Periodontitis, caries and salivary factors in Sjögren's syndrome patients compared to sex- and age-matched controls.

The aims of this investigation were: (i) to study a group of dry mouth Sjögren's syndrome (SS) patients comprising individuals with pathological and non-pathological amounts of rest saliva and (ii) to compare these two categories of SS patients with a sex- and age-matched control group with respect to their periodontal and dental status. Thirty-three dry mouth patients and 33 sex- and age-matched patients, referred to the same private dental clinic in southern Norway, were examined for rest and stimulated saliva, as well as their dental and periodontal status. All patients were referred to the local hospital for blood and urine examinations. The dry mouth SS patients were all of the secondary type. Volumes of rest and stimulated saliva were significantly lower in the low saliva SS group compared with the high saliva SS group; the values for immunoglobulin G (IgG) and IgA were similarly lower for the low saliva group, but not for IgM which was significantly higher. The two SS subgroups and their controls were compared for the volume of rest and stimulated saliva, which showed a statistically significant lower volumes for the low saliva SS group compared with the control group. None of the subgroups and their controls differed concerning filled or missing teeth, but the total SS group revealed significantly higher number of missing teeth. The periodontal and dental status did not show any statistically significant differences except for a few scattered higher periodontal level losses of attachment in the SS subgroups. The blood and urine analyses showed statistically significant higher values for sedimentation rate, white blood cell count and haemoglobin in the SS low saliva group compared with the control group while anti-streptolysin was lower. In the high saliva SS group only sedimentation rate and white cell count were higher compared with the control. The conclusions is SS patients do not have an increased risk for developing periodontitis.

The accuracy of the Vivacare true pressure-sensitive periodontal probe system in terms of probing force.

BACKGROUND: The Hunter TPS Vivacare periodontal probe was invented to perform consistent, accurate and reliable periodontal examinations "with controlled pressures". AIMS: The aims of the present investigation are 3: (1) what is the accuracy of the probing force when various probe heads are used in a correct operation position; (2) what is the effect of over- and under-reading of the operation position on the probing force; (3) what is the accuracy of the probing force when different probe handles are used. The Hunter TPS probe consists of a tip connected to a special spring mechanism, which controls the pressure extended to the probe tip. According to the manufacturer, the force indicator lines coincide at approximately 20 g force. METHOD: The test apparatus consisted of an electronic balance, and an electronic caliper. 12 TPS probes tips and 3 handles were selected to test whether there were differences in force between probes. Each probe tip was adapted to the same handle and tested 10 times. In a 2nd test, the TPS handles and over-, accurate-, and under-readings were analyzed as to how they affect the probing force. The 12 TPS probe tips were connected to each of the 3 handles and tested 10x for each of 3 handles and levels. RESULTS: The range in force between TPS probe tips was 8.4 g (p<0.001). For the handles as well as for each of the readings of the operating positions, the differences were small and non-significant. However, between over- and under-readings, there were statistical significant differences. CONCLUSION: The conclusion is that the variation in force between probe tips is high and always above the manufacturer's "approximately" 20 g. As long as the same handle and the same probe tip are used together, and the examiner is reading the markings correct, the TPS probe is adequate.

Scanning electron microscopy of the root surface texture of extracted periodontally diseased teeth following various etching and chelating regimens.

Scanning electron microscopy of root surfaces that had been ultrasonically scaled and subjected to various conditioning regimens revealed the presence of two distinct types of cracks: extensive cracks, presumed to have been caused by drying before and during sputter-coating procedures; and smaller cracks that reflected the pattern of the irregular underlying dentin. Both etching and chelating agents appear to cause demineralization of the interfacial layer between cementum and dentin, causing a "peeling off" of cementum and exposure of the underlying dentin. The results suggest that burnishing the scaled root surface with either saline or any of the etching or chelating agents for at least 10 seconds, followed by soaking the cementum in 8% ethylenediaminetetraacetic acid for about 40 seconds, achieved a root surface that might be regarded as optimal for regeneration of periodontal tissues.

