Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

Perio Reports


Perio Reports  Vol. 21 No. 10
Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians.
Perio Reports research summaries will be included in each issue to keep you on the cutting edge
of dental hygiene science.
Poor oral health linked to COPD

Chronic obstructive pulmonary disease (COPD) is a progressive disease making breathing difficult. It’s the fourth leading cause of death in the United States. According to the National Institutes of Health, more than 12 million people are currently diagnosed with COPD and there are likely just as many more who are undiagnosed. Smoking is a significant risk factor for COPD.

Researchers at the Capital Medical University in Beijing, China evaluated patients at eight hospital in China to determine if oral health and preventive behaviors were linked to COPD. They examined 306 COPD patients and 328 controls who did not have the disease. COPD diagnosis was confirmed by lung function examination. The average age of subjects in both groups was 64 years old. Significantly more former smokers were in the COPD group. There were 47 current smokers in the COPD group and 41 in the control group. Periodontal clinical indices were measured and a questionnaire was completed by each subject about oral health habits and beliefs.

Patients with COPD had fewer teeth and higher plaque levels than controls. They also had greater loss of attachment than controls, indicating more periodontal disease history. Visiting the dentist within the last year was reported by 42 percent of the COPD subjects compared to 59 percent of controls. Twenty-five percent of COPD subjects reported having regular supragingival scaling compared of 46 percent of controls.

Clinical Implications: Patients with COPD might require more instruction in preventing periodontal disease and actual periodontal therapy than patients without COPD.

Wang, Z., Zhou, X., Zhang, J., Zhang, L., Song, Y., Hu, F., Wang, C.: Periodontal Health, Oral Health Behaviours, and Chronic Obstructive Pulmonary Disease. J Clin Perio 36: 750-755, 2009
CHX rinsing improves SRP outcomes

In the 1970s and 1980s research suggested that supragingival plaque control every two weeks following SRP would provide better clinical health outcomes and reduced levels of sublingual microbes. Following these initial findings, no additional research was done. More recently, researchers have used molecular genetic testing to determine that colonization of specific pathogens supragingivally might in fact contribute to subgingival colonization. These tests have identified the desirable microbial profile compatible with periodontal health when weekly dental hygiene visits are provided.

Researchers at Gaurulhos University in Brazil wanted to know if twice daily rinsing with chlorhexidine (CHX) was as beneficial as twice weekly supragingival plaque control visits begun during SRP and carried out for 63 days. Sixty subjects participated in the study, divided into three groups: SPR plus twice daily CHX rinsing, SPR plus bi-weekly professional plaque control plus a placebo rinse, and the control group of SRP plus a placebo rinse. SRP was completed using local anesthesia and primarily hand instruments. It was done by periodontists in four to six, one-hour visits over at most, a 21- day period.

Bi-weekly supragingival plaque control and CHX rinsing both resulted in greater healing and reductions in subgingival pathogens than SRP alone. At six months, those rinsing with CHX showed slightly greater gain in clinical attachment levels and more reduction in the number of moderate to deep pockets. They also had more reductions in pathogens, due in part to reductions in bacteria on the tongue and mucous membranes.

Clinical Implications: Providing bi-weekly supragingival plaque control during and after SRP and especially rinsing twice daily with CHX provides for better healing.

Feres, M., Gursky, L., Faveri, M., Tsuzuki, C., Figueiredo, L.: Clinical and Microbiological Benefits of strict Supragingival Plaque Control as Part of the Active Phase of Periodontal Therapy. J Clin Perio 36: 857-867, 2009.
Photodynamic therapy best after repeated treatments

Photodynamic therapy (PDT) is now available in Canada and Europe. PDT uses a photosensitizer solution injected subgingivally that binds to bacteria. A cold laser light of a specific wavelength is applied to the outside of the tissue. The laser light activates the photosensitizer, changing the energy levels of molecules and releases oxygen that destroys the bacteria. This technology has been used in medicine to treat tumors. It’s now used as an adjunct to SRP and has shown reductions in bleeding on probing.

Researchers at the University of Bern in Switzerland wanted to know if PDT would provide better healing when used several times during maintenance therapy. The test subjects were 10 maintenance patients with 70 residual pockets measuring 5mm or more. The test group received the PDT following debridement. The control group received the same treatment, but with a non-activated laser. Patients were seen for periodontal maintenance at three, six and 12 months.

The greatest probing depth reductions were seen in the test group with nearly a millimeter reduction compared to none in the control group after six months. Bleeding scores were reduced more in the test group, from 97 percent at baseline to 64 percent at three months, 67 percent at six months and 77 percent at 12 months. In the control group, bleeding scores remained constant at 84, 84, 90 and 87 percent.

The benefits of PDT seem to be greatest at six months following repeated applications.

Clinical Implications: Photodynamic therapy, when available in the United States might provide an effective adjunct for periodontal maintenance patients.

Lulic, M., Görög, I., Salvi, G., Ramseier, C., Mattheos, N., Lang, N.: One-Year Outcomes of Repeated Adjunctive Photodynamic Therapy during Periodontal Maintenance: A Proof-of-Principle Randomized-Controlled Clinical Trial. J Clin Perio. 36: 661-666, 2009.
Maintenance therapy found cost effective

The goals of periodontal therapy are to stop disease progression, achieve health in the supporting tissues and preserve the teeth. Periodontal maintenance therapy is an essential part of tooth preservation, however research studies rarely report the number or costs of these visits.

