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Background: Smoking is correlated with a large number of oral conditions such as tooth staining and bad breath, periodontal diseases, impaired healing of wounds, precancer and oral cancer. These effects are often visible and in the early stages they are reversible after cessation of smoking. Dentists, as part of the health profession, are frequently in contact with the general population and there is evidence that they are as effective in providing smoking cessation counselling as any other healthcare group., Aims and Methods: Patients' knowledge of the effects of smoking and their attitudes towards the role of dentists in smoking cessation activities were analysed via a self-completing questionnaire and compared depending on their smoking status (smokers and non-smokers)., Results: The results show that patients hold very positive attitudes towards dentists' role in smoking cessation. The results also show that although patients have a good knowledge of the effects of smoking on general health, smokers are significantly less aware of the relationship between smoking and gum disease and on wound healing., Conclusions: Dentists should inform their patients about the oral effects of smoking and strongly advise them not to smoke, especially in patients diagnosed with periodontal disease and requiring surgical procedures.

Background: This study establishes baseline prevalence of smoking and cigarette consumption among Cork bar workers prior to the Republic of Ireland's (ROI) smokefree workplace legislation and compares gender- and age-specific smoking rates and estimates the adjusted odds of being a smoker for Cork bar workers relative to the general population., Methods: Cross-sectional random sample of bar workers in Cork city and cross-sectional random telephone survey of the general population were conducted prior to the smokefree legislation., Results: Self reported smoking prevalence among Cork bar workers (n = 129) was 54% (58% using cotinine-validated measures), with particularly high rates in women (70%) and 18-28 years old (72%). Within the ROI (n = 1,240) sub-sample rates were substantially lower at 28%. Bar workers were twice as likely to be smokers as the general population sub-sample (OR = 2.15)., Conclusions: Cork bar workers constitute an occupational group with an extremely high smoking prevalence.

Unlabelled: Maintenance periodontal therapy is essential for the long-term stabilization of periodontal disease. An individualized programme of maintenance requirements, based on patient risk assessment for disease progression, is important, as is the need for teamwork in long-term patient management., Clinical Relevance: Maintenance or supportive therapy is an essential requirement in the management of periodontal therapy. Patients should be informed at their first visit that part of the management of their disease is regular maintenance visits.

Unlabelled: The possibility that periodontal diseases have an effect on systemic health is being widely investigated. This paper reviews the potential links and the mechanism of these effects., Clinical Relevance: Although the effects of periodontitis on systemic health do not yet have an effect on clinical decisions, knowledge and understanding of the link, effects and mechanism are important.

Unlabelled: Periodontal disease can significantly impact on the appearance of the anterior teeth. Prior to any definitive treatment, stabilization of the periodontal condition is a requirement. Treatment options can range from the placement of simple restorations, through orthodontic realignment, to the extraction and replacement of hopeless teeth. Each treatment plan must be individually tailored to the patient and level of periodontal disease, and must include provision for maintenance periodontal therapy., Clinical Relevance: Periodontal diseases may compromise the prognosis of anterior teeth. Management is challenging and clinicians should take into consideration the short and long-term survival in treatment planning.

Unlabelled: Periodontitis affecting multi-rooted teeth presents a challenge for non-surgical and surgical management. This paper reviews the management of compromised posterior teeth., Clinical Relevance: Successful management of compromised posterior teeth requires careful assessment of all contributing factors and the implementation of a long term maintenance programme.

Unlabelled: Gingival recession is a common condition affecting the dentition. This paper describes the aetiology of gingival recession and discusses the appropriate management of this condition., Clinical Relevance: Careful examination to detect gingival recession, or the factors that may place the patient at risk for recession, are important for prevention.

Unlabelled: The surgical crown lengthening procedures are usually used to facilitate the restoration of teeth with poor retentive properties. These techniques can also be applied to the management of aesthetic gingival problems., Clinical Relevance: It is important that the need for crown lengthening procedures is evaluated before any complex restorative treatments are carried out.

Unlabelled: Non-surgical periodontal therapy is the first line of management in the treatment of periodontitis. Gingival and periodontal surgery should be carried out after non-surgical therapy and on patients who show excellent plaque control. This article presents the indication, contra-indication and complications of gingival and periodontal surgery and the clinical outcome of the most common procedures used., Clinical Relevance: Knowledge of the periodontal surgical procedures, their indication and outcomes, are important to allow adequate evaluation and referral.