Strong cytotoxicity to human gingival fibroblasts by Porphyromonas gingivalis ATCC 33277.

The aim of the present study was to analyze the cytotoxicity of some bacterial species associated with periodontal diseases. The specificity of cytotoxicity was estimated against cells of various origin and from different individuals. The reference bacteria were Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Fusobacterium nucleatum. These bacteria were cultured for 24 h in liquid media and the supernatants were used in cytotoxicity assays. The target cells used were human gingival fibroblasts (GF), dermal fibroblasts (K4), gingival epithelial cells (E) and HeLa-cells (HeLa). These cells were exposed at 4 h or 24 h, respectively, to various concentrations of culture supernatants from the selected bacteria. The influence on the viability and metabolism of the cells were estimated quantitatively as increase in neutral red uptake and lactic acid production. Growth medium supernatants of P. gingivalis 33277 were strongly cytotoxic to gingival fibroblasts after 24 h incubation, compared to supernatants of P. gingivalis 381 or W 50, A. actinomycetemcomitans or F. nucleatum cultures. The toxic effect of P. gingivalis 33277 decreased drastically after heat inactivation, which indicates effects of proteins. By adding anti-sera the cytotoxicity of P. gingivalis 33277 could be dose dependently neutralized, which was not the case when supernatants of A. actino-mycetemcomitans was tested. Target cells of epithelial origin did not show increased cytotoxicity to P. gingivalis 33277. The results of the present study strengthen the hypothesis that P. gingivalis remains as a suspect causative key component in periodontal diseases.

The interference of gingival cell cultures with growth of selected bacteria.

The aim of the present study was to analyze the interference of oral tissue cells or cell lines (effector cells) with growth of reference bacteria, and furthermore to investigate whether cells derived from different individuals differ in such activity. The reference bacteria were Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus mitis, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Fusobacterium nucleatum. The effector cells used were gingival fibroblasts (GF) from 21 periodontally involved persons, gingival epithelial cells (E) from 2 such persons, HeLa cells (HeLa), and an amnion cell line (Amnion). The cells were cultivated and their supernatants tested for antibacterial activity in a Bioscreen robot analyzer (Labsystems, Finland). Results suggest that the antibacterial activity of each tested primary cell line of tissue had its own profile depending on cell type and donor, and that the composition of oral microbiota was influenced by oral cells, which might, in turn, contribute to the variations in the pathogenesis of periodontal diseases.

Bacterial interference in vitro. Comparison between a quantitative kinetic and a cocultivation blood agar test method.

The aim of the present study was to compare two methods for estimation of bacterial growth interference between various bacteria using a Bioscreen robot analyzer, allowing kinetic documentation, and a cocultivation test on blood agar plates. Six laboratory strains with different virulence and growth requirements were used: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Fusobacterium nucleatum, Streptococcus mitis, Staphylococcus aureus, and Staphylococcus epidermidis. The interference activity was correlated with a reference system of Streptococcus sanguis (strain alpha 89) and Streptococcus pyogenes (group A streptococci, GAS serotypes T 9 and T 22). The methods used and results obtained were as follows: 1. Estimation of synergistic and antagonistic bacterial interferences using a Bioscreen robot analyzer. Suspensions of viable bacteria were added to microtiter plates with different concentrations of UV light-killed bacteria in liquid media. The Bioscreen analyzer monitored bacterial growth every 10 min for 24 h giving kinetic data during the growth period. Synergisms as well as antagonisms were demonstrated between the tested bacterial strains which have not earlier been reported in the literature. However, the antagonistic effect observed between the six strains was less than that induced by the S. sanguis strain on the two strains of S. pyogenes. 2. Cocultivation of bacterial strains on blood agar surface with precultivated or simultaneously stamped interfering bacteria indicated no detectable interference between the six tested bacterial strains, while the S. sanguis strain inhibited the growth of S. pyogenes strains as well as the hemolysis around the colonies. The Bioscreen method was found more sensitive for testing bacterial interference compared to the commonly used blood agar test.

