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There is increasing public interest in natural or herbal-based healthcare products. This trend is not only visible in supermarkets and dental practices, but also in the scientific world. An improving number of clinical trials are being conducted to validate the claims made about these products in regards to periodontal health. Among single component preparations, Aloe vera and green tea are the most studied natural ingredients. Concerning polyherbal mixtures, triphala has garnered great interest. The effects of these natural products on periodontal health is encouraging, with almost all studies showing an inhibitory effect on plaque accumulation and an improvement in gingival health. However, more studies are needed to be able to design clinical guidelines to guide the use of these natural products in periodontal practice. For most of these products, few studies are available and, moreover, the available studies are limited in duration, the number of participants, and the specific composition of the natural product is often not described in detail., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To examine the adjunctive effect of a Lactobacillus reuteri probiotic (ATCC PTA 5289 & DSM 17938) on the re-instrumentation of residual pockets., Materials and Methods: This randomized, double-blind, placebo-controlled study included 39 previously non-surgically treated periodontitis patients. A re-instrumentation was carried out, and probiotic and/or placebo drops were applied according to the study protocoll. Patients afterwards received lozenges to use 2×/day for 12 weeks. Probing pocket depth (PPD), recession, bleeding on probing and plaque levels were analysed, next to the microbiological impact., Results: No effects of the probiotic drops could be found. However, after 24 weeks, the overall PPD in the probiotic lozenges group (2.64 ± 0.33 mm) was significantly lower compared to the control lozenges (2.92 ± 0.42 mm). This difference was even more pronounced in moderate (4-6 mm) and deep (≥7 mm) pockets. In the probiotic lozenges group, there were also significantly more pockets converting from ≥4 mm at baseline to ≤3 mm at 24 weeks (67 ± 18% versus 54 ± 17%) and less sites in need for surgery (4 ± 4% versus 8 ± 6%). However, the probiotic products did not influence the microbiological counts of the periodontopathogens., Conclusion: The adjunctive consumption of L. reuteri lozenges after re-instrumentation improved the PPD reduction, without an impact on pocket colonization with periodontopathogens., (© 2019 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

There is some evidence that periodontitis increases the risk of atherothrombosis. Abdominal aortic aneurysm (AAA) is a cardiovascular disease with specific risk factors and physiopathological mechanisms that can lead to rupture in the absence of treatment. The aim of the present systematic review was to explore the influence of periodontitis on the progression of AAAs as a specific disease. A systematic search in PubMed/MEDLINE and Embase databases was performed. Human and animal studies exploring the influence of periodontal pathogens on the progression of AAA were considered for inclusion. After systematic screening, 5 articles were included in the review. Due to the heterogeneity of the selected studies, a meta-analysis could not be performed. The descriptive analyses of the studies emphasized that periodontal pathogens or their by-products contribute to systemic and local innate immunity likely to be associated with AAA physiopathology. Periodontitis seems to play a role in the development and progression of AAA. The present systematic review suggests that the presence of periodontal bacteria in the bloodstream or in situ in the vascular lesion is a risk associated with aneurysmal disease progression.

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non-dental plaque biofilm-induced gingival diseases and dental plaque-induced gingivitis. Non-dental plaque biofilm-induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque-induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque-induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non-periodontitis patient or in a currently stable "periodontitis patient" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient-centered approach to care, and therefore, creates differences in the way in which a "case" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations., (© 2018 American Academy of Periodontology and European Federation of Periodontology.)

