Yi-Min Wu

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.

The association of psychosocial factors and smoking with periodontal health in a community population.

BACKGROUND AND OBJECTIVE The association between psychosocial factors and periodontal disease has been widely reported and might be modified by smoking status. This study investigated the association of periodontal status with psychosocial factors and smoking in a community population. MATERIAL AND METHODS A structured questionnaire was administered to a total of 1,764 civilian noninstitutional (general population excluding from nursing homes, sanitariums and hospitals) Taiwanese individuals to assess the presence and severity of psychosocial factors [using the 12-item Chinese health questionnaire (CHQ-12)], smoking habits and other related factors. Periodontal status was established using the community periodontal index and by measuring clinical loss of attachment. RESULTS Psychological factors and smoking were significantly associated with loss of attachment (odds ratio = 1.69, 95% confidence interval = 1.01-2.77, comparing the CHQ-12 score of >or= 6 with the CHQ-12 score of 0-2 and p = 0.032 for linear trend; odds ratio = 2.21, 95% confidence interval = 1.45-3.37, comparing smokers with nonsmokers) but not with community periodontal index. The association was found to be stronger among smokers than among nonsmokers. Smokers with a CHQ-12 score of >or= 6 had a higher odds ratio of loss of attachment (odds ratio = 2.49, 95% confidence interval = 0.91-6.49) than nonsmokers (odds ratio = 1.43, 95% confidence interval = 0.76-2.58). For periodontal health measured using the community periodontal index, married and divorced/widowed subjects tended to have poorer periodontal health (odds ratio = 3.38, 95% confidence interval = 1.26-10.81 and odds ratio = 3.83, 95% confidence interval = 1.21-13.83, respectively) than single subjects among nonsmokers but not among smokers. CONCLUSION Poor mental health had a stronger association with periodontal disease among smokers than among nonsmokers, especially in accumulative attachment loss. Our findings suggest that mental health and smoking might have a synergistic effect on the risk of developing periodontal disease.

Impacted mandibular second molars.

OBJECTIVE To determine the prevalence and severity of impacted permanent mandibular second molars (MdM2s) in the general population of Taiwan as well as to evaluate treatment outcomes with an innovative method for impacted MdM2s. MATERIALS AND METHODS Dental records of 21,580 patients were retrospectively screened in this study. The impactions of MdM2s were registered. The chosen study population consisted of 96 patients with 125 impacted MdM2s who received orthodontic treatment in our clinics. Standardized periapical radiographs were taken to measure the angles and depths of the impacted MdM2s. In addition, the initial uprighting periods of the impacted MdM2s were recorded. RESULTS The prevalence of MdM2 impaction in the Taiwanese population was 0.65%. Most of the angles and depths of the MdM2s were 31-60° and 9-12 mm, respectively. The mean initial uprighting period of the impacted MdM2 was 3.6 months. There were no significant differences between genders in the initial uprighting period based on patient ages, impacted angles, or impacted depths (P > .05). Correlation analysis revealed that the impacted depth was highly and positively correlated with the initial uprighting period (r > .75). CONCLUSIONS The prevalence of MdM2 impaction in this study was low but slightly higher than previous reports investigating whites. Although such impactions are rare, it is recommended to diagnose early for an optimal treatment time and reduction of complications. In addition, the effective molar uprighting appliance used in this study has displayed good treatment outcomes with natural improvement of the adjacent infrabony defects of the first molars.

Relationship between remaining teeth and self-rated chewing ability among population aged 45 years or older in Kaohsiung City, Taiwan

The purposes of this study were to (1) examine the relationship between the number of various types of healthy remaining natural teeth at different sites and self‐rated chewing ability and (2) evaluate the relationship between the number of functional tooth units (FTUs), comprising functional natural teeth (FNT) or fixed prostheses, and self‐rated chewing ability. A sample of 296 adults (122 men and 174 women), aged 45 years or older (average age, 56.6 ± 9.7), were recruited from seven dental clinics in Kaohsiung City. Dental information on the number and status of remaining teeth was obtained through examination by trained and calibrated dentists. Self‐assessment of chewing ability (masticatory score) was evaluated with a self‐administered questionnaire. Results showed that increased age is associated with a greater likelihood of difficulty in chewing. To avoid chewing difficulty, at least 24.7 FNT, 13.3 posterior‐FNT, 8.1 units of natural tooth‐FTUs, or 9.6 units of fixed tooth‐FTUs must remain. Age and the number of healthy remaining teeth, including natural teeth and fixed prostheses, are key factors in chewing ability. Given that aging is unavoidable, the preservation of healthy remaining teeth plays a relatively important role in the maintenance of chewing ability among middle‐aged and elderly people.

Periodontal Manifestations and Treatment of Sturge-Weber Syndrome - Report of Two Cases

Encephalotrigeminal angiomatosis (Sturge-Weber syndrome) is a rather uncommon congenital condition characterized by the combination of venous angioma of the leptomeninges over the cerebral cortex with ipsilateral angiomatous lesions of the face and sometimes, the skull, jaws and oral soft tissues. Two patients came to the Kaohsiung Medical College Hospitals dental clinic with complaints of localized gingival enlargement or tumor-like swelling. Based on the presence of facial nevus flammeus, examinations of angiography, radiological evidence of calcific densities, and ipsilaterally intraoral vascular hyperplasia in the lip, cheek and gingiva, encephalotrigeminal angiomatosis was diagnosed. Dental management included plaque control instructions, scaling, root planing and periodontal surgery. Recurrence of gingival enlargement in both cases was noted, so periodontal surgery was performed a second time. Close follow up and complete plaque control have kept the periodontal condition fairly well under control in these two cases. We introduce the oral manifestations and the experience of treatments in these two cases.

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.