Gingival Recession:Cause,Classification & Treatment

[Drsumitra]

– A team of engineers and clinical researchers from West Virginia University (WVU) and the University of Pittsburgh is making progress in their quest to develop a 3D ultrasound system for assessing gingival tissue and inflammation and diagnosing gingivitis.

 

While ultrasound is best known in dentistry for its scaling and surgical abilities, the WVU team has been studying the use of high-frequency ultrasound to construct 3D images of hard and soft tissues in the oral cavity. In previous research, they demonstrated the ability to construct 3D images of the mandible and surrounding tissues.

At the International Association for Dental Research (IADR) meeting in Brazil this week, they will present findings from a new study using this technology to assess gingival tissue.

"We are in the early stages of developing 3D ultrasound to measure tissue alterations in gingivitis," said Eros Chaves, DDS, MS, DMD, an associate professor at WVU who will be presenting the study at the IADR meeting on June 22. "We know that we can do it in vitro; for this study, we compared histologies with the ultrasound in vitro."

Clinical and research applications

Dr. Chaves and his colleagues collected in vitro ultrasound scans via a proprietary high-resolution system that uses a 55-MHz single-element transducer. Gingival tissue samples were immersed in water near the ultrasound transducer focus, and continuous acquisition with a 400-MHz data acquisition card was synchronized with a high-precision 2D positioning system to acquire measurements of the gingival tissue samples.

The researchers found that ultrasound scans for tissues with gingivitis exhibited higher values of integrated backscatter, time variance, time entropy, frequency integrated backscatter, wavelet root mean square value, and wavelet integrated backscatter than normal tissue samples or samples with mild gingivitis.

When they compared the ultrasound scans with the tissue histologies, both revealed similar changes in the tissue, the researchers noted.

These findings indicate that parametric ultrasound has the potential to be used for diagnosing gingivitis, the researchers concluded, although more research is needed to investigate the diagnostic value of ultrasound for clinical research and chairside use.

Before joining the faculty at WVU, Dr. Chaves was in private practice and also worked in product testing doing studies for some of the major toothbrush and toothpaste suppliers, he said. He sees a need for a better diagnostic tool for product testing.

"It was all based on subjective criteria of gingivitis and plaque," he said. "And knowing the cost of the examiners and the subjectivity, it felt like we needed a better tool. So we are trying to see if ultrasound, which has been demonstrated to be effective in soft tissue in other medical areas, could work in gingival tissue also. I see this more for the research field, but my partners see it more as a diagnostic tool that could be used in the dental office."

Ultrasound advantages

Ultrasound imaging offers several advantages over conventional imaging methods for assessing gingival tissue, according to Dr. Chaves. There is no exposure to ionizing radiation, it is potentially more accurate than manual probing, and it is noninvasive.

"In clinical diagnostics of gingivitis, you have to probe the gingival tissue, which is an irreversible index because when you touch the tissue, it changes," he said. "If it starts bleeding and you have second examiner, they will see something different. Ultrasound is noninvasive and reversible. It doesn’t change anything."

In addition, ultrasound technology is getting increasingly sophisticated, Dr. Chaves noted.

"The waves are much higher intensity now, so you can scan the tissue much better," he said. "CT scans can give a 3D image of the mandible, and now ultrasound can do the same thing with sound waves instead of x-rays."

Even so, there is more work to be done. While they originally had to use the same kind of ultrasound machine that is used in obstetrics and other medical examinations, the researchers have been able to reduce the size of the ultrasound scanner so they can now do more precise intraoral imaging rather than extraoral. The next challenge will be to image more of the oral cavity during a scan, rather than just specific areas. This will enable them to then begin in vivo studies.

"At this point, we are really learning and developing," Dr. Chaves said. "Every time we learn that it is possible to do this, then we have to learn how to do it in the patient, then the entire mouth of the patient, then in a patient population, very fast. It is going to take some work and creativity to learn how to do this in the entire mouth of the patient, rather than just specific parts of the gingival tissue."

 

        

[Drsumitra]

The latest research and science behind periodontal disease is your biggest tool to convince a patient to begin—and stick with—preventive and SPT appointments. The first step is to clearly understand the information behind your case to the patient. The following are key points about periodontal disease to have in your toolbox when you talk to patients.

