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Children in the London Boroughs of Kensington, Chelsea and Westminster have one of the highest levels of caries in England and Wales. In 1997/98, the mean dmft for 5-year-old children was 2.83 with only 45.9% of the children being caries free. The aim of this study was to determine whether teacher-supervised toothbrushing, once a day, at school, during term time, with commercial toothpaste containing 1,450 ppm fluoride, could reduce dental caries in primary school children when compared with children from the same community who did not receive this intervention. A total of 517 children (mean age 5.63 years) were recruited for the study. Class teachers were trained individually by the same dental hygienist in an appropriate toothbrushing technique for young children. Children in the intervention group brushed once a day at school. All examinations were by visual assessment only. All teeth present were assessed using the BASCD criteria. For children in the intervention group, the overall caries increment (2.60) was significantly less (10.9%; p < 0.001) than for children in the non-intervention group (2.92). Among different tooth surfaces, the difference in caries increment between the intervention group (0.78) and the non-intervention group (1.03) was greatest for the proximal surfaces (21.4%; p < 0.01). In conclusion, this study suggests that a programme of daily teacher-supervised toothbrushing with fluoride toothpaste can be effectively targeted into socially deprived communities and a significant reduction in dental caries can thereby be achieved especially among caries-susceptible children. [ABSTRACT FROM AUTHOR]

Previous in vitro permeability and scanning electron microscopic (SEM) studies have demonstrated the effectiveness of the oxalate ion in dentine permeability reduction and effective tubule occlusion. The aim of this randomized double-blind, split mouth 4-week clinical study, therefore was to determine whether a 1-min application of ferric oxalate (Sensodyne Sealant) on exposed root dentine was effective in reducing dentine hypersensitivity (DH). Thirteen subjects [8F:5M, mean age 46.2 (s.d. 4.15) years] completed the study. The subjective response was evaluated by tactile, thermal and evaporative methods of assessment. Data were collected at baseline and post-application at +5 min and 4 weeks. Analysis was based on paired t-test (P=0.05) and Wilcoxon-Mann-Whitney tests. No statistically significant differences were noted between ferric oxalate and placebo preparations at +5 min and 4 weeks for any of the test stimuli. There was, however, a clear trend towards immediate reduction (+5 min) in DH reverting back to baseline values at 4 weeks with the exception of the Biomat Thermal Probe mean values, which maintained the reductions in DH compared with placebo. The results of the present study demonstrated that a 1-min application of ferric oxalate is both rapid and effective in reducing DH although its long-term effectiveness still needs to be determined. [ABSTRACT FROM AUTHOR]

As many diseases have been shown to have several or indirect causes (i.e. are multifactorial) the question is what is the relative importance of each factor in a given disease? Also, what happens when some diseases, although apparently disparate, share causative factors and/or tissue pathologies? Host inflammation response mechanisms are largely shared by the body's different tissues and systems and only recently has special attention been paid to the possible linkages among chronic periodontitis and other chronic systemic diseases. The aim of this review was to consider and discuss the mounting evidence that the basis for the inter-relationships between chronic periodontitis and atheromatous disease and diabetes lie at a fundamental intracellular level, namely oxidative stress and mitochondrial dysfunction, as a meeting background among such chronic diseases and periodontitis., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Aims: In periodontitis it has been found that some perturbation exists in lipid biomarkers, such as increased serum total cholesterol and low-density lipoprotein cholesterol. Nevertheless, the relationship between fatty acids and periodontitis has been demonstrated only in a few studies and remains controversial. The aim of this investigation was to explore the effects of periodontitis on a cluster of traditional and novel cardiovascular risk factors such as plasma-lipids profile, types of plasma fatty acids, adhesion molecules and systemic inflammatory markers., Methods and Results: At a university dental school, 56 patients all over 35 years old were enrolled and invited to participate in the study. Total plasma fatty acids, saturated, n-6 polyunsaturated and monounsaturated fatty acids, peroxidability index, soluble VCAM, TNF-alpha, cholesterol, triacylglycerols, and VLDL-c were significantly higher in the periodontitis group compared to the non-periodontitis group., Conclusions: This close association found between plasma triacylglycerols, LDL-c, saturated fatty acids, polyunsaturated fatty acids, total amount of fatty acids and coenzyme Q(10) with some periodontal data such as periodontal probing depth, recession of the gingival margin and clinical attachment level (Pearson correlation between 0.3 and 0.6), leads to the conclusion that there is an inter-relationship between periodontitis, plasma fatty acids profile and the increase in metabolic risk factors for cardiovascular diseases., (Copyright 2009 Elsevier B.V. All rights reserved.)

A review of pathological mechanisms that can explain the relationship between periodontitis and cardiovascular disease (CVD) is necessary to improve the management of both conditions. Metabolic syndrome is a combination of obesity, hypertension, impaired glucose tolerance or diabetes, hyperinsulinemia, and dyslipidemia. All these have been examined in recent years in terms of their relationship to periodontitis. Reviewed data indicate an association between some of them (body mass index, high-density lipoprotein-cholesterol [HDL-C], triglycerides, high blood pressure, among others) and periodontitis. Oxidative stress may act as a potential common link to explain relationships between each component of metabolic syndrome and periodontitis. Both conditions show increased serum levels of products derived from oxidative damage, with a pro-inflammatory state likely influencing each other bidirectionally. Adipocytokines might modulate the oxidant/anti-oxidant balance in this relationship.

