Association of Environmental Cadmium Exposure with Periodontal Disease in U.S. Adults

Background: Periodontal disease is a complex, multifactorial, chronic inflammatory disease that involves degradation of periodontal structures, including alveolar bone. Cadmium adversely affects bone remodeling, and it is therefore possible that environmental Cd exposure may be a risk factor for periodontal-disease–related bone loss. Objective: We examined the relationship between environmental Cd exposure and periodontal disease in U.S. adults. Methods: We analyzed cross-sectional data from the third National Health and Nutrition Examination Survey (NHANES III). We defined periodontal disease as clinical attachment loss of at least 4 mm in > 10% of sites examined. We used multivariable-adjusted logistic regression analyses to estimate the association between creatinine-corrected urinary Cd levels and periodontal disease. Results: Of the 11,412 participants included in this study, 15.4% had periodontal disease. The age-adjusted geometric mean urine Cd concentration (micrograms per gram creatinine) was significantly higher among participants with periodontal disease [0.50; 95% confidence interval (CI), 0.45–0.56] than among those without periodontal disease (0.30; 95% CI, 0.28–0.31). Multivariable-adjusted analyses, which included extensive adjustments for tobacco exposure, showed that a 3-fold increase in creatinine-corrected urinary Cd concentrations [corresponding to an increment from the 25th (0.18 μg/g) to the 75th (0.63 μg/g) percentile] was associated with 54% greater odds of prevalent periodontal disease (odds ratio = 1.54; 95% CI, 1.26–1.87). We observed similar results among the subset of participants who had limited exposure to tobacco, but only after removing six influential observations. Conclusion: Environmental Cd exposure was associated with higher odds of periodontal disease

DNA probe detection of periodontopathogens in advanced periodontitis.

Species-specific DNA probes were used to determine the presence of Actinobacillus actinomycetemcomitans (A.a.), Porphyromonas (Bacteroides) gingivalis, Prevotella intermedia, Treponema denticola, Eikenella corrodens, Fusobacterium nucleatum, and Wolinella recta in subgingival plaque from deep pockets/sites of patients with advanced periodontitis. The subjects were 20 patients with severe adult periodontitis, 13 men and 7 women (mean age 45.6 +/- 6.7 yr). For each subject, 9-10 subgingival sites with the deepest probing depths from each quadrant were sampled by the paper point method, a total of 198 sites, with mean probing depth 7.2 +/- 1.6 mm and clinical attachment level 9.5 +/- 2.7 mm. A.a. was present in at least one site in 75% of the subjects; P. gingivalis was found in 95%; P. intermedia and W. recta were found in 90%, respectively; and T. denticola, E. corrodens, and F. nucleatum were found in all subjects. In the 198 samples, A.a. was detected in 25.8%, P. gingivalis in 51.5%, P. intermedia in 64.1%, T. denticola in 60.6%, E. corrodens in 72.9%, F. nucleatum in 74.7%, and W. recta in 65.7%. The predominant combination was the simultaneous presence of P. intermedia, T. denticola, E. corrodens, F. nucleatum, and W. recta in 89.5% of the subjects and 46.8% of the sites. Of these sites, 51.1% showed the combined presence of P. gingivalis and 28.4% that of both A.a. and P. gingivalis. None of the seven bacteria could be detected in 14.4% of the total sites sampled. The present study indicates that severe destructive adult periodontitis is a multibacterial infection and that certain combinations of periodontopathogens seem to be important in the pathogenesis of the disease.link_to_subscribed_fulltex

Periodontal status in an urban adult population in Sweden.

The purpose was to describe the current periodontal status in a Swedish urban population aged 31-40 yr. 1681 individuals, 840 men and 841 women, participated in the study. 68.5% of the subjects had low amount of plaque, 82.8% low level of calculus and 28.9% healthy gingiva or mild gingivitis. 82.8% of the subjects had no pockets with probing depth (PD) > or = 5 mm. 4.9% of the subjects had one tooth with PD > or = 5 mm, 6.7% 2-5 teeth, 2.4% 6-9 teeth and 3.2% > or = 10 teeth with pockets. 55.8% of the subjects had no missing teeth, third molars excluded. 16.5% had one tooth missing, 23.8% 2-5 teeth, 2.7% 6-9 teeth and 1.2% > or = 10 teeth. 8.6% of the subjects had at least one front tooth missing, 28.7% one premolar and 24.1% one molar missing. Men had significantly higher scores than women for plaque (DI-S), calculus (CI-S), gingivitis (GI-M), and number and percent of remaining teeth with PD > or = 5 mm. Smokers had significantly higher scores than non-smokers for DI-S, CI-S, GI-M, number and percent of remaining teeth with PD > or = 5 mm, and number of missing teeth. The individuals who visited the dentist every year had better oral hygiene and gingival status than those who attended for > 3 yr. The multiple regression analysis showed that calculus (P = 0.0001) smoking (P = 0.001), and dental visits (P = 0.0284) were significantly correlated to the number of teeth with PD > or = 5 mm.link_to_subscribed_fulltex

A longitudinal investigation of the individual consistency of plaque levels in adults.

