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Notes: Background and aims: Bacteria play an essential role in the pathogenesis of destructive periodontal disease. It has been suggested that not all bacteria associated with periodontitis may be normal inhabitants of a periodontally healthy dentition. In particular, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans have been isolated infrequently from subjects without periodontitis. The aim of the present study was to compare prevalence and proportions of a number of periodontal bacteria in periodontitis patients and control subjects.Material and methods: In all, 116 consecutive subjects diagnosed with moderate to severe periodontitis (mean age 42.4) and 94 subjects without radiographic evidence of alveolar bone loss (mean age 40.4) were recruited for the study. The gingival condition in the control group varied between gingival health and various degrees of gingivitis. In patients, the deepest pocket in each quadrant was selected for microbiological sampling. In control subjects all mesial and distal sites of all first molars were selected for sampling. All paper points from a patient were pooled and processed for anaerobic cultivation within 6 h after sampling. Clinical variables of sampled sites included bleeding index, probing pocket depth and clinical attachment level.Results: A. actinomycetemcomitans, P. gingivalis, Prevotella intermedia, Bacteroides forsythus, Fusobacterium nucleatum and Peptostreptococcus micros were significantly more often prevalent in patients than in controls. The highest odds ratios were found for P. gingivalis and B. forsythus (12.3 and 10.4 resp.). Other odds ratios varied from 3.1 to 7.7 for A. actinomycetemcomitans and P. micros, respectively. Absolute numbers of target bacteria were all higher in patients, but only the mean percentage of B. forsythus was significantly higher in patients in comparison to controls (P 〈 0.001). Conclusions: A. actinomycetemcomitans, P. gingivalis, P. intermedia, B. forsythus, F. nucleatum and P. micros are all significant markers for destructive periodontal disease in adult subjects. Based on calculated odds ratios, B. forsythus and P. gingivalis are the strongest bacterial markers for this disease and are infrequently cultured from subjects without periodontal bone loss.

Notes: Aim:  The purpose of the present study was to compare the ability of the Braun Oral-B 3D Excel power toothbrush (BPT), the Sonicare power toothbrush (SPT) and the Philips Sensiflex 2000 (HX 2550) power toothbrush (PPT) to control plaque and reduce experimentally induced gingivitis.Materials and methods: Two experiments were carried out in two different groups of subjects using a split-mouth design whereby the two halves of the mandible which had been allowed to develop gingivitis were brushed over a 4-week period with the test toothbrushes. Experiment 1 compared the BPT with the SPT (n = 35) and experiment 2 compared the BPT with the PPT (n = 32). The study used a run-in period of 2 weeks, which, together with the 3-week experimental gingivitis phase, represented the pretrial phase of the experiment. The purpose of this phase was two-fold: first, to enable the subjects to become acquainted with the two power brushes and for them to receive proper oral hygiene instruction, and, second, to develop a reasonable level of gingivitis on the mandible. Those subjects with at least 40% of sites exhibiting bleeding in each quadrant in the mandible at day 21 of the experimental gingivitis phase were allowed to continue with the trial. During the next 4 weeks (treatment phase) of each experiment, subjects were told to brush according to a split-mouth design, the right and left sides of the mouth being randomly allocated to a toothbrush. During this period, no rinsing with an antiseptic mouthwash or flossing was allowed and a standard toothpaste (Zendium®) was used. After 1, 2 and 4 weeks, the plaque index (Quigley & Hein) and the bleeding tendency on marginal probing were assessed in the mandible.Results: Experiment 1 showed that the bleeding score was reduced from 1.63 to 1.12 at 4 weeks by the BPT and from 1.65 to 1.26 by the SPT. This reduction was more rapid and greater with the BPT (P 〈 0.05). The plaque index was reduced from 2.19 at day 21–1.03 at 4 weeks by the BPT, and from 2.18 to 1.20 by the SPT. The difference between the two toothbrushes was not significant. Experiment 2 showed that the bleeding score was reduced from 1.77 at day 21 to 1.07 at 4 weeks by the BPT and from 1.75 to 1.24 by the PPT. This reduction was more rapid and greater with the BPT (P 〈 0.05). There was no significant difference in plaque index at 4 weeks (BPT, 1.09; PPT, 0.95). Data from the questionnaire at the end of the study revealed that, in both experiments, most subjects preferred the BPT.Conclusions:  The data from this study show that the design and action of the Braun Oral-B 3D Excel power toothbrush are more effective in resolving gingivitis than the Sonicare & the Philips Sensiflex 2000 power toothbrushes.

