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Perio Reports


Perio Reports  Vol. 22 No. 6
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.
Age-related treatment response

There is consensus that the aging process negatively affects various stages of wound healing. This is the first study to evaluate the effects of aging on healing following non-surgical periodontal therapy.

A retrospective evaluation of treatment records of patients receiving non-surgical periodontal therapy at the University of Ferrara in Italy was conducted. Subjects were divided into two groups, one young (mean age 35 years) and one older (mean age 60 years). Each group contained approximately 60 subjects who had received one to five sessions of non-surgical therapy, either completed in one visit or spread out over several visits treating by quadrants. All received detailed oral hygiene instructions with reinforcement at subsequent visits.

Significant improvement in probing depths and bleeding on probing scores were experienced by both groups, with no differences evident between groups. Both groups had similar numbers of patients treated with a full-mouth approach compared to quadrant visits. Bleeding shifted from 30 percent of sites to 16 percent of sites after treatment.

The study researchers speculated that similar levels of periodontitis in both groups might indicate the younger group was more susceptible to disease and could potentially confound the results of the comparison.

Clinical Implications: Based on these findings, age shouldn’t limit the healing ability of tissues following non-surgical periodontal therapy.

Trombelli, L., Rizzi, A., Simonelli, A., Scapoli, C., Carrieri, A., Farina, R.: Age-Related Treatment Response Following Non- Surgical Periodontal Therapy. J Clin Perio 37: 346-352, 2010.
Perio’s negative impact on life

Perio research tends to focus on clinical pathology rather than the impact the disease has on the person’s life. This is the traditional biomedical approach to disease. The health-care market is becoming more consumer driven and biopsychosocial research is needed that evaluates the effects of disease on one’s psychology and social functioning.

Researchers at Newcastle Dental Hospital in Newcastle Upon Tyne in the UK interviewed 15 people with periodontal disease. This qualitative rather than quantitative research gathered feedback from people based on a series of quality of life questions and elicited their views rather than just answers to questions.

Locker’s conceptual model of oral health includes several themes that were applied to the findings of the interviews (impairment, function, limitation, discomfort, disability, and handicap). Subjects reported physical impairment due to tooth mobility and sensitivity, keeping them from eating certain foods, like apples. Bad breath associated with periodontal disease had psychological implications and prevented full participation in social activities. They felt the need to keep their distance, cover their mouths and avoid close contact. Appearance of their teeth also kept them from fully participating in life by laughing and smiling with others.

Two additional themes emerged from the interviews, a stigma associated with having perio disease and a retrospective regret that better care hadn’t been taken earlier in life to prevent the current condition. If people knew they had periodontal disease, they believed others thought they were “unclean” and “unhygienic.”

Clinical Implications: Many clinicians already play a role as a psychologist, helping patients deal with life as well as dental disease. The future will bring more patient-centered measurement tools added to our clinical indices.

O’Dowd, L., Durham, J., McCracken, G., Preshaw, P.: Patients’ Experiences of the Impact of Periodontal Disease. J Clin Perio 37: 334-339, 2010.
People can smell their own bad breath

The odor of bad breath is due to the release of volatile sulphur compounds (VSCs) through putrefaction of food particles, blood, bacteria and epithelial cells. Previous studies suggest that individuals either overestimate their own oral malodor or can’t smell it at all. Only a few studies have evaluated one’s ability to accurately assess their own breath.

Researchers at the University of Torino in Italy enrolled 180 patients in the study, all seeking help for bad breath. Prior to their breath test, subjects were instructed to report to the dental school without having cleaned their teeth that morning, or used breath freshener, chewed gum or smoked for the past 12 hours. They were asked to refrain from eating spicy food for 48 hours and from drinking anything for three hours.

To smell their own breath, they cupped their hand over their mouth, breathed out through their mouth and smelled with their nose. They graded their breath on a scale from zero to five. Organoleptic testing was done by one examiner. Subjects put a tube in their mouth, breathed out and the examiner smelled the air as it come out the other end of the tubing. Periodontal clinical indices were also recorded.

Bad breath was found in 94 percent of the group. Subjects generally overestimated the severity of their bad breath with just 38 percent with similar self-test and organoleptic scores. Organoleptic scores correlated well with the clinical indices, but not with self-test scores. Of all the clinical indices, bleeding scores correlated highest with bad breath.

Clinical Implications: In many cases, people can detect their own bad breath.

