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Perio Reports


Perio Reports  Vol. 22 No. 8
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.
Similar outcomes with different treatment approaches

Scaling and root planing (SRP) can be provided in one long full-mouth (FM) visit or in several weekly visits treating one or more quadrants at a time. The reinfection hypothesis is the basis for FM disinfection completed within 24 hours, rather than weekly quadrant SRP. However, clinical studies demonstrate similar clinical outcomes for both approaches.

Researchers at the University of Groningen in the Netherlands compared FM and multiple session SRP to determine if subgingival recolonization was reduced with one approach over the other. Dental hygienists provided the instrumentation for patients in the Clinic for Periodontology. All treatment was begun in the upper right quadrant (the test quadrant) using hand instruments and anesthesia per patient request. After completing this quadrant, the clinician was informed to either complete FM SRP or schedule the patient for two more visits, one week apart, to complete the rest of the SRP. FM clinical indices included probing depths, bleeding and plaque and were recorded at baseline and three months. Subgingival plaque samples were taken from a single site in each quadrant at baseline, immediately after treatment, and on days one, two, seven, 14 and 90.

Both treatment groups experienced significant clinical healing. Reductions in subgingival bacterial counts were evident for both groups as well. The number of sites positive for any of the five species decreased over the test period, with reductions evident in earlier treated quadrants without additional instrumentation.

Clinical Implications: Both full-mouth and quadrant SRP provide similar clinical outcomes. Decide which is best for your patients based on individual needs and preferences.

Zijnge, V., Meijer, H., Lie, M., Tromp, J., Degener, J., Harmsen, H., Abbas, F.: The Recolonization Hypothesis in a Full-Mouth or Multiple-Session Treatment Protocol: A Blinded, Randomized Clinical Trial. J Clin Perio 37: 518-525, 2010
Nanoparticles in sensitivity toothpaste

Nearly half of adults suffer from dentin hypersensitivity (DH) with dentinal tubules open to the oral cavity. Sensitivity is explained most often by the hydrodynamic theory. Fluid in open tubules is rapidly displaced by a stimulus that excites the nerve, causing pain. Home-use toothpastes containing potassium salts have been recommended to either block the open tubules or stop the neural response. Recently zinc has been added to hydroxyapatite crystals and shown to produce a mineralized coating of dentin in laboratory tests.

Researchers at the University of Marche in Ancona, Italy compared a new desensitizing toothpaste containing hydroxyapatite nanocrystals with zinc to Sensodyne ProNamel in a group of 70 volunteers. Sensitivity was measured at baseline and after using the assigned toothpaste for four and eight weeks. Sensitivity was tested four ways: explorer, air blast, cold water and the patients subjective perception.

Both toothpastes were effective desensitizers, with reductions in sensitivity at eight weeks ranging from 28 percent to 63 percent. There was no difference between groups for the explorer and cold water test. Results for the new toothpaste were significantly better for the air blast test and the patient's subjective perception.

Clinical Implications: A new toothpaste containing zinc and carbonate/hydroxyapatite nanocrystals was found to be as effective as the traditional potassium nitrate/fluoride toothpaste.

Orsini, G., Procaccini, M., Manzoli, L., Giuliodori, F., Lorenzini, A., Putignano, A.: A Double-Blind Randomized- Controlled Trial Comparing the Desentizing Efficacy of a New Dentrifice Containing Carbonate/Hydroxyapatite Nanocrystals and a Sodium Potassium Nitrate Dentifrice.
Er:YAG laser tested for non-surgical perio

Laser therapy is suggested as an alternative or an adjunct to traditional scaling and root planing (SRP). Several types of lasers are now available, including the erbium-doped: yttriumaluminum-garnet, better known as the Er:YAG. Lasers are suggested to replace traditional instrumentation because of the following effects: tissue ablation, hemostatic abilities, bactericidal and detoxification effects.

Researchers at the University of Florence in Italy compared an Er:YAG laser to traditional instrumentation. Four test groups were created, treating a total of 27 patients: supragingival scaling and polishing, Er:YAG, SRP, and Er:YAG plus SRP. Each patient was treated with all four treatments, one in each quadrant. Treatments were assigned randomly to each quadrant. Clinical indices were collected at baseline, three months and six months. The supragingival treatment group showed less healing than the other three treatment groups that demonstrated similar healing.

The goal of treatment is to stop disease progress and return the tissues to health measured clinically by bleeding, probing depths and attachment levels. Bleeding in sites measuring 4mm or more ranged from 71-75 percent at baseline and remained high at six months ranging from 53- 58 percent. The number of sites measuring 4mm or more was reduced 24-28 percent.

Less time was spent using the laser – 13 minutes per quadrant compared to 16 minutes for SRP, 19 minutes for SRP plus laser and seven minutes for supragingival scaling and polishing.

Clinical Implications: The Er:YAG laser provided similar healing compared to traditional SRP, took less time, was more comfortable, but comes with a significantly higher price tag.

