Prevotella nigrescens and Porphyromonas gingivalis are associated with signs of carotid atherosclerosis in subjects with and without periodontitis.

BACKGROUND AND OBJECTIVE: Oral microorganisms may be involved in the development of cardiovascular diseases, and Porphyromonas gingivalis is one of the periodontal microorganisms that has been found in carotid atheroma. The aim of this work was to study subgingival microorganisms and early carotid lesions in subjects with and without periodontitis. MATERIAL AND METHODS: Eighty-eight subjects with periodontitis and 40 subjects without periodontitis underwent dental examinations in 2003. The presence of the periodontal microorganisms Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens and Tannerella forsythia was analyzed from subgingival plaque using PCR amplification. The common carotid artery was scanned using ultrasound and the calculated intima-media area (cIMA) was measured. The association between periodontitis, the cIMA value and the presence of periodontal microorganisms, together with several confounders, was studied in a multiple logistic regression model. RESULTS: Smoking [odds ratio (OR) = 5.64; p = 0.001), level of education (OR = 5.02; p < 0.05) and the presence of P. gingivalis (OR = 6.50; p < 0.05) were associated with periodontitis. Explanatory factors for the increased cIMA were periodontitis (OR = 4.22; p < 0.05), hypertension (OR = 4.81; p < 0.05), high body mass index (OR = 5.78; p < 0.01), male gender (OR = 3.30; p < 0.05) and poor socioeconomic status (OR = 4.34; p < 0.05). P. nigrescens (OR 4.08; p < 0.05) and P. gingivalis (OR 7.63; p < 0.01) also appeared as explanatory variables associated with increased cIMA values. CONCLUSION: This cross-sectional study showed that P. nigrescens and P. gingivalis were significantly associated with increased cIMA values.

Matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 in blood as markers for early atherosclerosis in subjects with chronic periodontitis.

BACKGROUND AND OBJECTIVE: An association has been found between periodontal disease and the development of atherosclerosis. We investigated the hypothesis that periodontal disease triggers the expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in blood. Increased levels of these parameters might then indicate early atherosclerosis. MATERIAL AND METHODS: In this cross-sectional study, the material comprised 80 subjects with chronic periodontitis and 31 subjects with no periodontal disease. Sixteen years after diagnosis of periodontal disease ultrasonography revealed a statistically significant difference (p < 0.001) of carotid intima-media thickness between the subjects with chronic periodontitis and the periodontally healthy subjects. Matrix metalloproteinase-9 and TIMP-1 were analyzed from blood as periodontal and systemic inflammatory markers. The relationship between MMP-9, TIMP-1 and MMP-9/TIMP-1 as dependent variables and several independent variables (age, sex, smoking, education, body mass index, hypertension, periodontal disease and cholesterol) were analyzed in multiple logistic regression models to assess the value of the inflammatory markers in predicting carotid atherosclerosis. RESULTS: Matrix metalloproteinase-9 and TIMP-1 were significantly higher in plasma from subjects with periodontal disease and atherosclerosis. Periodontal disease was identified as the principal independent predictor both for atherosclerosis (odds ratio 3.89 for increase in bilateral carotid intima-media thickness) and for increased MMP-9, TIMP-1 and MMP-9/TIMP-1 (odds ratio 2.58, 5.53 and 3.41, respectively). Classical atherosclerosis risk factors, such as increased total cholesterol, age and sex (women), were significant predictors in the model. CONCLUSION: Matrix metalloproteinase-9, TIMP-1 and MMP-9/TIMP-1 in blood from subjects with periodontal disease could be useful laboratory markers for increased carotid artery intima-media thickness.

Periodontitis and premature death: a 16-year longitudinal study in a Swedish urban population.

