Dental Disease, Inflammation, Cardiovascular Disease, Nutrition and Nutritional Supplements
Stephen T. Sinatra, Mark C. Houston in Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
Traditionally, periodontal disease has been diagnosed by increases in pocket depth, bleeding gums and bone loss around the teeth leading to clinical attachment loss. Today, the same information is utilized to determine if the disease is and has been present; however, dentists are using the presence of gingival bleeding (bleeding on probing) to determine if the disease is active or stable. The presence of a periodontal pocket (4 mm or greater) is not indicative of active disease, especially when bleeding is not identified on probing. Radiographic evidence of bone loss associated with the teeth indicates prior disease, but it is the presence of bleeding on probing that determines disease activity and the presence of inflammation or in the case of zero bleeding on probing disease stability. When inflammation is identified, it signifies that there has been a histological alteration and bleeding on probing is a result of that change. Dental practitioners recognize that bleeding on probing and gingival inflammation can also be initiated by other systemic issues as well such as caries, failing restorative dentistry, herbals taken in supplement form and other factors. These other initiators of bleeding on probing need to be taken into consideration during the formulation of the diagnosis.
Periodontal Diseases
Lars Granath, William D. McHugh in Systematized Prevention of Oral Disease: Theory and Practice, 2019
Bleeding on probing is a fairly objective measure which can easily be utilized by the dentist. This diagnostic procedure has been recommended by several authors.1,110,115 A realistic goal for the prevention of periodontal disease may thus be to keep the gingival inflammation at a level where the probability of further progression of the disease is low. Until more is known about the progression of periodontal disease, gingivitis which has not reached the established stage, i.e., it is not bleeding on probing, may be a practical goal.
The Role of Dentistry in Cardiovascular Health and General Well-Being
Stephen T. Sinatra, Mark C. Houston in Nutritional and Integrative Strategies in Cardiovascular Medicine, 2015
Patients are often unaware that they have periodontal disease. Therefore, to detect a problem at the earliest stage, it is very important to maintain regular dental visits. As part of an initial examination, I do a periodontal probing around every tooth. If I find a pocket of more than 3 mm deep, I suspect that bone has been lost; however, this is just historical information. How do I know if the pocket is actively infected and if the infectious process is ongoing? Bleeding on probing is one indication that this may be occurring. However, I find that the best way to make this determination is by viewing a plaque sample. Plaque is the sticky substance that you feel on your teeth at the end of the day. A sample can be gathered or taken from under the gum as well as from a pocket. This sample is then placed on a glass slide in a solution similar to saliva, and a coverslip is placed over it. Using a phase-contrast microscope, I can view the sample at a magnification of 400×. A healthy slide will have certain types of bacteria, but not a lot of “activity,” whereas an unhealthy slide will be characterized by a lot of activity, lots of white blood cells, spirochetes, and, usually, amoebas. An amoeba is a parasite, and a spirochete is a snake-like bacteria. The spirochete associated with periodontal disease is called Treponema denticola. The specific amoeba associated with periodontal disease is called Entamoeba gingivalis. T. denticola and E. gingivalis are not seen in a healthy mouth. An unhealthy slide sample taken from a pocket would indicate an ongoing infection in that pocket. A healthy slide sample taken from a pocket would indicate that there had previously been a problem, but that it was presently quiescent. No pockets, but a microladen slide, tells me that a person may be at risk, at some point in the future, for periodontal disease and possibly other problems. As you can see, the use of a phase-contrast microscope in the dental office is very important.
Genome analysis and clinical implications of the bacterial communities in early biofilm formation on dental implants restored with titanium or zirconia abutments
Published in Biofouling, 2018
Flávia Correa Raffaini, Alice Ramos Freitas, Thalisson Saymo Oliveira Silva, Tarsis Cavagioni, Jessica Felix Oliveira, Rubens Ferreira Albuquerque Junior, Vinícius Pedrazzi, Ricardo Faria Ribeiro, Cássio do Nascimento
Primary stability was achieved for all the implants after surgery and no further complication was reported after loading. A total of 720 sampling sites were assessed over time. They consisted of the peri-implant or periodontal samples collected from implant-related sites and contralateral teeth. The mean values of probing depth (mm, ±SD), clinical attachment level (mm, ±SD) and bleeding on probing (%) of all sampling sites are displayed in Table 1. Overall, the peri-implant and periodontal status remained unchanged over time. Few differences were found between the titanium and zirconia groups. Regarding probing depth, peri-implant sulci from zirconia abutments had higher mean values at baseline (T0) but reduced over time (p < 0.05). Also, implants restored with zirconia presented higher values of probing depth when compared with their contra-lateral teeth (p < 0.05). Bleeding on probing increased significantly over time for both tested materials and contralateral teeth. However, no relationship was found between bleeding on probing and deep sulci. Clinical attachment level did not change over time.
Oral health in the indigenous Sámi population in Norway – the dental health in the North study
Published in Acta Odontologica Scandinavica, 2020
Magritt Brustad, Ann-Kristine Sara Bongo, Ketil Lenert Hansen, Tordis A. Trovik, Nils Oscarson, Birgitta Jönsson
Bleeding on probing (BOP) and periodontal probing depth (PPD) were assessed at six sites per tooth for all teeth (except the third molar). Periodontal probing depth was measured to the nearest millimetre with a periodontal probe, WHO-probe LM555B. Bleeding on probing was measured in conjunction with the periodontal probing. To improve and secure measurements and inter-examiner reliability, different precautions were taken. Prior to study start, all examiners were trained and calibrated towards an experience periodontist who was the gold standard (NO), regarding the diagnostic criteria and examination procedures including radiographic examination technique and periodontal pocket probing on one patient. The measurement with pocket probing was repeated for three teeth (six surfaces). In addition, each examiner received a diagnostic manual in which all measurements and the procedures for diagnostics were described.
Defining the gut microbiota in individuals with periodontal diseases: an exploratory study
Published in Journal of Oral Microbiology, 2018
Talita Gomes Baeta Lourenςo, Sarah J. Spencer, Eric John Alm, Ana Paula Vieira Colombo
At the first visit, individuals answered anamnesis questionnaires and data on age, gender, race, smoking and lifestyle (eating habits, physical activity practice and use of alcoholic beverages). Clinical examinations were performed by calibrated periodontists and included probing depth (PD) and clinical attachment level (CAL), presence of bleeding on probing (BOP), gingival bleeding (GI), visible supragingival plaque (PL), calculus (CA) and suppuration (SUP). Individuals were diagnosed as having periodontal health (PH), gingivitis (G), and chronic periodontitis (CP) according to Silva-Boghossian et al. [47]. Briefly, periodontal health was defined as ≤ 10% of sites with BOP and/or GI, no PD or CAL > 3 mm, although PD or CAL = 4 mm in up to 5% of sites without BOP was allowed. Gingivitis was defined as > 10% of sites with BOP and/or GI, no PD or CAL> 3 mm, although PD or CAL = 4 mm in up to 5% of sites without BOP was allowed. Chronic periodontitis was defined as > 10% of teeth with PD and CAL ≥ 5 mm with BOP.
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