Unlabelled: Non-surgical periodontal therapy is an integral part of periodontal treatment and has been defined as plaque removal, plaque control, supra- and subgingival scaling, root surface debridement, and the adjunctive use of chemical agents., Clinical Relevance: Knowledge of the role of non-surgical periodontal therapy is central to good patient care.

Unlabelled: Periodontitis is an inflammatory condition initiated by microbial plaque but influenced by an array of factors that affect the development and progression of the disease. This paper summarizes the major risk factors for periodontal disease and the potential to modify specific factors., Clinical Relevance: The assessment of patients with periodontal diseases must include an evaluation of risk and susceptibility. While removal of bacterial plaque and plaque-retentive factors remains the focus of treatment, for successful, long-term management of periodontal diseases, it is also important to eliminate known risk factors.

Unlabelled: The diagnosis and management of periodontal diseases requires a detailed examination of the signs and symptoms associated with periodontal disease. This requires a screening procedure, the BPE being sufficient in the majority of cases. Detailed examination is, however, required in more advanced or severe cases. The general dental practitioner should follow a systematic and organized examination to identify and differentiate between individuals with gingivitis, and those with mild, moderate and more advanced forms of periodontitis. Treatment planning, including the decision to refer to a consultant/specialist when appropriate, requires a clear understanding and satisfactory interpretation of the information gathered from the examination. This reduces the risk of over or under treatment, helps in evaluating the individual's response to therapy and reduces the risk of litigation., Clinical Relevance: The assessment and clinical examination of patients with periodontal diseases, as detailed in this paper, are essential for the diagnosis, effective treatment planning and future maintenance care of patients in general dental practice.

The purpose of this study was to assess the outcomes of early medical abortion in an inner-city hospital abortion service, using misoprostol as the primary agent. This was a retrospective chart review from July 2001 through December 2002. Women were eligible if they had a viable pregnancy with gestational age 8 weeks or less by transvaginal ultrasound and no medical contraindications. Two doses of 800 microg misoprostol were administered vaginally, 24 h apart. Initial follow-up was scheduled 2-3 days later. Of the 440 women who underwent medical abortion, 373 (90.8%, 95% confidence interval (CI) 88-94%) completed abortion medically, 38 (9.2%) had uterine aspiration and the remainder had incomplete or no follow-up. Of uterine aspirations, 11 were medically indicated, giving a rate of indicated aspiration of 2.7%. Gestational age, age, gravidity, parity, past abortion history, ethnic group and payer did not significantly correlate with overall rate of aspiration or rate of follow-up, but gestational age was correlated with medically indicated aspiration. Among 57 women who reported a time of tissue passage, the mean time from initial misoprostol dose was 8.5 h (95% CI 6.5-13 h).

This study investigated the prevalence of bacteraemia on removal of fixed appliances. Venous blood samples were taken before and after debonding and debanding for 30 patients (mean age 17 years 8 months) who had worn fixed appliances for an average of 19 months. Before removal of the fixed appliances, bacteraemia was detected in one of the 30 subjects (3%) and in four subjects (13%) following removal of their fixed appliances. The 95 per cent confidence intervals for the prevalence of post-debanding bacteraemia were 3.8 and 30.7 per cent. No significant relationship was detected between the mean plaque scores (t = -0.65, P = 0.52) or the mean gingival scores (t = 0.75, P = 0.46) and the occurrence of bacteraemia. The prevalence of bacteraemia detected following debanding in this study is considerably lower than reported for dental procedures traditionally covered by antibiotic prophylaxis guidelines.

It is a curious state of affairs that the children in Northern Ireland (NI) compared with their counterparts in the Republic of Ireland and Great Britain have some of the worst dental health.

This article will highlight some of the problems encountered when orthodontic treatment is provided for patients who have serious medical conditions. The way in which various disease processes might influence treatment decisions will be described, as well as recommended methods of avoiding potential problems.

Aim: To review the evidence on using Guided Tissue Regeneration (GTR) techniques and materials in various clinical circumstances., Method: Literature review., Main Outcome Measures: The success of GTR techniques and materials in halting or reversing the destruction of tooth attachment apparatus caused by progressive periodontal disease., Results: GTR and osseous grafting are the two techniques with the most clinical and histological documentation of periodontal regeneration., Conclusions: GTR materials, whether non-resorbable or bioabsorbable, give similar clinical results. GTR procedures have been demonstrated to be clinically effective in treating infrabony osseous defects, recession defects, preserving alveolar bone in recent extraction sites and in some types of furcation defects. GTR procedures are technique sensitive and are adversely affected by poor home oral hygiene care, poor follow-up professional maintenance care and smoking.

