Lars A. Christersson

The Origin of Periodontal Infections

Periodontal diseases are recognized as bacterial infections, and some forms are associated with specific organisms, such as Actinobacillus actinomycetemcomitans in juvenile periodontitis, and Bacteroides gingivalis and others in adult periodontitis. The source of the periodontal organisms, whether they are part of the indigenous or resident flora and overgrow to become opportunistic oral pathogens, or whether they are exogenous oral pathogens, is important to determine. The chain of periodontal infection, microbial agent(s) and their transmission, and host response are reviewed with respect to the role of A. actinomycetemcomitans in localized juvenile periodontitis and B. gingivalis in adult periodontitis. The present data lead us to hypothesize that some periodontal organisms may be exogenous pathogens. Prevention of periodontal diseases may be influenced by the knowledge of whether various forms are caused by opportunistic organisms or exogenous pathogens. If exogenous pathogens are responsible, prevention can be directed to intercepting transmission, thereby preventing colonization. On the other hand, if the organisms are opportunistic pathogens, prevention might be directed at interfering with initial acquisition of the flora earlier in life, as well as suppressing them to low levels consistent with health. For those exogenous periodontal infections, attempts at eradication and prevention of re-infection are likely to be effective. If the organisms are part of the indigenous flora, there is little hope of complete elimination of the organism. Criteria for distinguishing exogenous periodontal pathogens from opportunistic periodontal pathogens include the prediction that exogenous pathogens would be transient members of the oral flora associated with periodontal disease, likely to be comprised of one or a few clonal types, and intrinsically virulent. In contrast, opportunistic periodontal pathogens would likely be members of the indigenous flora and would overgrow. They would likely be comprised of many clonal types, and have an intrinsically low level of virulence.

Actinobacillus actinomycetemcomitans in the pathogenesis of human periodontal disease.

The present report reviews data implicating Actinobacillus actinomycetemcomitans in the etiology of human periodontal disease. Recent data are also presented relative to: (1) serological studies of this microorganism using monoclonal antibodies and the serodiagnosis of A. actinomycetemcomitans infections; (2) characterization of the serotype antigens; (3) studies of the serotype distribution of A. actinomycetemcomitans in extra-oral infections; and (4) examination of the correlation between A. actinomycetemcomitans colony morphology and fimbriae.

Usefulness of Subtraction Radiography in the Evaluation of Periodontal Therapy

Subtraction radiography, a sensitive and accurate technique for identifying alveolar crestal change from standardized pairs of radiographs, is useful in monitoring periodontal therapy. One half of the radiographs were found to be appropriate for subtraction analysis using present technology for taking standardized radiographs. The criterion for usability was identical interpretation of subtraction images made in duplicate from a pair of radiographs. A set of radiographs was analyzed by subtraction radiography as well as by measurement of alveolar bone-crest height. Subtraction radiography was found to be more sensitive in detecting change. Whereas 53% pairs of radiographs showed a change on subtraction radiography, only 14% showed a change in crest height. Comparison of change by subtraction radiography and probing attachment level showed an overall correlation. Since these two measures assess different aspects of the periodontium, perfect correlation was not expected.

Monitoring of Subgingival Bacteroides Gingivalis and Actinobacillus Actinomycetemcomitans in the Management of Advanced Periodontitis

In a series of clinical trials involving 79 adult periodontitis patients, we evaluated the clinical and microbiological effects of H2O2, NaHCO3, and a commercially available povidine solution, as adjuncts to mechanical periodontal debridement. Each trial included a placebo as a control. The healing response was monitored clinically by measurement of changes in probing attachment levels after treatment. The current report includes data from single-rooted teeth only. In general, healing in severely advanced periodontal lesions (initial pocket depth ≥ 7 mm) was enhanced by the use of the listed topical antimicrobial agents administered subgingivally during mechanical debridement. Correlations were sought between changes in probing attachment levels 12 months after treatment, and the presence of subgingival B. gingivalis and A. actinomycetemcomitans in the periodontal lesions. For a total of 428 lesions included in this report, B. gingivalis was detected in 53.1% of lesions showing probing attachment loss (≥1.5 mm), but in only 4.7% of lesions showing gain (≥ 1.5 mm). Either B. gingivalis or A. actinomycetemcomitans was detected in 70.1% of the lesions showing loss and in only 4.8% of those showing gain. These studies indicate the benefits of the adjunctive antimicrobial therapy described, and the usefulness of specific microbiological monitoring as an aid to clinical measurements in the evaluation of success or failure of treatment of chronic adult periodontitis.

Self-efficacy and reasoned action: Predicting oral health status and behaviour at one, three, and six month intervals

Abstract This study tested the usefulness of the theory of reasoned action and the addition of self-efficacy to this model for the prediction of oral health behaviour as part of a larger intervention at the State University of New York at Buffalo School of Dental Medicine. Self-efficacy is a belief in ones ability to perform a particular behavior. The theory of reasoned action is an attitudinal model focused on predicting behavior. One hundred and sixty-six patients volunteered for an intervention and assessment program at the Oral Health Enhancement Clinic. Participants visited the clinic 7 times over a 14 month period. Relationships among social cognitive model variables and clinical and self-report outcome measures were examined at three different time points over increasingly longer time spans. Results indicated that the theory of reasoned action model was useful in predicting oral health behavior, and adding self-efficacy to the model significantly increased the reliability of predictions of outcome...

The effect of removable partial denture framework design on gingival inflammation: A clinical model

A clinical trial using the experimental gingivitis model developed for periodontal clinical research was performed to evaluate the effect of a removable partial denture mandibular major connector design on the surrounding gingival tissues. A comparison of the state of health of adjacent gingival tissues was made between the linguoplate (control) and cingulum bar (test) major connectors. Clinical parameters were recorded in a single-blind crossover experimental gingivitis trial. Subjects were brought to a level of optimal gingival health and then randomly assigned to use one framework design while refraining from any oral hygiene. Measurements were made at 7-day intervals for 21 days. The subjects were returned to optimal oral health and repeated the experimental period with the alternate design. Results showed a greater increase in mean gingival inflammation with the control than with the test removable partial denture, suggesting that the cingulum bar has fewer detrimental effects on gingival tissues than the linguoplate major connector. Results of this study suggest that the experimental gingivitis model can be a useful and valid system for studying the potential effects of a removable partial denture design on surrounding oral tissues.

Crestal Alveolar Bone Change in Patients with Periodontitis as Observed by Subtraction Radiography: An Overview

Subtraction radiography is a highly sensitive and useful technique for detecting crestal alveolar bone changes in patients. Utilizing this technique, researchers have demonstrated that 9% of crestal sites lose bone over a six-month period in untreated subjects with periodontitis. On the order of 10-13% of crestal sites were found to lose bone three months post-periodontal therapy which included surgery. Non-surgical therapy resulted in 0.5-2% of crestal sites with bone loss. Subtraction requires radiographs which have closely approximating projection geometry. Presently available technology for taking standardized radiographs based on an occlusal stent system is adequate for obtaining interpretable subtraction images.