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Background: A recent study conducted in humans demonstrated for the first time that bone loss in the immediate period after implant insertion before loading did not significantly differ in organ transplant recipients with respect to normal subjects., Purpose: The purpose of this study is to evaluate bone and periodontal response and peri-implant microflora in a group of organ-transplanted patients 1 year after prosthetic loading., Materials and Methods: The study population included 13 consecutive organ-transplanted (11 hearts, two livers) patients and 13 normal (healthy) control subjects who received 29 and 28 submerged dental implants, respectively. Crestal bone level, peri-implant probing depth (PIPD), and bleeding on probing were evaluated at prosthetic loading and after 1 year. Samples for microbiological testing were taken from the subgingival microbiota of each implant 1 year after loading and analyzed with polymerase chain reaction. All samples were examined for the presence of five microorganisms: Treponema denticola, Porphyromonas gingivalis, Prevotella intermedia, Tannarella forsythensis, and Actinobacillus actinomycetemcomitans., Results: A mean bone loss of 0.17 ± 0.10 and 0.20 ± 0.10 mm at 1 year was observed in the group of transplant recipients and in controls, respectively (N.S.). Similar results were obtained considering PIPD changes at 1 year (respectively 0.06 ± 0.71 mm in transplants vs 0.11 ± 0.74 mm in controls). Detection frequencies of pathogens were not statistically different between normal and transplanted patients., Conclusions: The present pilot study seems to indicate that bone and periodontal response and microbiological status around submerged dental implants in immunocompromised organ-transplanted patients do not differ 1 year after loading from those observed in control patients and that this particular population of patients may be successfully rehabilitated with dental implants., (© 2014 Wiley Periodicals, Inc.)

Oral leukoplakia (OL) is the most common potentially malignant lesion of the oral cavity. Immunohistochemical analysis of p53 and Ki67 proteins is a simple and inexpensive method widely used in non-dysplastic OLs to reveal lesions predicted to develop oral cancer. The present longitudinal study evaluated the predictive role of p53 and Ki67 proteins alone or in combination in a group of OLs without dysplasia followed for many years. Seventy-seven OL patients referred to our Department between January 2006 and October 2013 underwent histochemical analysis of p53 and Ki67 expression. OLs were considered at high risk in the presence of either high p53 expression (>20%), or low/normal p53 expression associated with high Ki67 expression (Ki67/p53 ratio >3). Seven OLs evolved to OSCC during the follow-up period. Three cases had p53 overexpression, while four had a high Ki67/p53 ratio. Statistical significance was reached when samples with p53 overexpression were combined with samples with high Ki67/p53 ratio (Chi square 5.3; p<0.02). The combined immunohistochemical expression of p53 and Ki67 proteins could be a useful and simple molecular marker for early detection of non-dysplastic OLs at risk of developing oral cancer.

p53 over-expression has been proposed as a reliable marker associated to oral carcinogenesis, although only about 50% of oral carcinomas (OSCC) are associated with p53 over-expression and even p53-negative lesions can progress to OSCC. The aim of the study was to determine whether the combination of p53 over-expression and p53 low-expression associated with Ki67 over-expression (high Ki67/p53 ratio) could lead to a more sensitive parameter. Immunohistochemical expression of Ki67 and p53 was measured in 54 specimens from OSCC; 27 specimens from moderate/severe epithelial dysplasia; 32 specimens from oral leukoplakias without epithelial dysplasia, and 13 specimens with normal epithelium. p53 over-expression was found in 31 (53%) samples from OSCC, in 10 (37%) samples from severe dysplasias, and in 5 (15%) samples from non-dysplastic lesions, while the combination of high p53 values with high Ki67/p53 ratio was observed in 93% of OSCC, in 81% of dysplastic lesions, and in 50% of non-dysplastic lesions. This parameter may have a clinical implication to detect early lesions with an impairment of p53 pathway, and probably at risk of progress to OSCC.

One of the most commonly observed adverse effects of cyclosporin A (CsA) is the development of gingival overgrowth (GO). Fibroblasts are involved in GO, but the question why only a percentage of patients undergoing CsA treatment shows this side-effect remains unanswered. In a previous study, CsA has been demonstrated to induce over-expression of phospholipase C (PLC) beta(1) in fibroblasts of patients with clinical GO, in cells from both enlarged and clinically healthy gingival sites. In this work, we assessed the expression of PLCbeta isoforms to investigate whether the exaggerated fibroblast response to CsA related to increased PLCbeta(1) expression could also be detected in CsA-treated patients without clinical signs of GO. Our results support the hypothesis of a multi-factorial origin of gingival overgrowth, including specific changes within the gingival tissues orchestrating fibroblastic hyper-responsiveness as a consequence of a long-term in vivo exposure to cyclosporin A.