This report describes the clinical presentation of three cases of vertical root fractures in adult patients where an initial diagnosis of localized periodontitis had been considered. Loss of the affected tooth occurred in all of these patients. The effects of endodontic therapy and the provision of post-retained restorations are considered in relation to their potential effect of weakening the root and predisposing the tooth to vertical fracture. The last case presents an unrestored molar tooth with a complete vertical root fracture.

The primary objectives of this study were to investigate the prevalence of 8 putative periodontal pathogens in subjects with early-onset periodontitis (EOP) and to evaluate the microbial differences between localized and generalized forms of this periodontal disease condition. Thirty-one females and 11 males with a mean age of 30.3 (s.d. 4.0) years were examined. Seventeen subjects had generalized (GEOP) and 25 had localized early-onset periodontitis (LEOP). Subgingival plaque samples were assayed using PCR which provided subject prevalence data for the pathogens; Bacteroides forsythus 78.6%, Treponema denticola 88.1%, Actinobacillus actinomycetemcomitans 19.0%, Porphyromonas gingivalis 16.7%, Prevotella intermedia 40.4%, Prevotella nigrescens 61.9%, Eikenella corrodens 42.3% and Campylobacter rectus 92.8%. Only 3 healthy sites harbored one or more of these periodontal pathogens. Seven of the 8 subjects positive for A. actinomycetemcomitans had LEOP. P. intermedia was present in 58.8% of GEOP compared with 28% of LEOP subjects (p=0.046). At 82.4% of GEOP sites P. nigrescens was present while this bacteria was detected at 52% of LEOP (p=0.044). P. gingivalis was isolated from 22.6% of females but no male subjects (p=0.084). C. rectus was recovered from all female subjects compared to 72.7% of males (p=0.014). A. actinomycetemcomitans (37.5%) and C. rectus (86.5%) were more frequently identified in non-smokers compared to 7.6% and 68.8% of smokers, respectively (p <0.05). Microbial associations coincided with the clinical division of the cases into LEOP and GEOP in 83% of the subjects.

Background: The study of periodontitis provides a unique model for assessing the involvement of neuropeptides in inflammatory disease., Aim: To investigate the effects of periodontal treatment, resulting in a return to periodontal health, on the levels of substance P (SP) and neurokinin A (NKA) in gingival crevicular fluid (GCF)., Method: We completed a cause of non-surgical treatment for 8 subjects with periodontitis (6 females 2 males, mean age 45.1, range 38-67 years) started a course of non-surgical periodontal treatment. Clinical indices were measured at 2 periodontitis sites at the initial visit and at 8 weeks after the completion of treatment in each subject. A 30-s sample of GCF was collected from each test site using perio paper strips. Each strip was placed into 500 microl of ice cold 0.1 M PBS, pH 7.4, vortex mixed for 30 s, and then stored at -70 degrees C until analysed by radioimmunoassay., Results: The clinical condition of all test sites improved as a result of the periodontal treatment. The levels (pg/30 s sample) of SP fell from 56.3 (SD 66.0) at the initial visit to 4.2 (3.1) after treatment, p=0.017. The concentration (pg/microl) of SP in GCF fell from 140.6 (175.6) to 24.2 (11.1), p=0.036. The levels of NKA fell from 30.5 (17.1) to 10.6 (4.9), p=0.012 whereas the concentration changed little from 85.4 (43.5) to 61.6 (15.1), p=0.41., Conclusion: The reduction in inflammation resulting from effective periodontal treatment is associated with a reduction in the levels of tachykinins in gingival crevicular fluid.

