A prospective study on sucrose consumption, visible plaque and caries in children from 3 to 6 years of age.

OBJECTIVES: As data on the association of sugar consumption and dental caries in the industrialized countries give mixed results, we prospectively studied this association in 135 healthy Finnish children (71 boys, 64 girls). METHODS: The dental health and oral hygiene of the children was first examined at the mean age (+/-SD) of 37.4 (+/-2.1) months and again at 73.7 (+/-2.6) months. On both occasions the parents were interviewed about the child's sweet intake and toothbrushing habits, and sucrose consumption was analyzed using 4-day food diaries. RESULTS: The proportion of children with caries experience, enamel and dentin lesions combined, increased from 16% to 40%. Daily sucrose intake of children who developed caries by 6 years of age, whether expressed as absolute (g) or as relative (E%) amounts, was already higher at 3 years of age than that of children who stayed caries-free (P<0.05 and P<0.03, respectively). Furthermore, children who used sweets more than once a week at 3 years of age, consumed more sucrose 3 years later (P<0.01) than those who used sweets once a week or less. The proportion of children with a combination of a sweet intake more than once a week and visible plaque, increased (P<0.05) during the follow-up. The risk ratio of children with the combined risk habit at 3 years of age to develop carious lesions by 6 years of age was 1.7 compared to the rest of the children (95% confidence interval 0.9-3.0). CONCLUSIONS: We conclude that the manifestation of dental caries at 6 years of age seemed to be associated with a higher daily sucrose intake that had started already at 3 years of age. Moreover, a combination of sweet intake more than once a week and visible plaque at 3 years of age may be predictive of dental health 3 years later.

Rehabilitation of a periodontal patient with rapidly progressing marginal alveolar bone loss: 1-year follow-up.

BACKGROUND: The present case report describes a 1-year follow-up of functional rehabilitation of a young periodontal patient with severely advanced, rapidly progressing marginal bone loss treated by using a new splinting material, i.e., glass fiber-reinforced composite (FRC). Apart from one single tooth, the young man had retained all his natural teeth. TREATMENT: Periodontal treatment was based on cleaning and root planing enabled by partial-thickness-flap operations. This method was selected to avoid further damage to the remaining alveolar bone. After healing for 6 months, a cavity retained internal FRC splint was constructed and 1 missing lower molar was replaced by an inlay-retained FRC resin-bonded fixed partial denture (FPD). A 12 months follow-up period revealed a healthy periodontium and good functional and esthetic results. CONCLUSIONS: The new material allows the use of periodontal treatment methods instead of prosthetic alternatives, which until now have been a more generally used approach in the treatment of severely advanced periodontal cases. Internal fiber-reinforced composite splinting being affordable for the patient, easy for the clinician to construct and giving good esthetic and functional results, suggests that the method may be a valuable aid in periodontal treatment.

The effect of hormone replacement therapy on salivary calcium concentrations in menopausal women.

Hormone replacement therapy in menopausal women is known to affect the general calcium turnover of the body. No information is available about the effects of hormone therapy on salivary electrolytes and on calcium in particular. A group of 16 healthy peri- and postmenopausal women, all recommended to start hormone replacement therapy, were studied longitudinally for 5 months. Paraffin-stimulated whole saliva was collected at baseline, at 3 and at 5 months after the onset of therapy, and analysed for calcium, sodium and potassium concentrations. In response to hormone replacement therapy, calcium concentration decreased (p = 0.037), that of sodium increased (p = 0.019), while no change was observed in the potassium concentrations during the follow-up period.

The limited value of three pathogen species in predicting healing of periodontal pockets.

