Periodontal Status as Mediator of the Association between Socioeconomic Status and Oral Health-Related Quality of Life in Pregnant Women.

OBJECTIVE: To test periodontal status as a mediator between socioeconomic status (SES) and oral health-related quality of life (OHRQoL) in pregnant women. BASIC RESEARCH DESIGN: Secondary cross-sectional analysis of baseline data from a randomised clinical trial with 303 pregnant women. MAIN OUTCOME MEASURES: Demographic variables, SES, smoking, interproximal hygiene, and self-reported gingival bleeding were collected as independent variables. The Oral Health Impact Profile-14 was used to assess OHRQoL. The relationship between SES, periodontal status and OHRQoL was investigated in structural equation modelling. RESULTS: There was a moderate association of SES with periodontal status (standardised coefficient SC = -0.26, p⟨0.01) and number of teeth (SC = 0.24, p⟨0.01). Periodontal status and the number of teeth were also associated with OHRQoL (respectively, SC = 0.25, p⟨0.01 and SC = -0.31, p⟨0.01), but SES was only indirectly related to OHRQoL (SC = -0.17, p⟨0.01). Socioeconomic inequalities in quality of life were mainly explained by the remaining number of teeth, contributing to about 47%, and periodontal status, contributing to about 41%. CONCLUSIONS: There was no direct effect of SES on OHRQoL in pregnant women. Periodontal status and missing teeth each explained almost half of the total indirect association.

Impacts of supragingival and subgingival periodontal treatments on oral health-related quality of life.

OBJECTIVE: The aim of this study was to evaluate the impact of distinct phases of a non-surgical periodontal treatment protocol on oral health-related quality of life (OHRQoL). METHODS: Fifty-five participants (51.4 ± 9.4 years), diagnosed with both gingivitis and moderate-to-severe periodontitis, were included. Periodontal and OHRQoL (OHIP-14) data were collected before (Day 0) and after the supragingival (Day 30) and subgingival (Day 90) treatments. A linear mixed model was used. OHIP-14 scores, effect size, and ceiling and floor effects were calculated. RESULTS: The total OHIP-14 score was significantly higher at Day 0 (17.3 ± 10.5) compared to Day 30 (9.7 ± 8.3) and Day 90 (9.5 ± 7.4). Scores of all domains decreased significantly after the supragingival treatment. This response was maintained after the subgingival therapy, except in the physical pain and physical disability domains. Clinical variables were not associated with the change in OHIP scores. The effect size was 0.72 at Day 30 and 0.74 at Day 90. No ceiling and floor effect were observed. CONCLUSIONS: Perceptions on OHRQoL improved along periodontal therapy, particularly after the supragingival treatment, suggesting that this intervention might be considered important to reduce the negative impacts in oral health-related quality of life.

The association between alcohol consumption and periodontitis in southern Brazilian adults.

BACKGROUND AND OBJECTIVE: An association between alcohol consumption and periodontitis has been suggested in the literature, but the evidence is still unclear. The aim of the present study was to investigate the relationship between alcohol consumption and periodontitis in a probability sample of adults from south Brazil. MATERIAL AND METHODS: This analysis included 1115 subjects aged 18-65 years derived from a representative sample from south Brazil. Data were collected from participants from clinical examination and structured interviews. Alcohol consumption was assessed by asking participants about the usual number of drinks consumed in a week. Four categories of alcohol consumption were defined: non-drinker, ≤ 1 glass/wk, > 1 glass/wk, ≤ 1 glass/d and > 1 glass/d. Individuals with ≥ 30% teeth with periodontal attachment loss ≥ 5 mm were classified as having periodontitis. Logistic models adjusting for age, race, socioeconomic status, dental care, body mass index, self-reported diabetes and smoking were used to estimate odds ratios (OR) and confidence intervals (95% CI). RESULTS: After adjusting for co-factors, females who reported drinking > 1 glass/d were more likely to have periodontitis (OR = 3.8, 95% CI = 1.4-10.1), whereas females who reported drinking up to 1 glass/d were 50% less likely to have periodontitis (OR = 0.5, 95% CI = 0.3-0.8). No significant associations between overall alcohol intake and periodontitis were observed for males. In an exploratory analysis, wine consumption was associated with a lower likelihood of periodontitis among males (OR = 0.2, 95% CI = 0.1-0.5) but not females. CONCLUSION: The periodontal health of males and females appears to be affected differently by alcohol consumption. Moderate wine consumption may have a beneficial effect in males.

