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Query: UMLS:C0031099 (periodontitis)
 12,489 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Periodontal disease is one of the most prevalent health problems in the world and is the major cause of tooth loss in the adult population. Its two major subdivisions are gingivitis where disease is confined to the gingiva, and periodontitis where disease is present both in the gingiva and the supporting periodontal tissues. During the first stage there is a vasculitis of vessels subjacent to the junctional epithelium which is followed by exudation of fluid from the gingival sulcus and migration of leukocytes. There is variable expression of this stage throughout the mouth with new areas of involvement appearing in place of healed areas. Mast cells which are present in the gingival connective tissues may participate in this inflammatory response by liberating histamine. Ascorbic acid deficiency has been shown to be a conditioning factor in the development of gingivitis. When humans are placed on ascorbic acid deficient diets there is increased edema, redness and swelling of the gingiva. These changes have been attributed to deficient collagen production by gingival blood vessels. However, this may be due to an antihistamine role of ascorbic acid. This vitamin may act to directly detoxify histamine or effect a change in the level of enzymes responsible for histamine metabolism. This could occur through the influence of ascorbic acid in altering cyclic AMP (c-AMP) levels. Such changes in the level of this regulatory molecule could result in increased histamine-N-methyl transferase and other enzymes responsible for the breakdown of histamine.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The role of ascorbic acid deficiency in human gingivitis--a new hypothesis. 674 85

Loss of bone is a characteristic feature of periodontitis and in later life assumes increasing importance as a cause of tooth morbidity and tooth loss. The rate, pattern and form of bone loss varies between individuals, from tooth to tooth and from tooth surface to tooth surface. This variation may be attributed to specific organisms or groups of organisms in subgingival plaque, factors that enhance plaque retention or factors that modify the course or nature of the disease. Certain high risk individuals should be identified at an early stage of the disease process. Plaque is the sole cause of periodontal disease and an effective plaque control programme is essential for periodontal health. The responsibility for maintaining an effective plaque control programme must rest primarily with the individual. The profession should provide active support by educating and instructing the patient and removing tooth deposits.
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PMID:The aetiology and pathogenesis of bone resorption in chronic periodontal disease. 695 80

The findings of a recent study show that smoking was more prevalent in a group of patients with generalized early-onset periodontitis and adult periodontitis than in patients with localized juvenile periodontitis or healthy periodontium. In patients with generalized early-onset periodontitis, smoking had a significant effect on periodontal attachment loss; these patients had significantly more teeth with affected sites and a greater mean loss of attachment than patients who did not smoke. Thus, the risk of smoking could greatly accelerate tooth loss in this relatively young group of individuals who are already at high risk for progressive periodontal attachment loss.
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PMID:Smoking and its effects on early-onset periodontitis. 756 May 67

Chronic periodontitis is a major cause of tooth loss in adults and is a consequence of the colonisation of the subgingival region by organisms such as Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum. Lipopolysaccharide (LPS) is a constituent of the cell walls of all of these bacteria and is found in large quantities on the surfaces of periodontally-diseased teeth. LPS from oral bacteria has a marked effect on most types of cell found in the periodontal tissues including macrophages, lymphocytes, fibroblasts and osteoblasts. Fibroblasts and macrophages respond to oral LPS by secreting a range of cytokines, and other effector molecules, with inflammatory, immunomodulatory and tissue-destroying capabilities. Lymphocytes are stimulated by LPS to produce a wide range of antibodies with different specificities, hence exacerbating the inflammatory response. By its actions on bone cells, LPS can stimulate bone resorption and inhibit bone formation resulting in erosion of the tooth-supporting alveolar bone. There is, therefore, considerable evidence implicating LPS in the pathogenesis of chronic periodontitis. However, the possible involvement of other biologically-active bacterial components must not be overlooked.
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PMID:Biological activities of lipopolysaccharides from oral bacteria and their relevance to the pathogenesis of chronic periodontitis. 759 16

Endpoints are conditions or events that are associated with individual study subjects and that are used to assess treatment efficacy. 2 types of endpoints can be distinguished: "true" endpoints (reflect unequivocal evidence of tangible benefit to the patient) and "surrogate" endpoints (usually a measure of disease process). The purpose of this study was to survey four aspects of endpoint usage in randomized controlled trials (RCT's) on the treatment of periodontitis: (1) the typical number of endpoints per RCT, (2) the proportion of RCTs using the same endpoint, (3) the proportion of RCTs using true endpoints, and (4) whether treatment choice influenced endpoint choice. 92 publications (1988-1992) reporting on 82 RCT's were identified. The typical number of endpoints per RCT was 6 (range: 1-28). The 3 most frequently used endpoints were mean probing depth (78% of the trials), mean probing attachment level (66%), and the plaque index (37%). In total, 153 distinct surrogate endpoints were defined. Most of these were used infrequently; over 80% of the 153 endpoints were used in fewer than 5 of the 82 trials. No trials used tooth loss as a true endpoint. In the design of an RCT, treatment choice influenced surrogate endpoint choice. Surrogate endpoints based on re-entry surgery were exclusively used for regenerative procedures and microbiological surrogate endpoints were mostly used for RCT's on anti-microbials. The conclusion is that the typical RCT used multiple surrogate endpoints, some of which were used infrequently by other trials. Such endpoint usage characteristics are suitable for exploratory RCTs (designed to identify active treatments or to elucidate treatment mechanisms). The question is raised as to whether periodontal research has reached the point of needing properly designed definitive studies, whose purpose it would be to provide unequivocal evidence of tangible benefits to the patient by the various treatments. If a need for definitive randomized controlled trials is perceived, then the use of (multiple) surrogate endpoints as primary outcomes should be questioned. Surrogate endpoint usage has led to both false positive and false negative conclusions in other chronic disease studies. Endpoint selection and validation in RCTs may be an important element in resolving controversies about periodontal treatments.
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PMID:A survey of endpoint characteristics in periodontal clinical trials published 1988-1992, and implications for future studies. 760 22