Baseline level of Actinobacillus actinomycetemcomitans has been suggested as being predictive of periodontal treatment outcome. We analyzed the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia in 55 deep periodontal pockets of 29 patients (18 men, 11 women, 37-75 years) before and after periodontal treatment. At baseline and after treatment, 62% and 33%, respectively, of the subjects presented with 1, 2, or a combination of all 3 pathogens. The mean pocket depth of 6.6 mm (0.4 mm) before treatment decreased to 2.2 mm (0.4 mm) in response to treatment (P<0.001). The treatment plan of non-surgical or surgical treatment was based on pocket depths and tooth morphology only. No antimicrobial medications were used during the treatment. Eighty-two percent of the deep pockets healed satisfactorily to < or = 4 mm. The presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, or Prevotella intermedia at baseline was not associated with the outcome of the periodontal therapy. In conclusion, we found that the presence of the 3 periodontopathogen species had little or no value in predicting healing of periodontal pockets.

Associations between salivary calcium and oral health.

Recently, we have shown positive correlations between high salivary calcium content and periodontitis, and between high salivary calcium level and the number of intact teeth in selected groups of subjects. The aim of our present study was to determine whether these correlations could be seen in a randomized group of healthy adults. A thorough oral examination including orthopantomograms was carried out for a total of 137 healthy subjects, 63 men (35.4+/-5.6 years) and 74 women (33.2+/-4.7 years). Paraffin-stimulated saliva was collected from the subjects and salivary flow (ml/min), buffering capacity, calcium (mMol/l) and microbial variables including lactobacilli, yeasts, mutans streptococci, total streptococci, total number of aerobes, and anaerobes were determined. The calcium level of whole saliva had a median of 1.23 mMol/l. Subjects with calcium level below the median were categorized as 'low', while those with higher values formed the 'high' salivary calcium group. There were more men than women in the 'High' salivary calcium group (p=0.025). Subjects in the 'high' calcium group showed more bleeding on probing (p=0.026), had more intact teeth (p=0.045), and lower DMF-scores (p=0.025) than their counterparts. No other differences were found between the two groups. We found clear associations between the level of salivary calcium and factors reflecting gingival health on one hand, and dental health on the other in a randomly selected group of healthy subjects, and conclude that salivary calcium may be important with regard to both dental and gingival health.

Salivary cholesterol of healthy adults in relation to serum cholesterol concentration and oral health.

Salivary lipids are mostly glandular in origin, but some are believed to diffuse directly from serum. This diffusion and the role of salivary lipids in oral health have scarcely been studied. Therefore, the serum and saliva cholesterol concentrations and oral health were analyzed in a group of healthy adults (n = 139; 64 men and 75 women; 34.2 +/- 5.2 yrs). Paraffin-stimulated whole saliva was collected, centrifuged (10,000 x g; 30 min, 4 degrees C), and lyophilized, and the cholesterol and other neutral lipids were extracted, separated by thin-layer chromatography, and quantified. The mean +/- SD (range) of saliva cholesterol concentration was 1.20 +/- 0.75 (0.02-5.46) mumol/L, and the saliva cholesterol level of men (1.36 +/- 0.85 mumol/L) was significantly higher than that of women (1.06 +/- 0.64 mumol/L; p < 0.05). Weak positive correlations between saliva and serum cholesterol concentrations and saliva cholesterol and serum non-high-density lipoprotein cholesterol concentrations were found (r = 0.22, p < 0.05; r = 0.28, p < 0.005, respectively). The saliva cholesterol assay detected subjects with high (> or = 6.5 mmol/L) serum cholesterol values, with sensitivity and specificity values of 100% and 29%, respectively. A positive correlation between the body mass index and the level of saliva cholesterol concentration was also found (r = 0.31 p < 0.01). Oral health, microbial counts, or saliva flow rate revealed no differences in subjects with low and high salivary cholesterol level. We conclude that, in healthy adults, saliva cholesterol concentration reflects serum concentration to some extent and can be used to select individuals with high serum cholesterol levels.

Oral health of 3-year-old children and their parents after 29 months of child-focused antiatherosclerotic dietary intervention in a prospective randomized trial.

