Association between type 1 diabetes and periodontal health.

PURPOSE: We assessed periodontal status in patients with type 1 diabetes and healthy individuals in relation to their glycemic control, smoking and inflammatory biomarkers. MATERIAL/METHODS: Periodontal status was examined in 107 patients with diabetes and 40 controls, using Oral Hygiene Index (OHI), Community Periodontal Index (CPI) and tooth number. CPI values of 0-2 and 3-4 were classified as non-periodontitis and periodontitis, respectively. Blood samples were analyzed for glucose, HbA1c, CRP, fibrinogen, interleukin-1 and tumor necrosis factor-alpha (TNF-α). RESULTS: Periodontitis was found in 15.0% of the controls and 57.9% of diabetic patients, including 40.0% of these with good metabolic control (GMC) and 59.5% of those with poor metabolic control (PMC). Severe periodontitis was more frequent in the PMC than in the GMC group and in the controls (26.0% vs. 20.0% vs. 5.0%). The PMC patients had lower number of sextants with CPI 0 and higher number of sextants with CPI 3 and CPI 4 as well as lower tooth number in comparison with the controls. The patients with periodontitis had higher TNF-α (p<0.001) and OHI (p<0.001) than the patients without periodontitis. The number of sextants with CPI 0 correlated negatively with fibrinogen and TNF-α levels, whereas the number of sextants with CPI 3 correlated positively with TNF-α and fasting glucose level. CONCLUSIONS: There is good evidence that type 1 diabetes increases the risk of periodontal disease. Our results suggest that poor metabolic control of diabetes together with smoking and inadequate oral hygiene increase the risk of severe periodontal destruction in patients with type 1 diabetes.

Pulpal involvement-roots-sepsis index: a new method for describing the clinical consequences of untreated dental caries.

OBJECTIVES: To describe a modification of the index of clinical consequences of untreated dental caries [pulpal involvement, ulceration, fistula and abscess (PUFA/pufa) index] to pulpal involvement-roots-sepsis (PRS/prs) and to compare the two indices using the example of caries in primary molar teeth in children aged 6-8 years. SUBJECTS AND METHODS: The study sample included 542 children aged 6-8 years, from five randomly selected schools in the Bialystok District, Poland. The occurrence of clinical consequences of untreated caries in deciduous molars using the pufa and prs indices was evaluated. Data were analysed to express the prevalence, the experience and the distribution of particular pufa and prs codes in the sample population. The differences in layout of the pufa and prs components were expressed. RESULTS: The response rate was 77.6%. The prevalence of the clinical consequences of untreated caries was 40.77%, mean pufa and prs were the same (0.85 ± 1.33). According to the pufa index, the following mean values were obtained: p = 0.79, u = 0.01, f = 0.04 and a = 0.01. For the prs index, the mean values were as follows: p = 0.45, r = 0.35 and s = 0.05. CONCLUSION: The proposed prs index was a useful epidemiological instrument for the evaluation of the clinical consequences of untreated caries in the surveyed population. The PRS instrument could be a good alternative to the PUFA index.

Cytological picture of the oral mucosa in patients with gastric and colon cancer.

The incidence of malignant gastrointestinal cancers in Poland has been constantly growing, which has led to an intensification of the search for new markers of the early clinical stage of this disease. The oral cavity,as the first part of the gastrointestinal tract, has a very important role. The oral cavity presents symptoms of both typically stomatological and systemic diseases. Oral cancers, benign or malignant, may originate and grow in any of the tissues of the mouth, and within this small area they may be of varied clinical, histological and biological features. These can be lesions typically observed in the oral cavity, but also characteristic of cases where the symptoms occur both in the mouth and in other body parts. The aim of this study was to present a cytological picture of the oral mucosa in patients with gastric and colon cancer and to compare the cytological picture with that obtained from a group of patients with no cancer, using the Papanicolaou classification and the Bethesda system. The study was conducted in 126 patients treated surgically in the II General and Gastroenterological Surgery Clinic between 2006 and 2008. All patients were divided into two groups based on the type of lesions. In both of the studied groups, more than half of the patients did not present any abnormalities in the mucosa of the mouth, lips and cheeks in the physical examination. None of the patients had erosion, ulceration or lesions typical of leukoplakia or lichen planus. No malignant cells were detected in either of the studied groups, and there were no well-defined lesions found in the oral cavity that would distinguish the patients with gastrointestinal cancer.

Ozone in dentistry: microbiological effects of gas action depending on the method and the time of application using the ozonytron device. Experimental study.

