Relationship between clinical periodontal condition and the radiological appearance at 1st molar sites in adolescents. A 3-year study.

There has been considerable controversy about the incidence of periodontal disease in adolescents. It is noteworthy that there is disagreement between workers as to be radiological features that should be used to detect the earliest signs of periodontitis, and variation in the choice of criteria may have influenced the results of previous studies. The present project represents a 3-year longitudinal assessment into the periodontal condition, assessed clinically and radiologically, of a group of adolescents. The radiographic investigations were carried out using vertical bitewing radiographs and, to reduce potential error caused by variation in film placement and tube alignment, individual impressions were used so that the film could be positioned accurately at repeat assessments. It was found that several of the radiographic features, such as the width of the periodontal ligament space and the angle of the interproximal bone crest relative to the tooth, similar to those previously attributed to the commencement of destructive periodontal changes, were found to be correlated with the maturation changes associated with the eruption of the adjoining permanent teeth. In spite of the use of impressions, some of the series of radiographs showed variation in tube alignment, and several of the above radiological features were also found to correlate with errors in radiographic technique. It was concluded that the various eruptive and maturation changes taking place during this stage in the adolescent dentition must be allowed for when looking for the earliest signs of periodontal destruction.

The effect of systemic ibuprofen on gingival inflammation in humans.

This clinical trial investigated the influence of short-term ibuprofen therapy on the early phase of the treatment of adult chronic periodontitis. The subjects were 17 patients in good general health referred for specialist periodontal treatment, having moderate chronic adult periodontitis. A series of assessments were made every 2 weeks over an 8-week period, including evaluations of oral hygiene, gingival inflammation and probing pocket depths. All participants received oral hygiene instruction, and following baseline examinations, had half the dentition, chosen at random, treated by scaling and root planing. The patients were randomly distributed into 2 groups, a test group receiving a 14-day course of 800 mg ibuprofen daily, in 4 divided doses, and a control group who did not receive any drug regime. At the 2-week assessment following the drug regime, significantly greater reduction in gingival bleeding, colour and pocketing was detected in the test compared with the control group. The beneficial effects were less evident thereafter. Although clinical application of the regime used in this study would not be justified by these results, further research into anti-inflammatory agents as an adjunct in the treatment of periodontal diseases could be considered, in the light of the beneficial effect on gingivitis in the early phase of periodontal treatment reported.

A 4-year controlled clinical study into the use of a ceramic hydroxylapatite implant material for the treatment of periodontal bone defects.

10 patients with chronic adult periodontitis who had greater than 1 tooth with infra-bony pockets were treated at the test defects by periodontal flap procedures with implantation of hydroxylapatite particles; the control defects were treated by the same surgical procedures but without the implant. A total of 58 test defects and 59 control defects were treated. Each defect had measurements carried out at given sites on the involved tooth surfaces, the sites being considered for subsequent tabulation purposes under the category of shallow (less than 3 mm) moderate (3-6 mm) and deep (greater than 6 mm) initial pocket depths. There were 146 and 152 shallow sites, 216 and 241 moderate sites and 140 and 133 deep sites, at test and control sites, respectively. Measurements of recession, probing pocket depths and probing attachment levels were made at 6 months and 1, 2, 3 and 4 years. At all sites over the period of the study, for the moderate and deep initial pockets there was a significant reduction in probing depths and an increase in the probing attachment levels. At the 4th year of assessment for the initially deep pockets, the reduction in probing depths was significantly greater for the sites treated with the implant material. In view of the difficult clinical problem posed by the treatment of teeth with deeper periodontal bone defects, further research using either this type of implant material or similar material should be considered.

Computerized densitometric analysis of interproximal bone levels in a controlled clinical study into the treatment of periodontal bone defects with ceramic hydroxyapatite implant material.

The aim of this controlled clinical study was to utilize computer-assisted densitometric analysis of radiographs to assess the effectiveness of treating periodontal osseous defects with a sintered hydroxyapatite implant material. It was found that over the 2-year period of the study for the osseous defects treated by the implant material, there was a gain in the height of the hard tissue relative to the cemento-enamel junction; this gain was statistically significant compared with the results for the control sites.

A comparison between measurements made with a conventional periodontal pocket probe, an electronic pressure probe and measurements made at surgery.

This study compared clinical measurements using a manual periodontal probe and an electronic pressure probe using a 0.25 N force, and related them to measurement of the bone levels at the time of surgery. All measurements were taken from the cemento-enamel junction at specified sites. It was found that neither probing technique provided a means for accurately measuring bone level. In the presence of healed tissue, little difference was found between the two instruments; whereas the manual probe more closely approximated the actual level of bone in the presence of inflammation. It was therefore concluded that under the conditions of present study the manual probe depth measurements were the more applicable for routine clinical use.

Histological investigation of the tissue response to hydroxyapatite used as an implant material in periodontal treatment.

