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To cite this article: Int J Dent Hygiene  8, 2010; 276-279 DOI: 10.1111/j.1601-5037.2008.00419.x Van der Weijden GA, ten Heggeler JMAG, Slot DE, Rosema NAM, Van der Velden U. Parotid gland swelling following mouthrinse use. Background: Unilateral or bilateral swelling of the parotid gland is a reported side effect of rinsing the mouth with chlorhexidine. Although the incidence rate is extremely low, there have been several case reports on this topic and the authors of these reports have suggested several explanations for the mechanism of this complication. Methods: In this report, two cases of parotid gland swelling are discussed. Both patients developed unilateral parotid swelling following the use of a mouthwash, case 1 after using a chlorhexidine mouthwash following flap surgery and case 2 after using a hexetidine mouthwash in an approved clinical trial that was testing different mouthwashes. Results: In both of the cases, differential diagnoses were made to explain the cause of the parotid swelling. However, discontinuing use of the product resulted in an eventual complete resolution of symptoms in both patients. Conclusions: Swelling of the parotid gland following use of a mouthwash has previously been reported, although previous reports found this side effect only in patients who used chlorhexidine mouthwashes. This complication has therefore been informally linked to chlorhexidine. The present case report questions this hypothesis and suggests that parotid gland swelling may not be related to the type of mouthwash used, but may instead be a consequence of the rinsing action itself. [ABSTRACT FROM AUTHOR]

To cite this article: Int J Dent Hygiene  8, 2010; 280-285 DOI: 10.1111/j.1601-5037.2010.00475.x Rosema NAM, Timmerman MF, Versteeg PA, van Palenstein Helderman WH, van der Velden U, van der Weijden GA. Safety and efficacy of two manual toothbrushes. Objective: The purpose of this study was to test the efficacy and safety of a newly designed multi-level manual toothbrush (Profit-Haije-Brush) compared with a control flat-trimmed manual reference toothbrush from the American Dental Association (ADA). Material and methods: For this study, 36 healthy subjects without previous experience in the use of the Profit-Haije-Brush (PHB) were selected. Subjects were given a period of 2 weeks to become familiar with both types of brushes and were instructed to use them on alternate days for 2 min twice daily. Prior to their visit, subjects refrained from all oral hygiene procedures for 48 h. Prebrushing plaque and gingival abrasion scores were assessed. Subsequently, two randomly chosen contra-lateral quadrants were brushed with one of both brushes and the other two quadrants with the alternate brush. Subjects were supervised during their 2-min brushing exercise. After brushing, plaque and gingival abrasion were re-assessed. A questionnaire was filled out to investigate the subjects' attitudes towards both brushes. Results: The overall mean prebrushing PI was 2.47 for the PHB and 2.44 for the ADA. The reduction in PI was 1.32 and 1.23 respectively ( P < 0.05). With regard to gingival abrasion the overall mean prebrushing scores were 4.57 (PHB) and 5.34 (ADA). Post-brushing scores were 13.49 and 13.77 for the PHB and ADA respectively. Conclusion: Statistically, the multi-level PHB was significantly more efficacious than the flat-trimmed ADA. However, the difference is clinically considered small and the amount of remaining plaque was not significantly different between brushes. No greater potential to cause gingival abrasion to the oral tissues was observed. [ABSTRACT FROM AUTHOR]

The article discusses the scope, competences, proficiencies and learning results in Postgraduate Periodontal Education. Under the European Directives, a postgraduate program in periodontology should include a 3-year full-time course or part-time for 4 years in order to allow the student to practise Periodontics and Oral Implant Therapy at a specialist level. A list of competences and proficiences in postgraduate periodontal education is presented.

Aim: To evaluate the inhibition of plaque growth by an experimental mouthrinse (BioXyl®) based on hydrogen peroxide/glycerol. Design: It was a double-blind, randomized study involving 40 volunteers in good general health. At the start of the trial, all participants received a dental prophylaxis to remove all plaque deposits. During the next 3 days subjects refrained from any mechanical oral hygiene procedure, except for the allocated mouthrinse being either the hydrogen peroxide (H2O2; 0.013% H2O2/0.004% glycerol) or the placebo without H2O2. At the third day of appointment, plaque levels were assessed at six sites per tooth. Results: The test group had a mean overall plaque score of 2.66 and the placebo group of 2.70. The difference in plaque scores between the two groups was not statistically significant. Conclusions: The results of this pilot study showed that there was no statistically significant difference between the H2O2/glycerol group and the placebo group with respect to plaque inhibition within this study design. [ABSTRACT FROM AUTHOR]

Abstract: Smoking is a strong risk factor for periodontitis. Treated patients who smoke show increased risk for further periodontal breakdown, despite receiving maintenance care. Previous work indicated that such patients have a monocytic cytokine response favoring Th2 activity. The purpose of this study was to investigate the T lymphocytic cytokine production representing Th1 and Th2 subpopulations in smokers and non-smokers. Venous blood was collected from 30 treated periodontitis patients (12 smokers) and 24 healthy subjects (12 smokers). Whole blood cell cultures were stimulated and interferon (IFN)-γ and interleukin (IL)-13 were measured in the culture supernatants, representing types 1 and 2 Th subpopulations, respectively. Unadjusted data showed that smokers had more lymphocytes, and higher levels of IFN-γ and IL-13, irrespective of being periodontal patient. However in a multivariate analysis, increased IFN-γ production was not significantly explained by smoking, while higher IL-13 was strongly explained by smoking (21%, p <0.001). We suggest that the increased Th activity and specifically an elevated Th2 profile in smokers may constitute a risk for smoking patients which may induce conversion of periodontal stability into progressive disease. This phenomenon may be equally important in other conditions, where connective tissue and bone loss are hallmarks of disease pathophysiology. [Copyright &y& Elsevier]

