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There is scarce information about the relationship between periodontal disease and osteoarthritis. This study investigated the effect of surgically induced osteoarthritis on alveolar bone loss in experimental periodontitis in rats.12 rats were divided into test and control groups. On day 1, the animals were anaesthetized, and silk ligatures were ligated around 6 maxillary posterior teeth in each animal from both groups. Surgical induction of osteoarthritis was performed on the left knees in the test group. No knee surgeries were performed in the control group. The ligatures were kept in place for 30 days, at which time the animals were euthanatized, and the maxillae and knee joints were harvested and processed for histological analysis. The alveolar bone loss was assessed using a zoom stereomicroscope.The knee joint histologic sections of the control group showed normal joint features, whereas in the test group there were substantial changes typical of osteoarthritis, including wide joint spaces, prominent monocytic infiltration of the synovium, invasion of periarticular bone, and decreased chondrocyte density. Comparison of the bone height between the groups showed a significantly higher bone loss in the test than in the control group The marginal mean bone height, adjusted for covariates and the intraclass correlation between sites, was 1.19 and 0.78 mm in the test and control groups, respectively (p .0001).Surgically induced osteoarthritis leads to greater alveolar bone loss in the experimental periodontitis model in rats.

Objective Our objective was to phenotype periodontal disease (PD) diagnoses from three different sections (diagnosis codes, clinical notes, and periodontal charting) of the electronic dental records (EDR) by developing two automated computer algorithms. Methods We conducted a retrospective study using EDR data of patients (n = 27,138) who received care at Temple University Maurice H. Kornberg School of Dentistry from January 1, 2017 to August 31, 2021. We determined the completeness of patient demographics, periodontal charting, and PD diagnoses information in the EDR. Next, we developed two automated computer algorithms to automatically diagnose patients' PD statuses from clinical notes and periodontal charting data. Last, we phenotyped PD diagnoses using automated computer algorithms and reported the improved completeness of diagnosis. Results The completeness of PD diagnosis from the EDR was as follows: periodontal diagnosis codes 36% (n = 9,834), diagnoses in clinical notes 18% (n = 4,867), and charting information 80% (n = 21,710). After phenotyping, the completeness of PD diagnoses improved to 100%. Eleven percent of patients had healthy periodontium, 43% were with gingivitis, 3% with stage I, 36% with stage II, and 7% with stage III/IV periodontitis. Conclusions We successfully developed, tested, and deployed two automated algorithms on big EDR datasets to improve the completeness of PD diagnoses. After phenotyping, EDR provided 100% completeness of PD diagnoses of 27,138 unique patients for research purposes. This approach is recommended for use in other large databases for the evaluation of their EDR data quality and for phenotyping PD diagnoses and other relevant variables.

There are few large surveys of periodontal disease in young age cohorts, and national surveys in Africa do not exist. This study assessed the prevalence and severity of periodontal disease in a national survey of adolescents and young adults in Morocco.A multistage probability sampling design was used to draw a sample of 14,667 students 12-25 years old attending 87 schools. The sample was representative of approximately three million Moroccan students in this age group.A total of 27.9%, 11.9%, and 7.7% of the subjects had ≥1 teeth with ≥4, ≥5, and ≥6 mm probing depth, and the population estimates were ≈ 822,436, 349,961, and 226,297 affected subjects, respectively. For attachment loss, the prevalences were: 11.6%, 9.5%, and 6.9% (or ≈ 341,761, 281,043, and 203,977 affected subjects) for ≥4, ≥5, and ≥6 mm, respectively. The rates of probing depth and attachment loss increased significantly with the increase in age (p 0.01, p 0.001). Sex and urban status did not show significant effects on the prevalence of periodontal disease (p 0.05). Similarly, the relationship between the occupation status and periodontal status was modest and not statistically significant (p 0.05).Children and young adults attending public schools in Morocco have a high prevalence and severity of periodontal disease compared with other populations of similar age. The rate of periodontal disease reported here may be used as baseline population estimates in the surveillance of disease status in this population.

National surveys of periodontal diseases in children are rare. This study describes the first national survey of oral health of adolescents attending public schools in Morocco. We report the prevalence and demographic determinants of periodontal diseases, and generate population estimates for this young population.This study used a multi-stage probability sample comprising 14,667 students in 87 schools and 520 classrooms, representative of students attending grades 6-12 (age 12-18 years) in Morocco. The students were interviewed and then examined clinically to assess their periodontal status, which was classified according to the 2017 World Workshop. In addition, the diagnosis of aggressive periodontitis (AgP) was assessed.Of approximately 3 million students in this age cohort, 12.3% (or approximately 360,894 subjects) had periodontitis and 46.9% (1.4 million) had gingivitis. They comprised 10.8%, 2.9%, and 6.1% subjects with periodontitis stage I, II, and III/IV, respectively; 5.0%, or 148,336 subjects, had AgP. The prevalence rates were not significantly different by gender or urban status. However, the prevalence of AgP was particularly high in certain regions of Morocco.The prevalence of staged periodontitis and AgP in this young population is among the highest reported in national surveys worldwide.

Aim To determine the association between periodontitis stage and grade with oral-health-related quality of life (OHRQoL). Materials and methods This cohort was derived from the Porto Alegre study. The original sample was representative of more than 3 million inhabitants of a Brazilian urban area. Full-mouth periodontal examinations at six sites per tooth were performed at baseline and 5 years later. Periodontitis grade was determined by direct evidence of progression of attachment loss over the follow-up. Stage of periodontitis and OHRQoL, determined by the oral health impact profile version 14 (OHIP-14), were recorded at the follow-up examination. Mean ratios (MRs) and 95% confidence intervals (95% CIs) were estimated adjusting for age, sex, smoking, systemic diseases, tooth loss, and baseline periodontitis diagnosis. Results Five-hundred and ninety-nine individuals were analysed. Individuals with periodontitis grade C + stage II (MR = 1.49; 95% CI = 1.08-2.04) and stages III/IV (MR = 1.83; 95% CI = 1.25-2.66) had significantly higher OHIP scores than those without periodontitis or with periodontitis stage I/grade B. Individuals with periodontitis stages II and III/IV + grade B did not differ from those without periodontitis or with periodontitis stage I/grade B. Conclusion Severity and progression rate of periodontitis are associated with poor OHRQoL.

Introduction: There is growing recognition of immune related adverse events (irAEs) from immune checkpoint therapies being correlated with treatment outcomes in certain malignancies. There are currently limited data or consensus to guide management of irAEs with regards to treatment rechallenge. Methods: We conducted a retrospective analysis with an IRB-approved protocol of adult patients seen at the WVU Cancer Institute between 2011–2019 with a histopathologic diagnosis of active cancers and were treated with immune checkpoint inhibitors (ICI) therapy. Results: Demographics were similar between the ICI interrupted irAE groups within cancer types. Overall, out of 548 patients who received ICI reviewed, there were 133 cases of ≥1 irAE found of any grade. Being treated with anti-CTLA-4 inhibitor ICI was associated with lower risk of death compared to anti-PD-1 ICI. The overall survival difference observed for irAE positive patients, between rechallenged (37.8 months, reinitiated with/without interruption, 38.6 months, reinitiated after interruption) and interrupted/non-reinitiated (i.e., discontinued) groups (24.9 months) was not statistically significant, with a numerical trend favoring the former. Conclusions: Our exploratory study did not identify significantly different survival outcomes among the Appalachian West Virginia adult cancer patients treated with ICI who developed irAE and had treatment reinitiated after interruption, when compared with those not reinitiated.

