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Background: We investigated the efficacy of two different cold atmospheric pressure jet plasma devices (CAP09 and CAPmed) and an air polishing device with glycine powder (AP) either applied as monotherapies or combined therapies (AP + CAP09; AP + CAPmed), in microbial biofilm removal from discs with anodised titanium surface. Methods: Discs covered with 7-day-old microbial biofilm were treated either with CAP09, CAPmed, AP, AP + CAP09 or AP + CAPmed and compared with negative and positive controls. Biofilm removal was assessed with flourescence and electron microscopy immediately after treatment and after 5 days of reincubation of the treated discs. Results: Treatment with CAP09 or CAPmed did not lead to an effective biofilm removal, whereas treatment with AP detached the complete biofilm, which however regrew to baseline magnitude after 5 days of reincubation. Both combination therapies (AP + CAP09 and AP + CAPmed) achieved a complete biofilm removal immediately after cleaning. However, biofilm regrew after 5 days on 50% of the discs treated with the combination therapy. Conclusion: AP treatment alone can remove gross biofilm immediately from anodised titanium surfaces. However, it did not impede regrowth after 5 days, because microorganisms were probably hidden in holes and troughs, from which they could regrow, and which were inaccessible to AP. The combination of AP and plasma treatment probably removed or inactivated microorganisms also from these hard to access spots. These results were independent of the choice of plasma device. [ABSTRACT FROM AUTHOR]

Aim: To investigate the medium‐term associations of serum protein subfractions derived from proton nuclear magnetic resonance (1H‐NMR) spectroscopy with periodontitis and tooth loss. Materials and Methods: A total of 3031 participants of the cohort Study of Health in Pomerania (SHIP‐TREND) were included. In addition to conventional serum testing, serum lipoprotein contents and subfractions were analysed by 1H‐NMR spectroscopy. Confounder‐adjusted associations of lipoprotein variables with periodontitis and the number of missing teeth variables were analysed using mixed‐effects models with random intercepts for time across individuals, accounting for multiple testing. Results: While only spurious associations between lipoprotein levels from conventional blood tests were found—that is, triglycerides were associated with mean clinical attachment level (CAL) and low‐density lipoprotein cholesterol/high‐density lipoprotein cholesterol (LDL‐C/HDL‐C) ratio with the number of missing teeth ‐ several associations emerged from serum lipoprotein subfractions derived from 1H‐NMR analysis. Specifically, elevated LDL triglycerides were associated with higher levels of mean probing depth (PD), mean CALs, and increased odds of having <20 teeth. HDL‐4 cholesterol levels were inversely associated with mean PD. Systemic inflammation (C‐reactive protein) might mediate the effects of LDL and HDL triglyceride contents on periodontitis severity. Conclusions: Several associations between serum lipoprotein subfractions and periodontitis were observed. As the underlying biochemical mechanisms remain unclear, further research is needed. [ABSTRACT FROM AUTHOR]

Aim: To estimate association between the use of interdental cleaning aids (IDAs) and type on 7‐year follow‐up levels of interdental plaque, interdental gingival inflammation, interdental periodontitis severity, the number of interdental sound surfaces and the number of missing teeth in a population‐based cohort study. Materials and Methods: We used 7‐year follow‐up data of 2224 participants from the Study of Health in Pomerania (SHIP‐TREND). We applied generalized linear and ordinal logistic models, adjusting for confounding and selection bias using inverse probability treatment weighting and multiple imputation. Results: Flossers were 32% less likely to have higher interdental plaque (iPlaque) levels than non‐users of IDAs (odds ratio [OR] = 0.68; 95% confidence interval [CI]: 0.50–0.94); flossing resulted in 5% lower means of iPlaque. Effects on interdental bleeding on probing (iBOP), mean interdental probing depths and mean interdental clinical attachment levels were direction‐consistent but statistically non‐significant. Interdental brushing was associated with lower follow‐up levels for interdental plaque (OR = 0.73; 95% CI: 0.57–0.93) and iBOP (OR = 0.69; 95% CI: 0.53–0.89). IDAs were more effective in reducing iPlaque in participants with periodontitis, whereas iBOP reduction was more pronounced in participants with no or mild periodontitis. The analyses did not suggest that the use of IDAs affected caries. Finally, applying change score analyses, flossing reduced tooth loss incidence (incidence rate ratio [IRR] = 0.71) compared with non‐users of IDAs. Conclusions: Recommending flossing and interdental brushing in dental practices represents an approach to the prevention of gingivitis and consequently periodontitis. [ABSTRACT FROM AUTHOR]

