Prevalence and simultaneous occurrence of periodontitis and dental caries.

AIM: The aim of the study was to evaluate the prevalence and simultaneous occurrence of periodontal disease and dental caries in Finnish adults. MATERIAL AND METHODS: The study was performed as part of the nationally representative Health 2000 Survey. The study population was 5255 subjects aged 30 years and older. Probing pocket depth (PPD) and untreated dentinal caries were recorded by tooth. Teeth with PPD 4mm and deeper indicated periodontal disease, and teeth with PPD 6mm and deeper indicated a severe periodontal disease. RESULTS: Sixty-four percent of persons had periodontal disease, 21% had a severe periodontal disease, and 29% had dental caries. Persons having periodontal disease had significantly more often dental caries (33%) compared with those without periodontal disease (23%). This was even more evident in persons having severe periodontal disease (44%). Accordingly, persons having dental caries had significantly more often severe periodontal disease (31%) compared with those without dental caries (16%). The mean number of teeth with dental caries or periodontal disease per person was greater when the mean number of teeth with the other disease was also greater. CONCLUSIONS: These data indicate that especially severe periodontal disease and dental caries tend to accumulate in the same subjects.

Dietary xylitol protects against the imbalance in bone metabolism during the early phase of collagen type II-induced arthritis in dark agouti rats.

The aim of the present study was to evaluate the changes in bone metabolism during the early phase of type II collagen-induced arthritis in rats and to evaluate whether a 10% dietary xylitol supplementation is able to protect against these changes. Arthritis was induced in female dark agouti rats by injections of type II homologous rat collagen emulsified with an equal volume of incomplete Freund adjuvant. In one group, the diet was supplemented with 10% xylitol. After 17 days, the rats were killed. Serum osteocalcin, as a marker of bone formation, and serum tartrate-resistant acid phosphatase, as a marker of bone resorption, were measured. Histologic measurements were made from Masson-Goldner trichrome-stained sections of distal tibiae. All the collagen-injected rats had arthritic symptoms at the end of the experiment. Serum osteocalcin was significantly higher in the collagen-injected rats fed a xylitol-supplemented diet (CI-X) than in the collagen-injected rats not fed xylitol (CI) and in the controls. Serum tartrate-resistant acid phosphatase was significantly higher in the CI and CI-X groups than in the controls. Trabecular bone volume was significantly lower in the CI group as compared with the CI-X and control groups. These results suggest that, at the time of the appearance of arthritic symptoms, bone resorption activity is high, but bone formation is not severely affected. Furthermore, dietary xylitol seems to protect against the imbalance of bone metabolism during the early phase of collagen type II-induced arthritis.

Self-reported gingivitis and tooth loss poorly predict C-reactive protein levels: a study among Finnish young adults.

OBJECTIVES: Our aim in this cross-sectional study was to investigate whether self-reported gingivitis and tooth loss were associated with elevated levels of C-reactive protein (CRP) using the same study population where these dental conditions have earlier been associated with prevalent angina pectoris. MATERIAL AND METHODS: The study population consisted of those Northern Finland birth cohort 1966 members who lived in Northern Finland or in the Helsinki region (n=8463) at the time of the survey (1996-1997). The participation rate in a health examination was 71% (n=6033). Gingivitis and tooth loss were determined on the basis of self-reported questions. Prevalence proportion ratios (PPR) and 95% confidence intervals (CI) were estimated using multivariate regression models. RESULTS: The results showed that self-reported gingivitis and tooth loss were weakly associated with elevated levels of CRP (>3 mg/l): adjusted PPR 1.1, CI 1.0-1.3 and PPR 1.1, CI 0.7-1.7, respectively. The proportion of variation in CRP explained by self-reported gingivitis and tooth loss was small, being <1%. CONCLUSION: The results suggest that self-reported gingivitis and tooth loss have a miniscule effect on CRP levels among a general population of young adults.

Cynical hostility as a determinant of toothbrushing frequency and oral hygiene.

AIM: Our aim was to investigate whether cynical hostility, self-reported toothbrushing frequency and objectively assessed levels of oral hygiene were associated. MATERIAL AND METHODS: The present study sample consisted of 4156 30-64-year-old dentate Finns. The questionnaire and the home interview included information about socioeconomic and sociodemographic factors and behavioural variables, such as toothbrushing frequency, dental attendance, smoking and cynical hostility. The level of oral hygiene was assessed during a clinical oral examination. The chi(2) test and ordinal logistic regression analyses were used. RESULTS: After controlling for sociodemographic and socioeconomic factors, smoking habits and reported dental attendance, the subjects belonging to the lowest cynical hostility level were found to brush their teeth significantly more often and to have better oral hygiene compared with those belonging the highest cynical hostility level. Toothbrushing frequency was adjusted when oral hygiene was used as the outcome variable. The association of cynical hostility with toothbrushing frequency and the oral hygiene seems to be partly dependent on the level of education. CONCLUSIONS: Cynical hostility is a psychosocial risk marker for the frequency and quality of toothbrushing and it could be a connecting trait between general health behaviour and oral health behaviour.

