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Periodontitis
Kinds of Periodontitis Terms modified by Periodontitis Selected AbstractsSerum IgG to heat shock proteins and Porphyromonas gingivalis antigens in diabetic patients with periodontitisJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 6 2002Tom J. Sims Abstract Background: Past studies have reported a correlation between the presence and severity of periodontitis and serum antibody titers to species-specific antigens of Porphyromonas gingivalis or to cross-reactive antigens, such as lipopolysaccharide (LPS) and heat shock proteins (HSP), shared between P. gingivalis and other bacteria. Our recent study of periodontal treatment outcome in insulin-dependent (type 1) diabetes mellitus patients with severe periodontitis (IDDMI/periodontitis) resulted in two key findings: 1. serum glutamic acid decarboxylase autoantibody (GAD65 Ab) levels were significantly associated with periodontal pocket depth change (PDC) and 2. serum IgG titers to P. gingivalis cells were positively associated with GAD65 Ab level in seropositive (GAD65 Ab +) patients. We have therefore hypothesized that profiles of serum autoantibody levels and IgG titers, to P. gingivalis -specific antigens may be useful in assessing risk for refractory periodontitis in such patients. Aim: To determine whether PDC resulting from non-surgical periodontal treatment can be predicted using profiles of baseline IgG titers to P. gingivalisspecific antigens, human HSP, and GAD65. Methods: PDC was assessed two months after non-surgical periodontal treatment of 7 GAD65 Ab + and 11 GAD65 AbIDDM/periodontitis patients. Pretreatment titers to GAD65, recombinant human heat shock proteins (HSP90, HSP70, and HSP60), and various P. gingivalis antigens were measured using radioligand precipitation or enzyme-linked immunosorbent (ELISA) assays and compared to the same measurements for 154 recent-onset IDDM patients and 46 non-diabetic controls. Results: Median titers (ELISA units) to HSP90 and HSP70 were significantly higher than non-diabetic controls for GAD65 Ab + (p°= 0.002) and GAD65 Ab- (p =,0.034) IDDM/periodontitis patients, respectively. Multivariate regression analysis indicated significant partial correlation of PDC with log-transformed titers to HSP90 (r =,, 0.62, p = 0.008), HSP70 (r =,+ 0.62, p = 0.009), GAD65 (r =,, 0.60, p = 0.01) and P. gingivalis LPS (r = , 0.5 1, p = 0.04). Furthermore, hierarchical clustering of baseline profiles of log-transformed HSP90, HSP70, and GAD65 Ab titers sorted patients into two distinct clusters with significantly different median PDC (1.45 min, n = 10 vs. 0.65 min, n = 8; p = 0.016, Mann,Whitney). Conclusion: Pretreatment profiles of serum antibody titers to HSP90, HSP70, GAD65, and P. gingivalis LPS may be useful for predicting which patients with IDDM/periodontitis will have a poor response to non-surgical periodontal therapy. [source] Periodontitis and cardiovascular disease: an ecological fallacy?EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 4 2001Hans-Peter Müller [source] Interleukin-6 (G-174C) and tumour necrosis factor-alpha (G-308A) gene polymorphisms in geriatric patients with chronic periodontitisGERODONTOLOGY, Issue 1 2010A. M. Costa doi:10.1111/j.1741-2358.2009.00291.x Interleukin-6 (G-174C) and tumour necrosis factor-alpha (G-308A) gene polymorphisms in geriatric patients with chronic periodontitis Background and objective:, Periodontitis is a chronic inflammatory disease, and genetic factors may have an important role in its severity. Polymorphisms in the promoter regions of the interleukin-6 (IL-6) and tumour necrosis factor-, (TNF-,) genes have been reported to cause changes in the production of these cytokines. The aim of this study was to evaluate the possible role of IL-6 (G,174C) and tumour necrosis factor (G,308A) polymorphisms, in the severity of chronic periodontitis in an elderly population. Materials and methods:, In this study, a group of 65 elderly women, comprising 17 patients with moderate chronic periodontitis, 21 with severe chronic periodontitis and 27 healthy patients were selected. DNA was isolated from all subjects, and polymerase chain reaction was used to study the IL-6 and TNF-, gene polymorphisms. Results:, The results of this study showed a significant difference in the allele and genotype frequencies of IL-6 gene polymorphism between patients with periodontal disease and controls. Subjects carrying the G/G genotype of IL-6 were most severely affected by periodontitis. The TNF-, gene polymorphism showed no association with chronic periodontitis between patients and controls. Conclusion:, The results suggest that the IL-6 gene polymorphism may be associated with chronic periodontitis, and that TNF-, gene polymorphism may not be involved in the progression of chronic periodontitis in the population of elderly Brazilian women. [source] A study to evaluate the relationship between periodontitis, cardiovascular disease and serum lipid levelsINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 2 2009R Sridhar Abstract:, Background:, The search for cellular mechanisms linking periodontitis to changes in systemic health has resulted in the evolution of a new area of lipid research. So far the causality and possible pathways of the association between periodontal disease and cardiovascular disease is obscure. Method:, A total of 120 subjects were included in the study with 30 subjects in each of the following groups: healthy group (A), chronic periodontitis group (B), coronary heart disease (CHD + periodontitis group) (C) and CHD , periodontitis group (D). All subjects underwent oral examination and their Gingival Index, Oral Hygiene Index, Periodontal Disease Index scores and attachment loss were recorded. Two millilitres of fasting venous blood sample was drawn and tested for the level of total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL) and triglyceride level. Results and Conclusion:, The results revealed no significant difference with respect to the lipid profile levels between the four groups. Interpreting the results of the study, periodontal disease did not cause an increase in total CHL, LDL or triglyceride levels or a decrease in the HDL levels in an otherwise systemically healthy individual or in a CHD patient. Periodontitis in a CHD patient did not seem to exacerbate the destruction of periodontal tissue. Higher triglyceride levels did not have any correlation with the severity of attachment loss in a periodontitis subject. [source] C-reactive protein in gingival crevicular fluid may be indicative of systemic inflammationJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 9 2010Emma Megson Megson E, Fitzsimmons T, Dharmapatni K, Bartold PM. C-reactive protein in gingival crevicular fluid may be indicative