It has been stated that cyclosporin and nifedipine produce gingival overgrowth. However, the specific pathogenic mechanism remains uncertain. We used an experimental rat model to test the hypothesis that changes in collagen metabolism and numbers of gingival blood vessels are not mediated by intracellular calcium concentration (ratiometric Fura-2 AM measurement) in gingival fibroblasts. In the cyclosporin group, both width (364.2 +/- 67.5 mum) and microvessel density (number of vessels/mm(2), stained with anti-CD34 antibody) (41.6 +/- 5.1) of gingiva were statistically different when compared with those in the control group (width = 184.3 +/- 35.2 mum, microvessel density = 19.6 +/- 2.4). The nifedipine group showed the highest content of collagen (proportion of total stroma occupied by collagen, stained with Picro-Mallory) (nifedipine group = 66.3 +/- 9.4, cyclosporin group = 55.2 +/- 7.9, control group = 30.1 +/- 10.2). Freshly cultured fibroblasts from the cyclosporin group exhibited higher ratiometric values of fluorescence than did both the control and nifedipine groups (p = 0.03). Our results support the hypothesis that changes in gingival collagen metabolism are not mediated by calcium intracellular oscillations.

Capnocytophaga spp. have been implicated as putative periodontal pathogens associated with various periodontal diseases. Although the genus is known to contain five human oral isolates, accurate identification to species level of these organisms recovered from subgingival plaque has been hampered by the lack of a reliable method. Hence, most studies to date have reported these isolates as Capnocytophaga spp. Previous attempts at identification were based on biochemical tests; however, the results were inconclusive. Considering the differing virulence features of the respective isolates, it is crucial to identify these isolates to species level. The universal and conservative nature of the 16S rRNA gene has provided an accurate method for bacterial identification. The aim of this study was to identify Capnocytophaga spp. via restriction enzyme analysis of this gene (16S rRNA PCR-restriction fragment length polymorphism). The results (backed up by 16S rRNA gene sequencing) showed that this method reliably identifies all named Capnocytophaga spp. to species level.

Background: The subgingival microflora in patients presenting concurrently with periodontitis and diabetes mellitus (DM) are poorly understood. While traditional putative periodontal pathogens are implicated, research involving other oral organisms; e.g., Capnocytophaga spp., is lacking. These organisms produce a range of bacterial enzymes relevant to periodontal breakdown. It is inferred that periodontal bacteria acquire systemic access through the ulcerated periodontal pocket surface; conclusive evidence supporting this notion is limited. The aims of this investigation were to: 1) quantify and identify Capnocytophaga spp. present in healthy and diseased sites in periodontitis patients with and without DM, and 2) isolate periodontal pathogens from these patients' blood., Methods: Twenty-one DM-periodontitis and 25 periodontitis patients were recruited. Subgingival plaque was collected from three healthy and three diseased sites per subject. Capnocytophaga spp. and total (facultative and obligate) anaerobic counts from each site were estimated. Capnocytophaga spp. were identified using 16S rRNA polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP). Statistical analyses were performed using multilevel modeling. Blood samples were subjected to HbA(1c) estimation and bacterial culture., Results: A total of 848 Capnocytophaga spp. were isolated and identified. Significantly higher numbers of Capnocytophaga spp. (P <0.001) and anaerobes (P <0.001) were present in diseased sites in DM-periodontitis subjects compared to healthy sites in non-DM-periodontitis and DM-periodontitis subjects. C. ochracea (and variant) and C. granulosa were the most prevalent species. Blood samples were negative for Capnocytophaga spp., Conclusions: Total mean counts for Capnocytophaga spp. were significantly higher in DM-periodontitis subjects versus non-DM-periodontitis (P = 0.025) and at diseased sites versus healthy sites (P <0.001). Analysis of individual species revealed that the outcome varied with site status and DM status.

Objective: The aims of this study were to establish how many dental hygienists were licensed to practice in Canada, Japan, USA and the 18 member states of the European Economic Area (EEA) and to compare these with the populations and numbers of dentists practising in the countries concerned., Method: Data for the overall populations, numbers of 'active' dentists, of dental hygienists and of employed dental hygienists in the member states of the EEA in 1998 were taken from the responses to a Council of European Chief Dental Officers survey carried out in 2000/2001. Data for these variables for Canada, Japan and the USA in 1998 were accessed from published reports. The ratios of population: active dentist; population: dental hygienist; and active dentist: dental hygienist were calculated and compared., Results: The overall populations and total number of active dentists in the 18 EEA member states and Canada plus Japan plus the USA were broadly similar in 1998 (EEA overall population 381 million with 245169 active dentists: Canada/Japan/USA overall population 421 million with 253825 active dentists). However, there were only 13295 dental hygienists in the EEA as opposed to a total of 215435 in Canada, Japan and the USA. In terms of population:dental hygienist and active dentist: dental hygienist ratios the UK was found to have proportionally far fewer dental hygienists than Canada, Japan, USA or the four Nordic members of the EEA., Conclusion: The survey revealed that relative to overall populations and numbers of dentists, there are far fewer dental hygienists in the EEA than in Canada, Japan and the USA and that scope for the UK to import dental hygienists from other EEA member states is probably very limited.

Keratinocyte growth factor stimulates the growth and activity of epithelial cells via the keratinocyte growth factor receptor. We have recently shown that the growth factor is markedly elevated in cyclosporin A-induced gingival hyperplasia tissue in vivo, but the effects of cyclosporin A on the receptor are not yet known. The present study was therefore carried out to determine whether expression of the keratinocyte growth factor receptor is up-regulated in gingival hyperplasia compared with normal gingiva. Using immunohistochemistry and the reverse-transcribed polymerase chain-reaction, we obtained results which showed that receptor antigen and gene transcript levels were both elevated in gingival hyperplasia tissue. In addition, flow cytometry and the reverse-transcribed polymerase chain-reaction showed that the receptor and mRNA were also higher in gingival epithelial cells following incubation with cyclosporin A in vitro. These findings suggest that the keratinocyte growth factor-receptor pathway of mesenchymal-epithelial interaction could play an important part in the molecular pathogenesis of gingival hyperplasia.