Background To report the prevalence of peri-implant diseases in a North African patient population, and to assess the concurrent associations of patient- and implant-level characteristics with probing depth and bone loss around dental implants METHODS: A total of 642 implants in 145 subjects were followed up for a mean 6.4 years. At the last follow-up visit the subjects were examined clinically and radiographically to assess the status of peri-implant tissues and teeth. Data analysis used the generalized linear mixed models RESULTS: The prevalence of peri-implant mucositis and peri-implantitis were 82.1% and 41.4% at the subject level, and 68.4% and 22.7% at the implant level, respectively. Inadequate plaque control, peri-implant inflammation, history of previous implant failures, and pain/discomfort at the implant site were significantly associated with both outcomes (increased probing depth and bone loss). Diabetes mellitus, inadequate implant restoration, single restorations (versus multi-unit), cement-retained restorations, and presence of occlusal wear facets on teeth were significantly associated with one of the two outcomes. Implants placed in the lower anterior jaw region had the most favorable outcome. Smoking, history of periodontitis, and type of implant surface did not show significant associations with higher frequency of peri-implant diseases in the multivariable analysis. Conclusions Peri-implant diseases are prevalent in this North African patient population. Multiple subject- and implant-level variables were associated with peri-implant diseases. Risk assessment of these effects should consist of a concurrent inclusion of these factors in multivariable analyses that also adjust for the complex variance structure of the oral environment.

Aim To assess obesity as a risk factor for tooth loss over 5 years in an urban sample of Brazilian adults. Materials and methods A total of 1586 individuals were surveyed using a multistage probabilistic approach. Five years later, 635 individuals 14-64 years old were re-examined. An incident case of tooth loss was determined for a participant that had lost at least one tooth over time. Obesity was evaluated by calculating body mass index at baseline and by the change in obesity status over time. Results Incident cases of tooth loss were significantly more frequent among obese (47.1%) than normal-weight individuals (32.4%) (p = .004). Obese individuals had 31% higher risk [relative risk (RR) =1.31; 95% confidence interval (95%CI) 1.04-1.65] for tooth loss than normal-weight individuals adjusting for age, socio-economic status, smoking, dental care and periodontitis. This association was significant for females (RR=1.47, 95%CI 1.08-2.01), but not for males. The risk for tooth loss was also modified by presence of periodontitis at baseline and lifetime smoking exposure. There was an increased risk for tooth loss for those that remained obese than those that remained normal weight. Conclusion Obesity is associated with higher risk for tooth loss. This association was modified by sex, periodontal status and smoking.

Aim This study assessed the prevalence, clinical characteristics, and demographics of chronic and aggressive periodontitis in a representative sample drawn from a subpopulation in Morocco. Materials & methods Eight hundred and thirty students representative of 12+ years old attending schools in the Province of Benslimane, Morocco were selected by a multi-phased, probability sampling. Their age was 12-25 years (mean: 16.1 years) and comprised of 50% males and 50% females. Chronic and aggressive periodontitis were determined clinically. Results A total of 31% and 10.1% of the subjects had ≥4 mm and ≥6 mm attachment loss, respectively; 4.9% had aggressive periodontitis, and 6.4% had chronic periodontitis. Subjects with chronic periodontitis typically had 4-5 mm attachment loss affecting a few molars or premolars. Subjects with aggressive periodontitis had ≥5 mm attachment loss affecting multiple teeth, and 68% and 73% of these subjects had ≥6 mm attachment loss affecting maxillary and mandibular molars respectively. Attachment loss and periodontitis were significantly more prevalent in the 19-25 years group, than the 12-18 years age group. There were no significant differences in disease prevalence by gender or ethnic groups (Arab versus Berber). Conclusion This young Moroccan population is at high risk of destructive periodontal disease, and further studies are indicated to investigate the biological and environmental factors that may contribute to the increased risk of disease in this population.

Aim The aim of this study was to assess the effect of overweight and obesity on periodontal attachment loss (PAL) progression in an urban population from south Brazil. Methods In 2001, a population-based oral health survey entitled “Epidemiology of periodontal diseases: the Porto Alegre Study” was conducted by drawing a probabilistic sample of 1586 individuals. After 5 years, 755 (participation rate: 47.6%) individuals were re-examined. For this analysis, self-reported diabetics, underweight individuals, and individuals with

Background: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. Methods: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. Results: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking – now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues – is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues. Conclusion: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.

Periodontal diseases are common and their prevalence varies in different populations. However, prevalence estimates are influenced by the methodology used, including measurement techniques, case definitions, and periodontal examination protocols, as well as differences in oral health status. As a consequence, comparisons between populations are severely hampered and inferences regarding the global variation in prevalence can hardly be drawn. To overcome these limitations, the authors suggest standardized principles for the reporting of the prevalence and severity of periodontal diseases in future epidemiological studies. These principles include the comprehensive reporting of the study design, the recording protocol, and specific subject-related and oral data. Further, a range of periodontal data should be reported in the total population and within specific age groups. Periodontal data include the prevalence and extent of clinical attachment loss (CAL) and probing depth (PD) on site and tooth level according to specific thresholds, mean CAL/PD, the CDC/AAP case definition, and bleeding on probing. Consistent implementation of these standards in future studies will ensure improved reporting quality, permit meaningful comparisons of the prevalence of periodontal diseases across populations, and provide better insights into the determinants of such variation.

The aim of this study is to investigate the impact of alcohol consumption on clinical attachment loss (AL) progression over a period of 5 years.A multistage probability sampling strategy was used to draw a representative sample of the metropolitan area of Porto Alegre, Brazil. Five hundred thirty-two individuals (209 males and 293 females) aged 18 to 65 years at baseline with no medical history of diabetes and at least six teeth were included in this analysis. Full-mouth periodontal examinations with six sites per tooth were conducted at baseline and after 5 years. Alcohol consumption was assessed at baseline by asking participants about the usual number of drinks consumed in a week. Four categories of alcohol consumption were defined: 1) non-drinker; 2) ≤1 glass/week; 3)1 glass/week and ≤1 glass/day; and 4)1 glass/day. Individuals showing at least two teeth with proximal (clinical AL) progression ≥3 mm over 5 years were classified as having disease progression. Multiple Poisson regression models adjusted for age, sex, smoking, socioeconomic status, and body mass index were used to estimate relative risks (RRs) and 95% confidence intervals (CIs).Overall, individuals who consumed1 glass/day had 30% higher risk for clinical AL progression (RR = 1.30; 95% CI: 1.07 to 1.58) than non-drinkers. Among males, risk of clinical AL progression for individuals drinking1 glass/day was 34% higher than non-drinkers (RR = 1.34; 95% CI: 1.09 to 1.64). Never-smoker males drinking ≤1 glass/week had significantly lower risk for clinical AL progression than non-drinkers (RR = 0.52; 95% CI: 0.30 to 0.89), whereas those drinking1 glass/day had significantly higher risk (RR = 1.50; 95% CI: 1.08 to 1.99). Among females, no association between alcohol consumption and clinical AL progression was observed.Alcohol consumption increased the risk of clinical AL progression, and this effect was more pronounced in males. Low dosages (≤1.37 g of alcohol/day) of alcohol consumption may be beneficial to prevent periodontal disease progression in males. The impact of alcohol cessation initiatives on periodontal health should be evaluated.

