Hepatocyte growth factor in patients with coronary artery disease and its relation to periodontal condition.

Hepatocyte growth factor (HGF) is an angiogenic, cardioprotective factor important for tissue and vascular repair. High levels of HGF are associated with chronic inflammatory diseases, such as coronary artery disease (CAD) and periodontitis, and are suggested as a marker of the ongoing atherosclerotic event in patients with CAD. Periodontal disease is more prevalent among patients with CAD than among healthy people. Recent studies indicate a reduced biological activity of HGF in different chronic inflammatory conditions. Biologically active HGF has high affinity to heparan sulfate proteoglycan (HSPG) on cell-membrane and extracellular matrix. The aim of the study was to investigate the serum concentration and the biological activity of HGF with ELISA and surface plasmon resonance (SPR), respectively, before and at various time points after percutaneous coronary intervention (PCI) in patients with CAD, and to examine the relationship with periodontal condition. The periodontal status of the CAD patients was examined, and the presence of P. gingivalis in periodontal pockets was analyzed with PCR. The HGF concentration was significantly higher, at all time-points, in patients with CAD compared to the age-matched controls (P< 0.001), but was independent of periodontal status. The HGF concentration and the affinity to HSPG adversely fluctuated over time, and the biological activity increased one month after intervention in patients without periodontitis. We conclude that elevated concentration of HGF but with reduced biological activity might indicate a chronic inflammatory profile in patients with CAD and periodontitis.

Periodontal conditions in 70-year-old women with osteoporosis.

The aim of the present study was to examine the periodontal conditions in an age cohort of 70-year-old women and compare an osteoporosis group with a control group with normal bone mineral density. 210 women 70 years old and randomly sampled from the population register of the community of Linköping were examined. Bone mineral density (BMD) of the hip was measured by dual energy X-ray absorptiometry. 19 women were diagnosed with osteoporosis (BMD below 0.640 g/cm2 in total hip). 15 of them accepted to participate in the study. As a control group 21 women with normal bone mineral density (BMD exceeding 0.881 g/cm2) were randomly selected from the initial population. The clinical examination included registration of the number of remaining teeth, dental plaque and periodontal conditions. The radiographic examination included a dental panorama and vertical bite-wing radiographs. The subjects also answered a questionnaire about their general health, age at menopause, concurrent medication, smoking and oral hygiene habits. The results from this study showed no statistically significant differences in gingival bleeding, probing pocket depths, gingival recession and marginal bone level between the women with osteoporosis and the women with normal bone mineral density. In conclusion, the present randomly selected and controlled study of osteoporotic and non-osteoporotic women, showed no statistically significant differences in periodontal conditions or marginal bone level. As periodontitis as well as osteoporosis are associated with age, our study of a well-defined age cohort is of interest, but the results should be interpreted with caution since the compared groups are small.

Caries and periodontal conditions in patients with primary Sjögren's syndrome.

The present investigation was designed to study caries and periodontal conditions in a selected group of patients with primary Sjögren's syndrome (1oSS). Twenty-one patients, 20 females and 1 male aged 44-75 years (mean 64 years), with recently diagnosed 1oSS constituted the study population. As a control group, 21 patients matched according to sex and age were randomly selected from patients at one clinic in the Public Dental Service. Clinical examinations including registrations of dental caries, restorations, and periodontal conditions were performed. Unstimulated and stimulated salivary secretion rates were recorded. The 1oSS group had a mean number of 16.4 +/- 8.9 and the control group 17.1 +/- 8.4 natural teeth. The 1oSS patients had significantly more DF crown surfaces (63 +/- 25.8 vs 43 +/- 21.3) and more inactive root caries (4.4 +/- 5.4 vs 0.5 +/- 0.9) than did the control patients. No significant differences were found between the groups in the periodontal conditions. The mean value of the unstimulated salivary secretion rate was 0.09 +/- 0.16 ml/15 min in the 1oSS group and 3.33 +/- 2.81 ml/15 min in the control group. The stimulated secretion rate was 0.16 +/- 0.15 ml/min and 1.47 +/- 0.64 ml/min respectively. This study confirms results from other studies that patients with 1oSS face a high risk of developing both coronal and root caries due to xerostomia. The periodontal conditions are similar to those found in patient groups in general dentistry.

The effect of acupuncture in the treatment of patients with primary Sjögren's syndrome. A controlled study.