of systemic inflammation. J Clin Periodontol 2010; 37: 797,804. doi: 10.1111/j.1600-051X.2010.01603.x. Abstract Background and Aim: Periodontitis is associated with elevated C-reactive protein (CRP) in both serum and gingival crevicular fluid (GCF). Although the liver is the primary source of CRP, extra-hepatic production of CRP has been reported. This study aimed to determine whether CRP in GCF is produced locally in the gingivae. Materials and Methods: Gingivae and GCF were collected from non-periodontitis and periodontitis sites. Presence of CRP in gingivae was assessed by immunohistochemistry. CRP in GCF was measured using ELISA. Gene expression for CRP in gingivae was determined using real-time polymerase chain reaction. Results: CRP was found in both the gingivae and GCF. No gingivae had detectable amounts of CRP mRNA. Not all patients with periodontitis had detectable levels of CRP in the GCF. Some non-periodontitis patients had detectable levels of CRP in the GCF. Conclusion: CRP in the GCF appears to be of systemic origin, and therefore may be indicative of systemic inflammation from either a periodontal infection or inflammatory disease elsewhere. The correlation between levels of CRP in GCF and serum requires validation in future studies. [source] Metabolic syndrome, insulin resistance, and periodontitis: a cross-sectional study in a middle-aged French populationJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2010Catherine Benguigui Benguigui C, Bongard V, Ruidavets J-B, Chamontin B, Sixou M, Ferrières J, Amar J. Metabolic syndrome, insulin resistance and periodontitis: a cross-sectional study in a middle-aged French population. J Clin Periodontol 2010; 37: 601,608. doi: 10.1111/j.1600-051X.2010.01571.x. Abstract Aim: Metabolic syndrome consists of a cluster of clinical and biological abnormalities, influenced by insulin resistance and promoting cardiovascular diseases. We examined the relationships between metabolic syndrome, its various components, insulin resistance, and periodontitis. Materials and Methods: The study included 276 subjects (35,74 years) recruited within a cross-sectional survey on cardiovascular risk factors. Twenty-one were excluded because of infectious risk or total tooth loss. Clinical attachment loss (CAL), probing pocket depth (PD), gingival and plaque indexes were recorded. Periodontitis was classified into moderate and severe forms. Results: The mean age was 58, 41% of the subjects had moderate and 39% had severe periodontitis. In univariate comparisons, periodontitis was associated with metabolic syndrome (p=0.050), most of its components, and HOMA index (homoeostasis model assessment of insulin resistance). After adjustment for confounders, only HOMA index remained associated with severe periodontitis (odds ratio [OR]=3.97 [95% confidence interval: 1.22,12.9], OR=3.78 [1.14,12.5] for third and fourth versus the first quartile of the HOMA index, respectively). The HOMA index was also associated with the number of periodontal sites with CAL4 mm, CAL5 mm, or PD4 mm (greater number for higher HOMA-index values). This relationship disappeared in never-smokers. Conclusions: Our data support the relationships between metabolic disturbances and periodontitis, with a central role of insulin resistance. [source] Tooth loss and cognitive impairmentJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2009Hans Joergen Grabe Abstract Objectives: Chronic subclinical inflammation may elevate the risk of cognitive impairment. Periodontitis is associated with subclinical inflammation and accounts in part for tooth loss. The hypothesis was tested that periodontitis and tooth loss as a proxy of chronic periodontitis is associated with cognitive impairment in the elderly. Subjects and Methods: The population-based Study of Health in Pomerania comprises 1336 subjects (60,79 years). Cognitive impairment was assessed with the Mini-Mental Status Examination (MMSE). Tobit regression analyses were adjusted for potential confounders. Results: A decreased number of teeth was associated with lower MMSE scores in females (p<0.001) and males (p=0.007) in age-adjusted models. In the fully adjusted models, tooth loss was associated with cognitive impairment in females (p=0.002) but not in males (p=0.825). Conclusions: A significant association between tooth loss and cognitive impairment was found in females that was not accounted for by potential confounders. Former periodontitis may account for this association as periodontitis was frequently the cause for tooth extractions. [source] 5-aminoisoquinolin-1(2H)-one, a water-soluble poly (ADP-ribose) polymerase (PARP) inhibitor reduces the evolution of experimental periodontitis in ratsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2007Rosanna Di Paola Abstract Background: Poly (ADP-ribose) polymerase (PARP), a nuclear enzyme activated by strand breaks in DNA, plays an important role in the tissue injury associated with ischaemia-reperfusion and inflammation. Recent studies have demonstrated that PARP activation plays a crucial role in the pathogenesis of acute periodontal injury. Aim: We have investigated the effect of 5-aminoisoquinolin-1(2H)-one (5-AIQ), a water-soluble PARP inhibitor, in a rat model of periodontitis. Materials and Methods: Periodontitis was induced in rats by placing a 2/0 braided silk ligature around the lower left first molar. At day eight, the gingivomucosal tissue encircling the mandibular first molar was removed for biochemical and histological analysis. Results and Conclusions: Ligation significantly induced an increased neutrophil infiltration and a positive staining for PARP activation. Ligation significantly increased Evans blue extravasation in gingivomucosal tissue and alveolar bone destruction. Intraperitonial injection of 5-aminoisoquinolin-1(2H)-one (5-AIQ) (5 mg/kg daily for eight days) significantly decreased all of the parameters of inflammation as described above. This suggests that inhibition of PARP may represent a novel approach for the treatment of periodontal disease. [source] The association of gingivitis and periodontitis with ischemic strokeJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 5 2004Christof E. Dörfer Abstract Objectives: The aim of this study was to assess the associations of different periodontal parameters with cerebral ischemia. Methods: In a case,control study, 303 consecutive patients with ischemic stroke or transient ischemic attack, and 300 representative population controls received a complete clinical and radiographic dental examination. Patients were examined on average 3 days after ischemia. The individual mean clinical attachment loss measured at four sites per tooth was used as indicator variable for periodontitis. Results: Patients had higher clinical attachment loss than