A long-term prospective, randomized dietary intervention to prevent exposure of children to the known atherosclerosis risk factors (the STRIP baby project) was started when the age of the children was 7 months. The aim of this substudy was to analyze the oral effects of the dietary intervention in the children and their parents when the children had reached the age of 3 years. Every fifth family of the main study was invited to this substudy (n = 179). Those studied (n = 148) represented well the intervention and the control groups and both genders in terms of intake of saturated fatty acids, the dietary polyunsaturated fatty acid to saturated fatty acid (PUFA/SAFA) ration and serum cholesterol and HDL cholesterol concentrations. Though no difference was found in sucrose consumption between the intervention and the control groups, the intervention children received relatively (in E%) more energy from carbohydrates than the control children (p < 0.005), used absolutely (in g) and relatively (in E%) less fat (p < 0.05) and had a higher PUFA/SAFA ratio in their diet (p < 0.001). Of the 3-year-old children 93% were caries free, and dental decay was a prevalent in the intervention as in the control children. Control children brushed their teeth unassisted more often than the intervention children (p < 0.05). The intervention fathers also received more energy (in E%) from carbohydrates (p < 0.01), the intervention mothers used less fat (p < 0.05) and had a higher PUFA/SAFA ratio in the diet (p < 0.05) than the control fathers and mothers, respectively. Dental and periodontal health of the intervention and control parents (n = 250, 84% attending, mean +/- SD age: 34.2 +/- 54.5 years also showed no differences even though the control parents had more commonly last visited a dentist over 3 years before this examination (p < 0.05). We conclude that a 29-month period of a low-saturated-fat, low-cholesterol but high-carbohydrate diet as advocated in the STRIP baby trial does not seem to have harmful effects on the oral health of the children or their parents. Minor untoward differences had occurred in the dental health behavior of the control children and their parents.

Dietary shifts may explain the incidence of periodontitis in industrialized countries.

A new hypothesis for the etiology of periodontal disease is presented. We suggest that the formation of calcifying dental plaque, together with an established gingival sulcus, leads to circumstances which favor the growth of pathogenic microbes associated with the destruction of the periodontium. We assume that, in ancient humans, this problem was avoided by the nonexistence of sulci around the teeth. Such a situation may have resulted from the usage of a hard and gritty diet which caused occlusal attrition compensated by tooth eruption. Unfortunately, in modern humans, sulcus formation is normal. However, only a part of the population in industrialized countries has hard, calcifying dental plaque any more. Soft plaque may be associated with the lower calcium content of the modern diet. The impetus behind the introduction of this alternative hypothesis now is our fear that routine treatment of this disease by antibiotics will lead into an insoluble dilemma.

Analysis in gingival crevicular fluid of two oligopeptides derived from human hemoglobin beta-chain.

HPLC on a reversed phase column, amino acid sequencing and mass spectrometry were used to determine the structure of two human gingival crevicular exudate oligopeptides (Leu-Thr-Pro-Glu-Glu-Lys-Ser-Ala-Val-Thr-Ala-Leu and Leu-Val-Val-Tyr-Pro-Trp-Thr-Gln-Arg-Phe) which were shown to have been derived from the beta-chain of hemoglobin. These sequences may simply represent two degradation products of the beta-chain. However, their preservation in an exudate characterized by active peptidolysis may also prompt the question about their possible more specific role.

Calcium and other salivary factors in periodontitis-affected subjects prior to treatment.

Salivary calcium was shown to be higher in treated periodontitis-affected subjects (P+) than in periodontitis-free patients (P-). Here the aim was to study whether differences in calcium or other salivary factors exist prior to treatment. The test group consisted of 20 (15 men, 5 women) periodontitis-affected subjects and the control group 15 subjects (10 men, 5 women) free from periodontitis. Paraffin-stimulated whole saliva was collected to determine the flow-rate, calcium and phosphate concentrations, pH, buffering capacity, numbers of mutans streptococci, lactobacilli and yeasts. The results showed a higher calcium concentration (p < 0.05) in the P+ group (mean: 1.68 mmol/l; SE: 0.06 in men and mean: 1.49 mmol/l; SE: 0.10 in women) than in the P-group (mean: 1.48 mmol/l; SE: 0.09 in men and mean: 1.18 mmol/l; SE: 0.10 in women). The P+ group had more intact teeth (mean +/- SE: 9.9 +/- 0.8 in men and 11.2 +/- 2.0 in women) than the P-group (mean +/- SE: 8.3 +/- 0.7 in men and 8.2 +/- 2.4 in women). The present findings may indicate that an elevated level of salivary Ca is characteristic of P+ patients both before and after periodontal treatment.