Periodontal disease is an inflammatory disease that affects the soft and hard tissues that support the teeth. The early stage of this disease is gingivitis. In later stages, the teeth may become loose, and the bone surrounding the teeth can degenerate. The most advanced stage of periodontitis is termed chronic periodontitis.1 Major risk factors for this disease include an inherited or a genetic predisposition, smoking, lack of routine home care, age, diet, certain systemic diseases, and various medications.2

Any time bleeding is present, pathological change is occurring in your patient’s mouth that needs to be evaluated and appropriately treated sooner rather than later. When periodontal disease is present, the potential for bone loss has already begun. Depending upon the patient’s risk factors, bone loss can occur quickly and become aggressive very easily. In patients with few or no risk factors, periodontal disease can be reversed with early nonsurgical intervention.3 With this knowledge, a patient will be much more likely to say yes to your treatment plan.

Phase 1 treatment is complete after the patient undergoes scaling and root planing, followed by a successful postoperative report from the 6-week re-evaluation appointment. This 6-week re-evaluation appointment is the first of the SPT appointments. During the early stage of periodontal disease and at the end of phase 1, the periodontium has the best chance to reverse the diseased state and, in many cases, halt the progression of further oral and systemic disease. Patients need to know, however, that this is not the end of the story. After phase 1 therapy is complete, a patient is now and forever considered a periodontal patient, which means regular SPT is a must to prevent active disease. A regular prophy just won’t do. If your patient were to ask, alternating prophylaxis appointments with SPT appointments is not appropriate and should not be considered as an appropriate phase for future treatment. Bone loss is not reversible, and it is imperative that patients understand this. Removal of the biofilm and microbiological factors also becomes very important for future health of the patient.4

For years, we have understood that periodontal disease is episodic. Make sure your patients understand what that means. It is another key point to use when explaining why regular periodontal maintenance is crucial. Periodontal pathogens will repopulate a healthy and recently scaled sulcus as early as 9 to 12 weeks post-scaling.5 That means a patient can brush and floss all day long, or even see the dental hygienist every 3 months; yet this may not be enough to prevent the return of periodontal pathogens. Without these pathogens removed, bone loss is likely to continue. Other clinical studies have shown that even with the supragingival environment as the single source for colonizing bacteria, a complex subgingival microbiota can develop within one week.6

You can strengthen your case for preventive care even more when your patient is aware that oral health affects the whole body. Countless studies have emerged during recent years suggesting a strong link between periodontal health and systemic health. For example, when patients with Crohn’s disease receive the appropriate treatment for periodontal disease, research reports a decrease in the enzymes that would normally increase inflammation in the sulcus—and the body.7 In addition, much research states that when a patient with type 2 diabetes mellitus is diagnosed with periodontal disease, nonsurgical periodontal therapy was associated with improved glycemic control.8 The role of the dental hygienist becomes extremely valuable when patients’ teeth are not merely "cleaned." Scaling, root planing, and various adjunct chemotherapeutic intervention along with lasers can improve a patient’s oral health8,9 and thus may actually help a patient live a longer, healthier life.

Your chances of getting a yes to nonsurgical periodontal therapy and routine SPT appointments will increase when patients understand the vital link between their oral health and systemic health. On that note, what’s even more effective is to share science’s good news. Decades of research and advances in periodontal therapy have proven that the majority of patients who receive routine preventive care can retain their dentition throughout their lifetimes.10 Many patients who do routine, long-term, supportive, nonsurgical therapy can maintain optimal gingival health that is free from reinfection.

If you have your patients’ attention at this point, they will probably want to know how often they need to come in for periodontal therapy. Although each patient will need an individualized treatment plan, dental hygiene appointments for routine preventive care will ideally range from 2- to 6-month intervals.11 Presenting the scientific evidence to patients takes good communication, and their understanding will leap forward, giving them a reason to sit up, listen, and take action, saying, "Yes!" to case acceptance of nonsurgical periodontal treatment.

Written by Debra Seidel-Bittke, RDH, BS

 

        

[Drsumitra]

Each patient has a different healing potential that can directly influence the response to treatment. The patient-related factors that have a negative influence on the regeneration of these lesions include smoking, stress, diabetes mellitus, acquired immunodeficiency syndrome and other acute and debilitating diseases, and the presence of multiple deep periodontal pockets. Age, gender and type of periodontal disease do not seem to play a major role in regenerative therapy (10,16).

Smoking. Epidemiological and longitudinal studies have shown an increased prevalence of periodontal disease and progression rate among smokers compared to non-smokers (17). Evidence has indicated that smokers present a less favorable response following both non-surgical and surgical periodontal therapy (18).