Dentine sensitivity (DS) is a common condition which affects 8-35% of the population. Both In-Office and Over-the-Counter products have been used in treatment, usually occluding open dentine tubules on the exposed root surface. Currently there appears to be no ideal material which permanently occludes dentine tubules. Bioactive and biocompatible glasses are known to induce osteogenesis in physiological systems and may offer suitable materials for surface reactivity which could theoretically occlude tubules. A new dentifrice formulation containing a modified Bioglass material replacing part of the abrasive silica component was compared with original 45S6 bioactive glass. Dentine discs were treated with original Bioglass, three coded dentifrices containing 0, 2.5 and 7.5% Bioglass and two further selected dentifrice products. These specimens were prepared for scanning electron microscopy (SEM) and viewed in a Cambridge stereoscan 90B. The results demonstrated that original bioactive glass particles covered the dentine surface and/or occluded dentine tubules, although this original formulation was easily dislodged. Dentifrice with different ratios of added Bioglass was assessed to provide greater surface coverage and tubule occlusion than without Bioglass. It was concluded that the inclusion of bioactive glass particles in a suitably formulated vehicle may be an effective agent for the treatment of dentine sensitivity.

Glucose quantification in serum or plasma is traditionally based on a colourimetric enzymatic assay using commercially available assay kits. Sample volumes of blood or serum are usually in the range of a few microlitres to a few millilitres. However, for biological fluids such as gingival crevicular fluid (GCF), which can only be sampled in submicrolitre volumes, such assays have proven unsuitable. The aim of this study was to develop a reliable and reproducible assay for quantifying glucose in submicrolitre samples of GCF. The assay involved modification of a commercially available kit for glucose quantification. Test solutions of (i) serum and (ii) serum with added glucose at known concentrations (range 50-400 mg/dl) were prepared to simulate GCF and GCF enriched with glucose, respectively. Submicrolitre volumes (range 0.2 microl to 0.8 microl) of the test solutions were added to the reagent solution (200 microl) using a Hamilton syringe. The reaction was performed under standard conditions of time and temperature. The colour change was assayed spectrophotometrically at 492 nm. The results showed that this microassay is sufficiently sensitive to detect 50 mg/dl glucose in 0.2 microl of sample and indicate that the accuracy and sensitivity of this assay make it suitable for glucose quantification in submicrolitre volumes of GCF, particularly relevant to investigations of the relationship between diabetes mellitus and chronic inflammatory periodontal disease. In vivo evaluation of this novel microassay was performed using GCF samples taken from periodontally healthy and chronic periodontitis patients. Using non-parametric analysis, the results showed that the assay detected statistically significant differences in glucose concentrations between the two patient groups (p < 0.05). Higher glucose levels were detected at the periodontally diseased sites. For each patient, the GCF-glucose: blood-glucose ratio was calculated. The results show that this ratio was higher in the periodontitis group (1: 2) when compared to the healthy group (1: 9). In conclusion, the results of this investigation have shown that this microassay can quantify glucose in GCF and that GCF-glucose levels are higher at periodontitis sites.

The aim of the present investigation was to determine by questionnaire, UK dentists' perception of Dentine Hypersensitivity (DH) and knowledge of its treatment. A total of 403 questionnaires were sent to a selected group of UK dentists who had either inquired about further postgraduate education or had attended a course at the Eastman Dental Institute/Hospital. A total of 181 of 403 dentists (44.9%) (118M; 36F, 17 no response, mean age 38.2 years [s.d. 8.97]) returned the questionnaire. About 92.8% (n=168) of responding dentists claimed to see patients with DH in their practice. According to the dentists' replies at least one of four of their patients suffered from the complaint. About 71.8% (n=130) of dentists reported that DH was a severe problem in at least 10% of their patients and that pain from DH lasted no more than 4 weeks. Most of responding dentists claimed to be asked about DH by their patients and stated that they offered advice or treatment to their patients. Nearly 87.3% (n=158) of responding dentists provided a wide range of treatment options/advice which included both in-office and over-the-counter (OTC) products. Popular responses included desensitizing pastes/gels, Topical F(-) varnishes and toothpastes/rinses/gels, advice on atraumatic tooth brushing, dentine bonding agents (DBA), glass-ionomer cements (GIC) and other unspecified restorations. Of the various in-office treatments Duraphat was the most cited choice of varnish/primer options. Sensodyne toothpaste was the most popular of the specified OTC products. Most dentists appeared to understand the aetiological features associated with DH and provided a wide range of factors including the effects of incorrect tooth brushing, dietary acids as well as the possible influence on non-dental topics such as stress. Most responding dentists believed that their advice on DH was generally effective although they did highlight that certain aspects on the condition were lacking such as appropriate scientific information including the prevention of DH and its treatment. The results from the present study highlight several discrepancies in the perception and knowledge of the treatment of DH between dentists and their patients. The results from this study are, however, reasonably consistent with those previously reported by Dutch investigators. The results from this study also highlighted a need for guidelines on the aetiology, prevention and treatment of DH for both dentists and their patients. The reported average frequency and duration of discomfort from DH by the responding dentists appeared to be consistent with the available literature.

