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Perio Reports


Perio Reports  Vol. 22 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.
BANA Test Predicts Preterm Births

Preterm birth is often associated with infection or inflammation as the immune response triggers prostaglandin production, which is associated with an increase in uterine contractions leading to preterm delivery. This is one of the mechanisms suggested to explain the impact of periodontal disease on preterm delivery.

Three prominent periodontal pathogens Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola all contain the enzyme benzoyl-DL-arginine-naphthylamide (BANA). Dr. Walter Loesche developed a test to measure this enzyme in a plaque sample, identifying the presence of one or all of these pathogens. The BANA test is done chairside or bedside, using a wooden toothpick between the first and second molars in each quadrant to collect a plaque sample. It is then placed on a reagent card, moistened, closed and incubated at 55 degrees Celsius for five minutes. A color change indicates a weak or strong presence of the enzyme associated with the perio pathogens.

Researchers at the University of Michigan in Ann Arbor, Michigan together with colleagues in Changhua, Taiwan monitored 268 pregnant women using the BANA test to determine if the presence of specific periodontal pathogens could predict preterm delivery. The BANA test was performed at the second and third trimester visits.

There were 19 preterm births in the group. Ruling out other risk factors, those with a positive BANA test in two or more of the four quadrants tested at the third trimester visit were six times more likely to deliver preterm than those with negative tests.

Clinical Implications: The BANA test may prove to be an easy way for both dental and medical professionals to test for periodontal disease.

Chan, H., Wu, C., Welch, K., Loesche, W.: Periodontal Disease Activity Measured by the Benzoyl-DL-Arginine- Naphthylamide Test Is Associated With Preterm Births. J Perio 81: 982-991, 2010.
Breast-feeding Lowers Risk of Crossbite

The World Health Organization recommends breastfeeding exclusively for the first six months of an infant's life. This recommendation is based on benefits for both the mother and the child. Breast-feeding exclusively enhances craniofacial growth and development, and helps prevent non-nutritive sucking habits. Breast-feeding for less than six months or not at all has been shown to result in malocclusion and posterior crossbite in particular. Crossbite in deciduous teeth develops early and rarely self-corrects, so early preventive action is warranted.

Researchers in University of Sao Paulo City, in Brazil clinically examined 1,377 children from 11 public schools in Sao Paulo. The children ranged in age from three to six years. Mothers completed a questionnaire to determine breast-feeding history.

Posterior crossbites were divided into three categories: bilateral, true unilateral, and unilateral with functional deviation of the mandible. Four categories of breast-feeding were identified: never (119), less than six months (720), six to 12 months (312), and more than 12 months (226).

Crossbite was diagnosed in 16.2 percent of the entire group, with subcategories being 2.8 percent bilateral, 4.4 percent true unilateral and 9.4 percent with functional unilateral crossbite. Crossbite decreased with longer history of breast-feeding. In children who were not breast-fed, the crossbite incidence was 31.1 percent. For those breast-fed less than six months, the incidence was 22.4 percent. Much lower incidence was found for those breast-fed six to 12 months - 8.3 percent and 2.2 percent for those breast-fed more than 12 months.

Clinical Implications: Breast-feeding exclusively for at least six months and more than 12 months can reduce the potential for posterior crossbite in deciduous teeth.

Kobayashi, H., Scavone, H, Ferreira, R., et al. Relationship Between Breastfeeding Duration and Prevalence of Posterior Crossbite in the Deciduous Dentition. Am J Orthod Dentofacial Orthop 137: 54-58, 2010.
Comparison of Needle-free Anesthetics for SRP

Controlling pain during scaling and root planing (SRP) is generally accomplished with injected local anesthetics. Topical anesthetic products are available that provide pain control during SRP, without injection. One is a topical gel injected into the pocket and the other is a patch. Electronic anesthesia is another needle-free option allowing the patient to control the electronic stimulation to reduce pain.

Researchers at the Centenary Dental College and Hospital, Rohtak University in Haryana, India compared three needle-free local anesthetic options to control pain during SRP. The options were five percent EMLA (Oraqix), 20 percent lidocaine patch (DentiPatch), and electronic anesthesia. Patients had probing depths of 5mm or more and received one of the needle-free options in each of three quadrants for SRP. The fourth quadrant was instrumented without anesthesia, as the control. The 25 test subjects were asked to describe their pain after each quadrant using both a visual analog scale and a verbal scale to rate their pain – from no pain, to mild, moderate, severe and very severe pain.

Quadrants were randomly assigned to the anesthetic used or control. If the patient experienced pain during the procedure and wanted relief, rescue local anesthesia was injected.

All three options were effective in controlling pain. Oraqix and the DentiPatch were similar and slightly more effective than the electronic anesthesia.

Clinical Implications: Needle-free anesthetic options are available to reduce pain during SRP.

Pandit, N., Gupta, R., Chandoke, U., Gugnani, S.: Comparative Evalutation of Topical and Electronic Anesthesia During Scaling and Root Planing. J Perio 81: 1035-1040, 2010.
More Periodontitis with Birth Control Pills

Oral contraceptive use is linked to increased gingival inflammation due to an increase in the concentration of sex hormones in the gingival tissues. Newer formulations of oral contraceptives contain lower levels of hormones, however the number of years taking the drug may influence gingival conditions.