Aim: Aim of this study is to elucidate which standard setting method is optimal to prevent incompetent students to pass and competent students to fail a dental Objective Structured Clinical Examination (OSCE). Material and methods: An OSCE with 14 test stations was used to assess the performance of 119 third year dental students in a training group practice. To establish the pass/fail standard per station, three standard setting methods were applied: the Angoff I method, the modified Angoff II with reality check and the Borderline Regression (BR) method. For the final decision about passing or failing the complete OSCE, three methods were compared: total compensatory (TC), a partial compensatory (PC) within clusters of competence and a non-compensatory (NC) model. The reliability of the pass/fail standard of the three methods was indicated by the root mean square error (RMSE). As a criterion measure, a sample of the students ( n = 89) was rated in the clinic by their instructors and accordingly these students were divided into two groups: competent and incompetent students. The students’ clinical rating (considered for this study as ‘true qualification’) was compared with the pass-fail classification resulting from the OSCE. Undeserved passing of an incompetent student was considered as more damaging than failing a competent student. Results: The BR method showed more acceptable results than the two Angoff methods. In terms of pass rate the BR method showed the highest pass rates: for the TC model the Angoff method I and II and the BR showed pass rates of 86.6%, 86.6% and 97.5% respectively. For the PC model the pass rates were 30.3%, 34.5% and 61.3%, and for the NC model the pass rates were 0.8%, 1.7% and 7.6%. The BR method showed lower RMSEs (higher reliability): for the TC model the RMSEs were 1.3%, 1.0% and 0.3% for the Angoff I, Angoff II and BR method respectively, and for the PC model the RMSE of the clusters of competence range was 2.0—3.7% for Angoffs I; 1.8—2.2% for Angoff II and 0.6—0.7% for the BR method. In terms of incorrect decisions, the BR method had a higher loss due to incorrect decisions for the TC model than for the PC model which is in accordance with the results of other studies in medical education. Conclusions: Therefore we conclude that the BR method in a PC model provides defensible pass/fail standards and seems to be the optimal choice for OSCEs in health education. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the present study was to test the accuracy and precision with which the cemento-enamel junction (CEJ) can be assessed using three commercially available periodontal probes with different tip endings in both deciduous and permanent teeth. Material and Methods: An 'in vitro' model was developed, consisting of 70 extracted permanent and 30 deciduous human teeth mounted in plaster with an artificial gingiva made of silicone rubber. The probes tested were the Merritt-B probe, the ball-ended CPITN probe and the Vivacare TPS beveled-ball probe. With each probe, duplicate CEJ assessments were carried out at six sites per tooth by four examiners. Upon completion, the distance between the CEJ and the artificial gingival margin was determined using a stereomicroscope. Results: The mean difference between the microscopic assessment and the mean clinical probe measurements in permanent teeth was -0.05 mm with the Merritt-B, 0.11 mm for the CPITN and 0.19 mm with the TPS probe. In deciduous teeth, the differences were -0.02, 0.35 and 0.63 mm, respectively. In both permanent and deciduous teeth, only the Merritt-B did not differ from the microscopic assessment. Conclusions: Results showed that the use of the Meritt-B probe offered the most accurate location of the CEJ in both permanent and deciduous teeth. [ABSTRACT FROM AUTHOR]

Background and Objective: Smoking is associated with increased severity of periodontitis. The underlying mechanisms of this phenomenon are not well understood. The purpose of the present study was to compare the monocyte-derived T cell directing (Th1/Th2) response and pro-inflammatory cytokine production in ex vivo whole blood cell cultures (WBCC) of smoking and non-smoking chronic periodontitis patients. Material and Methods: Venous blood was collected from 29 periodontitis patients (18 non-smokers and 11 smokers) receiving supportive periodontal treatment, and diluted 10-fold for WBCC. The WBCC were stimulated for 18 h with Neisseria meningitidis lipo-oligosaccharide (LOS) or Porphyromonas gingivalis sonic extract (Pg-SE). The production of the T cell directing cytokines interleukin (IL)-12 p40 and IL-10, as well as the pro-inflammatory cytokines IL-1β, IL-6 and IL-8, was measured in the culture supernatants. Results: After LOS stimulation of WBCC, smokers showed a lower IL-12 p40/IL-10 ratio than non-smokers ( P < 0.05). Interleukin-1β production was significantly lower in smokers compared with non-smokers after stimulation with either LOS or Pg-SE ( P < 0.05). Interleukin-6 and IL-8 production was similar in WBCC from both smokers and non-smokers, for both LOS and Pg-SE. Conclusion: A more pronounced Th2 response in smoking periodontitis patients may be related to increased severity of the disease. [ABSTRACT FROM AUTHOR]

Background and Objective: Radiographs are an essential adjunct to the clinical examination for periodontal diagnoses. Over the past few years, digital radiographs have become available for use in clinical practice. Therefore, the present study investigated whether measuring alveolar bone loss, using digital radiographs with a newly constructed dental image analyzer tool was comparable to the conventional method, using intra-oral radiographs on film, a light box and a Schei ruler. Material and Methods: Alveolar bone loss of the mesial and distal sites of 60 randomly selected teeth from 12 patients with periodontitis was measured using the conventional method, and then using the dental image analyzer tool, by five dentists. The conventional method scored bone loss in categories of 10% increments relative to the total root length, whereas the software dental image analyzer tool calculated bone loss in 0.1% increments relative to the total root length after crucial landmarks were identified. Results: Both methods showed a high interobserver reliability for bone loss measurements in nonmolar and molar sites (intraclass correlation coefficient ≥ 0.88). Also, a high reliability between both methods was demonstrated (intraclass correlation coefficient nonmolar sites, 0.98; intraclass correlation coefficient molar sites, 0.95). In addition, the new dental image analyzer tool showed a high sensitivity (1.00) and a high specificity (0.91) in selecting teeth with ≥ 50% or < 50% alveolar bone loss in comparison with the conventional method. Conclusion: This study provides evidence that, if digital radiographs are available, the dental image analyzer tool can reliably replace the conventional method for measuring alveolar bone loss in periodontitis patients. [ABSTRACT FROM AUTHOR]

Variance in expression of receptors for immunoglobulin G (FcγRs), complement (CR3) and lipopolysaccharide (mCD14) on polymorphonuclear neutrophils (PMNs) and monocytes might affect susceptibility for infection with certain pathogens in periodontitis, a chronic infectious disease of tooth-supportive tissues. Levels of FcγRI, IIa, III, CR3 and mCD14 on PMNs and monocytes were measured in 19 periodontitis patients and 18 healthy controls. Subgingival infection with Aggregatibacter actinomycetemcomitans ( Aa) and Porphyromonas gingivalis ( Pg) was determined. Activation of PMNs and monocytes in response to stimulation with Aa and Pg was assessed by means of change in mCD14 expression. Periodontitis is associated with an enrichment of the FcγRIII+ monocytes ( P = 0·015) with concomitant low mCD14 ( P = 0·001). Unadjusted data showed that the subjects culture-positive for Aa ( Aa+) had significantly lower expression of monocytic FcγRI ( P = 0·005) and FcγRIIa ( P = 0·015) than Pg+ subjects. The FcγRI was still lower on monocytes from Aa+ subjects after adjusting for the background factors ( P = 0·037). PMNs from Aa+ subjects responded in a hyper-reactive manner, in particular when stimulated with Aa ( P = 0·011). Lower FcγRs expression by monocytes is related to a higher susceptibility of a subject to become infected with Aa. The higher proportion of FcγRIII+ monocytes may be involved in the chronicity of this condition. Hyper-reactive PMNs in Aa+ subjects may contribute to accelerated breakdown of tooth-supportive tissues. [ABSTRACT FROM AUTHOR]

Aim: To investigate the correlation of six functional polymorphisms in the MBL gene with MBL plasma levels in relation to periodontitis.Material and Methods: A total of 92 periodontitis patients and 70 controls, all of Caucasian origin, were included. Patients and controls were genotyped for the L/H, X/Y, P/Q, A/D, A/B and A/C polymorphisms. Distributions of genotypes, rate of allele carriage and allele frequencies were compared between patients and controls. Patients and controls were subdivided in groups of genotypes. Plasma MBL levels were compared between different genotype groups.Results: On the basis of genotyping, three phenotypes with regard to mannose-binding lectin (MBL) production were distinguished: high-producers, low-producers and deficient subjects. No differences in the genotype frequencies were observed between patients and controls. Within patients and controls, subjects with the high-producing genotypes had significantly higher MBL plasma levels than low-producers and deficient subjects (p<0.001). Plasma MBL was higher in low-producer patients compared with low-producer controls (p[adjusted]=0.021).Conclusion: No association could be observed between MBL gene polymorphisms and susceptibility to periodontitis in Caucasians. However, now that genotyping could distinguish the low producing and deficient subjects from the high-producers, it was observed, for the first time, that MBL acts as a weak acute-phase protein in periodontitis. [ABSTRACT FROM AUTHOR]