Relatively few studies have reported on the frequency, distribution and severity of dentine hypersensitivity (DH) in subjects recruited for clinical trials of desensitizing agents. Potential subjects (n= 48 M, 81 F, mean age 35.1 years) for inclusion into such a study were screened to determine the extent of the problem. 117 subjects (41 M, 76 F) mean age 24.9 years were clinically examined. Evaluation by questionnaire indicated that the prevalence of DH was proportionately higher in the 20-29.9 years (34.9%), and 30-39.9 years groups (33.3%), respectively. Sensitivity to cold was the main presenting symptom. Tactile (probe) and cold air (dental air syringe) stimuli were used to clinically evaluate DH. Of the teeth eligible for evaluation 1561/3136 (49.8%) responded to either one or both of the test stimuli; 274/3136 (8.7%) responded to tactile only stimulation, 779/3136 (24.8%) to thermal only stimulation and 508/3136 (16.2%) to both tactile and thermal stimulation. Of those teeth responding to the stimuli, 477 (30.6%) were premolars, 437 (28%) incisors, 415 (26.8%) molars and 232 (14.9%) canines. The results agree with those of previously reported studies in that DH is most frequently observed on premolars and that proportionately more teeth are sensitive to evaporative than to tactile stimulation. Furthermore it would appear from the results of the study that tactile is less effective than thermal/evaporative stimulation in the evaluation of DH.

Background/aims: Saliva, a heterogeneous fluid comprising proteins, glycoproteins, electrolytes, small organic molecules and compounds transported from the blood, constantly bathes the teeth and oral mucosa. It acts as a cleansing solution, an ion reservoir, a lubricant and a buffer. In addition to its other host-protective properties, saliva could constitute a first line of defence against free radical-mediated oxidative stress, since the process of mastication and digestion of ingested foods promotes a variety of reactions, including lipid peroxidation. Moreover, during gingival inflammation, gingival crevicular fluid flow increases the change of saliva composition with products from the inflammatory response; this, in turn, could have some rôle in controlling and/or modulating oxidative damages in the oral cavity. This is the reason why the antioxidant capacity of saliva has led to increasing interest, and the development of techniques suitable for saliva antioxidant evaluation., Materials and Methods: Here, we review the current peer-reviewed literature concerning the nature and characteristics of free radicals, reactive oxygen species, oxidants, pro-oxidants and antioxidants in saliva, especially pro-oxidant and antioxidant features, as well as current methods for assessing the antioxidant capacity of saliva., Results and Conclusions: In the last decade, several methods have been developed for assaying the antioxidant activity of saliva, indicating an increasing interest of researchers and clinicians. Unfortunately, systematic studies of saliva are still lacking, even in healthy populations.

Aim: In the present 6-month multicentre trial, the outcome of 2 different approaches to non-surgical treatment of chronic periodontitis, both involving the use of a locally delivered controlled-release doxycycline, was evaluated., Material and Methods: 105 adult patients with moderately advanced chronic periodontitis from 3 centres participated in the trial. Each patient had to present with at least 8 periodontal sites in 2 jaw quadrants with a probing pocket depth (PPD) of > or =5 mm and bleeding following pocket probing (BoP), out of which at least 2 sites had to be > or =7 mm and a further 2 sites > or =6 mm. Following a baseline examination, including assessments of plaque, PPD, clinical attachment level (CAL) and BoP, careful instruction in oral hygiene was given. The patients were then randomly assigned to one of two treatment groups: scaling/root planing (SRP) with local analgesia or debridement (supra- and subgingival ultrasonic instrumentation without analgesia). The "SRP" group received a single episode of full-mouth supra-/subgingival scaling and root planing under local analgesia. In addition, at a 3-month recall visit, a full-mouth supra-/subgingival debridement using ultrasonic instrumentation was provided. This was followed by subgingival application of an 8.5% w/w doxycycline polymer at sites with a remaining PPD of > or =5 mm. The patients of the "debridement" group were initially subjected to a 45-minute full-mouth debridement with the use of an ultrasonic instrument and without administration of local analgesia, and followed by application of doxycycline in sites with a PPD of > or =5 mm. At month 3, sites with a remaining PPD of > or =5 mm were subjected to scaling and root planing. Clinical re-examinations were performed at 3 and 6 months., Results: At 3 months, the proportion of sites showing PPD of < or =4 mm was significantly higher in the "debridement" group than in the "SRP" group (58% versus 50%; p<0.05). The CAL gain at 3 months amounted to 0.8 mm in the "debridement" group and 0.5 mm in the "SRP" group (p=0.064). The proportion of sites demonstrating a clinically significant CAL gain (> or =2 mm) was higher in the "debridement" group than in the "SRP" group (38% versus 30%; p<0.05). At the 6-month examination, no statistically significant differences in PPD or CAL were found between the two treatment groups. BoP was significantly lower for the "debridement" group than for the "SRP" group (p<0.001) both at 3- and 6 months. The mean total treatment time (baseline and 3-month) for the "SRP" patients was 3:11 h, compared to 2:00 h for the patients in the "debridement" group (p<0.001)., Conclusion: The results indicate that simplified subgingival instrumentation combined with local application of doxycycline in deep periodontal sites can be considered as a justified approach for non-surgical treatment of chronic periodontitis.