It has long been assumed that parodontal disease can be a cause of false positive results in syphilis serology, but so far there are no definitive data supporting this hypothesis. In this study we tested 250 serum samples obtained from blood donors. All of them were negative when routinely screened for antibodies against Treponema pallidum. Then, all these samples were tested by immunoenzymatic (ELISA) and Western Blot (WB) assays to investigate reactivities against T. denticola. Thirteen samples showed a strong positivity when tested by both methods. When tested by WB against T. pallidum no sample met the positivity criteria. Nevertheless, bands with molecolar weights of about 30-35 KDa (endoflagellar core antigens) were recognized. All the 13 subjects serologically T. denticola positive underwent oral clinical and radiological observation: all showed a very poor parodontal status (CPSS > 103). Eleven crevicular fluid samples out of the total of 13 patients were T. denticola positive by Real Time PCR carried out using a LightCycler system. In this study we demonstrated that the presence of T. denticola in the crevicular fluid samples obtained from patients with a severe periodontal status and/or a positive serology against T. denticola is not a cause of false positive results in syphilis serology.

Objectives: A relationship between poor oral health and coronary heart disease (CHD) and systemic inflammatory and haemostatic factors has been recently documented in an Italian population. The present study was performed to assess whether intensive dental care may produce a periodontal improvement along with a change in systemic inflammatory and haemostatic factors., Material and Methods: The study population consisted of 18 males aged 40-65 years with proven CHD and elevated values of systemic inflammatory and haemostatic factors. A detailed description of their oral status was given by using two different dental indices (clinical periodontal sum score and clinical and radiographic sum score). Blood samples were taken for measurement of the following systemic markers of inflammation [(C-reactive protein (CRP), leucocytes, fibrinogen)] and haemostatic factors [(von Willebrand factor, fibrin D-dimer and oxidized-low density lipoprotein (Ox-LDL)]. All parameters were determined in each subject at baseline, after 4 months as a control and 3 months after an intensive protocol of scaling and root planing. anova for repeated measures was used for the statistical analysis., Results: No statistical difference was found between values at baseline and at the 4-month-control. All oral indexes showed a significant decrease (p< .01) 3 months after periodontal treatment. All systemic inflammatory indexes decreased but only the decrease in CRP reached statistical significance (p< .05). A significant decrease (p< .01) was also found as regards Ox-LDL among haemostatic factors., Conclusions: Preliminary results from the present study suggest an association between poor oral status and CHD, and provide evidence that the improvement of periodontal status may influence the systemic inflammatory and haemostatic situation., ((c) Blackwell Munksgaard, 2005.)

Treponema denticola and Porphyromonas gingivalis have been identified in atheromatous plaques of two patients suffering from atherosclerosis by PCR and fluorescence in situ hybridization (FISH). The use of the FISH technique suggested that these periodontopathic micro-organisms might be metabolically active within the wall of arteries, under the atherosclerotic lesion.

Background: The authors conducted a study to evaluate the sensitivity of heart rate variability, or HRV, in quantifying the cardiocirculatory reaction to dental stress compared with other clinical parameters more frequently used in clinical practice., Methods: Twenty-five healthy subjects (15 men and 10 women aged 19 through 73 years) who underwent dental extractions were enrolled in the study. The authors measured systolic blood pressure, or SBP; diastolic blood pressure, or DBP; heart rate, or HR; and HRV at baseline, immediately after local anesthetic was administered, during the dental extraction and five minutes after the dental extraction. Time domain measures of HRV were based on interbeat intervals and were obtained by using standard deviations of the R-R intervals, which were calculated during a five-minute period in a continuous electrocardiographic record., Results: Analysis of variance for repeated measures showed no time-related difference between the four study periods with regard to SBP and DBP. However, HR values were significantly different in three of the four periods, and HRV values were significantly different in all four testing periods. Furthermore, HRV values exhibited greater variability in the maximum changes recorded during dental extractions compared with HR values (0 to 80 milliseconds versus 0 to 31 beats/minute, respectively)., Conclusions: HRV is a highly sensitive parameter for quantifying the sympathetic drive to the heart during a cardiovascular reaction to a dental operation., Clinical Implications: Clinicians may find that HRV evaluation is useful in monitoring patients with heart disease to detect early signs of cardiac impairment related to local, high sympathetic activity and to prevent cardiovascular emergencies.

