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The aim of this study was to measure lipid peroxidation (as an end product of oxidative stress) and corresponding antioxidant activity in patients with periodontitis and assess the influence of smoking and periodontal treatment on these parameters. Thirty healthy subjects (including 15 smokers) were compared to periodontitis patients (n = 30, including 15 smokers). Malondialdehyde (MDA), glutathione peroxidase (GSHPx) and the total antioxidant capacity (TAOC) were recorded in saliva. The lowest level of lipid peroxidation (MDA) was measured in saliva in the non-smoking periodontally healthy subjects (0.065 +/- 0.05 micromol/l). MDA levels were significantly higher in periodontitis patients who smoked (0.123 +/- 0.08 micromol/l) compared to non-smoking controls (0.065 +/- 0.05 micromol/l; p < 0.05). The periodontally healthy subjects demonstrated significantly lower levels of GSHPx (antioxidative parameter) than the periodontitis group (p < 0.05). The TAOC flow rate (delivered antioxidant components within saliva) was significantly lower in patients with periodontitis (0.34 +/- 0.26 micromol/ml) in comparison to the controls (0.62 +/- 0.24 micromol/ml; p < 0.05). Patients with periodontitis demonstrate more lipid peroxidation than healthy subjects, and this effect is enhanced by smoking. Imbalance between oxidative stress and antioxidant capacity may play a role in the pathogenesis of periodontal disease. Non-surgical periodontal treatment leads to a reduction of MDA and GSHPx to levels comparable to healthy controls.

Background: In the last few years knowledge about periodontal infections has increased enormously, nevertheless practitioners are still seeking guidelines for suitable treatment concepts., Methods: The aim of this study was to examine the effect of doxycycline, metronidazole, and clindamycin used adjunctively in a 2-step nonsurgical procedure in patients with rapidly progressive periodontitis (RPP). The first step included scaling, root planing, and polishing (SRP) in each quadrant using 4 to 5 visits. The second step included full-mouth enhanced root planing (RP) and wound dressing in 1 or 2 visits after SRP and the beginning of antibiotic therapy. Forty-eight patients (mean age 32.4 years) with generalized RPP, with an average of 16 sites with probing depths (PD) deeper than 8 mm, and high counts of Porphyromonas gingivalis were randomly assigned to 4 different groups: group 1 (doxycycline) n = 12, group 2 (metronidazole) n = 15, group 3 (clindamycin) n = 11, and group 4 (control group; no antibiotic treatment) n = 10. Clinical evaluations, including plaque index (PI), sulcus bleeding index (SBI), probing depth (PD), clinical attachment level (CAL), and bacteriological and crevicular cell sampling, were done at baseline (BL), 3 weeks after SRP, and 6 and 24 months after RP., Results: After the first step (SRP), we observed an improvement of PI and SBI in all 4 groups, but did not see any statistically significant PD reduction 3 weeks after SRP compared to baseline. However, 6 and 24 months after the second step (RP) we observed a significantly greater reduction of PD in groups 2 and 3 and a significantly greater CAL gain in comparison to groups 1 and 4. After 24 months, the attachment level gain in group 1 and group 4 was less than 1.5 mm, and less than 1.0 mm in PD site categories 6 to 9 mm and >9 mm. PI showed no significant difference between the groups throughout the period after SRP until 24 months, compared to 3 weeks after SRP. SBI decreased most in the metronidazole and clindamycin groups. P. gingivalis and Actinobacillus actinomycetemcomitans were almost completely eradicated in these 2 groups 24 months after RP. In addition, the phagocytotic capacity of crevicular polymorphonuclear neutrophils was increased in groups 2 and 3 after the second step., Conclusions: The present results show that metronidazole and clindamycin are effective antibiotics when used adjunctively in a 2-step nonsurgical procedure of scaling and root planing in RPP patients.