BACKGROUND AND OBJECTIVE: Growing experimental evidence implicates chronic inflammation/infection due to periodontal diseases as a risk factor for death. The objective was to evaluate the role of periodontitis in premature death in a prospective study. METHODS: The causes of death in 3273 randomly-selected subjects, aged 30-40 years, from 1985 to 2001 were registered. At baseline, 1676 individuals underwent a clinical oral examination (Group A) and 1597 did not (Group B). Mortality and causes of death from 1985 to 2001 were recorded according to ICD-9-10. RESULTS: In Groups A (clinically examined group) and B, a total of 110 subjects had died: 40 subjects in Group A, and 70 in Group B. In Group A significant differences were present at baseline between survivors and persons who later died, with respect to dental plaque, calculus, gingival inflammation and number of missing molars in subjects with periodontitis (p < 0.001). The multiple logistic regression analysis results of the relationship between being dead (dependent variable) and several independent variables identified periodontitis with any missing molars as a principal independent predictor of death. CONCLUSIONS: Young individuals with periodontitis and missing molars seem to be at increased risk for premature death by life-threatening diseases, such as neoplasms, and diseases of the circulatory and digestive systems.

Levels of matrix metalloproteinases-8 and -9 with simultaneous presence of periodontal pathogens in gingival crevicular fluid as well as matrix metalloproteinase-9 and cholesterol in blood.

BACKGROUND AND OBJECTIVES: To investigate the levels of matrix metalloproteinase (MMP) -8 and -9 with the simultaneous presence of periodontal pathogens in gingival crevicular fluid (GCF) as well as MMP-9 and cholesterol in blood. Although bacterial pathogens are required to initiate the periodontal disease process, in some individuals the reaction to bacteria may lead to an excessive host response, resulting in a general inflammatory response. METHODS: MMP-9 and lipids were analyzed from the blood samples of 33 subjects with a 16-year history and oral health records of periodontal disease as well as from 31 periodontally healthy controls. Information was obtained on education, body mass index, and family history of atherosclerosis. GCF was taken to determine MMP-8 and MMP-9 levels, and bacterial samples were simultaneously collected for polymerase chain reaction assessment of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Tannerella forsythia, and Treponema denticola. Analysis of variance, chi-squared test, and multiple logistic regression analysis were used to analyze the results. RESULTS: Demographic data showed significant differences between patients and controls in smoking (P < 0.01), body mass index (P < 0.05), family history of atherosclerotic disease (P < 0.01), and education (P < 0.01). Significant differences were also observed in oral health data, in the detection of P. gingivalis (P < 0.001), P. intermedia (P < 0.01), P. nigrescens (P < 0.001), and T. forsythia (P < 0.001) and in the levels of MMP-8 and MMP-9 in GCF between patients and controls. T. forsythia[odds ratio(OR) 10.1; P = 0.001] and age (OR 5.54; P = 0.008) appeared to be the main independent predictors for high MMP-8 in GCF. Patients had significantly higher total cholesterol (P < 0.01), low-density lipoprotein cholesterol (P = 0.05), and triglycerides (P < = 0.01) than controls. Plasma levels of MMP-9 were significantly higher in patients than in controls (P = 0.001). CONCLUSIONS: Specific periodontal microorganisms appeared to induce host response, with increased release of MMP-8 and MMP-9 in gingival pockets as well as of MMP-9 in plasma, possibly triggering its up-regulation in blood.

The relation between foetor ex ore, oral hygiene and periodontal disease.

Bad breath usually originates in the mouth. It is described with different names as oral malodor, halitosis or foetor ex ore. Dental plaque, bacterial products from deep periodontal pockets and bacterial products from the tongue probably cause bad breath but also bacterial products from tonsils and pharynx probably are involved. In this study we clinically examined subjects with very strong bad breath, foetor ex ore. Foetor ex ore was defined as strong evil-smelling odor from the mouth of the patient which had an affect on the examiner and made the oral examination excruciating. Subjects with foetor ex ore are not aware of it. It is usually noticed by others. There are also persons who complain of bad breath that cannot be detected by others, halitophobia. Our aim was to study the relation between foetor ex ore, halitophobia and oral hygiene, periodontal disease. A total of 840 men, mean age 35.7(+/- 2.8 SD) and 841 women, mean age 35.7+/- 2.9 SD), participated. Clinical findings were noted, including the presence or absence of foetor ex ore. The subjects also filled in a self-reported questionnaire concerning problems in the oral cavity and teeth. Foetor ex ore was present in 2.4 percent of the subjects. Multiple regression analysis showed that calculus (P < 0.001), plaque (P < 0.01), and dental visits once every 3 yr. (P < 0.01) were significantly correlated to foetor ex ore. Periodontitis patients with foetor ex ore had more severe disease (P < 0.001) than those without. Foetor ex ore was not related to suspected halitosis. One percent of the subjects had suspected halitosis. Using multiple regression analysis, we found a significant correlation between calculus (P < 0.001) and suspected halitosis. In conclusion this study shows that foetor ex ore was correlated to oral hygiene and dental visits. Periodontitis patients with foetor ex ore had more severe disease than those without.

