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Perio Reports Trisha E. O'Hehir, RDH, BS, Editorial Director, Hygienetown Magazine

More by this author (282)
Perio Reports  Vol. 20 No. 9
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.
Gingival tissues reservoir for viruses

Human herpes viruses have been implicated with bacteria as pathogens responsible for periodontal disease. A virus-bacterial pathogen model was proposed to explain the impaired host response and increased virulence of periodontal pathogens.

Researchers at the University of Ferrara in Italy evaluated gingival biopsies taken from 24 patients with periodontitis and 13 healthy patients. Patients with periodontitis had either chronic (13 patients) or aggressive (11 patients) periodontitis. Prior to tissue biopsies, all subjects received single or multiple sessions for periodontal debridement and oral hygiene instructions. Biopsies were taken during subsequent periodontal surgical procedures or for the healthy patients, during extractions. Tissue samples were evaluated for the presence of herpes virus 7, Epstein-Barr virus, and cytomegalovirus.

Epstein-Barr virus was found significantly more often in patients with periodontal disease than in healthy patients, 50 percent vs. eight percent. Herpes virus 7 was found in small amounts in patients with chronic periodontitis, but rarely in those with aggressive periodontitis or periodontally healthy patients. Cytomegalovirus was found in only one subject who was periodontally healthy.

Herpes virus 7 and cytomegalovirus do not appear to be involved with the pathogenesis of periodontal disease. However, these findings suggest that the Epstien-Barr virus might be involved in the pathogenesis or progression of periodontal disease.

Clinical Implications: Periodontal disease is multifactorial and the viral component will be considered more seriously in the future.

Gürsoy, M., Pajukanta, R., Sorsa, T., Könönen, E.: Clinical Changes in Periodontium During Pregnancy and Post-Partum. J Clin Perio 35: 576-583, 2008.
Herpes in HIV-positive patients

Periodontal disease is the same infection in both HIV-positive and HIV-negative patients. However, an altered immune response exhibits rapid onset and progression of the disease. HIV-induced immunosuppression is known to facilitate herpes viruses’ reactions or reinfections and be responsible for increased levels of gingival interleukin 1 and tumor necrosis factor alpha and onset and progression of periodontal disease. Epstein-Barr virus has been identified in the etiology of oral hairy leukoplakia, Hodgkin’s disease, peripheral T-cell lymphoma and B-cell lympho-proliferative diseases. A co-infection with cytomegalovirus in HIV-positive patients may result in painful ulcers and erosions on the lips, tongue and buccal mucosa.

Researchers at the University of Sãn Paulo in Brazil compared levels of these three viruses in subgingival plaque, finger-stick blood and unstimulated saliva in HIV-positive and HIV-negative patients. Based on clinical examination, the 50 HIV-positive patients were subdivided into 23 with gingivitis and 27 with periodontitis. All 50 HIV-negative patients had chronic periodontitis.

Virus detection was done using a laboratory test called polymerase chain reaction. Polymerization is a chemical reaction using nucleic acids to create three dimensional networks or polymer chains to compare identified virus DNA with nucleic acids isolated from the plaque, blood and saliva samples to determine if the viruses are present.

Epstien-Barr virus was detected more often in HIV-positive patients than in HIV-negative patients. Cytomegalovirus was found in both HIV-positive and HIV-negative patients with periodontal diseases.

Clinical Implications: Periodontal pockets of HIV positive individuals appear to be reservoirs for viruses that contribute the the extent and severity of periodontal disease.

Grande, S., Imbronito, A., Okuda, O., Lotufo, R., Magalhães, M., Nunes, F.: Herpes Viruses in Periodontal Compromised Sites: Comparison Between HIV-Positive and -Negative Patients. J Clin Perio 35: 838-845, 2008.
Licorice extract has anti-inflammatory properties

A variety of Gram-negative, subgingival bacteria release lipopolysaccharides (LPS) that trigger an immune response in the host. Host cells then release cytokines into the supporting periodontal tissues, causing connective tissue and bone destruction. Four destructive cytokines are interleukin1 (IL1ß), interleukin 6 (IL6), interleukin 8 (IL8) and tumor necrosis factor-alpha (TNFa). IL1ß and IL6 stimulate production of osteoclasts, leading to bone destruction.

Licorice is a natural compound used in alternative medicine to treat a variety of conditions, including gastric ulcers, bronchitis, allergies, dermatitis, and arthritis. Researchers at Laval University in Quebec City, Canada, wondered if a licorice extract might have anti-inflammatory benefits for periodontitis.
They performed a variety of laboratory studies to determine if a CO2-supercritical extract of licorice could inhibit cell production of various cytokines. Whole blood from patients with periodontitis is a popular model for studying these reactions. When licorice was added to whole blood, LPS induced production of IL1ß, IL6, IL8 and TNFa by leukocytes was significantly reduced. Licorice might be a valuable therapeutic compound to control the production of cytokines that destroy healthy tissue in response to the LPS of periodontal pathogens. The next step in this research process is to determine the effects of licorice extract on fibroblasts and epithelial cells. Human studies are further down the line.

Clinical Implications: One day you might see licorice extract incorporated into a variety of products to prevent and/or treat periodontal inflammation.

