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The prevalence of gingivitis and gingival recession in 1884 dentate adults, aged 15–65 yr, continuously resident in the natural fluoride area of Hartlepool (1.5–2.0 ppm F.) was compared with that in 2015 dentate adults from the low-fluoride town of York (0.15–0.28 ppm F.). The measurement of gingivitis was restricted to the anterior labial gingival sites, after the method described by Jackson (1965). The prevalence of gingivitis did not vary with increasing age. Therefore, data for all age groups were combined. Eighty nine per cent in Hartlepool and 87 per cent in York had one or more gingival sites inflamed. In both communities, the slightly higher prevalence of gingivitis in males than in females disappeared when only those with good oral cleanliness were considered. In Hartlepool, the site prevalence of gingivitis was 37.2 per cent and in York 35.4 per cent. In those with good oral cleanliness, the site prevalence of gingivitis was 21.8 per cent in Hartlepool and 19.8 per cent in York. The maximum divergence between the two communities was 0.4 gingival units. No sex difference in the prevalence of gingival recession was observed in either community. Therefore, data for males and females were combined. In Hartlepool at 15–19 yr of age, 3.0 per cent were affected by gingival recession; at 60–65 yr, virtually 100 per cent were affected. The trend with age in York followed exactly the same pattern as that observed in Hartlepool. The percentage of teeth with gingival recession also increased steadily with age. In Hartlepool at 15–19 yr of age, 0.2 per cent of teeth had gingival recession. At 60–65 yr, 66.7 per cent of teeth were affected. The corresponding values in York were 0.2 per cent and 63.8 per cent. No significant differences were observed between Hartlepool and York data. It was concluded that fluoride in drinking water, at least up to the level of 2 ppm, has no effect of clinical significance on the prevalence of gingivitis or gingival recession in adults.

Right, first and second maxillary molars of albino mice were extracted at 25 days of age to observe the long-term effect of early loss of function on teeth without antagonists. Four experimental and three intact controls were sacrificed every 50 days thereafter. Molars were studied grossly as well as microscopically. Macroscopic observations showed marked gingival recession and root exposure on teeth without function. Little cuspal wear occurred on these molars, and there was an intense blackening and discoloration of the enamel. Histologic sections revealed that loss of function alone, without any apparent infection, caused a remarkable and progressive atrophy of the periodontium, leading to its almost total disappearance by 900 days. Alveolar bone was extensively resorbed, particularly interdental bone. There was an apical proliferation of the epithelial attachment, a disorientation and detachment of fibres of the periodontal ligament and a considerable resorption of cementum. Only traces of periodontal tissues remained in the interdental region at 900 days and, in some instances, fusion of root tips of adjacent molars had taken place. There was a pronounced narrowing of the interdental space, but the direction of tooth movement could not be evaluated due to extensive loss of familiar periodontal landmarks. No cemental hyperplasia or supraeruption was apparent. These severe changes, which apparently are initiated at the alveolar crest, were interpreted as being due to the almost complete lack of stimulation of the periodontal tissues by occlusal contact.

Effects of multiple sublethal doses (6 weekly exposures of 200 r each) on the subsequent appearance of the periodontal and dental tissues were studied in male mice fed either a highly purified diet complete in all know nutrients or a natural food stock ration. Periodontal lesions were observed in x-irradiated animals on the purified diet 100 days following the 1st irradiation exposure, but not prior to this time. The subsequent development of the lesions generally paralleled that of primate periodontitis and was characterized by plaque formation, gingival recession, periodontal destruction, dental necrosis, and exfoliation. In contrast, no periodontal pathology was observed in xirradiated mice on the stock diet. Multiple sublethal x irradiation appears to be a primary etiologic factor in the formation of periodontal lesions in mice fed the purified diet. Secondary factors, such as age, diet, trauma, oral bacterial flora, heredity, may also be implicated. Two manifestations of radiation injury, namely, diminution of body resistance to infection and the so-called aging effect of radiation, should be considered too. Histologic studies indicated that salivary function, particularly of the palatal gland system, was impaired. Areas of fibrosis and reduced glandular tissue were prominent in several irradiated animals on the purified diet.more » This suggests a more specific type of radiation- induced somatic lesion, with its focus upon the oral environment. Impaired salivary function could play an important etiological role in the lesions observed, by facilitating the accumulation of plaque material. (H.H.D.)« less