Rotundo, R., Nieri, M., Francesco, D., Mervelt, J., Bonaccini, D., Esposito, M., Pini-Prato, G.: Lack of Adjunctive Benefit of Er:YAG Laser in Non-Surgical Periodontal Treatment: A Randomized Split-Mouth Clinical Trial. J Clin Perio. 37: 526-533, 2010
Perio and prostatitis share similar pathogenesis

Prostate-specific antigen (PSA) is synthesized by prostate epithelial cells and functions to lyse protein gels of the seminal clot, releasing motile sperm for fertilization. Prostate inflammation contributes to elevated PSA levels likely because of a break in the epithelial tissue integrity of the gland allowing PSA to leak into the blood stream rather than an actual increase in PSA production.

Prostatitis is an inflammation of the prostate gland which affects eight percent of men, according to a study published in 1998. Similar to periodontitis, Gram-negative bacteria are implicated along with proinflammatory cytokines.

To determine if there is an association between periodontitis and prostatitis, medical and dental researchers at Case Western Reserve University in Cleveland, Ohio, designed a small pilot study to compare periodontal indices, PSA levels and severity of prostatitis as determined by needle biopsy specimens. A total of 35 subjects participated in the study which showed those with clinical attachment levels equal to or greater than 2.7mm and with moderate to severe prostatitis had the highest PSA levels

Clinical Implications: Poor oral hygiene is no more likely than good oral hygiene to affect colonization of oral Candida organisms.

Darwazeh, A., Hammad, M., Al-Jamaei, A.: The Relationship Between Oral Hygiene and Oral Colonization with Candida Species in Healthy Adult Subjects. Int J Dent Hygiene 8: 128-133, 2010
Exercises reduce signs of OSAS

Obstructive sleep apnea syndrome (OSAS) affects a large segment of the population and presents significant health problems. It is characterized by frequent episodes of obstructed sleep during the night, causing interrupted sleep, sleepiness during the day and increased risk of cardiovascular disease. Currently the most effective treatment for OSAS is continuous positive airway pressure or CPAP. Other treatment options include mandibular advancement, weight loss and surgery. Patients with OSAS often have a floppy and elongated soft palate and uvula, enlarged tongue and inferior displacement of the hyoid bone.

Researchers at the University of Sao Paulo in Brazil used oropharyngeal exercises to remodel the airway musculature of patients with moderate OSAS. A total of 31 people participated, 15 in the control group were taught nasal breathing exercises and given a daily 10 percent nasal rinse. The 16 subjects in the test group were instructed to perform 30 minutes of exercises each day involving the tongue, soft palate, and lateral pharyngeal wall. These exercises involved the muscles of chewing, talking, swallowing and breathing. Results after three months showed no changes in the control group, but significant changes in the exercise group. Neck circumference was reduced 1.1cm, snoring was reduced, as well as sleepiness during the day. Ten of the 16 test patients shifted from moderate OSAS to mild or no OSAS. Results are similar to those reported with mandibular advancement appliances for the apnea hypopnea index (API) of 39 percent.

Clinical Implications: Oral myology exercises provide a viable treatment option for those with moderate OSAS.

Guimaraes, K., Drager, L., Genta, P., Marcondes, B., Lorenz-Filho, G.: Effects of Oropharyngeal Exercises on Patients with Moderate Obstructive Sleep Apnea Syndrome. Am J of Respir and Critical Care Med Vol 179: 962-966, 2009.
Does smokeless tobacco cause recession?

Smoking tobacco in many forms is the most significant risk factor for periodontal disease. The effects of smoking on periodontal health have been studied extensively, unlike smokeless tobacco, which has not received the same attention. Smokeless tobacco is used by approximately 4.5 percent of the population, and by up to 10 percent in certain rural, male populations.

A team of researchers from the University of South Carolina, in Colombia, South Carolina, Ohio State University in Columbus, Ohio and the University of Nebraska in Omaha, Nebraska evaluated a group of 73 smokeless tobacco users, all male, from two rural Appalachian Ohio communities and part of a large, ongoing clinical trial. Subjects each had a unilateral keratosis smokeless tobacco lesion. Recession at this site was compared to recession on the contralateral side with no lesion.

Recession was evident on teeth where the keratosis was present in 20 percent of the lesions, compared to 10 percent on the teeth when no lesion was present. The difference between teeth associated with keratosis lesions was statistically significant, but at 0.5mm, it might not be clinically relevant. Larger studies are needed.

Clinical Implications: Smokeless tobacco use was believed to cause severe recession, as reported in isolated cases, however, this study demonstrates only slightly more recession associated with smokeless tobacco lesions than those on the contralateral non-lesion side.

Chu, Y., Tatakis, D., Wee, A.: Smokeless Tobacco Use And Periodontal Health in Rural Male Population. J Perio. 81: 848-854, 2010
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