Annsofi Johannsen

Smoking and inflammation: evidence for a synergistic role in chronic disease.

Tobacco smoking is the most important preventable risk factor for periodontitis; however, the underlying biological mechanisms responsible for the detrimental effects of smoking on periodontal health remain largely unclear. It is also well established that smoking has a negative impact on several inflammatory diseases, including rheumatoid arthritis, multiple sclerosis and inflammatory bowel disease. The aim of this paper was to review smoking-related changes in local and systemic host responses with a focus on cellular and molecular effects that could explain a hyperinflammatory response leading to periodontal destruction. Biological mechanisms that may be common to periodontal disease and other chronic inflammatory diseases were also explored, together with gene-smoking interactions. An epidemiologic perspective on the burden of smoking on periodontal health and the potential for smoking cessation is also presented. Tobacco smoking seems to induce changes ranging from decreased leukocyte chemotaxis to decreased production of immunoglobulins. Smoking also seems to cause a stronger inflammatory reaction with an increased release of potentially tissue-destructive substances (e.g. reactive oxygen species, collagenase, serine proteases and proinflammatory cytokines). These findings support a hypothesis that periodontitis is a hyperinflammatory condition rather than a hypo-inflammatory condition.

Local Delivery of Hyaluronan as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Periodontitis

BACKGROUND The aim of the present study was to evaluate the adjunctive effect of the local application of a hyaluronan gel to scaling and root planing in the treatment of chronic periodontitis. METHODS Twelve patients with chronic periodontitis were recruited to participate in a study with a split-mouth design and provided informed consent. Plaque formation and bleeding on probing were evaluated pretreatment (baseline) and at 1, 4, and 12 weeks post-treatment. Probing depths and attachment levels were evaluated at baseline and at 12 weeks. The patients received full-mouth scaling and root planing. A hyaluronan gel was administered subgingivally in the test sites at baseline and after 1 week. Significant differences between test and control were evaluated using the paired t test, repeated-measures analysis of variance (Wilks lambda), and a non-parametric Wilcoxon signed-rank test. RESULTS A significant reduction in bleeding on probing scores and probing depths was observed in both groups at 12 weeks (P <0.05). Significantly lower bleeding on probing scores were observed in the hyaluronan group compared to control at 12 weeks (P <0.05). Mean probing depth reductions between baseline and 12 weeks were 1.0 +/- 0.3 mm and 0.8 +/- 0.2 mm for the hyaluronan and control groups, respectively. The difference between the groups was statistically significant (P <0.05). CONCLUSION The local application of hyaluronan gel in conjunction with scaling and root planing may have a beneficial effect on periodontal health in patients with chronic periodontitis.

The role of the toothbrush in the abrasion process

AIM To evaluate the relative abrasivity of different toothbrushes both qualitatively and quantitatively. MATERIALS AND METHODS Acrylic plates were exposed to brushing in a brushing machine with ten different toothbrushes with water alone and with a toothpaste. The results were evaluated using a profilometer after one and 6 h of brushing (corresponding to 2000 and 12,000 double strokes, respectively). A surface roughness value (Ra-value) and also a volume loss value were calculated from the profilometer measurements. These values were then compared to each other. RESULTS The results showed that brushing with water alone caused less abrasion than when a toothpaste was added. Six-hour brushing with water caused less abrasion than 1 h with a toothpaste. The number of filaments or filament diameter influenced the results in various ways. When brushing with water, the harder toothbrush (Jordan Medium) caused more abrasion (higher Ra-value), but when adding the toothpaste, the softer toothbrush (Jordan soft) caused more abrasion after 12,000 double strokes. CONCLUSION Besides supporting the fact that a toothpaste is needed to create a significant abrasion, this study also showed that a softer toothbrush can cause as much and in some cases more abrasion than harder ones. When conducting abrasivity studies, it is important to look at both the quantitative and qualitative aspect of abrasivity.