Increased respiratory burst activity is associated with normal expression of IgG-Fc-receptors and complement receptors in peripheral neutrophils from patients with juvenile periodontitis.

The respiratory burst activity in peripheral neutrophils from nine patients with localized juvenile periodontitis (LJP) and age- and sex-matched healthy controls was studied by measuring the intensity of luminol-enhanced chemiluminescence (CL) induced by unopsonized and three differently opsonized zymosan particles, formyl-methionyl-leucyl-phenylalanine (FMLP) or phorbol myristate acetate (PMA). The neutrophils from LJP patients showed in general more intense CL with all activators than did their controls. Particularly, the CL response induced by unopsonized zymosan particles and FMLP were significantly higher (p < 0.05 and 0.001). When comparisons were made between female LJP patients (n = 6) and matched controls, also serum-opsonized and IgG-opsonized zymosan particles produced CL was significantly increased (p < 0.05). In order to determine whether the elevated CL responses to zymosan particles were due to altered levels of the interacting receptors on neutrophil surface, an immunofluorescence analysis of the expression of IgG-Fc-receptors (FcR) and complement receptors (CR) was performed with flow cytometry. No significant difference in the expression of FcRII, FcRIII, CR1 and CR3 was detected in LJP group compared to controls. Since the elevated CL responses can not be explained by changes in receptor numbers it is hypothesized that the increased respiratory burst activity in LJP may be caused by altered post receptor signalling pathway.

Rapid bony healing in localized juvenile periodontitis: a case report.

A 16-yr-old man with localized juvenile periodontitis was treated in one single surgical treatment visit. No adjunctive chemotherapy, implant material, or guided tissue regeneration (GTR) was used. Excellent bone repair was seen after 14 wk at the sites of the vertical periodontal lesions. The rapid healing could have been due to the treatment method, the youth of the patient, or the type and form of the bony defects. Radiographic control seems to be indicated 12-14 wk after surgical treatment.

Periodontal disease in three siblings with familial neutropenia.

The periodontal status and treatment of three teenagers in a Finnish family with familial neutropenia is described. The mother was also diagnosed with neutropenia. At initial examination, the 15-year-old male and the 10-year-old female had severe periodontitis, whereas the 13-year-old male had oral ulcerations but no significant periodontal disease. The two siblings with periodontitis were treated and followed approximately 5 years. It was concluded that periodontal therapy including scaling, surgery, and use of antimicrobial agents can be successful in patients with familial neutropenia, and that such patients are not necessarily candidates for full mouth extraction. The role of granulocyte colony-stimulating factor in which was used in the treatment of these patients remains to be established.

Efficacy of bone-fill favoring treatment on juvenile periodontitis.

In this study we evaluated the effect of bone-fill favoring mechanical treatment on the marginal bone level and periodontal pockets of juvenile periodontitis patients. A total of 10 patients (3 men and 7 women) 13-29 yr of age were treated until no gingivitis or periodontal pockets were present. The intensive therapy (3-8 wk) included scaling, curettage and modified Widman flaps. The maintenance therapy comprised 4 recall visits during the first year after therapy and 2-5 visits per year thereafter. The efficacy of the therapy was evaluated by radiologic measurements of bony defects (%) 12 and 16-65 months after the treatment. The results showed a significant improvement both 1 yr after treatment and at the end of the study. The bone loss was 10.1% less than prior to the treatment and no sites with new bone loss were found after therapy in any of the patients. The bulk of healing took place during the first year after the active therapy, while some further improvement was detected thereafter. Our results show that non-resective mechanical treatment allows excellent healing and regeneration of JP lesions. Our findings also suggest that an adequate follow-up period is needed before definite conclusions can be drawn about the efficacy of the treatment procedures used.