Notes: Background/aims: In an Indonesian population deprived of regular dental care, the experienced progression of disease between baseline (1987) and follow-up (1994) was investigated in relation to the composition of the subgingival microbiota at follow-up. At baseline the age ranged from 15 to 25 years. Clinical and microbiological evaluation was completed in 158 of the 167 subjects available at follow-up.Methods: Plaque index (PI), pocket depth (PD), bleeding on probing (BOP), and attachment loss (AL) were scored at the approximal surfaces of all teeth and subgingival calculus on the approximal surfaces of the Ramfjord teeth only (number of sites with subgingival calculus: NSC). A pooled sample of the deepest pocket in each quadrant was evaluated using microbiological culture techniques.Results: At baseline the mean values of the clinical parameters were AL=0.35 mm, PI=1.01, BOP=0.80 PD=3.25 mm and NSC=6.04 and at follow-up AL=0.75 mm, PI=1.16, BOP=1.19, PD=3.34 mm and NSC=5.85. All parameters except PD and NSC showed a statistically significant increase. At follow-up the prevalence of Actinobacillus actinomycetemcomitans was 40%, of Porphyromonas gingivalis 67%, of Prevotella intermedia 66%, of Fusobacterium nucleatum 79%, of Bacteroides forsythus 16%, of Campylobacter rectus 4%, and of P. micros 6%. No differences in clinical parameters were found between groups with or without these micro-organisms. In 129 subjects AL of 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280703:ges" location="ges.gif"/〉2 mm at 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280703:ges" location="ges.gif"/〉1 site was found. Logistic regression showed three significant odds-ratio’s for experienced progressive periodontitis: Plaque index (12.2), gender (3.4) and Actinobacillus actinomycetemcomitans (2.9).Conclusions: The results of this retrospective study suggest that plaque is the most important parameter related to experienced disease progression, and that the presence of A. actinomycetemcomitans may be associated with increased chance of disease progression.

Notes: Abstract. The aim of the present study was to investigate the clinical and microbiological effects of initial periodontal therapy in conjunction with systemic amoxicillin plus clavulanic acid in adult periodontitis patients using a double-blind, parallel-group, and placebo-controlled protocol. 21 patients with a clinical diagnosis of generalised adult periodontitis were recruited. Clinical measurements and microbiological assessments were carried out at baseline, 3, and 12 months posttreatment. Approximately 6 weeks after initial periodontal treatment (3–6 h), patients were randomly assigned to receive coded study medication of 500 mg amoxicillin plus 125 mg clavulanic acid (Augmentin®) or placebo, every 8 h for 10 days. Patients returned for follow-up visits 3, 6, 9, and 12 months after completion of the medication. The mean plaque index (PI) at baseline was 1.1 for placebo group and 0.9 for the test group. At 3 months, the PI had dropped to 0.3 in both groups, and was maintained during the rest of the study. The changes in bleeding on probing (BOP) and gingival index (GI) in the course of the study were similar in both groups. The mean whole mouth probing pocket depth (PPD) in the placebo group was 3.8 mm at baseline and 3.9 mm in the test group. A mean reduction of 1.0 mm in the placebo group and 0.9 mm in the test group was observed during the first 3 months. No further reduction in PPD was noticed during the study period in either group. There was no statistically significant difference in the PPD reduction between the 2 groups. The change in clinical attachment level (CAL) from baseline to 3 months amounted to 0.5 mm in both groups. Between 3 and 12 months, the CAL changed in neither group. In both groups, treatment resulted in a decrease in the number of spirochetes and motile rods in positive patients, but no significant differences between either group were noted in any of the dark field microscopy observations. At baseline, 1 patient in the placebo group and 2 patients in the test group were culture positive for Actinobacillus actinomycetemcomitans (Aa). After therapy, Aa was not detectable in the placebo group and 1 patient remained positive in the test group. In the placebo group, the number of patients positive for Porphyromonas gingivalis (Pg) decreased from 7 to 2 after therapy. In the test group, the 4 patients positive for Pg at baseline remained positive after therapy. In both groups, all subjects were positive for Prevotella intermedia (Pi) and Fusobacterium nucleatum (Fn) at baseline. At 12 months, all subjects had detectable subgingival Fn. 9 out of the 11 placebo and 8 of the 10 test patients remained positive for Pi. There were no differences in detection frequency of Peptostreptococcus micros (Pm) and Bacteroides forsythus (Bf) in both groups between baseline, 3, and 12 months post-treatment. The findings demonstrated that, in comparison to placebo, systemic amoxicillin plus clavulanic acid provided no additional clinical and microbiological effects in the treatment of adult periodontitis patients.