Cytotoxicity in bacterial cultures: interaction and cell-specificity, possible factors in periodontal disease.

Cytotoxicity in culture media of various growing bacterial strains was estimated by Cr-51 release of labelled target-cells. Interaction studies were made by adding each of the different UV-killed bacteria to the medium with viable bacteria. The reference oral bacterial strains were: Actinobacillus actinomycetemcomitans Y4, Porphyromonas gingivalis, Fusobacterium nucleatum and Streptococcus mitis, which were compared with the reference bacteria Staphylococcus aureus 209 and Staphylococcus epidermidis. The target cells were: gingival fibroblasts (GF), periodontal membrane fibroblasts (PMF), pulpal fibroblasts (PF), HeLa-cells (HeLa), and lymphoid neoplasm cells (LN). Synergistic, as well as antagonistic, effects on target cells were observed. The cytotoxicity of A. actinomycetemcomitans in presence of P. gingivalis is neutralized while in presence of S. aureus it was increased. Bacterial interactions with F. nucleatum and P. gingivalis cytotoxicity were observed. The cytotoxicity of F. nucleatum was increased when cultured together with A. actinomycetemcomitans. Each cell type reacted differently to the toxicity of the supernatant of growth medium in which the same bacterial strain had been cultivated, which indicates cell specificity of the toxins.

Location of the mucogingival junction 18 years after apically repositioned flap surgery.

The apically repositioned flap procedure, by definition, implies that the mucogingival junction (MGJ) is shifted into an apical location. That this actually would be the case has never been shown in long-term studies. The 13 subjects in the present study had during the years 1964-1965 received treatment of moderately advanced periodontal disease (probing pocket depths less than or equal to 5 mm) in the lower jaw. An apically repositioned flap (ARF) procedure was applied in the left or right half of the mandible and a gingivectomy (GE) was performed in the contralateral side. Starting in December 1981, the patients were recalled for clinical and radiographic determination of long-term results. The width of the band of keratinized gingiva was measured clinically and the distance from the MGJ to the lower border of the mandible (LBM) was measured from orthopantomograms. Slightly less keratinized gingiva was observed on the sides where GE had been used. There was no statistically significant difference in the orthopantomographic distance from the MGJ to the LBM between ARF and GE operations. The results indicate that the apically repositioned flap procedure does not result in a permanent apical shift of the MGJ.

Craniomandibular disorders in adult populations of West Bothnia, Sweden.

A randomly selected sample of 1992 adults (995 men and 997 women) representing four equally sized age groups of 25-, 35-, 50-, and 65-years-old inhabitants of West Bothnia were studied for prevalence of symptoms and clinical signs of mandibular dysfunction. Of the sample 79% completed a questionnaire and a clinical examination. The chewing inability increased with age. Recurrent headaches (once a week or more often) were reported to occur in 11% to 15% of the four age groups, and the duration of headaches was generally more than 2 years. Tooth-clenching, which was the most frequent oral parafunction, was reported significantly more often in women, whereas attrition was more severe in men. The commonest clinical finding was temporomandibular joint clicking, which varied between 13% and 35% in the different age groups. Crepitation was observed more often in women and increased with age. The jaw muscles were more frequently tender to palpation in women and the elderly. The mean maximal mouth opening capacity varied between 55 mm and 44 mm, decreasing with age, and was for the whole sample significantly higher among men. Since signs and symptoms of craniomandibular disorders were common findings in all age groups, routine dental examination should always include functional evaluation of the stomatognathic system.

Role of brushing technique and toothbrush design in plaque removal.