population (p<0.001). After adjustment for age, gender, number of teeth, vascular risk factors and diseases, childhood and adult socioeconomic conditions and lifestyle factors, a mean clinical attachment loss >6 mm had a 7.4 times (95% confidence interval 1.55,15.3) a gingival index >1.2 a 18.3 times (5.84,57.26) and a radiographic bone loss a 3.6 times (1.58,8.28) higher risk of cerebral ischemia than subjects without periodontitis or gingivitis, respectively. Conclusion: Periodontitis is an independent risk factor for cerebral ischemia and acute exacerbation of inflammatory processes in the periodontium might be a trigger for the event of cerebral ischemia. [source] Periodontitis and perceived risk for periodontitis in elders with evidence of depressionJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2003G. R. Persson Abstract Background: Depression and periodontitis are common conditions in older adults. There is some evidence that these two conditions may be related. Aims: To study a population of dentate elders and assess the prevalence of depression, self-assessment of risk for periodontitis and tooth loss, in relation to periodontal disease status. Material and methods: Data were obtained from 701 older subjects (mean age 67.2 years (SD±4.6), of whom 59.5% were women. Self-reports of a diagnosis of depression, scores of the Geriatric Depression Scale (GDS), and self-assessment of risk for future tooth loss and periodontitis were compared with a diagnosis of periodontitis based on probing depth, and bone loss assessed from panoramic radiographs. Other systemic diseases and smoking habits were also determined and studied in relation to depression. Results: A history of depression was reported by 20% of the subjects. GDS scores 8 were reported by 9.8% of the elders. Periodontitis was identified in 48.5% of the subjects. Depression was associated with heart attack (p<0.05), stroke (p<0.01), high blood pressure (p<0.02), all combined cardiovascular diseases (p<0.001), chronic pain (p<0.01), osteoarthritis (p<0.001), and osteoporosis (p< 0.001) but not with periodontitis (p=0.73). Subjects with depression had a higher self-reported risk score for future tooth loss (p<0.02). No group difference emerged for self-perceived risk for periodontitis. Logistic regression analysis demonstrated that a past history of tooth loss (p<0.001), self-perceived risk for periodontitis (p<0.02), the number of years with a smoking habit (p<0.02), and male gender (p<0.02) were associated with a diagnosis of periodontitis but neither measure of depression could be included in an explanatory model for periodontitis. Conclusions: Evidence of depression (self-report or by GDS) is not associated with risk for periodontitis in older subjects but is associated with tooth loss and chronic conditions associated with pain. Zusammenfassung Hintergrund: Depression und Parodontitis sind gewöhnliche Bedingungen bei älteren Erwachsenen. Es gibt einige Evidenz, dass diese zwei Bedingungen miteinander in Beziehung stehen könnten. Ziel: Studium einer älteren bezahnten Population und Feststellung der Prävalenz der Depression, Selbstbestimmung des Risikos für Parodontitis und Zahnverlust in Beziehung zum parodontalen Erkrankungsstatus. Material und Methoden: Die Daten wurden von 701 älteren Personen erhalten (mittleres Alter 67.2 Jahre, SD+4.6), von denen 59.5% Frauen waren. Die Selbstberichte zur Diagnose Depression, Scorewerte einer geriatrischen Depressionsskala (GDS) und Selbstbeobachtung des Risikos eines zukünftigen Zahnverlustes und der Parodontitis wurden mit der Diagnose Parodontitis verglichen, die auf der Sondierungstiefe und dem Knochenverlust, gemessen an Panoramaaufnahmen, beruhte. Andere systemische Erkrankungen und Rauchen wurden auch bestimmt und in Beziehung zur Depression studiert. Ergebnisse: Eine Depression wurde von 20% der Personen berichtet. GDS Werte 8 wurden bei 9.8% der Älteren berichtet. Parodontitis wurde bei 48.5% der Personen identifiziert. Depression war verbunden mit Herzattacken (p<0.05), Schlaganfall (p<0.01), Bluthochdruck (p<0.02), allen kombinierten kardiovaskulären Erkrankungen (p<0.001), aber nicht mit Parodontitis (p=0.73). Personen mit Depression hatten ein höheres selbst berichtetes Risiko für zukünftigen Zahnverlust (p<0.02). Keine Gruppendifferenzen tauchten für das selbst berichtetes Risiko für Parodontitis auf. Die logistische Regressionsanalyse demonstrierte, dass vergangener Zahnverlust (p<0.001), selbst erkanntes Risiko für Parodontitis (p<0.02), die Anzahl der Jahre mit Zigarettenrauchen (p<0.02) und das männliche Geschlecht (p<0.02) mit der Diagnose Parodontitis verbunden waren, aber keine Messung der Depression konnte in das erklärende Modell für Parodontitis eingebunden werden. Schlussfolgerungen: Die Evidenz für Depression (selbst berichtet oder mit Hilfe des GDS) ist nicht verbunden mit dem Risiko für Parodontitis bei älteren Personen, aber ist verbunden mit Zahnverlust und chronischen mit Schmerz verbundenen Bedingungen. Résumé Contexte: La dépression et la parodontite sont des conditions banales chez les adultes âgés. Il existe quelques preuves de la relation entre ces deux conditions. Buts: étudier une population de sujets âgés et dentés et mettre en évidence la prévalence de la dépression, l'évaluation personnelle de risque de développement d'une parodontite et de perte dentaire en relation avec l'état de maladie parodontale. Matériels et méthodes: Des données furent obtenues chez 701 sujets âgés (age moyen 67.2 ans (SD±4.6), dont 59.5%étaient des femmes. Le rapport personnel de diagnostique de dépression, les scores de l'échelle gériatrique de dépression (GDS), et l'évaluation personnelle de risque de future perte dentaire et de parodontite furent comparés avec un diagnostique de parodontite fondé sur la profondeur au sondage et la mise en évidence de perte osseuse sur des radiographies panoramiques. D'autres maladies systémiques et le tabagisme furent aussi déterminés et étudiés en relation avec la dépression. Résultats: Un historique de dépression fut reporté chez 20% des sujets. Des scores de GDS 8 furent reportés par 9.8% des personnes âgés. Une parodontite fut identifiée chez 48.5% des sujets. La dépression était associée avec une attaque cardiaque (p<0.05), congestion cérébrale (p<0.01), hypertension (p<0.02), toute maladie cardiaque confondue (p<0.001), douleur chronique (p<0.01), arthrite osseuse (p<0.001), et ostéoporose (p< 0.001) mais pas avec la parodontite (p=0.73). Les sujets atteints de dépression avait un score de risque auto-rapporté de future perte dentaire plus important (p<0.02). Aucune différence des groupes n'émergeait pour l'auto-perception d'un risque de parodontite. Une analyse de régression logistique démontrait qu'un historique préalable de perte dentaire (p<0.001), un risque