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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. 3
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.
Anabolic steroids and gingival tissue volume

Steroid abuse is reported to be as high as 95 percent of professional football players and 80-99 percent of male bodybuilders. Alarmingly, the rate among young American adults is four to six percent. The common name of the synthetic derivate of testosterone is anabolic androgenic steroid (AAS). The two effects of these drugs are anabolic, promoting muscle growth and androgenic, development of male sexual characteristics. All tissues, including gingival tissue have androgenic receptors.
Researchers at Cukurova University in Turkey compared the gingival conditions among a group of 24 males between the ages of 17 and 29 who reported using AAS for more than one year and an age matched group of 20 bodybuilders and weight lifters who had never used AAS drugs. Those using drugs were non-professional athletes who used both oral and injectable forms of a variety of AAS drugs. They were promised anonymity since use of this drug is illegal.

The drugs are used in several ways. Stacking is the use of both oral and injectable forms of AAS. Pyramid stacking is done in cycles of six to 12 weeks with gradual increases in drug intake followed by slowly decreasing to zero. Intake of these illegal drugs varies due to finances of the athletes and drug quality varies as they are obtained on the black market. All these factors complicate objective evaluation of drug effects.

Plaque and gingivitis levels were the same for both AAS users and controls. Gingival thickness, encroachment on neighboring teeth and enlargement were all significantly higher for AAS users compared to controls.

Clinical Implications: Suspect use of anabolic androgenic steroids when you see gingival enlargement in patients who are body builders and weight lifters. Systemic effects of these drugs are seen in the oral cavity as well as other places in the body.

Ozcelik, O., Haytac, M., Seydaoglu, G.: The Effects of Anabolic Androgenic Steroid Abuse on Gingival Tissues. J Perio 77: 1104-1109, 2006.
Caries and periodontal disease still prevalent

It is assumed that oral health today is better than a century ago due to improved oral hygiene and dental care. Not exactly, say researchers at the University of Pittsburgh. They compared a collection of 100 skulls from the early 1900s. This collection of skulls is most likely from people who didn't have the financial means for burial and thus a part of the lower social economic group. The skulls were examined to determine age, sex, ethnicity, the presence of caries and bone loss representative of periodontal disease. Age, sex and ethnicity can be determined by established anthropological characteristics of skulls. The collection consists of six children, 43 older than 40 years of age at death, twice as many males than females, two-thirds Caucasian and the rest of African and Asian descent.

Findings were compared to statistics from the third National Health and Nutritional Examination Survey 1988-94 (NHANES III). Less than 10 percent of the skulls showed no signs of periodontal disease, which is lower than reported for NHANES III. The incidence of moderate to severe periodontal disease is higher in the skulls than reported for comparable age/gender/ethnicity groups, suggesting improved periodontal health in the past 100 years.

Rates for decayed, missing and filled teeth were comparable for the skulls under age 40 and the NHANES III subjects in that age group, suggesting the incidence of this preventable disease has not been reduced in the past 100 years.

Clinical Implications: Despite being preventable, caries and periodontal disease continue to affect a significant portion of our population. Oral diseases are still considered a "silent epidemic."

Rose, E., Vieira, A.: Caries and Periodontal Disease: Insights from Two US Populations Living a Century Apart. Oral Health and Preventive Dentistry 6: 23-29-8-28, 2008.
Mini piezio tip reaches bottom of the pocket

Traditionally subgingival instrumentation was completed with hand instruments, but more recently power scalers are being used more as they reach difficult areas to access. Ultrasonic tips are being designed with slimmer profiles to reach deeper pockets.

Researchers at the Academic Centre for Dentistry in Amsterdam, The Netherlands, tested the depth of penetration for three instruments in both treated and untreated periodontitis. The Hu-Friedy Gracey After Five Vision curette, the Jonker pressure sensitive probe and a new EMS Perio Slim (PS) piezo tip were compared. The Gracey curette measures 0.7mm at the working surface and increases width to 0.84mm at the 5mm mark and 1.21mm at the 10mm mark. The Jonker probe measures 0.5mm at the tip, increasing to a width of 0.6mm
at the 5mm mark and 0.7mm at the 10mm mark. The EMS PS tip is a flat-tapered tip with a width of 0.39mm at the tip, increasing to 0.66mm at the 5mm mark and 1.02mm at the 10mm mark. Probe markings were added to the ultrasonic tip.

Four teeth in each of 20 untreated periodontitis patients and 15 periodontal maintenance patients were used for this experiment. Measurements were taken at mesial and distal surface from both facial and lingual aspects. The Jonker probe was used first, followed in random order by the curette and ultrasonic tip.

The Jonker probe and the Gracey curette penetrated similar distances in both test groups, while the EMS tip penetrated deeper in the untreated periodontitis patients. All three instruments penetrated similar depths in the periodontal maintenance patients.

Clinical Implications: The EMS Mini ultrasonic insert penetrates deeper in untreated periodontal pockets than a Gracey curette or the Jonker probe, thus providing greater subgingival access.

Barendregt, D., van der Velden, U., Timmerman, M., van der Weijden, F.: Penetration Depths with an Ultrasonic Mini Insert Compared with a Conventional Curette in Patients with Periodontitis and in Periodontal Maintenance. J Clin Perio 35: 31-36, 2008.
Smoking, obesity and periodontal disease: What's the connection?