Background and Objective An association between alcohol consumption and periodontitis has been suggested in the literature, but the evidence is still unclear. The aim of the present study was to investigate the relationship between alcohol consumption and periodontitis in a probability sample of adults from south Brazil. Material and Methods This analysis included 1115 subjects aged 18–65 years derived from a representative sample from south Brazil. Data were collected from participants from clinical examination and structured interviews. Alcohol consumption was assessed by asking participants about the usual number of drinks consumed in a week. Four categories of alcohol consumption were defined: non-drinker, ≤ 1 glass/wk, > 1 glass/wk, ≤ 1 glass/d and > 1 glass/d. Individuals with ≥ 30% teeth with periodontal attachment loss ≥ 5 mm were classified as having periodontitis. Logistic models adjusting for age, race, socioeconomic status, dental care, body mass index, self-reported diabetes and smoking were used to estimate odds ratios (OR) and confidence intervals (95% CI). Results After adjusting for co-factors, females who reported drinking > 1 glass/d were more likely to have periodontitis (OR = 3.8, 95% CI = 1.4–10.1), whereas females who reported drinking up to 1 glass/d were 50% less likely to have periodontitis (OR = 0.5, 95% CI = 0.3–0.8). No significant associations between overall alcohol intake and periodontitis were observed for males. In an exploratory analysis, wine consumption was associated with a lower likelihood of periodontitis among males (OR = 0.2, 95% CI = 0.1–0.5) but not females. Conclusion The periodontal health of males and females appears to be affected differently by alcohol consumption. Moderate wine consumption may have a beneficial effect in males.

A number of systemic disorders increase a patient's susceptibility to destructive periodontitis and have impacts on periodontal disease progression and severity. The underlying factors are usually genetic and are mainly related to alterations in the immune response and in certain endocrine functions, leading to various syndromes in which periodontitis and/or early tooth loss are secondary manifestations. Neutrophils are important immune defense cells that play a significant role in controlling the spread of microbial plaque infections in the dentogingival region. This review focuses on a selected group of systemic disorders that are associated with alterations in either neutrophil counts (quantitative disorders) or function (qualitative disorders), and defects in the mineralization of bone and dental tissues. In most of these diseases controlling the periodontal disease progression is very challenging. Proper diagnosis is a prerequisite for proper management of the periodontal problem. Future advances in research, including gene targeting and the resolution of enzyme deficiencies, may bring about remedies of the underlying systemic disorders and may significantly improve the outcome of periodontal treatment in these patients.

Aggressive periodontitis is a destructive disease characterized by the following: the involvement of multiple teeth with a distinctive pattern of periodontal tissue loss; a high rate of disease progression; an early age of onset; and the absence of systemic diseases. In some patients periodontal tissue loss may commence before puberty, whereas in most patients the age of onset is during or somewhat after the circumpubertal period. Besides infection with specific microorganisms, a host predisposition seems to play a key role in the pathogenesis of aggressive periodontitis, as evidenced by the familial aggregation of the disease. In this article we review the historical background of the diagnostic criteria of aggressive periodontitis, present a contemporary case definition and describe the clinical parameters of the disease. At present, the diagnosis of aggressive periodontitis is achieved using case history, clinical examination and radiographic evaluation. The data gathered using these methods are prone to relatively high measurement errors. Besides, this diagnostic approach measures past disease history and may not reliably measure existing disease activity or accurately predict future tissue loss. A diagnosis is often made years after the onset of the disease, partly because current assessment methods detect established disease more readily and reliably than they detect incipient or initial lesions where the tissue loss is minimal and usually below the detection threshold of present examination methods. Future advancements in understanding the pathogenesis of this disease may contribute to an earlier diagnosis. Insofar, future case definitions may involve the identification of key etiologic and risk factors, combined with high-precision methodologies that enable the early detection of initial lesions. This may significantly enhance the predictive value of these tests and detect cases of aggressive periodontitis before significant tissue loss develops.

Epidemiologic studies of aggressive periodontitis have used different study designs and a range of examination methods and case definitions, and this greatly complicates the study of disease prevalence in populations. The wide range of disease case definitions, in particular, profoundly impacts the reported rate of disease, and the use of a standard disease definition is strongly recommended. Surveys of aggressive periodontitis that use only clinical examinations, without radiographic examination to confirm the presence of a distinctive pattern of tissue loss, may overestimate the prevalence of this disease, particularly when a low threshold of attachment loss is used. The prevalence of aggressive periodontitis varies significantly between populations, and differences in race/ethnicities seem to be a key factor. Studies consistently show that aggressive periodontitis is most prevalent in Africa and in populations of African descent and is least prevalent in Caucasians in Europe and North America. Among children and young adults the prevalence of this disease is higher in older than in younger age groups. Most studies show comparable disease prevalence in male and female subjects. These findings show that aggressive periodontitis is a significant health problem in certain populations. This review also highlights a lack of information on the epidemiology and demographics of this disease in many parts of the world, particularly in Asia and Africa. Epidemiologic studies of aggressive periodontitis in high-risk populations are important and could provide vital data on the determinants of this disease, and this information is needed for the establishment of effective health-promotion measures.

Inflammatory periodontal diseases are highly prevalent, although most of these diseases develop and progress slowly, often unnoticed by the affected individual. However, a subgroup of these diseases include aggressive and acute forms that have a relatively low prevalence but show a rapid-course, high rate of progression leading to severe destruction of the periodontal tissues, or cause systemic symptoms that often require urgent attention from healthcare providers. Aggressive periodontitis is an early-onset, destructive disease that shows a high rate of periodontal progression and distinctive clinical features. A contemporary case definition of this disease is presented. Population studies show that the disease is more prevalent in certain geographic regions and ethnic groups. Aggressive periodontitis is an infectious disease, and recent data show that in affected subjects the subgingival microbiota is composed of a mixed microbial infection, with a wide heterogeneity in the types and proportions of microorganisms recovered. Furthermore, there are significant differences in the microbiota of the disease among different geographic regions and ethnicities. There is also evidence that the Aggregatibacter actinomycetemycomitans-JP2 clone may play an important role in the development of the disease in certain populations. The host response plays an important role in the susceptibility to aggressive periodontitis, where the immune response may be complex and involve multiple mechanisms. Also, genetic factors seem to play an important role in the pathogenesis of this disease, but the mechanisms of increased susceptibility are complex and not yet fully understood. The available data suggest that aggressive periodontitis is caused by mutations either in a few major genes or in multiple small-effect genes, and there is also evidence of gene-gene and gene-environment interaction effects. Diagnostic methods for this disease, based on a specific microbiologic, immunologic or genetic profile, currently do not exist. Genetic markers have the potential to be implemented as screening tools to identify subjects at risk. This approach may significantly enhance treatment outcome through the early detection and treatment of affected subjects, as well as using future approaches based on gene therapy. At present, the treatment of this disease is directed toward elimination of the subgingival bacterial load and other local risk factors. Adjunctive use of appropriate systemic antibiotics is recommended and may contribute to a longer suppression of the microbial infection. Other aggressive forms of periodontal diseases occur in patients who are affected with certain systemic diseases, including the leukocyte adhesion deficiency syndrome, Papillon-Lefevre syndrome, Chediak-Higashi syndrome and Down syndrome. Management of the periodontal component of these diseases is very challenging. Acute gingival and periodontal lesions include a group of disorders that range from nondestructive to destructive forms, and these lesions are usually associated with pain and are a common reason for emergency dental consultations. Some of these lesions may cause a rapid and severe destruction of the periodontal tissues and loss of teeth. Oral infections, particularly acute infections, can spread to extra-oral sites and cause serious medical complications, and even death. Hence, prompt diagnosis and treatment are paramount.