INTRODUCTION: Bactericidal, virucidal, and fungicidal activity of ozone is generally known and has been exploited for years in industry and medicine. Ozone therapy became an inherent element of the treatment of infection in such fields as surgery, dermatology, cosmetics, and dentistry. Ozone is a gas, so it penetrates very well even into such tissues and spaces that are not easily accessible. Thanks to the property of deep penetration and long ozone presence in tissues after treatment, a long-lasting bactericidal effect is achieved. The action of oxygen radicals is, however, not neutral for the human organism, therefore the use of an appropriate procedure and therapy algorithms is essential. MATERIAL AND METHODS: We decided to confirm the effect of antibacterial activity of ozone applied by means of the Ozonytron device (made by Biozonix) on model strains of Streptococcus salivarius, pneumonia, pyogenes, and agalactiae, Enterococcus faecalis, Staphylococcus aureus and epidermidis, using two application patterns developed by us. RESULTS: We found a statistically significant difference in the size of zones of inhibited bacterial growth on all media depending on the time of action of ozone. In the present paper, the bactericidal activity of ozone in relation to bacterial strains that are most frequently isolated from the oral cavity was confirmed. What is more, two models of application of the gas on the infected medium were compared. CONCLUSION: Research on the use of ozone in combatting bacteria typical for dental diseases has shown that the gas has an oxidizing effect on these bacteria and is bactericidal.

[Salivary phosphate-binding chewing gum--an integrative approach to chronic kidney disease and oral diseases]. / Guma do zucia wiazaca fosforany--jednoczesne leczenie przewleklej choroby nerek i chorób jamy ustnej.

The course and treatment of chronic kidney disease (CKD) is adversely affected by numerous metabolic disarrangements, comorbid states and general diseases, i.e. hyperphosphatemia and metabolic bone disease, chronic inflammation, accelerated atherosclerosis (partly of infectious etiology) and devastating cardiovascular disease. Furthermore, CKD patients are usually afflicted by multiple oral abnormalities, including troublesome oral dryness and the very aggressive form of periodontal disease. The use of chitosan-containing chewing gum in CKD subjects seems to offer a novel therapeutic approach of interdisciplinary importance: the chitosan binds salivary phosphates and, when swallowed, likely phosphates in the alimentary tract, thus beneficially lowering blood phosphate levels, while the gum itself increases impaired salivary flow and has a potent oral antimicrobial activity. Thus, it effectively improves general oral hygiene and prevents progression of periodontal disease being (besides of hyperphosphatemia) one of the established causes of atherosclerosis development/progression. The undemanding maneuver of chewing the chitosan-containing, phosphate-binding gum has a potential to diminish excessive morbidity in CKD patients.

[Oral cavity changes in patients after kidney transplantation and preventive-treatment algorithms]. / Zmiany chorobowe w jamie ustnej u pacjentów po transplantacji nerki i algorytmy postepowania profilaktyczno-leczniczego.

Kidney transplantation is the best option of treatment for patients with end-stage renal failure. However, following kidney transplantation many stomatological abnormalities are frequently reported. It is mainly due to immunosuppressive therapy and subsequent impaired immune response. There is an increased risk of infections and malignancies. The most frequent findings in the oral cavity include: aphthae, erosions of bacterial, viral and fungal origin, lichen-like or leukoplakia-like changes. The another type of change is gingival hyperplasia and its periodontologial consequences. In this review etiology, clinical symptoms of periodontological changes are described together with algorithm of pre- and posttransplant management of oral healthy is provided.

The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients.