Altered tissue metabolism of progesterone in pregnancy gingivitis and granuloma.

The metabolism of progesterone may play a special role in the gingival physiology. The lower the metabolism the higher its hormonal activity in the tissue. In healthy human gingiva, progesterone is metabolized only partially and is therefore in an active form. In the present study, gingival samples from pregnancy gingivitis (n = 1) and granulomas (n = 4) were studied histologically and biochemically. All samples were homogenized and then incubated with [4-14C]-progesterone and NADPH for 2 h at pH 7.4 and 37 degrees C. The metabolites were separated and characterized with column, solvent and thin-layer chromatographies as well as radioautography and quantified with liquid scintillation counting. The results showed low metabolism of progesterone, indicating active hormonal function as in healthy gingiva. It is suggested that progesterone functions as an immunosuppressant in the gingival tissues of pregnant women, preventing the rapid acute-type of inflammatory reaction against plaque, but allowing an increased chronic-type of tissue reaction, resulting clinically in an exaggerated appearance of inflammation.

Comparative study on mineralization-related intraoral parameters in periodontitis-affected and periodontitis-free adults.

The parameters related to an intraoral mineralization tendency in periodontitis-affected (P+) and periodontitis-free (P-) study subjects (16 adults, 46-74 yr, matched for sex and age) were compared. For this purpose the calcium (Ca) and phosphate (P) concentration of both plaque and saliva, resting pH and the acidogenic response of interdental plaque, plaque wet weight, salivary flow rate, buffering capacity and sucrase activity, interdental plaque, plaque S. mutans levels as well as salivary lactobacilli and yeast levels were estimated. Plaque Ca (micrograms/mg protein, P less than 0.025) and P (micrograms/mg protein, P less than 0.05), saliva Ca (micrograms/ml, P less than 0.005) and the saliva Ca:P ratio (P less than 0.005) were higher in the P+ than in the P- group. The resting pH values were higher (P less than 0.025) and the acidogenic response of the interdental plaque was lower (P less than 0.025) in the P+ group than in the P- group. The P+ group had lower S. mutans levels in saliva and interdental plaque. No differences were found in the wet weight of plaque and in the flow rate, buffering capacity or sucrase activity of saliva between the groups. The findings of the mineralization-related parameters in the two "extreme" groups of periodontal status suggest a higher intraoral mineralization tendency in periodontitis-affected persons than in periodontitis-free subjects. Ca and P accumulation of supragingival plaque seem to be connected with low acidogenicity of plaque and high salivary Ca concentration.

A mineral-related feature of young plaque characteristic to periodontitis-affected adults.

The calcium concentration of 3-day-old total supragingival plaque in periodontitis-affected adults (n = 12) and their age and sex-matched periodontitis-free pairs was compared. The young plaque of the periodontitis-affected adults contained more calcium per protein (P less than 0.025, sign test) than that of the periodontitis-free pairs. The findings of the present study may suggest that high Ca-content of supragingival plaque is connected to the development of adult periodontitis.

A study of the possible correlation of high salivary calcium levels with periodontal and dental conditions in young adults.

The periodontal bone level and the number of erupted and intact teeth were assessed from the X-rays of 46 dental students (mean age 24.2 yr). Paraffin-stimulated whole saliva was collected in a standardized way and the salivary flow-rate was measured. The salivary concentration of calcium was analysed by atomic absorption spectrophotometry. The subjects were divided into 2 groups according to the salivary Ca level. Subjects with salivary Ca levels over the mean value (51.03 micrograms/ml) were included in the 'high salivary Ca group' (n = 20). Age- and sex-matched pairs showing Ca levels below the mean formed the 'low salivary Ca group' (n = 26). The results show that subjects in the high salivary Ca-group had significantly more intact teeth than their pairs in the low salivary Ca group (p less than 0.025). There was no difference in the total number of teeth present nor in the salivary flow rate. No periodontal breakdown could be detected in any of the X-rays. It seems that in young adults high salivary Ca content can be correlated with good dental health but not with periodontal bone destruction.