Ya-Ping Ho

The levels of volatile sulfur compounds in mouth air from patients with chronic periodontitis

BACKGROUND AND OBJECTIVE Volatile sulfur compounds may be the main source of oral malodor. The aim of this study was to clarify the relationship between periodontal parameters and volatile sulfur compounds and to evaluate the improvement of several halitosis-related outcomes by tongue scraping, nonsurgical periodontal treatment (including oral hygiene instruction) and oral hygiene instruction/chlorhexidine + cetyl pyridinium gargling. MATERIAL AND METHODS Seventy-two chronic periodontitis patients with heavy tongue coating were assessed for oral malodor and periodontal status. Oral malodor was evaluated by measuring the levels of volatile sulfur compounds using OralChroma and the organoleptic test score. Thirty participants were selected for the subsequent experiments: tongue scraping; nonsurgical periodontal treatment; and oral hygiene instruction/chlorhexidine + cetyl pyridinium gargling. Twenty-five participants completed all experimental stages. RESULTS Significant correlations were observed between the organoleptic test score and hydrogen sulfide (H2S), methyl mercapton (CH3SH), tongue coating score and volatile sulfur compounds, which was also significantly correlated with bleeding on probing percentage and tongue coating score. Tongue scraping significantly reduced the levels of volatile sulfur compounds. Further reduction of volatile sulfur compounds after nonsurgical periodontal treatment and oral hygiene instruction/chlorhexidine + cetyl pyridinium gargling were noted compared with baseline. CONCLUSION Volatile sulfur compounds, with H2S and CH3SH as the main components, in mouth air are the prominent elements of malodor. Volatile sulfur compounds were decreased by more than 50% after tongue scraping. Nonsurgical periodontal treatment and oral hygiene instruction/chlorhexidine + cetyl pyridinium gargling maintained a significantly lower level of malodor compared with baseline.

Changes in Gingival Crevicular Fluid Interleukin-4 and Interferon-gamma in Patients with Chronic Periodontitis Before and After Periodontal Initial Therapy

Cytokines are pivotal to the immune response of chronic periodontitis. The present study investigated the changes of gingival crevicular fluid (GCF) interleukin‐4 (IL‐4) and interferon‐gamma (IFN‐γ) in patients with chronic periodontitis before and after initial nonsurgical periodontal therapy (NSPT). GCF was collected from 17 patients by means of Periopaper® at baseline and 1 month after NSPT. IL‐4 and IFN‐γ were measured by enzyme‐linked immunoabsorbent assay. NSPT resulted in decreased total amount of IFN‐γ, increased concentration of IL‐4, and increased ratio of IL‐4 to IFN‐γ levels. We suggest that a low ratio of IL‐4 to IFN‐γ levels might be involved in the destruction (diseased sites) of periodontal tissue, whereas an increased ratio of IL‐4 to IFN‐γ levels could be related to the improvement of clinical periodontal health.

Cyclooxygenase-2 Gene-765 single nucleotide polymorphism as a protective factor against periodontitis in Taiwanese.

AIM Prostaglandin E(2) (PGE(2)) is considered to be an important mediator of tissue destruction in periodontitis. The cyclooxygenase (COX) catalyses the production of PGs. COX-2, which is induced in an inflammatory response, is responsible for PGs synthesis at sites of inflammation. A single nucleotide polymorphism of COX-2(-765) has been shown to alter the expression of the COX-2 gene. The purpose of the present study was to evaluate the association of the COX-2(-765) polymorphism and susceptibility to periodontitis in Taiwanese. MATERIAL AND METHODS Eighty-five cases of aggressive periodontitis (AgP), 343 cases of chronic periodontitis (CP) and 153 cases of healthy controls (HC) were recruited for the study. Genotypes of COX-2(-765) were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The distribution of genotypes among groups was compared by logistic regression analyses. The risk for periodontitis associated with genotypes was calculated as the odds ratio (OR). RESULTS The prevalence of the GC and CC genotypes was significantly lower in AgP (5%) and in CP (29%) compared with the HC (42%). The ORs for carriage of the -765C allele (GC+CC versus GG) in AgP and CP were 0.068 (95% CI=0.020-0.173, p<0.0001) and 0.571 (95% CI=0.385-0.849, p=0.006), respectively. After adjustment for age, gender and smoking status, the OR was 0.071 (95% CI=0.017-0.219) and 0.552 (95% CI=0.367-0.829) for AgP and CP, respectively. CONCLUSIONS The results of the study suggest that the -765G to C polymorphism of the COX-2 gene is associated with a decreased risk for periodontitis in Taiwanese, especially in AgP. However, the biological meaning needs further investigation.