Aim: Although the complexity of the oral ecology and the ecological differences between health and disease are well accepted, a clear view on the dynamics in relation to disease is lacking. In this study, the prevalence and abundance of 20 key oral bacteria was assessed in health and disease and more importantly a closer look was given to the inter-bacterial relationships., Materials and Methods: A blinded microbiological database was analysed in this cross-sectional, retrospective study. The database was constructed based on microbiological analyses of samples from 6308 patients, with gradations of periodontitis (healthy to periodontitis). Data concerning the abundance of 20 oral bacteria and probing pocket depth were provided., Results: Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Eubacterium nodatum, Porphyromonas micra and Porphyromonas intermedia showed a clear increase in abundance and prevalence with increasing pocket depth. Correlation matrices illustrated that almost all microorganisms were in one way correlated to other species and most of these correlations were significant. Several beneficial bacteria showed strong correlations with other beneficial bacteria., Conclusion: Knowledge on bacterial correlations can pave the way for new treatment options focusing on restoring the shifted balance., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To compare undisturbed plaque formation on teeth bonded with different types of orthodontic brackets with non-bonded control teeth, via a de novo plaque growth experiment over a 7-day period., Material and Methods: A randomized controlled trial with split-mouth design was set up enroling 16 dental students. Within each subject sites with Speed(S) and GAC(G), brackets and control sites were followed. Clinical periodontal parameters were recorded at baseline, on days 3 and 7. Microbiological samples were taken from the brackets and the teeth on days 3 and 7., Results: Both anaerobe and aerobe colony-forming units (CFU) were significantly higher in S-sites than in G-sites (p=0.0002, p=0.02). The shift from aerobic to anaerobic species was observed earlier in S-sites than in G-sites. The aerobe/anaerobe CFU ratio was significantly lower in S-sites than in G-sites (p=0.01). On day 3, the crevicular fluid flow was significantly higher in S-sites than in control sites (p=0.01). On day 7, S-sites and G-sites showed a significantly higher crevicular flow than control sites (both p<0.0001). More hypertrophy was seen in S- than in G- and control sites (p=0.05). No significant differences for bleeding on probing were observed., Conclusion: Bracket design can have a significant impact on bacterial load and on periodontal parameters.

Background: Periodontitis is a chronic inflammatory disease characterized by Gram-negative bacteria responsible for the degradation of tissues surrounding tooth. Moreover, periopathogens can invade the bloodstream, disseminate and promote cardiovascular disease, such as the link between Porphyromonas gingivalis and atherosclerosis. The aim of this study was to explore the relationship between the severity of periodontitis and of abdominal aortic aneurysm (AAA).Methods: This cross-sectional study compared patients with stable AAA (n = 30) and patients with unstable AAA (n = 31) based on aortic diameter, growth rate, and eligibility for surgical intervention. Periodontal clinical parameters were recorded as well as the Periodontal Inflamed Surface Area and the Periodontal Index for Risk of Infectiousness (PIRI). Microbiological analyses were performed on saliva and supragingival and subgingival plaque. Quantification of Tannerella forsythia (Tf), Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), Fusobacterium nucleatum (Fn), and Prevotella intermedia (Pi) was done by quantitative polymerase chain reaction.Results: The two AAA groups were homogeneous for age, sex, and most risk factors except hypertension and chronic obstructive pulmonary disease. Periodontal parameters were comparable but the proportion of patients with high PIRI scores was greater in those with unstable AAA (51.6% versus 23.3%). The probing depth (PD) and the proportion of PD >6 mm were positively correlated with AAA size and thrombus volume. Several associations were found between periopathogens such as Pg and AAA diameters and volumes, but no difference could be evidenced between stable and unstable AAA groups.Conclusions: Periodontitis was highly prevalent in both stable and unstable AAA patients. Severe and progressive periodontitis (stage IV and grade C) tended to be more frequent in the group of patients with unstable AAA. Moreover, Pg was observed in all the samples (saliva, supragingival, and subgingival plaque) and was correlated with AAA diameters and volumes. The study evidenced potential relationships between periodontitis severity and size of AAA. [ABSTRACT FROM AUTHOR]

Purpose: To compare the subgingival microbiota around two differently designed implant systems that were in function for more than 12 years in a randomised split-mouth study design, and to compare the outcome with natural dentition. Materials and methods: A total of 18 partially edentulous patients received at least two TiOblast™ (Astra Tech) and two Branemark (Nobel Biocare) implants following a split mouth design. At the last follow-up visit, periodontal parameters (probing depth, bleeding on probing and plaque) were recorded and intraoral radiographs were taken to calculate bone loss. Subgingival plaque samples were collected for culture, qPCR and checkerboard DNA-DNA hybridisation analysis. These data were related to implant design and bone loss. This study setup allowed a comparison of 34 Astra Tech (Impl A) with 32 Branemark (Impl B) implants. Results: During the 12-year follow up, five patients dropped out. One Branemark implant was lost before abutment connection in a dropout patient. Mean bone loss between loading and year 12 was 0.7 mm (range: -0.8–5.8) (Impl A), and 0.4 mm (range: 1.1–4.1) (Impl B). No significant microbiological differences (qualitative and quantitative) could be observed between both implant types. Compared to teeth, subgingival plaque samples from implants did not reach the concentration of pathogens, even after 12 years of function. Conclusions: These data show that both implant systems (with differences in macro-design and surface characteristics), in patients with good oral hygiene and a stable periodontal condition, can maintain a successful treatment outcome without significant subgingival microbiological differences after 12 years of loading. The presence of periodontopathogens did not necessarily result in bone loss. [ABSTRACT FROM AUTHOR]