Researchers at University of Buenos Aires in Argentina evaluated the effect of oral contraceptives on periodontal health and the presence of specific bacterial and yeast species in 91 women. A group of 41 women taking oral contraceptives was compared to an age-matched control group of 51 women not taking oral contraceptives.

In the group taking oral contraceptives, more women had moderate to severe periodontitis compared to those not taking oral contraceptives.

There were 21 smokers in the oral contraceptive group and 20 smokers in the control group. The incidence of moderate to severe periodontitis was nearly twice as high in those taking oral contraceptives and smoking compared to controls who smoked.

Those taking oral contraceptives more than three years also had a higher prevalence of moderate to severe periodontitis. Periodontal pathogens were identified in subgingival samples in all but 16 women; 11 of these were in the control group. Those taking oral contraceptives had a higher prevalence of periodontal pathogens than those not taking oral contraceptives. Candida species were identified in 95 percent of those taking oral contraceptives and 78 percent of controls.

Clinical Implications: Women taking oral contraceptives and smoking are at greater risk of periodontal disease and should be advised to pay careful attention to their daily oral hygiene.

Brusca, M., Rosa, A., Albaina, O., Moragues, M., Verdugo, F., Ponton, J.: The Impact of Oral Contraceptives on Women's Periodontal Health and the Subgingival Occurrence of Aggressive Periodontopathogens and Candida Species. J Perio 81: 1010- 1018, 2010.
Vitamin B12 for Treatment of Aphthous Ulcers

Recurrent aphthous stomatitis (RAS) is seen in 23 percent of the population, with half of these people suffering with a recurrence of RAS within three months. The Greek term "aphthai," credited to Hippocrates, was first used to describe oral disorders. RAS is idiopathic in nature, with local trauma and stress being the most likely precipitating factors. Many treatments have been suggested including herbs, multivitamins, adhesive pastes, local antiseptics, local and systemic antibiotics, topical NSAIDs, topical and systemic corticosteroids and immunosuppressants. Vitamin B12 has been shown to provide both immediate and long-term benefits for the treatment and control of RAS.

Medical researchers at Ben-Gurion University of Negev in Beer-Sheva, Israel compared the clinical effects of taking either a sublingual vitamin B12 tablet (1,000mcg) or a sublingual placebo each evening before bed. At baseline, all subjects had a blood test for vitamin B12 and were given an "Apthous Ulcers Diary" and instructed to keep track of outbreaks and pain levels. Subjects were seen at the clinic monthly during the six-month study to review their diary and to receive the next month's tablets. There were 27 test subjects and 25 placebo subjects who completed the study.

Pain levels were higher in the control group in the last three months. By the last month of the study, 74 percent (20 patients) of the test group and 32 percent (8 patients) in the placebo group reached the status of no oral lesions. Initial blood levels of vitamin B12 did not influence the clinical outcomes.

Clinical Implications: Sublingual vitamin B12 is a simple, easy, inexpensive treatment for patients suffering from frequent aphthous ulcers.

Volkow, I., Rudoy, I., Freud, T., Sardal, G., Naimer, S., Peleg, R., Press, Y.: J Am Board Fam Med 22: 9-16, 2009.
Respiratory Bacteria in Oral Biofilm and Saliva

Oral bacterial biofilm contains an estimated 700 species including oral as well as respiratory pathogens. Medically important pathogens include Enterobacter, Hemophilus and various strains of pneumoniae bacteria. Respiratory pathogens in oral biofilm can be released into the salvia and aspirated into the lungs of hospitalized patients, especially those who have a breathing tube in place.

Researchers at the Federal University of Rio de Janeiro and the Brazilian National Institute of Cardiology in Brazil evaluated the periodontal condition and the presence of six respiratory pathogens in 30 hospitalized patients before and after heart bypass surgery. Thirteen of the subjects were edentulous and 17 were dentate. Those with teeth all had moderate periodontal disease and poor oral hygiene. Most of the subjects were men with a history of both smoking and hypertension.

Bacterial species in saliva and biofilm samples were identified using either culturing or polymerase chain reaction. The most prevalent respiratory bacteria found in plaque and saliva samples both pre-operatively and post-operatively were Pseudomonas and Acinetobacter. The numbers increased post-operatively, but not significantly.

Poor oral hygiene and periodontal disease provide an inflammatory condition and biofilm environment conducive to the proliferation of respiratory pathogens. The risk of nosocomial pneumonia may be increased in hospitalized patients as the biofilm provides a reservoir for pathogenic species.

Clinical Implications: Oral hygiene for hospitalized, intubated patients should be considered not only for oral health, but also to prevent aspiration of bacteria into the lungs.

Zuanazzi, E., Souto, R., Mattos, M., et al: Prevalence of Potential Bacterial Respiratory Pathogens in the Oral Cavity of Hospitalized Individuals. Arch Oral Biol 55: 21-28, 2010. n
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