Various factors contribute to the deleterious periodontal effects of smoking, including alterations of the microflora and host response (17). The proposed mechanisms of the negative periodontal effects of smoking are decreased vascular flow, altered neutrophil function, decreased IgG production and lymphocyte proliferation, increased prevalence of periopathogens, altered fibroblast attachment and function, difficulty in eliminating pathogens by mechanical therapy, and negative local effects on cytokine and growth factor production (17). These deleterious effects have been related to the presence of more than 4000 toxic constituents in cigarette smoke (19).

Cigarette smoking has been associated with a reduced healing response following GTR treatment (14,19,20). Evidence indicates that the impact of smoking on regenerative therapy is more significant in the tissue maturation phase (19,20). Machtei et al. (20) recommended that when GTR is performed for class II furcation defects in smokers, anti-infective therapy should be incorporated into the treatment protocol to enhance the regenerative outcome. In that study, the experimental (anti-infective therapy) and control groups gained similar levels of tissue at membrane retrieval; however, the experimental group exhibited significantly less tissue loss between retrieval and 1-year reentry, indicating that the effect of smoking is crucial at the tissue maturation phase. Thus, while smoking prevented tissue maturation and mineralization, the anti-infective protocol enhanced these processes, resulting in a more favorable outcome. Adjunctive systemic or local antimicrobial therapy has been recommended in smokers due to evidence suggesting that subgingival pathogens are more difficult to eliminate in smokers following scaling and root planing (17).

Ah et al. (18) reported that smokers of more than 10 cigarettes a day respond less favorably to both conservative and surgical periodontal therapy than do non-smokers. Kaldahl et al. (21) noted that heavy smokers (>20 cigarettes per day) respond less favorably than light smokers (<20 cigarettes per day). It is important to note that former smokers respond to non-surgical and surgical therapy in a similar manner to those who have never smoked (17). Thus, tobacco cessation may result in better predictability and an improved regenerative response; however, the period that is required for host responses to return to normality following cessation is yet to be determined.

Stress. The influence of stress on periodontal regenerative therapy has not yet been studied. However, recently, psychological stress has been considered to be a possible risk factor for periodontal breakdown. The proposed mechanisms for the negative periodontal effects of stress include neglect of oral hygiene, changes in diet, increase in smoking and other pathogenic oral behaviors, bruxism, alterations in gingival circulation, changes in saliva, endocrine imbalances and lowered host resistance (22).

Diabetes mellitus. The diabetic’s susceptibility to periodontal disease and impaired wound healing can affect the progression of diabetes mellitus and the response to periodontal therapies such as GTR (23). Various features or events seem to be responsible for delayed wound healing in diabetic patients, such as impaired cell function, decreased tissue oxygenation, microvascular complications, increased collagenase production, deficiency in growth factors activity, deregulation of cytokines at the wound site, and decreased migration of periodontal ligament cells, which can interfere in the regenerative process (23,24).

A negative prognosis might be anticipated in patients with insulin-dependent diabetes mellitus, especially if their glucose levels vary (14). Treating furcation defects with GTR can be an option in well-controlled diabetics; however, the possibility of postsurgical complications should be considered. If complications arise because of delayed wound healing, treatment results may be less successful than expected. Thus, patients with diabetes require close supervision and frequent monitoring of the regenerated site to achieve long-term success.

Other systemic conditions. A negative prognosis might be anticipated in HIV-positive patients with other clinical or immunological deficiencies, in patients with rheumatoid arthritis, and other immune-complex diseases. High doses of irradiation in patients with a history of head and neck tumors might be detrimental to the regenerative process (14).

Presence of multiple deep periodontal pockets. GTR should be performed in patients with low levels of pathogens in the oral cavity. Barrier membranes are at risk of becoming contaminated within 3 min of intra-oral membrane manipulation in individuals with multiple deep periodontal pockets, bleeding on probing in other parts of the dentition, and high subgingival levels of putative periodontopathogens. Research has shown a negative correlation between bacterial contamination of the membrane and clinical attachment gain (25).

 

LOCAL FACTORS INFLUENCING SUCCESSFUL REGENERATION

The predictability of GTR in class II furcations is also strongly influenced by local factors, such as furcal anatomy, defect morphology, thickness of gingival tissue, and tooth mobility (8,10,26-29).

Furcal Anatomy

The furcal anatomy-related factors are the presence of cervical enamel projection, enamel pearls, root or root trunk concavities, bifurcation ridge, accessory canals, furcation entrance dimension and length of root trunk.