BACKGROUND: Periodontitis contributes to generalized inflammation and development of systemic diseases, including atherosclerosis and cardiovascular disease. Its extent in maintenance haemodialysis (HD) patients is disputable and not known in continuous ambulatory peritoneal dialysis (CAPD) and pre-dialysis chronic kidney disease (CKD) patients. METHODS: One hundred and six patients (35 on HD, mean age, 56 years; 33 on CAPD, mean age 51 years; and 38 pre-dialysis CKD stage 2-5, mean age 51 years) from north-eastern Poland were enrolled. Dialysis subjects were recruited from a cohort of 141 HD and 61 CAPD patients. Two control groups comprised 26 generally healthy individuals with advanced periodontitis requiring specialized treatment, and 30 subjects from general population. Gingival index (GI), papillary bleeding index (PBI), plaque index (PI), loss of clinical attachment level (CAL) and community periodontal index of treatment needs (CPITN) were determined according to WHO recommendations. RESULTS: Average values of the indices in HD, CAPD, pre-dialysis CKD, advanced periodontitis and general population subjects were as follows: GI-1.37, 0.95, 1, 2 and 1; PBI-1.45, 0, 0, 2.20 and 1; PI-2.05, 1.59, 1, 2 and 1; and CAL loss-5.11, 3.47, 2.50, 4.68 and 1.40 mm, respectively. CPITN, analysed separately as community periodontal index and periodontal treatment needs, further indicated a high severity of periodontitis in all renal failure groups as compared with general population subjects. The disease was most advanced in maintenance HD patients-comparable to the full-symptomatic form of periodontitis; then it was successively diminished in CAPD and pre-dialysis CKD subjects. CONCLUSIONS: Periodontal disease is prevalent, severe and under recognized in renal failure patients. Prophylaxis and early dental treatment should be intensified in these subjects, and may be of interdisciplinary importance.

Hepatocyte growth factor in saliva is a potential marker of symptomatic periodontal disease.

Evidence has been emerging that hepatocyte growth factor (HGF) - a pluripotential regenerative cytokine - is a key factor in the pathogenesis and progression of periodontal disease, mostly through its over-stimulation of gingival epithelial cell growth and impairment of the regeneration of collagenous structures. We measured the levels of immunoreactive HGF in unstimulated whole mixed saliva from 26 patients referred for treatment of periodontal disease, and from 20 healthy subjects. HGF was detected in all saliva samples from the patients, the concentration ranging from 0.06 to 5.38 ng/ml, with a mean concentration of 1.87 +/- 1.32 ng/ml. In healthy individuals, the median salivary HGF level was 0.68 ng/ml (range: 0 - 7.33 ng/ml), being almost 3-fold lower (P < 0.0001) than that in the patients. Periodontal parameters in the patients were: gingival index (GI) 2.0 (0 - 2.8), papillary bleeding index (PBI) 2.2 (0 - 3.2), plaque index (PI) 2.0 (0 - 3.0), probing depth (PD) 3.0 (1.8 - 5.9) mm, and loss of clinical attachment level (CAL) 4.7 (1.1 - 10.6) mm. We found that the salivary HGF level was positively correlated with GI (P = 0.004), PBI (P = 0.046) and PI (P = 0.001), but not with PD (P = 0.351), CAL loss (P = 0.172), number of teeth (P = 0.279) or patient age (P = 0.362). Our findings suggest that salivary HGF concentration may be a novel marker of symptomatic periodontal disease, and that it warrants further validation.

[Dietary habits and early childhood caries intensity among young children]. / Nawyki zywieniowe a intensywnosc próchnicy wczesnej u malych dzieci.

The aim of this study was to evaluate the influence of a diet and the feeding method on caries intensity among children aged 36-48 months. Dental examination was carried out in 255 children and their mothers were asked about child's dietary habits. The population checked was divided into three groups: with dmf = 0, dmf 1-3 and dmf > or = 4. Statistically significant correlation between caries intensity and bottle feeding during sleep and frequency of eating cariogenic food were shown. Parents of young children should be educated about the influence of dietary habits on dental condition.

[Metabolism of tryptophan via the kynurenine pathway in saliva]. / Metabolizm tryptofanu w slinie szlakiem kinureninowym.

In this review, the role of the kynurenine pathway enzymes TDO (tryptophan 2,3 dioxygenase) and IDO (indoleamine 2,3 -dioxygenase) as well as the properties of the metabolites of kynurenine degradation present in human saliva described. The implications of these metabolites in the pathomechanism of tissue and organs dysfunction are demonstrated. The authors also describe at length the role of saliva kynurenine derivatives in the onset and development of periodontal disease in humans.

Evaluation of selected peripheral blood leukocyte functions in patients with various forms of periodontal disease.