Our objective was to compare three methods (enzyme-linked immunosorbent assay [ELISA], endpoint and quantitative polymerase chain reaction [E-PCR and Q-PCR]) for detection and quantitation of Bacteroides forsythus in 56 plaque samples from seven subjects with progressive periodontal disease. Samples collected in buffer were pelleted and resuspended in 500 microl of water. Fifty microl aliquots were removed for an ELISA performed on bacteria or plaque immobilized on 96-well plates and probed with B. forsythus specific antibody. An occurrence of 3.7+/-0.6 x 10(4) or more bacteria were detected by ELISA in pure culture; 26 of 54 plaque samples were positive, two samples could not be analyzed. Samples for PCR were autoclaved for 10 min prior to use. The detection level of E-PCR using primers specific for B. forsythus 16S rRNA was 200 cells and 42 out of 56 samples were positive based on ethidium bromide stained agarose gels. Q-PCR using the same primers combined with a nested fluorescent oligonucleotide probe detected 10+/-0.32 bacteria in pure culture; 43 of 56 plaque samples were positive. The ELISA and Q-PCR obtained identical results with 36 of the 54 samples assayed; there were one false positive and 17 false negative ELISA results using Q-PCR as standard. The positive proportions of plaque samples were almost the same for E-PCR and Q-PCR. We conclude that the PCR methods are more appropriate for a multicenter study because of greater sensitivity and convenience of sample transportation from clinics to a central laboratory.

This paper reviews the available evidence supporting 2 commonly used methods of surgically exposing palatally ectopic canines. The closed eruption method (a bonded attachment is placed at operation and the palatal flap is sutured back intact) is compared with the open eruption method (a window of palatal mucosa is excised and the canine allowed to erupt naturally). The choice of surgical technique is reviewed in terms of the long-term periodontal implications, the rate of repeat surgery, and treatment time.

Background: The aims of this study were to investigate the extent and distribution of bone loss in subjects with early-onset periodontitis (EOP) referred for periodontal care and to study the relationship between smoking and EOP., Methods: A total of 71 consecutive referrals (21 male, 50 female) under 35 years old, who were otherwise healthy, with a clinical diagnosis of severe periodontitis were recruited for the study. Bone loss was measured from available radiographs using a Schei ruler to identify 2 patterns of destruction: localized (LEOP) in 41 (58%) and generalized early-onset periodontitis (GEOP) in 30 (42%) subjects., Results: The study population had a mean of 25.0 (SD 2.4) teeth, excluding third molars, and mean bone loss of 28.7% (SD 13.0). Bone loss was more severe in the maxilla, 30.9% (SD 13.8) compared with 26.6% (SD 14.0) in the lower arch. More than one-third (36%) of the teeth examined had at least 30% bone loss. Mean smoking experience was 9.2 pack years (SD 5.6), and 39 (55%) of the EOP subjects smoked. Smokers had significantly more maxillary bone loss than non-smokers. A much higher proportion of GEOP (70%) currently smoked compared with 44% of LEOP, P = 0.029., Conclusions: It is concluded that young adults with early-onset forms of periodontitis often have advanced periodontal destruction before they are referred for specialist care. In addition, there was a relationship between smoking and severe bone destruction in subjects with EOP, particularly those with generalized disease.

The aim of this study was to investigate the relationship between cigarette smoking and furcation involvement in molar teeth. A consecutive group of 50 smokers were recruited from referrals to a periodontal clinic and age and gender matched with never smokers. Smokers consumed an average of 18.0 (SD 6.7) cigarettes per day and had smoked for 2.7 (SD 6.5) years. Radiographs of all molar teeth were assessed 2 x by an examiner blinded to the smoking status. Smokers had slightly fewer molar teeth 6.7 (SD 2.6) than the never smokers, 7.3 (SD 2.3), t = 1.2, P = 0.22. More smokers (72%) had evidence of furcation involvement than never smokers (36%), x2 = 13.0, P = 0.0003. The odds ratio for a smoker having 1 molar with furcation involvement was 4.6 (c.i. 2 - 10.6). Smokers had more molars with furcation involvement 1.94 (SD 1.7) compared with never smokers, 0.94 (SD 1.4), t = 3.1, P = 0.003. It is concluded that cigarette smoking is associated with a greater expression of molar furcation involvement in periodontitis affected subjects.

This study examined the association between occupational stress and the progression of periodontitis in employed adults. 23 regular dental attenders, enrolled in a longitudinal study of periodontal disease, were examined on 2 occasions at an interval of 5.5 (SD 0.6) years. The mean age at the 2nd examination was 41.1 (SD 7.3) years. Clinical measurements of periodontal status including clinical attachment level were made at four proximal sites on all teeth. A questionnaire, the occupational stress indicator, was used at the second examination to assess stress retrospectively. The mean change in clinical attachment level was 0.63 (SD 0.42) mm and 9.6 (SD 8.6)% of sites measured at both examination lost > or = 3 mm of periodontal attachment. Multiple regression analysis was used to explore the relationship between mean loss of periodontal attachment and measures of occupational stress and sociodemographic data. In the final regression model, an increase in loss of periodontal attachment was significantly predicted by increasing age, lower socio-economic status, lower job satisfaction and type A personality. In addition, locus of control was included in the regression model which explained 65% of the variance in the loss of periodontal attachment. The results suggest that occupational stress may have a relationship to the progression of periodontitis.