Researchers at the University of Heidelberg in Germany wanted to measure the financial costs of saving teeth through periodontal maintenance therapy as compared to the alternatives of tooth replacement. They evaluated nearly 100 patients after 10 years of periodontal therapy.

The government established dental fee schedule was used to determine costs for periodontal maintenance, SRP, and various restorative procedures. Fees were totaled and divided by the number of teeth to determine a per-tooth treatment fee, which could then be compared to implant and restorative fees.

Despite treatment plans calling for four maintenance visits a year patients averaged 14 visits over 10 years with nine visits for the non-compliers and 20 for the regular compliers. Some teeth received no SRP during this time and others received SRP 14 times. Patients seen more frequently averaged a lower cost per tooth compared to higher costs per tooth for those who had more sporadic maintenance visits.

Tooth survival rate was 96.4 percent with 155 of 2,249 teeth lost. Comparing maintenance fees with implant and prosthetic fees showed significantly higher costs to replace lost teeth. Several factors influenced costs per tooth, including tooth type, initial bone loss, furcation involvement, abutment status, and previous regenerative surgery.

Clinical Implications: Periodontal maintenance therapy provides high value for retaining teeth, compared to implants and bridgework.

Pretzl, B., Wiedemann, D., Cosgarea, R., Kaltschmitt, J., Kim, T., Staehle, H., Eickholz, P.: Efforts and Costs of Tooth Preservation in Supportive Periodontal Treatment in a German Population. J Clin Perio 36: 669–676, 2009.
Probiotic milk prevents gingivitis

Probiotics are live microorganisms that provide health benefits. Most common are Lactobacillus acidophilus and Bifidus that are often used to control antibiotic induced diarrhea in children. Probiotics are considered an alternative to antibiotics in some cases. Researchers on the Medical Faculty at the University of Leipsig in Germany tested a probiotic milk drink to determine if it would impact experimental gingivitis.

Fifty medical and dental students participated in the two-month study. Half the group drank a probiotic milk drink containing Lactobacillus casei daily and the control group received no placebo drink. The probiotic concentration was 100 billion per 100 milliliter. Subjects were examined at baseline, eight weeks and four days later, after stopping all oral hygiene. Clinical indices were recorded and in two sites gingival crevicular fluid was collected.

After eight weeks, there were no differences clinically between the test and control groups for plaque levels or gingival bleeding. Following four days without oral hygiene, the test group had more buccal and lingual plaque than the control group and both groups had similar bleeding scores.

Crevicular fluid analysis showed changes in the test group that indicated immunological changes. Both elastase and myeloperoxidase activity were higher in the control group before and after the four days of experimental gingivitis, indicating more inflammation.

Clinical Implications: The probiotics added to the milk drink didn’t produce measurable changes in the plaque scores, but changes in subgingival cytokines suggest a positive impact on the immune response.

Staab, B., Eick, S., Knöfler, G., Jentsch, H.: The Influence of a Probiotic Milk Drink on the Development of Gingivitis: A Pilot Study. J Clin Perio 36: 850-856, 2009.
Frequent DH visits important for those with oralfacial clefts

The progression from embryo to fetus occurs between the seventh and 12th weeks of gestation. At this time, the maxillary and palatal processes merge to form the lips, the palate and the alveolar process of the maxilla. Cleft lip occurs with a failure of the nasal and maxillary processes to merge. Cleft palate is caused by incomplete fusion of the palatal processes. Infants born with oralfacial clefts require treatment by medical and dental specialists.

In 1959, a special program was developed at University Hospital in Bern, Switzerland to provide multidisciplinary care for these infants. Twenty years later, in 1979, 80 subjects were examined to determine periodontal health adjacent to clefts.

While attachment levels were similar between cleft and non-cleft sites, more bone loss was evident adjacent to clefts. In 1993, 26 of the 80 subjects were examined again. None of them had been receiving periodontal maintenance at the university, but instead were seeing their general dentists once or twice a year. The cleft sites showed more periodontal breakdown than the control sites. In 2004, 20 subjects were available for reevaluation. Both cleft and control sites now had high plaque and bleeding scores. More periodontal destruction was evident at cleft sites, with a half of a millimeter more attachment loss compared to control sites.

Despite once or twice yearly visits to their general dentist, these people did not effectively remove plaque and consequently suffered from periodontal disease.

Clinical Implications: Strict periodontal maintenance therapy schedules should be followed for those with cleft palate and cleft lip, when signs of periodontal disease are present to prevent disease progression.

Huynh-Ba, G., Brägger, Zwahlen, M, Lang, N., Salvi, G.: Periodontal Disease Progression in Subjects with Orofacial Clefts Over a 25-Year Follow-Up Period. J Clin Perio 36: 836-842, 2009.
Dentaltown Magazine
September 2025
Dentaltown Magazine September 2025 Read Current Issue Read Archived Issues
Sponsors
Townie Perks
Townie® Poll
Who or what do you turn to for most financial advice regarding your practice?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds Dental News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2025 Dentaltown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450