Association between lactoferrin gene polymorphisms and aggressive periodontitis among Taiwanese patients

BACKGROUND AND OBJECTIVE A dramatic difference in the frequencies of the Lys/Arg single nucleotide polymorphism in the lactoferrin genotype between a small population of patients with localized juvenile periodontitis and healthy subjects has been reported. As the single nucleotide polymorphism could be associated with ethnicity, the present study aimed to investigate the association between polymorphisms of the lactoferrin gene and periodontitis. MATERIAL AND METHODS Sixty-five patients with aggressive periodontitis, 278 with chronic periodontitis and 88 healthy controls were genotyped for the Lys/Arg polymorphism of the lactoferrin gene at position 29 [reference sequence (rs) 1126478] in the N-terminal alpha-helical region. RESULTS The frequencies of the GG genotype and the G allele were highest in the aggressive periodontitis group, followed by the chronic periodontitis group and then the healthy controls. The frequency of the G allele was significantly higher in aggressive periodontitis and chronic periodontitis groups than in healthy controls (p = 0.0037 and 0.0212). Although the difference of the GG genotype distribution between subjects with chronic periodontitis and healthy controls did not reach significance, the distribution of genotypes between aggressive periodontitis and healthy controls was significantly different. The association of the gene polymorphism and aggressive periodontitis still existed, even after adjusting for age, gender and smoking status by logistic regression analysis (GG/AG+AA: odds ratio = 2.16, 95% confidence interval = 1.09-4.35, p = 0.0287). After the study, subjects were further stratified by their smoking status; the GG genotype was still significantly associated with the risk of aggressive periodontitis in the nonsmoking group (odds ratio = 2.69, p = 0.018). However, there were no statistical differences between chronic periodontitis vs. healthy controls and aggressive periodontitis vs. healthy controls in the smoking group. CONCLUSION The present study revealed that the A/G polymorphism in the lactoferrin gene might be associated with aggressive periodontitis. The A allele might reduce the risk of development of aggressive periodontitis in a Taiwanese population. Our results also support the hypothesis that lactoferrin genetic polymorphisms could play a role in the risk for periodontitis separate from the smoking factor. The functionality of this genes polymorphisms has to be further elucidated.

Interleukin-10 (−592 C/A) and interleukin-12B (+16974 A/C) gene polymorphisms and the interleukin-10 ATA haplotype are associated with periodontitis in a Taiwanese population

BACKGROUND AND OBJECTIVE Single nucleotide polymorphisms are assumed to be associated with the differential production of cytokines. We evaluated gene polymorphisms of interleukin-10 (-592C>A, -819C>T and -1082G>A) and interleukin-12B (+16974) in patients with chronic periodontitis (n = 145) and generalized aggressive periodontitis (n = 65) in comparison with healthy controls (n = 126). MATERIAL AND METHODS Gene promoter polymorphisms were analyzed by polymerase chain reaction with sequence-specific primers. Genotype and allele frequencies were analyzed using the chi-square test and logistic regression analysis. RESULTS The interleukin-10 -592 polymorphism showed significant differences among the three groups (p = 0.0330). The genotype frequencies of the -592 locus between the chronic periodontitis and healthy control groups were significantly different (AC vs. AA: odds ratio = 0.33). The combination ATA/ATA seemed to be associated with susceptibility to generalized aggressive periodontitis (p = 0.0276). Patients with the composite ATA/ACC were less likely to develop chronic periodontitis (p = 0.0248). The CC genotype of interleukin-12B (+16974) was related to chronic periodontitis (CC vs. AA, p = 0.0211; CC vs. AA+AC, p = 0.0187). The AC heterozygosity of interleukin-12B was significantly lower in chronic periodontitis vs. healthy controls (p = 0.0500). CONCLUSION The interleukin-10 gene polymorphism at position -592C>A may be associated with a lower risk for development of chronic periodontitis. The interleukin-10 haplotype ATA is associated with generalized aggressive periodontitis. On the other hand, interleukin-12B genetic variants at position +16974 are associated with susceptibility to chronic periodontitis.

