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What is the prevalence of temporomandibular dysfunction in patients with early rheumatoid arthritis and individuals at risk of rheumatoid arthritis? 3 groups (of 50 participants each) were examined for a possible TMD diagnosis: 1. patients with early rheumatoid arthritis, 2. at-risk individuals, and 3. healthy controls. A possible association with bruxism, determined on the basis of self-reporting and clinical features, was also examined. At-risk patients had a higher prevalence of TMD pain diagnoses compared to healthy controls (p = 0.046). Within the early rheumatoid arthritis group, seronegative patients had a higher prevalence of TMD pain diagnoses than seropositive patients (p = 0.048). No further differences in the prevalence of TMD diagnoses were found between the groups. Participants with a TMD pain diagnosis were more often diagnosed with probable sleep bruxism than those without a TMD pain diagnosis. The prevalence of TMD pain is increased in individuals at risk of rheumatoid arthritis and seronegative early rheumatoid arthritis patients, and is associated with signs of bruxism.

This study investigated the effect of initial nonsurgical treatment in patients with peri-implantitis with or without prescription of an antibiotic regimen consisting of amoxicillin and metronidazole. For this purpose, patients with peri-implantitis were randomized into a group of initial treatment with antibiotics and a group without antibiotics. They were re-evaluated 12 weeks after treatment. Analyses were performed at the patient level at 1 peri-implant pocket per patient. Both groups showed significant peri-implant pocket depth reductions after initial treatment. Treatment with antibiotics resulted in a higher mean reduction in peri-implant pocket depth than when no antibiotics were used, but this difference did not reach statistical significance. Only 2 implants, 1 in each group, showed a successful outcome of a peri-implant pocket depth ofunder ≤ 5 mm and with an absence of bleeding and pus after probing. Initial treatment with or without antibiotics is ultimately not sufficient to fully treat peri-implantitis; additional surgical procedures will often be required.

Gingivitis and periodontitis can worsen with reduced immune fitness. Various causes can reduce immune fitness in a host, as a result of which the balance between the host and the microbiome is disturbed. Among others, lifestyle factors, such as stress and smoking, can have a negative influence on immune fitness. An association has been demonstrated between stress and periodontitis and also acute necrotising ulcerative gingivitis or periodontitis. There are indications that neurons are able to secrete pro-inflammatory cytokines and chemokines that worsen chronic inflammatory reactions in the periodontium and compromise immune fitness. In vitro studies show high cortisol levels may contribute to the increased growth of P. gingivalis. Stress as a risk factor for periodontitis and the role of stress as a negative influence on the results of periodontal treatment are difficult to estimate clinically. Nevertheless, attention to and awareness of stress as an aspect of the comprehensive set of risk factors for periodontitis can diminish its negative impact on immune fitness.

The evidence for an association between systemic diseases and periodontitis is strongest with diabetes mellitus type 2 and cardiovascular disease. There is a moderate association of periodontitis with adverse pregnancy outcomes and rheumatoid arthritis. Periodontal treatment has, on average, a positive effect on reducing systemic infection and improving the condition of the vascular system. For diabetes patients, periodontal treatment can also have a positive effect on metabolic regulation. There is insufficient evidence that periodontal treatment prevents adverse pregnancy outcomes and rheumatoid arthritis.

In the May edition of The Nederlands Tijdschrift voor Tandheelkunde the editorial commentary was devoted to the question to what extent the treatment of periodontitis in patients with diabetes mellitus is worthwhile. B.G. Loos, W.J. Teeuw, V. Gerdes and F. Abbas offer a response to this commentary and argue that the treatment of periodontitis in patients with diabetes mellitus is always worthwhile.

In order to gain insight into the degree to which periodontal disease is related to quality of life, research was carried out among 85 patients with moderate or severe periodontal disease in which they were asked to complete the Oral Health Impact Profile-NL49. Their scores on this questionnaire were compared with the scores of 85 control subjects of comparable age and gender. The patients with periodontal disease demonstrated significantly worse scores compared to the control group and patients with severe periodontal disease had scores which were statistically significantly worse than patients with moderate periodontal disease. The results of this study suggest a causal negative association of periodontal disease with quality of life.

Periodontitis is a complex, multifactorial disease and the susceptibility is genetically determined. In the last decade a multitude of research projects on genotyping of patients and controls in search of putative genetic risk factors has been performed. The disease (phenotype) however is also dependent on the presence of environmental and lifestyle factors, and their interaction with the various genes. Many candidate genes have been proposed and studied in relation to periodontitis. Most of the studied candidate genes code for proteins that play a role in the innate immune system. Some variants of candidate genes (gene polymorphisms) in the IL1 gene cluster and the FcgammaR genes are possibly associated with periodontitis. However till today there is no strong evidence for target genes and gene polymorphisms that play a key role in the susceptibility to and severity of periodontitis. Therefore genetic testing for periodontitis is currently not indicated.

The aim of this cross-sectional study was to investigate the prevalence and several risk indicators of root cariës in 45 periodontal maintenance patients, who had been actively treated for adult periodontitis 11-22 years ago. These patients were part of a routine 3-6 monthly maintenance schedule. Active and inactive root caries and root fillings were recorded, as well as coronal caries experience. Plaque and bleeding scores, number of exposed root surfaces, rate of saliva secretion, saliva buffer capacity, S. mutans counts and Lactobacilli were also scored. From the total of 45 subjects, 37 patients (82%) showed root lesions (root caries and/or fillings), while only 8 patients were free of any root lesions. On average, there were 4.3 lesions per patient (range 0-19) in the present study. Of all damaged root surfaces, 9% were active lesions, mostly located on mandibular teeth at lingual and vestibular sites; 40% were inactive lesions often detected at vestibular sites. The remaining damaged root surfaces (51%) were restored; they were equally divided over both jaws. A higher number of root lesions was observed in those patients with > 106 S. mutans/ml saliva. Although the actual number of lesions per patient was low in relation to the large number of sites with gingival recession, the results from this cross-sectional study in periodontal maintenance patients indicate that: root cariës can be regarded as a complication in periodontal maintenance patients, that the individual number of root lesions correlate with individual dental plaque score, that a high number of root lesions is associated with counts of salivary S. mutans, and that no relation between root cariës and coronal caries experience, salivary secretion rate or salivary buffering capacity seems present. Therefore, repeated oral hygiëne instructions and adjunctive preventive measures including diet counseling and fluoride rinses, as well as fluoride and chlorhexidine varnishes, should be advocated in high-risk patients.

An overview is given of typing methods for bacteria that are associated with periodontitis. Special attention is paid to new molecular biological techniques, based on the characterization of protein and DNA. Bacteria that are associated with periodontitis have a population structure similar to that of opportunistic bacteria. Typing methods are used to study transmission of bacteria. P. gingivalis can be transmitted between spouses, but transmission from parent to child seems to be uncommon. A. actinomycetemcomitans transmission between adults does not occur frequently, while transmission from parent to child can occur in a low frequency.