auto-perçu de parodontite (p<0.02), la durée de tabagisme (p<0.02), et l'appartenance au sexe masculin (p<0.02) étaient associés avec un diagnostique de parodontite mais aucune mesure de dépression ne pouvait être incluse dans un modèle d'explication de parodontite. Conclusions: la mise en évidence de la dépression (auto-rapportée ou par GDS) n'est pas associée avec un risque de parodontite chez des personnes âgés mais avec la perte dentaire et des conditions chroniques associées avec la douleur. [source] Comments on: M. Zigmond et al. (2006) The Outcome of a Preventive Dental Care Programme on the Prevalence of Localized Aggressive Periodontitis in Down's Syndrome (DS) Individuals (Journal of Intellectual Disability Research, 50(7), pp.JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 1 2008[source] The temporal expression and localization of extracellular matrix metalloproteinase inducer (EMMPRIN) during the development of perio-dontitis in an animal modelJOURNAL OF PERIODONTAL RESEARCH, Issue 4 2010L. Liu Liu L, Li C, Cai X, Xiang J, Cao Z, Dong W. The temporal expression and localization of extracellular matrix metalloproteinase inducer (EMMPRIN) during the development of periodontitis in an animal model. J Periodont Res 2010; 45: 541,549. © 2010 John Wiley & Sons A/S Background and Objective:, We previously demonstrated extracellular matrix metalloproteinase inducer (EMMPRIN) was associated with the matrix metalloproteinases production of human periodontitis. The aim of this study was to investigate the temporal expression and localization of EMMPRIN during ligature-induced periodontitis in rats. Material and Methods:, Periodontitis was inducd in rats by placing a thread around the cervix of the first mandibular molar. Animals were killed 3, 7, 11, 15 or 21 d after ligation. Mandibles were processed for paraffin sections and stained with hematoxylin and eosin or picrosirius red. The distance from the amelocemental junction to the alveolar crest (ACJ,AC) and the area fraction (Area%) of collagen fibers were measured. EMMPRIN was examined by immunohistochemistry and quantified by positive cell counting. Correlation analyses were then performed. Results:, Histologically, alveolar bone was gradually destroyed from day 3 to 11 and then stabilized. Collagen fibers were slightly dissociated on day 3 and extensively broken on day 7. They were reconstructed from day 11 to 21. EMMPRIN was localized predominantly in infiltrating cells and adjacent fibroblasts in interdental gingiva. The number of EMMPRIN-positive cells increased on day 3, peaked on day 7 and then gradually subsided from day 11 to 21. Statistically, there was a moderate positive correlation regarding the ACJ,AC distance (r = 0.552, p < 0.01) and a strong negative correlation with the Area% of collagen fibers (r = ,0.808, p < 0.01). In gingival epithelium, the immunoreactivity was extremely strong in basal layer cells and sulcular epithelial cells in health. It was greatly enhanced in the inflamed conditions on days 3 and 7. In the interradicular bone, EMMPRIN was localized in the osteoclasts on days 3 and 7, as well as in the osteoblasts from day 11 onwards. Conclusion:, The expression and localization of EMMPRIN are temporally varied during the development of periodontitis. In addition, the inflammation-dependent expression of EMMPRIN might be involved in alveolar bone resorption and collagen breakdown. [source] Periodontitis-induced lipid peroxidation in rat descending aorta is involved in the initiation of atherosclerosisJOURNAL OF PERIODONTAL RESEARCH, Issue 4 2009D. Ekuni Background and Objective:, Periodontitis is a risk factor for the development of atherosclerosis. Recent studies indicate that oxidative mechanisms, including lipid peroxidation, are involved not only in periodontitis but also in atherosclerosis. Lipid peroxidation may play an important role in the pathogenesis of atherosclerosis, particularly during its earliest stages. The purpose of this study was to investigate the relationship between lipid peroxidation induced by periodontitis and the initiation of atherosclerosis. Material and Methods:, Sixteen rats were randomly divided into two groups of eight rats each. Periodontitis was ligature-induced for 4 wk in the experimental group, whereas the control group was left untreated. After the experimental period, the mandibular first molar regions were resected and then subjected to histological analysis and measurement of hexanoyl-lysine expression as an indicator of lipid peroxidation. Descending aorta was used for measuring the levels of hexanoyl-lysine, reactive oxygen species and lipid deposits, and for real-time polymerase chain reaction microarray analysis. The level of hexanoyl-lysine was also measured in serum. Results:, In the experimental group, the levels of hexanoyl-lysine in periodontal tissue and serum increased. Only aorta samples in the experimental group showed lipid accumulation, with increased expression of hexanoyl-lysine, reactive oxygen species and oxidative stress-related genes (including nitric oxide synthases 2 and 3), whereas the superoxide dismutase 1 gene level was down-regulated. Conclusion:, In a ligature-induced periodontitis rat model, increased lipid peroxidation was found in serum and aorta as well as in periodontal tissue. Atherosclerosis-related gene expression and histological changes were also stimulated. Periodontitis-induced lipid peroxidation in the aorta may be involved in the early stage of atherosclerosis. [source] E-selectin and L-selectin polymorphisms in patients with periodontitisJOURNAL OF PERIODONTAL RESEARCH, Issue 1 2009B. Houshmand Background amd Objective:, Periodontitis is a multifactorial disease in which environmental and genetic determinant factors contribute to individual subject's susceptibility. A DNA polymorphism in the regulating region of adhesion molecule genes is suggested to modulate the molecule's physiological effects. The aim of this study was to investigate the genetic association between the E-selectin Ser128Arg and L-selectin Phe206Leu polymorphisms and periodontitis. Material and Methods:, DNA was isolated from the whole blood of 88 patients with periodontitis and 139 healthy individuals. All samples were genotyped for the E-selectin Ser128Arg and L-selectin Phe206Leu polymorphisms using the polymerase chain reaction with sequence specific primers. Results:, Our findings revealed a significant difference in the Ser128Arg polymorphism of E-selectin, but not in the L-selectin polymorphism, between periodontal patients and controls. The 128Arg allele was present more frequently in patients than in healthy individuals (31.25% vs. 12.2%, p < 0.0001). In addition, there was an association between the presence of the 128Arg allele and periodontitis (odds ratio 2.9; 95% confidence