Aim: To evaluate oral environmental changes in cannabis users. Material and Methods: The MEDLINE and Cochrane Central register of controlled trails (CENTRAL) were searched up to April 2007 to identify appropriate studies. Results: Independent screening of 982 titles and abstracts (MEDLINE-Pubmed) and (Cochrane) papers resulted in seven eligible publications. Conclusion: Based on the limited data, it seems justified to conclude that with increasing prevalence of cannabis use, oral health care providers should be aware of cannabis-associated oral side effects, such as xerostemia, leukoedema and an increased prevalence and density of Candida albicans. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effect of two soft manual toothbrushes with different filament and brush head designs in relation to gingival abrasion and plaque removing efficacy to the in relation flat trimmed manual reference toothbrush of the American Dental Association (ADA). Methods: The study had a randomized single use cross-over model ( n = 76) with three sessions whereby all brushes were used by each subject. Subjects were asked to abstain from all oral hygiene procedures for 48 h. They brushed according to split-mouth design. Pre- and post-brushing plaque and gingival abrasion were assessed. Results: The Sensodyne® Sensitive (SENS) was more abrasive than the ADA ( P < 0.001) while the Oral-B® Sensitive Advantage® (OBSA) was less abrasive than the SENS ( P < 0.001). There was no statistically significant difference between the OBSA and the ADA ( P = 0.319). All three brushes showed statistically significant reductions (49–56%) in plaque versus baseline. Compared to the ADA and the SENS, the OBSA had a smaller percentage of plaque removal (56% versus 49%, P ≤ 0.001; and 50% versus 52%, P = 0.028). Conclusions: The present study which compared two soft toothbrushes showed that the OBSA caused less gingival abrasion compared to the SENS-brush with a marginal loss (2%) of efficacy. [ABSTRACT FROM AUTHOR]

Objectives: To compare a tapered filament toothbrush (TFTB) to a control toothbrush (ADA) in their potential to cause gingival abrasion and improve the gingival condition following a period of experimental gingivitis. Methods: Thirty-two subjects refrained from brushing mandibular teeth for 21 days. During a subsequent 4-week treatment phase, the left or right side of the mouth was brushed with either the TFTB or ADA as randomly allocated. Gingival abrasion, plaque and gingival bleeding were assessed. Results: During the treatment phase gingival abrasion showed a trend to be lower with the TFTB than the ADA, which was significant at the 2-week assessment. The mean plaque scores changed from 2.98 (day 21) to 1.59 for the TFTB and from 3.00 (day 21) to 1.31 for the ADA. The mean bleeding scores changed from 1.86 (day 21) to 1.35 for the TFTB and from 1.85 (day 21) to 1.20 for the ADA. Plaque and bleeding scores were significantly lower with the ADA. Conclusions: Both toothbrushes improved gingival health and effectively removed plaque. Although there was a tendency towards fewer sites with gingival abrasion with the TFTB brush, it was less effective than the ADA in the removal of plaque biofilm and reduction of bleeding. Subjects considered the TFTB to be more pleasant to use. [ABSTRACT FROM AUTHOR]

Aim: The first aim was to study the reliability of a dental objective structured clinical examination (OSCE) administered over multiple days, and the second was to assess the number of test stations required for a sufficiently reliable decision in three score interpretation perspectives of a dental OSCE administered over multiple days. Materials and methods: In four OSCE administrations, 463 students of the year 2005 and 2006 took the summative OSCE after a dental course in comprehensive dentistry. The OSCE had 16–18 5-min stations (scores 1–10), and was administered per OSCE on four different days of 1 week. ANOVA was used to test for examinee performance variation across days. Generalizability theory was used for reliability analyses. Reliability was studied from three interpretation perspectives: for relative ( norm) decisions, for absolute ( domain) and pass–fail ( mastery) decisions. As an indicator of reproducibility of test scores in this dental OSCE, the standard error of measurement (SEM) was used . The benchmark of SEM was set at <0.51. This is corresponding to a 95% confidence interval (CI) of <1 on the original scoring scale that ranged from 1 to 10. Results: The mean weighted total OSCE score was 7.14 on a 10-point scale. With the pass–fail score set at 6.2 for the four OSCE, 90% of the 463 students passed. There was no significant increase in scores over the different days the OSCE was administered. ‘Wished’ variance owing to students was 6.3%. Variance owing to interaction between student and stations and residual error was 66.3%, more than two times larger than variance owing to stations’ difficulty (27.4%). The SEM norm was 0.42 with a CI of ±0.83 and the SEM domain was 0.50, with a CI of ±0.98. In order to make reliable relative decisions (SEM <0.51), the use of minimal 12 stations is necessary, and for reliable absolute and pass– fail decisions, the use of minimal 17 stations is necessary in this dental OSCE. Conclusions: It appeared reliable, when testing large numbers of students, to administer the OSCE on different days. In order to make reliable decisions for this dental OSCE, minimum 17 stations are needed. Clearly, wide sampling of stations is at the heart of obtaining reliable scores in OSCE, also in dental education. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Evaluate the efficacy and safety of an experimental toothbrush with a slow-release system of chlorhexidine (CHX) and determine its ability to inhibit plaque, bleeding, staining and oral tissue abnormalities during 6 weeks of use. MATERIAL AND METHODS: One hundred and fifty healthy volunteers were randomly assigned to one of three groups: the Test Brush group with a template slow-delivery system of CHX (Ttb), the Control Brush group without CHX (Ctb) and the Control Brush group without CHX but rinsing post-brushing with a 0.2% CHX mouthrinse (Ctb+R). At baseline as well as at 3 and 6 weeks, all clinical parameters were assessed. Following the baseline assessment, a supragingival prophylaxis was provided. RESULTS: One hundred and forty subjects completed the study. The Ctb+R group had lower plaque and bleeding scores than the Ttb and the Ctb group and significantly (p=0.0001) higher stain scores. There were no significant differences in plaque, bleeding and stain scores between the Ttb and the Ctb group. No differences were detected in oral tissue changes, except for discoloration of the tongue. CONCLUSIONS: In the present study, no beneficial effect could be demonstrated for the experimental CHX-releasing toothbrush. The use of a 0.2% CHX mouthrinse (in combination with brushing) remains the gold standard for additional chemical plaque control. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the serotype distribution and stability of Aggregatibacter actinomycetemcomitans over an 8-year period in untreated Indonesian subjects. MATERIAL AND METHODS: Clinical periodontal status and the presence of A. actinomycetemcomitans were established in 1994 and 2002 in 107 subjects from an Indonesian tea estate deprived from dental care. On an average, 3.6 isolates per patient were subcultured and serotyped using specific PCR reactions. RESULTS: In 1994, the predominant serotype was b (53.7%), whereas a and c occurred in 17.1% and 14.6% of the subjects, respectively. In 2002, a reduction in serotypes a (7.5%) and b (30.2%) occurred. Serotypes c and e increased in prevalence from 14.6% to 35.8% and 2.4% to 9.4%, respectively. Multiple serotypes were found in 12.2% in 1994 and 17% in 2002. From 24 subjects who were positive at both time points, 14 (58.3%) had the same serotype, whereas in 10 subjects (41.7%), a different serotype was found. Mean clinical attachment loss had increased from 0.74 mm in 1994 to 1.96 mm in 2002 but could not be related to subgingival presence of A. actinomycetemcomitans. CONCLUSIONS: A. actinomycetemcomitans serotypes distribution in Indonesian young adults shifts from predominantly serotype b to a more equal prevalence of serotypes b and c. This shift suggests an opportunistic character of A. actinomycetemcomitans. [ABSTRACT FROM AUTHOR]

