Section 1:
Section 1: Periodontal Disease and Treatment
Section 2:
Periodontal Medicine (Periodontal Disease and Your Health)
Section 3: Platelet Rich Plasma
Section 1: Periodontal Disease and Treatment
Periodontal
Disease Quick Facts
- More than 75% of Americans past the age of 35 have some form of periodontal disease.
- Periodontal disease is a chronic infection caused by many different types of bacteria.
Some of these bacteria may be transmitted between family members.
- Several risk factors have been linked to periodontal disease. The most notable:
1. Age
2. Smoking
3. Diabetes
4. Heredity (approximately 1/3 of all people have a hereditary risk for developing
periodontal disease)
- Periodontal disease in pregnant women has been identified as a risk for
low birth-weight babies.
- Periodontal disease can negatively affect blood sugar control in diabetics.
- Periodontal disease may be a risk factor for
developing coronary artery disease.
- Like other chronic diseases (diabetes,
arthritis, etc.) periodontal disease cannot be
completely cured. It can, however, be
predictably treated and managed in more than
90%
of all cases.
Treatment
Longitudinal Comparison of the
Periodontal Status of Patients
with Moderate to Severe
Periodontal Disease Receiving No
Treatment, Non-surgical
Treatment, and Surgical
Treatment Utilizing Individual
Sites for Analysis. Harrel, SK
and Nunn, ME. J Periodontol
2001;72:1509-1519.
Aim: To evaluate the
response of individual teeth to
treatment (non-surgical,
surgical and no treatment).
Method: 91 patient
records from private practice
were divided into three groups
according to the treatment they
received (untreated,
non-surgical & surgical) and
clinical parameters evaluated
over a 10 year period.
Bottom Line:
Teeth
receiving no treatment or only
non-surgical (although surgery
was recommended) show worsening
probing depths, mobility,
furcations and overall prognosis
versus teeth receiving surgical
treatment. Teeth receiving
surgical periodontal treatment
showed improved periodontal
status and improved pocket
depths.
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Initial outcome and long-term
effect of surgical and
non-surgical treatment of
advanced periodontal disease.
Serino G, Rosling, B, Ramberg P,
Socransky S, Linde J. J Clin
Periodontol 2001;28:910-916.
Aim:
To determine the initial and 12
year outcome of non-surgical and
surgical sites in subjects with
advanced periodontal disease.
Method:
64 subjects with advanced
periodontal disease were
randomly selected to have either
non-surgical therapy (scaling
and root planning) or surgical
access therapy. Following
therapy, subjects underwent
meticulous dental cleanings 3-4
times per year. Comprehensive
exams were performed at 1, 3, 5
and 13 years.
Bottom Line: Surgical
therapy provides better short
and long-term periodontal pocket
reduction and may lead to fewer
subjects requiring additional
therapy.
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Effect of Non-surgical Periodontal Therapy. II. Severely Advanced Periodontitis. Badersten A., et al.. J Clin Peridontol 1984A;11:63-76.
Aim: To observe the effect of non-surgical therapy on single rooted teeth (anterior or front teeth).
Method: 16 patients with severely advanced periodontitis were treated by hand instrumentationh single roots. The results were reported at 24 months following therapy.
Bottom Line: Single rooted teeth (front teeth)
can be successfully treated non-surgically. However, if the initial probing depth is very deep, further treatment may be warranted.
Section 2: Periodontal Medicine
Periodontal Disease and Your
Health
Periodontitis: A Risk Factor
for Coronary Heart Disease?Beck
JD., Offenbacher S., Williams
R., et al. Ann Periodontal
1998;3:127-141.
Aim: To evaluate the current
information on the relationship
between oral disease (periodontitis)
and atherosclerosis/coronary
heart disease (CHD). A review of
3 case-control studies and 5
longitudinal studies.
Bottom Line: The associations
found across a wide variety of
subjects represented by
incidence odds ratio
approximately 2.0. Thus implying
patients with severe periodontal
disease are twice as likely to
experience coronary heart
disease. The authors present a
potential disease model viewing periodontitis as a microbial
burden to the host/patients
blood circulation resulting in a
hyperinflammatory response which
may promote atheroma formation
(precursor to CHD.