interval: 1.75,4.4, p < 0.0001). No significant association was found between the polymorphisms tested and the subgroups of periodontal disease (i.e. chronic periodontitis and aggressive periodontitis). Conclusion:, The findings of this study showed that the Ser128Arg polymorphism of E-selectin might contribute to the susceptibility of Iranian individuals to periodontitis. [source] Periodontitis and premature death: a 16-year longitudinal study in a Swedish urban populationJOURNAL OF PERIODONTAL RESEARCH, Issue 4 2007B. Söder Background and Objective:, Growing experimental evidence implicates chronic inflammation/infection due to periodontal diseases as a risk factor for death. The objective was to evaluate the role of periodontitis in premature death in a prospective study. Methods:, The causes of death in 3273 randomly-selected subjects, aged 30,40 years, from 1985 to 2001 were registered. At baseline, 1676 individuals underwent a clinical oral examination (Group A) and 1597 did not (Group B). Mortality and causes of death from 1985 to 2001 were recorded according to ICD-9-10. Results:, In Groups A (clinically examined group) and B, a total of 110 subjects had died: 40 subjects in Group A, and 70 in Group B. In Group A significant differences were present at baseline between survivors and persons who later died, with respect to dental plaque, calculus, gingival inflammation and number of missing molars in subjects with periodontitis (p < 0.001). The multiple logistic regression analysis results of the relationship between being dead (dependent variable) and several independent variables identified periodontitis with any missing molars as a principal independent predictor of death. Conclusions:, Young individuals with periodontitis and missing molars seem to be at increased risk for premature death by life-threatening diseases, such as neoplasms, and diseases of the circulatory and digestive systems. [source] Milk basic protein increases alveolar bone formation in rat experimental periodontitisJOURNAL OF PERIODONTAL RESEARCH, Issue 1 2007H. Seto Background and Objective:, It is conceivable that the active components extracted from milk whey protein (i.e. milk basic protein, MBP) stimulate bone formation and suppress bone resorption. Periodontitis is characterized by excessive alveolar bone resorption. We examined whether milk basic protein could recover alveolar bone loss in rat experimental periodontitis. Material and Methods:, A nylon ligature was placed around the cervix of molars in 8-wk-old male Fischer rats for 20 d. Then, the ligature was removed and a powder diet containing 0.2 or 1.0% milk basic protein was provided daily for another 45,90 d. On days 45 and 90, the maxillae were extracted and analyzed using microcomputerized tomography (micro-CT), followed by histological analysis. Results:, Micro-CT images showed that alveolar bone resorption was severely induced around the molar by the 20-d ligature procedure. Treatment with high-dose milk basic protein (1.0%) clearly recovered ligature-induced alveolar bone resorption on days 45 and 90, whereas low-dose milk basic protein (0.2%) did not show such a clear effect. Histological examination clarified that the osteoid thickness of alveolar bone was dose dependently increased by milk basic protein treatment for 90 d. Conclusion:, These findings suggest that a systemic administration of milk basic protein may be effective for the recovery of alveolar bone loss in periodontitis. [source] Periodontitis and Gestational Diabetes Mellitus: Exploring the Link in NHANES IIIJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2006Karen F. Novak DDS Abstract Objectives: The authors hypothesized that women with a history of gestational diabetes mellitus (GDM) during pregnancy would exhibit more severe periodontal disease than controls without a history of diabetes during pregnancy. Methods: Data from NHANES III provided information for 4,244 women ages 20,59. One hundred and thirteen had a history of GDM (GDM+), while 4,131 had no history of diabetes before or during their pregnancies (GDM-). Women were further classified by the presence or absence of diabetes mellitus (DM+ or OM-) at the time of their NHANES 111 examination. Periodontal disease (PO) was defined as one or more teeth with one or more sites with probing depth ,4mm, loss of affachment ,2mm, and bleeding on probing. Results: The PD prevalence among women who were GDM+DM- was 9.0% and 4.8% for those who were GDM-DM-. PD prevalence for women who were GDM+DM+ was 30.5% and 11.6% for GDM-DM+ subjects, respectively. A logistic regression model, controlling for age, calculus, smoking, and income estimated women who were GDM+DM+ were more likely to have periodontal disease than women who were GDM-DM- and women who were GDM-DM+. The GDM+DM- group also tended to be more likely to have PD than the GDM-DM- and GDM-DM+ groups. However, the odds ratios were not statistically significant. Conclusions: These results support the hypothesis that women with gestational diabetes mellitus (GDM) during pregnancy may be at greater risk for developing more severe periodontal disease than pregnant women without GDM. [source] Elevated platelet and leukocyte response to oral bacteria in periodontitisJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 1 2009E. A. NICU Summary.,Background:,Periodontitis is associated with an increased risk for cardiovascular diseases (CVD), but the underlying mechanisms are poorly understood. Recently, we showed that platelets from periodontitis patients are more activated than those from controls. Objective:,Given the regularly occurring bacteremic episodes in periodontitis patients, we hypothesized that platelets and/or leukocytes from periodontitis patients are more sensitive to stimulation by oral bacteria, in particular the known periodontal pathogens, than platelets from control subjects. Methods:,Three-color flow cytometry analysis was performed to quantify activation of platelets (P-selectin, PAC-1, CD63) and leukocytes (CD11b) in whole blood from patients with periodontitis (n = 19) and controls (n = 18), with and without stimulation by oral bacteria. Phagocytosis was assessed by using green-fluorescent protein (GFP)-expressing Aggregatibacter actinomycetemcomitans (Aa). Results:,Neutrophils and monocytes were activated by all species of oral bacteria tested, but no differences were observed between patients and controls. In response to several species of oral bacteria, platelets from periodontitis patients showed, compared with controls, increased exposure of P-selectin (P = 0.027) and increased formation of platelet-monocyte complexes (P = 0.040). Platelet-leukocyte complexes bound and/or phagocytosed more GFP- Aa than platelet-free leukocytes (for neutrophils and monocytes, in both