ABSTRACT
The current data suggest that local delivery of antimicrobials into the periodontal pocket can improve periodontal health. However, they do not provide a superior result to scaling and root planing. In conjunction with scaling and root planing, the adjunctive use of local drug delivery devices may enhance the results in sites which do not respond to conventional therapy.
Subject(s)
Anti-Infective Agents, Local/administration & dosage , Doxycycline/analogs & derivatives , Periodontitis/drug therapy , Anti-Bacterial Agents/administration & dosage , Anti-Infective Agents, Local/adverse effects , Anti-Infective Agents, Local/pharmacokinetics , Chlorhexidine/administration & dosage , Doxycycline/administration & dosage , Drug Hypersensitivity/etiology , Drug Resistance, Microbial , Humans , Minocycline/administration & dosage , Periodontal Pocket/metabolism , Tetracycline/administration & dosageABSTRACT
BACKGROUND: Although a growing body of evidence indicates that oral irrigation with water has therapeutic benefits in periodontitis, the mechanisms of action have not been elucidated. The aims of this study were: (1) to analyze the effects of oral irrigation (Water Pik Oral Irrigator) on the clinical signs of adult periodontitis (AP) and on the levels of interleukin-1 beta (IL-beta), prostaglandin-E2 (PGE2), interleukin-10 (IL-10) and interferon-gamma (IFN-gamma) in GCF, and (2) to analyze the influence of the periodontitis-related IL-1 genotype (IL-1GT) on these variables. METHOD: A single-center, blinded study in otherwise healthy humans (n= 52) with localized mild to moderate AP was carried out, using the following groups: group A (n= 12), no oral hygiene for 14 days; group B (n=20), routine oral hygiene (ROH) for 14 days; group C (n=20), supra-gingival oral irrigation plus ROH for 14 days. Group A patients were crossed-over to group C for 14 days (=day 28) after a professional prophylaxis. Group assignment was randomized by a coin toss, with the exception of group A subjects, who were self-selected as per recommendations of the internal review board for human subjects. GCF was sampled from 3 study teeth per patient and analyzed for IL-1 beta, PGE2, IL-10 and IFN gamma by ELISA on days 0, 7, 14 and 28. Probing pocket depths (PPD), clinical attachment levels (CAL), bleeding on probing (BOP), gingival index (GI) and plaque index (PI) were measured by a calibrated examiner (TWS) on days 0, 14 and 28. Analysis of covariance was performed using SAS 6.12 and Proc Mixed with group and IL-1GT as the factors and the baseline levels as the covariate, with output being least squares means and least significant difference (LSD). Significant differences were declared if the p-value for the F-statistic was < or =0.05. RESULTS: Oral irrigation plus ROH resulted in a significant reduction in PPD, BOP, GI and PI, as well as IL-beta levels by 7 days and PGE2 levels by 14 days, relative to ROH or no oral hygiene. Interestingly, decreased IL-1 beta levels in patients using oral irrigation plus ROH was accompanied by a trend for increased levels of the "anti-inflammatory" cytokine IL-10. ROH reduced GI, BOP and PI, and PGE2 levels by 14 days, but had no effect on IL-1 beta or IL-10 levels relative to no oral hygiene. The effects of no oral hygiene were reversed by a prophy followed by oral irrigation plus ROH for 14 days. No clinical differences were evident between IL-1 GT (+) patients (n= 1) and GT (-) patients (n=40), but the former had significantly elevated levels of GCF IL-10 and borderline increases in IL-1 beta (p=0.07). CONCLUSIONS: Oral irrigation with water for 14 days had an improved therapeutic benefit for AP over that of routine oral hygiene alone and this improvement was accompanied by a down-modulation of the pro-inflammatory cytokine profile in GCF.
Subject(s)
Cytokines/analysis , Dental Plaque/therapy , Inflammation Mediators/analysis , Periodontitis/therapy , Water , Adult , Dental Plaque/metabolism , Enzyme-Linked Immunosorbent Assay , Female , Gingival Crevicular Fluid/chemistry , Humans , Male , Middle Aged , Mouth , Oral Hygiene/methods , Periodontitis/metabolism , Single-Blind Method , Therapeutic Irrigation/methodsABSTRACT
CREST syndrome is a slowly progressive form of systemic scleroderma. It is characterized by calcinosis cutis, Raynaud's phenomenon, esophageal involvement, sclerodactyly, and telangiectasia. There are limited reports of dental treatment for patients with this syndrome, and no reports of periodontal surgical procedures. This paper presents a case report of periodontal surgical treatment in a 38-year-old female patient with CREST syndrome, and a discussion of the clinical manifestations of the syndrome as they relate to dental treatment.
Subject(s)
CREST Syndrome/complications , Gingival Recession/surgery , Adult , Dental Scaling , Female , Follow-Up Studies , Gingiva/transplantation , Gingival Recession/therapy , Humans , Oral Hygiene , Patient Education as Topic , Periodontal Pocket/therapy , Root Planing , Transplantation, AutologousABSTRACT
Thirty human mucogingival specimens were evaluated histologically and histochemically to determine whether a difference exists in the mucogingival junction of dentulous and edentulous areas of the maxilla and mandible. No significant differences were observed between the two areas. The presence of an intermediate zone is described, which may have clinical implications in some surgical procedures.