Notes: Background: A major aspect of the adaptive host response in periodontitis is the production of antibodies. Several risk and susceptibility factors for periodontitis, including smoking, age and composition of the subgingival microflora, have also been suggested to influence antibody production.Aim: The present study was conducted to investigate plasma levels of immunoglobulin (Ig) G, A and M antibodies in periodontitis patients of Caucasian European heritage in relation to disease severity, smoking, diagnosis and prevalence of periodontopathogens.Methods: In this study, 29 patients with severe periodontitis, 51 with moderate periodontitis and 55 controls without periodontal destruction were enrolled. From the total of 80 patients, 18 were diagnosed with aggressive periodontitis and 62 with chronic periodontitis. Total IgG, IgA and IgM as well as IgG isotypes were analyzed in plasma samples.Results: Levels of total IgG, IgA and IgM were not different between patients and controls; however, in periodontitis, higher levels of IgG1 and IgG2 were observed. Smoking appeared to be significantly and inversely related to antibody levels in periodontitis, in particular for total IgG and IgG2. The absence of an elevated total IgG and IgG2 in smoking patients was irrespective of severity, prevalence of periodontal pathogens and diagnosis. The elevation of total IgG and IgG1 and IgG2 in non-smoker periodontitis patients was observed in patients with moderate periodontitis and even greater in patients with severe periodontitis, but was independent whether patients were infected with Actinobacillus actinomycetemcomitans or Porphyromonas gingivalis and independent of diagnosis. Clinically, it was observed that patients who smoked had more periodontal bone loss; the current findings on antibody levels may be one of several mechanisms related to more extensive periodontal breakdown in smoker patients.Conclusion: The current study shows that non-smoker periodontitis patients have higher levels of total IgG and IgG2 than smoker periodontitis patients.

Notes: Objectives: Evidence suggests functional relevance for polymorphisms in FcγR in relation to inflammatory and infectious diseases. The present aim was to investigate genetic polymorphisms in three FcγR in relation to susceptibility and severity of periodontitis.Material and Methods: The study population consisted of 68 periodontitis patients and 61 controls (Northern European Caucasian background, mean ages 44 and 42 years, respectively). Among the patients, 12 subjects were diagnosed with aggressive periodontitis (AgP) and 56 individuals were diagnosed with chronic periodontitis (CP). Radiographic bone levels were scored for all teeth in the patients. Subjects were typed for the following genes (alleles): FcγRIIa (R131 or H131), FcγRIIIa (V158 or F158) and FcγRIIIb (NA1 or NA2).Results: Hardy–Weinberg equilibrium criteria were fulfilled for the different genotypes at the three genes investigated. The frequency of the FcγRIIIa-V158 allele in the patient population (53%) was higher than in the control group (39%) (OR 1.73 [1.06–2.85], p=0.034). The V158 carriage rate in AgP was even higher (63%). The frequency of the FcγRIIa-H131 allele in the total periodontitis population was 58%; for AgP this was 79%, compared with 51% in the control population (OR 3.68 [1.29–10.5], p=0.013). Also, the frequency of the FcγRIIa-H/H131 genotype was significantly higher in AgP patients than in controls (OR 9.07 [1.29–63.56], p=0.026, adjusted for smoking status and other potential confounders). Moreover, patients with the FcγRIIa-H/H131 genotype had more severe radiographic bone loss than patients with the other FcγRIIa genotypes.Conclusion: The current study of relative small sample size suggests that the FcγRIIa-H/H131 genotype may be a putative susceptibility and severity factor, and the FcγRIIIa-V158 allele a putative susceptibility factor for periodontitis in Northern European Caucasians. These results need further verification and the biological importance of these findings needs further investigation.