Objectives: Examine the clinical and microbiological benefits of a dual‐strain Lactobacillus reuteri probiotic on the non‐surgical therapy of initial peri‐implantitis. Materials and methods: This randomized, double‐blind study targeted patients with initial peri‐implantitis, that is peri‐implantitis with a maximum mean probing pocket depth of 6 mm and maximum 3 mm bone loss compared with loading. A full‐mouth prophylaxis was performed and the peri‐implantitis sites were debrided. Subsequently, local application of the study drops was carried out at the peri‐implantitis sites and the study lozenges were handed out. The patients in the probiotic group received drops and lozenges containing L. reuteri (ATCC PTA 5289 & DSM 17938), those in the control group received placebo products. At the implant level the measurements of interest were bleeding, probing pocket depth and plaque. Full‐mouth bleeding and plaque scores were also recorded. Microbiological samples were taken from the tongue, saliva and subgingivally around the implants. Results: All clinical parameters were significantly decreased after 12 and 24 weeks. At the implant level the only statistically significant difference was a greater decrease in plaque levels in the probiotic versus the control group (p =.002 at 24 weeks). At the full‐mouth level, the only intergroup difference was the greater decrease in full‐mouth bleeding on probing sites in the probiotic group compared with the control group (p <.001 at 24 weeks). Concerning the microbiological outcomes, no significant differences could be found at any time point, neither intra‐ nor intergroup. Conclusions: No adjunctive effects of the use of L. reuteri probiotics in the treatment of peri‐implantitis were found. [ABSTRACT FROM AUTHOR]

Peri-implantitis can be explained using a multicausality model. Many factors are involved in the etiology of peri-implantitis, but patient compliance also plays a key role. Oral hygiene, attending recall visits, smoking behavior, and therapy comprehension are relevant factors that contribute to peri-implant health. The clinician should create the most optimal conditions for patients to facilitate adequate oral self-care and to help patients improve their oral hygiene skills. Implementation of a supportive periodontal therapy program is mandatory to control inflammation and plaque accumulation, as well as to keep the incidence of peri-implant diseases low. Patient compliance, including plaque control and dental follow-up, must be optimal. Consequently, precautions must be taken with patients treated with dental implants. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in the use of probiotics in periodontal therapy; however, until now, most research has focused on lactobacilli probiotics. The aim of this study is to evaluate the effect of 4-week use of yogurt supplemented with Bifidobacterium animalis subsp. lactis DN-173010 versus a placebo yogurt, followed by a 5-day non-brushing period.Methods: Individuals were included in this single-mask, randomized, controlled study if probing depth (PD) was ≤3 mm and attachment loss was ≤2 mm. After professional prophylaxis, they were randomized into two groups receiving yogurt containing either placebo or B. animalis for 28 days, followed by a 5-day non-brushing period. Outcome measures were plaque index (PI), gingival index (GI), bleeding on probing (BOP), PD, gingival crevicular fluid (GCF) volume, and total amount and concentration of interleukin (IL)-1β in GCF. These were measured at baseline, after 28 days of study product use, and subsequently after 5 days of plaque accumulation.Results: Fifty-one patients were analyzed. No intergroup differences could be detected before and after intake of study products. However, after plaque accumulation, significantly better results for all parameters were seen in the probiotic group compared with the control group (P <0.001): lower PI and GI, less BOP, less increase in GCF volume, and lower IL-1β total amount/concentration.Conclusion: The use of a probiotic yogurt supplemented with B. animalis can have a positive effect on plaque accumulation and gingival inflammatory parameters after refraining from oral hygiene practices. [ABSTRACT FROM AUTHOR]