Background: Receptors for the Fc part of IgG (Fc γRIIa) on polymorphonuclear leukocytes (PMN) mediate phagocytosis and cell activation. Previous results show that one of the genetic variants of the Fc γRIIa, the 131 H/H, is associated with more periodontal breakdown than the R/R. This may be due to hyper-reactivity of the H/H-PMNs upon interaction with bacteria. Aim: To study whether the Fc γRIIa genotype modifies the PMN reactivity in periodontitis patients. Material and Methods: A cohort of 98 periodontitis patients was genotyped. From these, 10 H/H and 10 R/R consented to participate. PMNs were incubated with immune serum-opsonized Actinobacillus actinomycetemcomitans ( A.a.). Phagocytosis, degranulation (CD63 and CD66b expression), respiratory burst and elastase release were assessed. Results: Patients of the H/H genotype showed more bone loss than those with the H/R or R/R genotype ( p=0.038). H/H-PMNs phagocytosed more opsonized A.a. than did R/R-PMNs ( p=0.019). The H/H-PMNs also expressed more CD63 and CD66b than did the R/R-PMNs ( p=0.004 and 0.002, respectively) and released more elastase ( p=0.001). Conclusions: The genotyping results confirm previous reports that more periodontal destruction occurs in the H/H genotype than in the H/R or R/R genotype. The functional studies indicate a hyper-reactivity of the H/H-PMN in response to bacteria, which may be one of several pathways leading to more periodontal breakdown. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether Non-Native dental students perceive drawbacks in their education and examination experience because of their lack of language proficiency and to test whether prolonging Objective Structured Clinical Examination (OSCE) test-station duration improves their performance. Materials and methods: Dental students ( n = 345) completed a questionnaire about their native country, their language background and the possible drawback they perceived in dental education and examination because of their language proficiency. Students were marked as ‘native’, when they were born in the Netherlands with Dutch as native language or ‘Non-Native’ when they were born outside the Netherlands, raised with a non-Dutch native language, or raised bilingually. A sample of 108 students was assessed by an OSCE testing a periodontal course with nine test-stations. Test-station topics were: (1) history taking, (2) measuring attachment level, (3) educating patients, (4) tracing a radiograph, (5) root-planing, (6) writing a prescription, (7) diagnostics and prognostics, (8) differential diagnostics and (9) writing a referral letter. The first five test-stations mentioned were of 5-min duration. The other four test-stations were provided in two modes: either with a short (5 min) or longer (10 min) version. Every student took at random two long and two short test-stations. Results: In the group of 345 questionnaire responders, Non-Native students ( n = 116) perceived significantly more drawback in education and examination than Native students ( n = 229) ( P < 0.001). When Non-Native students speak Dutch at home, around 38% of them reported perceived drawbacks in education, whereas when they speak their native language at home, around 60% reported perceived drawbacks in education ( P = 0.005). In the periodontal OSCE ( n = 108), the Native group ( n = 70) had significantly higher total scores than the Non-Native ( n = 38), ( P = 0.009, d = 0.53). The Non-Native group had significantly lower mean scores in the communication station ‘educating patients’ ( P = 0.034, d = 0.42). Prolonged test-station duration from 5 to 10 min had no positive effect in all experimental test-stations in the Native and Non-Native group. Female students in the Native group out-performed male in a communication test-stations. Female students in Native and Non-Native groups were found to be more successful in ‘tracing bone loss on radiographs’. Conclusion: Non-Native students perceived a drawback in dental education and examination because of their language proficiency in Dutch, which is confirmed by their actual OSCE performance. Prolonging the time for a test-station did not improve OSCE performance of Non-Native students. It is recommended that students with problems in language ability need additional tuition and practice. [ABSTRACT FROM AUTHOR]