Factors associated with self-reported use of mouthwashes in southern Brazil in 1996 and 2009.

OBJECTIVE: To evaluate the association between sociodemographic factors and self-reported use of mouthwashes in a city in the south of Brazil over a time span of 13 years. METHODS: The study involves a comparison of two household surveys conducted in 1996 and 2009. Respectively, 850 and 982 households were included in each year. The mother of the family answered to a structured questionnaire to provide sociodemographic data. Self-reported use of mouthwash was evaluated in a binary manner (yes/no). Multivariate Poisson regression models were used to estimate proportion ratios (PR) and 95% confidence intervals (95% CI). RESULTS: The proportion of mouthwash use increased significantly from 10.8% to 24.2% after 13 years. The probability of using mouthwashes increased more than two times from 1996 to 2009 (PR = 2.25 95% CI 1.80-2.82). Higher probabilities for using mouthwashes were observed in households with higher income (PR = 2.63 95% CI 1.97-3.51) and in those households where the mothers had higher educational levels (PR = 1.46 95% CI 1.05-2.03). CONCLUSION: Higher family income and higher maternal educational level were associated with self-reported use of mouthwashes in a higher proportion of households.

Effect of nonsurgical periodontal therapy on serum and gingival crevicular fluid cytokine levels during pregnancy and postpartum.

BACKGROUND AND OBJECTIVE: A low-grade systemic inflammatory status originating from periodontal infection has been proposed to explain the association between periodontal disease and systemic conditions, including adverse obstetric outcomes. The aim of this study was to evaluate the effect of periodontal therapy during pregnancy on the gingival crevicular fluid and serum levels of six cytokines associated with periodontal disease and preterm birth. MATERIAL AND METHODS: A subsample of 60 women (18-35 years of age) up to 20 gestational weeks, previously enrolled in a larger randomized clinical trial, was recruited for the present study. Participants were randomly allocated to receive either comprehensive nonsurgical periodontal therapy before 24 gestational weeks (n = 30, test group) or only one appointment for supragingival calculus removal (n = 30, control group). Clinical data, and samples of blood and gingival crevicular fluid, were collected at baseline, at 26-28 gestational weeks and 30 d after delivery. The levels of interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12p70 and tumor necrosis factor-α were analyzed by flow cytometry. RESULTS: After treatment, a major reduction in periodontal inflammation was observed in the test group, with bleeding on probing decreasing from 49.62% of sites to 11.66% of sites (p < 0.001). Periodontal therapy significantly reduced the levels of IL-1ß and IL-8 in gingival crevicular fluid (p < 0.001). However, no significant effect of therapy was observed on serum cytokine levels. After delivery, the levels of IL-1ß in the gingival crevicular fluid of the test group were significantly lower than were those in the control group (p < 0.001), but there were no significant differences between test and control groups regarding serum cytokine levels. CONCLUSION: Although periodontal therapy during pregnancy successfully reduced periodontal inflammation and gingival crevicular fluid cytokine levels, it did not have a significant impact on serum biomarkers.

Association between psychosocial factors and periodontitis: a case-control study.

OBJECTIVE: This case-control study investigated the association between life events, anxiety, and depression with periodontitis. METHODOLOGY: The study counted with 165 individuals, both sexes, 35-60 years of age. Case group included 96 individuals suffering from periodontal disease; and in control group 69 subjects with no history of periodontitis. Clinical examinations were performed by a single examiner. Psychological assessment included four inventories: Life Events Scale, Beck Anxiety Inventory, State-Trait Anxiety Inventory and Beck Depression Inventory. Bivariate and multivariate logistic regression analyses were performed to compare cases and controls. RESULTS: Mean probing depth and clinical attachment level were 3.44+/-0.80 and 4.01+/-1.61 in the case group and 1.96+/-0.19 and 0.95+/-0.50 in the control group, respectively (p<0.05). Positive association of periodontitis with age (odds ratio (OR)=1.15 95% confidence interval (CI): 1.06-1.24), male gender (OR=2.71, CI: 1.13-6.49), smoking (OR=6.05, CI: 1.67-21.94) and educational level (OR=6.49, CI: 1.14-36.95) was confirmed. Bivariate analysis did not demonstrate significant mean differences in life events, anxiety symptoms, trait or state of anxiety, or depression symptoms between cases and controls. Multivariate logistic regression, controlling for confounding factors, demonstrated no significant association between psychosocial factors and periodontal disease. CONCLUSIONS: Within the limits of this study it is possible to conclude that there was no significant association between periodontitis and the psychosocial factors analysed.