Potential Role of Vascular Endothelial Growth Factor, Interleukin-8 and Monocyte Chemoattractant Protein-1 in Periodontal Diseases

Host‐mediated immunoinflammatory pathways activated by bacteria lead to destruction of the periodontal connective tissues and alveolar bone. The objective of this study was to elucidate the activation of the inflammatory processes in periodontal disease by quantitative assessment of cytokines and periodontopathogens. Gingival crevicular fluids (GCF) and subgingival plaque samples were collected from patients with chronic periodontitis and gingivitis and from periodontally healthy sites. Vascular endothelial growth factor (VEGF), monocyte chemoattractant protein‐1 (MCP‐1), and interleukin 8 (IL‐8) in GCF were analyzed by enzyme‐linked immunosorbent assay. Periodontopathogens, including Bacteroides forsythus, Campylobacter rectus, Porphyromonas gingivalis and Prevotella intermedia, were analyzed by immunofluorescence and dark‐field microscopy. There was significantly more VEGF and IL‐8 in chronic periodontitis and gingivitis sites than in periodontally healthy sites. There were significant positive correlations between the concentrations and total amounts of VEGF and IL‐8 in chronic periodontitis and gingivitis sites, and between the levels of periodontopathogens and the total amounts of VEGF, MCP‐1 and IL‐8. These data indicate that inflammatory processes induced by periodontopathogens and the activation of certain cytokines (VEGF, MCP‐1, IL‐8) in periodontal diseases may be relevant to host‐mediated destruction in chronic periodontitis.

Investigation of interleukin-13 gene polymorphisms in individuals with chronic and generalized aggressive periodontitis in a Taiwanese (Chinese) population

BACKGROUND AND OBJECTIVE The interleukin-13 (IL-13) -1112 C/T polymorphisms have been analyzed previously in a North European population of patients with aggressive periodontitis. The present study was carried out to investigate the association of polymorphisms in the IL-13 gene with susceptibility to periodontitis in a Taiwanese population. MATERIAL AND METHODS The genotyping of IL-13 -1112 C/T polymorphisms in 60 patients with aggressive periodontitis, 204 patients with chronic periodontitis and 95 healthy controls was carried out using the polymerase chain reaction-restriction fragment length polymorphism technique. Genotypes and allele frequencies among study groups were compared using Fishers exact test (p < 0.05). Pearsons chi-square test was used for analysis of the Hardy-Weinberg equilibrium. RESULTS The distributions of CC genotypes and C alleles between patients with aggressive periodontitis and healthy controls were significantly different (p = 0.034 and 0.046). After adjustment for age, gender, betel nut chewing and smoking status using logistic regression analysis, the odds ratio (OR) was 6.45 [95% confidence interval (CI) = 1.99-23.72, p = 0.003] for aggressive periodontitis. However, the CC genotype was only significantly associated with the risk of aggressive periodontitis in the nonsmoking group (OR = 4.48, 95% CI = 1.31-16.93, p = 0.020). CONCLUSION The CC genotype or C allele appears to increase the risk of developing aggressive periodontitis in Taiwanese subjects.