The periodontal status of approximately 5,000 subjects belonging to nine ethnic groups of Oriental origin, aged four years and above and living in villages in Israel, was investigated. The severity of periodontal involvement of a group was found to be similar whether expressed as gingivitis in childhood or as destructive periodontal disease in adolescence and adult life. Gingivitis reached its peak at the age of 10 to 11 years and then tended to level off or even decline. The periodontal index (PI) and gingival recession rate (GRR) both formed straight line graphs between the ages of 17 and 55+. The incidence and prevalence of periodontal disease were almost uniformly higher in males than in females. In the populations investigated in the present study, it appears unwarranted to attribute this difference to differences in attitude to oral health and hygiene between the sexes. The possibility that habitual chewing of the leaves of Catha edulis is a causative factor in the exceptionally high rates of periodontal disease in Yemenite males is discussed. The periodontal health of the best groups was inferior to that of white Americans, and of the same order as that of American Negroes and the inhabitants of Lebanon and Chile. The most severe degree of involvement was comparable to findings in South-East Asia, and occurred in people who had immigrated from India.

The causative factors of full porcelain veneer crown failures have been pointed out. For many years, the primary thought has been to construct full porcelain veneer crowns with as much bulk of porcelain as possible but with little thought to the requirements for the individual case. By making an accurate analysis of mandibular function, a guide is established for the amount of tooth reduction necessary for full porcelain coverage. By adequate tooth support to the porcelain, the need for bulk of porcelain decreases, and tooth reduction can be kept to a minimum. By utilizing a chamfer preparation at the labial gingival margin of anterior teeth, excessive tooth reduction can be eliminated, and the porcelain can be laid on the dentine just as the enamel covering has been on the teeth. Soft tissue irritation is eliminated by the protective contour of glazed porcelain, and instead of gingival recession, the gingivae will hug the porcelain crown and remain firm and healthy. Full porcelain veneer crowns can be ground accurately to balanced occlusion by painting the opposing teeth with an oil base pigment, such as Prussian blue thinned with eugenol or a thin sweet oil. Colored paper or cloth interposes bulk between teeth, thus creating a tendency to grind the completed crown out of occlusion.

The author's unified theory of growth and age-dependent disease is outlined. It is illustrated with reference to a degenerative disorder, gingival recession (“getting long in the tooth”), and a malignant condition, colorectal cancer. Results are presented from a population survey in the North-East of England for the age-specific prevalence of gingival recession, for each type of tooth separately. Some attacks at left/right homologous teeth affect one only (unilateral), other affect both teeth (bilateral). The age-specific prevalence of unilateral and bilateral attacks of gingival recession, as a function of age, is consistent with the author's auto-aggressive theory and inconsistent with various other theories of aging. It is proposed that multiple random events, triggering the growth of multiple forbidden clones of cells, initiate the disease process, whether unilateral or bilateral. National age-specific mortality and onset statistics for colorectal cancer are analysed. At least three distinctive forms of this malignancy can be delineated clinically, and by the analysis of the age-dependence. Statistics for colorectal cancer in patients with familial intestinal polyposis offer strong support for the view that the mechanisms that initiate malignant change are fundamentally similar to those that initiate non-malignant, degenerative change. It is concluded that both these forms of aging arise from random changes (somatic gene mutations) in stem cells of the central system of growth-control.

An attempt was made to weigh the relative importance of several nutritional and physiological factors in the severity of periodontal index and gingival recession scores. The sample used in this study consisted of 549 Chilean persons on whom complete examinations were performed. The data were analysed by multiple correlation; the relative importance of each factor was assessed by calculating the separate determination coefficient, expressing it as per cent of the total variance (R2), and also by partial correlation, keeping constant the effects of age and oral hygiene. Blood levels of serum protein, haemoglobin, ascorbic acid and vitamin A, and urinary levels of thiamine and riboflavin showed essentially no effects in the variance of periodontal index and gingival recession scores. Age and oral hygiene were responsible for most of the variance (R2), age being responsible for a larger proportion of the variance in gingival recession scores. Oral hygiene accounted for 85 per cent of the variance in non-destructive periodontal disease, and for only 15 per cent in destructive disease. In the latter, age (46 per cent), molar attrition (20 per cent), and the number of DMF teeth (17 per cent) were the factors that explained most of the variance.