Cervical enamel projections and enamel pearls. Cervical enamel projections and enamel pearls may contribute to plaque accumulation and furcal invasion, hence, should be removed by odontoplasty during regenerative procedures. New attachment cannot be observed over these anatomical conditions (27).

Root concavity. Areas of root concavity also contribute to plaque accumulation and are covered by more cementum than are the adjacent convexities. This may have clinical significance because of the ability of the cementum to hold toxic bacterial products (27). Root surfaces exposed to the environment of a periodontal pocket may become hypermineralized. In addition to a direct cytotoxic effect on host cells, these surfaces may represent a poor substrate for plasma protein adsorption and subsequent fibrin adhesion (30). Thus, ultrasonic, hand and rotary instruments must be used for more effective decontamination in furcation areas, as well as the chemical conditioning of the scaled roots.

Root trunk concavities. The presence of root trunk concavities in molars, especially mandibular molars, has been reported to have possible effects on the regenerative results. Pustiglione et al. (31) and Kon et al. (32) reported that 100% of mandibular molars have root trunk concavities with a mean depth of 1.12 mm in first molars and 1.05 mm in mandibular second molars. Dunlap and Gher (33) determined the location of the first detectable buccal and lingual root concavities at 0.7 mm and 0.3 mm apical to the cemento-enamel junction, respectively, which progressively deepened to reach the furcation. The concavities of the root trunks negatively influence the results of GTR because adequate adaptation of the membranes, when placed 2 to 3 mm apical to the cemento-enamel junction, does not occur. This permits apical migration of the junctional epithelium, thus impeding the regeneration process. This was demonstrated by Novaes et al. (8), who evaluated the effect of the concavities on the regeneration of class II furcation lesions histomorphometrically in dogs. The authors suggested that a modification in the design of the membrane collars would allow more intimate adaptation of the membranes to the surface of the root trunk concavities, favoring the regeneration of periodontal tissues. In lesions treated with the modified membrane there was significant regeneration with less junctional epithelium migration and more bone regeneration. Villaça et al. (9) confirmed these results in humans and reported greater horizontal resolution of class II furcation defects treated with the modified membrane. Thus, these studies concluded that the collars of the membranes should be modified to improve regenerative results when root trunk concavities are present (8,9).

Bifurcation ridge. The bifurcation ridge is an anatomic structure formed mostly of cementum that originates from the mesial surface of the distal root, runs across the bifurcation and ends high up on the mesial root. This creates niches for plaque accumulation and has been found in 70-73% of mandibular molars. Odontoplasty should be considered in the presence of severe bifurcation ridges to ensure proper root surface preparation (27).

Accessory canal. Histologic studies have demonstrated accessory canals in the region of furcation (27). Endodontic infections can cause periodontal disease in the furcation region of molars by accessory canals and impair the healing response following GTR.

Entrance of the furcation. The architecture of the furcation entrance is an important factor for root preparation access, representing a major determinant of treatment success. Bower (34) has shown that the diameter of the furcation entrance in molars is smaller than the blade width of commonly used curettes in 58% of the furcations examined, hindering effective instrumentation of these areas. Matia et al. (35) showed that calculus removal in narrow furcations (less than 2.3 mm) is significantly better with open ultrasonic debridement than with open hand debridement; however, in wide furcations, there is no significant difference between the two approaches of calculus removal. Hence, it appears that hand instrumentation alone may not be adequate for complete root surface preparation in all furcation areas.

Length of root trunks. Molars with short root trunks are generally considered to be at higher risk for developing furcation involvement than teeth with long root trunks and are also the best candidates for tooth resection procedures (27). Bowers et al. (10) demonstrated that molars with the longest root trunks (5-6 mm) tended to respond more often with complete furcation closure following GTR therapy than teeth with shorter root trunks (100% versus 71%, respectively), although this difference failed to reach statistical significance. Hutchens (36) suggested that short root trunk length is considered to be less favorable for membrane coverage, coronal positioning and flap adaptation against the tooth. In contrast, Horwitz et al. (26) reported that long root trunk has a negative influence on the success of regenerative therapy. The results of this study indicated that long root trunks were associated with less favorable clinical horizontal probing attachment gains.

Type of tooth. Mandibular first and second molars frequently exhibit differences in root morphology and furcation access, which may affect surgical management (10). Mandibular first molars have shorter root trunks, which may account for the higher prevalence of furcation defects in mandibular first molars compared to second molars. Mandibular first molars frequently exhibit complex cementum morphology, an intermediate bifurcation ridge and intraradicular root concavities. Mandibular second molars have the longest root trunks and smaller root divergence, which may impair access for root preparation. Bowers et al. (10) demonstrated that despite comparable percentages of first and second molars with incomplete furcation closure, second molars exhibited a trend towards a higher proportion of defects with residual class II furcation. However, Machtei et al. (16) showed that first and second molars responded similarly to regenerative treatment.