Twenty-four adults participated in an intraindividual crossover experimental study to compare the plaque removing ability of straight multitufted and V-shaped brushes. Twelve of the participants had loss of periodontal tissue resulting in open but healthy interdental areas while the other 12 displayed no periodontal breakdown. In part 1 the participants were asked to brush their teeth using their own brushing technique and length over two 12-day periods during which time they, at random, used one brush for the first and the other brush for the second period. In part 2 the participants were professionally brushed by two dental assistants using four brushing techniques (The Bass, The Roll, The Circular Scrub and The Horizontal Scrub) randomly assigned to the four quadrants of the mouth. Cleaning was performed once a day for two 5-day periods, during which time the participants refrained from brushing and interdental cleaning. Initial toothbrush assignment was randomized. At the beginning of the study and each test period no plaque or gingival inflammation was visible. At the end of each period the accumulated plaque was registered. The results showed that there was no difference between the two brushes tested in the unsupervised part. The plaque removing ability when using either of the brushes varied between participants. When professionally used the straight multitufted and V-shaped toothbrushes did not show any difference in plaque removal on buccal and lingual surfaces. Interproximally the V-shaped toothbrush was better at plaque removal than the straight one.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy of plaque-removal using interdental brushes and waxed dental floss.

The plaque-removing efficacy when using waxed dental floss and three interdental brushes was compared in an intraindividual clinical trial. Nine adult patients treated for periodontal disease, with a reduced but healthy periodontium and large interdental spaces were subjects in the study. Each subject tested the four interdental cleaning aids in random sequence over a 2-wk period. The duration of the study was 8 wk. The results indicated that the use of interdental brushes is preferable to that of dental floss in cleaning interdental areas where the papilla is missing. No difference in achieved cleanliness was noted after use of the different interdental brushes tested. No gingival damage or damage to the hard tissue of the teeth was observed after use of interdental brushes or dental floss.

Plaque removal by dental floss or toothpicks. An intra-individual comparative study.

The amount of plaque accumulation was assessed in an intraindividual study comprising 10 individuals. During different 2-week periods, the test subjects used nylon floss (unwaxed, waxed and specially treated), silk floss (unwaxed and waxed), Superfloss or triangular toothpicks for interdental tooth cleaning. Only teeth in contact with neighboring ones and with open interdental spaces were included in the study. The plaque removal of the interdental aids used was registered by estimating the amount of plaque present at the end of each experimental period according to a Plaque Index (Silness & Löe 1964) modified for plaque registration on 10 surface units around each tooth. In general, dental floss had a higher plaque removing potential than triangular toothpicks, especially on lingual axial surfaces.

Connective tissue response to periodontal dressing.

The effects of three periodontal dressings (Coe-Pak, PPC, Perio Putty) upon subcutaneous tissues in 26 Sprague-Dawley rats were investigated. The three dressings, and a control (Teflon), were placed into polyethylene tubes. Two tubes per animal were implanted on either side of the dorsal midline area. After 14 days the specimens were retrieved and prepared for histological examination. Three methods of scoring were utilized for evaluation. First, a system evaluating the overall number of inflammatory cells, connective tissue capsule thickness, and the vascular changes produced; second, an inflammatory cell count, the Inflammatory Index (I.I), computing the inflammatory cells in a particular field of view for each material; and third, a Reaction Spread Index (R.S.I.) comparing the distance of the spread of the inflammatory reaction into the connective tissues. Statistical analysis of the data was carried out utilizing the Chi-square test and analysis of variance. While the three scoring systems utilized did result in some comparative variation in reactions, the overall order of decreasing severity was always PPC, Coe-Pak, Perio Putty, and Teflon.

Flexor tendon specimens in organ cultures.

The healing process of sectioned and subsequently sutured rabbit tendon segments was studied over a period of 3 weeks, using an organ culture technique. In one series, the tendon specimens were exposed to a chemically defined culture medium for nutrition. In two control series, the specimens were kept in the synovial cavity of the knee joint for varying periods of time, before being transferred to the culture medium. The tendons remained viable in the medium. The superficial tendon cells demonstrated the morphological characteristics of fibroblasts, but cellular fibroplasia could not be detected. The two control series subjected to synovia prior to transfer into the culture medium showed superficial repair similar to the findings in previous studies on healing capacity of tendon nourished by synovia. The investigation supports the hypothesis that superficial tendon cells are fibroblasts with a potential for repair and that synovia is an efficient nutrient medium. Thus, the beneficial effects on repair exercised by the tendon sheath function should be utilized in flexor tendon surgery.