Background: The oral cavity accommodates one of the most diverse microfloras in the human body. Knowledge of this microflora, and of the periodontal microflora in particular, proves crucial towards an understanding of the bacterial-host interactions which lead to the development of infectious inflammatory periodontal diseases. Capnocytophaga species have been implicated as putative periodontal pathogens. To date, only 3 members of this genus (C. gingivalis, C. ochracea and C. sputigena) have been isolated from subgingival plaque., Aim: This communication reports the isolation of 2 recently-speciated strains, namely C. granulosa and C. haemolytica, from subgingival plaque collected from adult periodontitis patients., Material and Methods: Subgingival plaque was collected from 29 patients with chronic adult periodontitis. Plaque samples were inoculated onto fastidious anaerobe agar and incubated anaerobically for 5 days. Routine identification of clinical isolates was performed by 16S rRNA PCR-RFLP analysis, using Cfo I as restriction enzyme and corroborated by 16S rRNA gene sequencing., Results: 16 of 29 patients (55%) tested positive for either C. granulosa and or C. haemolytica. A total of 70 isolates (63 C. granulosa and 7 C. haemolytica) were cultivated from subgingival plaque. 15 (51%) patients tested positive for C. granulosa, and 3 (10%) patients tested positive for C. haemolytica., Conclusion: This is the 1st report which recounts the presence of C. granulosa and C. haemolytica in subgingival plaque. Further research is required to establish the relative proportions of these species subgingivally in health and disease.

This study evaluated the ability of topically applied amine fluoride (AmF) and AmF-tin fluoride to inhibit the adhesion of Streptococcus sanguis within a parallel plate flow cell system. One of three AmF compounds and two tin fluoride preparations significantly reduced the net bacterial adhesion to conditioned glass over a 1-h period. Tin(IV) fluoride inhibited S. sanguis adhesion to the greatest extent, and this was shown to be dependent on the formation of the conditioning film prior to agent application.

In this study the ultrastructure of human dental calculus was investigated using transmission electron microscopy (TEM). The aim of the study was to observe and clarify the calcification process and the part played by dental plaque in this process. Supragingival calculus from 10 patients was harvested and processed. It was shown that both calculus, and dental plaque within non-mineralised lacunae in calculus, are heterogeneous. Furthermore it was shown that the calculus/dental plaque interface was distinct, although also variable. As calcification occurred apparently independently of dental plaque in some places and when calcification of dental plaque bacteria occurred, it was also varied, it was concluded that supragingival calculus is not simply 'mineralised plaque' but a complex heterogeneous material consisting of numerous phases of mineralisation and non-mineralised areas. The role of dental plaque in the mineralisation process is unclear. However, calculus was not observed arising out of mineralising dental plaque. Mineralising dental calculus and maturing dental plaque are two distinct and different phases occurring simultaneously, albeit with great variability.

Epidemiological data on dentine hypersensitivity (DH) prevalence are limited. Few studies have compared prevalence between populations. The aim of this investigation, therefore, was to compare the perception and prevalence of DH in two distinct non-periodontal practice populations, one U.K. and one Korean. Completed questionnaires from 557 patients (230 males and 327 females, comprising 115 males and 162 females, mean age 41.7 years (s.d.=14.36), U.K. and 115 males and 165 females, mean age 29.7 years (s.d.=11.86), Korean) were collected. Analysis was by frequency distribution and cross-tabulation (Statistical Package for the Social Sciences (SPSS)). DH prevalence was similar and at levels comparable with those reported previously. Prevalence was higher in the third and fourth decades in both populations. Although there were no differences between U.K. or Korean males and U.K. or Korean females, there was a significant difference between gender reporting of DH, with more females complaining of DH than males (standard normal deviation (SND)=4.3, 95% confidence interval (CI)=0.1134-0.2736). DH appeared to be regarded by patients as not severe in most cases, so treatment was not generally sought. Of those who claimed to have sought treatment, a significant number had received restorative treatment. Of those patients, only 23.3% of U.K. and or=7 days in either population. The results indicated that there were no significant differences between U.K.- and Korean-based populations in their perception of DH, with the exception that more females complained of sensitivity than males in both groups. Overall, DH was not considered a major dental problem by most patients in either of the populations.

There have been concerns about the quality of referral letters received by specialist periodontists. This retrospective study aimed to assess the quality of all referral letters received over a nine month period, by a specialist periodontist working in a publicly financed community clinic, and to compare the results with those obtained from a study which assessed referral letters received by the periodontal department of a London teaching hospital during the same period. After the assessors had trained for intra- and inter-examiner reproducibility, the letters were assessed using the Categorisation System for Periodontal Referral Quality (CSPRQ) (Snoad et al., 1999). The year and country of qualification (UK or non-UK), and possession or otherwise of postgraduate qualifications for each of the referring dentists was ascertained from the UK Dentists Register. The results from this study and those from the hospital study were statistically tested using the Chi-squared test. Before the studies commenced the assessors achieved 100% inter-examiner reproducibility when applying the CSPRQ. A total of 114 letters was received, six of which were excluded. Of the remaining 108, 38 were categorised as of an acceptable standard. There were differences in the performance of dentists from different age groups in that 56% of letters from those qualified from 10-20 years, 29% of those from dentists qualified < 10 years and 27% of those qualified > 20 years were of an acceptable standard. The results were broadly similar to those of the hospital study except that there was a statistically significant difference (P< 0.05) between the quality of referrals from dentists qualified between 10 and 20 years and those with non-UK primary qualifications. It was concluded that the overall quality of referral letters assessed in this study was poor and that the CSPRQ provided a highly reproducible technique for assessing the quality of periodontal referral letters.