The GTR procedure has a limited application for class II furcations of maxillary molars. Pontoriero and Lindhe (12) observed the largest clinical improvement in class II furcations of mandibular molars, followed by buccal class II furcations of maxillary molars and with interproximal furcation lesions exhibiting the least or no improvement. The authors reported that the reason for the different outcome of GTR in maxillary and mandibular furcation defects is most likely related to the anatomy of the defects, the presence of deep grooves in the root surface of the maxillary furcation, the limited access for root surface debridement, and the amount of remaining periodontium facing the defect. Furthermore, in interproximal furcation lesions, adaptation of the membranes is more difficult.

Defect Morphology

The clinical success of furcation therapy also appears to be strongly related to defect morphology. In a prospective study performed by Bowers et al. (10), multiple factors predictive of clinical outcome in the treatment of facial class II furcations in mandibular molars were identified: a) probing pocket depth, b) horizontal probing attachment level, c) distance of furcation roof to base of defect, d) distance of furcation roof to crest of bone, e) interproximal bone height, f) distance of bone crest to base of defect, g) root divergence, h) horizontal depth of defect, and i) furcation defect volume.

Probing pocket depth. Increases in presurgical pocket depth were associated with a significant reduction in complete furcation closure. However, Horwitz et al. (26) reported that a deep probing depth at the furcation site at baseline increases the likelihood for more favorable horizontal attachment gain in furcations. Machtei et al. (16) also demonstrated that the greater the initial pocket depth, the greater the potential for periodontal regeneration, suggesting that initial probing depth might be a useful indicator for the regenerative potential of a given site.

Horizontal probing attachment level. Increased baseline horizontal probing attachment level was associated with decreased clinical closure. Furcations with horizontal probing depths of 5 mm or greater demonstrated a lower likelihood of complete closure.

Distance of bone crest to base of defect. This measurement failed to account for differences in outcome relative to furcation closure. However, Cortellini et al. (37) reported that the depth of the infraosseous component of the defect is one of the most important factors in achieving the maximum regenerative potential. Anderegg et al. (38) also reported that the deeper the vertical component, the greater the repair.

Distance of furcation roof to base of defect. Increases in this measurement were associated with decreased clinical closure. Complete furcation closure was observed in 63% of defects with a distance of furcation roof to base of defect of 4 mm or greater. Machtei and Schallhorn (14) reported that if this measurement is lower than 4 mm and associated with defects that are mainly intra-osseous there is a better prognosis than the same measurement associated with defects that are mainly supra-osseous.

Distance of furcation roof to crest of bone. Increases in the distance of furcation roof to crest of bone were associated with a lower probability of complete furcation closure. Over 90% of defects with this measurement of 2 mm or less demonstrated complete furcation closure, compared to 67% of sites with a measurement of 3 mm or more.

Interproximal bone height. Teeth with interproximal bone height at the same level or superior to the roof of the furcation resolved with complete closure in a significantly higher percentage of cases (94% complete closure) than sites where interproximal bone was below the roof of the furcation (70% complete closure). Horwitz et al. (26) reported that, if there is bone coronal to the furcation fornix at the mesial and distal aspect of the tooth, coverage and stabilization of the membrane may be achieved with a coronally positioned flap. Under these conditions, the area of periodontal ligament available to provide cells to colonize the blood clot within the defect is larger than in the situation where the fornix is located coronal to the alveolar crest.

Root divergence. Increases in root divergence measured at crest of bone were associated with decreases in complete furcation closure. Complete furcation closure was achieved in 61% of defects with associated root divergence of 4 mm or greater, compared to 93% of defects with root divergence of 3 mm or less. However, it should be noted that furcation defects must have a root divergence sufficient to allow root preparation with hand, rotary, and ultrasonic instrumentation. Horwitz et al. (26) also demonstrated that a wide furcation entrance has a negative influence on the success of GTR therapy.

Horizontal defect depth. Furcation defects with a horizontal depth of 5 mm or greater measured at the level of the crest ofbone demonstrated a lower probability of complete closure (10). Complete furcation closure was obtained in 52% of cases, whereas defects with a horizontal depth of 4 mm or less responded with complete furcation closure in 84% of cases. Thus, in general, the findings of this study suggest that the less severe the defect, the greater the likelihood of achieving complete clinical furcation closure.

