A Two-Domain Self-Report Measure of Periodontal Disease Has Good Accuracy for Periodontitis Screening in Dental School Outpatients.

BACKGROUND: The assessment of periodontitis and treatment needs is primarily based on clinical and radiographic examinations. Albeit effective in predicting treatment needs, these examinations are costly, time-consuming, and impractical for assessing population-level needs. The purpose of the present study is to evaluate a two-domain self-report questionnaire for rapid periodontitis screening. METHODS: Six hundred white adult individuals, dentate or partially dentate and seeking dental therapy at a university clinic, underwent oral examination utilizing the full-mouth Community Periodontal Index of Treatment Needs (CPITN). To assess predictive value of self-reported periodontal measures (SRPMs) for periodontitis screening, four questions were formulated. Two questions aimed to assess "dentist-diagnosed periodontal disease" and two inquired about "self-assessed periodontitis." Multiple logistic regression models were used to construct receiver-operating characteristic curves, and predictor selection was performed via a forward stepwise selection process. RESULTS: Five hundred thirty-five volunteers with a mean age of 50.1 years elected to respond to SRPMs via telephone interview. After oral examination, 17.8% of participants were assessed as having CPITN = 4, representing compromised periodontal status. Sensitivity and specificity for correctly classifying compromised periodontal status ranged from 5.3% to 72.6%, and 87.8% to 99.5% for individual SRPMs. Sensitivity and specificity were increased when combining a measure of self-assessed periodontal disease and a measure of dentist-diagnosed disease as predictors. Addition of age and sex maximized sensitivity/specificity at 82.1%/82.2%. Diabetic status, smoking, and body mass index did not enhance the prediction. CONCLUSIONS: A two-domain self-report measure combining two self-report items with age and sex has good sensitivity and specificity for periodontitis screening in a white, university-based population. The proposed self-report measure can be valuable for periodontitis screening in resource-limited settings where gold standard clinical examination may not be pragmatic. Further validation studies are required to assess whether findings from this study are context-specific.

Prevalence of ß-lactam (bla TEM) and Metronidazole (nim) Resistance Genes in the Oral Cavity of Greek Subjects.

OBJECTIVES: The aim of this study is to investigate the prevalence of bla TEM and nim genes that encode resistance to ß-lactams and nitroimidazoles, respectively, in the oral cavity of systemically healthy Greek subjects. MATERIALS AND METHODOLOGY: After screening 720 potentially eligible subjects, 154 subjects were recruited for the study, including 50 periodontally healthy patients, 52 cases of gingivitis and 52 cases of chronic periodontitis. The clinical parameters were assessed with an automated probe. Various samples were collected from the tongue, first molars and pockets >6mm, and analysed by polymerase chain reaction-amplification of the bla TEM and nim genes, using primers and conditions previously described in the literature. RESULTS: There was a high rate of detection of bla TEM in plaque and tongue samples alike in all periodontal conditions (37% of plaque and 60% of tongue samples, and 71% of participants). The bla TEM gene was detected more frequently in the tongue samples of the periodontally healthy (56%) and chronic periodontitis (62%) groups compared to the plaque samples from the same groups (36% and 29%, respectively; z-test with Bonferroni corrections-tests, P<0.05). The nim gene was not detected in any of the 343 samples analysed. CONCLUSION: The oral cavity of Greek subjects often harbours bla TEM but not nim genes, and therefore the antimicrobial activity of ß-lactams might be compromised.

Evaluation of autogenous PRGF+ß-TCP with or without a collagen membrane on bone formation and implant osseointegration in large size bone defects. A preclinical in vivo study.