Aim To assess sociodemographic and behavioural risk factors for periodontal attachment loss (PAL) progression after 5 years in an urban sample from south Brazil. Methods At baseline, 1586 subjects, 14 years and older, were derived using a multistage probabilistic sample strategy. At follow-up, 653 of 755 subjects had ≥6 teeth and were included in this analysis. A modified multiple Poisson regression was used to calculate adjusted relative risks (RR) and 95% confidence intervals (CI). Results Overall, 247 (37.8%) subjects exhibited PAL progression ≥3 mm in ≥4 teeth. Subjects older than 30 years had approximately two times higher risk of having PAL progression than younger subjects. Subjects with low education had 53% higher risk (RR = 1.53; 95% CI:1.06–2.22) of PAL progression compared to those with high education. A significant interaction between gender and smoking was observed. Among never-smokers, males were 33% more likely (RR = 1.33; 95% CI:1.06–1.66) to experience PAL progression than females. Among smokers, there was 8% increased risk of PAL progression (RR = 1.08; 95% CI:1.01–1.14) for males and 21% (RR = 1.21; 95% CI:1.11–1.33) for females per 10 packyears. Skin colour, socioeconomy, dental care and diabetes were not significantly associated with PAL progression after statistical adjustment. Conclusion Sociodemographic factors and smoking are independent risk factors for PAL progression in this Brazilian population.

Objectives This review proposes case definitions and diagnostic considerations of systemic disorders and conditions that affect the periodontal attachment apparatus. Importance Periodontal diseases and certain systemic disorders share similar genetic and/or environmental etiological factors, and affected patients may show manifestations of both diseases. Characterizing these diseases and the nature of the association between them could have important diagnostic value and therapeutic implications for patients. Findings Numerous systemic disorders and certain medications can affect the periodontal attachment apparatus and cause loss of periodontal attachment and alveolar bone. Although many of these disorders are rare or uncommon, they often cause significant loss of periodontal tissue by influencing periodontal inflammation or through mechanisms distinct from periodontitis. Most of these disorders are due to innate mechanisms and some are acquired via environmental factors or lifestyle. Several disorders affect periodontal inflammation through alterations in the host immune response to periodontal infection; others cause defects in the gingiva or periodontal connective tissue, instigate metabolic changes in the host that affect various tissues of the periodontal apparatus, or operate by other mechanisms. For some systemic disorders that are more common, their contribution to the loss of periodontal tissue is modest, while for others, contribution is not supported by clear evidence. Few systemic medications are associated with increased loss of periodontal tissue, and these are typically medications used in the treatment of malignancies. Conclusions This review identifies systemic diseases and conditions that can affect the periodontal attachment apparatus and cause loss of periodontal supporting tissues and, where possible, presents case definitions for these. Many of these diseases are associated with a profound loss of periodontal attachment and alveolar bone, and for some of these disorders the periodontal manifestations may be among the first signs of the disease. These case definitions may be useful in the early diagnosis of these diseases and may contribute to an improvement in the management of periodontal manifestations and improve the quality of life for these patients.

Little is known about the factors that may be used in clinical practice to predict the therapeutic response of aggressive periodontitis patients. The aim of this study was to determine predictors of clinical outcomes after non-surgical treatment of aggressive periodontitis. A total of 24 patients (aged 13-26 years) received oral hygiene instructions, as well as subgingival scaling and root planing. Twelve subjects received systemic azithromycin at random. Clinical variables were assessed at baseline, 3, 6, 9, and 12 months. Baseline microbiological assessment was performed by checkerboard DNA-DNA hybridization. Multivariable models used generalized estimating equations. There were significant improvements in the entire sample in regard to pocket depth, clinical attachment level and bleeding on probing. Significant predictors of a reduction in mean pocket depth were: use of azithromycin, non-molar teeth, generalized disease and baseline pocket depth. Absence of plaque predicted a 0.22 mm higher attachment gain, whereas a baseline pocket depth ≥7 mm predicted a 1.36 mm higher attachment loss. Azithromycin, plaque, and baseline pocket depth were significant predictors of bleeding on probing. The concomitant presence of all three red complex species predicted a 0.78 mm higher attachment loss. It may be concluded that dental plaque, tooth type, disease extent, baseline pocket depth, and use of azithromycin were significant predictors of the clinical response to treatment for aggressive periodontitis in young individuals. Moreover, the presence of multiple periodontal pathogens may predict challenges in achieving a favorable outcome for aggressive periodontitis.

Objectives To compare the subgingival microbiological outcomes of azithromycin or placebo as adjuncts to scaling and root planing (SRP) in the treatment of aggressive periodontitis (AgP), and to secondarily evaluate the microbiological effect of supragingival scaling in AgP patients. Methods Twenty-four AgP subjects 13–26 years of age received a 15-day programme of supragingival scaling (SC) and were then randomly assigned to SRP with systemic azithromycin or placebo. Subgingival samples were taken with sterile paper points at baseline, 15 days after SC, and at 3, 6 and 12 months following SRP. Microbiological analysis was performed by the checkerboard DNA–DNA hybridization. Results Changes in bacterial levels from baseline to 15 days after SC were similar in the 2 groups. When subjects were analysed as a single group, significant reductions after SC were observed for Actinomyces gerencseriae , Capnocytophaga ochracea , and Treponema denticola . During the 12-month follow-up, levels of most of the bacteria decreased in both groups in a similar pattern. For instance, Actinomyces israelli , Veillonella parvula , Streptococcus gordonii , C. ochracea , Eikenella corrodens , Eubacterium nodatum , Fusobacterium periodonticum and Fusobacterium nucleatum ssp. polymorphum decreased significantly within the groups. Conclusions Azithromycin was ineffective in lowering the subgingival levels of important putative periodontal pathogens in young AgP subjects compared to placebo. Clinical significance Scaling and root planing with adjunctive systemic azithromycin provides little additional benefit compared to placebo in reductions of major subgingival periodontal pathogens.

doi: 10.1111/j.1741-2358.2011.00617.x Oral health status in elders from South Brazil: a population-based study Objective: To assess the oral health status of community-dwelling adults aged 60 years and older from southern Brazil and to determine demographics, socioeconomic, behavioural and dental risk indicators. Materials and methods: This cross-sectional study used a multistage, probability sampling method to draw a representative sample of the metropolitan area of Porto Alegre, Brazil. A subsample of 217 subjects was included in this analysis. Oral mucosal lesions, dental caries, tooth loss and periodontal status (full-mouth, six sites per tooth exam) were assessed by calibrated examiners. Results: Prevalence of edentulism was 39.5%, and mean tooth loss was 20.2 (SE = 0.6). Older individuals [Odds Ratio (OR) = 2.2], women (OR = 2.3), white people (OR = 5.9), individuals of lower socioeconomic status (OR = 5.6) and smokers (OR = 3.5) had higher likelihood of being edentulous. Approximately 36% of dentate individuals had caries and/or restoration affecting, in average, 5.0 teeth. Periodontitis affected 79% of subjects, and it was associated with older age (OR = 4.0), men (OR = 3.4) and large amounts of supragingival plaque (OR = 3.0). Conclusion: Poor oral health was observed in this elderly population from South Brazil. Sociodemographic disparities accounted for most of the burden of disease and treatment needs.