Patients with severe periodontitis and who had one or more teeth with infrabony pockets were treated by periodontal surgery with implantation of hydroxyapatite particles into the bone defects at the time of surgery. Subsequently, in three patients it was found necessary to extract a tooth for reasons not related to the previous periodontal treatment. Specimens that included the local soft tissues and crestal bone attached to the teeth were obtained at 22, 40 and 80 weeks after placement of the implant. They were decalcified and stained with haematoxylin and eosin and examined under light microscopy. The healing response was found to vary between specimens, and between sites within the same specimen. The early stage of healing showed the implant particles surrounded by collagen. Subsequently, varying degrees of resorption of the periphery of the particles was seen, and at some sites bone deposition was observed. These different healing responses were found to be progressing concurrently at sites in close proximity. Further work is needed to confirm the histological findings described in the paper.

The relationship between the multidimensional health locus of control and the performance of subjects on a preventive periodontal programme.

Criteria have been defined to quantify a personality characteristic-termed locus of control. The criterion at one extreme of this range was referred to as external, indicating a belief that health was determined by a variety of other factors such as powerful other individuals or by chance. The criterion at the other extreme was termed internal, indicating a belief that health might be modified by the behaviour pattern of the individual. Locus of control scales have been used to relate psychological factors to physical disease, and the response of patients to disease. The aim of the present study was to investigate whether locus of control could be used to anticipate the response of subjects to a plaque control programme. A study was carried out on 14 males and 46 females to investigate the relationship between the multidimensional health locus of control (MHLC) and the response of a group of office workers to a plaque control programme. It was found that there was significant correlation between the external MHLC dimension of powerful others and improvement in some of the clinical criteria; a similar result was found for the internal dimension of the MHLC. In contrast, there was minimal correlation between the external dimension of the MHLC termed chance and the clinical results. It was concluded that subjects who perceive their susceptibility to disease being influenced by powerful external factors or who believe that susceptibility can be controlled by their own actions, respond more positively to a plaque control regime than those subjects who consider that susceptibility to disease is an event of chance.

A comparison of 4 techniques for clinical detection of early plaque formed during different dietary regimes.

The purpose of this study was to evaluate the sensitivity of 4 clinical techniques used in detecting early plaque during a period of dietary sucrose restriction and during a period of sucrose supplementation. The accumulation of plaque during experimental periods of 3 h, 6 h and 18 h was recorded in a group of 38 dental personnel for the 1st part of the study, and in a group of 32 for the 2nd part. Plaque levels were assessed using a caries probe, a plaque detection probe, erythrosin and a 2-tone disclosing agent. There was a progressive increase in plaque over the period of the study, with significant variation between the detection methods used and the sites being assessed. Plaque formed more rapidly interdentially and on the posterior teeth. 3 h after the teeth had been thoroughly cleaned, plaque was detectable on over 12% of sites for the sucrose-restricted diet and on up to 23% of sites for the sucrose-supplemented diet. After 18 h of plaque formation, the proportion of plaque-covered surfaces had increased to between 52% and 73%. For minimal amounts of plaque, the disclosing solutions were found to be the most sensitive assessment techniques. However, for moderate and abundant plaque deposits, the techniques using the probes resulted in a greater degree of differentiation in the proportional measurements of plaque. Overall, the plaque probe was found to be as sensitive or better than the other techniques under most conditions and was favoured on clinical grounds, as it aided access to the interdental areas and provided a contrasting colour at the tip to enable plaque to be detected with greater ease.(ABSTRACT TRUNCATED AT 250 WORDS)

An investigation into the response of subjects to a plaque control programme as influenced by friends and relatives.

The aim of the present study was to assess the response of patients to a course of instruction in plaque control as influenced by friends and relatives. The subjects in the study were 41 patients who had been referred to a dental hospital for treatment. There was a major reduction in plaque and gingivitis levels in the subjects at both the 10th and 14th weeks of the study. There was a greater proportional reduction in gingivitis levels in those subjects who had a higher number of reported discussions with their friends. The effect of discussions with members of the family was less clear. Lower values for gingivitis levels at 10 weeks were associated with a higher number of discussions with parents. However the levels of gingivitis tended to be adversely affected by discussions between the subjects and their spouses. The importance of recognising the influence of family and friendship networks needs to be understood when preventive programmes are designed, especially where high levels of self-care are sought as outcomes. Further work is in progress on a group of office workers being treated in a dental practice environment. This will allow the type of advice being obtained from the various contacts to be investigated in more detail.

Effect of variation in dietary sucrose intake on plaque removal by mechanical means.

The influence of dietary sucrose on the rate of plaque formation was investigated for 22 dental personnel. The subjects were instructed to continue their normal oral hygiene procedures throughout the study period. It was found that an increase in the frequency of sucrose intake resulted in an enhancement of plaque deposition and an increase in gingival inflammation. The restriction of dietary sucrose for this group of subjects had a minimal effect on either plaque retention or levels of gingival inflammation; this result might have been caused by the habitual diet of these particular subjects being relatively low in sugar. The results of this study would suggest that an assessment of sucrose intake of patients might be appropriate when planning an oral hygiene programme, consideration being given to modifying the diet as an aid to plaque removal for individuals having a relatively high intake.