The aim of this longitudinal study was to monitor patients’ microbiological and clinical parameters from bracket placement up to 3 months post-treatment. Twenty-four patients (10 males and 14 females, aged 14.6 ± 1.0 years) were included in this investigation. Microbiology (sub- and supragingival), periodontal probing depth (PPD), bleeding on probing (BOP), and gingival crevicular fluid (GCF) flow were assessed at baseline (T1), at bracket removal (T2), and 3 months post-treatment (T3). A statistical comparison was made over time and between the banded, bonded, and control sites. Repeated measurements on patients were taken into account by modelling the patients as a random factor. Except for PPD and BOP, values were log-transformed before analysis. Corrections for simultaneous hypothesis testing were performed via simulation.The results demonstrated that sub- and supragingival colony-forming units ratio (CFU ratio aerobe/anaerobe) decreased significantly (relatively more anaerobes) at T2 compared with T1. Between T2 and T3 no significant increase in CFU ratio was seen, resulting in a significantly lower CFU ratio at T3 compared with T1 for subgingival plaque. The difference concerning supragingival plaque between T3 and T1 was not significant. Clinical parameters PPD, POB, and GCF flow showed a significant increase between T1 and T2. Between T2 and T3 these variables decreased significantly but remained significantly higher than at T1 [except for BOP values at the bonded sites (P = 0.0646)]. Placement of fixed orthodontic appliances has an influence both on microbial and clinical periodontal parameters, which were only partly normalized, 3 months following the removal of the appliances. [ABSTRACT FROM PUBLISHER]

Escribano M, Herrera D, Morante S, Teughels W, Quirynen M, Sanz M. Efficacy of a low-concentration chlorhexidine mouthrinse in non-compliant periodontitis patients attending a supportive periodontal care programme: a randomized clinical trial. J Clin Periodontol 2010; 37: 266–275. doi: 10.1111/j.1600-051X.2009.01521.x. Objective: To assess the clinical and microbiological efficacy of a 0.05% chlorhexidine and 0.05% cetyl-pyridinium chloride mouth rinse in supportive periodontal care (SPC) in patients with inadequate plaque control. Material and Methods: The study was a randomized, double-blinded, placebo-controlled clinical trial in patients with moderate to severe chronic periodontitis under SPC with an inadequate plaque control (Turesky index >1). After supragingival prophylaxis and oral hygiene reinforcement, participants rinsed twice a day for 3 months with the test or placebo solutions, in addition to conventional hygiene. Primary clinical outcome variables included plaque and gingival indices. As secondary outcomes, periodontal and microbiological variables were studied.ancova and χ2 tests were used to compare the variables. Results: Forty-seven patients (22 placebo and 25 test group) participated. After 3 months, plaque levels increased in the placebo group, while diminished in the test group ( p<0.001). Similar effects were found for bleeding on probing. The other clinical parameters did not show significant differences. Microbiological variables demonstrated inter-group significant reductions in subgingival counts of Fusobacterium nucleatum and Prevotella intermedia and a decrease of the total bacterial counts in saliva. Conclusions: The tested mouth rinse demonstrated efficacy in reducing plaque and gingivitis, as well as in decreasing the microbial load in saliva and gingival sulcus. [ABSTRACT FROM AUTHOR]

Aim: To monitor the intra-oral microbiological changes after full-mouth extraction using quantitative polymerase chain reaction (qPCR). Material and Methods: Nine patients with severe, aggressive periodontitis, for whom a full-mouth tooth extraction was the only remaining treatment option were recruited. Before and 6 months after extraction, microbial samples were obtained (tongue, saliva and subgingival plaque) and analysed by qPCR. Results: The elimination of subgingival niches, by extraction of all natural teeth, resulted in a 3-log reduction of Porphyromonas gingivalis and Tannerella forsythia, and more modest reductions of Aggregatibacter actinomycetemcomitans and Prevotella intermedia. However, the detection frequencies of these periodontopathogens in saliva and on the tongue remained unchanged after full-mouth tooth extraction. Conclusion: In contrast to what has been believed so far, full-mouth tooth extraction does not result in eradication of all periodontopathogens but only in a significant reduction. The clinical consequences of this observation remain speculative. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that there are differences in total bacterial counts and capacity for biofilm formation between seven different bracket types. Material and Methods: By means of an in vitro experiment, seven commercially available bracket systems (Damon [A], Clarity [B], Mystique [C], Speed [D], Victory MBT [E], Micro-bc [F], and Generus [G]) were compared. A total of 25 premolar brackets of each bracket system were incubated in brain heart infusion medium containing the saliva and bacteria of two orthodontic patients. After 72 hours, the amounts of aerobe and anaerobe bacteria were determined by counting the colony-forming units (CFU). The CFU ratio (aerobe/anaerobe) also was calculated, and the black pigmented bacteria were analyzed. Results: Significant differences between the different bracket types in terms of biofilm formation were found. Bracket types can be arbitrarily divided into low, intermediate, and high plaque-retaining brackets. The group with low adhesion consists of bracket types E, F, and G; the group with high adhesion of bracket types A, B, and C; and type D exhibits intermediate adhesion. The group with high microbial adhesion (A, B, and C) did present significantly lower CFU ratios (aerobe/anaerobe) than were exhibited by the other bracket systems (P < .05). Conclusion: The hypothesis is accepted. Orthodontic brackets serve as different loci for biofilm formation; in this in vitro study, significant differences were noted between the different types of brackets. [ABSTRACT FROM AUTHOR]