Sense of coherence as a determinant of toothbrushing frequency and level of oral hygiene.

BACKGROUND: Antonovsky's salutogenic theory seeks to find general health-promoting factors in individuals as distinct from characteristics that function as risks for specific diseases. A central construct of the theory is sense of coherence (SOC). Individuals with a strong SOC have the ability to define events as less stressful (because of comprehensibility); to mobilize resources to deal with encountered stressors (manageability); and to possess the motivation, desire, and commitment to cope (meaningfulness). Our aim is to investigate whether SOC, self-reported toothbrushing frequency, and objectively assessed levels of oral hygiene are related. METHODS: The sample of the present study consisted of 4,131 30- to 64-year-old dentate Finns belonging to a large nationally representative sample. The questionnaire and home interview included information about socioeconomic and demographic factors, behavioral variables, such as oral health behaviors (toothbrushing frequency), and a 12-item SOC scale, used here as a unidimensional measure categorized into quintiles. The level of oral hygiene was measured during clinical oral examination. Chi-square test, ordinal, and ordinary logistic regression analyses were used. RESULTS: Subjects belonging to the strongest SOC quintile were found to be significantly more often two, or more, times a day brushers compared to those with less strong SOC. After controlling for toothbrushing frequency, sociodemographic and socioeconomic factors, smoking habits, and number of teeth, both strong and moderate levels of SOCs were also found to be related to a good level of oral hygiene compared with moderate and poor levels of oral hygiene. Furthermore, subjects within the weakest SOC quintile were found to have significantly more often than others poor levels of oral hygiene. CONCLUSIONS: Our results suggest that a weak sense of coherence increases both the probability of having a poor level of oral hygiene and a frequency of toothbrushing of less than once a day. This and the theory concerning the development of SOC suggest that sense of coherence may be taken as a determinant of both the frequency and the quality of toothbrushing.

Effects of a long-term dietary xylitol supplementation on collagen content and fluorescence of the skin in aged rats.

BACKGROUND: Dietary xylitol has been shown to increase the amounts of newly synthesized collagen, and to decrease fluorescence of the collagenase-soluble fraction in the skin of both healthy and diabetic rats. As in diabetic rats, a decreased rate of collagen synthesis and increased collagen fluorescence has also been detected in the skin of aged rats. We hypothesize that dietary xylitol supplementation may protect against these changes during aging. OBJECTIVE: The purpose of the present study was to investigate whether a long-term dietary supplementation can protect against the decrease in the amounts of newly synthesized collagen, and against the increase in fluorescence in the collagenase-soluble fraction in the skin of aged rats. METHODS: Twenty-four male Sprague-Dawley rats were used in the study. After weaning, the rats were divided into 2 groups of 12 animals. The rats in the control group were fed a basal RM1 diet, while the rats in the experimental group were fed the same diet supplemented with 10% xylitol. After 20 months, the rats were killed and pieces of skin from their dorsal areas were excised. The thickness of the samples was measured with a micrometer screw gauge. The collagen contents of rat skin were measured as hydroxyproline, and glycosylation as fluorescent intensity of collagen. Statistical significances of the differences between the groups were determined using the unpaired t test. RESULTS: No general side effects were detected in the rats during the experimental period. The skin of the xylitol-fed rats was a little thicker than that of the control rats. The hydroxyproline content of the acid-soluble fraction was significantly greater in the xylitol group as compared to the controls. However, there were no significant differences in the hydroxyproline content of the collagenase-soluble fraction between the groups. The fluorescence of the collagenase-soluble fraction was significantly smaller in the xylitol-fed aged rats than in the aged rats fed the basal diet. CONCLUSIONS: The results of this study indicate that xylitol caused an increase in the amount of newly synthesized collagen and a decrease in collagen fluorescence in the skin of aged rats.

The effect of a simultaneous dietary administration of xylitol and ethanol on bone resorption.