Aim: To study transmission of Porphyromonas gingivalis in a population living in a remote area in Southern Java, Indonesia. Material and Methods: Subgingival plaque samples from 167 subjects with varying degrees of periodontal breakdown were obtained and cultured for the presence of P. gingivalis. After extraction and purification of bacterial DNA, amplified fragment length polymorphism technique was applied to genotype the bacterial isolates. Computer-assisted analysis of the bacterial DNA profiles was used to study distribution of P. gingivalis genotypes within family units. Results: One hundred and five of the 167 (63%) subjects were culture positive for P. gingivalis. In total, 371 P. gingivalis isolates were obtained from the 105 subjects. Of the 105 subjects, 30 were siblings representing 13 families. In six of the 13 families (46%), identical P. gingivalis genotypes were found among siblings. In the study group of 105 subjects, 13 married couples were identified of which both spouses were culture positive for P. gingivalis. None of the 13 couples shared an identical P. gingivalis genotype. Twenty P. gingivalis-positive subjects had spouses that were culture negative for P. gingivalis. Conclusions: In this study population, vertical transmission of P. gingivalis has occurred within family units, most likely from parents to children. Transmission of P. gingivalis between spouses could not be established. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of an Objective Structured Clinical Examination (OSCE) on dental students’ learning strategies and competence to manage periodontal diseases in patients. The implemented OSCE was expected to be superior to the existing Written Exam in fostering the acquisition of clinical competencies in terms of study strategies that are more oriented towards clinical practice, longer study time, greater clinical proficiency, and more realistic self-assessment. Material and methods: After a clinical course in periodontology, 72 third year dental students were assessed summatively, either using a Written Exam or an OSCE (P-OSCE). The students were informed beforehand about the assessment formats. The self-assessed clinical competence, study time and strategies (i.e. practice with a manikin, peers and patient case) were evaluated by means of a questionnaire. After a comprehensive dental care course, all 72 students were assessed by an overall end-of-year OSCE, in which three periodontal stations were included ‘measuring pockets’, ‘educating patients’ and ‘tracing an X-ray with bone-loss’. The competence of the previous Written Exam group and the P-OSCE group was investigated by determining the mean scores and pass-fail scores of three periodontal test-stations as well as the total score of the end-of-year OSCE. The degree of realistic self-assessment was studied by correlating the self-assessed competencies as evaluated by means of the questionnaire with the total score of the end-of-year OSCE. Results: Self-assessed clinical competence, study time and study strategies showed no differences between the P-OSCE and the Written Exam-group. The clinical competence determined in the test-station ‘measuring pockets’ in the end of year overall OSCE was higher for the P-OSCE group ( P = 0.05) when compared with the Written Exam group; the two groups performed equally well in the test station ‘educating patients’, whereas the performance in ‘tracing an X-ray with bone-loss’ was better in the Written Exam group. This group also had a higher total score in the end-of-year OSCE ( P = 0.05). The degree of realistic self-assessment was higher in the P-OSCE group than in the Written Exam group: in the P-OSCE group the self-assessed clinical competencies correlated significantly with the total score of the overall end-of-year OSCE ( P ≤ 0.05). Conclusions: No effects of the implementation of an OSCE in undergraduate periodontal education were observed in study strategies, but the implementation of an OSCE in undergraduate periodontal education appears to stimulate learning, resulting in greater achievement of specific clinical competence and a greater level of realistic self-assessment. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate (1) reduction in the number of microorganisms obtained directly after subgingival instrumentation, (2) rate of bacterial re-colonization during 2 weeks, under supragingival plaque-free conditions. MATERIALS AND METHODS: Effects of subgingival instrumentation were measured at one deep pocket in 22 patients (11 smokers and 11 non-smokers). Immediately after initial therapy, experimental sites, under strict plaque control, were instrumented subgingivally. Microbiological evaluation was performed at pre-instrumentation, immediate post-instrumentation and 1 and 2 weeks post-instrumentation. RESULTS: Mean total anaerobic colony forming units (CFUs) dropped from 3.9 x 10(6) before to 0.09 x 10(6) immediately following instrumentation. Significant reductions were found for Tannerella forsythia, Micromonas micros, Fusobacterium nucleatum and spirochetes. Significant reductions were not observed for Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Campylobacter rectus. Except for spirochetes, no reduction in prevalence of specific periodontal bacteria was found immediately after instrumentation. During follow-up, mean total CFU tended to increase. Prevalence of periodontal bacteria further reduced. No effect of smoking was found. CONCLUSION: Results indicate that subgingival mechanical cleaning in itself, has a limited effect, in actually removing bacteria. The subsequent reduction in prevalence of specific periodontal bacteria shows that it is apparently difficult for these species to survive in treated pockets. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare two sonic toothbrushes in relation to the reversal of experimental gingivitis. MATERIALS AND METHODS: Subjects refrained from brushing mandibular teeth for 21 days. During a 4-week treatment phase, the right or left side of the mouth was brushed with either the Sonic Complete (SC) or Sonicare Elite (SE) toothbrush as randomly allocated. Plaque and gingivitis were assessed on day 0, after 21 days of no oral hygiene and after 1, 2 and 4 weeks of brushing twice daily. RESULTS: Thirty-four subjects provided evaluable data. The experimentally induced gingivitis (EIG) resulted in higher bleeding and plaque scores compared with day 0. The mean plaque scores at day 21 changed from 3.09 to 1.30 for the SC, and from 3.02 to 1.21 for the SE. At the end of the treatment period, there was no significant difference between the two brushes. The mean bleeding scores changed from 1.87 (day 21) to 0.97 for the SC, and from 1.83 to 0.92 for the SE. For the assessments at 1, 2 and 4 weeks post-EIG, both brushes showed a significant decrease in bleeding scores. There were no statistically significant differences between brushes. [ABSTRACT FROM AUTHOR]

Persons who smoke display a less pronounced increase of gingival bleeding in the experimental gingivitis model as compared with non-smokers. The aim of the present study was to investigate whether this could partly he explained by differences in levels of parotid total secretory IgA (S-IgA) or parotid S-IgA reactive with selected oral microorganisms. Parotid saliva samples were obtained from 11 smoking and 14 non-smoking volunteers, at baseline, after 5 and 14 days of full mouth experimental gingivitis. Output levels of total S-IgA and of specific S-IgA reactive with cell extracts from Actinobacillus actinomyecetemcomittans, Actinomyces naeslundii, Campylobacter rectus, Fusobacterium nucleation, Porphyromonas gingivatis, Prevotella intermedia, Prevotella nigrescens, Peptostreptococcus micros, Streptococcus gordonii, and Streptococcus mutans were determined in the samples by means of ELISA. Smokers and non-smokers were found to have similar output levels (µg/mm) of total S-IgA, and the values did not significantly change during the experimental gingivitis trial. Parotid salivary outputs (units/min) of the bacteria-specific S-IgA at baseline and at days 5 and 14, were not different between smokers arid non-smokers; no changes were observed during the experimental gingivitis trial. The present observations indicate that total S-IgA and bacteria-specific S-IgA in saliva are not main factors that can explain the less pronounced increase of gingival bleeding in the experimental gingivitis model in smokers as compared with non-smokers. [ABSTRACT FROM AUTHOR]

Background: A double-blind, randomized, parallel, comparative study was designed to evaluate the long-term safety and efficacy of subgingivally administered minocycline ointment versus a vehicle control. Methods: One hundred four patients (104) with moderate to severe adult periodontitis (34 to 64 years of age; mean 46 years) were enrolled in the study. Following scaling and root planing, patients were randomized to receive either 2% minocycline ointment or a matched vehicle control. Study medication was administered directly into the periodontal pocket with a specially designed, graduated, disposable applicator at baseline; week 2; and at months 1, 3, 6, 9, and 12. Scaling and root planing was repeated at months 6 and 12. Standard clinical variables (including probing depth and attachment level) were evaluated at baseline and at months 1, 3, 6, 9, 12, and 15. Microbiological sampling using DNA probes was done at baseline; at week 2; and at months 1, 3, 6, 9, 12, and 15. Results: Both treatment groups showed significant and clinically relevant reductions in the numbers of each of the 7 microorganisms measured during the entire 15-month study period. When differences were detected, sites treated with minocycline ointment always produced statistically significantly greater reductions than sites which received the vehicle control. For initial pockets ≥5 mm, a mean reduction in probing depth of 1.9 mm was seen in the test sites, versus 1.2 mm in the control sites. Sites with a baseline probing depth ≥7 mm and bleeding index >2 showed an average of 2.5 mm reduction with minocycline versus 1.5 mm with the vehicle. Gains in attachment (0.9 mm and 1.1 mm) were observed in minocycline-treated sites, with baseline probing depth ≥5 mm and ≥7 mm, respectively, compared with 0.5 mm and 0.7 mm gain at control sites. Subgingival administration of minocycline ointment was well tolerated. Conclusions: Overall, the results demonstrate that repeated subgingival administration of minocycline ointment in the treatment of adult periodontitis is safe and leads to significant adjunctive improvement after subgingival instrumentation in both clinical and microbiologic variables over a 15-month period. [ABSTRACT FROM AUTHOR]

Examines the prevalence and serotype distribution of Porphyromonas (P) gingivalis in Indonesia. Assessment on serotype distribution and periodontal parameters; Link between P. gingivalis serotypes and periodontal attachment loss; Role of P. gingivalis on the destructive forms of periodontal disease.