When gingival recession has been observed, it is diffecult to clean the approximate surfaces only using toothbrush. The purpose of this study is to observe which interdental cleaner is effective on the approximate surface. Three types of interdental cleaner have been studied. They were “Interdental brush (Denticator co.)”, “Rubber tip (Denticator co.)” and “Wooden stimulator (Navec International pty co.)”. Between the cleaning effect of interdental brush and that of rubber tip, significant difference (p

The pathological effects of occlusal disturbances may be seen in the temporomandibular articulation and related musculature and in certain periodontal tissues. Periodontal traumatism may be primary or secondary. The treatment of primary traumatism usually requires only changes in the force applied on a tooth; treatment of secondary traumatism requires many procedures, sometimes including permanent splinting. Occlusal overloading is not an etiological factor in gingivitis, gingival hyperplasia, or pocket formation, and ordinarily will not cause gingival recession, gingival clefts or resorption of the alveolar crest.

recut after contact with any drug, saliva or other moisture. Schoonover and Souder5 found stain­ ing to be the result of electrolysis, which was common to leaking fillings having rough margins and surfaces which col­ lected food debris as an electrolyte. They concluded that restorations with tight margins well-finished and polished would not corrode and stain tooth structure if given reasonable mouth hygiene. Massler and Barber7 observed that cement bases protected cut dentin against staining. Cement bases, however, are not the solution to the problem. Black8 taught that amalgam or any other dur­ able material seated on cement would not resist functional stress. Copalite var­ nish will seal cut dentin against thermal shock and against staining, without the insecurity common to cement bases. Amalgam restorations will give a serv­ ice second only to that of well executed gold foil restorations. Amalgam can be removed and replaced without too much lost effort, if gingival recession continues or if caries recurs. It can be used in regions inaccessible by the gold foil tech­ nic. It is a splendid substitute for gold foil where the temperament, time, health or finances of the patient favor this easier, quicker restoration. Under fa­ vorable circumstances, including good mouth hygiene, amalgam restorations will give many years of service. 632 Republic Building

A controlled study was carried out on 103 dentally-oriented university students to compare the effects of hand and electric toothbrushing. The study lasted two years. Subjects were examined at the beginning, and 3, 6, 12 and 24 months later. Oral debris and calculus formation were assessed by a modification of Greene and Vermillion's (1960) methods, and gingivitis and periodontitis by Russell's (1956) technique. Half of the subjects using the electric brushes and half of those using hand brushes were instructed how to brush; the others were not. No significant differences in oral debris or calculus formation, in gingivitis and periodontitis, or in gingival recession were found between any of the groups at any stage in the study. It is concluded that the electric brush is not superior to the hand brush when used by dentally-oriented young adults.

The prevalence of gingival recession in individual teeth in 1,884 dentate adults, aged 15–65 years, continuously resident in the natural fluoride area of Hartlepool (1·5–2·0 ppm F) was compared with that found in 2,015 dentate adults from the low fluoride town of York (0.15–0.28 ppm F). In each tooth type, gingival recession increased steadily with age. A distinctive pattern of gingival recession was observed in each community. Mandibular incisors showed the highest prevalence of gingival recession, followed by maxillary first molars, mandibular first molars, premolars, maxillary second molars, mandibular second molars and canines. Maxillary incisors showed the lowest prevalence of gingival recession. There was an extremely high correlation between Hartlepool and York data, for each group of teeth. It was therefore concluded that fluoride in drinking water, at least up to 2 ppm F, has no effect on the pattern of gingival recession in adults.