Notes: Objectives: This study was designed to test the efficacy in plaque removal and the potential for gingival abrasion of 3 electric toothbrushes. The established Braun Oral-B ‘Ultra’ plaque remover (D9), the Philips/Jordan HP 735, and the newly designed Braun Oral-B 3D Plaque Remover (3D).Material and Methods: This study was designed as a split-mouth, single blind, randomised clinical study consisting of 3 identical experiments with 3 combinations of toothbrushes (exp 1:3D–HP735, exp 2:D9–HP735, exp 3:D9–3D). 40 subjects were requested not to brush their teeth 48 h prior to each examination. At this visit, both the gums and teeth were disclosed for the assessment of baseline plaque and gingival abrasion. Abrasion sites were scored as small (〈inlineGraphic alt="leqslant R: less-than-or-eq, slant" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280605:les" location="les.gif"/〉5 mm) or large sites (〉5 mm). Plaque was assessed according to the Quigley & Hein index at 6 sites per tooth. The participants brushed 60 s with the 2 brushes, each brush in 2 randomly selected contra-lateral quadrants.Results: The increase in number of small abrasions after brushing (exp. 1) was 1.2 versus 1.7 for 3D and HP735, respectively (ns); In exp. 2 the increase was 0.9 for both D9 and HP735. In exp. 3 the increase was 0.4 sites for both D9 and 3D. Comparison of the 3D and HP735 showed a mean plaque reduction of 67% and 54%, respectively (p〈0.05); when the D9 and HP735 were compared, a mean plaque reduction of 70% and 58%, respectively, was found (p〈0.05); a mean plaque reduction of 74% was found in the comparison of D9 and 3D.Conclusion: The results show that the potential gingival abrasion after brushing is comparable for all 3 electric toothbrushes. In addition the longer the subjects used the brushes the less abrasion occurred. Finally both 3D and D9 were more effective than the HP735 in removing plaque.

Notes: Abstract Background, aims: The aim of this double-blind, parallel study was to evaluate the adjunctive effects of systemically administered amoxicillin and metronidazole in a group of adult periodontitis patients who also received supra- and subgingival debridement.Methods: 49 patients with a diagnosis of generalised severe periodontitis participated in the study. Random assignment resulted in 26 patients in the placebo (P) group with a mean age of 40 years and 23 patients in the test (T) group which had a mean age of 45 years. Clinical measurements and microbiological assessments were taken at baseline and 3 months after completion of initial periodontal therapy with additional placebo or antibiotic treatment. Patients received coded study medication of either 375 mg amoxicillin in combination with 250 mg metronidazole or identical placebo tablets, every 8 hours for the following 7 days.Results: At baseline, no statistically significant differences between groups were found for any of the clinical parameters. Except for the plaque, there was a significantly larger change in the bleeding, probing pocket depth (PPD) and clinical attachment level (CAL) in the T-group as compared to the P-group after therapy. The greatest reduction in PPD was found at sites with initial PPD of 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280402:ges" location="ges.gif"/〉7 mm, 2.5 mm in the P-group and 3.2 mm in the T-group. The improvement in CAL was most pronounced in the PPD category 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280402:ges" location="ges.gif"/〉7 mm and amounted to 1.5 mm and 2.0 mm in the P- and T-groups, respectively. No significant decrease was found in the number of patients positive for any of the test species in the P-group. The number of patients positive for Porphyromonas gingivalis, Bacteroides forsythus and Prevotella intermedia in the T-group showed a significant decrease. After therapy there was a significant difference between the P- and the T- group in the remaining number of patients positive for P. gingivalis, B. forsythus and Peptostreptococcus micros. 4 subgroups were created on the basis of the initial microbiological status for P. gingivalis positive (Pg-pos) and negative patients (Pg-neg) in the P- and the T-groups. The difference in reduction of PPD between Pg-pos and Pg-neg patients was particularly evident with respect to the changes in % of sites with a probing pocket depth 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280402:ges" location="ges.gif"/〉5 mm. This % decreased from 45% at baseline to 23% after treatment in the Pg-pos placebo subgroup and decreased from 46% to 11% in the Pg-pos test subgroup (p〈inlineGraphic alt="leqslant R: less-than-or-eq, slant" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280402:les" location="les.gif"/〉0.005). In contrast, the changes in the proportions of sites with a probing pocket depth 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280402:ges" location="ges.gif"/〉5 mm in the Pg-neg placebo and Pg-neg test subgroup were similar, from 43% at baseline to 18% after treatment versus 40% to 12%, respectively.Conclusions: This study has shown that systemic usage of metronidazole and amoxicillin, when used in conjunction with initial periodontal treatment in adult periodontitis patients, achieves significantly better clinical and microbiological results than initial periodontal treatment alone. Moreover, this research suggests that especially patients diagnosed with P. gingivalis benefit from antibiotic treatment.

