation.

Twenty-six patients with cleft lip and palate (18 with unilateral and eight with bilateral clefts) with 34 canines that had erupted through grafted alveolar cleft defects were studied to evaluate their periodontal status. The results were compared with 58 canines erupted through a normal alveolus in 29 noncleft control patients. The overall periodontal status revealed a higher plaque index in the patients with cleft compared to the orthodontic control patients, but parameters of gingival index, probing depth, and attachment loss had no significant differences between these groups. The cleft-associated canines had more than 90 percent of their possible clinical attachment levels intact at the examination. This indicated that grafting of these alveolar cleft defects resulted in a clinically satisfactory periodontium to support these canines as they erupted through the osseous grafts for periods of at least 2 to 8 years following surgery.

Effects of scaling and root planing on subgingival microbial proportions standardized in terms of their naturally occurring distribution.

This investigation included a cross-sectional component (284, 20-40-year-old subjects/568 sites) and a longitudinal component (19 subjects with moderate to advanced periodontitis/76 sites). Subgingival plaque samples and clinical data were obtained from all upper second bicuspids and first molars in the longitudinal subjects and from both upper first molars in the cross-sectional subjects. The purpose was to: determine/confirm changes in proportions of selected subgingival microorganisms following root planning combined with conventional oral hygiene procedures in the longitudinal subjects, evaluate those changes in terms of an estimate of the naturally occurring distribution of subgingival microorganisms based on data obtained from the cross-sectional subjects and relate shifts in the subgingival microorganisms to changes in clinical measurements. Changes following treatment at sites with pre-instrumentation probing depths greater than or equal to 4.5 mm included cocci, 18.3 to 46.9%; spirochetes, 20.9 to 3.1%; total motile organisms, 28.5 to 5.9%; Fusobacterium spp., 10.2 to 2.2%; and dark-pigmented Bacteroides spp., 14.0 to 9.7%. Translating proportions of microorganisms in samples from subjects in the longitudinal treatment study to equivalent percentile ranks within the large cross-sectional data base demonstrated that at probing depths greater than or equal to 4.5 mm cocci moved from below the 50th percentile in our estimate of the naturally occurring distribution of subgingival microorganisms to above, and spirochetes, total motile organisms and Fusobacterium spp. moved from above the 50th percentile to below. The microbiological findings were consistent with statistically significant improvements in clinical measurements. Statistically significant changes also occurred in microorganisms at sites with initial probing depths less than 4.5 mm.

A comparison of 3 systems for quantifying gingival crevicular fluid with respect to linearity and the effects of qualitative differences in fluids.

This investigation compares the Periotron 6000, Periotron 600, and ninhydrin area systems for quantifying gingival fluid. All systems have highly significant (p less than 0.001) linear relationships between measurements and fluid volumes. Additional curvilinear components have virtually no clinically significant implications. Qualitative differences in fluid only have clinically significant implications for the Periotron 600. When both quantitative and qualitative properties of gingival crevicular fluid are being investigated, the Periotron 6000 is the system of choice.

Periodontal evaluation of canines erupted through grafted alveolar cleft defects.

Two to eight years after receiving autogenous iliac crest grafts for treatment of alveolar cleft defects, eighteen patients who had unilateral cleft palate were evaluated for their periodontal status. When cleft-associated canines were compared with contralateral control canines, no statistically significant differences were found between specific surface values for plaque index, gingival index, or probing depths. Attachment loss was found to be greater (less than 0.72 mm) on the mesio-facial, facial, and mesio-palatal surfaces of the cleft-associated canines than on the control canines. Fifty-six per cent of the cleft-associated canines required surgical exposure and 44% also required orthodontic assistance to erupt to a functional occlusion. Osseous grafting of alveolar cleft defects resulted in satisfactory clinical periodontal support for cleft-associated canines.

Relative error (variability) associated with an improved instrument for measuring gingival crevicular fluid.

This investigation was undertaken to compare the variability in a new Periotron model 6000 to the variability in the previous Periotron model 600 and to the variability of the ninhydrin area method (NAM) for measuring quantities of fluid collected on filter paper strips. A Hamilton microliter syringe was used to deliver normal human serum to filter paper strips. Strips receiving varying quantities were randomly and blindly assigned to Periotron models 6000 and 600 until 10 strips containing each of 0.15, 0.30, 0.45, 0.60, 0.75, 0.90 and 1.05 microliter had been read using model 6000 and 10 strips containing each of 0.15, 0.30 and 0.45 microliter had been read using model 600. All strips were subsequently read using the NAM. The entire procedure was repeated using distilled water containing 0.1% methyl green. Coefficients of variation (CV) were computed for all sets of data. In all cases the CVs for the Periotron 6000 were significantly smaller than those for the Periotron 600 or the NAM. Pooled estimates of CVs (0.15-0.45 microliter) for the Periotron models 6000 and 600 were 0.054 and 0.116, respectively, (P less than or equal to 0.005) with serum and 0.059 and 0.095, respectively, (P less than or equal to 0.05) with distilled water containing 0.1% methyl green. Pooled estimates of CVs (0.15-1.05 microliter) for the Periotron model 6000 and the same strips subsequently measured with the NAM were 0.046 and 0.069, respectively, (P less than or equal to 0.005) with serum and 0.055 and 0.076, respectively, (P less than or equal to 0.001) with distilled water containing 0.1% methyl green.(ABSTRACT TRUNCATED AT 250 WORDS)

Management of the dental patient receiving corticosteroid medications.

Patients who have undergone therapy with glucocorticoids present unique problems for the dentist. Persons currently receiving steroid therapy have altered responses to infection and wound healing. More important, many patients who are taking or have taken glucocorticoids have a high risk of developing acute adrenal insufficiency when placed in a stressful situation. When treating patients with a history of glucocorticoid therapy, one must obtain precise information from the medical history to determine the relative risk of pituitary-adrenal suppression. If the patient is at risk, the dentist must determine the need for the following prophylactic measures: (1) systemic antibiotic therapy, (2) anxiety control, and (3) increased administration of glucocorticoids (steroid prep). If a patient experiences adrenal crisis, the dentist must be capable of interpreting the signs and administering appropriate therapy.