Evaluation of the dentogingival area during early plaque formation.

BACKGROUND: The aims of this investigation were to evaluate the pattern of supragingival plaque formation in the dentogingival area within 96 hours after abstinence from mechanical plaque control and to clinically analyze the gingival inflammatory response observed. METHODS: Six male volunteers, 20 to 23 years of age, had their upper incisors and cuspids polished. Four independent periods of no mechanical plaque control--24, 48, 72, and 96 hours--were instituted. In each period, plaque was disclosed and standardized individual photographs were taken. Impressions were taken and replicas were analyzed by scanning electron microscopy. Gingival crevicular fluid (GCF) was collected at baseline and 96 hours. The height of the gingival papilla was measured at baseline, 24, and 96 hours. RESULTS: Results showed the presence of a plaque-free zone (PFZ) along the gingival margin up to 72 hours. After 96 hours, there was a significant reduction in the presence of PFZ in the proximal thirds of the buccal surface when compared to the other experimental periods. At the end of the study, there was a significant increase in the GCF flow as well as edema of the interdental papilla, when compared to baseline values. CONCLUSIONS: The PFZ observed during the initial phase was less apparent at the 96-hour period. At this time, there was an increase in the gingival inflammatory response, represented clinically by increased GCF flow and edema.

Effect of aqueous solutions of sorbitol-xylitol on plaque metabolism and on growth of Streptococcus mutans.

The present study showed that the growth of Streptococcus mutans strain GS5 was inhibited by xylitol, and this indicates together with previous reports that this is a common phenomenon in this species. Sorbitol was found to increase the growth of S. mutans strains OMZ 176 and GS5 slightly compared with cultures with no external carbon source. Addition of small amounts of xylitol to the sorbitol cultures gave a growth below that of cultures with no extra carbon. Dental plaque challenged with sorbitol gave a small pH drop whereas xylitol caused a negligible decrease in pH. Sorbitol-xylitol challenges gave less acid production than sorbitol challenges alone.

Effect of fluoride and non-fluoride salts of copper, silver and tin on the acidogenicity of dental plaque in vivo.

The aim of the present study was to assess the relative importance of the metal and fluoride components in the inhibiting effect on the acidogenicity of plaque exhibited by silver fluoride and copper fluoride. The effect of these salts was therefore compared with that of silver nitrate and copper sulfate. Four subjects with a 3-day-old sucrose induced plaque received topical application of the test agents. Plaque pH-measurements, in the presence of sucrose, were performed prior to and at given time intervals after this application. No significant differences were observed in the inhibitory effect of 5 mM solutions of the copper and silver salts. These salts were all more effective than stannous fluoride in the first 4 h following application. Sodium fluoride was the least effective. All metals tested were found to be retained in plaque. The inhibitory activity appears to be carried by the cations. Other properties than retention alone may explain the higher effectiveness observed for silver and copper.

Thiol groups and reduced acidogenicity of dental plaque in the presence of metal ions in vivo.