Prostaglandin E2 levels in blood plasma and in crevicular fluid of advanced periodontitis patients before and after surgical therapy.

AIM: The aim of the study was to determine PGE2 levels in venous blood plasma (VBP), gingival blood plasma (GBP) and gingival crevicular fluid (GCF) in advanced periodontal patients before and after 6 months surgical treatment. PATIENTS AND METHODS: There were 12 patients aged 28-45 years and seven healthy subjects as controls included into the study. Clinical parameters such as PLI, GI, BI, PD, AL and bone height % from radiographs were recorded before and after treatment. PGE2 levels were determined by radioimmunoassay (125 I RIA Kit, NEN(R)). RESULTS: Before treatment the mean VBP, GBP and GCF PGE2 levels in periodontal patients were higher than healthy controls (P < 0.001, Student's t-test). Six months after treatment the mean levels of PGE2 in VBP, GBP and GCF were significantly reduced in patients with improvement of clinical and roentgenological parameters (P < 0.001, Student's t-test). CONCLUSIONS: It can be concluded that PGE2 is involved in the pathogenesis of periodontal disease. The inflamed periodontal tissues may produce significant amount of PGE2 and the degree of inflammation might be determined by the ratios of PGE2. The lower levels of PGE2 in blood plasma and in gingival crevicular fluid after treatment are signs of improvement of periodontal disease.

Granulocyte elastase activity and PGE2 levels in gingival crevicular fluid in relation to the presence of subgingival periodontopathogens in subjects with untreated adult periodontitis.

This study aimed to determine the association between the levels of granulocyte elastase and prostaglandin E2 (PGE2) in GCE and the concomitant presence of periodontopathogens in untreated adult periodontitis (AP). GCF and subgingival plaque were sampled by paper strips and paper points respectively, from various periodontal sites in 16 AP subjects. Granulocyte elastase activity in GCF was analyzed with a low molecular weight substrate specific for granulocyte elastase, pGluProVal-pNA, and the maximal rate of elastase activity (MR-EA, mAbs/min/site) was calculated. PGE2 levels in GCF were determined by radioimmunoassay. 5 species-specific DNA probes were used to detect the presence of A. actinomyceterncomitans (A.a., ATCC 43718), B. forsythus (B.f, ATCC 43037), P. gingivalis (P.g., ATCC 33277), P. intermedia (P.i., ATCC 33563), and T. denticola (T.d., ATCC 35405), with a sensitivity of 10(3) cells/paper point. No A.a. was detectable from all sites sampled. The predominant combination of species detected was B.f., P.g., P.i. & T.d. and it was significantly higher at periodontitis sites (68%) than at healthy (7%) or gingivitis sites (29%) (p<0.05). Overall, MR-EA values were strongly correlated with PGE2 levels (r=0.655, p<0.001), especially at these periodontitis sites co-infected by B.f., P.g., P.i. & T.d. (r=0.722, p<0.001). The periodontitis sites co-infected by the 4 species were observable from 15 subjects. These sites were sub-grouped into 8 subjects with a high MR-EA and 7 subjects with a low MR-EA. The PGE2 levels in the high MR-EA group were significantly higher than in the low MR-EA group (p<0.05). No significant differences in clinical or bacterial data were found between the two groups. While within the high MR-EA group, similar results were found between the paired periodontitis sites in each subject with highest and lowest MR-EA values. This study shows that the local host response to bacterial challenge in untreated periodontal pockets is diverse in terms of the intensity of inflammatory response measured by granulocyte elastase and PGE2 levels in GCE A more thorough evaluation of the risk for active periodontal disease may involve the combined approaches to the test of the dynamic bacteria-host relations.

