ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1986.tb01421.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

AbstractEconomic factors in diagnosis and treatment planning in periodontology may be considered from several points of view. A first perspective is that of government responsibility. Because of the explosion in health care expenditure in the last decade, public funding of dental care programmes may become static or even reduced. Most governments try to curb the ever growing public health expenditure. Consequently, terms like effectiveness, efficiency and accountability are now becoming common words also in relation to periodontal health care. Moreover, private insurance companies, which have entered this area, may be individual patient who, explicitly or implicitly, would like to consider the services individual patient, who explicitly or implicitly, would like to consider the sendees rendered in periodontal therapy and prevention as cost‐effective. Features of supply of and demand for care on an individual basis should also be considered. Finally, the periodontist or general practitioner has to consider economic factors. In professional life, there should be a balance between good working conditions providing satisfactory care, and the demands and priorities of individual patients and the community at larg

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1986.tb01422.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

AbstractBoth epidemiological and clinical studies indicate that not all individuals are equally susceptible to periodontal breakdown. Therefore, the clinical differences were investigated between subjects highly susceptible and subjects insusceptible to periodontal breakdown. The highly susceptible group consisted of patients with a diagnosis of juvenile periodontitis. The insusceptible group consisted of older individuals with gross amounts of plaque and no periodontal breakdown. Results indicated that a high value of the bleeding/plaque ratio may possibly act as a prognostic indicator for periodontal breakdown. However, longitudinal data are indispensable for substantiation of this hypothesis. Since longitudinal research takes many years, the experimental gingivitis model was chosen for further investigation. 4 groups of individuals were selected on the basis of a different history of inflammatory periodontal disease: 2 younger age groups without periodontal breakdown, having either a low or a high bleeding/plaque ratio—a hypothetically susceptible and a hypothetically insusceptible group, respectively; one older age group with presence of gross amounts of plaque, no periodontal breakdown and a low bleeding/plaque ratio—an insusceptible group; and an adult group who previously suffered from severe periodontal disease—a susceptible group. Results of the experimental gingivitis studies indicated that the older insusceptible group developed only small amounts of bleeding, whereas the younger hypothetically insusceptible group developed a comparable low bleeding index. The younger hypothetically susceptible group developed a much higher bleeding index comparable to that of the susceptible group, the periodontal patients. In conclusion, comparison of the results of the experimental gingivitis studies in subjects with differing histories of inflammatory periodontal disease supports the concept that the bleeding/plaque ratio may act as a prognostic indicator for periodontal brea

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1986.tb01423.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

AbstractThis paper examines the relationships between 3 clinical parameters: pocket depth, gingival index, and bleeding index and 2 laboratory parameters: spirochaete counts and motility counts on the basis of analysis of 883 observations made in the mouths of 41 patients. The results were consistent with the findings of other studies in that deeper pockets tended to harbour higher %s of spirochaetes and motile organisms. The same overlap between all the parameters in general and between spirochaetes and pocket depth in particular as existed in our previous study was demonstrably evident. 8% of shallow pockets had spirochaete counts in excess of 20% and 79% of deep pockets had spirochaete counts of less than 20. 18% having no demonstrable spirochaetes. These results are consistent with those of our previous study and with the findings of Evian et al. that even in pockets of the order of 7 mm, the proportions of spirochaetes found varies from what may be expected at healthy sites to what may be expected at diseased sites.

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1986.tb01424.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

AbstractIn the absence of toothbrushing. the gingival crevice is colonized by a complex indigenous microflora causing gingivitis, a non‐specific inflammation. Subgingival plaque may develop by downgrowth into the inflamed pocket of those micro‐organisms from supragingival plaque which can multiply there. By direct microscopy, increased proportions of motile rods and spirochetes have been found in diseased pockets. Cultures on selective media have demonstrated increased prevalence of various gram‐negative rods. Cultures on non‐selective media have revealed the complexity and variability of the subgingival microflora. comprising more than 200 species. Destructive periodontitis is the result of subgingival colonization, which is favored by such ecological changes as plaque accumulation, gingivitis, and gingival exudate. These changes increase the numbers of micro‐organisms and alter their proportions, but no single species appears in active sites which is not also commonly present in inactive sites. The subgingival micro‐organisms have several virulence factors which promote colonization of the pockets, destroy host defense mechanisms, and provoke inflammation. It appears that different combinations of indigenous bacteria, rather than just a single species, can produce the pathogenic potential necessary to cause progression from gingivitis to destructive pe