Romano, F., Pigella, E., Guzzi, N., Aimetti, M.: Patients’ Self- Assessment of Oral Malodour and Its Relationship with Organoleptic Scores and Oral Conditions. Int J Dent Hygiene 8: 41-16, 2010.
Nd:YAG laser kills perio pathogens

Lasers are being used for a variety of dental treatments, including periodontics and endodontics. Claims are made that lasers are capable of ablating and vaporizing organic debris. The Nd:YAG laser emits light that is readily absorbed by melanin and hemoglobin, easily transmitted through water and poorly absorbed by hydroxyapitite, making it idea for periodontal therapy. Thin, flexible fiber optic systems allow easy access in subgingival areas.
Image courtesy of Dr. van der Weijden

Researchers at the Academic Centre for Dentistry Amsterdam, in The Netherlands used an Nd:YAG laser to determine the exposure needed to kill periodontal pathogens. Cultures of six pathogens, Aa, Pg, Pi, Tf, Fn, and Pm were tested using Eppendorf tubes that fit over the laser tip. Testing was done three times for each pathogen and each exposure time. The laser was placed in the Eppendorf tube and activated at four different time settings: five, 15, 30 and 45 seconds. Laser settings were six watts of power, 50 Hz frequency, and pulse duration of 250 microseconds. To avoid any heat buildup, the Eppendorf tubes were kept on ice during the experiment. Following activating of the laser for the prescribed time, the microorganisms were plated on blood agar and allowed to grow. A negative control was also included.

After five seconds, all the bacteria tested showed a decrease in total colony forming units. All other times tested resulted in no culture growth of the microorganisms at all.

Clinical Implications: Based on these findings, the Nd:YAG laser may be an effective adjunct for eliminating bacteria during supragingival and subgingival instrumentation.

Kranendonk, A., van der Reijden, W., van Winkelhoff, A., van der Weijden, G.: The Bactericidal Effect of a Genius Nd:YAG Laser. Int J Dent Hygiene 8: 63-67, 2010.
Less pain with Er:YAG laser compared to sonic scaler

Infection control is the goal of periodontal therapy, by removing subgingival bacterial biofilm and calculus. Power scalers have become an important instrument for this therapy, while lasers are just beginning to be used. Experiencing pain with supragingival or subgingival instrumentation can negatively influence compliance with therapy.

Researchers at two dental schools in Germany participated in a comparison study of pain experienced with use of a sonic scaler and a laser. Patients being treated at the University of Bonn and the University of Freiburg were asked to report pain levels after treatment using a visual analog scale for pain with scores from zero to 10. Each of the 40 patients had two teeth with residual 5mm bleeding pockets following conventional periodontal therapy that were treated in this study, one with the Kavo Sonicflex sonic scaler and the other with the Kavo KEY 3, Er:YAG Laser.

Additionally 11 patients used a handheld bulb to register pain on a computer screen during the procedure. This approach records all the variations in pain levels during the procedure, where as the visual analog scale is a measure of the greatest pain remembered after treatment is complete.

Less pain was associated with the laser used for subgingival biofilm removal than with the sonic scaler. Bleeding scores were similarly reduced in both groups at three months, reducing from 85 percent of sites at baseline to 50 percent of sites at three months.

Clinical Implications: As laser technology advances and units are designed for dental hygiene use, we may see patient preferences for lasers.

Braun, A., Jepsen, S., Deimling, D., Ratka-Krüger, P.: Subjective Intensity of Pain During Supportive Periodontal Treatment Using a Sonic Scaler or an Er:YAG Laser. J Clin Perio 37: 340-345, 2010.
Topical drugs first choice for treating oral candidiasis

Candida albicans will colonize the oral mucosa of denture wearers, those with compromised immune systems, or in conjunction with taking antibiotics or immunosuppressives. Antifungal drugs are either topical or systemic and are sometimes administered together.

Researchers at the University of Murcia in Spain sent out a questionnaire to practicing dentists to gather information about their experience with oral candidiasis. A random sample of 1,134 of Spain’s 22,000 dentists were given the questionnaires. Completed forms were returned by 840 dentists, a high return rate of 74 percent for this sample.

The form asked only a few questions including gender, years in practice, frequency of cases and medications used to treat oral candidiasis. They were also asked if their education was as a odontologist (dental school) or as a stomotologist (trained in medical school). Dental school training separate from medical school began in Spain in 1986.

Respondents were divided equally between men and women, with a mean age of 38 years. Sixty-five percent saw zero to one case/month, 26 percent saw two to three cases/month and eight percent saw more than four cases/month. Most (70 percent) prescribed topical antifungal drugs, compared to systemic drugs (30 percent). Male stomotologists with the most clinical experience were more likely to prescribe systemic antifungals. Referral to a specialist was made by 10 percent of the group. The two topical drugs most often prescribed were miconazole and nystatin. Chlorhexidine was recommended by 45 percent of the group.

Clinical Implications: Dentists in Spain treat oral candidiasis primarily with topical drugs.

Martínez-Beneyto, Y., López-Jornet, P., Velandrino-Nicolás, A., Jornet-García, V.: Use of Antifungal Agents for Oral Candidiasis: Results of a National Survey. Int J Dent Hygiene 8: 47-52, 2010.
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