Metal ions are known to influence the cariogenicity of dental plaque. Inhibition of acid metabolism in plaque may be of importance in this respect. Metal ions inhibit the acidogenicity of dental plaque to a different extent and it has been suggested that an enzyme inhibition based on oxidation of thiol groups may explain this observation. The aim of the present study was to evaluate the significance of oxidation of thiol groups in the inhibition of acid production in plaque by silver, tin and zinc salts. Nine subjects with 3-d sucrose induced plaque received topical applications of the metal ions. Cysteine or glutathione, which are known to reverse thiol oxidations, were then applied in one side of the mouth. Plaque pH measurements, in the presence of sucrose, were performed prior to and up to 2 h after treatment. The results showed that the acid production inhibited by the metal ions was reactivated by cysteine or glutathione. Iodoacetamide and p-chloromercuribenzoate were also shown to inhibit acid formation in dental plaque. The high affinity silver, tin and zinc have for SH groups, the observed inhibitory effect of these metals, the reactivation of the metabolism by monothiols and the fact that organic sulfhydryl reagents inhibit acid formation in plaque indicate that oxidation of thiol groups may be the mechanism by which these metals exert their effect.

In vivo effect of four antibacterial agents upon the acidogenicity of dental plaque.

The present study was carried out to compare the effect of chlorhexidine, iodine, alcohol and hydrogen peroxide on the acidogenicity of dental plaque in vivo. Plaque pH changes after application of sucrose were measured before and at various time intervals after the topical application of the agents. The MIC values of the different agents were assessed against plaque bacteria in vitro. The antimicrobial activity of chlorhexidine and iodine were similar whereas alcohol and hydrogen peroxide were less effective in the concentrations employed. The results showed that chlorhexidine 2%, iodine 2%, and alcohol 70% inhibited pH drops for a 24-h period after treatment whereas 3% hydrogen peroxide had no effect. Chlorhexidine 0.2% inhibited acid production to a greater extent than did alcohol 50% and iodine 0.2%. It is suggested that retention of chlorhexidine in plaque may explain the observed prolonged effect.

The effect of some cationic antiseptics on the acidogenicity of dental plaque in vivo.

Two series of experiments were performed in order to compare the ability of different cationic antiseptics to inhibit the acid production in plaque. In addition an attempt was made to evaluate the influence of oral retention on the acid-inhibiting properties of these agents. In one series of experiments acid production, following sucrose applications on plaque, was measured in situ prior to and at given time intervals after rinsing with the individual agents. In a second series the effect of eluting the antiseptics retained in the oral cavity by means of 5 consecutive acetic acid (6 mM) rinses was evaluated. The results showed that chlorhexidine (0.5 mM) was more effective than benzalkonium chloride (1 mM) and piperazine (1 mM). Cetylpyridinium chloride (1 mM) was the least effective. Acidic elution markedly reduced the inhibitory effect of single rinses of chlorhexidine (0.5 mM), benzalkonium chloride (1 mM) and the cetylpyridinium chloride (1 mM). This effect was less pronounced with a higher concentration (2.2 mM) of chlorhexidine. The results gave support to the view that retention of an agent in the mouth and in plaque is of significance for its ability to inhibit acid production of dental plaque.

The in vivo effect of glucose solutions containing Cu++ and Zn++ on the acidogenicity of dental plaque.

A series of experiments were performed to evaluate the lowest concentration of copper or zinc effective in reducing the acidogenicity of dental plaque in vivo when applied simultaneously with a carbohydrate challenge. The effect of a combination of sub-effective concentrations of these metals was also determined. The results showed a significant reduction in acid production in plaque challenged with glucose solutions containing 0.25 mM CuSO4 or 5.0 mM Zn (C2H3O2).2 as compared to glucose solutions alone. Neither 0.1 mM copper sulphate nor 2.5 mM zinc acetate reduced the acidogenicity of plaque significantly, whereas a combination of these subeffective concentrations was effective. The low metal concentrations causing reduction in acid formation in this study may be explained by the inhibiting substances reaching the bacteria at the same time as the substrate. The synergistic effect of the combination of low concentrations of copper and zinc is consistent with the view that these metals effect dental plaque by the same mechanisms.

Effect of chlorhexidine on acidogenicity of dental plaque in vivo.

In order to evaluate the effect of chlorhexidine on the acidogenicity of dental plaque, pH changes in plaque were measured in situ after sucrose applications. The results showed that a 0.2% chlorhexidine mouthrinse inhibited acid production for a period of 24 h, whereas a 0.05% chlorhexidine rinse showed an inhibitory effect for 4 h. It is suggested that the mechanism involved may be related to the retention of chlorhexidine in the mouth and in plaque providing a bacteriostatic milieu which may be of importance in the observed long-term effect.