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There is a preponderance of evidence in the literature that periodontal and other oral diseases, such as caries, can be treated and controlled by thorough mechanical plaque removal by the patient, the use of antimicrobial agents and antibiotics when necessary, and participation with the therapist in a well monitored, long-range program of supportive periodontal therapy. Recent evidence suggests that the control and prevention of oral disease, especially periodontitis, is especially important for patients with various systemic conditions that can be impacted by oral infections. It is far better for patients and therapists to practice primary and even secondary prevention with effective plaque control and regular, consistent supportive periodontal therapy, than having to rely on tertiary prevention for disease that has progressed to a level that requires costly treatment, is time-consuming and carries a greater risk of morbidity.

The dynamics of bone turnover in the furcations of teeth treated with expanded polytetrafluoroethylene (ePTFE) membranes were evaluated using multiple fluorochrome labels in 6 male beagle dogs. Loss of attachment involving the furcation area was induced in the second, third, and fourth premolar teeth using silk ligatures. The resulting defects were treated with the use of mucoperiosteal flaps for access, debridement of the defects, and placement of ePTFE membranes covering the furcations of the second and fourth premolars (experimental teeth) while the third premolar received only debridement without membrane placement (control tooth). Five fluorochrome labels were administered intravenously at timed intervals to act as markers of the osseous response. Membranes were removed at 4 weeks and all animals were terminated at 12 weeks post-membrane placement. One side of the mandible was decalcified, sectioned at 7 microns, and stained with either hematoxylin and eosin or Gomori's tri-chrome. The opposite side provided non-decalcified tissue processed as 100 microns ground sections. Using fluorescent light and point-hit evaluation, tissue in the coronal half of each specimen was classified as either labelled bone, unlabelled bone, or resorption space. In addition, microradiographs were prepared of each ground section and specimens classified as either woven bone, old lamellar bone, or new lamellar bone. No significant differences in attachment levels, or level of junctional epithelium, were observed in decalcified sections although greater remodeling activity was noted in the experimental specimens. Comparison of ground sections revealed significant differences (P < 0.05) in all categories with both methods of evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

This study compared the relative amounts of Actinobacillus actinomycetemcomitans (Aa), Eikenella corrodens (Ec), and black-pigmented anaerobic rods, and the proportions of coccoid forms, nonmotile rods, motile rods, spirochetes, and total motile organisms in subgingival plaque samples from 2 groups of young adults with generalized moderate to severe periodontitis. Two groups of 12 untreated patients were selected based on the relative amounts of subgingival calculus detected. Subgingival plaque samples (2 sites/patient) were taken with a sterile curet, dispersed, and plated under anaerobic conditions on ETSA, ETSA-kanamycin, ETSA-clindamycin, and TSBV agar. Appropriate biochemical tests were performed to confirm suspected microorganisms. Phase-contrast microscopy also was used to count the relative numbers of coccoid forms, nonmotile rods, motile rods, and spirochetes in each of the samples. Patients with no clinically detectable subgingival calculus harbored significantly greater proportions (%) of coccoid forms and Aa and greater amounts (CFU/mg) of Aa than did patients with obvious amounts of subgingival calculus. Subjects with clearly detectable subgingival calculus possessed greater proportions of motile rods, total motile organisms, and black-pigmented anaerobic rods than did subjects with little or no subgingival calculus. Young adult patients with generalized moderate to severe disease and little or no detectable subgingival calculus may possess a subgingival microbiota with relatively higher numbers of Aa and coccoid forms, and a lower percentage of BPB, motile rods, and total motile organisms as compared to similar patients with greater amounts of subgingival calculus.

Untreated periodontally-involved teeth contain cementum-bound endotoxin, that may prevent periodontal new attachment during healing after pocket therapy. The purpose of this study was to restore biocompatibility to diseased root surfaces by a non-invasive treatment. Untreated human teeth removed for severe chronic periodontal disease were split buccolingually, the level of connective tissue was scribed on the roots, the specimens cleaned of plaque and visible calculus, and autoclaved. Cementum removal was not attempted. One member of each pair was treated with phosphate-buffered saline as a control. Sodium desoxycholate (2%), Cohn plasma fraction IV1 (5%), or deoxycholate followed by plasma fraction were applied for one minute. Roots were incubated in a suspension of gingival fibroblasts for 48 hours, then rinsed, fixed, and stained. Counts were made of the number of attached cells at 40 x magnification using an ocular grid. There was a significant increase (p less than 0.01) of the combination treatment over controls. All treatments provided a biological surface for attachment of fibroblasts, in vitro, compared to untreated roots.

The determination of disease activity has a direct impact on therapeutic measures in periodontics. Evaluations that may indicate disease activity have been reviewed under the topics of traditional evaluations, gingival crevicular fluid contents, tissue changes, circulating factors, and sulcular microbiota. The traditional methods, such as probing, radiographs, and clinical indices, were static evaluations that had limited validity in determining disease activity. When used in longitudinal tests, these methods may be used retrospectively to detect disease activity. Evaluation of the contents of gingival crevicular fluid has promise as a noninvasive method of determining tissue changes in the periodontium. To date, none of the crevicular fluid constituents has been a reliable indicator of disease activity. Tissue changes in the periodontium are important in understanding the disease processes but have had limited value as indicators of disease activity. The ability to determine disease activity through identification of substances or changes in the systemic circulation would prove quite useful to the clinician. Although some reports found lymphocyte transformation indicative of active disease, others had conflicting results. Finally, examinations of sulcular microbiota provided evidence suggesting that active periodontal disease was associated with specific groups of pathogens and with elevated counts of motile organisms. The evaluation of such pathogens and motile organisms currently shows the most promise for determining periodontal disease activity. However, long-term assessments and further clinical trials are necessary before this type of evaluation can be widely accepted. It is hoped that such studies will enable the clinician to predict the natural history of active and inactive periodontal disease.

Standard wounds of simple incision and trauma were made in the gingivae of monkeys. The healing from the 1st to the 21st day was described clinically, his'tologically, physically and biochemically. There were no major clinical differences, but both atraumatic and traumatic wounds have reactions in the periodontium to be considered in postoperative care.

The periodontal probe is used clinically to measure pocket depth and the level of periodontal attachment. In order to be a more reliable, noninvasive method of assessment, it is necessary to investigate the position of the tip of the probe when at rest in the dentogingival junction. Probes were assessed for accuracy, and those closest to a standard millimeter scale were used to make pressure-cast, gold-coated, acrylic replicas. The replicas were placed in the gingival crevice of Rhesus monkeys with normal gingiva and with experimentally-induced gingivitis and periodontitis. Clinical, histologic, and histometric evaluations were made in block sections. In normal gingiva and in areas of gingivitis the probe tip stopped at the base of the crevice and was contained within epithelium. In periodontitis the probe sometimes penetrated the epithelium and stopped at the level of the connective tissue attachment. Even with gentle probing there was slight tearing and distortion of the gingiva at the base of the pocket. It was concluded that probing depth estimates indicated the level of a healthy dentogingival junction but did not differentiate between epithelial and connective tissue attachment.

Untreated periodontally-involved extracted human teeth were cleaned of plaque and calculus and then treated with chemicals having the potential to dissociate or degrade endotoxin. The count of attached gingival fibroblast cells after 48-hours of culturing was used as a measure of the biocompatibility of the diseased root surface. Paired specimens compared to their phosphate-buffered saline controls demonstrated no significant differences for the use of sodium lauryl sulfate and EDTA, plasma protein fraction, immune serum globulin, citric acid, or sodium deoxycholate followed by immune serum globulin.