An Interdisciplinary Treatment Approach Combining Orthodontic Forced Eruption with Immediate Implant Placement to Achieve a Satisfactory Treatment Outcome: A Case Report

BACKGROUND Periodontal disease often results in severely bony defects around the teeth and leads to eventual extraction. Remaining bone morphology often compromises ideally restoration-driven positions and deteriorates the success rates for dental implants. PURPOSE The present investigation illustrates the clinical outcome of immediately installing an implant following orthodontic forced eruption and atraumatic extraction. MATERIAL AND METHODS The subject of this study is a 40-year-old Asian female with a right mandibular first molar that had a deep probing depth on the mesial side and mobility. Via the aid of radiographic examination, the tooth that had an angular bony defect and apical lesion was diagnosed as having deep caries and chronic periodontitis with a poor prognosis. After consultation with the patient, we developed a treatment plan incorporating a forced eruption with immediate implantation, intended to augment the alveolar bone volume and increase the width of keratinized gingivae, in a nonsurgical manner. RESULTS Following 12 months of orthodontic treatment, the tooth was successfully moved occlusally in conjunction with an 8 mm vertical interdental bone augmentation. Because of sufficient volume of bone and satisfactory gingival dimensions, the implant showed adequate initial stability in the correct position to facilitate physiological and aesthetic prerequisites. After 6 months of osteointegration, a customized impression coping was utilized to transfer the established emergence profile to a definitive cast for the fabrication of a customized abutment. The final prosthesis was made using a customized metal abutment and ceramometal crown. CONCLUSION In the face of difficult clinical challenges, meticulous inspection and a comprehensive treatment plan were crucial. Interdisciplinary treatment through the careful integration of multiple specialists suggests the possibility of optimal results with high predictability.

The association of Fcγ receptor IIIb genetic polymorphism and susceptibility to periodontitis in Taiwanese individuals

AIM The allelic polymorphism of FcgammaRIIIb, the neutrophil-specific receptor involved in the phagocytosis of immunoglobulin G-opsonized bacteria, has functionally distinct capacities that are important in host defence mediated by neutrophils. The aim of this study was to identify whether the polymorphism of FcgammaRIIIb is associated with periodontitis in Taiwanese individuals. MATERIALS AND METHODS This case-control study included of 93 aggressive periodontitis (AgP) patients, 372 chronic periodontitis (CP) patients and 158 healthy controls (HC). The FcgammaRIIIb genotypes were determined by PCR using allele-specific primers. The risk for periodontitis associated with genotypes was calculated as the odds ratio (OR). RESULTS A significant difference was observed in the distribution of the FcgammaRIIIb genotype between either AgP and HC, or AgP and CP, but not between CP and HC. The OR for carriage of the NA2 allele (NA1NA2+NA2NA2 versus NA1NA1) in AgP was 3.27 [95% confidence interval (CI)=1.57-7.51, p=0.0027] and 2.94 (95% CI=1.49-6.48, p=0.0037), as compared with HC and CP. After adjusting for possible confounding factors, the association was still significant. CONCLUSIONS The results of the present study suggest that subjects carrying at least one copy of the FcgammaRIIIb-NA2 allele might be associated with susceptibility to AgP. However, the clinical implications of the FcgammaRIIIb allelic polymorphism should be determined by further studies.

New Classification of Crown Forms and Gingival Characteristics in Taiwanese

Objectives: The aim of the investigation was to examine the forms of the crowns in the maxillary anterior tooth segment and corresponding gingival characteristics among healthy Taiwanese subjects. Materials and Methods: The crown width at the apical third (CW), length (CL), gingival angle (GA) and the interdental papilla height were assessed from the diagnostic stone model using a calibrated periodontal caliper. A CW/CL-ratio was calculated for each tooth and averaged for each tooth region. Gingival thickness (GT) and width of keratinized gingiva (WG) were measured clinically. Results: The cluster analysis revealed 3 classifications of crown forms: narrow (N), compound (C) and square (S) types. There was a significant difference among the 3 classifications with respect to CW/CL-ratio, GT, and WG (p < 0.0001). Conclusions: The results demonstrated varied crown forms and corresponding gingival characteristics in Caucasian and Taiwanese. The new classifications hinted that there was a polymorphism in different races and could be a valuable esthetic guideline and reference for anterior tooth rehabilitation, including various periodontal and restorative treatments and anterior implant placement procedures in Taiwanese.