Aim The aim of this 5-years longitudinal study was to investigate the pattern and rate of periodontal attachment loss (PAL) progression in an urban population in South Brazil. Methods In 2001, a multistage probability sampling strategy was used to derive a representative sample of 1,465 dentate individuals from Porto Alegre, Brazil. Five years later, 697 dentate individuals (294M/403F, mean age: 37.9 ± 13.3) were available for follow-up. PAL was assessed by calibrated examiners using a full-mouth protocol. Estimates of proximal PAL progression and standard errors (SE) are reported. Results Fifty-six per cent (SE: 1.9) and 36% (SE: 1.8) of subjects showed PAL progression ≥3 mm affecting ≥2 and ≥4 teeth respectively. PAL progression ≥3 mm was mostly localized affecting 3.8 (SE: 0.2) teeth and 5.7 (SE: 0.3) sites. Annual PAL progression was, on average, 0.3 mm (SE: 0.01). Significant differences in PAL progression were observed according to age, gender, race and socioeconomic status. PAL progression increased with age reaching the highest progression rate in the 40–49 years cohort, and then decreased in older age groups. PAL progression was consistently higher among males and non-Whites than females and whites. Conclusion A large proportion of this urban Brazilian sample was affected by PAL progression underscoring the need for health promotion initiatives aiming at preventing progression of destructive periodontal disease.

A systematic review was performed to identify randomized, controlled, clinical trials designed to study the efficacy of adjunctive antimicrobial therapy with periodontal treatment of chronic periodontitis in smokers. A search was carried out using the databases PubMed (using MeSH terms and free text), EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Clinical Trials, and a manual search of 4 periodontal journals, bibliographies, review articles, and consensus statements. The databases were searched from their earliest records until December 31, 2009. The inclusion criteria of studies were as follows: (1) randomized, controlled clinical studies of ≥6 months study duration; (2) application of a systemic or local adjunctive antimicrobial agent for the treatment of chronic periodontitis in current smokers; (3) measurement of clinical attachment level, probing depth, and bleeding on probing as primary outcomes; (4) no periodontal treatment or use of systemic antibiotics within 6 months of the start of the trial; and (5) publication in an English-language, peer-reviewed journal.The key intervention was the use of antibiotics as an adjunct to nonsurgical or surgical periodontal treatment of chronic periodontitis in current smokers. There were no limitations on the type of antibiotics used, regimen, or the route of administration.The change in clinical attachment level and probing depth ≥6 months postoperatively following periodontal treatment.Five clinical trials met the inclusion criteria and their findings were used in this systematic review. Nine additional studies were excluded: 8 because smokers were not randomized, and 1 because the follow-up was only 3 months. The age of subjects in the included studies ranged from 42 to 52 years, and the sample size ranged from 30 to 181 subjects. Three studies used nonsurgical periodontal therapy (scaling and root planing) (Table 1). The first study used doxycycline 10% gel delivered locally and reported a gain in attachment level 24 months postoperatively. The second study used minocycline 1-mg microspheres delivered locally and reported a reduction in probing depth 9 months postoperatively. In the third study, the experimental group was administered azithromycin 250 mg systemically, and reported a gain in clinical attachment level and a reduction in probing depth 6 months postoperatively. The fourth study used a pocket reduction surgery and adjunctive use of systemic azithromycin 500 mg, and found no significant reduction in probing depth or gain in attachment level 6 months postoperatively. The fifth study used surgical therapy consisting of guided tissue regeneration (GTR) supplemented with local application of metronidazole 25% gel for the treatment of Class II furcation defects. The latter study reported a statistically significant gain in vertical attachment level but no significant change in horizontal attachment level or probing depth during a 12-month follow-up period. The risk of bias in all studies was estimated as high. The authors of the systematic review stated that the reviewed data were inadequate and inconsistent, and therefore meta-analyses were not performed.There is no sufficient evidence in the literature to support or refute that adjunctive antibiotic therapy would lead to a significant reduction in probing depth or gain in clinical attachment level when treating periodontitis in smokers.

The study design of national surveys of periodontal disease often uses partial-mouth examination protocols to rationalize the need for resources so that the collection of data from a large number of subjects can be achieved within the available means without significantly sacrificing precision and validity. Studies show that surveys that use partial examination protocols underestimate the prevalence of periodontitis, and the amount of underestimation varies depending on the number and type of sites examined, the case-definition of periodontal disease, tooth loss, and prevalence and severity of the disease. If a survey uses a partial-mouth examination it is recommended that the amount of underestimation be assessed in the same sample. This could be achieved by performing a full-mouth examination on a randomly selected subsample. Inflation factors should be calculated and used to adjust for the underestimation in disease prevalence because of the use of partial examination. Based on the NHANES III (1988 to 1994) data and adjusting for the bias caused by the examination protocol, it is estimated that approximately half of the United States population aged ≥30 years has periodontitis.

Elamin A, Albandar JM, Poulsen K, Ali RW, Bakken V. Prevalence ofAggregatibacter actinomycetemcomitansin Sudanese patients with aggressive periodontitis: a case–control study. J Periodont Res 2011; 46: 285–291.©2011 John Wiley & Sons A/S Background and Objective: Aggregatibacter actinomycetemcomitans is considered a possible etiological agent for aggressive periodontitis. The aim of this study was to determine the prevalence of the JP2 clone and non-JP2 genotypes of A. actinomycetemcomitans in the subgingival plaque of patients with aggressive periodontitis and controls among Sudanese high-school students. Material and Methods: In a previous study we examined a large representative sample of students attending high schools in Khartoum, Sudan. In this population, 17 patients with aggressive periodontitis and 17 controls (14–19 years of age) consented to participate in the present study. The subjects underwent a clinical periodontal examination, and subgingival dental plaque samples were collected using paper points. The presence of the A. actinomycetemcomitans JP2 clone and non-JP2 genotypes were assessed using loop-mediated isothermal amplification (LAMP) and the PCR. Results: The JP2 clone of A. actinomycetemcomitans was not detected in the subgingival plaque of either the cases or the controls. Non-JP2 types of A. actinomycetemcomitans were detected in the subgingival plaque of 12 (70.6%) patients with aggressive periodontitis and from only one (5.9%) control subject, showing a significantly higher frequency of detection in cases than in controls (p = 0.0001). The odds ratio for the detection of A. actinomycetemcomitans in the subgingival plaque of the patients with aggressive periodontitis was 38.4 (95% confidence interval: 4.0–373.0; p = 0.002). The PCR and LAMP methods showed identical results pertaining to the identification of non-JP2 types of A. actinomycetemcomitans. Conclusions: The JP2 clone of A. actinomycetemcomitans was not detected in the subgingival plaque of high school subjects in Sudan. The detection of non-JP2 types of A. actinomycetemcomitans may be a useful marker of increased risk for development of aggressive periodontitis in young subjects.