Bodet, C., Dang La, V., Gafner, S., Bergeron, C., Grenier, D.: A Licorice Extract Reduces Lipopolysaccharide-Induced Proinflammatory Cytokine Secretion by Macrophages and Whole Blood. J Perio 79: 1752-1761, 2008.
Probiotics improve periodontal health

Probiotics are bacteria with physiologic benefits. More than 100 years ago, Nobel Prize winner Ilya Metchnikoff hypothesized that lactic acid producing bacteria in the gastrointestinal tract would improve general health. His idea was to ingest good bacteria to displace bad bacteria that produce toxic chemicals. It’s only in the past 10 years that his theory has gained the respect of the scientific community. Several oral health studies report benefits from introducing probiotics into the oral cavity.

Researchers in Japan compared the effects of a Lactobacillus salivarius probiotic to a placebo. Both tablets contained xylitol. The eight-week study measured clinical, bacterial and salivary changes at baseline, four weeks and eight weeks in a study group of 66 volunteers from the Wakamoto Pharmaceutical, Co., makers of the probiotic and the placebo tablets.

Subjects had probing depths less than 6mm and no severe periodontitis. They received no oral hygiene instruction and no prophylaxis before the study. They were instructed to take the tablets three times each day and to let the tablets dissolve in their mouth.

Both test and control groups showed improved clinical indices. Some of this improvement is attributable to the Hawthorne Effect or being more attentive to oral hygiene because they are being evaluated as part of a research study. When current smokers were compared to non-smokers, greater reductions in bleeding and plaque levels was observed in the test group taking the probiotics.

Clinical Implications: We may soon see probiotics used to control oral bacterial levels leading to a reduction in caries and periodontal disease.

Shimauchi, H., Mayanagi, G., Nakaya, S., Minamibuchi, M., Ito, Y., Yamaki, K., Hirata, H.: Improvement of Periodontal Conditions by Probiotics with Lactobacillus Salivarius WB21: A Randomized, Double-Blind, Placebo-Controlled Study. J Clin Perio 35: 897-905, 2008.
SRP increases bone density

The primary measures of scaling and root planing effectiveness are clinical indices: probing depths, attachment levels and bleeding upon probing. Only a few studies have attempted to measure bone level changes. Measuring linear changes in bone height underestimates differences in bone density. Using subtraction radiography, bone density changes of as little as five percent can be detected when comparing baseline and post treatment radiographs.

Researchers at the Seoul National University in Korea evaluated radiographic changes in 13 subjects with a total of 39 test sites. Three test regions per site were identified for subtraction radiography comparisons.
Baseline probing scores were recorded with a Florida Probe set to 20 grams of pressure. Subjects received oral hygiene instruction and scaling and root planing over a period of four to five weeks. One month later, subjects were reexamined for residual calculus removal. Subgingival plaque removal was repeated at three months and post treatment digital radiographs were taken at six months. Control sites were also designated that did not receive treatment.

Increased bone density was evident at 101 of the 117 test regions or 83.3 percent of test regions. Increased density was evident more often at the base of the pocket, rather than the sides or crest of the bone. Pockets deeper than 5mm showed greater increase in bone density than pockets measuring less than 5mm. Scaling and root planing can significantly increase bone density.

Clinical Implications: Analyze the pre- and post-treatment radiographs of your patients who received SRP. Without subtraction radiography software, you won’t detect subtle changes in density, but any changes you do see are probably much greater than the radiograph indicates.

Hwang, Y., Fien, M., Lee, S., Kim, T., Seol, Y., Lee, Y., Ku, Y., Rhyu,, I., Chung, C., Han, S.: Effect of Scaling and Root Planing on Alveolar Bone as Measured by Subtraction Radiography. J Perio 79: 1663-1669, 2008.
Antibiotic combo helps smokers

Smoking is the greatest risk factor for periodontal disease and those who smoke respond less favorably following therapy. Smoking compromises the healing process. Various antibiotics used alone or in combination have been used in combination with periodontal treatment to reduce bacteria and enhance healing.

Researchers at the Guarulhos University in Sãn Paulo, Brazil compared scaling and root planing (SRP) with a single antibiotic or a combination of two antibiotics. Two test groups and one control group were formed: SRP plus metronidazole, 400 mg.; SRP plus metronidazole, 400 mg. and amoxicillin, 500 mg.; and SRP plus a placebo pill. A total of 43 subjects, all smokers, participated in the four month study.

Clinical indices at baseline revealed probing depths 5-7mm and attachment levels 5-10mm. All study subjects received oral hygiene instruction, were given Colgate Total toothpaste, and four to six, one-hour SRP visits using local anesthesia. Subjects began taking their assigned pills at the first SRP visit and were instructed to take the pills three times a day for 14 days. All instrumentation was completed within 21 days.

All three groups showed improved clinical health as measured by probing depths, attachment levels, bleeding and plaque scores. The greatest reduction in red and orange complex subgingival bacteria was evident in the combined antibiotic group. This group also showed 25% more reduction in bleeding than the SRP plus placebo group, and 0.5mm greater pocket depth reduction.

Clinical Implications: Both full-mouth and quadrant approaches to non-surgical therapy are viable choices. Deciding which to use should be based on patient preference and the convenience of scheduling. For some, four appointments are preferred, while others would prefer to accomplish the treatment in just one or two visits.

Eberhard, J., Jervøe-Strom, P., Needleman, I., Worthington, H., Jepsen, S.: Full-Mouth Treatment Concepts for Chronic Periodontitis: A Systematic Review. J Clin Perio 35: 591-604, 2008.
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