Persistent presence of Bacteroides forsythus as a risk factor for attachment loss in a population with low prevalence and severity of adult periodontitis.

BACKGROUND: Previous longitudinal studies investigating the role of microorganisms in periodontitis have focused on subjects with a high prevalence and severity of disease. The complex profile of microbial species in severe cases of periodontitis might not allow us to differentiate which bacterial species initiate disease or which species simply proliferate after disease progression. This prospective longitudinal study followed a group of 205 subjects who showed a low prevalence and severity of adult periodontitis, and thus allowed us to monitor early microbiological changes in the development of periodontitis. METHODS: Subgingival plaque was collected from proximal surfaces of a posterior sextant at 6-month intervals for 2 years. During the monitoring period, 44 subjects had either attachment loss or attachment gain. Using multiplex polymerase chain reaction (PCR), all plaque samples from those 44 subjects were analyzed for the presence of Actinobacillus actinomycetemcomitans, Bacteroides forsythus, and Porphyromonas gingivalis. RESULTS: Both subjects with attachment loss and those with attachment gain had a high prevalence of these 3 periodontal pathogens. The mere presence of any of the 3 species at a site could not predict future attachment loss at that specific site. However, subjects with a persistent presence of B. forsythus at any site across all visits had 5.3 times higher odds of having at least one site in their mouth losing attachment compared to subjects with occasional or no presence of B. forsythus. CONCLUSIONS: The persistence of B. forsythus identified subjects at higher risk, but not which specific sites in those subjects would lose attachment.

Evidence of a substantial genetic basis for risk of adult periodontitis.

BACKGROUND: A few previous studies have suggested that risk for adult periodontitis (AP) has a genetic (heritable) component. We estimated genetic and environmental variances and heritability for gingivitis and adult periodontitis using data from twins reared together. METHODS: One hundred seventeen (117) pairs of adult twins (64 monozygotic [MZ] and 53 dizygotic [DZ] pairs) were recruited. Probing depth (PD), attachment loss (AL), plaque, and gingivitis (GI) were assessed on all teeth by two examiners. Measurements were averaged over all sites, teeth, and examiners. Extent of disease in subjects was defined at four thresholds: the percentage of teeth with AL > or = 2, AL > or = 3, PD > or = 4, or PD > or = 5 mm. Genetic and environmental variances and heritability were estimated using path models with maximum likelihood estimation techniques. RESULTS: MZ twins were more similar than DZ twins for all clinical measures. Statistically significant genetic variance was found for both the severity and extent of disease. AP was estimated to have approximately 50% heritability, which was unaltered following adjustments for behavioral variables including smoking. In contrast, while MZ twins were also more similar than DZ twins for gingivitis scores, there was no evidence of heritability for gingivitis after behavioral covariates such as utilization of dental care and smoking were incorporated into the analyses. CONCLUSIONS: These results confirm previous studies and indicate that approximately half of the variance in disease in the population is attributed to genetic variance. The basis for the heritability of periodontitis appears to be biological and not behavioral in nature.

Maintaining mutans streptococci suppression with xylitol chewing gum.

BACKGROUND: One strategy for treating dental caries is to suppress oral mutans streptococci, or MS, with chlorhexidine, or CHX, mouthrinse. Oral MS levels, however, tend to quickly return to baseline values without further intervention. In this clinical study, the authors evaluated the effect of xylitol chewing gum on MS regrowth. METHODS: The authors selected 151 subjects with elevated oral MS levels (> or = 105 colony-forming units per milliliter, or CFU/mL, of paraffin-stimulated saliva). Subjects rinsed with 0.12 percent CHX gluconate mouthrinse twice daily for 14 days. The authors then randomly assigned the subjects to one of three groups. Those in the test group (n = 51) chewed a commercial xylitol gum three times daily for a minimum of five minutes each time for three months. The placebo group subjects (n = 50) used a commercial sorbitol gum, and the control group subjects (n = 50) did not chew gum. The authors estimated MS load on the dentition using paraffin-stimulated saliva samples. The authors serially diluted the samples, plated them on selective media and incubated them anaerobically; they then enumerated the colonies under a stereomicroscope. RESULTS: MS levels were not significantly different between the three groups at baseline (mean log CFU/mL +/- standard deviation: 5.4 +/- 0.7, 5.4 +/- 0.8, 5.2 +/- 0.7, respectively) nor after CHX therapy (2.7 +/- 0.8, 3.1 +/- 1.1, 3.0 +/- 1.1, respectively). After three months of gum chewing, the test group subjects had significantly lower salivary MS levels (3.6 +/- 1.2) than did the placebo (4.7 +/- 1.2) or control (4.4 +/- 1.3) group subjects. CONCLUSIONS: Xylitol chewing gum appears to have the ability to prolong the effect of CHX therapy on oral MS. CLINICAL IMPLICATIONS: Maintaining long-term caries-pathogen suppression is feasible with currently available commercial products and can be expected to result in significant caries inhibition.