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The Relationship Between Dental Disease and Cerebral Vascular Accident in Elderly United States Veterans
Loesche WJ., et al..Ann Periodontol 1998;3:161-174.
Aim: To report information obtained from a cross-sectional study of 401 veterans associating oral conditions to cerebral vascular accident (CVA, or stroke).
Bottom Line: Individuals with poor hygiene/poor oral health were 3.29 times more likely to have a CVA versus those with improved dental health. Furthermore, if these subjects did not have their teeth cleaned at least once a year, they were 4.76 times more likely to have a CVA. This information suggests that oral neglect may be associated with developing CVA. Dental treatment/dental health (reducing bacteria load in the mouth and bloodstream) could possibly prevent or delay the onset of CVA.
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Relationship Between Periodontal Disease and C-Reactive Protein among Adults in the Atherosclerosis Risk in Community Study.
Arch Intern Med: 2003;163: 1172.
Summary: C-Reactive Protein (CRP) is produced in the liver and serves as a systemic marker of inflammation and has been documented as a risk factor for cardiovascular disease. Chronic periodontal disease has been documented to be associated with increased CRP levels in an otherwise healthy adult. This data suggests the need for both medical and dental diagnosis to when evaluating the cardiac patient. The article documents the benefit for systemic health by maintaining periodontal health.
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Periodontal Disease and Diabetes Mellitus: A Two-Way Relationship.
Grossi, SG and Genco, R. Ann Periodontol 1998;3:51-61.
Aim: To evaluate how periodontal disease affects diabetes and vis versa.
Bottom Line: It has been well documented that subjects with diabetes (especially poorly controlled) negatively affects oral health leading to more severe periodontal disease. Bacteria responsible for causing periodontal disease triggers, the activation and secretion of many inflammatory mediators into the bloodstream and tissue. These inflammatory mediators have been suggested as the mediator of insulin resistance in infections by suppressing insulin induced tyrosine phosphorylation of insulin receptor substrate-1 (IRS-1), thus impairing insulin action and the accumulation of advanced glycation end products (AGEs) amplifying further tissue degradation and destruction. The authors propose that successful elimination of periodontal bacteria with systemic antibiotics would reduce the systemic bacteria challenge and inflammatory mediators leading to less tissue damage/degradation.
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Osteoporosis: A Possible Modifying Factor in
Oral Bone Loss.Jeffcoat MK..
Ann Periodontol 1998;3:312-321.
Aim: To investigate the literature addressing risk
factors for osteoporosis and periodontitis.
Bottom Line: Evidence exists that therapies designed
to improve bone mineral density may be associated
with slower alveolar bone loss and consequently less
tooth loss. Specifically, hormone replacement
therapy has been associated with less tooth loss and
bisphosphonate therapy associated with slower
alveolar bone loss.
Poor Periodontal Health of the Pregnant Women as a Risk Factor for Low Birth Weight.
Dasanayake AP. Ann Periodontol 1998;3:206-212.
Aim: To evaluate the hypothesis that poor oral health of the pregnant woman is a risk factor for low birth weight (LBW) using a matched case-control study.
Bottom Line: LBW infants are more likely to die during the neonatal period and infants that survive face extensive respiratory problems, neurodevelopment problems, congenital anomalies and complications due to neonatal intensive care resulting in a tremendous impact to the family and health care system. In this study, the mothers height, lack of prenatal care, and the number of healthy sextants in the mouth emerged as independent risk factors for LBW. Offenbacher, Jared, O’Reilly et al. (1998), demonstrated that periodontitis is a statistically significant risk factor for preterm LBW. Mothers with periodontitis were 7.5 - 7.9 times more likely to give birth to a preterm LBW infant.
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Osteoporosis: A Possible Modifying Factor in Oral Bone Loss.
Jeffcoat MK..Ann Periodontol 1998;3:312-321.
Aim: To investigate the literature addressing risk factors for osteoporosis and periodontitis.
Bottom Line: Evidence exists that therapies designed to improve bone mineral density may be associated with slower alveolar bone loss and consequently less tooth loss. Specifically, hormone replacement therapy has been associated with less tooth loss and bisphosphonate therapy associated with slower alveolar bone loss.
Bone Mineral Density in Periodontally Healthy and Edentulous Postmenopausal Women.
Bando K et al. Ann Periodontol 1998;3:322-326.