Twenty-one patients, 20 women and 1 man, participated in a controlled study. All patients were diagnosed with primary Sjögren's syndrome (primary SS) according to the Copenhagen and San Diego criteria. The patients were randomly assigned to either a group receiving acupuncture treatment or a control group with no active treatment. The patients in the control group received acupuncture after 10 weeks when the acupuncture treatment was completed in the first group. A majority of the patients subjectively reported some improvement after treatment, and a significant increase in paraffin-stimulated saliva secretion was found after treatment. No statistically significant differences between the acupuncture group and the control group were seen in unstimulated salivary secretion or most of the subjective variables. The study showed that acupuncture is of limited value for patients with primary SS.

Guided tissue regeneration therapy of 203 consecutively treated intrabony defects using a bioabsorbable matrix barrier. Clinical and radiographic findings.

THE AIM OF THIS RETROSPECTIVE three-center study was to evaluate guided tissue regeneration (GTR) therapy in a clinical periodontal setting. The material consisted of 203 consecutively treated intrabony defects > or = 4 mm in 143 patients using a bioabsorbable matrix barrier. Each center followed the same protocol for presurgical, intrasurgical, and follow up examinations. Initial therapy, surgical, and follow-up treatments followed the routine of each center. Treatment was evaluated after 1 year by clinical assessments for probing depth (PD) reduction and clinical attachment level (CAL) gain and by bone fill from computer digitized radiographs. Initial intrabony defect depth averaged 6.3 +/- 1.0 mm clinically and 5.7 +/- 1.8 mm radiographically. Mean PD was reduced from 9.0 +/- 1.0 mm to 3.3 +/- 1.0 mm. Mean CAL gain amounted to 4.8 +/- 1.5 mm corresponding to 79 +/- 13% of the initial intrabony defect depth; 78% of the defects exhibited CAL gain > or = 4 mm. Bone fill averaged 3.2 +2- 1.8 mm. Together with a crestal resorption of 1.1 +/- 1.4 mm this resulted in a defect resolution of 4.3 +/- 1.9 mm or 72%. Forty-seven percent (47%) of the variability in CAL gain could be explained by defect depth, defect width, early barrier exposure, and presence of plaque in the treated area. CAL gain and bone fill were positively correlated to the intrabony defect depth; i.e., the deeper the defect the more the CAL gain and bone fill. Sites with barrier exposure during the first 2 weeks of healing showed significantly less CAL gain than sites at which exposure occurred at a later stage or not at all. Presence of plaque in the treated area had a significant negative impact on both CAL gain and bone fill. It was concluded that GTR-treatment of intrabony defects > or = 4 mm in a periodontal specialist practice will result in clinical attachment level gain and bone fill comparable to what has been demonstrated in case studies and controlled clinical trials. The predictability to obtain CAL gain > or = 4 mm in defects > or = 4 mm was 78%.

Treatment of class II furcation involvements in humans with bioresorbable and nonresorbable guided tissue regeneration barriers. A randomized multi-center study.

In this multi-center study 38 patients with contralateral molar Class II furcation defects were treated with GTR therapy using a bioresorbable matrix barrier (test) and a nonresorbable expanded polytetrafluoroethylene (ePTFE) barrier (control). Following flap elevation, scaling, root planing, and removal of granulation tissue, each device was adjusted to cover the furcation defect. The flaps were repositioned and sutured to complete coverage of the barriers. A second surgical procedure was performed at control sites after 4 to 6 weeks to remove the nonresorbable barrier. Before treatment and 12 months postsurgery all patients were examined and probing depths, clinical attachment levels, and position of the gingival margin were recorded. The primary response variable was the change in clinical attachment level in a horizontal direction (CAL-H change). Both treatment procedures reduced the probing depths (P < or = 0.001). Statistically significant gain of clinical attachment level in both horizontal and vertical direction was found at the test sites. At control sites gain of attachment in horizontal direction was statistically significant. The gain of CAL-H was 2.2 mm at test sites compared to 1.4 mm at control sites (P < or = 0.05). At test sites, the gingival margin was maintained close to the pre-surgical level (0.3 mm), whereas at control sites gingival recession was evident (0.9 mm), the difference being statistically significant (P < or = 0.01). Postsurgical complications, such as swelling and pain were more frequent following the control treatment (P < or = 0.05).

Costs of periodontal and prosthodontic treatment and evaluation of oral health in patients after treatment of advanced periodontal disease.

Retrospective estimations of dental care costs of periodontal and prosthodontic treatment and evaluation of oral health in 37 patients with advanced periodontal disease were carried out. Measures of their subjective evaluation of oral health 7-10 yr after the treatment are presented as a health profile and as indices in single numbers. The relations between oral health as an index and the dimensions in the health profile are analyzed. Dental care costs for treatment in the mandible was SEK 35 550, for the maxilla SEK 45 380 and for both jaws SEK 74 230. After the treatment oral health as well as general health were in excess of 75 on a 0 to 100 scale. Chewing ability, comfort and aesthetics were the variables found to significantly affect the subjective oral health. Oral health in terms of periodontal and prosthodontic conditions was maintained over the observation period.