Aim: The study evaluates the efficacy of a set of objective parameters for monitoring facial swelling in a group of patients treated with clarithromycin., Methods: Fifty consecutive patients suffering from dental abscesses (22 in the maxillary arch and 28 in the mandibular arch) were enrolled. All these patients underwent antibiotic treatment with clarithromycin in a new formulation as a single daily dose (500 mg/day for 6 days). Pain and changes in facial swelling were evaluated at baseline and each day for 6 days through subjective parameters (visual analogic scale, VAS) and objective parameters (6 different tape measurements on the skin surface above the abscess)., Results: Pain and swelling recorded by patient and dentist (using VAS scores) showed statistically significant decreases (p<0.01) on days 2, 3 and 4, while no further significant variation was observed during days 4, 5 or 6. As regards the objective parameters to quantify facial swelling, the maximum dimensional change (from baseline to final values) in the mandibular arch was obtained with measurement 6 (mean value 2.27+/-0.53 cm); the maximum dimensional change in the maxillary arch was obtained with the sum of the other 5 measurements (mean value 6.34+/-4.09 cm)., Conclusion: The use of a single or a combination of linear measurements might provide a sensitive and reproducible method to evaluate facial swelling objectively and could be very useful in monitoring the efficacy of new antibiotics and to compare the results from different studies.

Objectives: To assess the relationship between poor oral health and coronary heart disease (CHD) and systemic inflammatory and haemostatic factors in an Italian population., Material and Methods: The study population consisted of 63 males aged 40-65 years with proven CHD and 50 controls matched for age, geographic area, and socioeconomic status. A detailed description of their oral status was given using four different dental indices (total dental index (TDI), panoramic tomography score, clinical periodontal sum score (CPSS), and clinical and radiographic sum score (CRSS)). Blood samples were taken for measurement of the following CHD risk factors: serum total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and glucose; a series of systemic markers of inflammation (C-reactive protein, leucocytes, fibrinogen, homocysteine) and a series of haemostatic factors (von Willebrand factor, fibrin D-dimer, prothrombinic fragment F1.2, plasminogen activator inhibitor type I (PAI-1), and serum antibodies) against oxidized LDL (anti-Ox-LDL)., Results: Multiple logistic regression adjusted for all risk factors for CHD showed statistically significant relationships (p<0.01) between all dental indices and CHD. Significant relationships (p always <0.01) were found between CPSS and CRSS and leucocyte count. Significant relationships (p always <0.05) were also found between TDI and the von Willebrand factor, and between CPSS and the von Willebrand factor, anti-Ox-LDL, and PAI-1., Conclusions: The present study suggests an association between poor oral status and CHD, and provides evidence that inflammatory and haemostatic factors could play an important role in this association.

To evaluate the efficacy of metronidazole on cyclosporine-induced gingival overgrowth (GO), a prospective intra-subject double-blind longitudinal study was performed on six heart transplant patients with GO. All patients underwent scaling and root planing before any treatment. Metronidazole gel (Elyzol, Cabon) was then applied in two of the four anterior hemi-sextants of each subject, following a balanced random pre-programmed list, with a placebo gel being applied to the remaining two hemi-sextants. Plaque index (PI), bleeding on probing (BP) and probing depth (PD) were recorded for all teeth of the four anterior hemi-sextants before and at 1, 2, 3, and 4 months after gel application. A general linear model was fitted and ANOVA for repeated measurements with split-plot design and Chi-square analysis were used for statistical analysis. PD significantly decreased after 1 month following both treatments. Analogous results were obtained as regards PI and BP. No statistically significant difference was detected between results obtained with metronidazole and placebo. However, PD in the group of teeth treated with placebo significantly increased after 4 months, while PD values obtained from teeth treated with metronidazole remained statistically unchanged with respect to the 1st month. In conclusion, short-term results suggest that metronidazole and placebo are equally effective in reducing periodontal parameters and GO when associated with scaling and root planing. Long-term results, however, showed greater efficacy of metronidazole with respect to placebo in controlling cyclosporine-induced GO.

Background, Aims: In a previous cross-sectional study, the relevant rôle of time in reducing gingival overgrowth (GO) in heart-transplanted patients undergoing Cyclosporin A (CsA) therapy was hypothesized to explain the inverse relationship between GO and months since the graft., Methods: In the present study, the relationship between GO and time was investigated prospectively in a group of 21 heart transplanted patients who have been regularly followed up to 48 months., Results: 6 months after beginning CsA therapy (1st appointment), 7 out of 21 patients (33%) had clinical GO as confirmed by a hyperplastic index (HI) >30. There was no significant difference between these values with respect to those detected during the 2nd appointment at 9 months. At this time, all patients underwent a regular oral hygiene program. Gingival and plaque indices significantly decreased at the 3rd appointment (12 months) both in the group of responders and in the group of non-responders and remained significantly unchanged with time; HI significantly decreased with time only in the group of responders, the decrease becoming significant 36 months after heart transplantation. As a consequence, the number of responders decreased from 7 at the 1st appointment to 5 after 12 months, 4 after 24 months, 2 after 36 months following heart transplantation., Conclusion: The results suggest that GO necessarily develops in responders within 6 months from heart transplantation and in most subjects may be a time-related side-effect probably due to a progressive reduction in the sensitivity of the periodontum to CsA.