Background, Aims: Conventional treatment of chronic periodontitis involves mechanical debridement of periodontal pockets. Recently, subgingival antimicrobials have been used adjunctively following such debridement. This 2-centre study compared the clinical effects of subgingival scaling (SRP) with SRP plus subgingival application of 25% metronidazole gel, Elyzol (SRP+gel), in patients with chronic adult periodontitis., Method: Voluntary informed written consent was obtained from 45 subjects at the Eastman (mean age 46, range 34-63) and 43 subjects at RAF Halton (mean age 47, range 34-71) who participated in this blind, randomised split-mouth design study. All had at least 2 sites in each quadrant with probing pocket depth (PPD) > or = 5 mm. PPD, bleeding on probing (BOP), and clinical probing attachment levels (CAL) measured using a stent, were recorded at baseline and at 1, 3, 6 and 9 months post-therapy. After subgingival scaling of all quadrants, 2 quadrants were randomly selected to be treated with metronidazole gel., Results: A paired t-test on baseline values showed no bias between groups. Both treatments effectively reduced the signs of periodontitis. At each follow-up visit, reduction in PPD, CAL and BOP after the combined treatment was greater than for SRP alone. Paired t-tests showed that the improvement in the SRP+gel group was statistically significantly better (p<0.001) than for SRP alone (mean 0.5 +/- 0.6 mm. 95% CI 0.4-0.6 mm.) Similarly, the % of sites which improved to a final pocket depth of < or = 3 mm and the % of sites which improved over the 9 months of the study by as much as > or = 2 mm were greater for SRP+gel than for SRP alone., Conclusions: At the end of the study, the mean reductions for PPD were 1.0 mm (SRP) compared to 1.5 mm (SRP+gel), and for CAL they were 0.4 mm (SRP) compared to 0.8 mm (SRP+gel), with mean difference for CAL between treatments of 0.4 +/- 0.6 mm (95% confidence intervals of 0.3-0.6 mm). The combination therapy of SRP+gel was superior to the conventional treatment of SRP alone, and these differences were maintained for 9 months.

A study was carried out in two villages in a rural area of Andhra Pradesh, India, 150 kilometres south of the state capital, Hyderabad. Ninety-eight women and sixty-two men, age range 15-70 years, were interviewed and examined. Information gathered included socio-economic data, distance travelled outside the village and previous access to health care. Data were recorded on periodontal status using CPITN and full periodontal charting. Comparisons were made between male and female subjects for travel outwith the village, attendance at medical and dental health facilities, tooth cleaning methods and materials and prevalence of periodontal disease. There was a high prevalence of chronic inflammatory periodontal disease in this population, and most of this was untreated. In view of the difficulties in access to health care, it would be prudent to offer good preventive oral health care within the rural community.

Gentle saline extraction releases a heterogeneous mixture of proteins associated with the cell surface of Actinobacillus actinomycetemcomintans, termed the surface protein fraction (SF). Some SF components are biologically active and may modulate cell behaviour in a manner of putative importance in the aetiology of periodontitis. To further characterize this activity, the ability of the SF to induce mitosis and apoptosis in MG63 cells was investigated. Cells were plated at 10(3)-10(4) cells/cm(2) and allowed to attach before culture in the serum-free medium in the presence of 25 microg/ml SF for 2-24 h. The apoptotic and mitotic figures present were counted and the results expressed as an apoptotic or mitotic index. The apoptotic and mitotic compartments were very small, but there was an inverse correlation between mitosis and apoptosis. In control experiments the mitotic was higher than the apoptotic index, whilst in the presence of SF this was reversed. These results were confirmed using in situ end-labelling. SF, therefore, may stimulate apoptotic, but inhibit mitotic, activity in MG63 cells. This raises the possibility that components of SF might induce subtle changes in the balance between apoptosis and mitosis, which, in turn, could contribute to the progression of periodontitis.

Background/aims: The aim of this study was to compare the efficacy of open debridement of class II and III furcations by a new diamond-coated sonic instrument tip (Sonicparo) with a conventional sonic insert (Sonicrecall) and hand instruments (Gracey curettes)., Method: Open debridement was simulated using a manikin head and standardised plastic teeth. The efficacy of debridement was examined by 3 parameters: residual root surface marker, 'tooth' weight loss and time taken for debridement. The teeth used were 1st and 2nd upper and lower molars. Upper left and lower right molars were chosen to represent class II furcation involvements and upper right and lower left molars class III furcation involvements. Each tooth was debrided 4 times with each instrument for both class of furcations., Results: The results of this study showed significantly less residual marker area comparing Sonicparo with Gracey curettes (mean difference 2.52 mm2, p<0.001). However, no significant differences in marker removal were observed between Sonicrecall inserts and the other instruments. Sonicparo inserts also took significantly less time to debride the furcation than Gracey curettes (mean difference 98.3 s, p<0.001) or Sonicrecall instruments (mean difference 74.3 s, p<0.001). However no significant differences were found between instruments concerning weight loss of the plastic teeth., Conclusions: It was concluded from this in-vitro study that the Sonicparo insert was a more efficient instrument for open molar furcation debridement than Sonicrecall and hand instruments (Gracey curettes) when considering both marker removal and debridement time.

