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Notes: Abstract. The relationship between radiographic crestal lamina dura and periodontitis disease-activity was studied longitudinally in 51 treated adult patients on a systematic 3-month maintenance program. The presence or absence of crestal lamina dura at 1809 interproximal sites was scored from periapical and bitewing radiographs taken at baseline of a 36-month maintenance care period. Semi-annual clinical evaluations by 2 independent examiners were carried out on each patient, with disease recurrence defined as sites revealing a 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE571:ges" location="ges.gif"/〉 3 mm increase in probing depth from baseline, or a 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE571:ges" location="ges.gif"/〉 2 mm increase in probing depth together with a 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE571:ges" location="ges.gif"/〉 2 mm loss of relative attachment level from an occlusal stent. Over the 36-month study period, 23 (45%) patients exhibited disease recurrence at 55 (3%) interproximal tooth sites scored for baseline crestal lamina dura. Absence of detectable baseline crestal lamina dura yielded high sensitivity (87–100%), but low specificity (17%) and low positive predictive values (0.8–3.2%), for localized periodontitis recurrence. In contrast, no sites exhibiting an intact baseline crestal lamina dura demonstrated periodontitis recurrence up to 24 months from baseline (100% positive predictive values). Presence of radiographic crestal lamina dura was positively associated with clinical periodontal stability (summary odds ratio for sites = 2.6, P= 0.0004), and negatively associated with periodontitis recurrence (summary odds ratio for sites = 0.4, P= 0.0004), for the 36-month study period. Evaluation of radiographic crestal lamina dura status appears valuable for assessing the risk of periodontitis disease-activity at interproximal tooth sites in patients on maintenance care programs.

Notes: Abstract The relationship between CPITN sextant scores and periodontitis recurrence at individual tooth sites was evaluated in a longitudinal study in 83 treated adult periodontitis patients receiving systematic 3-month maintenance care. At baseline and semi-annual examinations over 36 months. CPITN scores were assigned to each dentition sextant using probing depths and gingival index scores, and relative periodomal attachment level was assessed at individual tooth sites using an occlusal reference stent. Periodontitis recurrence was defined as any periodontal site exhibiting either a probing depth increase of ≥3 mm from baseline, or a probing depth increase of s 1 mm from baseline together with a loss of relative periodontal attachment of ≥2 mm from baseline. 49 (59.0%) subjects developed periodontitis recurrence in 147 (29.8%) sextants at 181 (2.2%) individual periodontal sites during the 36-month study period. Baseline CPITN scores of 4 were more common in disease-active subjects than clinically-stable subjects (p= 0.003. /-test), and were associated with a statistically significant 1.66 relative risk of periodonlitis recurrence within 36 months. CPITN sextant scores of 3 or 4 showed low specificity and low positive predictive values as indicators of periodontitis recurrence at s= 1 individual sites within the affected sextant. In comparison, low CPITN sextant scores (0-2) provided high specificity (96.2-100%). high positive predictive values (99.5-100%), and a summary odds ratio of 24.2 as an indicator of clinical stability at all periodontal sites within a given dentition sextant. Changes in sextant scores for CPITN over 6-month periods showed no relationship with periodontitis recurrence at individual periodontal sites. This study suggests that while CPITN is inadequate for detection of periodontitis recurrence, low CPITN scores provide rapid presumptive identification of clinically-stable sextants in adult periodontitis patients on maintenance care.

Notes: Abstract Bacteroides gingivalis. Bacteroides intermedius and Actinobacillus actinomycetemcomitans seem to be major pathogens in advancing periodontitis in man. First, these organisms are recovered in higher prevalence and proportions from progressive periodontitis lesions than from quiescent periodontal sites. Second, antibody levels against 6. gingivalis and A. actinomycetemcomitans are markedly elevated in serum and gingival crevice fluid of periodontitis patients compared to normal controls. Third. B. gingivalis and B. intermedius elaborate potent proteases and A- actinomycetemcomitans various noxious substances which have the potential to perturb important host defenses and to disintegrate key constituents of the periodontal tissues. Monitoring these bacteria in advanced periodontal lesions may greatly assist the assessment of treatment efficacy and risk of further periodontal breakdown.

Notes: Abstract Periodontitis is an inflammatory disease of the periodontium which is characterized by a progressive destruction of the tissues supporting the tooth. Its primary etiology is an ill-defined series of microbial infections which may be composed of only some of the more than 300 species of bacteria currently recognized in the oral cavity. The disease is currently considered to progress as periodic, relatively short episodes of rapid tissue destruction followed by some repair, and prolonged intervening periods of disease remission. Despite the apparent random distribution of episodes of disease activity, the resulting tissue breakdown exhibits a symmetrical pattern of alveolar bone loss and pocket formation which is common to several forms of periodontitis, although the distribution of the most affected teeth and surfaces may vary among diseases (e. g., juvenile periodontitis versus adult periodontitis or rapidly progressive periodontitis). Several reports have indicated that bacterial cells can be found in the pocket wall of periodontitis lesions. The translocation of bacteria into the tissues from the pocket environment is quite common, as evidenced by the common occurrence of bacteremias in patients with periodontitis following relatively minor events such as chewing and oral hygiene procedures. However, it is important to distinguish between the passive introduction of bacteria into periodontal tissues and frank invasion as might occur in an acute infection, since the pathological implications may be quite different.