Comparison of some salivary variables between vegetarians and omnivores.

The aim of the study was to compare salivary variables in a group of vegetarians with a group of omnivores. Twenty-nine vegetarians, 19 women and 10 men, mean age 35 yr, and 28 omnivores, 20 women and 8 men, mean age 35 yr, were compared in terms of salivary secretion rate, pH, buffer capacity, mutans streptococci and lactobacilli. The vegetarians had a significantly higher secretion rate, but there were no other significant differences regarding the salivary variables. The difference in secretion rate may have been caused by some lifestyle factor(s) differing between vegetarians and omnivores which probably mainly include nutrient(s), texture and roughness of the food.

Root surface caries.

Epidemiologic studies have shown that root surface caries are present worldwide. The prevalence and incidence of root surface caries differ widely among different populations but also among individuals within the same group. Differences in diagnostic criterias and reporting of data substantially influence epidemiologic data. The prevalence of decayed and filled root surfaces generally increases with age. However, age per se is not considered to be the main reason for caries development on root surfaces. The same main factors as for coronal caries, ie, cariogenic microorganisms, diet, saliva, and fluoride exposure, seem to play important roles in root caries development. Due to different anatomy, histology, and chemical composition of the tissues, there may be a higher risk of caries development on root surfaces than on coronal surfaces. In treatment of root surface caries, a causative treatment strategy should be determined. Prevention and treatment should focus on oral hygiene, fluoride exposure, and restriction of intake frequency of foods containing sugars or other easily fermentable carbohydrates.

Root caries susceptibility in periodontally treated patients. Results after 12 years.

The aim of the investigation was to study the individual susceptibility to root caries in periodontally treated patients in a long-term follow-up of 12 years. Age, plaque score, salivary counts of lactobacilli and mutans streptococci, salivary secretion rate and buffer effect, oral sugar clearance time and dietary habit index were tested as possible predictors for root caries incidence. During the whole observation period of 12 years, new root caries lesions were recorded in 24 of a total of 27 patients. In 8 of these, the root caries incidence was between 1 and 5, in 7 between 6 and 9 and in 9, 12 or more new DFS. However, the annual mean number of new DFS was rather low. 13 patients with > 5 new DFS% during the 3rd 4-year period (years 9-12) differed significantly from 14 patients with < or = 5 new DFS% in salivary mutans streptococcus counts (p < 0.01), plaque scores (p < 0.001) and new DFS% during the 2nd 4-year period (years 5-8) (p < 0.001). Simultaneously, risk values among the variables tested at the 8-year examination were about 3 x more prevalent in patients that developed > 5 new DFS% in years 9-12 than in those with < or = 5 new DFS%. During the whole 12-year observation period, smokers had significantly more root caries than non-smokers (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of a 12-month prophylactic programme on selected oral bacterial populations on root surfaces with active and inactive carious lesions.

In 15 caries-active patients, with a total of 770 exposed root surfaces, the effect of fluoride therapy and professional tooth cleaning was studied during a 1-year period. Dental plaque from 92 of the root surfaces and whole saliva samples were analysed at baseline and after 12 months for the presence of specific bacteria. The results showed that the number of active carious lesions had decreased from 99 to 46, while the inactive lesions had increased from 69 to 124. Of the active lesions which had been converted into inactive lesions, most were on the buccal and fewest were located on the distal surfaces. Lower plaque scores were found on sound and inactive root surfaces compared to active surfaces. The salivary concentrations of mutans streptococci and lactobacilli remained constant during the 12-month observation period. There was a tendency for higher levels of Streptococcus mutans in plaque from active lesions compared with sound root surfaces, whereas an inverse relationship was noted for the Streptococcus oralis group. No significant differences in the Actinomyces naeslundii counts were detected. In conclusion, the 12-month prophylactic programme had an effect on the clinical surface characteristics of root caries, but the components of the oral microflora selected for study seemed to be relatively unaffected during the observation period.

Prediction of root caries in periodontally treated patients maintained with different fluoride programmes.