A 15-month evaluation of the effects of repeated subgingival minocycline in chronic adult periodontitis.

BACKGROUND: A double-blind, randomized, parallel, comparative study was designed to evaluate the long-term safety and efficacy of subgingivally administered minocycline ointment versus a vehicle control. METHODS: One hundred four patients (104) with moderate to severe adult periodontitis (34 to 64 years of age; mean 46 years) were enrolled in the study. Following scaling and root planing, patients were randomized to receive either 2% minocycline ointment or a matched vehicle control. Study medication was administered directly into the periodontal pocket with a specially designed, graduated, disposable applicator at baseline; week 2; and at months 1, 3, 6, 9, and 12. Scaling and root planing was repeated at months 6 and 12. Standard clinical variables (including probing depth and attachment level) were evaluated at baseline and at months 1, 3, 6, 9, 12, and 15. Microbiological sampling using DNA probes was done at baseline; at week 2; and at months 1, 3, 6, 9, 12, and 15. RESULTS: Both treatment groups showed significant and clinically relevant reductions in the numbers of each of the 7 microorganisms measured during the entire 15-month study period. When differences were detected, sites treated with minocycline ointment always produced statistically significantly greater reductions than sites which received the vehicle control. For initial pockets > or =5 mm, a mean reduction in probing depth of 1.9 mm was seen in the test sites, versus 1.2 mm in the control sites. Sites with a baseline probing depth > or =7 mm and bleeding index >2 showed an average of 2.5 mm reduction with minocycline versus 1.5 mm with the vehicle. Gains in attachment (0.9 mm and 1.1 mm) were observed in minocycline-treated sites, with baseline probing depth > or =5 mm and > or =7 mm, respectively, compared with 0.5 mm and 0.7 mm gain at control sites. Subgingival administration of minocycline ointment was well tolerated. CONCLUSIONS: Overall, the results demonstrate that repeated subgingival administration of minocycline ointment in the treatment of adult periodontitis is safe and leads to significant adjunctive improvement after subgingival instrumentation in both clinical and microbiologic variables over a 15-month period.

Development of plaque and gingivitis after mouthrinsing with 0.2% delmopinol hydrochloride.

A double-blind, randomized, 2-wk experimental gingivitis clinical trial with cross-over design in 14 dental students was conducted in order to study the efficacy and safety of delmopinol hydrochloride solution (2 mg/ml), used with no other oral hygiene procedures, in comparison with placebo. Plaque formation was measured by the Quigley & Hein Plaque Index and gingivitis was assessed by bleeding on probing according to Mühlemann & Son. Rinsing with delmopinol resulted in lower plaque scores compared to placebo. The development of gingivitis was weak during the 2-wk test periods, and thus no conclusive results were obtained. As in previous studies, the most frequent adverse event when rinsing with delmopinol was a transient anaesthetic sensation in the oral mucosa. The results showed that rinsing with delmopinol hydrochloride solution (2 mg/ml) for 60 s twice daily with no other oral hygiene procedures led to less plaque formation than rinsing with placebo. This study also showed good tolerance and acceptability of mouthrinsing with delmopinol.

Variations in crevicular fluid elastase levels in periodontitis patients on long-term maintenance.

Granulocyte elastase was determined in the gingival crevicular fluid (GCF) of 18 periodontitis patients. They initially had similar severity of disease but had responded differently to 5-yr maintenance, 13 responders and 5 non-responders. A total of 102 sites were investigated and categorized as: i) consistently healthy, ii) healthy after treatment, iii) gingivitis, and iv) periodontitis, according to clinical criteria. GCF elastase activity was determined with a granulocyte-specific substrate. The sites from non-responders had consistently higher elastase levels than the corresponding category of sites from responders, despite similar gingival inflammation and periodontal destruction, with the exception of consistently healthy sites. Within the non-responders, the periodontitis sites had higher elastase levels than the gingivitis sites commensurate with probing depth, while no difference existed between gingivitis sites and sites healthy after treatment, despite a difference in probing depth. In contrast, in the responders similar elastase levels were found at the periodontitis sites and gingivitis sites despite difference in probing depth, while both diseased sites had higher elastase levels than the sites healthy after treatment, commensurate with probing depth. This study suggests that increased granulocyte-specific elastase levels in GCF may serve as a diagnostic marker for refractory periodontitis patients.