The traditional model that teeth are lost due to caries early in life and periodontitis later has been challenged by recent studies. Randomly selected Air Force records were reviewed for the reasons for extractions. Between the ages of 20 to 50, the rate of loss due to caries declined from 0.11 to 0.03, whereas the rate due to periodontitis increased from 0 to 0.34. This study supported the traditional model that tooth loss due to caries decreases with age and that periodontitis is the major cause of loss later in life.
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PMID:Tooth loss during compulsory dental care. 761 29

Periodontal diseases are among the most prevalent conditions in adults, and afflict many individuals of all ages. They refer to a cluster of inflammatory conditions of the periodontium, the tissues that surround the teeth. Ultimately, periodontal diseases cause the loss of alveolar bone support and may lead to tooth loss. The clinical presentation of periodontal diseases is primarily independent of the age of a person, and successful diagnosis and treatment can be achieved in both young and old individuals. These diseases primarily include gingivitis, periodontitis and oral vesiculobullous diseases of the gingival tissues. Multiple oral, systemic and behavioural factors contribute to the occurrence and progression of these conditions. Appropriate treatment requires accurate diagnosis and the use of oral nonsurgical and surgical techniques, topical and systemic medications and an emphasis on self-applied oral hygiene practices.
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PMID:Diseases of periodontal tissues in the elderly. Description, epidemiology, aetiology and drug therapy. 783 88

The prevalence and severity of periodontitis increases with age. Epidemiologic studies have identified several risk variables associated with advancing periodontitis in older adults: namely tobacco smoking, frequency of dental appointments, infection with anaerobic bacteria considered periodontal pathogens, plaque and calculus accumulation, and some socioeconomic variables. Future morbidity from periodontitis might be reduced by minimizing the impact of these risk-associated variables at younger ages. Treatment of periodontal disease in community-dwelling older adults should be aimed at (1) targeting care to their overall health, functional, and esthetic needs; (2) strategic planning for maximal health and patient satisfaction; (3) documentation of past susceptibility and current risk; (4) control of principal risk factors; (4) investing time in patient education and informed consent; and (5) planning ahead for a potentially catastrophic decline in health. Periodontal treatment needs should be met in an integrated treatment plan that considers the overall prognosis for the dentition and individual teeth and the most efficacious prosthodontic options. Frequent recall for supportive periodontal care is essential. Several medical, physical, and societal impediments to provision of optimal care for older adults should be sought and minimized by the practitioner. Population dynamics and health-oriented activism among older adults are increasing the demand for essential and elective periodontal and prosthodontic services, which are met by implant-supported prostheses. Over the next few decades, as the incidence of tooth loss declines and our knowledge of the pathogenesis of periodontitis and biology of tissue regeneration increases, there will likely be a renewed emphasis on the preservation of the natural periodontium.
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PMID:Periodontal care for community-dwelling older adults. 784 52

Gingivitis and periodontitis are the most prevalent periodontal diseases in adults. Gingivitis is characterized by inflammation of the gingiva without loss of connective tissue attachment to the teeth while periodontitis results in loss of attachment and alveolar bone and may lead to tooth loss. Gingivitis is highly prevalent in adults in the United States, and up to 70% of adults have at least mild periodontitis. In only a small proportion of adults (< 15%) does periodontitis progress to severe disease. The etiology of periodontal disease is infection with pathogenic dental plaque bacteria in a susceptible host. Strategies for preventing periodontal diseases therefore may intervene at the level of the initiation of the inflammatory process, or by preventing the progression of bone and attachment loss in periodontitis. Improved mechanical and chemical plaque control as well as improved restorative materials to facilitate plaque removal continue to enhance the patient's ability to control the plaque bacteria. Strategies to target prevention to the patients who need it most include risk factor assessment, new diagnostic methods, and further elucidation of the natural history of periodontal disease. Further study of the etiology and pathophysiology of periodontitis will aid in the prevention of further destruction through targeted use of local and systemic antibiotics and well as drugs to aid in the host response. Ultimately research may yield multivalent vaccines to be used in high-risk patients.
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PMID:Prevention of periodontal diseases in adults: strategies for the future. 784 43

Epidemiological studies have shown that loss of teeth is associated with increasing age. This was explained as the result of the action of microorganisms which, as components of dental plaque, destroyed the tooth by causing caries or periodontitis. Routine prevention programs therefore concentrated on removal of plaque, resulting in good oral hygiene. Despite good oral hygiene some individuals developed periodontitis. Studies have indicated that smoking may be a risk factor for this disease. This study was undertaken to determine whether or not smoking is also a risk factor for tooth loss. A total of 273 individuals were followed for 10 years, during which 93 individuals lost a total of 260 teeth. Younger individuals and especially males smoking more than 15 cigarettes a day were found to have the highest relative risk of losing teeth (4.55 and 3.18 respectively). In the younger age groups the proportional attributable risk was also highest; 78% for smokers smoking more than 15 cigarettes a day. The combination of a high plaque score and smoking was, together with age, the strongest predictor of tooth loss. The findings of this study suggest that smokers, especially those in the age group < 50 years, are a high risk group for tooth loss.
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PMID:Smoking as an additional risk for tooth loss. 785 36


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