Aging and oral health: effects in hard and soft tissues.

Changing demographics, including an increase in life expectancy and the growing numbers of elderly has recently focused attention on the need for geriatric dental care. Ageing affects oral tissues in addition to other parts of the human body, and oral health (including oral mucosa, lips, teeth and associated structures, and their functional activity) is an integral component of general health; indeed, oral disease can cause pain, difficulty in speaking, mastication, swallowing, maintaining a balanced diet, not to mention aesthetical considerations and facial alterations leading to anxiety and depression. The World Health Organization recommends the adoption of certain strategies for improving the oral health of the elderly, including the management and maintenance of oral conditions which are necessary for re-establishing effective masticatory function. Oral health is often neglected in the elderly, and oral diseases associated with aging are complex, adversely affecting the quality of life. Although oral health problems are not usually associated with death, oral cancers result in nearly 8,000 deaths each year, and more than half of these occur at an age of 65 years plus. This report, which is dedicated to geriatric physicians, geriatric dentistry and specialists in oral medicine reviews age-related oral changes in elderly patients and efforts to summarize the effects of aging in hard and soft oral tissues.

Effect of desquamative gingivitis on periodontal status: a pilot study.

OBJECTIVE: Desquamative gingivitis (DG) represents the gingival manifestation associated with several mucocutaneous disorders and systemic conditions. Little is known of whether or not DG could influence the onset or progression of plaque-related periodontitis. In this study, the potential impact of DG on plaque-related attachment loss and pocket formation has been evaluated. METHODS: A cross-sectional evaluation of 12 patients with DG [eight oral lichen planus (OLP), four mucous membrane pemphigoid (MMP)], never treated for DG lesions or plaque-related periodontitis, was carried out. Probing depth (PD), clinical attachment loss (CAL), full-mouth plaque (FMPS), and bleeding (FMBS) scores were evaluated at six sites per tooth. Clinical parameters of sites with DG lesions were compared with that of DG unaffected sites. RESULTS: Median PD and CAL, as well as FMPS and FMBS, were not significantly different (P > 0.05 Mann-Whitney test) for both OLP and MMP patients. However, a negative association between DG lesions and PD < 4 mm (OLP: OR = 0.26; MMP: OR = 0.47), and a positive association with PD 4-6 mm (OLP: OR = 3.76; MMP: OR = 2.68) and with PD > 6 mm (only for OLP: OR = 3.83) were found to be significant. CONCLUSIONS: The potential interference between DG lesions and periodontitis needs further prospective investigation; nonetheless, a higher level of attention might be prudent.

The association between periodontal diseases and cardiovascular diseases: a narrative review.

A possible relationship between periodontal diseases (PDs) and cardiovascular diseases (CVDs) has been supposed and investigated. This review of the literature focuses exclusively on published studies on current theories and models of correlation between PDs and CVDs. A literature search of clinical and observational studies, in the English language, was performed in MEDLINE/PubMed, OVID database and Cochrane Oral Health Group's Trial Register. In addition, references cited in reviewed studies were evaluated for relevant papers. Various mechanisms are described in order to explain this possible association such as a hyper-responsive inflammatory response to chronic infections in predisposed individuals, and systemic effects of periodontal microorganisms including blood platelet aggregation, atheroma formation, increase in lipid levels, activation of acute phase reaction and systemic production of proinflammatory mediators, but a ultimate relation as well as the potential mechanisms have not been defined yet. Controversial result can be related to different method or objectives of studies including different study design, exposure evaluation, outcome variables and clinical endpoints considered. This paper provides a narrative review of the epidemiological studies dealing with the potential association between PDs and cardiovascular events. A precise association between PDs and CVDs, as well as the involved mechanisms are not yet well defined. Additional large-scale longitudinal epidemiological and intervention studies are necessary to validate this association.

Root resorption and orthodontic treatment. Review of the literature.