A longitudinal investigation of the individual consistency of plaque levels in adults.

The present investigation was designed to determine the individual variation of plaque levels in adults over a period of 3 months. The participants were 20 healthy subjects, 11 men and 9 women, with a mean age of 42.3 +/- 7.3(SD) years. Plaque area was determined with a computerized image analysis system and expressed as percentage of tooth area (P% Index). The scoring procedures were carried out three times (tests 1, 2, and 3) at an interval of 4 weeks. After each test all plaque was removed. All subjects were instructed to maintain their personal oral hygiene habits during the study. The results showed no significant differences for the means of P% Index between tests 1, 2, and 3 in the whole mouth, upper and lower jaws, right and left sides, or each tooth surface. The intraindividual plaque levels for individual tooth surfaces were closely correlated between tests 1, 2 and 3. The intraindividual plaque level was consistent in tests 1, 2, and 3 with standard deviations within subjects ranging from 1.1% to 6.2%. This study suggests that individual plaque levels seem to be consistent on the basis of tooth surface over a certain period of time. Individual plaque control should be more directed towards tooth surfaces with comparably high plaque accumulation within the mouth for significant reduction of the overall plaque levels.

Granulocyte elastase in gingival crevicular fluid: improved monitoring of the site-specific response to treatment in patients with destructive periodontitis.

In 13 patients with severe destructive periodontitis, the response to periodontal therapy was estimated by granulocyte elastase level in gingival crevicular fluid (GCF). 62 sites were classified according to changes of probing depths (PD) and quantitative bone height (BH%) before and after 5-year regular maintenance treatment: (i) 17 consistently healthy sites with no changes of PD and BH%; (ii) 6 initially healthy sites with deterioration in PD and BH%; (iii) 14 diseased sites with improvement in PD and BH%; (iv) 25 diseased sites with no improvement in PD and BH%. GCF was collected by an intracrevicular washing system. The released elastase in the supernatants (EA-S) and the cell-bound elastase in the pellets (EA-P) were determined with a low molecular weight substrate specific for granulocyte elastase. The ratio of EA-S and EA-P (S/P-ratio) was used as a relative measure of elastase released by the granulocytes present. The sites classified as diseased with no improvement or initially healthy but deteriorating, had significantly higher EA-S, EA-P and S/P-ratios than the consistently healthy sites or diseased but improving sites (p < 0.01). Both EA-S and S/P-ratio showed strongly positive correlations with the current levels of gingival inflammation and periodontal destruction (p < 0.001). The present study suggests that increased elastase level is associated with disease progression, and may be used to monitor the response to longitudinal maintenance therapy.

The relation between tooth eruption and alveolar crest height in a human skeletal sample.

It is commonly assumed that alveolar crest height increases with continuing tooth eruption unless affected by marginal inflammation. To test this hypothesis, the relation between eruption and alveolar crest height was examined in skulls from a sample consisting of the remains of 244 individuals from the late medieval period. The mandibular first and second molars and second premolars were analysed. The age of the skulls was determined on the basis of dental development and molar attrition. Radiographs were taken and points representing the levels of the inferior dental canal (IDC), root apices (AP), alveolar crest (AC), cementum-enamel junction (CEJ) and occlusal surface were determined on the radiographs. The level of the IDC was used as a reference not changing with age. The distances between the points were measured with a help of a computer-digitizer system. Variable IDC-AP increased with age, indicating continuous eruption of the teeth. The distance between AC and CEJ also increased while the distance between IDC and AC remained constant, showing that the alveolar crest height did not increase accordingly. The lack of inflammatory changes on the alveolar bone surface suggests that occlusal attrition may be compensated for by continuous eruption without bone growth in the alveolar margin.

Clinical characteristics of destructive periodontitis in a risk group of Swedish urban adults.