Background, Aims: Polymorphonuclear neutrophils (PMN) are the predominant host defence cells in the gingival sulcus. Previous work demonstrates that the in vitro phagocytosis of crevicular cells in localised early onset periodontitis (LEOP) and generalised early onset periodontitis (GEOP) lesions is diminished. The present study extends this work by characterizing the chemotaxis function of crevicular fluid (CF) PMNs in various forms of periodontitis., Methods: We investigated 7 patients with LEOP, 11 patients with GEOP, 12 patients with adult periodontitis (AP) and 2 age- and sex-matched healthy control groups. The two deepest sites of each quadrant in test and control subjects were selected for crevicular sampling. Chemotaxis was performed in a micro chamber (moist atmosphere, 5% CO2, 37 degrees C, 30 min) using N-formyl-methionyl-leucyl-phenylalanine (FMLP, 1 x 10(-7) mol FMLP/l) as a chemoattractant. The total chemotaxis was defined as the difference between the number of cells migrating towards FMLP minus the number of cells migrating towards PBS, counted in 20 randomly selected fields. Membranes were examined microscopically at 400 x magnification., Results: The chemotactic activity in the adult periodontitis group was significantly higher compared to the age-related control group. However, we found a statistically significant reduction of chemotactic activity in LEOP and GEOP patients compared to the controls., Conclusions: These results indicate an increase of chemotactic activity from CF-PMN in patients with adult periodontitis, but on the other hand, a significant reduction of chemotactic responsiveness of these cells in LEOP and GEOP lesions.

Background and Objective: The periodontal region is a source of gram-negative bacterial infection. The pathogens involved have recently also been demonstrated in atheromatous plaques. They may increase the risk of myocardial infarction. In this study a strategy for eradicating periodontal bacteria and thus healing in patients with periodontal pockets and advanced destruction of alveolar bone was examined., Patients and Methods: Initial periodontal status was documented in 36 patients with periodontitis (24 women, 12 men) who were then randomly assigned to one of three groups. Those in two of the groups were given either metronidazole or doxycycline orally as adjuvant treatment, while the third group received no antibiotics. Patients in all groups were treated according to a two-step procedure. In step 1, extensive supra- and subgingival plaques and concrements were removed. In step 2, root debridement and/or closed curettage of all pockets was undertaken in one visit, and the antibiotic given to the patients in groups 1 and 2. Results were assessed 3 weeks after the first step and 6 months, 2 and 4 years after step 2., Results: The initial examination at 3 weeks revealed significant changes in all three groups with regard to the incidence of plaque and sulcus bleeding, but not regarding probing depth and attachment level. However, there were significant changes in probing depth and attachment level in all groups after step 2. Periodontal attachment was significantly improved at 2 and 4 years in the patients on metronidazole, but not those on doxycycline or no antibiotics. The greatest decrease in bleeding tendency was recorded in the metronidazole group. This group also had the greatest gain of new alveolar bone compared with the other two groups. Complete eradication of Porphyromonas gingivalis and Actinobacillus (Hemophilus) actinomycetemcomitans, important pathogenic bacteria that may have an atherogenic action, was obtained only in patients on metronidazole., Conclusion: The tissue-sparing two-step procedure brought about good clinical and radiological results, which can be significantly bettered by the addition of metronidazole, achieving eradication of pathogens involved in periodontal disease.

There is growing evidence for an important role of the immune system in the pathogenesis of periodontitis. To further characterize the possible immunoregulatory dysfunction of peripheral blood mononuclear cells (PBMC) in periodontitis patients, we investigated functional aspects of PBMC from patients with early-onset periodontitis (EOP) and adult periodontitis (AP). Compared to controls, we observed decreased proliferative responses of PBMC from patients with EOP following stimulation with a mitogenic stimulus (phytohemagglutinin). To investigate whether this abnormality reflects a modulation in cytokine production, we measured the in vitro production of interleukin (IL)-3, IL-5, granulocyte macrophage colony-stimulating factor (GM-CSF), and interferon-gamma (IFN-gamma) by activated PBMC. PBMC in EOP patients expressed significantly decreased levels of IFN-gamma protein in response to mitogenic stimulation. Reduced IFN-gamma secretion was associated with decreased IFN-gamma and IL-2 mRNA expression in these cells, as well as decreased HLA-DR surface expression on monocytes. On the other hand, we observed significantly higher levels of IL-5 and GM-CSF in the same system using PBMC from AP patients. These were comparable to the levels observed for patients with allergic asthma. These data imply that EOP is associated with decreased Th1-like cytokine expression, and that the PBMC response from patients with AP is predominantly Th2/Th0 in nature.