Thickness of Gingival Tissue

The amount and quality of the gingival tissue that will cover the membrane is also important. Inadequate gingival width and thin keratinized tissue should be analyzed because it can lead to gingival recession. Anderegg et al. (29) demonstrated that there is less post-treatment recession for tissue thickness greater than 1 mm than tissue thickness less than or equal to 1 mm. Thus, these authors suggest that the thickness of gingival tissue covering the membrane appears to be a factor to consider if post-treatment recession is to be minimized or avoided.

Many factors can account for this. The revascularization of any flap may be further compromised by blockage of the potential blood supply from the periodontal ligament and bone defect to the connective tissue flap by a membrane. The thicker the connective tissue, the better the potential circulatory pool and the greater the chance for flap survival. Mormann and Ciancio (39) demonstrated that flaps under tension become ischemic leading to necrosis. The blood supply in thin flaps is more likely to become compromised by tension than in thicker flaps of equal mobility. The likelihood of increased flap contraction associated with thin tissues might be magnified when placed over an ePTFE membrane, resulting in more postsurgery recession. Novaes et al. (40) reported that flaps with thin connective tissue are at greater risk for inflammation-induced postsurgery recession than thick flaps.

Tooth Mobility

Conflicting results exist concerning the effect that presurgical hypermobility has on surgical healing and, thus, on the post-therapeutic clinical outcome. Because of the scarcity of data available about the effect that tooth mobility has on periodontal regenerative therapy, the clinical relevance of mobility in regenerative therapy has not yet been elucidated. Trejo and Weltman (28) reported that intraosseous defects of teeth with Miller’s class 1 and 2 mobility responded favorably to regenerative therapy. In contrast, Cortellini et al. (41) reported that the greater the tooth mobility is at baseline, the smaller the clinical attachment level gain would be 1 year after regenerative therapy.

In clinical practice, the question of whether to splint mobile teeth prior to regenerative therapy to improve the healing outcome often arises. Further studies are needed to validate or refute the regenerative potential of splinting. Machtei and Schallhorn (14) recommended that very mobile teeth be splinted prior to GTR in class II furcation defects. Trejo and Weltman (28) recommended the splinting of hypermobile teeth to improve patient comfort during post-therapeutic healing. However, the clinician must recognize progressing tooth mobility due to trauma, teeth under premature centric occlusal contact, and teeth under traumatic excursional interferences. Such occlusal discrepancies should be removed to minimize trauma and thus tooth mobility prior to regenerative therapy

 

        

[drsushant]

More adults in the United States have gum disease than one would think.

A new study shows that about 50 percent of American adults age 30 and older have gum disease. The study appears in a recent issue of the Journal of Dental Research.

Periodontitis is a major problem and leads to tooth loss in many cases.

To compile the data for this study, a research team looked through data from a previous study involving 3,700 adults age 30 and older. There were 47 percent of the people who had periodontitis—9 percent had mild gum disease, 30 percent suffered from moderate gum disease and 8.5 percent had severe gum disease. According to this information, roughly 65 million American adults have gum disease.

The research also concluded that 64 percent of adults age 65 and older had some type of periodontitis that could at least be considered moderate. This estimation is much larger than previous studies have indicated, according to the lead author Paul Eke.

The study also showed that the gum disease rates were highest for males, Mexican Americans, adults with less than a high school education, adults whose income would be considered below the poverty line and people that currently smoke.

There are several warning signs for gum disease, including swollen, tender, or bleeding gums. Chronic bad breath is another sign of gum disease.

 

        

[Drsumitra]

Scaling and Root Planing: Manually removing the plaque and tarter from the root surfaces of your teeth below the gum line.
Antibiotics: Because bacteria cause periodontitis antibiotics may be prescribed as pills or as an Antibiotic fiber. The fibers are used in conjunction with scaling and root planing. They are placed directly into the pockets and are removed within 7-10 days later. Antibacterial mouth rinses may also be recommended to help plaque control.
Bite correction: An imbalanced bite may accelerate bone destruction. Your teeth may be adjusted for proper and better function. A Bite-guard (removable retainer fitting over teeth) may be required to protect teeth surfaces and relax tense muscles.
Splinting: This technique attaches weak teeth together, combining them into a stronger single unit, making them more stable and offering more comfortable chewing.
Surgical Therapy