An initial screening investigation of 1681 Swedish urban adults aged 31-40 years with untreated periodontitis showed that 17.2% (289) had at least one site with probing depth > or = 5 mm. The 289 subjects were offered a complete clinical examination and treatment. 144 subjects, 85 men and 59 women, agreed to participate and 145 were non-responding subjects and used as a drop out sample. The results from the screening data showed that the attendants had poorer oral hygiene status and more severe periodontitis than the drop out subjects. The present report describes clinical data of this representative sample with adult periodontitis. Clinical indices were recorded and bone height (BH%) for all teeth was measured with a computer digitizing system. In the 144 attendants, Plaque Index was > 1 in 56.2%, Calculus Index was > 1 in 57.0%, Gingival Index was > 1 in 97.2% and bleeding on probing was found in 89.1% of the sites. 11.1% of the subjects had 1-3 teeth with probing depth > or = 5 mm, 59.0% 4-10 teeth, 25.7% 11-20 teeth and 4.2% > 20 teeth. 47.9% of the subjects had mean BH% less than 80. 45.1% of the subjects had at least one site with an intrabony defect, of which 20% had 3-4 sites and 27.7% > or = 5 sites. It is concluded that advanced generalized periodontitis exists in a limited number of 31-40 year-olds in Sweden. Specific risk factors may be involved in the pathogenesis of the disease.

Periodontal status in an urban adult population in Sweden.

The purpose was to describe the current periodontal status in a Swedish urban population aged 31-40 yr. 1681 individuals, 840 men and 841 women, participated in the study. 68.5% of the subjects had low amount of plaque, 82.8% low level of calculus and 28.9% healthy gingiva or mild gingivitis. 82.8% of the subjects had no pockets with probing depth (PD) > or = 5 mm. 4.9% of the subjects had one tooth with PD > or = 5 mm, 6.7% 2-5 teeth, 2.4% 6-9 teeth and 3.2% > or = 10 teeth with pockets. 55.8% of the subjects had no missing teeth, third molars excluded. 16.5% had one tooth missing, 23.8% 2-5 teeth, 2.7% 6-9 teeth and 1.2% > or = 10 teeth. 8.6% of the subjects had at least one front tooth missing, 28.7% one premolar and 24.1% one molar missing. Men had significantly higher scores than women for plaque (DI-S), calculus (CI-S), gingivitis (GI-M), and number and percent of remaining teeth with PD > or = 5 mm. Smokers had significantly higher scores than non-smokers for DI-S, CI-S, GI-M, number and percent of remaining teeth with PD > or = 5 mm, and number of missing teeth. The individuals who visited the dentist every year had better oral hygiene and gingival status than those who attended for > 3 yr. The multiple regression analysis showed that calculus (P = 0.0001) smoking (P = 0.001), and dental visits (P = 0.0284) were significantly correlated to the number of teeth with PD > or = 5 mm.

Factors associated with salivary buffering capacity in young adults in Stockholm, Sweden.

The buffering capacity and flow rate of stimulated whole saliva were assessed in 150 persons, 20-24 yr of age. The associations were assessed between the buffer value and the flow rate, some dietary factors, tobacco habits, use of oral contraceptives, and some demographic variables. The results demonstrate that a low flow rate may predict a low buffer value but not a high value. Flow rate accounted for the largest part of the buffering variation but morning and afternoon saliva sampling, female gender, food consumption between meals, and smoking seem to have contributed to low buffering values. Snuff-taking habits, oral contraceptives, and protein consumption between meals were not associated with the buffering capacity.

DNA probe detection of periodontopathogens in advanced periodontitis.