OBJECTIVES: The aim of this study was to evaluate whether the adjunctive use of a collagen membrane enhances bone formation and implant osseointegration in non-contained defects grafted with chair-side prepared autologous platelet-rich growth factor (PRGF) adsorbed on a ß-TCP particulate carrier. MATERIALS AND METHODS: Large box-type defects (10 × 6 mm; W × D) were prepared in the edentulated and completely healed mandibles of six Beagles dogs. An implant with moderately rough surface was placed in the center of each defect leaving the coronal 6 mm of the implant not covered with bone. The remaining defect space was then filled out with chair-side prepared autologous PRGF adsorbed on ß-TCP particles and either covered with a collagen membrane (PRGF/ß-TCP+CM) (6 defects) or left without a membrane (PRGF/ß-TCP) (5 defects). RESULTS: Histology 4 months post-op showed new lamellar and woven bone formation encompassing almost entirely the defect and limited residual ß-TCP particles. Extent of osseointegration of the previously exposed portion of the implants varied, but in general was limited. Within the defect, new mineralized bone (%) averaged 43.2 ± 9.86 vs. 39.9 ± 13.7 in the PRGF/ß-TCP+CM and PRGF/ß-TCP group (P = 0.22) and relative mineralized bone-to-implant contact (%) averaged 26.2 ± 16.45 vs. 35.91 ± 24.45, respectively (P = 0.5). First, bone-to-implant contact from the implant top was 4.1 ± 1.5 and 3.2 ± 2.3 (P = 0.9), in the PRGF/ß-TCP+CM and PRGF/ß-TCP group, respectively. CONCLUSIONS: Implantation of chair-side prepared autologous PRGF adsorbed on a ß-TCP carrier in non-contained peri-implant defects resulted in large amounts of bone regeneration, but osseointegration was limited. Provisions for GBR with a collagen membrane did not significantly enhance bone regeneration or implant osseointegration.

Prevalence of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in the oral cavity.

OBJECTIVE: To assess the prevalence of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in plaque and tongue samples from systemically healthy subjects with periodontal health, gingivitis or chronic periodontitis. METHODS: After screening 720 potentially eligible subjects, 154 systemically healthy participants were ultimately enrolled in the current study. Subgingival samples were taken from the first molars and the tongue and analyzed for the presence of S. aureus and MRSA by polymerase chain reaction (PCR), using primers and conditions previously described in the literature. In addition, samples were taken from deep periodontal pockets of chronic periodontitis patients. Statistical analysis was performed by applying non-parametric tests (Kruskal-Wallis for clinical parameters, and z-test with Bonferroni corrections for distributions of assessed parameters). All comparisons were set at the 0.05 significance level. RESULTS: S. aureus was detected in 18% of all participants and in 10% of the samples tested. No significant differences were found in its distribution among the three investigated groups (z-test for proportions with Bonferroni corrections, p>0.05). The mecA gene was not present in any of the S. aureus found. CONCLUSIONS: S. aureus can be found in the oral environment regardless of the periodontal conditions and therefore should be considered as a member of the transient flora not participating in periodontal pathology. Subgingival sites and tongue surfaces seem to be an unusual habitat of MRSA.

Effects of doxycycline on clinical, microbiological and immunological parameters in well-controlled diabetes type-2 patients with periodontal disease: a randomized, controlled clinical trial.

AIM: To evaluate the clinical, microbiological and immunological effects of systemic doxycycline as an adjunct to scaling and root planing (SRP) in chronic periodontitis patients with well-controlled type 2 diabetes. MATERIALS AND METHODS: Sixty-six patients compliant to oral hygiene (Hygiene Index <20%) allocated to either a test (systemic doxycycline for 21 days) or a control (placebo) group participated in the present randomized controlled trial (RCT). Clinical assessments were recorded at baseline, 3 and 6 months after therapy and included clinical attachment level (CAL), set as the primary outcome of the study, probing pocket depth (PPD), recession (RE) and bleeding on probing (BOP). At the same time points, counts of 15 subgingival species were evaluated by "checkerboard" DNA-DNA hybridization, gingival crevicular fluid samples were analysed for matrix metalloproteinase-8 (MMP-8) by ELISA and HbA1c levels were determined. Comparisons between and within groups were performed by non-parametric tests (Mann-Whitney, Wilcoxon signed-ranks and z-test for proportions with Bonferroni corrections) at the 0.05 level. RESULTS: No major differences were noticed in clinical and microbiological parameters of periodontal disease or levels of MMP-8 between the two groups. CONCLUSIONS: Adjunctive systemic doxycycline does not seem to significantly enhance the effects of SRP in well-controlled diabetes type 2 patients.