Our previous studies have shown that dietary xylitol supplementation diminishes bone resorption in rats, as well as protects against ovariectomy-induced increase of bone resorption during experimental osteoporosis. Interestingly, ethanol, when given simultaneously with xylitol, is known to increase blood concentration of xylitol. On the other hand, ethanol, when given alone, has been shown to increase bone resorption. The aim of the present study was to evaluate the effects of a simultaneous dietary administration of 10% xylitol and 10% ethanol on bone resorption. Bone resorption was determined using measurement of urinary excretion of hydrogen 3 (3H) radioactivity in 3H-tetracycline prelabeled rats. Already 4 days after the beginning of dietary supplementations, excretion of 3H was about 15% lower in the xylitol group (diet supplemented with 10% xylitol) and about 25% lower in the xylitol-ethanol group (diet supplemented with 10% xylitol and 10% ethanol) as compared to the controls. The excretion of 3H in these groups remained smaller than that of the controls throughout the entire study period of 40 days. The excretion of 3 H in the xylitol-ethanol group remained also smaller than that of the xylitol group. Bone mineral density and bone mineral content were determined with a peripheral quantitative computed tomography (pQCT) system from the rat tibiae at the end of the experiment. Trabecular bone mineral density and trabecular bone mineral content were significantly greater in the xylitol group and in the xylitol-ethanol group compared to the controls. They were also greater in the xylitol-ethanol group as compared to the xylitol group. Cortical bone mineral density and cortical bone mineral content did not differ significantly between the groups. In conclusion, a simultaneous dietary supplementation with 10% xylitol and 10% ethanol seems to diminish bone resorption and to increase trabecular bone mineral density and trabecular bone mineral content in rats. These effects seem to be stronger than the effects induced by 10% xylitol supplementation alone.

Mast cell subpopulations in gingival overgrowth induced by immunosuppressive and nifedipine medication.

BACKGROUND: An immunohistochemical study was conducted to compare distributions of mast cell subpopulations in normal human gingiva and in gingival overgrowth induced by nifedipine and immunosuppressive medication. METHODS: Gingival samples were collected from 12 triple-medicated organ transplant recipients (immunosuppression group), 11 triple-medicated organ transplant recipients taking nifedipine (immunosuppression plus nifedipine group), 11 nifedipine-medicated cardiac outpatients (nifedipine group), and 20 generally healthy individuals (control group). Cryostat sections were stained with mAbs for tryptase and chymase, and an avidin-biotin enzyme complex method was used to detect tryptase-positive mast cells (MC(T)), tryptase- and chymase-positive mast cells (MC(TC)), and chymase-positive mast cells (MC(C)). Total numbers of labeled cells were determined in connective tissue beneath the sulcular epithelium, connective tissue beneath the oral epithelium, and middle connective tissue. Statistical analyses were conducted using the Kruskal-Wallis test, the Mann-Whitney U-test, and Pearson's correlation test. RESULTS: In the three counting zones combined, numbers of MC(TC) cells and MC(C) cells were lower (P = 0.001 and P = 0.048, respectively) in the immunosuppression group than in the control group. The difference in numbers of MC(TC) cells was most marked in the middle connective tissue. Nifedipine medication had no effect on numbers of the mast cell subclasses. CONCLUSIONS: Immunosuppressive medication without concomitant nifedipine decreases the numbers of MC(TC) and MC(C) in overgrown gingiva. Chymase-positive mast cells may play a role in formation of gingival overgrowth, especially in patients receiving cyclosporin A (CsA) medication with no concomitant nifedipine. In this respect, nifedipine and CsA are different.

Relation of different measures of psychological characteristics to oral health habits, diabetes adherence and related clinical variables among diabetic patients.

Among diabetic patients, oral health status and oral health behavior have been found to relate to metabolic control. The aim was to analyse which psychological characteristics, i.e. intention, self-efficacy, locus of control or self-esteem related to health behavior most comprehensively explain oral health habits, diabetes adherence, dental caries, deepened periodontal pockets, and the metabolic parameter HbA1c (glycosylated hemoglobin). The study subjects consisted of a group of 149 insulin-dependent diabetic patients. Data were obtained from self-completed questionnaires. The proportions of variance explained by the linear regression model were used as measures in the comparisons. It was found that oral health habits and diabetes adherence correlated. Both dental and diabetes self-efficacy scores were related to oral health habits and diabetes adherence. This indicates that self-efficacy is the best overall determinant of various health behavior practices. The ability of psychological characteristics to explain oral health was limited. Improvement of self-efficacy therefore may have a positive effect on various aspects of health behaviors.

Metabolic control as a modifier of the association between salivary factors and dental caries among diabetic patients.

The aim here was to analyze the role of metabolic control as a modifier of the association of salivary factors with dental caries among diabetic patients. Cross-sectional data were gathered from 149 insulin-dependent diabetes mellitus patients by means of clinical examination, a quantitative questionnaire and patient records. Dental caries was measured as the number of decayed surfaces. The data were analyzed using negative binomial regression models. HbA1(c) level appeared not to be associated with dental caries. Of the salivary factors, only high levels of mutans streptococci (MS) and lactobacilli were associated with dental caries. Among the subjects with HbA1(c) > or =8.5, the presence of dental caries was more distinctly associated with higher levels of MS (RR = 3.86, CI: 1.39-11.96) and lactobacilli (RR = 3.59, CI: 1.44-9.33) compared to those with HbA1(c)<8.5. It can be concluded that poor glycemic control strengthens the positive association of MS and lactobacilli with dental caries.