Aim: Evidence from a Phase IIa trial showed that a complement C3‐targeted drug reduced gingival inflammation in patients with gingivitis. Using drug‐target Mendelian randomization (MR), we investigated whether genetically proxied C3 inhibition alters the risk of periodontitis. Materials and Methods: We used multiple 'cis' instruments from the vicinity of the encoding loci of C3. Instrument selection was restricted to the drug target encoding loci (chromosome 19; 6,677,715–6,730,573 (GRCh37/hg19)). We selected three uncorrelated single‐nucleotide polymorphisms (rs141552034, rs145406915, rs11569479) that were associated with serum C3 levels (p value <1 × 10−4) from a genome‐wide association study (GWAS) of 5368 European descent individuals. We extracted association statistics from a GWAS of 17,353 clinical periodontitis cases and 28,210 European controls. Wald ratios were combined using inverse‐variance weighted meta‐analysis to estimate the odds ratio (OR) of the genetically proxied inhibition of C3 in relation to periodontitis. Results: MR analysis revealed that the inhibition of C3 reduces the odds of periodontitis (OR 0.91 per 1 standard deviation reduction in C3; 95% confidence interval 0.87–0.96, p value =.0003). Conclusions: Findings from our MR analysis suggest a potential protective effect of C3 blockade against periodontitis. [ABSTRACT FROM AUTHOR]

Aim: Assessment of treatment response after systemic amoxicillin/metronidazole adjunctive to subgingival instrumentation (SI) according to stages and grades of the 2018 classification of periodontal diseases. Materials and Methods: We carried out exploratory re‐analysis of the placebo‐controlled, multi‐centre ABPARO trial (52; 45/60 years of age; 205 males, 114 active smokers). Patients were randomized to SI with systemic amoxicillin 500 mg/metronidazole 400 mg (three times a day for 7 days, n = 205; ANTI) or placebo (n = 200; PLAC) and maintenance therapy every 3 months. Patients were reclassified according to the 2018 classification (stage/extent/grade). Treatment effect was the percentage of sites per patient with new attachment loss ≥1.3 mm (PSAL ≥ 1.3 mm) at 27.5 months post‐baseline/randomization. Results: All patients were assigned according to the stage (n = 49 localized stage III, n = 206 generalized stage III, n = 150 stage IV). Because of missing radiographs, only 222 patients were assigned to grades (n = 73 B, n = 149 C). Treatment (PLAC/ANTI) resulted in PSAL ≥ 1.3 mm (median; lower/upper quartile) in localized stage III (PLAC: 5.7; 3.3/8.4% vs. ANTI: 4.9; 3.0/8.3%; p =.749), generalized stage III (8.0; 4.5/14.3% vs. 4.7; 2.4/9.0%; p <.001), stage IV (8.5; 5.1/14.4% vs. 5.7; 3.3/10.6%; p =.008), grade B (4.4; 2.4/6.7% vs. 3.6; 1.9/4.7%; p =.151) and grade C (9.4; 5.3/14.3% vs. 4.8; 2.5/9.4%; p <.001). Conclusions: In generalized periodontitis stage III/grade C, a clinically relevant lower percentage of disease progression after adjunctive systemic amoxicillin/metronidazole was observed compared to placebo (PLAC: 9.7; 5.8/14.3% vs. ANTI: 4.7; 2.4/9.0%; p <.001). [ABSTRACT FROM AUTHOR]