INTRODUCTION: Periodontitis (P) is an infectious disease that develops in the supporting tissues of the tooth. One of the risk factors leading to it may be dysfunction of some immune system cells. Therefore, the object of the study was to assess selected functions of peripheral blood leukocytes in patients with various forms of P. As leukocytes are able to secrete interleukin (IL)-4 and IL-6, concentrations of their soluble receptors and the expression of their membrane receptors were investigated. MATERIAL AND METHODS: Twenty generally healthy subjects with aggressive (AP)and chronic periodontitis (CP)were enrolled in the study. The control group consisted of 8 healthy subjects,with no changes in periodontium. Peripheral blood mononuclear cells (PBMCs) were isolated and cultured. Levels of IL-4,IL-6,and their soluble receptors sIL-4R and sIL-6R were determined in the supernatant by ELISA. The expressions of cell surface IL-4R and IL-6R were assayed on PBMC using flow cytometry. RESULTS: No statistically significant differences were found in the selected parameters between people with periodontal disease and healthy controls. However, in subjects with AP, there was an increasing tendency in IL-6 concentration and IL-4R expression on PBMCs. CONCLUSIONS: Our results show that leukocytes play a significant part in P and their activity is probably lesion-dependent. Estimation of the cytokines secreted by leukocytes may facilitate differentiation and prognosis of the disease progression.

Fluoride concentration in superficial enamel layers of permanent teeth in children residing in areas with different levels of environmental pollution with fluorine compounds.

The concentration of fluoride in superficial layers of enamel of permanent teeth was studied in 14-year-old children residing in Szczecin and Bialystok-two cities differing regarding the level of environmental fluorine pollution. It was found that higher environmental pollution with fluorine favors the accumulation of this element in superficial layers of enamel in the form of structural fluoride. Total and structural fluoride concentration decreased with layer depth.

[Periodontal disease and atherosclerosis: an underestimated link?]. / Choroba przyzebia i miazdzyca: niedoceniany zwiazek?

Periodontal disease is a common bacterial and destructive disorder of oral tissues. We reviewed epidemiological and experimental to data studies demonstrating close associations between chronic periodontitis and development of generalized inflammation, vascular endothelial injury, and atherosclerosis. Periodontal disease has been convincingly emerging as an important independent cardiovascular risk factor. It deserves timely treatment also as a likely part of primary prevention of ischemic heart disease, stroke, and peripheral vascular disease.

The influence of cervical lesion on the stress state and strength of tooth with occlusal restoration: a numerical model study.

This paper is concerned with bio-engineering problems in dentistry. The analysis of stress in a lower premolar with a deep non-carious cervical lesion and restored occlusal Class I cavity under occlusal load of 100 N was shown. Finite element method was used for the analysis of a two-dimensional model of a human tooth. In order to facilitate the evaluation of the loads, four cross-sections in characteristical points of the model were made. The model was generated and the calculations were done on IBM Pentium III personal computer. The principal and equivalent stresses were calculated and used in qualitative and quantative evaluation of tooth tissue and tooth restoration strength. The results are shown in figures and charts. The analysis of the cross-sections distant to the cervical area has proved that the presence or absence of cervical lesion has no significant influence on the values and stress distribution. Only in the region of sharp-shaped notch in the bottom of defect (4-4) high stresses in the tooth tissues occur. The values of stress did not exceed the compressive and tensile strength in any case under investigation. The study has shown that the presence of cervical angular lesion does not affect the mechanical strength of a tooth with a properly restored occlusal cavity. Clinically, the situation is safe from the biomechanical point of view.

[Paracervical non-caries defects]. / Przyszyjkowe ubytki pochodzenia niepróchnicowego.

The aim of the study was the description of origin and treatment of paracervical, non-caries defects. Dental plaque is involved in the formation of caries defects, while those of non-caries origin are produced due to the action of mechanical and chemical factors. The treatment consists in wide fluoride prophylaxis (elimination of causes) and in the application of mineralization procedures and restoration of missing dental tissue using modern dental highly-adhesive materials. At the same time occlusion disorders and parafunctions are eliminated.

Evaluation of lymphocyte populations and subpopulations extracted from inflamed periodontal tissues.

The aim of the present study was evaluation the distribution of B- and T-cells and T-cell subsets in periodontal tissues from patients with different periodontitis forms. Periodontal tissue samples were collected from group P patients during routine surgical procedures, while from group C during tooth extraction for orthodontic or prosthetic purposes. Directly after collection, tissue samples were placed in a criostat or fixed in 10% buffered formalin for 24 h at room temperature. Following fixation the material was embedded in paraffin and subjected to routine histological techniques. Examinations of B- and T-lymphocytes populations and T-lymphocytes subsets were made with the use of immunohistochemical method. In C group single T and B lymphocytes were found in histological examination in pocket epithelium zones. In early onset periodontitis (EOP) patients in inflammatory infiltration lymphocytes T were dominating while in adult periodontitis (AP) patients dominating were B lymphocytes. Mean CD4/CD8 ratio in control group was 1.7 and in EOP and AP patients 1.1 and 2.6 respectively.