Role of smoking and HbA1c level in periodontitis among insulin-dependent diabetic patients.

OBJECTIVES: The aim was to analyse the role of smoking and HbA1c level in attachment loss (AL) and probing depths (PDs) among insulin-dependent diabetic patients. MATERIAL AND-METHODS: The study subjects were selected from a group of 149 insulin-dependent diabetic patients and included 64 patients (39 men and 25 women) aged 30 years or older. Data were obtained from patient records and by clinical examination. The outcome variables were the number of sites with AL and PDs of 5-9 mm. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated using Poisson regression models. RR was adjusted for the number of teeth, dental calculus and age. RESULTS: RR for AL among the smokers was 4.15 (95% CI: 2.30-7.63) and that for PD among the smokers was 7.96 (95% CI: 4.91-13.19). HbA1c was not related to AL or PD. Among smokers with HbA1c > 8.5, RR for AL was 12.34 (95% CI: 4.14-39.35), but RR was not elevated for PD. CONCLUSIONS: It can be concluded that the poor metabolic control together with smoking is extremely detrimental for AL.

Macrophage subpopulations in gingival overgrowth induced by nifedipine and immunosuppressive medication.

BACKGROUND: The immunomodulating effects of both immunosuppressive and nifedipine medication have been associated with drug-induced gingival overgrowth. The aim of the study reported here was to evaluate the presence of macrophage subpopulations in normal human gingiva and in gingival overgrowth induced by nifedipine and immunosuppressive medication. METHODS: Gingival samples were taken from 11 nifedipine-medicated cardiac outpatients (nifedipine group), 11 triple-medicated organ-transplant recipients also taking nifedipine (immunosuppression plus nifedipine group), 12 triple-medicated organ-transplant recipients (immunosuppression group), and 20 generally healthy individuals (control group). Cryostat sections were stained with mAbs for inflammatory 27E10, reparative RM3/1, and resident 25F9 macrophages using an avidin-biotin enzyme complex method. Total numbers of mAb-labeled cells were determined in connective tissue beneath sulcular epithelium, connective tissue beneath oral epithelium, and middle connective tissue. Expression of 27E10 was determined in keratinocytes in the oral epithelium. Statistics analyses were undertaken using the chi-square test, the Mann-Whitney U test, the independent samples t test, analysis of variance, and analysis of covariance. RESULTS: Greater numbers of inflammatory 27E10-positive macrophages were found in all 3 medicated groups and counting zones than in the control group except in connective tissue beneath sulcular epithelium in the immunosuppression group. The incidence of specimens expressing 27E10 antigen throughout the oral epithelium was significantly higher in the immunosuppression group (8 of 12) than in the control group (4 of 20) and the nifedipine group (2 of 11). Numbers of reparative RM3/1-positive macrophages were significantly greater in the immunosuppression group in connective tissue beneath oral epithelium than in the control group. The effect was markedly associated with degree of inflammation. Numbers of resident 25F9-positive macrophages were lower in connective tissue beneath sulcular epithelium in the immunosuppression group, and higher in middle connective tissue in the nifedipine group than in the control group. CONCLUSION: Our results show that the nature of drug-induced gingival overgrowth differs somewhat between immunosuppressive and nifedipine medications.

The theory of reasoned action in describing tooth brushing, dental caries and diabetes adherence among diabetic patients.

OBJECTIVES: Preventive oral health behaviour is important among diabetic patients, as it has been found that dental diseases and insulin-dependent diabetes mellitus (IDDM) have some psychological and biological factors in common. The aim here was to analyze the variables of Ajzen and Fishbein's theory of reasoned action to explain the reported frequency of tooth brushing, dental caries, HbA1c level and diabetes adherence. MATERIAL AND METHODS: Cross-sectional data were gathered from 149 IDDM patients by means of a quantitative questionnaire, clinical examination and patient records. RESULTS: The results showed that a firmer intention to brush the teeth was related to a higher reported frequency of tooth brushing (p < 0.001). The attitude to and the subjective norm of tooth brushing were related to the intention to brush(p < 0.001) and to the reported frequency of tooth brushing. A better dental attitude was related to better diabetes adherence (p = 0.002) and fewer decayed surfaces (p = 0.01), and a firmer intention to brush the teeth was related to a lower HbA1c level (p = 0.015). CONCLUSIONS: Our results suggest that in oral health promotion among diabetic patients, both subjective norm and attitude are important and that diabetes adherence may be influenced by promoting dental attitude.