Aim: To determine the long‐term effects of the use of powered tooth brush (PTB) in comparison to manual tooth brush (MTB) on periodontitis severity, coronal caries experience, and the number of missing teeth using in a population‐based cohort study. Materials and Methods: Using 7‐year follow‐up data of 2214 participants of the Study of Health in Pomerania (SHIP‐TREND), comprehensively adjusted linear models using generalized least squares and ordinal regression models estimated the effects of PTB usage on dental outcomes in complete case and imputed data. Results: At follow‐up, PTB users had lower medians for mean probing depth (PD; 2.21 mm) and mean clinical attachment levels (1.73 mm) than MTB users (2.30 and 1.96 mm, respectively). Adjusted models revealed the beneficial effects of PTB usage on follow‐up levels of plaque, bleeding on probing, mean PD, percentage of sites with PDs ≥4 mm, mean clinical attachment levels (all, interdental, and non‐interdental sites, respectively), and the number of missing teeth. For the number of missing teeth, the effects were more pronounced in participants aged ≥50 years. No significant effects of PTB usage on the number of decayed or filled surfaces (all and interdental sites) were found. Conclusions: A recommendation of PTB usage in dental practice could contribute to the long‐term promotion of oral health. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate whether extraction thresholds in persons with severe periodontitis have changed between 2000 and 2010 and whether potential shifts have contributed to the reported decrease in tooth extractions in German adults over the last decades. Materials and Methods: Data from two German population‐based cohort studies in Northeast Germany (Studies of Health in Pomerania; SHIP‐START [baseline 1997–2001; 11‐year follow‐up] and SHIP‐TREND [baseline 2008–2012; 7‐year follow‐up]) were used. In SHIP‐START (SHIP‐TREND), 522 (478) participants with severe periodontitis according to the CDC/AAP case definition were included. Patterns of maximum probing depth (PD) and maximum clinical attachment level (CAL) for retained and extracted teeth were compared between SHIP‐START and SHIP‐TREND participants. Results: No major differences in patterns of baseline maximum CAL of retained or extracted teeth were detected between SHIP‐START and SHIP‐TREND. Extraction thresholds were identified at the baseline at maximum CAL ≥6 and ≥9 mm. Tooth‐level incidence rates for extraction for baseline maximum CAL of 6 mm were comparable between SHIP‐START and SHIP‐TREND (17.1 vs. 15.9 events per 1000 person‐years). Conclusions: After a decade, teeth in persons with severe periodontitis were still undergoing extraction with minor or moderate attachment loss. A change in extraction pattern did not contribute to the higher tooth retention rate. [ABSTRACT FROM AUTHOR]

Objectives: Oral mucositis caused by intensive cancer chemotherapy or radiotherapy frequently results in pronounced damage of the oral mucosa leading to painful oral hygiene. To support oral care, antimicrobial effective mouth rinses may be used. Thus, the efficacy of a hypochlorite-based mouth rinse (Granudacyn®), assumed to be highly biocompatible because of the compounds being part of the natural pathogen defense, as possible antiseptic agent in case of oral mucositis was compared to that of an octenidine based antiseptic mouth rinse (Octenidol® md). Materials and methods: The study was conducted as monocentric, controlled, randomized, blind cross over comparative study on 20 volunteers. As a proof of principle, we performed the study on orally healthy subjects and not cancer patients. The efficacy was determined as reduction of colony forming units (cfu) on buccal mucosa as well as in saliva. After mouth rinsing for 30 s, samples were taken after 1 min, 15 min, 30 and 60 min. The lg-reduction was calculated as difference between lg-values of cfu pre- and post-treatment. Results: Both antiseptic mouth rinses induced a significant reduction of cfu on buccal mucosa and in saliva 1 min after mouth rinsing. The effect persisted up to 60 min. The octenidine based rinse was significantly superior to the hypochlorite-based rinse up to the last sample 60 min after rinsing. However, the known cytotoxicity of octenidine argues against its application. Conclusion: Within the limits of this study, due to its antiseptic efficacy, the hypochlorite-based rinse Granudacyn® can be regarded appropriate to support the oral hygiene in patients with a sensitive oral mucosa during an aggressive cancer chemotherapy and radiation treatment in case of oral mucositis. [ABSTRACT FROM AUTHOR]