Eight Sprague-Dawley male rats were injured at the gingival papillae mesial to the maxillary left first molars. Groups of these rats and controls were sacrificed 9 and 12 months after injury. Prior to sacrifice, all animals received 0.5μc of tritiated thymidine per gram body weight by intraperitoneal injection. Jaws were dissected out and prepared for histologic and autoradiographic analysis. Measurements at the wound and respective control sites indicated accelerated gingival recession at the sites of injury. Labeling indices, however, were similar at both areas examined. Within the limits of the experiment, the observations suggest similar functional demands at both sites regardless of the position of the marginal gingiva, but do not determine the reason for accelerated gingival recession at the wound sites with time.

The pulp and periodontal tissues too frequently have been regarded as independent and apart. Teeth, partially or completely devoid of supporting bone, may be more susceptible to pulp disease. Excessive mobility of such teeth may result in stenosis and/or tearing of apical vessels. Direct bacterial invasion through auxiliary or apical canals exposed by periodontal disease occurs. This anatomicopathologic mechanism may explain certain cases of so-called "idiopathic" pulpitis or other cases attributed to anachoresis. Mitchell 1 2 described pulpitis in an apparently healthy lower first bicuspid. After extraction, an auxiliary pulp canal with a foramen on the root surface only four millimeters below the cemento-enamel junction was seen as the point of pulp exposure after gingival recession. Starkey13 reported a similar case involving a deciduous molar in which an accessory canal near the cemento-enamel junction was shown to be the source of pulpal infection.

THE serum protein levels in patients with periodontal diseases have been described by a number of workers. In the majority of cases, total protein was almost normal. Serum globulin, however, showed higher levels in patients, and albumin was lower (KARSHAN et al., 1952; MATSUMURA et al., 1960; TANIMOTO, 1960). SHANNON and GIBSON (1964) and SHANNON, TERRY and CHAUNCEY (1966) reported that there were no significant changes in serum albumin or globulin level in relation to periodontal status. Those experiments were performed in an attempt to reveal that some systemic or metabolic condition might operate as one of the contributing factors in periodontal diseases. Although they used salt-fractionation or electrophoretical methods to separate the serum protein fractions, they determined only two (albumin and globulin) or four (albumin, a-, /?and y-globulins). In the present investigation, the authors analyzed sera by immuno-electrophoresis on agar gel plates and obtained more detailed information. As controls, eight healthy men and three women aged between 18 and 30 years old were examined. Thirty patients aged between 18 and 60 years old were divided into three groups according to the roentgenographic examination and clinical signs, as follows: (1) Inflammatory type (Periodontitis): Inflammatory changes of gingiva and pocket formation are present. Mobility of teeth increased. Roentgenographically the type of alveolar bone resorption is horizontal. (2) Atrophic type (Periodontosis): Atrophy of the alveolar processes and gingival recession are the chief signs. Vertical bone resorption, pocket formation and increased mobility of teeth are present. (3) Mixed type: Gingiva recession with inflammation. Alveolar bone resorption is irregular. Each type was subdivided into three stages, namely, incipient, moderately advanced and far advanced. Serum GOT and GPT were determined in all subjects to eliminate liver dysfunctions. Patients with severe pus discharge from the gingivae were excluded. Serum protein fractions were separated by electrophoresis on cellulose acetate membrane (Sephadex, Joko Sangyo Co., Tokyo), using Verona1 buffer, pH 8 ‘6, ionic

Twenty-six groups of twins, with ages ranging from 12–17 years, were examined in this study. Seven sets of twins were monozygous and nineteen sets were dyzygous. The following observations were made on each set using a modification of the Ramfjord Periodontal Index: 1. Gingival recession was measured with a Williams-Fox probe. 2. Crevicular depth was measured using a Williams-Fox probe. Six measurements were made for each tooth on the mesial, distal, facial and lingual aspects. 3. Gingival health around each of six teeth (as outlined by Ramfjord) was scored on the basis of the degree of inflammation. 4. Supragingival calculus was scored on the basis of the amount of deposit. 5. Dental plaque was scored on the basis of amount of stainable plaque. The determination as to whether the twins were monozygous or dyzygous was based on an examination of blood factors. If any difference was noted, the set was considered to be dyzygous. The results of this study can be summarized as follows: (a) No evidence was found to support the concept that gingival recession or gingival crevice depth is an inherited characteristic. (b) No significant difference was found between both groups for the gingival score, calculus score, and plaque score.