The influence of academic stress on gingival inflammation

OBJECTIVE The aim of the present study was to investigate the effects of academic stress on periodontal health, in relation to inflammatory markers in gingival crevicular fluid (GCF) and cortisol in saliva. MATERIALS AND METHODS The study included 20 healthy dental hygienists (females: mean age 29.3 +/- 8.5 SD) and was conducted during a major exam period and 4 weeks later after the exams. A clinical examination was performed and GCF was collected from four sites in each subject on these two occasions. Interleukin (IL)-1beta, IL-4, IL-6, IL-10 levels were determined using Luminex 100 and cortisol amounts by radioimmunoassay (RIA (125)I). Students registered their perceived stress on a visual analogue scale (VAS). Significance of the findings was determined using paired t-test, Wilcoxon-matched pair and Spearmans rank correlations. RESULTS Students had higher amounts of dental plaque (P < 0.007) and gingival inflammation (P < 0.001) during the exam period compared with after the exams. The amounts of IL-6 and IL-10 in GCF were significantly increased during the time of examinations. The median level of cortisol in saliva was also significantly raised during the exam period compared with after the exams, 20.52 nmol/l (range: 11.91-27.34) and 16.41 nmol/l (range: 10.91-24.17) respectively, P < 001. The results from the VAS registration revealed a significant difference (P < 001) between the two occasions. CONCLUSION Academic stress appears to affect periodontal health, shown by more plaque accumulation, gingival inflammation and increased amounts of IL-6, IL-10 in GCF and cortisol in saliva.

Dental caries, prevalence and risk factors in patients with Crohn's disease.

Objective The present study tested the hypothesis that patients with Crohn’s disease (CD) have a higher prevalence and risk for caries compared to people without CD. Material and Methods Patients with CD were divided into groups; 71 patients (50.7±13.9 years) who had gone through resective intestinal surgery and 79 patients (42.0±14.4 years) who had not. The patients were compared to 75 controls (48.6±13.4 years) regarding DMF-T and DMF-S, Lactobacilli (LB), Streptococcus mutans (SM), salivary flow and dental plaque. Statistical methods including ANOVA or Chi-square test for calculation of demographic differences between groups, analysis of covariance (ANCOVA) to compare the clinical variable and Post hoc analyses were done with Fischers Least Significant Difference test or Chi-square. Non-parametric Spearman’s correlation matrix coefficient was estimated between clinical variables and disease duration. Results CD patients who had been subjected to resective surgery had a higher DMF-S score (50.7 versus 36.5; p = 0.01) compared to the control group after adjusting for age, gender and smoking. These patients had higher counts of SM (1.5 versus 0.9; p = 0.04) and LB (10000.0 versus 1000.0; p = 0.01), and more dental plaque (53.7 versus 22.6; p = 0.001). CD patients reported a more frequent consumption of sweetened drinks between meals compared to controls (p = 0.001). Conclusions The present study shows that patients with CD who had undergone resective surgery had a higher DMFs score, and higher salivary counts of Lactobacilli and Streptococcus mutans compared to the control group.

Influence of culture conditions on porphyrin production in Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis

BACKGROUND Increasing antibiotic resistance among pathogens has raised the demands for new treatment methods such as antimicrobial photodynamic therapy (aPDT) and phototherapy (PT). Experiments for investigating the effects of these methods are often performed in vitro, but the procedures for cultivation of microbes vary between different studies. The aim of this study has been to elucidate how the profile of endogenously produced porphyrins differs by changing the variables of bacteria culturing conditions. METHODS Two oral pathogens, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, were selected as model organisms. The contents of porphyrins and heme in the bacteria were analysed with liquid chromatography-tandem mass spectrometry when bacteria was cultivated for different lengths of time (3-9 days), upon passaging as well as when growth medium were supplemented with or without horse blood. RESULTS Both porphyrin and heme content in A. actinomycetemcomitans are highly affected by the age of the culture, and that the porphyrin profiles changes during cultivation. When cultivated colonies of A. actinomycetemcomitans were passaged onto a new, fresh growth medium a large change in porphyrin content occurred. Additional porphyrins were detected; uroporphyrin and 7-carboxylporphyrin, and the total porphyrin content increased up to 28 times. When P. gingivalis was grown on blood containing medium higher concentrations of protoporphyrin IX (2.5 times) and heme (5.4 times) were quantified compared to bacteria grown without blood. CONCLUSIONS This study demonstrate that there is a need for more standardized culturing protocols when performing aPDT and PT experiments in vitro to avoid large variations in porphyrin profiles and concentrations, the aPDT/PT target compounds, depending on the culturing conditions.

Consumption of dental treatment in patients with inflammatory bowel disease, a register study.