patients and controls, P < 0.001). Conclusions:,In periodontitis, increased platelet response to oral bacteria is paralleled by increased formation of platelet-leukocyte complexes with elevated capacity for bacterial clearance. We speculate that activated platelets and leukocytes might contribute to increased atherothrombotic activity. [source] Immunization of Macaca fascicularis against experimental periodontitis using a vaccine containing cysteine proteases purified from Porphyromonas gingivalisMOLECULAR ORAL MICROBIOLOGY, Issue 3 2007R. C. Page Introduction:, Periodontitis is a common infectious disease to which Porphyromonas gingivalis has been closely linked, in which the attachment tissues of the teeth and their alveolar bone housing are destroyed. We conducted a study to determine if immunization using a purified antigen could alter the onset and progression of the disease. Methods:, Using the ligature-induced model of periodontitis in Macaca fascicularis, we immunized five animals with cysteine protease purified from P. gingivalis and used an additional five animals as controls. Alveolar bone loss was measured by digital subtraction radiography. Results:, Immunization induced high titers of specific immunoglobuin G serum antibodies that were opsonic. Total bacterial load, levels of P. gingivalis in subgingival plaque and levels of prostaglandin E2 in gingival crevicular fluid were significantly reduced. Onset and progression of alveolar bone loss was inhibited by approximately 50%. No manifestations of toxicity were observed. Conclusions:, Immunization using a purified protein antigen from P. gingivalis inhibits alveolar bone destruction in a ligature-induced periodontitis model in M. fascicularis. [source] Periodontitis as an infectious disease: specific features and their implicationsORAL DISEASES, Issue 2003A Mombelli Periodontitis may be viewed as an infectious disease with a number of specific characteristics. Pathogens of the subgingival microbiota can interact with host tissues even without direct tissue penetration. Hence, antimicrobial agents must be available at a sufficiently high concentration not only within the periodontal tissues, but also outside, in the environment of the periodontal pocket. The subgingival microbiota accumulate on the root surface to form an adherent layer of plaque with the characteristics of a biofilm. Several mechanisms, such as diffusion barriers, and selective inactivation of agents lead to an increased resistance of bacteria in biofilms. Mechanical supragingival plaque control is indispensable to prevent the re-emergence of periodontal pathogens and the re-establishment of a biofilm in treated sites. Since specific features have important implications for the use of antimicrobial agents in periodontal therapy, extrapolations from experiences made in the therapy of other infections are only partially valid. The ultimate evidence for the efficacy of systemic or local chemotherapy must be obtained from treatment studies in humans with adequate follow-up. [source] Periodontitis and incidence of cerebrovascular disease in men,ANNALS OF NEUROLOGY, Issue 4 2009Monik Jimenez SM Objective To identify associations between periodontitis and incidence of cerebrovascular disease. Methods We analyzed data of 1,137 dentate men in the Veterans Affairs Normative Aging and Dental Longitudinal Study who were followed with triennial medical/dental exams for up to 34 years (mean, 24 years). We evaluated incidence of cerebrovascular events consistent with stroke or transient ischemic attack in relation to mean radiographic alveolar bone loss (a measure of periodontitis history) and cumulative periodontal probing depth (a measure of current periodontal inflammation). Cox proportional hazards models were fit controlling for age, baseline socioeconomic status, and time-varying effects of established cardiovascular risk factors. Results Eighty incident cases of cerebrovascular disease occurred from 27,506 person-years. Periodontal bone loss was significantly associated with an increased hazard rate (HR) of cerebrovascular disease (HR, 3.52; 95% confidence interval [CI], 1.59,7.81 comparing highest to lowest bone loss category; p for trend, <0.001). There was a stronger effect among men aged <65 years (HR, 5.81; 95% CI, 1.63,20.7) as compared with men aged ,65 years (HR, 2.39; 95% CI, 0.91,6.25). Periodontal probing depth was not associated with a significantly increased rate of cerebrovascular disease in the combined or age-stratified analyses. Interpretation These results support an association between history of periodontitis,but not current periodontal inflammation,and incidence of cerebrovascular disease in men, independent of established cardiovascular risk factors, particularly among men aged <65 years. Ann Neurol 2009;66:505,512 [source] Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defectsAUSTRALIAN DENTAL JOURNAL, Issue 1 2010M Esposito Background:, Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development. Objectives:, To test whether EMD is effective, and to compare EMD versus GTR, and various BG procedures for the treatment of intrabony defects. Search strategy:, We searched the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of randomized controlled trials (RCTs) identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: February 2009. Selection criteria:, RCTs on patients affected by periodontitis having intrabony defects of at least 3 mm treated with EMD compared with open flap debridement, GTR and various BG procedures with at least 1 year follow-up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), bone levels from the bottom of the defects on intraoral radiographs, aesthetics and adverse events. The following time-points were to be evaluated: 1, 5 and 10 years. Data collection and analysis:, Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). It was decided not to investigate heterogeneity, but a sensitivity analysis for the risk of bias of the trials was performed. Main results:, Thirteen trials were included out of 35 potentially eligible trials. No included trial presented data after 5 years of follow-up, therefore all data refer to the 1-year time point. A meta-analysis including nine trials showed that EMD treated sites displayed statistically significant PAL improvements (mean difference 1.1 mm, 95% CI 0.61 to 1.55) and PPD reduction (0.9 mm, 95% CI 0.44 to 1.31) when compared to placebo or control treated sites, though a high degree of heterogeneity was found. Significantly more sites had <2 mm PAL gain in the control group, with RR 0.53 (95% CI 0.34 to 0.82). Approximately nine patients needed to be treated (NNT) to have one patient gaining 2 mm or more PAL over the control group, based on a prevalence in the control group of 25%. No differences in tooth