Notes: Abstract The predictive utility of 5 major putative periodontopathic microbial species, “superinfecting” organisms, and several clinical periodontal parameters were assessed relative to periodontitis recurrence over a 12-month period in 78 treated adult patients participating in a 3-month maintenance care program. At baseline, pooled subgingival microbial samples were collected from each patient, and whole-mouth evaluations of probing depth, relative periodontal attachment level, furcation involvement, and indices of plaque and gingival inflammation were carried out. 67 (85.9%) subjects were culture-positive at baseline for presence of either Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia. Campylobacter rectus or Peptostreptococcus micros, with 48 (61.5%) subjects yielding one or more of these species at or above designated threshold proportions of ≥0.01% for A. actinomycetemcomitans, ≥0.1% for P. gmgivalis, ≥2.5% for P. intermedia, ≥2.0% for C. rectus, and ≥3.0% for P. micros. Subgingival yeasts were recovered from 12 subjects, staphylococci from 7, and enteric rods/pseudomonads from 6; however, no subjects revealed 21.0% baseline proportions of these “superinfecting” organisms in subgingival specimens. Periodontitis recurrence in subjects was defined as any periodontal site exhibiting either a probing depth increase of 2:3 mm from baseline, or a probing depth increase of 22 mm from baseline together with a loss in relative periodontal attachment of 22 mm from baseline. 15 (19.2%) study subjects showed periodontitis recurrence within 6 months of baseline, and 25 (32.1%) within 12 months. The mere baseline presence of the 5 major test species and “superinfecting” organisms were not significant predictors of periodontilis recurrence over 12 months. However, a 2.5 relative risk for periodontitis recurrence over 12 months was found for subjects yielding one or more of the 5 major test species at or above the designated baseline threshold proportions (p=0.022. Mantel-Haenszel %2 test). The positive predictive value for periodontitis recurrence of a microbiologic analysis encompassing the 5 major test species at or above the designated threshold proportions improved with increasing time from baseline, up to approximately 42% at 12 months. Baseline variables jointly providing in multiple regression analysis the best predictive capability for periodontitis recurrence in subjects over a 12-month period were recovery of one or more of the 5 major test species at or above designated threshold proportions, the proportion of sites per subject with 25 mm probing depth, and the mean whole-mouth probing depth. These findings indicate that one or more of 5 major putative periodontal pathogens in elevated subgingival proportions together with increased probing depth predispose adults on maintenance care to recurrent periodontitis.

Notes: Abstract The feasibility of using the Ramfjord index teeth to estimate whole-mouth periodontal disease activity was investigated. Whole-mouth examinations were carried out semi-ammally over a 36-month period in 98 maintenance patients previously treated for adult periodontitis. Recurrent periodontitis was defined as either a 3-mm or greater probing depth increase from baseline, or a 2-mm or greater probing depth increase together with 2-mm or greater of relative attachment loss measured from a reference stent. Whole-mouth disease activity was compared lo Ramfjord index teeth data, with and without adjustment. Adjustment was made by multiplying disease activity rates on Ramfjord index teeth by the ratio formed from the sum of all teeth present over the sum of all Ramfjord index teeth in the study population. Without adjustment, Ramfjord index teeth markedly underestimated subjects with recurrent disease activity when compared to whole–mouth findings. However, with adjustment, the hypothesis that upper and lower limits on whole-mouth incidence of recurrent periodontitis could be estimated from Ramfjord index teeth disease-activity rates were not rejected (P 〉 0.20, z-test) at any 6-month interval. At 5 of 6 examinations, the % of disease active subjects as determined from whole-mouth evaluations was below the upper limit for disease incidence calculated, with 95% confidence, from point estimates derived from adjusted Ramfjord index teeth data. Partial-mouth examinations with appropriate adjustment of Ramfjord index teeth data may be useful for assessing periodontal disease progression in longitudinal population studies of human periodontitis.

Notes: Abstract Periodontal diseases are best considered as the outcome of an imperfect host-parasite interaction. In most cases, diagnosis involves labelling certain clinical manifestations without a complete understanding of the causes of the disease. Therefore, treatment based on the “diagnosis” is not necessarily logical or effective. As the causes which underly the disease become more evident, the underlying mechanisms of disease can be used to refine our diagnostic methods. For example, deficiencies in host defenses, or the presence or increased proportions of certain bacterial pathogens may be indicative of imbalances in the normal host-parasite equilibrium. For a laboratory test to be reliably applied to the diagnosis of a clinical condition, it is essential that an absolute criterion of the clinical disease first be established. Then the sensitivity and the specificity of the test can be determined using appropriate experimental designs. The demonstration of a good correlation between a test outcome and a clinical condition is, of itself, insufficient grounds to use the test for diagnostic purposes.

Notes: Abstract. This study examined the distribution of P. gingivalis, P. intermedia and B. forsythus in plaque on metallic and porcelain pontics adjacent to healthy and inflamed mucosa. Subpontic plaque was collected from 33 inflamed and 31 healthy sites. Plaque suspension was incubated with specific rabbit antisera to P. gingivalis (FDC 381), P. intermedia (ATCC 25261) and B. forsythus (FDC 335), and the labelled cells disclosed with fluorescein-labelled goat-anti-rabbit IgG by indirect immunofluorescence microscopy. Mean proportions of P. gingivalis, P. intermedia, and B. forsythus at inflamed sites were 0.60±0.75, 2.48±2.28, and 0.44±0.64% respectively, and at healthy sites 0.21±0.43, 1.27±1.05, and 0.15±0.18% respectively. These differences were statistically significant. Almost all sites were positive for P. intermedia, whereas only 12/31 healthy and 21/33 inflamed sites were positive for P. gingivalis.18/31 healthy and 28/33 inflamed sites were positive for B. forsythus. P. intermedia was recovered in higher proportions from metallic pontics adjacent to inflamed sites (MI) than healthy sites (MH) or porcelain pontics next to inflamed (PI) or healthy sites (PH), P. gingivalis is was recovered in higher proportions from MI than PH. We conclude that both the nature of the pontic material and the health status of the mucosa affect the composition of the associated microbiota.