Phagocytes from the gingival crevice fluid (CF-cells) of 11 patients with localized juvenile and post-juvenile periodontitis (LJP/PJP), 14 with rapidly progressive periodontitis (RPP), 11 with adult periodontitis (AP), and 14 controls without periodontal disease were examined. Phagocytic activity in vitro was assessed. Crevicular washings were obtained from healthy sites of controls and diseased sites of patients after completion of the oral hygiene phase (professional and home care). The cells were carefully processed to avoid mechanical damage. The in vitro phagocytosis by uptake of opsonized C. albicans was performed in a moist chamber (30 minutes, 37 degrees C) and examined by light microscopy. CF-cells were differentiated on the basis of their morphological appearance. The majority of cells in crevicular washings were PMNs, some macrophages, and few lymphocytes. Phagocytic activity in patients with LJP/PJP and RPP was significantly decreased in comparison with that from AP and the control group. The decreased percentage of cells phagocytosing opsonized C. albicans was associated with the enhanced adherence of opsonized C. albicans. Moreover cell viability of CF-cells from LJP/PJP sites was significantly reduced. The data from the present study suggest that the in vitro phagocytosis of crevicular phagocytes in juvenile and rapidly progressive periodontitis lesions is diminished.

At present diagnosis and therapy of rapidly progressive periodontitis is still difficult in the daily practice. It is possible to define this form of periodontitis by suitable clinical and paraclinical characteristics. In searching a practical therapeutic concept, including effective motivation, first results of a sufficient therapy confirm the possibility of a successful strategy in the treatment of patients with rapidly progressive peridontitis.

Background: Polymorphonuclear neutrophils (PMNs) represent the first line of cellular defences in the gingival crevice. Smoking, as probably the most important environmental risk factor for periodontitis, has been shown to adversely affect many neutrophil functions. Objective: The aim of this study was to investigate the influence of smoking on PMN numbers and function in periodontally healthy smokers and non-smokers. Methods: Sixty subjects were recruited: 15 non-smokers, 15 light smokers (< 5 cigarettes/day), 15 moderate smokers (5–15 cigarettes/day) and 15 heavy smokers (> 15 cigarettes/day). Full mouth plaque index, sulcus bleeding index and probing depths were measured. Crevicular washings were obtained from all subjects to harvest PMNs. Numbers of PMNs, percentage viability, and percentage phagocytosis of opsonized Candida albicans were recorded. Results: Mean plaque scores and probing depths were (non-significantly) increased in smokers compared to non-smokers. Mean sulcus bleeding index scores were significantly lower in moderate (0.10 ± 0.10) and heavy (0.07 ± 0.11) smokers compared to non-smokers (0.14 ± 0.13) ( p < 0.05). Compared to non-smokers (1.73 ± 1.08 × 106/ml), the numbers of PMNs were higher in light (1.98 ± 0.96 × 106/ml) and moderate (2.03 ± 1.43 × 106/ml) smokers and were lower in heavy smokers (1.68 ± 1.18 × 106/ml), though there were no significant differences in PMN counts between the groups ( p > 0.05). Percentage viability of PMNs was significantly lower in light (77.6 ± 7.8%), moderate (76.5 ± 8.2%) and heavy (75.0 ± 6.5%) smokers compared to non-smokers (85.5 ± 6.0%) ( p < 0.05). Furthermore, the ability of PMNs to phagocytose was significantly impaired in light (58.3 ± 4.1%), moderate (51.9 ± 2.33%) and heavy (40.9 ± 3.5%) smokers compared to non-smokers (74.1 ± 4.1%) ( p < 0.05), with evidence of a dose–response effect. Conclusion: Cigarette smoking adversely affected PMN viability and function in this periodontally healthy population. [ABSTRACT FROM AUTHOR]