Masato Minabe

Salivary pathogen and serum antibody to assess the progression of chronic periodontitis: a 24-mo prospective multicenter cohort study

BACKGROUND AND OBJECTIVE A diagnosis of periodontitis progression is presently limited to clinical parameters such as attachment loss and radiographic imaging. The aim of this multicenter study was to monitor disease progression in patients with chronic periodontitis during a 24-mo follow-up program and to evaluate the amount of bacteria in saliva and corresponding IgG titers in serum for determining the diagnostic usefulness of each in indicating disease progression and stability. MATERIAL AND METHODS A total of 163 patients with chronic periodontitis who received trimonthly follow-up care were observed for 24 mo. The clinical parameters and salivary content of Porphyromonas gingivalis, Prevotella intermedia and Aggregatibacter actinomycetemcomitans were assessed using the modified Invader PLUS assay, and the corresponding serum IgG titers were measured using ELISA. The changes through 24 mo were analyzed using cut-off values calculated for each factor. One-way ANOVA or Fishers exact test was used to perform between-group comparison for the data collected. Diagnostic values were calculated using Fishers exact test. RESULTS Of the 124 individuals who completed the 24-mo monitoring phase, 62 exhibited periodontitis progression, whereas 62 demonstrated stable disease. Seven patients withdrew because of acute periodontal abscess. The ratio of P. gingivalis to total bacteria and the combination of P. gingivalis counts and IgG titers against P. gingivalis were significantly related to the progression of periodontitis. The combination of P. gingivalis ratio and P. gingivalis IgG titers was significantly associated with the progression of periodontitis (p = 0.001, sensitivity = 0.339, specificity = 0.790). CONCLUSIONS It is suggested that the combination of P. gingivalis ratio in saliva and serum IgG titers against P. gingivalis may be associated with the progression of periodontitis.

Bone trabecular pattern analysis in Down's syndrome with the use of computed panoramic tomography with a laser scan system: Quantitative analysis with the power spectrum method

A quantitative analysis of the mandibular bone trabeculae of 44 patients with Downs syndrome and 68 normal persons by means of panoramic tomography was performed with a laser scan system. The results showed that the normal persons exhibited a correlation between the trabecular pattern and aging, whereas the patients with Downs syndrome showed no such correlation. These findings were consistent with geromorphism, which is one of the systemic features of Downs syndrome.

Assessing the progression of chronic periodontitis using subgingival pathogen levels: a 24-month prospective multicenter cohort study

BackgroundThe diagnosis of the progression of periodontitis presently depends on the use of clinical symptoms (such as attachment loss) and radiographic imaging. The aim of the multicenter study described here was to evaluate the diagnostic use of the bacterial content of subgingival plaque recovered from the deepest pockets in assessing disease progression in chronic periodontitis patients.MethodsThis study consisted of a 24-month investigation of a total of 163 patients with chronic periodontitis who received trimonthly follow-up care. Subgingival plaque from the deepest pockets was recovered and assessed for bacterial content of Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans using the modified Invader PLUS assay. The corresponding serum IgG titers were measured using ELISA. Changes in clinical parameters were evaluated over the course of 24 months. The sensitivity, specificity, and prediction values were calculated and used to determine cutoff points for prediction of the progression of chronic periodontitis.ResultsOf the 124 individuals who completed the 24-month monitoring phase, 62 exhibited progression of periodontitis, whereas 62 demonstrated stable disease. The P. gingivalis counts of subgingival plaque from the deepest pockets was significantly associated with the progression of periodontitis (p < 0.001, positive predictive value = 0.708).ConclusionsThe P. gingivalis counts of subgingival plaque from the deepest pockets may be associated with the progression of periodontitis.

Analysis of the relationship between periodontal disease and atherosclerosis within a local clinical system: a cross-sectional observational pilot study

AbstractIt has been revealed that atherosclerosis and periodontal disease may have a common mechanism of “chronic inflammation”. Several reports have indicated that periodontal infection is related to atherosclerosis, but none have yet reported such an investigation through the cooperation of local clinics. This study was performed in local Japanese clinics to examine the relationship between periodontal disease and atherosclerosis under collaborative medical and dental care. A pilot multicenter cross-sectional study was conducted on 37 medical patients with lifestyle-related diseases under consultation in participating medical clinics, and 79 periodontal patients not undergoing medical treatment but who were seen by participating dental clinics. Systemic examination and periodontal examination were performed at baseline, and the relationships between periodontal and atherosclerosis-related clinical markers were analyzed. There was a positive correlation between LDL-C level and plasma IgG antibody titer to Porphyromonas gingivalis. According to the analysis under adjusted age, at a cut-off value of 5.04 for plasma IgG titer to Porphyromonas gingivalis, the IgG titer was significantly correlated with the level of low-density lipoprotein cholesterol (LDL-C). This study suggested that infection with periodontal bacteria (Porphyromonas gingivalis) is associated with the progression of atherosclerosis. Plasma IgG titer to Porphyromonas gingivalis may be useful as the clinical risk marker for atherosclerosis related to periodontal disease. Moreover, the application of the blood examination as a medical check may lead to the development of collaborative medical and dental care within the local medical clinical system for the purpose of preventing the lifestyle-related disease.

Associations among tooth loss, systemic inflammation and antibody titers to periodontal pathogens in Japanese patients with cardiovascular disease

BACKGROUND AND OBJECTIVE It is well known that there is a strong relationship between periodontitis and cardiovascular disease (CVD). Tooth loss reflects an end-stage condition of oral diseases, such as periodontitis. Infection with specific periodontal pathogens is known as a possible factor that influences development of CVD. The aim of this study was to assess the relationship between the number of residual teeth and systemic inflammatory conditions in patients with CVD. MATERIAL AND METHODS We divided 364 patients with CVD into four groups, according to the number of residual teeth: (i) ≥20 teeth; (ii) 10-19 teeth; (iii) 1-9 teeth; and (iv) edentulous. We recorded medical history, blood data and periodontal conditions. Serum samples were obtained and their IgG titers against three major periodontal pathogens were measured. RESULTS Smoking rate and the prevalence of diabetes mellitus were higher in edentulous patients and in subjects with a few teeth compared with patients with many teeth. The levels of C-reactive protein were higher in patients with 1-9 teeth than in those with 10-19 teeth and with ≥20 teeth. The level of Porphyromonas gingivalis IgG in the group with 10-19 teeth was statistically higher than that in the group with ≥20 teeth. The level of P. gingivalis IgG in the edentulous group tended to be lower than that in the other groups. CONCLUSION The patients with 1-9 teeth had the highest level of C-reactive protein among the four groups, and the patients with 10-19 teeth had the highest level of IgG to periodontal bacteria. We conclude that the number of remaining teeth may be used to estimate the severity of systemic inflammation in patients with CVD.

Guided tissue regeneration using a collagen barrier and bone swaging technique in noncontained infrabony defects.

This clinical study evaluated the effectiveness of guided tissue regeneration using a resorbable collagen membrane and bone swaging in noncontained infrabony defects by assessing changes in probing pocket depth, probing attachment level, and radiographic bone level after 6 months, 1 year, and 2 years. Postsurgical clinical and radiographic measurements were statistically significantly different from presurgical measurements. The rate of bone fill was positively associated with the baseline depth of the bone defect but not associated with the width. The noncontained infrabony defects treated with this combined regenerative method improved clinically and radiographically.

Effects of periodontal treatment on carotid intima-media thickness in patients with lifestyle-related diseases: Japanese prospective multicentre observational study

Atherosclerosis, a chronic inflammatory disease in arterial blood vessels, is one of the major causes of death in worldwide. Meanwhile, periodontal disease is a chronic inflammatory disease caused by infection with periodontal pathogens such as P. gingivalis (Porphyromonas gingivalis). Several studies have reported association between periodontal infection and atherosclerosis, but direct investigation about the effects of periodontal treatment on atherosclerosis has not been reported. We have planned Japanese local clinics to determine the relationship between periodontal disease and atherosclerosis under collaborative with medical and dental care. A prospective, multicentre, observational study was conducted including 38 medical patients with lifestyle-related diseases in the stable period under consultation at participating medical clinics and 92 periodontal patients not undergoing medical treatment but who were consulting at participating dental clinics. Systemic and periodontal examinations were performed before and after periodontal treatment. At baseline, LDL-C (low-density lipoprotein cholesterol) levels and percentage (%) of mobile teeth were positively related to plasma IgG (immunoglobulin) antibody titer against P. gingivalis with multivariate analysis. Corresponding to improvements in periodontal clinical parameters after treatment, right and left max IMT (maximum intima-media thickness) levels were decreased significantly after treatment (SPT-S: start of supportive periodontal therapy, SPT-1y: at 1 year under SPT, and SPT-3y: at 3 years under SPT). The present study has clarified our previous univariate analysis results, wherein P. gingivalis infection was positively associated with progression of atherosclerosis. Thus, routine screening using plasma IgG antibody titer against P. gingivalis and periodontal treatment under collaborative with medical and dental care may prevent cardiovascular accidents caused by atherosclerosis.

Japanese Cardiovascular Disease Patients with Diabetes Mellitus Suffer Increased Tooth Loss in Comparison to Those without Diabetes Mellitus -A Cross-sectional Study

Objective Tooth loss is an irreversible condition that reflects the end-stage of oral diseases, including periodontitis. Although periodontitis is a major factor in the progression of diabetes mellitus (DM) and cardiovascular disease (CVD), no previous studies have compared tooth loss in CVD patients with and without DM. Methods The subjects included CVD patients with (n=94) and without (n=145) DM who attended Tokyo Medical and Dental University Hospital. Blood examinations and periodontal measurements were performed. Results The oral and periodontal examinations revealed that the numbers of missing teeth in the DM group were increased in comparison to the non-DM group. There was no significant difference between the groups with regard to the incidence of edentulism, the probing pocket depth, the clinical attachment level or the incidence of bleeding on probing. Conclusion We showed that the numbers of missing teeth among CVD patients with DM was significantly higher than that among CVD patients without DM.

Relationship between non-alcoholic fatty liver disease and periodontal disease: a review and study protocol on the effect of periodontal treatment on non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease that is prevalent worldwide. Non-alcoholic steatohepatitis (NASH) is an advanced form of NAFLD and carries the risk of progression from hepatic inflammation and fibrosis to cirrhosis and hepatocellular carcinoma. Pathological mechanisms of NAFLD have been proposed, such as the two-hit hypothesis and the multiple parallel hit hypothesis. Periodontal disease is a chronic infectious disease of the tissues surrounding the teeth that result in tooth loss. Several reports have indicated that periodontal infection is related to NAFLD. NAFLD and periodontal disease are chronic inflammatory conditions that are known as ‘silent diseases’. Therefore, both conditions need to be detected early and treated under collaborative medical and dental care in order to prevent progression to NASH. For this purpose, further investigations in humans on the relationship between NAFLD and periodontal disease and on the effect of periodontal treatment on NAFLD are necessary. In this paper, studies on the relationship between NAFLD and periodontal disease are reviewed and a clinical study investigating the effect of periodontal treatment on NAFLD is introduced. Introduction Several studies in recent years have reported on the relationship between systemic disease and periodontal disease [1,2]. It has been reported that chronic periodontal disease is related to conditions, such as diabetes mellitus (DM), atherosclerosis and heart disease [3-6]. We have previously reported that infection with periodontal pathogens is associated with the progression of atherosclerosis [7]. Fatty liver disease, which is one of the causes of atherosclerosis [8,9], includes non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD) [10]. NAFLD (in which fat accumulates in the liver without a history of drinking or immune system disease) has gained attention worldwide. NAFLD includes simple steatosis and nonalcoholic steatohepatitis (NASH), which is characterized by a chronic and progressive liver pathology [11]. The prevalence of NAFLD in the American general adult population is 10%-40% and that of NASH is approximately 2%-5% [12]. Recent animal and human investigations have indicated that NAFLD/NASH is related to periodontal disease [13,14]. As patients with liver or periodontal disease have few subjective and early symptoms, the diseases are often severe when they are discovered at medical institutions. [15,16]. Therefore, early detection and treatment under collaborative medical and dental care is important to prevent progression to NASH, which may then develop into cirrhosis or liver cancer. Further investigations in humans on the relationship between NAFLD and periodontal disease and on the effect of periodontal treatment on NAFLD are desired. This paper reviews studies on NAFLD and periodontal *Correspondence to: Dr. Chieko Kudo, DDS, PhD, Lecturer, Division of Periodontology, Department of Oral Function and Restoration, Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan, Tel: +81-46-822-8855; E-mail: kudo@kdu.ac.jp

Basic study of the Effects of Minocycline HCl on Periodontally-involved Root Surfaces.

本研究は機械的根面清掃を行った歯周病罹患歯根面に対するミノサイクリン水溶液の根面処理効果について, 細菌学的および形態学的観察を行った。被験歯は歯周疾患により保存不可能と診断された58歯を使用した。各試験片の根の片側をCont群 (視覚的に確認できる歯石のみを除去) とし, 一方の片側をPolish群 (歯根表面のポリッシング), SL群 (セメント質表層のルートプレーニング), DL群 (象牙質までルートプレーニング) のいずれかに振り分けた。ミノサイクリンのPorphynomonas gingivalisに対する抗菌活性, ミノサイクリンの根面内浸透性および根表面への沈着率について観察を行った。その結果, 抗菌活性はミノサイクリン処理後0日目および7日目ともに各群で認められ, 特にDL群で高い活性を示した (0日目と7日後の平均はそれぞれ94.8 Unit (p<0.01) と54.1 Unit (p<0.05))。根面内浸透性はCont群では平均11.4μmであるのに対し, SL群では21.5μm, DL群では42.7μmと, 多群間で有意に高い浸透性が認められた (P<0.01)。根表面へのミノサイクリンの沈着率は, Cont群の87.0%に対し, SL群は92.8%, DL群は97.4%と多群間で有意に高い沈着率を示した (P<0.01)。以上のことから, セメント質を残存させた処置においてもミノサイクリンの根面処理効果が期待できることが示唆された。