Species-specific DNA probes were used to determine the presence of Actinobacillus actinomycetemcomitans (A.a.), Porphyromonas (Bacteroides) gingivalis, Prevotella intermedia, Treponema denticola, Eikenella corrodens, Fusobacterium nucleatum, and Wolinella recta in subgingival plaque from deep pockets/sites of patients with advanced periodontitis. The subjects were 20 patients with severe adult periodontitis, 13 men and 7 women (mean age 45.6 +/- 6.7 yr). For each subject, 9-10 subgingival sites with the deepest probing depths from each quadrant were sampled by the paper point method, a total of 198 sites, with mean probing depth 7.2 +/- 1.6 mm and clinical attachment level 9.5 +/- 2.7 mm. A.a. was present in at least one site in 75% of the subjects; P. gingivalis was found in 95%; P. intermedia and W. recta were found in 90%, respectively; and T. denticola, E. corrodens, and F. nucleatum were found in all subjects. In the 198 samples, A.a. was detected in 25.8%, P. gingivalis in 51.5%, P. intermedia in 64.1%, T. denticola in 60.6%, E. corrodens in 72.9%, F. nucleatum in 74.7%, and W. recta in 65.7%. The predominant combination was the simultaneous presence of P. intermedia, T. denticola, E. corrodens, F. nucleatum, and W. recta in 89.5% of the subjects and 46.8% of the sites. Of these sites, 51.1% showed the combined presence of P. gingivalis and 28.4% that of both A.a. and P. gingivalis. None of the seven bacteria could be detected in 14.4% of the total sites sampled. The present study indicates that severe destructive adult periodontitis is a multibacterial infection and that certain combinations of periodontopathogens seem to be important in the pathogenesis of the disease.

Computerized planimetric method for clinical plaque measurement.

A computerized planimetric method for plaque area measurement has been developed. Using a computerized image analysis system (CIAS), the plaque area and tooth area on color slides were digitized and the number of pixels automatically counted. The proposed Plaque Percent Index (P% Index) expresses plaque area as a percentage of tooth area. The reproducibility of this method was tested and the influence of photographic technique on the P% Index was determined. The association of the Turesky modified Quigley-Hein plaque index (Q-H Index) and the P% Index was assessed. The present method was highly reproducible for the P% Index with an intraexaminer variation of 0.28% and intraexaminer correlation coefficient of 0.99. The results show that highly reproducible P% Index values with an error of less than 3.0% were obtained when the photographs were taken under the following conditions. For the buccal surfaces of anterior teeth, the slides were photographed within a 20-degree range in the horizontal plane and a 30-degree range in the vertical plane; and for the lingual/palatal surfaces of anterior teeth and the buccal or lingual/palatal surfaces of posterior teeth, the slides were photographed with an image of the whole tooth surfaces in the photographic mirrors. The comparison of the Q-H Index and the P% Index revealed that for each score of the Q-H Index the corresponding values of P% Index were wide with a significant crossover value, although a strongly positive correlation was found between the Q-H Index and the P% Index (r = 0.92, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Granulocyte elastase in gingival crevicular fluid. A possible discriminator between gingivitis and periodontitis.

The granulocyte elastase activity and the immuno-reactive (antigenic) granulocyte elastase of gingival crevicular fluid (GCF) were studied in 16 periodontitis patients and in 10 gingivitis patients. The elastase activity was measured with a low molecular weight substrate specific for granulocyte elastase. The antigenic elastase was determined with specific antibodies against granulocyte elastase. Intracrevicular sampling of GCF with paper strips for 30 s seemed to provide representative values of elastase. The elastase activity correlated with probing depth and attachment loss and appeared to be a measure of the degree of tissue destruction. Antigenic elastase represents the number of granulocytes in GCF and should thus be related to the degree of inflammation. The periodontitis patients and the gingivitis patients both had a similar degree of inflammation as measured by antigenic elastase per microliter GCF and gingival index. The elastase activity per microliter GCF, however, was higher in the periodontitis group. Elevated granulocyte elastase activity in GCF seems to be independent of inflammation and could thus be an indicator of patients at risk for periodontitis.

Gingival fluid and tissues around successful titanium and ceramic implants. A comparative clinical, laboratory, and morphologic study.

The gingival tissue reactions around 19 titanium implants (Brånemark System) and 6 ceramic implants (Frialit) were studied by using established variables for monitoring periodontal status. Natural teeth in the same or the opposite jaw served as controls. Both clinical and laboratory examinations showed healthy gingival status. No differences in soft-tissue reactions between the two types of implant or between the implants and the natural teeth were registered.