Flap Surgery: Our periodontist separates the gum from the teeth creating a "flap" and accesses the infected pocket. It aims to reduce pocket depth and increase the ability to maintain the remnant pockets clean.
Gingivectomy: This procedure is performed when excess amounts of gum growth around the teeth have occurred. This results in false pocket formation and the inability to keep them clean.
Osseous (bone) surgery: This procedure is done to smooth shallow craters and defects in the bone due to mild or moderate bone loss. Guided Tissue Regeneration: This procedure is done in combination with a surgical flap operation where gum growth into a defect is barriered off to allow slower growing bone, cementum and ligament cells to populate a bony defect.
Bone Grafts: Tiny fragments of the patient’s bone, synthetic bone or bone obtained from a bone bank are used to fill a bony defect around the teeth. These grafts act as a scaffold on or around which patients own bone is conducted or induced to grow.
Soft Tissue Graft: In cases of gum recession a graft is usually taken from the palate and transplanted onto the receding area to reinforce the thin gum and to inhibit further gum recession.
Flap and Bone Surgery

When gum is inflamed severely (periodontitis), alveolar bone will be absorbed, and defected. Periodontal ligaments which connect between the alveolar bone and the teeth will disappear. Sever bone lose will cause tooth moving and missing. Flap and bone surgery is order to contour the bone, deeply clean the tooth to reduce the inflammation, and promote bone re-growing and connections firm.

 

 

        

[Drsumitra]

        

[Drsumitra]

Teeth whitening is one of the most popular dental procedures today, but it often comes with the undesirable side effect of tooth sensitivity.

Now a new study has found that a calcium-containing 35% hydrogen peroxide gel can reduce tooth sensitivity during in-office dental bleaching (Journal of the American Dental Association, December 2012, Vol. 143:12, pp. e81-e87).

Manufacturers have attempted to reduce bleaching-related sensitivity by adding desensitizing agents such as fluorides and potassium nitrate to the formulation of bleaching gels, but the benefits of including these agents remain unclear, the study authors noted.

Some studies have shown the effects of calcium-containing compounds in bleaching gels with the aim of preventing the mineral loss and reduction in enamel microhardness produced by bleaching, they added. If these components do indeed prevent mineral loss, it is possible that hydrogen peroxide penetration may occur at a lower diffusion rate, reducing sensitivity.

"To our knowledge, no clinical study investigators have evaluated the clinical benefits of such inclusion," wrote the study authors, which prompted them to conduct a randomized clinical trial to assess the whitening efficacy and sensitivity associated with a 35% hydrogen peroxide gel containing 2% calcium gluconate.

Stable pH key

The researchers recruited 40 study participants from the State University of Ponta Grossa School of Dentistry in Brazil. Participants were at least 18 years old and had good general and oral health. The study took place in the dental school’s clinic from March 2009 through April 2010.

They randomly divided the participants into two groups, in which one received bleaching with the calcium-containing gel and the other received bleaching with a calcium-free gel.

The researchers performed two bleaching sessions with a one-week interval in between. They registered the color at baseline and after the first and second bleaching sessions by using a shade guide. They also gauged the participant’s perception of tooth sensitivity as registered on a scale from 0 (none) to 4 (severe).

They found that both groups had similar and significant teeth color enhancement with an average bleaching of seven to eight shade-guide units. Most of the participants from the calcium-free group (80%) experienced sensitivity, while 40% of participants from the calcium-containing group reported experiencing sensitivity. The intensity of sensitivity was significantly higher for the calcium-free group during in-office dental bleaching.

"It is likely that the addition of calcium gluconate and the stable and high pH of the calcium-containing product were responsible for the reduced sensitivity reported by participants receiving this bleaching agent in our study," the authors concluded. "The calcium-containing hydrogen peroxide gel caused less sensitivity during in-office dental bleaching without any deleterious effects on bleaching effectiveness."

Related research

This is not the first time that calcium gluconate has been tested as an addition to bleaching gels. A study presented last year at the International Association for Dental Research meeting tested whether the addition of 2% calcium gluconate to bleaching gels reduces whitening efficacy.

The authors of that study reported that the addition of calcium in the bleaching gels does not interfere with the whitening effect. These results can be considered favorable for the clinical performance of bleaching agents since the advantageous effects of adding remineralizing agents to reduce the possible adverse effects to enamel did not impair the bleaching result of gels tested, they noted.

The efficacy of calcium compounds in relieving bleaching-related sensitivity also has been tested, and not just as an addition to gels. One study looked at whether chewing sugar-free gum containing Recaldent (casein phosphopeptides-amorphous calcium phosphate [CPP-ACP]) could reduce the incidence, duration, and intensity of whitening-induced tooth sensitivity.