The aim of the present investigation was to study longitudinally the periodontal condition of married couples. The data are derived from a longitudinal study in a young population living in a remote village in Indonesia and showing a relatively high prevalence of periodontal destruction. In 23 married couples, clinical measurements were carried out in 1987 and 1994. During the latter examination, a pooled gingival sample was obtained for microbiological evaluation. In 1994, the mean age of the group was 29.1 years and the couples were married for on the average 10 years. In each couple, the partner showing in 1994 the highest score for mean loss of attachment (LA) was classified as the diseased proband and the other partner as the spouse. Evaluation of the clinical data showed that: (1) the diseased probands already had in 1987 a worse periodontal condition compared to that of the spouses; (2) in both groups the mean LA increased during the 7-year period; (3) the difference in mean LA between diseased probands and spouses increased between 1987 and 1994. The microbiological evaluation revealed a relatively high prevalence of Actinobacillus actinomycetemcomitans (50%), Porphyromonas gingivalis (67%) and Prevotella intermedia 61%. Analysis showed no differences in microbiota between diseased probands and spouses. The 23 Actinobacillus actinomycetemcomitans positive subjects included 2 positive couples. Furthermore, the 31 Porphyromonas gingivalis and 28 Prevotella intermedia positive subjects included 9 and 7 positive couples respectively. In conclusion, 10 years of cohabitation showed no influence on the periodontal condition of the spouses. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine whether variations occur in the % of motile micro-organisms on the dorsum of the tongue during a 1-month time-period and further to examine 2 transport fluids: the growth medium BM and reduced transport fluid (RTF), for their ability to conserve motility of microorganisms in comparison to sterile saline. Both transport fluids showed a significant reduction in the % of motile micro-organisms within 15 min. The use of RTF resulted, during a 60-min period, in a significantly higher % of motile micro-organisms compared to sterile saline. Results showed that the % of motile micro-organisms on the dorsum of the tongue was not constant. A significant reduction in the % of motile micro-organisms was observed in the course of the month involved in this study. [ABSTRACT FROM AUTHOR]

The effect of improved metabolic control on the clinical periodontal condition and the subgingival microflora of diseased and healthy periodontal pockets in 6 ambulatory insulin-dependent diabetes mellitus (IDDM) patients was prospectively studied. Duplicate measurements with a time-interval of 3 days were made every 4 moths for assessment of the metabolic status, the clinical periodontal condition and the subgingival microflora. During the study, patients maintained personal oral hygiene measures as they usually did before the study. Neither supplementary dental prophylaxis nor oral hygiene measures were applied during the investigation. Long-term metabolic control (HbA1c) improved significantly with intensive conventional insulin treatment. Gingival redness decreased significantly whereas gingival swelling showed a not significant trend to decrease. It is suggested that microvascular changes associated with improved metabolic control in diabetes mellitus may mediate the observed change in gingival redness. No effect could be demonstrated for probing pocket depth, probing attachment level, bleeding on probing and the plaque index. Statistical analysis of the effect of improved metabolic control on the subgingival microflora revealed that only the % of streptococci increased significantly in diseased periodontal pockets. In general, no significant changes were found in either healthy or diseased pockets with regard to the bacterial flora associated with periodontal disease. The results of the present study indicate that improved metabolic control in IDDM patients may have no potential impetus for an improved clinical periodontal condition nor on the subgingival bacterial flora. It is concluded that the periodontal condition in IDDM patients may only ameliorate when local oral hygiene measures are applied. [ABSTRACT FROM AUTHOR]

In the present study, the effect of supra and subgingival plaque debridement on the dynamics of the subgingival microflora in deep pockets was investigated. 8 adult periodontitis patients participated in the study. In each patient, 4 clinically diseased sites were investigated microbiologically by phase contrast microscopy for the determination of both the %s as well as the total numbers of spirochetes and motile rods and by anaerobic cultivation for the determination of the different black-pigmented Bacteroides species. After base-line examination, patients were treated by mechanical removal of supra- and subgingival plaque deposits. 2 and 8 weeks after treatment, clinical and microbiological parameters were re-evaluated. During the experimental period, no oral hygiene procedures were performed in order to achieve last recolonization of the pockets. Treatment resulted in a significant reduction in probing pocket depth and gain of probing attachment. 2 weeks after treatment, no further improvements could be observed, A positive correlation was found between the reduction in probing pocket depth and decrease in Bacteroides gingivalis (P<0.009) and between gain in probing attachment and reduction in the % of B. gingivalis (P<0.009). No correlation between these clinical parameters and B. intermdius, spirochetes or motile rods was apparent. An inverse relationship between B. gingivalis and B. intermedius was observed. We found that changes in %s of spirochetes and motile rods are not correlated with changes in total numbers of these bacterial groups. It was concluded that monitoring of %s of micro-organisms may not supply rational information on the microbiological conditions of the subgingival area. [ABSTRACT FROM AUTHOR]