Effect of surface treatments on the wettability of vinyl polysiloxane impression materials.

STATEMENT OF PROBLEM: A number of vinyl polysiloxane (VPS) impression materials are claimed to be hydrophilic, but it has been hypothesized that the degree of hydrophilicity may be altered by the exposure to saliva, disinfecting agents, and surfactants. PURPOSE: This study compared the effects of 6 treatment regimes on the hydrophilicity of 3 VPS materials. MATERIAL AND METHODS: Three VPS materials (Dimension Garant L, Hydroflex, Imprint II, referred to as G, H, and I, respectively) were each treated with: (1) nothing (control), (2) saliva, (3) saliva and NaOCl, (4) saliva and 2-propanol-based disinfectant, (5) saliva, NaOCl and surfactant, and 6) saliva, 2-propanol-based disinfectant, and surfactant. Advancing contact angles (thetaA) were measured using a Cahn Dynamic contact angle analyzer and WinDCA software. Using saturated CaSO4 solutions, thetaA was determined for the 3 materials in each of the 6 conditions. For each combination of VPS and treatment, 5 determinations were made using fresh samples and fresh solution each time. Considerable contact angle hysteresis was observed. Two-way ANOVA was performed, followed by post-hoc Boneferroni-Dunn tests. RESULTS: For all outcome variables, the treatment effects were not the same for all materials (P < .001). However, for all materials, treatments that included surfactants were among the groups with the lowest thetaA values and thus had the best wettability. For example, materials G and I, as made, had high thetaA values (109.7 and 115.2 degrees, respectively), but these values reduced to approximately 90 degrees after surfactant treatment. Material H had a thetaA value of 87.1 degrees. Exposure of material H to saliva and/or a disinfectant raised this value, but a thetaA close to the original value was achieved by the use of a surfactant. CONCLUSION: Treatments affected the VPS materials in different ways but, after disinfectant treatment, the wetting of "hydrophilic" VPS materials was improved by surfactant treatment.

The use of bispectral analysis in patients undergoing intravenous sedation for third molar extractions.

PURPOSE: The bispectral (BIS) index has been used to interpret electroencephalogram (EEG) recordings to predict the level of sedation and loss of consciousness in patients undergoing general anesthesia. It was the purpose of this project to assess the usefulness of BIS technology in determining the level of sedation in patients undergoing third molar extraction under conscious sedation. PATIENTS AND METHODS: Twenty-five subjects undergoing third molar extraction in an outpatient setting were analyzed. The EEG activity was recorded continually during surgery using a microcomputer (Aspect-1050 Monitor; Aspect Co, Natick, MA) with real-time bispectral data obtained by EEG skin electrodes through a frontotemporal montage. The Observer's Assessment of Alertness and Sedation (OAA/S) scale was used to subjectively assess the level of sedation observed by the anesthetist before initiating the sedation procedure and then at 5-minute intervals until the end of the procedure. The BIS level was simultaneously recorded. The initial sedation was accomplished using a standard dose of midazolam (0.05 mg/kg) and fentanyl (1.5 microg/kg) followed by a 10- to 30-mg bolus of propofol until a level of sedation at which the patient's eyes were closed and he or she was responsive only to vigorous stimulation or repeated loud calling of their name (OAA/S level of 1 to 2). Local anesthesia was then administered. Additional doses of sedative medication (midazolam or propofol) were given during the procedure to maintain the desired level of sedation (an OAA/S level of 2 to 3). The time and dose of the drug given were recorded. The level of sedation based on a single anesthetist's interpretation (OAA/S) and the BIS readings were then compared. RESULTS: A strong positive relationship between the BIS index and OAA/S readings was found (P < .0001). Pairwise comparisons of mean BIS index and its corresponding OAA/S level were significantly different from each other (P < .003) except for OAA/S levels 2 and 3 (P = .367). CONCLUSION: BIS technology offers an objective, ordinal means of assessing the depth of sedation. There was a strong relationship between the objective BIS values and subjective assessment (OAA/S scale) of the depth of anesthesia. This can be invaluable in providing an objective assessment of sedation in oral and maxillofacial surgery where it may be difficult to determine the level of sedation clinically.