Notes: Abstract. In this study, the prevalence and serotype distribution of Porphyromonas gingivalis in an Indonesian population (n=158) is described. The relationship between subgingival P. gingivalis and periodontal attachment loss was investigated. The serotype distribution and periodontal parameters were studied. Serotyping was also used to study person-to-person transmission between siblings and between spouses. Approximately 50% of the subjects had periodontal attachment loss ≥3 mm at 1 or more recorded sites. The population was divided into 2 subgroups based on the presence or absence of P. gingivalis. No differences in plaque index, pocket depth, clinical attachment loss, bleeding upon probing, % of sites with ≥3 mm clinical attachment loss and % of sites with probing pocket depth 〉5 mm, were observed between both sub-populations. All known 6 capsular serotypes were found in the study population, with the exception of the K1 type. Detection of 1 of the known P. gingivalis serotypes was not related with the amount of clinical attachment loss. In 3 out of 29 sibships with more than one member positive for P. gingivalis, an identical P. gingivalis serotype was found. None of the 15 couples in the study shared an identical P. gingivalis serotype, indicating that transmission is probably not a common phenomenon in this population.

Notes: Aim: The purpose of the present study was to compare 2 indices, i.e., the Eastman interdental bleeding (EIB) index and the bleeding on marginal probing (BOMP) index. The comparison was made (a) in terms of the degree of bleeding provoked and the relationship with plaque in natural gingivitis and (b) for the ability of these 2 methods to detect differences between the development of experimental gingivitis in a control group and a group in which the development of gingival inflammation was suppressed by treatment. For the present studies, subjects were selected without interdental recession of the gingival tissues.Methods experiment 1: In this experiment, 43 subjects having established moderate gingivitis were assessed using a random splitmouth design (1st and 3rd/2nd and 4th quadrant). Plaque was scored on all approximal sites after which the BOMP index was assessed in one half of the mouth and the EIB index in the other.Results experiment 1: The BOMP index showed a bleeding score of 84% and the EIB index of 87%. The significant correlation between plaque and gingival bleeding for the BOMP index (0.55) was higher than for the EIB index (0.44).Methods experiment 2: For this experiment, 25 subjects participated in an experimental gingivitis trial of the lower jaw. At baseline, first the BOMP index and immediately thereafter the EIB index were assessed at all approximal sites. Experimental gingivitis (EG) was carried out in one randomly assigned quadrant and as a treatment modality only floss was used in the other (FL). Results experiment 2: In the EG quadrant, the BOMP index increased to 69% and the EIB index to 73%. Both indices showed a significant correlation with plaque; 0.60 and 0.64 respectively. In the FL quadrant, the BOMP index increased to 38% and the EIB index to 30%. No significant correlation between both gingivitis indices and the amount of plaque was present in the FL quadrant. Conclusion: The ability of the BOMP index and the EIB index to assess the level gingival inflammation appears to be comparable.