Background: In the past few decades, more patients have been treated orthodontically, but no longitudinal study has compared orthodontic bands and brackets microbiologically and clinically. Methods: This longitudinal trial (split-mouth design) included 24 patients. Microbiology (sub- and supragingival), probing depth (PD), bleeding on probing (BOP), and gingival crevicular fluid flow (GCF) were assessed at baseline (band placement) and at weeks 18 (bracket bonding) 20, 24, and 36. A statistical comparison was made over time and among the banded, bonded, and control sites. Results: The aerobe/anaerobe ratio of sub- and supragingival colony forming units decreased significantly (relatively more anaerobes) over the study period for the banded and bonded sites (P<0.00l). This decrease was accompanied by significant elevations in PD, BOP, and GCF. These changes occurred faster after bonding compared to banding. No significant changes were observed 18 weeks after banding with the exception of increased PD (P <0.001). At week 36, all microbial and clinical variables at the bonded site had changed significantly in the negative direction (P <0.001) compared to week 18. The control sites did not show any significant changes over time, indicating that the effects were localized. Conclusions: The placement of fixed orthodontic appliances had a significant impact on microbial and clinical variables. The changes occurred faster at the bonded sites compared to the banded sites, probably because wire insertion caused difficulties in approximal cleaning. Over the long term, banding did not lead to more adverse microbial and periodontal effects than bonding. [ABSTRACT FROM AUTHOR]

Background: From an ecological viewpoint, the oral cavity, in fact the oro-pharynx, is an ‘open growth system’. It undergoes an uninterrupted introduction and removal of both microorganisms and nutrients. In order to survive within the oro-pharyngeal area, bacteria need to adhere either to the soft or hard tissues in order to resist shear forces. The fast turn-over of the oral lining epithelia (shedding 3 ×/day) is an efficient defence mechanism as it prevents the accumulation of large masses of microorganisms. Teeth, dentures, or endosseous implants, however, providing non-shedding surfaces, allow the formation of thick biofilms. In general, the established biofilm maintains an equilibrium with the host. An uncontrolled accumulation and/or metabolism of bacteria on the hard surfaces forms, however, the primary cause of dental caries, gingivitis, periodontitis, peri-implantitis, and stomatitis. Objectives: This systematic review aimed to evaluate critically the impact of surface characteristics (free energy, roughness, chemistry) on the de novo biofilm formation, especially in the supragingival and to a lesser extent in the subgingival areas. Methods: An electronic Medline search (from 1966 until July 2005) was conducted applying the following search items: ‘biofilm formation and dental/oral implants/surface characteristics’, ‘surface characteristics and implants’, ‘biofilm formation and oral’, ‘plaque/biofilm and roughness’, ‘plaque/biofilm and surface free energy’, and ‘plaque formation and implants’. Only clinical studies within the oro-pharyngeal area were included. Results: From a series of split-mouth studies, it could be concluded that both an increase in surface roughness above the Ra threshold of 0.2 μm and/or of the surface-free energy facilitates biofilm formation on restorative materials. When both surface characteristics interact with each other, surface roughness was found to be predominant. The biofilm formation is also influenced by the type (chemical composition) of biomaterial or the type of coating. Direct comparisons in biofilm formation on different transmucosal implant surfaces are scars. Conclusions: Extrapolation of data from studies on different restorative materials seems to indicate that transmucosal implant surfaces with a higher surface roughness/surface free energy facilitate biofilm formation. [ABSTRACT FROM AUTHOR]