Both epidemiological and clinical studies indicate that not all individuals are equally susceptible to periodontal breakdown. Therefore, the clinical differences were investigated between subjects highly susceptible and subjects insusceptible to periodontal breakdown. The highly susceptible group consisted of patients with a diagnosis of juvenile periodontitis. The insusceptible group consisted of older individuals with gross amounts of plaque and no periodontal breakdown. Results indicated that a high value of the bleeding/plaque ratio may possibly act as a prognostic indicator for periodontal breakdown. However, longitudinal data are indispensable for substantiation of this hypothesis. Since longitudinal research takes many years. the experimental gingivitis model was chosen for further investigation. 4 groups of individuals were selected on the basis of a different history of inflammatory periodontal disease: 2 younger age groups without periodontal breakdown, having either a low or a high bleeding/plaque ratio - a hypothetically susceptible and a hypothetically insusceptible group. respectively; one older age group with presence of gross amounts of plaque. no periodontal breakdown and a low bleeding/plaque ratio - an insusceptible group; and an adult group who previously suffered from severe periodontal disease - a susceptible group. Results of the experimental gingivitis studies indicated that the older insusceptible group developed only small amounts of bleeding, whereas the younger hypothetically insusceptible group developed a comparable low bleeding index. The younger hypothetically susceptible group developed a much higher bleeding index comparable to that of the susceptible group, the periodontal patients. In conclusion, comparison of the results of the experimental gingivitis studies in subjects with differing histories of inflammatory periodontal disease supports the concept that the bleeding/plaque ratio may act as a prognostic indicator for periodontal breakdown. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to investigate the significance of oral mucosal surfaces as a habitat of periodontopathic micro-organisms. For this investigation, 7 young adults were selected for an experimental gingivitis study. At the start of the experiment, bacterial samples were taken by means of a sterile swab from 4 oral mucosal surfaces: the buccal mucosa, the vestibular fold, the dorsum of the tongue and a tonsil. All individuals were asked to abstain from oral hygiene procedures in 1 quadrant of the mouth for a period of 23 days. At the end of this period, plaque samples were taken from 4 tooth surfaces by means of a sterile periodontal probe just coronal from the gingival margin. The study included evaluation of spirochetes and motile organisms by means of phase- contrast microscopy and of black-pigmented Bacteroides, Fusobacterium, Actinomyces, Actinobacillus actinomycetemcomitans and capnocytophaga by means of cultural studies. Results showed a relationship between the prevalence of motile organisms and black-pigmented Bacteroides in samples from both the mucosal surfaces and the 23-day-old plaque. In addition, a relationship was found between the presence of motile organisms on the dorsum of the tongue at the start of the experiment and their prevalence in the 23-day-old plaque. It was suggested that the dorsum of the tongue may function as a nidus for periodontopathic micro-organisms. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to investigate the clinical differences between individuals highly susceptible and individuals insusceptible to periodontal breakdown. The susceptible group consisted of 7 patients with a diagnosis of juvenile periodontitis. The insusceptible group consisted of 7 individuals selected on the basis of age (52 years or older), presence of at least 18 teeth, no evidence of extractions due to periodontal breakdown, no loss of attachment, shallow pockets, gross amounts of plaque and no history of interdental cleaning. Results showed that the susceptible group had more bleeding, less plaque and deeper pockets than the insusceptible group. Since the 2 groups seem to behave differently with regard to bleeding upon probing and amount of plaque, bleeding, plaque ratios were calculated. Testing showed a highly significant difference between the 2 groups. The same results were obtained if only sites with shallow pockets were included in the analysis. On the basis of these results, it is hypothesized that a high value of the ratio between bleeding and plaque may act as a prognostic indicator for periodontal breakdown. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the rate of development of experimentally-induced gingival inflammation in relation to the susceptibility to periodontal disease. By selection according to age, a younger (25-39 years) and an older (45-54 years) age group, with a comparable reduced but healthy periodontium, was selected. This equal amount of periodontal breakdown may suggest that the younger age group represented individuals with a relatively higher degree of susceptibility to periodontal disease. At the start of the experiment, each patient was instructed to abstain from oral hygiene procedures in 1 quadrant of the mouth for a period of 18 days. Results showed that all subjects developed signs of gingival inflammation. Regarding the development of redness and swelling, no differences could be assessed between the 2 age groups. However, analysis of the bleeding scores revealed that bleeding on probing developed more rapidly in the younger age group. It was concluded that those patients who have suffered from a more rapid form of periodontal disease also develop inflammation, in terms of bleeding on probing, more rapidly. [ABSTRACT FROM AUTHOR]

It is generally known that the degree of periodontal breakdown increases with increasing age The extent to which aging of periodontal tissues plays a part in this respect poses a question which is yet to be answered Aging proves to be accompanied by a variety of periodontal changes The periodontal tissues themselves show evidence of aging, there are indications that the composition of the plaque changes, and the reaction of the periodontium to the presence of plaque probably changes as well There is as yet no sufficient evidence of a physiological apical migration of the epithelial attachment inhuman subjects It seems plausible that periodontal breakdown can occur only in the presence of plaque with consequent inflammation of the periodontium, or as a result of trauma Whether changes in plaque composition with age exert any influence on the course of periodontal breakdown is uncertain the data available are not yet sufficient to warrant definite conclusions The same applies to the influence which a changing reaction of the periodontium to the presence of plaque may have on the course of periodontal breakdown Research findings do suggest that the degree of periodontal breakdown increases with age, that with increasing age inflammation of the periodontium tends to develop more rapidly and that in the process of aging the periodontium shows a slower rate of wound healing However, these phenomena are overshadowed by the patients' susceptibility to periodontal disease. This implies that (1) the susceptibility to periodontal disease is more significant for the rate of periodontal destruction than the length of time plaque is present (the age effect) and (2) the greater the susceptibility to periodontal disease, the slower the rate of wound healing and the more rapidly inflammation of the periodontium tends to develop. [ABSTRACT FROM AUTHOR]

In the present investigation wound healing was studied clinically in 8 younger (mean age 33.5 years) and 8 older patients (mean age 48 years), who were surgically treated for the same amount of severe periodontitis. This implies that the patients in the younger age group represented individuals with a higher degree of susceptibility to periodontal disease than the patients in the older age group. After surgery all patients were subjected to a carefully controlled oral hygiene program. Patients were recalled weekly until 8 weeks post surgery and again after 15 weeks for a final examination. At every recall session oral hygiene measurements were carried out and the bleeding tendency of the pockets was determined after probing with a standardized pressure. Bleeding on the basis of mechanical trauma after probing was considered to be a clinical parameter for wound healing in a plaque free environment. Results indicate that the oral hygiene program resulted in equally low plaque scores in both age groups. However, in a period from 5-15 weeks after surgery younger patients showed significantly more bleeding pockets that older patients. Furthermore it was found in both groups that the more loss of attachment there was, the slower the rate of wound healing. It was concluded that the time span for wound healing is longer in patients who are more susceptible to periodontal disease, than in those who are less susceptible [ABSTRACT FROM AUTHOR]

The present study investigated the location of the gingival margin, following denudation of the interdental alveolar bone. In seven patients apically positioned flap procedures were performed in such a way that complete interdental denudation was achieved. Teeth showing interdental osseous craters were excluded from the study. Three years post-treatment a mean pocket depth of 2.17 mm was found. No differences in attachment level prior to and 3 years after treatment could be assessed. Results showed a mean distance of 4.33 mm between the location of the gingival margin 3 years posttreatment and the bone level during surgery. This finding is discussed in relation to the question of how much alveolar bone should be removed if, in ease of extensive carious lesion or crown fracture, the cervical outline of the restoration is located near the bone level. [ABSTRACT FROM AUTHOR]

In the present study the location of the probe tip was studied on human teeth scheduled for extraction for periodontal reasons. Prior to extraction all teeth were subjected to initial treatment consisting of plaque control and removal of supra- and subgingival deposits. Results showed that: 1) 43% of the pockets examined were still bleeding on probing after treatment 2) bleeding pockets were deeper than non-bleeding pockets 3) in non-bleeding pockets the probe tip was located more accurately at the attachment level than in bleeding pockets. [ABSTRACT FROM AUTHOR]

This study investigates the relationship between probing force and probe penetration into the periodontal tissues in pockets with overt gingivitis and in pockets with minimal gingival inflammation. In eight dogs experimental periodontal tissue breakdown was induced during a period of 14 weeks. The dogs were then distributed over two groups of four dogs each. In one group the dogs were subjected to meticulous tooth cleaning once every day for a period of 3 weeks. The dogs in the second group did not receive any oral hygiene measures. Next, wooden probes were inserted, mesial and distal to each premolar. In each dog six different probing forces were used. Microscopic examination showed that, in the brushed group, epithelium was always present between the probe tips and the connective tissue. In the nonbrushed group presence of epithelium was found in 21 of 23 specimens. In both groups of dogs it was found that, with increasing probing forces, the location of the tips of the probes changed from a position occlusal to the most coronal connective tissue fibers to a position apical to the most coronal connective tissue fibers. With light probing forces it appeared that in the nonbrushed group the tips of the probes were located more apically. When greater probing forces were used, no differences between the brushed and the nonbrushed group were found. It is suggested that, using a probe of 0.63 mm in diameter, the optimal force level for clinical pocket measurements is about 0.75 N, or in other words, the optimal probing pressure is about 240 N/cm2. [ABSTRACT FROM AUTHOR]

