Proinflammatory factors in saliva as possible markers for periodontal disease

Studies have indicated that host inflammatory proteins, enzymes and indicators of bone metabolism present in saliva differ in different types of periodontal disease. However, the number of markers analyzed was limited and the effect of edentulousness was not examined. We measured the concentration of host inflammatory proteins: C-reactive protein (CRP), C3 and C4 complement components, alpha-2-macroglobulin (alpha-2M) and tumor-necrosis factor (TNF) in unstimulated saliva of 14 periodontally healthy (PH), 9 edentulous persons (EP), 10 patients with chronic periodontitis (CP) and 18 with aggressive periodontitis (AgP). TNF was below the level of detection in all samples except one. Edentulous persons and patients with CP had significantly reduced concentrations of CRP, C3 and alpha-2M. Edentulous persons and AgP patients had lower C4 concentrations. We can conclude that edentulous persons and CP patients have reduced salivary concentrations of host inflammatory proteins. These findings suggest that a reduction in host responsiveness might play a role in the pathogenesis of CP.     

Use of DNA probes in the diagnosis and treatment of periodontitis --a case series

Aggressive periodontitis is characterized by rapid attachment and bone loss with no underlying systemic disease and is associated with specific bacteria like Actinobacillus actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg). In this case series 25 patients were diagnosed with aggressive periodontitis by the aid of DNA probes for Aa and Pg and other periodontal pathogens. The use of DNA probes for the detection of periodontal pathogens may aid in the diagnosis and treatment of aggressive periodontitis. Clinical experience suggests that lowering periodontal pathogens to undetectable levels could improve the long-term stability of periodontal health.     

Lymphocyte subpopulations and the expression of intercellular adhesion molecules in chronic periodontitis

Immunological responses to invading bacteria play a major role in the course of inflammatory periodontal diseases, such as CP. It was suggested that one of the major elements in determining the course of the disease is the expression of cellular adhesion molecules. We therefore investigated the expression of cellular adhesion molecules, ICAM-1 and beta-1 integrins, capillary density and lymphocyte subpopulations in gingival biopsies obtained from 20 patients with CP who responded and 21 patient who failed to respond to initial treatment using immunohistochemical methods. We found no differences between the two groups in capillary density, ICAM-1 and beta-1 integrin expression. Patients who responded to treatment had a lymphocytic inflammatory infiltrate consisting predominantly of T cells, while those who failed to respond had an approximately equal number of T and B cells. Our findings support the role of host immunological mechanisms in determining the outcome of CP and argue against a major role of differential cellular adhesion molecule expression.     

Ten-year evaluation of conservative and surgical treatment of gingival recession. A case series study

In the last years the treatment of non-inflammatory periodontal diseases has greatly changed. Apico-coronal dimension of gingival tissue is not considered to be of utmost importance, but significance of tissue thickness over each tooth is stressed. Purpose of this study was to show results of conservative and surgical treatment of gingival recession. Sample consisted of two groups of subjects, which have been treated in one of stated ways during ten years. The data was obtained on the beginning and after ten years of recall. Both groups showed increased dimension of keratinized gingiva during observed time with decrease of gingival recession, plaque- and gingival index. It is considered that treatment should start with conservative measures with necessary motivation of the patients. If it does not show improvement, one should consider best surgical method available for each patient. Clinical results show success in both groups, meaning that treatment was properly decided on.     

Reasons for extraction of permanent teeth in urban and rural populations of Croatia

The survey aimed to determine the reasons for extraction of permanent teeth by general dental practitioners in urban and rural population of the Senj region, Adriatic coast, Croatia. During a two-year period (1998-9), a total of 2006 teeth were extracted in both regions, in patients aged 15+. The causes were defined as follows: (1) decay or root without a crown (radix relicta), (2) periodontal disease, (3) endodontic or periapical diseases and (4) other reasons--orthodontics/prosthodontics and dental trauma. The statistical Chi-square-test was used to determine the significant difference between the populations and the sexes. Dental caries was the most frequent cause for extraction (over 50%), followed by endodontic and periapical diseases (23%) as the result of untreated caries and at the end periodontal disease (21%). Urban population more often lose teeth due to periodontal disease (22.75%) than rural (18.93%, p < 0.05). Similarly, this is more frequent in the urban male population (25.61%) than the female urban population (20%, p < 0.05). In rural areas, people more often lost teeth as a result of endodontic and periapical disease (25.85%) than in the urban locations (19.07%, p < 0.01) and this is more frequent in women from rural areas (28.37%) than the rural men (22.44%, p < 0.05). Periodontal disease was not the main cause of tooth loss in either the rural or the urban population. Dental caries and its sequel remain the most important challenge for the dental service. It also reveals the inadequacy of dental services. Education of both the population and the general dental practitioners must be conducted in order to improve oral hygiene and to insist on conservative rather than extraction therapy.     

Prevalence of periodontal diseases in Zagreb population, Croatia, 14 years ago and today

The aim of this study was to assess prevalence of periodontal diseases within Zagreb adult population in 2000. The sample comprised of 412 examinees of both sexes and all age groups. World Health Organization (WHO) methodology and Community Periodontal Index (CPI), (1997) were used. The data gained was statistically assorted and compared with the data from previously conducted research in 1986. Results showed relatively high prevalence of periodontal diseases. No healthy periodontium was recorded in the 45-and-above age group. Shallow periodontal pockets was registered in 12% of nineteen-year-olds, whereas this symptom was very evident in 45-54 age group (45.7%) and in older than 65 (48.2%). Over 90% of participants had insufficient oral hygiene and 80% required initial periodontal therapy. Approximately 20% needed complex periodontal treatment. Comparison of this data with the previous 1986 research showed improvement of periodontal status in up-to-44 age group due to more healthy persons and more subjects with the initial stages of disease. The possible reason for periodontal health improvement in the last 14 years, evident specially in younger age groups, were the effects of large preventive program measures conducted on schoolchildren in Croatia in 1980-ties and terminated in 1990-ties when the war in Croatia started. Following studies are needed to monitor whether deterioration in oral health will occur regarding to absence of organized preventive programs since 1990-ties.     

The distribution of periodontal disease and loss of attachment in jaw sextants in different age groups--cross-sectional study

The distribution of periodontal disease stages is not the same in both human jaws, parts of the same jaw or in different ages of life. In the sample of 2,730 sextants, 455 persons 15+ years of age, analysis of distribution of both periodontal disease and loss of attachment in jaw sextants in different age groups was made, using the Community Periodontal Index (CPI) and Loss of Attachment (LA). Statistical significance testing was checked using the Pearson Chi-Square-test with probability of 95%. Healthy periodontium is mostly found in upper anterior sextant (36%, p < 0.001), and bleeding on probing in lower right sextant (25.45%, p < 0.001). There is most calculus in lower anterior sextant (48.19%, p < 0.001), followed by upper posterior (15-17%). Deep pockets are more often in lower anterior sextant (31.87%, p < 0.001), and upper and lower posterior sextants are without teeth in 18-20.5% of cases, but lower anterior sextant in only 7.73% (p < 0.001). Cumulative minimal loss of attachment (0-3 mm) significantly is more often present in upper anterior sextant (21.2%, p < 0.001), while values 5-11 mm are more often in lower anterior sextant (25-43%, p < 0.001). Loss of attachment > or = 12 mm appears in only 1.4% present sextants and it is rear on left jaw side. Significant differences in distribution of both periodontal disease and loss of attachment appear in age 30+.