Susin C, Haas AN, Valle PM, Oppermann RV, Albandar JM. Prevalence and risk indicators for chronic periodontitis in adolescents and young adults in South Brazil. J Clin Periodontol 2011; 38: 326–333. doi: 10.1111/j.1600-051X.2011.01699.x. Abstract Aim: To describe the distribution of clinical attachment loss (CAL) and to study risk indicators for chronic periodontitis in a large population-based sample of adolescents and young adults from south Brazil. Material and methods: This cross-sectional study used a subset of data from a larger survey representative of Porto Alegre, Brazil. The sample consisted of 612 individuals (291 males/321 females) aged 14–29 years. Full-mouth, six sites per tooth clinical examinations were performed by calibrated periodontists. Chronic periodontitis was defined as CAL 3 mm affecting two or more teeth. Aggressive periodontitis cases were excluded from the analysis. Results: CAL 3 and 5 mm affected 50.4% and 17.4% of subjects and 9.7% and 1.1% of teeth, respectively. Prevalence of chronic periodontitis ranged between 18.2% and 72.0% among subjects 14–19 and 24–29 years old, respectively. In the multivariable logistic regression analysis, older age [odds ratio (OR)=2.6, 95% confidence interval (CI)=1.7–3.9 and OR=7.2, 95% CI=3.7–14.0 for 20–24 and 25–29 years old, respectively], low socioeconomic status (OR=1.9, 95% CI=1.4–2.7), heavy smoking (OR=1.7, 95% CI=1.1–2.7) and larger amounts of calculus (OR=2.0, 95% CI=1.2–3.2) were significantly associated with chronic periodontitis. Conclusion: This population of adolescents and young adults had a high prevalence of chronic periodontitis, and its presence was associated with age, socioeconomic status, smoking and calculus.

Purpose: This 1-year randomized clinical trial compared the bone regeneration and success rates between immediate and conventional loading of dental implants placed immediately after extraction in patients with a past history of periodontal disease. Methods: Sixty patients who chose an immediate implant treatment option to replace a hopeless tooth were included in this study. Patients: Patients were randomly assigned to receive immediate implants with either immediate loading (group A) or conventional loading after 3 months (group B). At baseline, both groups received a mucoperiosteal flap, extraction, implant placement, allograft bone, and a membrane. Group A received a provisional crown. In group B, a cover screw was placed and primary closure was achieved. The patients were evaluated at 3, 6, and 12 months postoperatively. Results: The 1-year implant survival rate was 95% for the whole study group: 96.6% for group A, and 93.3% for group B. The bone level increased significantly in both groups (group A: 0.99 ± 0.22 mm; group B: 0.75 ± 0.17 mm), and the difference was not statistically significant (p > 0.5). At the 1-year postoperative visit, the mucogingival junction (MGJ) was found to be displaced coronally in 65% of implant sites in group B compared with 15% sites in group A. Conclusions: Both the immediate and delayed loading of immediately placed implants showed similar outcome with regards to treatment success rates and stability of radiographic bone level. Submerging an immediately placed implant and primary soft tissue closure did not show significant outcome advantages over the transmucosal approach.

OBJECTIVE: The objective of the study was to assess the prevalence of oral mucosal lesions (OML) and to perform a multivariable risk assessment of demographic, socioeconomic, behavioral, and oral risk indicators for its occurrence in an urban population in South Brazil. METHODS: This cross-sectional study selected 1586 subjects (719M⁄867F, age: 14‐104 years) using a multistage probability sampling strategy (65.1% response rate). Prevalence, odds ratios (OR), and confidence intervals (95% CI) were calculated accounting for the survey design. RESULTS: Leukoplakia and lichen planus were observed in 1.01% and 1.02% of subjects, respectively. In the multivariable analysis, these lesions were significantly associated with moderate⁄heavy smoking (OR = 9.0, 95% CI = 2.1‐39.1) and heavy drinking (OR = 2.0, 95% CI = 1.1‐3.7). Candidiasis and proliferative lesions were observed in 14.09% and 3.80% of the subjects, respectively. These lesions were significantly associated with female gender (OR = 2.2, 95% CI = 1.5‐3.2 and OR = 1.7, 95% CI = 1.0‐2.8), older age (OR = 22, 95% CI = 8.0‐60.8 and OR = 8.9, 95% CI = 3.4‐23.7), and low socioeconomic status (OR = 1.9, 95% CI = 1.0‐3.5 and OR = 3.0, 95% CI = 1.2‐7.2). CONCLUSIONS: This population is in need of OML prevention and treatment. Future studies should validate the findings that premalignant lesions are causally related to smoking and alcohol consumption, and that other OML are associated with socioeconomic-demographic disparities in this and similar populations. Oral Diseases (2010) doi: 10.1111/j.1601-0825.2010.01712.x

This study examined the clinical efficacy of enamel matrix derivative (EMD) and bioactive ceramic filler (BCF) in the treatment of intrabony periodontal defects and evaluated factors influencing the treatment outcome.Thirteen chronic periodontitis patients, 41 to 74 years of age, who had two proximal intrabony defects in different jaw quadrants withor =3 mm vertical radiographic bone loss were selected for this study. After initial therapy, the sites in each patient were randomly assigned to EMD or BCF treatment. Clinical attachment level (CAL), probing depth (PD), tooth mobility (TM), gingival recession (GR), bleeding on probing, and dental plaque were recorded at baseline and at 6 and 12 months. At surgery, the intrabony component was characterized by recording the number of bony walls, distance in millimeters from the buccal crest (BC) to the most apical point of the defect, distance from the cemento-enamel junction (CEJ) to the BC, and the mesio-distal width of the defect at the level of the bony crest.BCF treatment resulted in a significant gain in proximal CAL (P = 0.005) and a reduction in proximal PD at 6 months (P0.001), but there was no further improvement from 6 to 12 months. Paired comparisons by time for the EMD group revealed a significant reduction in proximal PD at 12 months (P = 0.001), whereas the gain in proximal CAL approached significance (P = 0.056). Mean GR increased significantly from baseline to 6 months in both groups (P = 0.001). Regression analysis revealed that within the EMD group, smoking and TM negatively influenced the gain of attachment, whereas within the BCF group, gingival recession increased with age, increasing CEJ to BC distance, and increasing mesial-distal width of the defect.The gain in proximal attachment after treating intrabony defects by flap surgery with BCF was significant (P = 0.004) and twice that following treatment with EMD (P = 0.056). Patient and site variables affected the clinical outcome differently.