Prevalence of antibiotic resistance genes in subjects with successful and failing dental implants. A pilot study.

OBJECTIVES: To investigate the prevalence of the bacterial genes encoding resistance to beta-lactams, tetracyclines and metronidazole respectively, in subjects with successful and failing dental implants and to assess the presence of Staphylococcus aureus and the mecA gene encoding for Methicillin Resistant Staphylococcus aureus (MRSA) in the same samples. MATERIALS AND METHODOLOGY: The subject sample included 20 participants with clinically healthy osseointegrated implants and 20 participants with implants exhibiting peri-implantitis. Clinical parameters were assessed with an automated probe, samples were collected from the peri-implant sulcus or pocket and analyzed with Polymerase Chain Reaction for bla TEM , tetM, tetQ and nim genes, S. aureus and MRSA using primers and conditions previously described in the literature. RESULTS: Findings have shown high frequencies of detection for both groups for the tetracycline resistance genes tetM (>30%), tetQ (>65%) with no statistical differences between them (z-test with Bonferroni corrections, p<0.05). The bla TEM gene, which encodes resistance to beta-lactams, was detected in <15% of the samples. The nim gene, which encodes resistance to metronidazole, S.aureus and the mecA gene encoding for MRSA were not detected in any of the analyzed samples. CONCLUSIONS: Healthy peri-implant sulci and peri-implantitis cases often harbor bacterial genes encoding for resistance to the tetracyclines and less often for beta-lactams. Thus, the antimicrobial activity of the tetracyclines and to a lower extent to beta-lactams, might be compromised for treatment of peri-implantitis. Since no metronidazole resistance genes were detected in the present study, its clinical use is supported by the current findings. S.aureus may not participate in peri-implant pathology.

Treatment outcomes of ligature-induced recession in the dog model using guided tissue regeneration or coronally positioned flap procedures.

AIM: The aims of the study were: (1) to determine the quality of the hard and soft tissues formed in segments treated with coronally positioned flaps alone (CPF group) or combined with a polylactic acid resorbable membrane (guided tissue regeneration--GTR group) in wide type defects (canine teeth), and (2) to evaluate the behaviour of the newly regenerated tissues to an experimentally induced inflammation initiated by microbial plaque at the submarginal level in recession type defects (premolar teeth). MATERIALS AND METHODS: The randomized block design was used in the study, with each dog receiving both treatments (GTR and CPF). Gingival recession defects were surgically created in the 2nd and 4th mandibular premolars and, after 10 weeks, also in the maxillary canines of three dogs. The defects in the premolar area were created earlier than the defects in the canine teeth so that both areas would be ready for biopsy at the same time. Two months after the creation of the defects the exposed roots in the control group of teeth were surgically covered with coronally positioned flaps only (CPF group), and in the test group of teeth a coronally positioned flap was used in combination with a resorbable membrane (GTR group). In the premolar teeth only, after a healing period of five months, cotton ligatures were placed intrasulcularly and these areas were left without plaque control for 10 weeks. Following this, biopsies were taken from the canines and the premolars in order to examine (1) the quality of the hard and soft tissues formed after five months of healing in the canine teeth and (2) the response of the newly formed tissues to microbial accumulation induced by the subgingival ligature placement. RESULTS: In the wide defects of the canine teeth, the use of the membrane produced a mean new attachment formation of 44%, while the repositioned flap technique produced 22% new attachment. The regeneration of bone was limited to the apical area for both techniques and amounted to 15% and 10%, respectively. In the narrow defects of the premolars both techniques produced comparable mean root coverage percentages. The inflammatory conditions created in the study led to a comparable loss of mean clinical attachment and an increase in tissue recession and the extent of the inflammatory process for both groups. CONCLUSIONS: The use of resorbable membranes for the treatment of wide recession type defects in the canine teeth (GTR group) produced significantly better clinical results, with higher mean root coverage and increased regenerative capacity of the periodontal tissues, compared with the coronally positioned flap technique (CPF group). Additionally, the regenerated tissues created after the use of both techniques in narrow recession defects (premolar teeth) demonstrated comparable resistance to the microbial accumulation conditions created.