Objective The aim of this study was to compare the consumption of dental treatment among patients with Crohn´s disease (CD) or ulcerative colitis (UC) compared to age and gender matched control groups. Design The study group comprised 2085 patients with CD and 3161 with UC from the Uppsala-Örebro region and from the Stockholm region. The patients in the cohort were diagnosed between 1960 and 1989. Patients up to 70 years of age were included in the study. The two patients groups were compared to age- and gender-matched, randomly selected control groups from the same geographic area comprising a corresponding number of participants. Results CD patients had significantly higher total number of procedures registered (p < 0.000). The difference was most pronounced for removable dentures (+65%), fillings in front teeth (+52%) and endodontic treatment (+46%) when Crohn’s patients were compared to controls (p<0.001). The corresponding figures for UC patients were also a significantly higher total number of procedures (p < 0.005), more clinical examinations (p<0.000), fillings in canines and incisors (p < 0.001) and fillings in bicuspids and molars (p < 0.000). Conclusion This study demonstrate that CD and UC individuals use more dental treatment compared to an age-gender matched control group, and more caries-related treatments. The difference was most pronounced for restorative treatment in patients with Crohn’s.

Salivary Colony Stimulating Factor-1 and Interleukin-34 in Periodontal Disease

BACKGROUND Colony-stimulating factor (CSF)-1 and interleukin (IL)-34 are macrophage growth factors and regulators of osteoclastogenesis. Their potential involvement in periodontal disease is yet unknown. The aim of this study is to explore the presence of CSF-1 and IL-34 in whole saliva in relation to periodontal disease. METHODS Protocol validation was assessed in saliva of healthy donors (n = 21) by enzyme-linked immunosorbent assay. Salivary CSF-1, IL-34, and matrix metalloproteinase (MMP)-8, a biomarker candidate of periodontitis, were determined in 48 patients (29 patients with periodontitis, 12 with gingivitis, and seven healthy patients) and related to the following clinical periodontal parameters: bleeding on probing, probing depth, clinical attachment loss, and plaque index. An additional separate group of patients with gingivitis (n = 21) and some of the patients with periodontitis (n = 11) were subjected to non-surgical periodontal treatment, whereupon changes in salivary CSF-1, IL-34, and MMP-8 levels were determined and related to periodontal outcome. RESULTS Patients with periodontitis displayed higher CSF-1 and MMP-8 levels in saliva compared with healthy patients, and IL-34 levels were lower. A higher CSF-1/IL-34 ratio was observed in patients with periodontitis compared with healthy patients. There was a positive correlation between CSF-1 and MMP-8, which both correlated negatively to IL-34, in patients with gingivitis and periodontitis. Clinical periodontal parameters correlated positively with CSF-1, MMP-8, and with the CSF-1/IL-34 ratio, and negatively with IL-34 in patients with periodontitis. After treatment CSF-1 and MMP-8 levels decreased together with observed clinical improvement in patients with gingivitis. CONCLUSION CSF-1 and IL-34 are present in saliva and seem to have complementary roles in periodontal disease: IL-34 in steady-state and CSF-1 in inflammation.

Dental patients’ perceptions and motivation in smoking cessation activities

Abstract Objective The aim of the present study was to investigate smokers’ perceptions of and motivation for smoking cessation activities in dentistry. Materials and methods Patients who smoked were consecutively recruited from general as well as specialist dental care clinics in Sweden. After a dental visit the patients completed a questionnaire about self-perceived oral health, smoking habits, motivation, reasons to quit and not to quit smoking, support to quit, smoking cessation activities and questions about smoking asked by dentists and dental hygienists. Results The sample consisted of 167 adult patients (≥ 20 years) who smoked daily. During the last 6 months, 81% of the patients had experienced oral health problems. The most common complaints were discolourations of the teeth, periodontal problems and dry mouth (38%, 36% and 33%, respectively). Improved general health was a major reason to quit smoking (89%). It was also stated that it was important to avoid oral health problems. 71% of the patients preferred to quit by themselves and 16% wanted support from dentistry. High motivation to quit smoking was reported by 20%. Occurrence of periodontitis during the last 6 months was significantly associated with being highly motivated to stop smoking (OR = 3.0, 95% CI = 1.03–8.55). Conclusions This study revealed that, although it was important to quit smoking to avoid oral health problems, the patients were not aware that tobacco cessation activities can be performed in dentistry. Periodontal problems seem to be the most motivating factor among the patients who were highly motivated to stop smoking.