This case illustrates a restorative approach using adhesive techniques to overcome the aesthetic and functional problems associated with infraclusion of a mandibular canine tooth resulting from ankylosis. In this case a diagnosis of ankylosis was confirmed after 3 months of fixed appliance orthodontic therapy failed to extrude the tooth.

A double-blind controlled clinical trial with parallel groups was designed to investigate the effectiveness of a herbal-based toothpaste in the control of plaque and gingivitis as compared with a conventional dentifrice. 70 subjects with gingivitis completed the 6-week study. All participants had at least 20 natural teeth with no probing depths greater than 3 mm and a plaque index of 2 or more at baseline. At baseline, both groups were balanced for the parameters measured: plaque index, plaque vitality, gingival index, bleeding on probing and gingival crevicular fluid flow. At the end of the trial, there were reductions within both groups, however, there were no significant differences between the groups. It was concluded that the herbal based toothpaste was as effective as the conventionally formulated dentifrice in the control of plaque and gingivitis.

The aim of this investigation was to assess the prevalence and severity of periodontal destruction in irregular dental attenders. 50 subjects aged between 20 and 49 years completed a questionnaire and had a periodontal examination. Measurements of plaque, calculus, bleeding, probing depth and clinical attachment level were made at 4 proximal sites per tooth. Results were compared to those for 132 regular attenders. The irregular attenders had more sites with plaque (46.3 +/- 27% versus 17.3 +/- 21.1%) than the regulars and significantly more sites which bled (53.7 +/- 20.4% versus 33.6 +/- 20.7%) and with calculus (35 +/- 21.1% versus 13.4 +/- 12.8%). However, the irregulars had virtually the same number of teeth as the regular attenders, 25.6 +/- 3.3 compared with 25.4 +/- 4.3. Irregular attenders had slightly deeper mean probing depths (2.9 +/- 0.4 versus 2.7 +/- 0.4 mm) but the prevalence and extent of attachment loss was no different between the groups. It was concluded that the prevalence and severity of destructive periodontal disease as indicated by periodontal attachment loss was not related to the regularity of dental attendance in the groups studied.

The purpose of this study was to determine whether gingival crevicular fluid (GCF) sampling by paper strip removes sufficient bacteria to affect subsequent subgingival plaque sampling using a curette. In 25 subjects, one healthy, gingivitis and periodontitis site was sampled for GCF using a strip followed by subgingival plaque sampling with a curette. Bacterial assays indicated that GCF strips removed significant numbers of bacteria when placed intracrevicularly for 5 s. A greater proportion of total bacteria was removed with strip sampling at healthy rather than gingivitis or periodontitis sites. Qualitative assessment of presence or absence of spirochaetes and dark-pigmented species indicated potential for significant interference of curette sampling by the strip at gingivitis and healthy sites. We concluded that paper strip GCF sampling may significantly affect curette sampling at the same sites. The magnitude of this impact depended on the clinical classification of specific sites and the assay performed.

The relationship between cigarette smoking and periodontal destruction was assessed in young adults. Eighty-two regular dental attenders (21 current cigarette smokers, 61 non-smokers) aged between 20 and 33 years were examined. The smokers consumed on average 15.4 (+/- 7.3) cigarettes per day and had smoked for an average of 11.8 (+/- 7) years. Cigarette smokers had almost the same levels of plaque as non-smokers but had more proximal surfaces with subgingival calculus (P < 0.01) and which bled on probing (P < 0.05). Smokers had significantly more pockets > or = 4 mm (14.6 +/- 19.9) than non-smokers (5.8 +/- 7.9), P < 0.01. Only 2 (10%) of the smokers and 1 (2%) of the non-smokers had deep pocketing (> or = 6 mm). Smokers had significantly more sites (21.8 +/- 24.9) with periodontal attachment loss of > or = 2 mm than non-smokers (9.3 +/- 12.2), P < 0.01. Severe loss of periodontal attachment (> or = 6 mm) was present in 4 (19%) of smokers compared with 2 (3%) of non smokers. In total 4 (19%) of the smokers had "established periodontitis" compared with 1 (2%) of the non-smokers. The odds ratio for the presence of "established periodontitis" and smoking was 14.1 (confidence interval 1.5 to 132.9). It is concluded that cigarette smoking was a major environmental factor associated with accelerated periodontal destruction in this selected group of young adult regular dental attenders.