The present investigation was designed to determine the individual variation of plaque levels in adults over a period of 3 months. The participants were 20 healthy subjects, 11 men and 9 women, with a mean age of 42.3 +/- 7.3(SD) years. Plaque area was determined with a computerized image analysis system and expressed as percentage of tooth area (P% Index). The scoring procedures were carried out three times (tests 1, 2, and 3) at an interval of 4 weeks. After each test all plaque was removed. All subjects were instructed to maintain their personal oral hygiene habits during the study. The results showed no significant differences for the means of P% Index between tests 1, 2, and 3 in the whole mouth, upper and lower jaws, right and left sides, or each tooth surface. The intraindividual plaque levels for individual tooth surfaces were closely correlated between tests 1, 2 and 3. The intraindividual plaque level was consistent in tests 1, 2, and 3 with standard deviations within subjects ranging from 1.1% to 6.2%. This study suggests that individual plaque levels seem to be consistent on the basis of tooth surface over a certain period of time. Individual plaque control should be more directed towards tooth surfaces with comparably high plaque accumulation within the mouth for significant reduction of the overall plaque levels.link_to_subscribed_fulltex

Clinical characteristics of destructive periodontitis in a risk group of Swedish urban adults.

An initial screening investigation of 1681 Swedish urban adults aged 31-40 years with untreated periodontitis showed that 17.2% (289) had at least one site with probing depth > or = 5 mm. The 289 subjects were offered a complete clinical examination and treatment. 144 subjects, 85 men and 59 women, agreed to participate and 145 were non-responding subjects and used as a drop out sample. The results from the screening data showed that the attendants had poorer oral hygiene status and more severe periodontitis than the drop out subjects. The present report describes clinical data of this representative sample with adult periodontitis. Clinical indices were recorded and bone height (BH%) for all teeth was measured with a computer digitizing system. In the 144 attendants, Plaque Index was > 1 in 56.2%, Calculus Index was > 1 in 57.0%, Gingival Index was > 1 in 97.2% and bleeding on probing was found in 89.1% of the sites. 11.1% of the subjects had 1-3 teeth with probing depth > or = 5 mm, 59.0% 4-10 teeth, 25.7% 11-20 teeth and 4.2% > 20 teeth. 47.9% of the subjects had mean BH% less than 80. 45.1% of the subjects had at least one site with an intrabony defect, of which 20% had 3-4 sites and 27.7% > or = 5 sites. It is concluded that advanced generalized periodontitis exists in a limited number of 31-40 year-olds in Sweden. Specific risk factors may be involved in the pathogenesis of the disease.link_to_subscribed_fulltex

Variations in crevicular fluid elastase levels in periodontitis patients on long‐term maintenance

Granulocyte elastase was determined in the gingival crevicular fluid (GCF) of 18 periodontitis patients. They initially had similar severity of disease but had responded differently to 5-yr maintenance, 13 responders and 5 non-responders. A total of 102 sites were investigated and categorized as: i) consistently healthy, ii) healthy after treatment, iii) gingivitis, and iv) periodontitis, according to clinical criteria. GCF elastase activity was determined with a granulocyte-specific substrate. The sites from non-responders had consistently higher elastase levels than the corresponding category of sites from responders, despite similar gingival inflammation and periodontal destruction, with the exception of consistently healthy sites. Within the non-responders, the periodontitis sites had higher elastase levels than the gingivitis sites commensurate with probing depth, while no difference existed between gingivitis sites and sites healthy after treatment, despite a difference in probing depth. In contrast, in the responders similar elastase levels were found at the periodontitis sites and gingivitis sites despite difference in probing depth, while both diseased sites had higher elastase levels than the sites healthy after treatment, commensurate with probing depth. This study suggests that increased granulocyte-specific elastase levels in GCF may serve as a diagnostic marker for refractory periodontitis patients.link_to_subscribed_fulltex

Granulocyte elastase in gingival crevicular fluid: improved monitoring of the site-specific response to treatment in patients with destructive periodontitis.

In 13 patients with severe destructive periodontitis, the response to periodontal therapy was estimated by granulocyte elastase level in gingival crevicular fluid (GCF). 62 sites were classified according to changes of probing depths (PD) and quantitative bone height (BH%) before and after 5-year regular maintenance treatment: (i) 17 consistently healthy sites with no changes of PD and BH%; (ii) 6 initially healthy sites with deterioration in PD and BH%; (iii) 14 diseased sites with improvement in PD and BH%; (iv) 25 diseased sites with no improvement in PD and BH%. GCF was collected by an intracrevicular washing system. The released elastase in the supernatants (EA-S) and the cell-bound elastase in the pellets (EA-P) were determined with a low molecular weight substrate specific for granulocyte elastase. The ratio of EA-S and EA-P (S/P-ratio) was used as a relative measure of elastase released by the granulocytes present. The sites classified as diseased with no improvement or initially healthy but deteriorating, had significantly higher EA-S, EA-P and S/P-ratios than the consistently healthy sites or diseased but improving sites (p < 0.01). Both EA-S and S/P-ratio showed strongly positive correlations with the current levels of gingival inflammation and periodontal destruction (p < 0.001). The present study suggests that increased elastase level is associated with disease progression, and may be used to monitor the response to longitudinal maintenance therapy.link_to_subscribed_fulltex