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1986.tb01425.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Abstract3 studies investigated the importance ofActinobacillus actinomycetem‐comitans, Bacteroides gingivalisandBacteroides intermediusin progressive adult periodontitis. A total of 196 adults with advanced periodontitis and 475 periodontal sites were examined. The periodontal disease activity was assessed by changes in probing periodontal attachment level and crestal alveolar bone level. The composition of the subgingival microflora was determined by nonselective and selective culturing and indirect immunofluorescence of direct smears.A. actinomycetemcomitansoccurred in 50% of progressing lesions and in only 6% of nonprogressing sites.B. gingivaliswas detected in 42–52% of progressing lesions and in 14% of nonprogressing sites. The medianB. gingivalisrecovery in culture‐positive sites was more than 10‐fold higher in progressing than in non‐progressing sites.B. intermediuswas recovered from 59–89% of progressing lesions and from 36–53% of nonprogressing sites.B. intermediusaveraged 5–10 higher recovery in infected progressing lesions than in infected nonprogressing sites. 1 progressing lesion only failed to reveal any of the above organisms Assessment of the overall results indicates thatA. actinomycetemcomitans. B. gingivalisandB. intermediusare major suspected pathogens in destructive periodontal di

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1986.tb01426.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

AbstractExperiments have been performed in beagle dogs in attempts to evaluate the effect of orthodontic‐ and jiggling‐type trauma on the supporting structures of premolars. The results reported have unanimously demonstrated that in situations where orthodontic or jiggling forces were inflicted on teeth with a normal periodontium, or on teeth with overt signs of gingivitis, the periodontal ligament tissue reacted by transitory signs of inflammation. These phenomena occurred without a concomitant loss of connective tissue attachment and development of pathologically deepened periodontal pockets. If the jiggling trauma was inflicted on teeth with an ongoing plaque‐associated, destructive periodontitis, the resulting inflammatory reactions caused enhanced loss of attachment and angular bony defects. Furthermore, orthodontic tilting movements of teeth (intrusion) in a plaque‐infected dentition may shift a supragingivally located plaque into a subgingival position resulting in periodontal tissue br

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1986.tb01427.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

AbstractA series of studies has investigated interactions between periodontal trauma and marginal periodontitis in relation to the initiation, progression and treatment of periodontal disease. Lesions of trauma in the periodontal ligament do not initiate the loss of connective tissue attachment characteristic of marginal periodontitis. Studies conducted in squirrel monkeys and beagle dogs in which jiggling forces were superimposed upon an established marginal periodontitis reported increased loss of alveolar bone, but the accelerated loss of attachment which occurred in the dog model did not occur in the monkey model. In order to clarify the relative importance of inflammation and tooth mobility in the treatment of advanced periodontal disease, periodontal responses were evaluated after removing combinations of traumatic and inflammatory components. Elimination of trauma in the presence of existing marginal inflammation did not reduce tooth mobility or increase bone volume. Osseous regeneration and decreased tooth mobility occurred after resolving both components; however, similar findings occurred after resolving inflammation in the presence of continued tooth mobility. After resolution of inflammation, remaining tooth mobility does not result in increased loss of connective tissue attachment. On a clinical level for periodontal disease treatment, the findings place decreased emphasis upon management of tooth mobility and increased emphasis upon resolution of marginal inflammation.

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1986.tb01428.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

AbstractThe host immune response to dental plaque products leads to altered levels of activity by several types of cells involved in host defence. Cells of the periodontium which contribute to the supporting tissues of the teeth may be directly damaged by cellular attack, or their activity may be modulated by a range of soluble mediators released by host immune cells. These changes contribute to the modification of the tooth‐supporting tissue which is seen in chronic inflammtory periodontal diseas

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1986.tb01429.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

AbstractNew insight into the possible involvement of specific bacteria in the etiology of periodontal disease has stimulated interest in antibiotic therapy. However, current knowledge does not allow the designation of one or more pathogens in periodontal diseases. Some bacteria are considered suspected periodontal pathogens due to their predominance in the pocket and their potential pathogenicity, yet they all appear to be indigenous bacteria. For this reason, one can question the rationale for the use of antibiotics in the treatment of periodontal disease since the theoretical basis for their application seems small. Several reports of clinical trials in which antibiotics were administered as an adjunct to scaling and rootplaning in adult periodontitis conclude with encouraging statements concerning bacterial inhibition and the cure of inflammatory periodontal disease. However, the data are conflicting and mostly negative. Antibiotic treatment in combination with scaling and rootplaning in juvenile periodontitis and refractory adult periodontitis has shown some benefit, but the clinical trials were not sufficiently controlled to permit conclusions. So far, antibiotics have been applied as a last resort in order to supplement the non‐specific approach of mechanical root debridement, but it can be doubted whether this approach offers any benefit in the long ru

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1986.tb01430.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY