Ulku Baser

Initial Periodontal Treatment for Prevention of Chronic Obstructive Pulmonary Disease Exacerbations

BACKGROUND Infective exacerbations in patients with chronic obstructive pulmonary disease (COPD) are associated with increased mortality. Therefore, effective management of COPD should include prevention and reduction of exacerbations. The oral cavity is an important reservoir for the respiratory pathogens and these pathogens can be aspirated into the lower respiratory tract, increasing the risk of respiratory infection. Periodontal therapy may reduce these pathogens colonized on the surfaces of teeth and thus may reduce the frequency of COPD exacerbations. The authors aim to assess the effect of initial periodontal therapy on exacerbation frequency in COPD patients. METHODS The authors conducted a prospective, controlled group trial of initial periodontal treatment in 40 patients with COPD with chronic periodontitis (CP) and a history of ≥1 infective exacerbation in the previous year. Number of exacerbations in the previous year was recorded. Patients were divided into two groups; the test group (n = 20) included patients who had initial periodontal treatment, and the control group (n = 20) included patients who did not have periodontal therapy. Number of exacerbations during the following 12 months was noted. Periodontal parameters were measured at baseline and 6 and 12 months. RESULTS The test group showed a significant reduction in the exacerbation frequency during the follow-up period (P = 0.01). Although median exacerbations declined from 3 to 2 in the test group, they increased from 2 to 3 in the control group. CONCLUSION Initial periodontal therapy in patients with COPD with CP may decrease the exacerbation frequency.

Gingival Inflammation and Interleukin-1 β and Tumor Necrosis Factor-Alpha Levels in Gingival Crevicular Fluid During the Menstrual Cycle

BACKGROUND Hormonal changes during puberty, pregnancy, and menopause may impact periodontal tissues by altering the host response. There are only a few studies that examined gingival changes during the menstrual cycle. This longitudinal and prospective study aims to investigate clinical and laboratory markers of gingival inflammation in women at different phases during their menstrual cycles. METHODS Twenty-seven females were included in this study. Subjects were given oral hygiene instructions before the study, and their plaque index scores were recorded once a week for 2 months. The duration and regularity of the menstrual cycle were also checked at the same time. The gingival index and bleeding on probing (BOP) were recorded. Probing depths were measured to assess the periodontal condition of the subjects. Gingival crevicular fluid (GCF) was collected to analyze the levels of interleukin (IL)-1beta and tumor necrosis factor-alpha on the first menstruation day (MD), estimated ovulation day (OD), and estimated predominant progesterone secretion day (PgD). These exact menstrual cycle days were determined according to serum progesterone and estradiol levels. RESULTS BOP and IL-1beta levels in GCF showed significant increases from the MD to PgD under optimal plaque control. Among the 12 subjects that had premenstrual symptoms, six subjects reported oral complaints during the premenstrual period, whereas apthous lesions were more frequent during the menstruation period. CONCLUSION These results demonstrate that the fluctuation of sex steroid hormones impact gingival inflammation during menstruation.

The Association between Periodontal Disease and Chronic Obstructive Pulmonary Disease: A Case Control Study

Abstract Introduction: Although there are studies evaluating the effects of periodontal health on chronic obstructive pulmonary disease (COPD), the effects of COPD – a systemic disease, on periodontal tissue is unknown. The aim of this study is to evaluate the effects of COPD on periodontal tissues by comparing COPD patients and controls. Methods: Fifty-two COPD patients and 38 non-COPD controls were included in this case-control study. Number of teeth, plaque index (PI), gingival index (GI), bleeding on probing, clinical attachment level and probing depth were included in the periodontal examination. In addition to clinical evaluations, gingival crevicular fluid (GCF) levels of high-sensitive C-reactive protein (hs-CRP), interleukin-1 beta (IL-lb) and prostaglandin-E2 (PGE2), and serum hs-CRP levels were measured in COPD patients and the controls. Results: The number of teeth was significantly lower while PI and GI were significantly higher in COPD patients when compared to the controls. As well as serum hs-CRP levels, the GCF levels of hs-CRP, IL-1b and PGE2 were significantly higher in COPD patients than the controls. Conclusion: Our results demonstrated that COPD may be associated with periodontal disease as manifested by lower number of teeth and higher levels of inflammatory mediators especially CRP in GCF. This finding may be a reflection of systemic effects of COPD on periodontal tissues. Poor oral health behavior of COPD patients have to be considered in larger size group studies in the future.

Plasma and salivary total antioxidant capacity in healthy controls compared with aggressive and chronic periodontitis patients

Objectives: To evaluate the plasma and salivary total antioxidant capacity (TAOC) in patients with generalized chronic periodontitis (CP), generalized aggressive periodontitis (AgP), and periodontally healthy controls. Methods: This cross-sectional study includes of 88 individuals seeking dental treatment at the Faculty of Dentistry, Istanbul University, Istanbul, Turkey between January 2011 and March 2012. Fifteen AgP patients were compared with 21 healthy controls (C1), while 36 CP patients were compared with 16 healthy controls (C2). Clinical periodontal measurements were recorded, and plasma and saliva samples were collected. The TAOC of the plasma and saliva samples were determined using a commercially available colorimetric kit. Results: The plasma TAOC of both AgP and CP patients was significantly lower for C1 and C2. The salivary TAOC of CP patients was significantly lower for C2, but there was no significant difference between AgP patients and C1. Conclusion: Our results demonstrate that severe periodontitis may be associated with a lower plasma antioxidant capacity. The reduced antioxidant capacity in patients with severe periodontitis, especially with aggressive forms may be an important contributing factor to severe tissue destruction.

Comparison of manual toothbrushes with different bristle designs in terms of cleaning efficacy and potential role on gingival recession

Objective: The aim was to compare the efficacy of plaque control and potential effects on gingival recession of the toothbrushes with angled and straight bristles. Materials and Methods: A total of 40 healthy dental students (25 females and 15 males; age range: 23-25 years) participated and two study groups were constituted. Participants were randomly distributed into two groups to use either angled or standard design manual tooth brushes with soft bristles. Oral hygiene indicators and soft tissue levels were monitored for 6 months. Plaque index, gingival index (GI), probing depth, clinical attachment level, and bleeding on probing were measured at six sites. Vertical recession (VR) and horizontal recession (HR) were also recorded. All measurements were repeated at 3 and 6 months. Results: Plaque scores were reduced significantly at 6 months compared to baseline in both groups (P < 0.05 and P < 0.005 in criss-cross and standard design brushes, respectively). Mean GI scores of the criss-cross design were reduced significantly at 6 months (P < 0.05). Inter-group comparisons revealed that gingival recession (GR) values were not statistically significant (P > 0.05) at baseline, 3 and 6 months suggesting no pronounced impact of bristle design in terms of GR (VR = 0.596, HR = 0.572; VR = 0.884, HR = 0.572; VR = 0.884, HR = 0.572 in the groups). Conclusions: Bristle design has little impact on plaque removal capacity of a toothbrush. Both designs are safe enough to prevent GR as long as soft bristle material is used.

Does Obstructive Sleep Apnea Increase the Risk for Periodontal Disease?: A Case-control Study.

BACKGROUND A possible association between periodontitis and obstructive sleep apnea (OSA) has been suggested. The aim of this study is to compare periodontitis prevalence between controls and patients with OSA by assessing clinical periodontal parameters and gingival crevicular fluid (GCF) levels of interleukin (IL)-1β, tumor necrosis factor (TNF)-α, and high-sensitive C-reactive protein (hs-CRP); serum hs-CRP was also sampled. METHODS A case-control study was performed that included 163 individuals: 83 individuals (18 females and 65 males) with OSA and 80 non-OSA individuals (23 females and 57 males) as controls. The test group was classified according to OSA severity. Clinical periodontal measurements were recorded, and GCF samples were collected. GCF hs-CRP, IL-lβ, and TNF-α levels were analyzed using an enzyme-linked immunosorbent assay method. Serum hs-CRP was measured by latex-enhanced immunoturbidimetric assay. RESULTS Prevalence of periodontitis in the OSA group (96.4%) was significantly higher than in the control group (75% [P <0.001]). Severe periodontitis prevalence was higher in the OSA group than control group. All periodontal clinical parameters and GCF IL-lβ concentrations were significantly higher in patients with OSA than in controls (P = 0.001). No significant differences were found between the mild OSA and moderate-to-severe OSA groups. Additionally, there was no significant difference in GCF TNF-α and hs-CRP levels between the groups (P >0.05). Serum hs-CRP levels were significantly higher in patients with OSA. A significant correlation was found between GCF IL-1β and all clinical parameters. CONCLUSIONS Results demonstrated higher prevalence of periodontitis and higher levels of GCF IL-1β and serum hs-CRP in patients with OSA. However, there is still a need for randomized clinical trials testing oral care interventions.

Evaluation of gingival bleeding awareness by comparison of self-reports and clinical measurements of freshman dental students

Objective: The aims of this descriptive, cross-sectional investigation were to evaluate the gingival health awareness of dental students by comparing their clinical gingival bleeding scores and self-reports, and to compare differences in awareness between males and females. Methods: In total, 100 (51 males, 49 females) freshman dental students were included in the study. Periodontal indices recorded were: Presence of plaque percentage (plaque index [PI], %), percentage of sites of bleeding on probing (BOP, %), probing depth, and community periodontal index (CPI). Percent agreement, kappa agreement, sensitivity, and specificity were calculated by comparing their self-reported gingival bleeding and BOP%. Results: The self-reports of gingival bleeding exhibited statistically significant correlations with BOP% in females (r = 0.42, P = 0.003). Female students showed a higher degree of awareness when kappa agreement, 0.23 (males: 0.16, females: 0.39), sensitivity, 48% (males: 42%, females: 51%), and specificity, 95% (males: 90%, females: 100%) were calculated. Although male dental students had higher PI and CPI scores, there was no significant difference by gender in the clinical measurements. Conclusions: According to our results, the validity of self-reported gingival bleeding was higher among dental students than in previous population-based studies. Female dental students showed a higher degree of awareness than males of their gingival health. Half of the included dental students could not differentiate whether they had gingival bleeding when there was actual bleeding. More emphasis should be given to the education of dental students regarding the relationship between gingival bleeding and active periodontal disease.

PERIODONTAL TREATMENT OUTCOMES IN POST MENOPAUSAL WOMEN RECEIVING HORMONE REPLACEMENT THERAPY

Purpose: To evaluate the effect of hormone replacement therapy(HRT) on periodontal treatment outcomes in a group of postmenopausal women with periodontitis. Materials and Methods: 23 post-menopausal chronic periodontitis patients were included in this study. The test group(n=11) consisted of women who started HRT with this study and received conjugated estrogen and medroxyprogesteron. The control group(n=12) was women not taking any HRT or supplement therapy. Study groups received the same periodontal treatment. All subjects examiend by recording the following: plaque index (PI), sulcus bleeding index (SBI), periodontal pocket depth (PD) and relative attachment level (RAL) from 6 sites in each tooth. Measurements were recorded at the baseline, 1 month, 3 months, and 6 months following periodontal treatment. Serum estrogene level and bone mineral density was recorded at baseline and 6 months following periodontal treatment. Results: The GI change was greater in the control group. There wasn’t significant difference by means of PD, the attachment gain was significantly greater in the HRT receiving group. Conclusion: HRT seems to have a positive effect on periodontal treatment outcomes.

The Effect Of İnitial Periodontal Therapy On Saliva And Plasma Total Antioxidant Capacity Of Non-Smoking Periodontitis Patients

Aim: Periodontal diseases are associated with increased oxidative stress and decreased antioxidant capacity. The aim of this long-term follow-up study was to evaluate the effect of initial periodontal therapy on saliva and plasma total antioxidant levels of severe chronic periodontitis patients and the controls. Material and Methods: A total of 34 (17 chronic periodontitis patients, 17 controls) non-smoking, systemically healthy subjects were enrolled in the study. At baseline, blood and saliva samples were collected; periodontal clinical measurements such as gingival index, bleeding on probing, probing pocket depth and clinical attachment level were done. 2 and 6 months after periodontal treatment clinical measurements and sample collection were repeated in periodontitis group. 2 and 6 months after the periodontal treatment. Total antioxidant capacity (TAOC) were measured by the trolox equivalent antioxidant assay. Results: Clinical periodontal parameters were higher in the periodontitis group and significantly improved after periodontal therapy. At baseline TAOC plasma levels were higher in the controls but the difference was not significant (p=0.07). TAOC plasma levels significantly increased after initial periodontal treatment in periodontitis patients (p<0.01). Saliva TAOC levels were similar between the groups and did not show any significant change after initial periodontal therapy. Conclusion: According to our study results initial periodontal therapy have positively effected TAOC plasma levels of severe periodontitis patients.