Changes in the microflora on oral carcinoma surfaces may lead to both local and systemic infections, which may complicate the morbidity of the patient suffering from oral malignant neoplasms. Thus, anticancer therapy, irradiation, chemotherapy or surgery impairs the defence mechanism of the oral mucosa and is accompanied by proliferation of the mucosal biofilm with overgrowth of yeast and bacteria. This study investigates the inhibition of the biofilm present on the surface of oral squamous cell carcinomas. Biofilm samples were obtained from the central surface (1 cm2) of each lesion in 10 patients (eight male, two female; mean age: 47.6 years; SD +/- 7.6) before any antibiotherapy or tumour treatment. Patients were randomly divided into two groups and were rinsed with Meridol mouthrinse (amine fluoride) or placebo (saline solution) for 7 days. Samples were repeatedly taken from the same site after rinsing. Samples were transported in pre-reduced brain heart infusion broth and cultured within 1 h of removal, using aerobic and anaerobic complete and selective media. Total aerobic and anaerobic counts were determined and isolated bacteria were identified. The median counts of colony forming units (CFU/ml) after rinsing with Meridol were significantly lower for both aerobes and anaerobes than before rinsing with Meridol. (For aerobes before rinsing: 1.35 x 10(6), after rinsing: 7.55 x 10(5); p = 0.025; for anaerobes before rinsing: 1.39 x 10(6), after rinsing: 7.15 x 10(5); p = 0.011. Rinsing with placebo: no significant difference was found. Aerobe median counts before rinsing: 1.17 x 10(6), after rinsing: 1.03 x 10(5), and for anaerobes: before rinsing 1.75 x 10(6), after rinsing: 1.51 x 10(6); p > 0.05 [Wilcoxon test].) It was concluded that 7-days (three times a day) Meridol rinsing significantly reduced the surface biofilm of oral carcinoma compared to rinsing with placebo. Clinical examination indicated no irritation of the mucosa. The mouthrinse was well tolerated by the patients, who commented on a reduction in burning sensation and bad breath. Besides routine oral hygiene, rinsing itself could reduce patient morbidity. The findings of the present study indicate that in addition to any other oral focus, the lesion itself, when ulcerated, should receive direct antimicrobial treatment so as to reduce patient morbidity and enhance quality of life.

Because of their importance in mediating cellular interactions in chronic inflammatory diseases, this study has examined the expression of a number of adhesion molecules in adult (n=11), generalized early onset (n=5) and localized early onset (n=2) forms of periodontitis. In comparison with immunostaining profiles of cryostat sections of healthy gingival tissue (n=7), the beta 1 integrins VLA-1, VLA-2 and VLA-4 were found to be up-regulated in periodontitis, with VLA-6 being markedly elevated. Although only small differences were observed in ICAM-1 and LFA-3 expression in the gingival epithelium, there was particularly notable up-regulation of these adhesion molecules within the inflammatory infiltrates of the diseased tissues. However, there were no statistically significant differences between the serum levels of a soluble form of LFA-3 in periodontitis patients (n=47) compared with healthy control subjects (n=40), although the generalized early onset and adult periodontitis groups exhibited wider ranges of circulating LFA-3. These findings show that there is localized modulation of adhesion molecule expression in the chronic inflammatory periodontal diseases studied, but that the levels of LFA-3 in the circulation nevertheless remain unaffected.

The periodontal ligament (PDL) is considered to contain subpopulations of cells responsible for the development, repair and regeneration of the periodontium. Cell cultures have been used as model systems in order to understand the complex cellular and biochemical events underlying these processes. In order to obtain long-term cultures of these cells that can be cloned and characterized, primary cultures of PDL and gingival cells were infected with an amphotropic retroviral construct encoding a temperature-sensitive SV40 large T antigen (tsT). After selection for drug resistance, the cells expressed the T antigen and proliferated at 34 degrees C for more than 40 passages. However, when the T antigen was inactivated by incubation at 39 degrees C, the cultures became growth-arrested and the granularity of the cells increased, possibly as a result of differentiation. Reverse transcribed-polymerase chain reaction and flow cytometry showed that the tsT-transduced cells expressed a number of soft and hard connective-tissue antigens, including osteocalcin, osteonectin, osteopontin, collagen type I and alkaline phosphatase. Moreover, incubation of the transduced PDL cells at 39 degrees C was found to upregulate the expression of osteocalcin, osteopontin and collagen type I, but downregulate osteonectin. At this temperature, the presence of the dexamethasone downregulated type I collagen, while vitamin D3 had no effect on the expression of any of the antigens examined. Under all culture conditions, antigen expression was far higher in the transduced PDL cells than the gingival cells. The findings thus show that growth of the tsT-transduced PDL and gingival cells is temperature-dependent and that the presence of the T antigen increases their lifespan but does not ablate the expression of certain of their characteristic phenotypic and functional features.

Recent studies have attempted to determine the prevalence of dentine hypersensitivity (DH) in both hospital and general practice. Results indicate that DH prevalence is higher in patients referred for specialist treatment than in general practice. The aim of this study was to determine perception and prevalence of DH in general practice. Completed questionnaires from 277 patients (115 males, 162 females, mean age 41.7 years [SD 14.36]) were collected. Self-reported DH prevalence (52%) was observed between the third and fourth decades, peaking in the third and in good agreement with that previously published (45.2%), and significantly more females complained of DH than males (SND=2.24, 95% CI 0.01734-0.2661). Cold was perceived as the most common cause of DH, in agreement with other studies. Only 12.6% of patients reported periodontal surgery compared to 15.5% previously. Of those who received hygiene therapy (67.9%) only 15.5% reported DH following treatment which mainly did not last >/=5 days. Most patients with DH did not perceive the condition as severe and did not seek treatment (75.1%). Only 23.3% used a desensitizing dentifrice. The results indicated that self-reporting of DH is lower than reported in a dental hospital population and was not perceived as a major dental problem by most patients in a general dental practice population.