Objectives: The study aim was to assess bias magnitudes of periodontal disease severity estimates for specific partial recording protocols (PRPs) in epidemiological studies. Material and Methods: Estimates of mean clinical attachment loss (MCAL) and mean probing pocket depth (MPPD) were derived for 20 different PRPs using full-mouth periodontal data from 1437 dentate Brazilian subjects 14–103 years old having at least four teeth. Biases, relative biases and intra-class correlations for all PRPs were evaluated. Graphical methods were used to assess how well the PRP-based estimates agreed with full-mouth scores across levels of disease. Results: Slightly higher levels of disease were evidenced on lingual than on buccal sites. Seven multi-site PRPs and the Ramfjord PRP produced small biases in MPPD (−0.17 to 0.04 mm) and MCAL with relative biases under 8% and 4% in absolute value for MPPD and MCAL, respectively. Biases for full- and random half-mouth-based PRPs were similar. The three-site random half-mouth MB–B–DL and the Ramfjord PRPs produced the smallest biases, with relative biases

Bioactive ceramic fillers are synthetic materials for medical use with the potential to enhance bone formation. The purpose of this study was to evaluate the clinical effectiveness of a bioactive ceramic filler in the treatment of teeth with poor prognosis because of deep osseous defects and increased tooth mobility.Nineteen patients, 35 to 75 years of age, who presented with one proximal intrabony periodontal defect with vertical radiographic bone lossor=3 mm were included. After initial therapy, defects were assigned randomly to a test (12 defects) or control (seven defects) procedure. Following flap reflection and root planing, test defects were filled with a bioactive ceramic filler. Mucoperiosteal flaps were replaced and sutured, and a periodontal dressing was applied. All patients received postoperative analgesics, rinsed twice daily with chlorhexidine, and were seen 2 weeks postoperatively for suture removal. Postoperative deplaquing and reinstruction in home care were performed at weekly intervals during the first month, and at 3, 6, and 12 months. At baseline and at 6 and 12 months, dental plaque, bleeding on probing (BOP), probing depth (PD), and probing attachment level (PAL) were assessed, and standardized radiographs were taken.The test and control groups showed similar periodontal status at baseline, with no significant differences in clinical or radiographic parameters. Plaque and BOP showed a non-significant deterioration over time. PD was reduced significantly in experimental and control sites following treatment (P0.001), but there was no significant between-group difference (P = 0.793). For PAL and radiographic bone levels, no overall within- or between-group differences were detected.The use of bioactive ceramic filler in combination with open debridement provided no significant beneficial effect over open debridement alone in the treatment of teeth with deep intraosseous defects, severe bone loss, and hypermobility.

Statins are medications administered orally and are widely used for lowering the blood cholesterol level. The aim of this study was to investigate the effects of orally administered statins on microorganisms infecting oral and perioral tissues. We performed a systematic review of published studies of the in vitro antimicrobial effects of statins on bacteria, viruses, and fungi, and searched PubMed, Web of Science, Cochrane Central, and Google scholar. Studies show that most statins exhibit antimicrobial effects against various oral microorganisms. Simvastatin is most effective against the periodontal pathogens Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, and against most dental plaque bacteria, including Streptococcus mutans. Statins also exhibit antiviral properties against human cytomegalovirus, hepatitis B virus, and hepatitis C virus, and have antifungal properties against Candida albicans, Aspergillus fumigatus, and Zygomycetes spp. There were notable differences in the minimum inhibitory concentrations (MICs) between different studies, which may be attributed to differences in study design. Further studies are warranted to ascertain if statins can be solubilized so that patients, who have been prescribed statins for cardiovascular diseases, can use the medication as a swish and swallow, giving patients the added benefit of the antimicrobial action topically in the mouth against infectious oral diseases.

Unsuccessful anesthesia of the inferior alveolar nerve (IAN) may be due to supplementary innervations of mandibular molars from other branches, namely the cervical plexus (CP). The purpose of this prospective, randomized, doubleblind, controlled trial was to determine the effectiveness of an intraoral cervical plexus anesthetic technique (ICPAT) in mandibular molars with symptomatic irreversible pulpitis (SIR) when the IAN and lingual nerve (LN) blocks failed, and to provide a description of the technique. Forty patients diagnosed with SIR received IAN and LN block anesthesia prior to treatment. After clinical signs of anesthesia, patients were subjected to an electrical pulp test (EPT) at 2-min cycles for 10 min post-injection. The anesthesia was considered unsuccessful if there was a positive EPT response ten minutes following profound lip numbness. The experimental group (n 5 20) were administered 2% Lidocaine with 1:100,000 epinephrine using the ICPAT. The control group (n 5 20) were administered 0.9% sterile saline using the ICPAT. Success was defined as no response on two consecutive readings from an EPT. In the experimental group, 60% of subjects showed successful anesthesia, whereas none of the subjects in the control group had successful anesthesia. A multiple logistic regression analysis showed that the anesthesia success rate using the ICPAT method was significantly higher (P < 0.05) than in the control group, irrespective of molar tooth type. The ICPAT method may be useful as a supplementary anesthetic technique for mandibular molars with SIR in subjects whom the IAN and LN blocks do not provide adequate anesthesia. Clin. Anat. 00:000–000, 2015. V C

There is scarce information on antibiotics prescription habits among dentists in general. The present investigation was undertaken to study some patterns of antibiotics prescription among Norwegian dentists. A total of 459 dentists (approximately 10% of Norwegian dentists) were randomly selected, and to each was mailed a letter describing the survey, accompanied by a questionnaire about age, type of practice, educational background and pattern of prescription of antibiotics. 78% of the dentists responded to these questions. The results indicate that during a typical week, 32% did not prescribe antibiotics, whereas 5% wrote greater than 5 prescriptions. The mean weekly number of prescriptions per dentist was 2.04. Periodontists and oral surgeons prescribed antibiotics significantly more often than did general practitioners and other disciplines. In addition, those with research and/or teaching experience seemed to prescribe significantly more often than those without. More than 1/3 of the sample indicated that they may prescribe antibiotics when treating periodontal diseases. Compared with other disciplines, periodontists prescribed such drugs significantly more often when treating periodontitis, but significantly less often in acute gingivitis, stomatitis and herpes simplex infections. Moreover, 22% of the dentists might prescribe antibiotics when the patient is in pain, 73 and 38% in cases of abscesses with or without generalized malaise, 2.5% in endodontic therapy, 60% to prevent general complications, and 68% for prophylactic use if the patient revealed a history of endocarditis. Norwegian dentists are somewhat restrictive in their prescription of antibiotics, but they mostly prescribe the correct drugs for the different conditions.

Developed and developing countries are facing an obesity epidemic with various health consequences. Few studies have addressed the relationship between obesity and periodontal health. The present study assessed the association of overweight and obesity with periodontitis in Brazilian adults.A representative probability sample comprising 706 subjects aged 30 to 65 years from south Brazil was examined clinically and using a structured interview. Overweight and obesity were assessed by body mass index (BMI) using the World Health Organization (WHO) criteria. Individuals withor =30% teeth with attachment lossor =5 mm were classified as having periodontitis. Statistical analysis accounted for survey design, and separate analyses were performed for non-smokers.In this population, 60% and 65% of males and females, respectively, were overweight or obese. Periodontitis was observed in 50.7% and 35.3% of males and females, respectively. The percentage of males with periodontitis was similar in the overweight/obese individuals compared to those with normal weight. In females, there was a positive correlation between the BMI index and the occurrence of periodontitis, with a significantly (P0.05) higher prevalence of periodontitis in obese than in normal weight females. The multivariable analysis showed that obese females were significantly more likely (odds ratio = 2.1) to have periodontitis than normal weight females. A separate analysis for non-smokers showed that obese females were approximately 3.4 times more likely to have periodontitis than the normal BMI group. There were no significant differences in the prevalence of periodontitis between BMI groups among smokers of both genders and in male non-smokers.Obesity was significantly associated with periodontitis in adult, non-smoker women. Overweight was not significantly associated with periodontitis. Smoking may attenuate the association of periodontitis with obesity.