Aim: To investigate the relationship of existing dentition and skeletal bone mineral density in postmenopausal women.
Method: 14 periodontally healthy subjects with existing teeth and 12 edentulous subjects were randomly selected and subjected to bone mineral density tests. Occlusal force (bite force) was also analyzed in each subject.
Bottom Line: Several studies have demonstrated a relationship between dental health and lifestyle. In this study, periodontally healthy subjects with existing teeth showed about 6 times higher occlusal force and significantly higher bone mineral density versus the edentulous (no existing teeth) subjects. The results suggest retaining your natural dentition providing sufficient masticatory (chewing) function may affect systemic bone metabolism and inhibit or delay osteoporotic change.
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The Association Between Alveolar Bone Loss and Pulmonary Function: The VA Dental Longitudinal Study.
Hayes C et al. Ann Periodontol 1998;3:257-261.
Aim: To investigate the relationship between chronic obstructive pulmonary disease (COPD) and periodontitis by assessing radiographic alveolar bone loss (ABL).
Method: Secondary data analysis was performed from participants in an ongoing Dental Longitudinal study (DLS) and Normative Aging Study (NAS) consisting of 1,118 subjects. Subjects are seen every 3 years for comprehensive oral examinations and periodic medical and psychosocial examinations.
Bottom Line: Of the 1,118 subjects, 261 subsequently developed COPD. Results showed that for each 20% increment in mean whole mouth alveolar bone loss (indicating periodontal disease), a persons risk for developing COPD was increased by 60%. Subjects with greater than 20% ABL per site raised the risk of developing COPD by 80%. The authors conclude that periodontal status is associated with an increased risk for COPD.
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Section 3: Platelet Rich Plasma
Platelet Rich Plasma
Growth Factor enhancement for bone grafts.
Marx RE, Carlson ER, Eichstaedt RM, et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:638-46.
Aim: To explore the potential of Platelet Rich Plasma (PRP).
Method: Eighty-eight cancellous morrow bone graft reconstructions receiving marrow grafts with or without PRP. Platelet counts and activity were assessed in addition to radiographic and histologic bone maturation.
Bottom Line: Collection of platelets was 338% over baseline which contained platelet-derived growth factor and transforming growth factor beta within them. Grafts with the PRP demonstrated a radiographic maturation rate 1.62 to 2.16 times that of the grafts without PRP. In addition, grafts combined with PRP demonstrated greater bone density versus grafts without PRP. Grafts + PRP significantly enhanced results versus grafts without PRP.
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Enhanced bone-to-implant contact by platelet-released growth factors in mandibular cortical bone: a histomorphometric study in minipigs.
Fuerst G, Gruber R, Tangl S., et al. Int J Oral Maxillofac Implants. 2003,18(4):505-11.
Aim: To evaluate the effects of PRP on bone to implant contact (BIC).
Method: Sixteen implants were placed in a total of 8 minipig mandibles (2 implants in each). In each minipig, one implant was coated with PRP while the other was not. Histologic evaluation of the implants were made at 4 and 8 weeks.
Bottom Line: Bone to implant contact (BIC) at 4 weeks was 44.2% with PRP coated implants versus 29.6% BIC with non-PRP coated implants. At 8 weeks, PRP coated implants displayed 70.36% BIC versus 48.2% BIC with non-PRP coated implants. Bone to implant contact was approximately 1.5x greater when implants were coated with PRP.
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Wound Repair/Cosmetic Surgery Healing Enhancement of Skin Graft Donor Sites with Platelet-Rich Plasma (PRP).
Monteleone K., Marx RE., Ghurani R..
Presented at the 82nd Annual American Academy of Oral and Maxillofacial Surgery Meeting. September 2000, San Francisco, CA.
Aim: To assess the potential of PRP to accelerate soft tissue wound healing and epithelialization of a split thickness skin graft donor site.
Method: Twenty patients underwent skin grafts in excess of 10x10cm (2 per patient). One donor area was treated with PRP and the other with only thrombin. Wound assessments were made at 7, 14, 20 and 30 days.
Bottom Line: Wounds treated with PRP resulted in significant acceleration in healing at each time point. PRP treated sites resulted in significantly less scar tissue formation and accelerated rate of epithelialization
(Skin formation).
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