This study investigates the effect of initial treatment on 1) probing force related to probing depth, 2) the attachment level, 3) the position of the gingival margin and 4) the clinical signs of color and change of contour of the gingiva in relation to the bleeding tendency of a pocket. It also addresses the question of whether, in deep inflamed periodontal pockets, the tip of the probe is located at the attachment level when a probing force of 0.75N is used, as has already been shown in pockets related to noninflamed gingival margins. Four different probing forces are used: 0.15N, 0.25N, 0.50N and 0.75N and results show an increasing probing depth with an increasing probing force, both before and after treatment. Initial treatment results in a decrease of mean probing depth but the change is dependent on the applied probing force. The mean probing depth reduction decreased from 1.71 mm (assessed with 0.15N) to 1.24 mm (assessed with 0.75N). Since results from this and a previous study indicate that both before and after treatment the tip of the probe is located at the attachment level when a probing force of 0.75N is used, it may be postulated that the reduction of mean probe-tip level measurements (= probing depth measurement from a fixed point) reflects a degree of connective tissue reattachment. Patients in the initial treatment study were selected on the basis of obvious redness and swelling of the gingiva. After treatment, both of these symptoms almost disappear, whereas the Periodontal Pocket Bleeding Index (P.P.B.I.) decreases only from 0.87 before treatment, to 0.45 after treatment. [ABSTRACT FROM AUTHOR]

Recently an increasing pocket depth was found to be related to an increasing probing force. The purpose of the present study was to investigate whether or not a plateau value in pocket depth measurements exists and to study, with different probing forces, the location of the tip of the probe in relation to the periodontal fibers and the alveolar bone. Two groups of patients were selected for this study; in one group a number of teeth had to be extracted for periodontal reasons (the extraction group) and in the other a single periodontal surgical procedure was required (the surgery group). All patients received preliminary treatment consisting of plaque control and removal of subgingival deposits. At the time of the investigation the gingival condition was assessed by means of a new index, the Periodontal Pocket Bleeding Index (P.P.B.I.) The criteria were: 0 - no bleeding of the pocket after probing with a force of 0.75N, and 1 - bleeding of the pocket within 30 sec after probing with a force of 0.75N. After local anesthesia in the extraction group, reference marks parallel to the long axis of the experimental teeth were cut with a cylindrical diamond burr. By means of the pressure probe, pocket depth measurements were performed with increasing forces of 0.50, 0.75, 1.00 and 1.25N. After extraction and staining of the remnants of the periodontal fibers, the distance from the most coronal intact connective tissue fibers to the most apical point of the reference marks was measured. In the surgery group using the same pressure probe, interproximal measurements with increasing forces of 0.50, 0.75, 1.00 and 1.25N were made from the apical border of the restorations to the bottom of the pocket. The same measurement, this time to the crest of the alveolar bone, was repeated after a flap had been raised. Results with the P.P.B.I. showed that oral hygiene procedures resulted in a mean index of 0.36 in the surgery group and 0.43 in the extraction group. The results of the present study indicated that 1) using a probe of 0.63 mm diameter, the optimal force level for clinical pocket depth measurements is 0.75N, 2) a force of 0.75N is clinically well tolerated and meets with few objections from patients, 3) when a probing force of 0.75N is used the tip of the probe in both shallow and deep periodontal pockets is located at the most coronal intact connective tissue fibers, 4) a plateau value in pocket depth measurements is found when a probing force of 1.25N is employed, and 5) the mean width of the connective tissue attachment is approximately 1.9 mm. [ABSTRACT FROM AUTHOR]

A new periodontal probe has been developed: the pressure probe. The probe consists of a cylinder and piston assembly connected to a variable air pressure system. The working end is a metal tube in which a plunger can move freely. By means of air pressure the plunger is constantly fully extruded. During probing the plunger will intrude from the position of maximum extrusion only as the probing force exceeds the predetermined force acting on the plunger. The difference by which the plunger is intruded can be read on a millimeter scale within the handle of the probe. The purpose of the present investigation was to determine whether probing force is constant during probing, to study the reliability of reading pocket depth measurements in vitro, and to investigate the relationship between pocket depth and applied force in man. In order to evaluate whether the probing force is constant during probing, measurements were performed on a force transducer. Results show that the device makes probing possible with a constant and adjustable pressure. The influence of the reading of the calibration on pocket depth assessment in vitro was studied in an in vitro model. Results show that pocket depths of 1 mm to 8 mm ± 0.25 mm were read correctly in about 90 % of instances. Generally about 45 % of the half millimeter values were recorded as the lower whole millimeter. To investigate the relationship between pocket depth and applied force, 173 pocket depth measurements were performed in eight patients. Patients selected for this study had, in some part of the upper anterior segment, loss of alveolar bone support up to two-thirds of the root length, visible on periapical radiographs. All patients received preliminary treatment consisting of plaque control and removal of subgingival deposits. The mean Sulcus Bleeding Index score was 0.2. Pocket depth measurements were carried out with forces of 0.15. 0.25, 0.50 and 0.75 N. Both approximal and vestibular pocket depths were recorded. In this study 0.75 N was chosen as the maximal force since in a pilot study a force of 1.0 N appeared too painful for patients. Results show an increasing pocket depth with increasing probing force. The mean pocket depths increased from 2.08 mm at 0.15 N to 3.71 mm at 0.75 N. Testing showed it to be statistically significant. At 0.75 N, 72 out of the 173 pockets examined were equal to or deeper than 4 mm. The percentages were calculated of differences equal to or inure than 2 mm between pocket depth measurements carried out with 0.75 N and lower forces. It was found that 63.3 % of pocket depths measured with 0.15 N were, when measured with 0.75 N, 2 mm or more deeper. This was 43.1 % when 0.25 N and 0.75 N were compared and 9.7 % when 0.50 N and 0.75 N were compared. The maximal differences varied from 5 mm to 7 mm. [ABSTRACT FROM AUTHOR]

The inaccuracy of the calibration of two Merritt-B probes, old and new style, was investigated. It appeared that the calibration of the Merritt-B "new style," probe was better than the calibration of the old one. The influence of the node of calibration and the reading of the calibration on pocket depth assessment with a Merritt-B "old style" probe was studied in an in vitro model. The model consisted of 32 aluminium cubes each with a hole in the centre. The holes were 1 mm in cross-section and the depth varied from 0.25 mm to 8 mm in 0.25-mm increments. Results show that pocket depths of 1 mm to 8 mm ± 0.25 mm generally wore read correctly about 90% of the time. This was not true for the 4- and 6-mm areas. When a probe was used where the 4- and 6-mm marks were omitted, pocket depths in that area were read correctly only in about 60% of instances. This difference disappeared when the 4- and 6-mm marks were added. Results of measuring the half millimeter values showed that generally 80% were recorded as the lower whole millimeter. [ABSTRACT FROM AUTHOR]