Objectives: The role of space provision as an independent prognostic factor for periodontal regeneration remains to be established. The objective of this study was to evaluate the role of space provision on alveolar bone regeneration in periodontal sites. Methods: Critical size, supra-alveolar, periodontal defects were created in 11 young adult Beagle dogs. Six animals received a porous ePTFE device to provide for space provision. Five animals received sham surgery. The animals were euthanized at 8 weeks post-surgery. A histometric analysis assessed vertical regeneration of alveolar bone and the width of the alveolar crest at the base of the defect. Because of the correlation of within-dog measurements, a mixed model anova/ancova was used to analyse the data. Results: A significant relationship between the width of the alveolar crest at the base of the defect and bone regeneration was observed with no significant difference between sites receiving the different treatments (p=0.84). Bone regeneration at sites treated with the space-providing device was significantly greater compared with that at sites treated with sham surgery (p=0.0003), and the difference remained significant after adjusting for bone width (p=0.0001). Conclusions: Space provision has a significant effect on alveolar bone regeneration in periodontal sites. The width of the alveolar bone appears to influence space provision effectively supporting bone regeneration.

Periodontal diseases are chronic inflammatory disorders encompassing destructive and nondestructive diseases of the periodontal supporting tissues of teeth. Gingivitis is a nondestructive disease ubiquitous in populations of children and adults globally. Aggressive periodontitis is characterized by severe and rapid loss of periodontal attachment often commencing at or after the circumpubertal age and is more prevalent among Latin Americans and subjects of African descent, and least common among Caucasians. Chronic periodontitis is a common disease and may occur in most age groups, but is most prevalent among adults and seniors world-wide. Approximately 48% of United States adults have chronic periodontitis, and similar or higher rates have been reported in other populations. Moderate and advanced periodontitis is more prevalent among the older age groups, and rates of 70% or more have been reported in certain populations. Chronic and aggressive periodontitis are multifactorial diseases caused primarily by dental plaque microorganisms, and with important modifying effects from other local and systemic factors. The study of the significance of demographic, environmental, and biologic variables is important for risk assessment and the control of periodontal diseases.

Background: Traditionally, the mean value from histometric assessments of several histologic sections from the same site has been, used for the histometric characterization of the site. The histometric analysis of the supraalveolar periodontal defect model uses observations from buccal and lingual sites in three stepserial sections representing the central aspect of the mesial and distal root for the third and fourth mandibular premolar teeth. The objectives of this study were to investigate the correlations and determine whether there are significant differences in the measurement values of various histometric parameters between the three step-serial sections and to test the hypothesis that, in this animal model, histometric assessments using the most central section of each root are comparable to the mathematical means of corresponding assessments of the site using the three step-serial sections. Methods: Histometric analysis using light microscopy, an attached digital camera system, and a personal computer-based image analysis system including a custom program for the supraalveolar periodontal defect model was performed on histologic sections acquired from one jaw quadrant in each of 12 dogs. The animals had received a protocol including placement of a coral biomaterial and guided tissue regeneration (GTR) membranes, and were evaluated following a 4-week healing interval. Twelve parameters were assessed using three central step-serial sections from each root. For each parameter, pair-wise comparisons were performed using the mixed models analysis of variance, and the correlations between measurements were assessed by the intraclass correlation coefficient (ICC). Results: For all parameters assessed, there were no significant differences (P >0.05) among the three sections. The differences between the central section and the means of the three step-serial sections were small and not statistically significant. Parameters that could be assessed on most or all specimens, such as defect height and area, membrane height, and bone regeneration area, showed high correlations among the three step-serial sections (intraclass coefficient [ICC] ∼ 0.91 to 0.98), and between each of the three sections and the mean for the three step-serial sections (ICC ≥0.95). The most central section had somewhat higher correlation with the mean than measurements made on the lateral sections. Conclusion: The results suggest that using the supraalveolar periodontal defect model representative histometric data can be obtained evaluating only the central section from each defect site. J Periodontol 2004;75:1688-1693.

Original Article Cobb CM, Carrara A, El-Annan E, Youngblood LA, Becker BE, Becker W, et al. Periodontal referral patterns, 1980 versus 2000: a preliminary study. J Periodontol 2003;74(10):1470-4. Level of Evidence 3 Purpose To compare trends in referral patterns of periodontal patients between 1980 and 2000 Source of Funding Information not available Type of Study/Design Time cohort, retrospective

Objectives: There is a limited understanding of the role of resident bone in periodontal regeneration. The objective of this study was to evaluate the influence of the resident alveolar bone on bone regeneration in conjunction with guided tissue regeneration (GTR) in the presence or the absence of cell occlusivity. Methods: Critical-size, 6-mm, supra-alveolar periodontal defects were created in six young adult Beagle dogs. Space-providing, occlusive or porous expanded polytetrafluaroethylene devices were implanted to provide for GTR. Treatments were alternated between left and right jaw quadrants in subsequent animals. The gingival flaps were advanced for primary intention healing. The animals were euthanized at week 8 postsurgery. The histometric analysis assessed regeneration of alveolar bone relative to space-provision by the GTR device and width of the alveolar crest at the base of the defect. Results: There were no significant differences in mean alveolar regeneration between sites receiving the porous GTR device with a narrow versus a wide alveolar ridge after adjusting for wound area (2.22 versus 2.50 mm, respectively; p=0.36). In contrast, analysis using sites receiving the occlusive GTR device revealed significantly greater bone regeneration at sites with a wide compared with a narrow alveolar ridge (3.34 versus 2.53 mm, respectively; p=0.02). Regression analysis showed a significant relationship (p0.05) between space-provision and bone regeneration for all groups except for sites with a wide alveolar ridge receiving the occlusive GTR device (p=0.5). Conclusions: The resident alveolar bone may significantly influence the magnitude of alveolar bone regeneration. The relative presence of cells from the gingival connective tissue may attenuate this effect.

BACKGROUND: Several oral implant design advances have been suggested to overcome poor bone quality, an impediment for successful implant treatment. A novel titanium porous oxide (TPO) surface has been shown to offer favorable results in several settings. The objective of this study was to evaluate the local bone formation and osseointegration at TPO-modified implants in type IV bone. METHOD: Three TPO surface-modified implants (TiUnite) were installed into the edentulated posterior maxilla in each of 8 Cynomolgus monkeys. The animals were injected with fluorescent bone labels at 2, 3, 4 and 16 weeks post-surgery and were euthanized at week 16 when block biopsies were collected for histologic analysis. RESULTS: The predominant observation of the TPO implant surface was a thin layer of new bone covering most of the implant threads. Mean (+/-SE) bone-implant contact for the whole study group was 74.1 +/- 4.8%. There was a significant variability in bone-implant contact between animals (P = 0.0003) and between sites of the same animal (P < 0.0001). The variance in bone-implant contact was 30% larger among sites of the same animal than between different animals (187.5 vs. 144.8, respectively). There was a small but significant difference in bone density immediately outside, compared to within the threaded area of the implants (37.1 +/- 3.2% vs. 32.1 +/- 3.2%, P < 0.0001). Bone density outside the implant threads was significantly correlated (beta = 0.682, P < 0.0001) with the bone density within the threaded area. Bone density within the threaded area was significantly correlated (beta = 0.493, P = 0.0002) with bone-implant contact, whereas bone density outside the implant threads did not have a significant effect (beta = 0.232, P = 0.1). CONCLUSIONS: The results suggest that the TPO surface possesses a considerable osteoconductive potential promoting a high level of implant osseointegration in type IV bone in the posterior maxilla.