The periodontal status of 14 regular dental attenders who had been wearing removable partial dentures was compared with a matched group of non-denture wearers. Most partial dentures were mucosally supported. Reported plaque control practices, levels of plaque, subgingival calculus and gingival bleeding, mean pocket depth and mean loss of periodontal attachment were similar in both groups. Severe destructive periodontal disease was present in five (36%) of the denture wearers compared with seven (50%) of the non-denture wearers. We conclude that regular dental attenders with partial dentures were no more likely to have poorer periodontal health than comparable non-denture wearers.

This investigation assessed the effect of an electronic pressure-sensitive probe on the reproducibility of probing-depth measurement. Clinical measurements were made at the mesial and distal aspects of all teeth from the buccal and palatal or lingual aspects. Probing was carried out either in a conventional manner using gentle pressure referred to as hand probing or using an electronic pressure-sensitive probe set at 25 g and referred to as pressure-controlled probing. Probing-depth recordings were repeated for one randomly selected quadrant in each subject with random application of the 4 different combinations of pressure-controlled and hand probing. A total of 2584 replicate pairs of probing depth measurements were recorded on 4 proximal surfaces in 646 teeth in 100 adult subjects. The majority (98%) of all repeated measurements were within 1 mm of the initial values. The highest levels of agreement resulted when the same probing method was used at both examinations with electronic pressure-controlled probing being superior to hand probing regardless of tooth position or site. Duplicate measurements recorded with combinations of hand and pressure-controlled probing showed significant systematic bias towards shallower pocket depths with electronic pressure-controlled probing.

This report describes candidal infection as a complication of barrier membrane placement in a diabetic patient. This resulted in failure of the regenerative procedure and necessitated extraction of the tooth involved. Candidal hyphae were demonstrated within the dentinal tubules of the tooth. Subsequent to appropriate medical treatment to regain control of the diabetes there was an improvement in oral health.

The aim of this study was to assess the prevalence and severity of periodontal destruction in regular dental attenders in Northern Ireland. 132 individuals aged between 20 and 49 years who had recently had a course of routine treatment in the General Dental Service completed a questionnaire and had a periodontal examination. Measurements of plaque, subgingival calculus, bleeding, probing pocket depth and periodontal attachment level were made at 4 proximal sites per tooth. Plaque was present at an average of 17%, subgingival calculus at 13%, and bleeding on probing at 34% of interproximal surfaces examined. The mean probing pocket depth was 2.7 mm and the mean probing attachment level was 1.0 mm. Incipient periodontal destruction was common with all subjects having at least 1 pocket of greater than or equal to 3 mm and 90% having at least 1 site with greater than or equal to 2 mm attachment loss. Only 24 (18%) of those examined had deep pocketing or severe loss of periodontal attachment (greater than or equal to 6 mm). The extent of deep pocketing and severe attachment loss was low at only 0.2% and 0.6%, respectively, of the sites examined. It was concluded that gingivitis and incipient periodontitis were prevalent and extensive in the regular dental attenders investigated, but that severe periodontal destruction was uncommon.

Clinical readings of pocket depth and loss of periodontal attachment were recorded on the approximal sites of 21 teeth scheduled for extraction. Corresponding laboratory measurements of pocket depth and loss of periodontal attachment were made on the teeth after extraction. Clinical measurements were within 1mm of their corresponding laboratory values on 95% of occasions. Clinical readings of loss of periodontal attachment of 0 or 1mm showed poor agreement with corresponding laboratory measurements. It was concluded that the presence of loss of periodontal attachment can only be reliably identified where a clinical reading of 2mm or greater is recorded.

A case of the nodular form of polymyositis is reported in which muscle necrosis and inflammation, and fibrosis of subcutaneous fat were observed. Although the patient had a short history, the presence of extensive fibrosis with acute lesions indicated that the disease had been present for some time. In addition to the nodular lesions, the patient had clinical, electrophysiological and pathological evidence of a more generalised myopathy. The subsequent development of a rash resembling that of vasculitis and a peripheral nerve lesion, suggested that the localised nodular myositis was associated with systemic vasculitis. Although immunoglobulin and complement deposits were not detected in blood vessel walls in muscle or skin, a positive reaction to intradermal injection of autologous serum suggested the presence of circulating immune complexes.