loss or aesthetic appearance as judged by the patients were observed. When evaluating only trials at a low risk of bias in a sensitivity analysis (four trials), the effect size for PAL was 0.62 mm (95% CI 0.28 to 0.96), which was less than 1.1 mm for the overall result. Comparing EMD with GTR (five trials), GTR showed statistically significant more postoperative complications (three trials, RR 0.12, 95% CI 0.02 to 0.85) and more REC (0.4 mm 95% CI 0.15 to 0.66). The only trial comparing EMD with a bioactive ceramic filler found statistically significant more REC (-1.60 mm, 95% CI ,2.74 to ,0.46) at the EMG treated sites. Authors' conclusions:, One year after its application, EMD significantly improved PAL levels (1.1 mm) and PPD reduction (0.9 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition, a sensitivity analysis indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD. Bone substitutes may be associated with less REC than EMD. Plain language summary:, Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects. Emdogain might have some advantages over other methods of regenerating the tissue supporting teeth lost by gum disease, such as less postoperative complications, but has not been shown to save more compromised teeth or that patients noticed any aesthetic improvement 1 year after its application. Bacteria in plaque can cause gum disease (periodontitis) that breaks down tissue supporting teeth. Surgical cleaning tries to stop the disease to save loose teeth. Bone grafting, guided tissue regeneration and enamel matrix derivatives (such as Emdogain) aim to regenerate support tissues. Emdogain contains proteins (derived from developing pig teeth) believed to regenerate tooth attachment. The review found that adjunctive application of Emdogain regenerates about 1 mm more tissue than surgical cleaning alone, although it is unclear to which extent such improvement is noticeable since patients did not find any difference in the aesthetic results. Emdogain showed similar clinical results to guided tissue regeneration, but is simpler to use and determines less complications. Bone substitutes may induce less gum retraction than Emdogain. No serious adverse reactions to Emdogain were reported in trials. [source] Systemic antibiotics in periodontal therapyAUSTRALIAN DENTAL JOURNAL, Issue 2009LJA Heitz-Mayfield Abstract Periodontitis is a biofilm infection with a mixed microbial aetiology. Periodontitis is generally treated by non-surgical mechanical debridement and regular periodontal maintenance care. Periodontal surgery may be indicated for some patients to improve access to the root surface for mechanical debridement. A range of systemic antibiotics for treatment of periodontitis has been documented, with some studies showing superior clinical outcomes following adjunctive antibiotics while others do not. This has resulted in controversy as to the role of systemic antibiotics in the treatment of periodontal diseases. Recent systematic reviews have provided an evidence-based assessment of the possible benefits of adjunctive antibiotics in periodontal therapy. This review aims to provide an update on clinical issues of when and how to prescribe systemic antibiotics in periodontal therapy. [source] Stem cells and periodontal regenerationAUSTRALIAN DENTAL JOURNAL, Issue 2 2008N-H Lin Abstract Periodontitis is an inflammatory disease which manifests clinically as loss of supporting periodontal tissues including periodontal ligament and alveolar bone. For decades periodontists have sought ways to repair the damage which occurs during periodontitis. This has included the use of a range of surgical procedures, the use of a variety of grafting materials and growth factors, and the use of barrier membranes. To date periodontal regeneration is considered to be biologically possible but clinically unpredictable. Recently, reports have begun to emerge demonstrating that populations of adult stem cells reside in the periodontal ligament of humans and other animals. This opens the way for new cell-based therapies for periodontal regeneration. For this to become a reality a thorough understanding of adult human stem cells is needed. This review provides an overview of adult human stem cells and their potential use in periodontal regeneration. [source] Enhancement of matrix metalloproteinase (MMP)-2 activity in gingival tissue and cultured fibroblasts from Down's syndrome patientsORAL DISEASES, Issue 1 2001T Komatsu OBJECTIVES: To identify one of the possible factors responsible for periodontal disease in Down's syndrome (trisomy 21) patients, we studied the enzyme activity and the mRNA expression pattern of matrix metalloproteinases (MMPs) of cultured gingival fibroblasts (GF) and fresh gingival tissues. MATERIALS AND METHODS: Gingival tissue was used as the cell source and was biopsied at the time of dental treatment from nine patients with Down's syndrome and nine non-Down's controls. GF were cultivated in serum-free media for analyses of their MMP activities at the transcription or the protein level. The MMP activities in the supernates were measured by gelatin impregnated zymography. Relative levels of MMP mRNA from the cultured GF or freshly isolated gingival tissues were determined using the reverse transcription polymerase chain reaction (RT-PCR). RESULT AND CONCLUSIONS: The production of the active type of MMP-2 in GF from Down's syndrome patients (D-GF) was found to be significantly higher (P < 0.05) than that of the control GF (C-GF) at the protein level. The mRNA expressions of membrane-type1 MMP (MT1-MMP) and MMP-2 in D-GF were constitutively augmented when compared with those of C-GF. These findings suggest that specific increase of the active form of MMP-2 in D-GF may possibly be due to the concomitant expression of MT1-MMP in the cultured cells, and this could be related to the pathogenesis of gingivitis/periodontitis associated with Down's syndrome patients. [source] Dental injuries resulting from tracheal intubation , a retrospective studyDENTAL TRAUMATOLOGY, Issue 1 2009Jobst Vogel Thus, this retrospective study was conducted including the data of 115,151 patients. All patients involved had been exposed to general anesthesia between 1995 and 2005. The resulting tooth injuries were assessed according to the following parameters: age, kind of hospital conducting treatment, intubation difficulties, pre-existing tooth damage, type and localization of tooth, type of tooth damage, and the number of teeth injured. At least 170 teeth were injured in 130 patients, while patients 50 years of age and older were especially affected. In contrast to older patients where in the majority of cases the periodontium (lateral dislocation) was injured, in younger patients dental hard tissue (crown fracture) was more likely to be