The aim of this paper was to provide a systematic review of the literature on the root resorption caused by orthodontic treatment. Original papers on this subject, published in English from January 2000 until December 2005, were located in the MEDLINE/PubMed database. Other sources were taken from the references of the selected papers. Root resorption is the most common sequela of the orthodontic treatment. It is an inflammatory process that leads to an ischemic necrosis localized in the periodontal ligament when the orthodontic force is applied. The onset and progression of root resorption are associated with risk factors related to the orthodontic treatment such as the duration of treatment, the magnitude of the force applied, the direction of the tooth movement, the method of force application (continuous versus intermittent), the orthodontic movement. Patient-related risk factors are the individual susceptibility on a genetic basis, some systemic diseases, anomalies in root morphology, dental trauma, and previous endodontic treatment. The prevention of root resorption during the orthodontic treatment may be performed controlling the risk factors. The periodic radiographic control during the treatment is necessary in order to detect the occurrence of root damages and quickly reassess the treatment goals.

A combined treatment regimen for desquamative gingivitis in patients with oral lichen planus.

BACKGROUND: Chronic desquamative gingivitis (DG) is a condition characterized by erythema, ulceration, and desquamation of the free and attached gingiva, usually expression of a district-systemic disease, such as oral lichen planus (OLP). METHODS: A combined protocol of oral hygiene and topic corticosteroid therapy was applied in 30 patients with DG associated with OLP. Plaque index (PI) and bleeding on probing (BoP) were evaluated at baseline and after 3 months. RESULTS: PI scoring was significantly lower after treatment in anterior, posterior, and all sites (P < 0.0001) as well as in vestibular and lingual ones (P < 0.0001 and P = 0.0001, respectively). BoP measures were found to be reduced significantly to 22.94% in a full-mouth evaluation (P < 0.0001; OR = 2.633; 95% CI: 2.2685-3.0561) as well as in each specific site (P < 0.0001). CONCLUSION: This clinical trial validated the efficacy, in patients with DG associated with OLP, of a protocol based on professional oral hygiene and self-performed plaque control measures in improving of gingival health status.

Periodontitis and preterm delivery. A review of the literature.

The aim of this paper was to review the relationship between periodontitis and preterm delivery (PTD). Original papers on this subject, published in English until the first quarter of 2004, were located in the MEDLINE/PubMed database. Additional papers were obtained by searching reference lists of previously published review papers. Case control studies pointed to an association between periodontitis and increased rates of PTD of low birth-weight (LBW) infants. Longitudinal studies showed that the incidence or progression of periodontitis during pregnancy may be an independent risk factor for PTD and LBW. Microbiological, immunological and animal model studies suggested that periodontal pathogens and their products may translocate to the fetal-placental unit resulting in PTD or fetal growth restriction. Maternal periodontal infection may also provide a chronic reservoir of inflammatory mediators and cytokines (TNF-alpha, IL-1, IL-6, PGE2) that could adversely affect pregnancy outcome. Randomized controlled studies published indicated that periodontal treatment significantly reduces the risk of PTD and LBW infants. If these results are confirmed in further intervention studies, then prevention and treatment of periodontitis should be considered as a necessary part of prenatal care.

[Request of dental care and periodontal treatment needs in a population sample of Palermo]. / Richiesta di visita odontoiatrica e necessità di trattamento parodontale in un campione di popolaizone della città di Palermo.

BACKGROUND: The organisation of periodontal health prevention programmes must take into account the public level of awareness of the periodontal diseases. The aim of the present investigation was to assess the relationships between the request of dental care and the periodontal treatment needs in a population sample of Palermo. METHODS: The study population consisted of 554 out-patients, consecutively examined during 18 months (January 1999 to June 2000) at the Palermo University Department of Oral Sciences. All participants answered a written questionnaire concerning the cause for the request of dental care and periodontal symptoms. Periodontal treatment needs were assessed using the Community Periodontal Index of Treatment Needs (CPITN). RESULTS: Statistical analysis (Chi-Square Test, Fisher's Exact Test) showed significant discrepancies between the request of dental care and the periodontal treatment needs, poor awareness of periodontal diseases and low perception of their symptoms by the patients. CONCLUSIONS: These findings showed that the awareness of periodontal diseases by the population examined is poor. This could be due either to the lack or failure of public education programmes on periodontal health. Yet, it could be related to an inadequate dentists' awareness of the periodontal diseases. Such findings should be considered in the planning of periodontal health programmes in relation to the population of Palermo.