The aims of the investigation were to evaluate the effect of different fluoride programmes, as adjuncts to professional plaque control every 3-4 months, on root caries incidence in periodontally treated patients and to identify risk factors for root caries development. Ninety-nine individuals, 33-76 years old, who had been treated for periodontal disease were subjected to one of three fluoride programmes during a 2-year period: (1) professional application, 3-4 times/year, of Duraphat (n = 34) or (2) of a 0.4% stannous fluoride gel (n = 33), or (3) daily mouthrinsing with a 0.05% sodium fluoride solution (n = 32). A number of clinical recordings and laboratory tests, used as presumptive risk indicators for root caries, were carried out before and on three different occasions after the periodontal treatment. No statistically significant differences were found between the various fluoride programmes. During the 2-year period, a total of 246 new decayed or filled surfaces (DFS) were recorded, 72 (29.3%) of which were diagnosed as active and 124 (50.4%) as inactive root caries lesions; 50 (20.3%) of the surfaces had been restored. Individuals with > or = 1 new root DFS during the 2 years (n = 50) differed significantly from those with 0 new root DFS (n = 49) as concerns salivary counts of mutans streptococci and lactobacilli, root plaque scores and percentage of exposed root surfaces. Baseline root caries prevalence (r = 0.43) and root plaque scores (r = 0.36) showed the highest correlations with new root DFS.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors associated with active and inactive root caries in patients with periodontal disease.

The aim of this study was to analyze a number of microbial, salivary, and dietary factors in patients with clinically active and inactive root caries. 147 patients, aged 30-78 years, referred for specialist treatment of periodontal disease, were randomly selected. 645 decayed and 539 filled root surfaces were found. Out of the carious lesions, 372 (58%) were recorded as clinically active and 273 (42%) as inactive. 30 patients showed no lesions (group 1), 46 had only fillings or inactive lesions (group 2), and 35 showed 1-2 (group 3) and 36 greater than or equal to 3 active lesions (group 4). The lactobacillus count differed significantly between all groups, except group 1 vs. 2, and the mutans streptococcus count between groups 1 vs. 4 and 2 vs. 3 and 4. Group 4 differed in plaque score from the other groups, and the salivary buffer effect differed between the inactive groups 1 and 2 and the active group 4. By stepwise multiple regression analysis, it was shown that lactobacillus count, plaque index, salivary buffer effect, dietary habit index, and number of exposed root surfaces contributed significantly to the coefficient of determination.

Long-term evaluation of root surface caries in periodontally treated patients.

Caries development on exposed root surfaces was evaluated in 31 patients who had been subjected to surgical and/or nonsurgical periodontal treatment 8 years earlier due to advanced chronic periodontitis. Besides assessments for evaluation of the periodontal treatment, a number of examinations and tests were carried out in order to assess variables presumed to influence the root surface caries development. Both statistical and graphical analyses were carried out to test differences between groups of subjects and to evaluate the variables studied as possible risk factors for root surface caries. The variables studied were: salivary lactobacillus count, salivary Streptococcus mutans count, plaque score, salivary secretion rate, salivary buffer effect, oral sugar clearance time, dietary habits and the age of the subject. The final results support previous findings from an initial 4-year period that root surface caries occurs, though to a minor extent, in this patient category demonstrating good or excellent periodontal conditions after periodontal treatment. A positive correlation was found between the baseline and final root surface caries scores. After the second 4-year period, the salivary counts of S. mutans and lactobacilli, the plaque score and the dietary habits differed significantly between groups of subjects who had developed 0 or greater than 5 new DFS %. Root surface caries was far more prevalent when risk values of the variables studied were present than when they were absent. The important variables in this respect differed considerably between the subjects. No single variable was found to be discriminative in all subjects.

Prediction of root surface caries in patients treated for advanced periodontal disease.

The present investigation was undertaken (1) to analyze the prevalence of root surface caries prior to and after periodontal treatment and (2) to determine the feasibility of using simple clinical criteria for predicting a patient's risk of developing root surface caries following periodontal therapy. Thirty-one patients were given advanced periodontal treatment including periodontal surgery. At baseline they were examined for oral hygiene status, root surface caries experience and number of lactobacilli per ml saliva as evaluated by the Dentocult dip-slide method. Follow-up examinations 1, 2 and 4 years after baseline showed that a majority of the patients were treated successfully and maintained in periodontal health. Root surface caries developed in approximately two-thirds of the patients during the 4-year observation period. However, the total increment of root lesions during these years was mostly extremely low, i.e. less than 5% of exposed root surfaces. In higher risk patients developing new root surface caries, significant correlations were demonstrated with initial pretreatment scorings from (1) their previous root surface caries experience, (2) high lactobacillus counts and (3) advancing age. In addition, root surface caries incidence and low saliva secretion rats were found to correlate significantly during the course of the study.