affected. It was calculated that patients from the cardiothoracic surgery clinic were showing the highest risk of tooth damage. In more than three-fourth of all cases the anterior teeth of the maxilla, especially the maxillary central incisors, were affected. Pre-existing dental pathology like caries, marginal periodontitis and tooth restorations were often distinguishable prior to operation. Mouthguards in connection with tracheal intubation are not generally recommended as preventive device, due to the already limited amount of space available. Instead, pre-existing risk factors should be thoroughly explored before the induction of intubation narcosis. [source] Bacteria of asymptomatic periradicular endodontic lesions identified by DNA-DNA hybridizationDENTAL TRAUMATOLOGY, Issue 5 2000J. J. Gatti Abstract , Possible inclusion of contaminant bacteria during surgery has been problematic in studies of periradicular lesions of endodontic origin. Therefore, in this study, two different surgical techniques were compared. A second problem is that some difficult to cultivate species may not be detected using bacteriological methods. Molecular techniques may resolve this problem. DNA-DNA hybridization technology has the additional advantage that DNA is not amplified. The purpose of this investigation was to determine if bacteria from periradicular endodontic lesions could be identified using DNA-DNA hybridization. A full thickness intrasulcular mucoperiosteal (IS) flap (n=20) or a submarginal (SM) flap (n=16) was reflected in patients with asymptomatic apical periodontitis. DNA was extracted and incubated with 40 digoxigenin-labeled whole genomic probes. Bacterial DNA was detected in all 36 lesions. Seven probes were negative for all lesions. In patients with sinus tract communication, in teeth lacking intact full coverage crowns, and in patients with a history of trauma, 4,13 probes provided positive signals. Seven probes were positive in lesions obtained by the IS, but not the SM technique. Two probes were in samples obtained with the SM technique, but not the IS. Only Bacteroides forsythus and Actinomyces naeslundii genospecies 2 were present in large numbers using either the IS or the SM technique. The SM flap technique, in combination with DNA-DNA hybridization, appeared to provide excellent data pertaining to periradicular bacteria. These results supported other studies that provide evidence of a bacterial presence and persistence in periradicular lesions. [source] Postoperative discomfort associated with surgical and nonsurgical endodontic retreatmentDENTAL TRAUMATOLOGY, Issue 2 2000T. Kvist Abstract , Endodontic retreatment decision-making must include an appraisal of the costs of the different strategies proposed. In addition to direct costs, postoperative discomfort may have other consequences in terms of time off work, unscheduled visits and suffering. To establish a foundation for the appraisal of such indirect and intangible costs the present study was set up in which patients' assessments of pain and swelling after surgical and nonsurgical retreatment procedures were recorded. Ninety-two patients with 95 root-filled incisors and canine teeth exhibiting apical periodontitis were included in the study. The mode of retreatment was randomly assigned. Each day during the first post-treatment week patients assessed their degree of swelling and pain on horizontal 100-mm visual analog scales (VAS). The scales ranged from "no swelling" to "very severe swelling" and "no pain" to "intolerable pain", respectively. Consumption of self-prescribed analgesics and time off work were also recorded. Significantly more patients reported discomfort after surgical retreatment than after nonsurgical procedures. High pain scores were most frequent on the operative day while swelling reached its maximum on the first postoperative day followed by progressive decrease both in frequency and magnitude. Postoperative symptoms associated with nonsurgical retreatment were less frequent but reached high VAS values in single cases. Analgesics were significantly more often consumed after periapical surgery. Patients reported absence from work mainly due to swelling and discoloration of the skin. This was found to occur only after surgical retreatment. Conclusively, surgical retreatment resulted in more discomfort and tended to bring about greater indirect costs than nonsurgical retreatment. [source] Alveolar bone loss associated with glucose tolerance in Japanese menDIABETIC MEDICINE, Issue 9 2003T. Marugame Abstract Aims Type 2 diabetes is known to affect alveolar bone loss (ABL). The purpose of this study was to examine whether impaired glucose tolerance (IGT) is associated with ABL, as is diabetes. Methods A case,control study was performed with 664 Japanese men aged 46,57 years. Panoramic radiographs revealed 513 severe ABL cases, 22 moderate ABL cases, and 129 controls with good alveolar bone. Diabetes status was classified into normal glucose tolerance (NGT), impaired fasting glucose (IFG), IGT, and newly diagnosed diabetes according to the fasting plasma glucose and 75-g oral glucose tolerance test (OGTT). Diabetes under treatment was excluded. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from ordinal logistic regression analysis. Statistical adjustment was made for total cholesterol, HDL-cholesterol, triglyceride, rank in the Self Defence Forces (SDF), cigarette-years, alcohol use, body mass index, previous 10 years' brushing habits and instrument use other than toothbrush, and history of periodontal treatment. Results A significant, approximately three-fold increase in the crude OR (crude OR = 3.28; 95% CI = 1.16,9.27) and non-significant 2.6-fold increase in the adjusted OR (adjusted OR = 2.55; 95% CI = 0.86, 7.54) of ABL was observed among men with newly diagnosed Type 2 diabetes compared with the reference group (NGT combined with IFG). However, there was no association between IGT and ABL (adjusted OR = 0.99; 95% CI = 0.59,1.64). Conclusions Type 2 diabetes, but not IGT, was positively associated with ABL. Preventive maintenance against periodontitis is important in middle-aged men with diabetes. [source] Periodontal infection control: current clinical conceptsENDODONTIC TOPICS, Issue 1 2006JAN L. WENNSTRÖM The main objective of the treatment of patients with periodontitis is to establish adequate infection control in the dentogingival area. Pocket/root instrumentation (scaling and root planing), combined with effective self-performed supragingival plaque control measures, constitute the basic treatment modalities, but also locally applied antiseptics and antibiotics may be utilized. The purpose of this article is to give an overview of current clinical concepts on periodontal infection control. [source] | |||||||||||||||||||||||||||||||