The authors of that study looked at 88 patients who had their teeth whitened in a single in-office visit, and following the procedure, each patient was randomly assigned to one of three study groups, in which one used a sugar-free chewing gum with Recaldent, one group did not use any desensitizing agent, and the third used a sugar-free chewing gum without Recaldent.

The participants returned for a 24-hour follow-up visit where they completed a questionnaire regarding tooth sensitivity.

"This study suggested that using a sugar-free chewing gum (both with and without CPP-ACP) could reduce the intensity of tooth sensitivity associated with in-office whitening procedures," the authors concluded. "However, it failed to demonstrate conclusively that using a sugar-free chewing gum with CPP-ACP could provide additional therapeutic benefits.

 

        

[drmithila]

New research from Queen Mary, University of London in collaboration with research groups in the USA sheds light on why gum disease can become more common with old age.

The study, published in Nature Immunology, reveals that the deterioration in gum health which often occurs with increasing age is associated with a drop in the level of a chemical called Del-1.
The researchers say that understanding more about Del-1 and its effects on the body’s immune system could help in the treatment or prevention of serious gum disease.
Periodontitis is a disease of the gums which causes bleeding and bone loss which can, over time, lead to loss of teeth. It affects about 20 per cent of the UK population and is caused by an over-active immune response to bacteria that grow in the mouth.
As people age they are more likely to suffer from inflammatory diseases, including gum disease.
The new research investigated gum disease in young and old mice and found that an increase in gum disease in the older animals was accompanied by a drop in the level of Del-1. This protein is known to restrain the immune system by stopping white blood cells from sticking to and attacking mouth tissue.
Mice that had no Del-1 developed severe gum disease and elevated bone loss and researchers found unusually high levels of white blood cells in the gum tissue.
When they treated the gums of the mice with Del-1, the number of white blood cells dropped, and gum disease and bone loss were reduced.
The researchers say their findings could be the basis for a new treatment or prevention of gum disease.
Mike Curtis is Professor of Microbiology at Queen Mary, University of London, Director of the Blizard Institute and the lead on the microbiological studies in the research. He said: “Periodontitis is an extremely common problem and we know that the disease tends to be more common as we get older.
“This research sheds some light on why aging makes us more susceptible and understanding this mechanism is the first step to an effective treatment.”

        

[drsushant]

The capsule of Porphyromonas gingivalis, the bacterium that causes gum disease, provides stealth, boosting the bacterium’s virulence, according to a paper published in the November Infection and Immunity. Call it a sugar coating, if you will, for in fact, the capsule is made from sugar molecules, which do not ordinarily elicit immunity. Thus it hides the bacterium’s proteins within, preventing immune response
In the study, the researchers, led by Janina P. Lewis of Virginia Commonwealth University, Richmond, compared the ability of normal, and mutant bacteria that were missing the capsule, to activate the immune system, to enter eukaryotic cells (the kind that are present in multicellular organisms), to cause disease, and to survive in mice. “The mutant bacteria activated the host to a greater extent, and thus, were more easily killed by eukaryotic cells,” says Lewis. “Thus, the capsule protects the bacteria and allows them to survive unnoticed in our bodies.”
Capsules also protect both bacteria and fungi, including P. gingivalis, as per this report, from being engulfed by the immune system’s phagocytes (phago=eat; cyto=cell) and from being identified by dendritic cells as dangerous, thus marking them for destruction by antibodies. Conversely, in the study, mutant, non-encapsulated P. gingivalis were rapidly engorged by immune cells, and killed.
“Thus, anything that would interfere with generation of capsule, such as drugs interfering with the action of enzymes involved in synthesis of the sugar coat, could be used in treatment of periodontal disease, and importantly, could have broader implications for prevention of more serious diseases,” by other encapsulated bacteria, such as pneumonia, anthrax, meningitis, endocarditis, and gastroenteritis, says Lewis.

        

[mgeg]

I’ve the problem about black triangle. And read another arcticle online.
It is a free soft tissue graft treatment to treat the black triangle. Please visit the linked page for details. http://www.jisponline.com/article.asp?issn=0972-124X;year=2012;volume=16;issue=4;spage=533;epage=538;aulast=Sawai
Is this method work ? And will the soft tissue glue with the tooth ? And what is the advantage and disadvantage of this method ?
Is it any side effects of it ?
Thank you for your time.

        

[Author]

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