Aim: The primary objective was to assess the standard of new-patient referral communications to the Periodontology Department of a teaching hospital and evaluate any differences in referral quality between referrals that used a standardised proforma and conventional letters. Secondary objectives were to evaluate the potential influence on referral performance of age, postgraduate qualifications and country of qualification of the referring practitioners., Design: A retrospective analysis of a randomised sample of all referral letters and proformae received during a nine-month period., Setting: Letters and referral proformae received by the Periodontal Department of the teaching hospital between 1 January and 30 September 1995 were surveyed., Methods: An objective Categorisation System for Periodontal Referral Quality (CSPRQ) was devised and tested for inter- and intra-examiner reproducibility. The referral communications in the random sample were then categorised for quality. The year, country of qualification (UK or non-UK) and possession or otherwise of postgraduate qualifications for each of the referring dentists was ascertained from the Dentists' Register. A Standard Normal Deviants (SND), or Z-test was applied to the resulting data., Outcome Measures: Acceptability or unacceptability of referral letters and proformae, related to the age (assessed by year of qualification), country of qualification and possession or otherwise of postgraduate qualifications., Results: A random sample of 378 referral communications (from a total of 2663) was analysed. Sixty-three of the random sample were referral proformae. The use of the referral proforma was associated with a highly significantly better (P < 0.01) referral performance, than the use of referral letters. There was a trend for referrals from the small numbers of practitioners who were Fellows in Dental Surgery or Masters of Science to be better than those from other practitioners. There was also a trend for use of the referral proforma to enhance the referral performance of practitioners who had been qualified for more than 20 years. Use of the referral proforma highly significantly (P < 0.01) improved the quality of referrals from non-UK qualified practitioners., Conclusions: In this study, the quality of periodontal referrals was associated for the better with the use of a referral proforma.

The purpose of this study was to evaluate the effects of calcitonin administration on bone healing, following titanium implant insertion. Thirty adult New Zealand rabbits received one implant in each femur. Fifteen animals were randomized to provide test (calcitonin) and control (saline solution) groups. The animals were sacrificed 7, 14, 21, 28 and 42 days after the surgical procedure. The analyzed parameters were new endosteal/periosteal bone length, new endosteal/periosteal bone area and total cortical length. Considering treatment, histometric measurements showed significant differences (p < 0.05) favoring the control group considering periosteal bone length and periosteal bone area, the other parameters were statistically similar between control and test groups.

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 > or =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 > or =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 > or =5 mm and > or =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.

Features of natural masticatory function, of physiological attrition, both occlusal and approximal, and of continuing tooth eruption in adult life need to be borne in mind in considering how the chronic inflammatory periodontal diseases and dental caries have become so widespread. Evidence is reviewed showing that teeth continue to erupt in adulthood, that natural masticatory function prevented plaque accumulation at the approximal risk site of onset of both CIPDs and caries, that epithelial attachment to cementum may be physiological, and that periodontal attachment studies must be age-related.

This study evaluated the susceptibility to amine fluorides (AmFs) of planktonic and biofilm cultures of Streptococcus sanguis grown with and without sucrose. Cultures were incubated with AmFs (250 mg of fluoride liter-1) for 1 min. The susceptibility of biofilms was less than that of the planktonic form and was further decreased by growth in the presence of sucrose.

Both local and systemic infections may complicate the morbidity of patients with oral malignant neoplasms, particularly those presenting intraorally. This study investigated the microbial contents of the biofilms present on the surfaces of oral squamous cell carcinomas. Biofilm samples were obtained from the central surface of the lesions in 21 patients (20 male, 1 female) aged 52.8 (+/- 8.2) years, and from contiguous healthy mucosa, before any antibiotic therapy or any tumour treatment. All lesions were keratinising squamous cell carcinomas with surface ulceration. Samples were transported in reduced brain heart infusion (BHI) broth and cultured within 1 h of removal, using aerobic and anaerobic complete and selective media. The median number of anaerobic colony forming units (CFU/ml) at the tumour sites (1.6 x 10(8)) was significantly higher than for the healthy (control) mucosa (3.0 x 10(7); P = 0.0001, Wilcoxon); the same was true for aerobes at the tumour sites (1.51 x 10(8)) relative to the controls (2.8 x 10(7); P = 0.0008, Wilcoxon). The species isolated in increased numbers at tumour sites were Veillonella, Fusobacterium, Prevotella, Porphyromonas, Actinomyces and Clostridium (anaerobes), and Haemophilus, Enterobacteriaceae and Streptococcus spp. (aerobes). Candida albicans was found at eight of the 21 tumour sites, but never at control sites. It was concluded that human oral carcinoma surface biofilms harbour significantly increased numbers of aerobes and anaerobes as compared with the healthy mucosal surface of the same patient. Candida albicans can also be present in these biofilms. These findings must be considered in relation to the known predisposition of such patients to systemic infections, and to the unpleasant complications of oral morbidity due to infected lesions.

The rationale for the adjunctive use of chemical anti-plaque agents depends on many factors in addition to the inherent antimicrobial properties of those agents. What is indicated generally is a basic oral hygiene regimen, as simple as it can be, bearing in mind the practical difficulties of getting people to clean their teeth optimally. Chemical adjuncts in many cases have the potential to simplify plaque control regimens. The mode of delivery may be critical to the success or otherwise of an adjunct. Adjuncts may simplify and accelerate the work of hygienists as well as patients. They may also serve to control plaque in severe forms of infectious inflammatory periodontal disease, as well as providing practical means of plaque control in the handicapped, or in those unable to practice optimal conventional home care oral hygiene. Chemical anti-plaque adjuncts offer a prospect of re-establishing the homeostasis of oral microbial biofilms fully consonant with the aims of modern periodontal medicine.