The state of Mississippi has the highest rates in the U.S. for both diabetes (8.8 percent) and obesity (24.3 percent). National averages are 7.3 percent for diabetes and 19.8 percent for obesity. Researchers at the University of Mississippi School of Dentistry evaluated the charts of 1,098 patients to determine the interrelationship between obesity, smoking, periodontal disease, diabetes and cardiovascular disease.

Using Periodontal Screening and Recording (PRS) scores it was determined that non-smokers with moderate periodontal disease (PSR 3) were at a greater risk of being overweight. In contrast, smokers with a higher PSR score of 4 had a lower risk of being overweight. This is the "smoker's paradox" suggesting smoking has benefits. Smokers might not be overweight, but they have advanced periodontal disease. Smokers with periodontal disease were not found to be at greater risk of diabetes or cardiovascular disease, contrary to other published data.

There are many complexities involved with comparing the many variables included in this study. Although research has established that smoking increases the risk of periodontal disease, it cannot be assumed that smoking will enhance the risk factors for systemic diseases in patients with periodontal disease. More studies are needed to determine the specific biological mechanism by which smoking reduces the risk for weight gain and increases the risk for periodontal disease.

Clinical Implications: The mouth is connected to the body and just as systemic conditions affect the mouth, oral conditions will have an impact on systemic conditions. Determining just how this happens on a biological level has yet to be discovered.

Wood, N., Johnson, R., The Relationship Between Smoking History, Periodontal Screening and Recording™ (PSR™) Codes and Overweight/Obesity in a Mississippi Dental School Population. Oral Health and Preventive Dentistry 6: 67-74, 2008.
Subgingival instrumentation important for controlling disease

Because so many people cannot effectively remove plaque daily, power toothbrushes and antimicrobial toothpastes have been introduced. Many comparisons of toothbrushes and toothpastes have been reported, some showing a difference and other not. Researchers at Göteborg University in Sweden and The Forsyth Institute in Boston, Massachusetts, evaluated the clinical effects over three years of two oral hygiene approaches in periodontal maintenance patients. The patients had completed periodontal treatment least one year at the time the study began. Half of the 128 adult subjects were given a manual toothbrush and fluoride toothpaste and instructed to brush using the Modified Bass Technique twice daily. The other half of the subjects were given an Oral-B rotating, oscillating electric toothbrush and Colgate Total toothpaste containing triclosan.

Subjects were seen every six months by a dental hygienist for subgingival debridement in areas 5mm and deeper and for review of oral hygiene. All subjects were instructed to clean between their teeth with floss, triangular sticks or interdental brushes. This aspect of the study probably overshadowed any differences between toothbrushes and toothpastes.

Over the three years, both groups showed improved periodontal health, despite a few subjects in each group demonstrating increased probing depths. Over the three years, no differences were seen between groups in the 40 subgingival bacterial species monitored by checkerboard DNA hybridization testing

Subjects began the study with high levels of plaque, bleeding points and probing depths. Plaque scores were approximately 46 percent, bleeding was at 34 percent and the overall average probing depth was 3.3mm. At the end of the study, plaque scores were 41 percent, bleeding was 23 percent and overall average probing depth was 3.0.

Clinical Implications: Regular, professional subgingival debridement is an essential part of controlling periodontal disease progression, based on the findings of this study that showed no clinical difference between a manual toothbrush with fluoride toothpaste and a rotary electric toothbrush with triclosan toothpaste.

Bogren, A., Teles, R., Torresyap, G., Haffajee, A., Socransky, S., Jönsson, Kerstin, Wennström, J.: Long-Term Effect of the Combined Use of Powered Toothbrush and Triclosan Dentifrice in Periodontal Maintenance Patients. J Clin Perio 35: 157-164, 2008.
Smart ultrasonic detects and removes calculus

A piezoceramic scaler is now available in Europe that detects the difference between subgingival calculus and cementum. A weak impulse of 50 Hz is sent through the tip of the ultrasonic, making it oscillate at a range of 5µm. This tiny oscillation stimulates the root surface to oscillate at one frequency if it is cementum and a different frequency if it is calculus. These oscillations are transmitted back to the instrument tip and analyzed by the system, telling the clinician if it finds calculus or clean cementum. When calculus is found, the power scaler can be activated to remove it.

Laboratory studies have been done showing the effectiveness of this smart ultrasonic to detect calculus. Researchers at the Ernst-Moritz-Arnd University in Greifswald, Germany, plus an employee of the Sirona Company (maker of the scaler), evaluated the accuracy of detecting calculus in the mouth on teeth just prior to extraction. By connecting a camera to the ultrasonic insert, data and video files were recorded and compared to the teeth after extraction. A total of 63 teeth (56 anterior, six premolar, and one molar) from 20 patients were evaluated. After extraction, 44 calculus spots were identified on the surfaces examined and 40 spots were correctly identified by the smart ultrasonic: correct positives. The four spots missed are considered false negatives. False positives are the spots identified by the smart ultrasonic that are not actually calculus, 28 false positives in this case.

Compared to previous studies reporting a 23 percent level of correct positives with blind identification of subgingival calculus using an explorer, the smart ultrasonic is much more accurate at 91 percent.

Clinical Implications: Soon this smart ultrasonic device will be available for purchase in the United States from the Sirona Company, thus giving clinicians an objective way to detect subgingival calculus.

Meissner, G., Oehme, B., Strackeljan, J., Kocher, T.: Clinical Subgingival Calculus Detection with a Smart Ultrasonic Device: A Pilot Study. J Clin Perio 35: 126-132, 2008.
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