Aim: To examine the associations between bone turnover markers and periodontitis in two cross‐sectional population‐based studies. Materials and Methods: We used data from two independent adult samples (N = 4993), collected within the Study of Health in Pomerania project, to analyse cross‐sectional associations of N‐procollagen type 1 amino‐terminal propeptide (P1NP), C‐terminal cross‐linking telopeptide, osteocalcin, bone‐specific alkaline phosphatase (BAP), fibroblast growth factor 23, wingless‐type mouse mammary tumour virus integration site family member 5a (WNT5A), and sclerostin values with periodontitis. Confounder‐adjusted gamma and fractional response regression models were applied. Results: Positive associations were found for P1NP with mean pocket probing depth (PPD; eβ=1.008; 95% confidence interval [CI]: 1.001–1.015), mean clinical attachment loss (mean CAL; eβ=1.027; 95% CI: 1.011–1.044), and proportion of sites with bleeding on probing (%BOP; eβ=1.055; 95% CI: 1.005–1.109). Similar associations were seen for BAP with %BOP (eβ=1.121; 95% CI: 1.042–1.205), proportion of sites with PPD ≥4 mm (%PPD4) (eβ=1.080; 95% CI: 1.005–1.161), and sclerostin with %BOP (eβ=1.308; 95% CI: 1.005–1.704). WNT5A was inversely associated with mean PPD (eβ=0.956; 95% CI: 0.920–0.993) and %PPD4 (eβ=0.794; 95% CI: 0.642–0.982). Conclusions: This study revealed scattered associations of P1NP, BAP, WNT5A, and sclerostin with periodontitis, but the results are contradictory in the overall context. Associations reported in previous studies could not be confirmed. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to identify the factors influencing the changes in the number of teeth present and the number of healthy or filled surfaces between two time points. Materials and Methods: Repeated cross‐sectional data from population‐based studies, namely the German Oral Health Studies (DMS‐III vs. DMS‐V), the Studies of Health in Pomerania (SHIP‐START‐0 vs. SHIP‐TREND‐0), and the Jönköping study (2003 vs. 2013), were analysed. Oaxaca decomposition models were constructed for the outcomes (number of teeth, number of healthy surfaces, and number of filled surfaces). Results: The number of teeth increased between examinations (DMS: +2.26 [adults], +4.92 [seniors], SHIP: +1.67, Jönköping: +0.96). Improvements in education and dental awareness brought a positive change in all outcomes. An increase in powered toothbrushing and inter‐dental cleaning had a great impact in DMS (adults: +0.25 tooth, +0.78 healthy surface, +0.38 filled surface; seniors: +1.19 teeth, 5.79 healthy surfaces, +0.48 filled surface). Inter‐dental cleaning decreased by 4% between SHIP‐START‐0 and SHIP‐TREND‐0, which negatively affected the outcomes. Conclusions: From this study, it can be concluded that education may be the most important factor having a direct and indirect effect on the outcomes. However, for better oral health, powered toothbrushing and inter‐dental cleaning should not be neglected. [ABSTRACT FROM AUTHOR]

Background: Peri-implantitis therapy is a major problem in implantology. Because of challenging rough implant surface and implant geometry, microorganisms can hide and survive in implant microstructures and impede debridement. We developed a new water jet (WJ) device and a new cold atmospheric pressure plasma (CAP) device to overcome these problems and investigated aspects of efficacy in vitro and safety with the aim to create the prerequisites for a clinical pilot study with these medical devices. Methods: We compared the efficiency of a single treatment with a WJ or curette and cotton swab (CC) without or with adjunctive use of CAP (WJ + CAP, CC + CAP) to remove biofilm in vitro from rough titanium discs. Treatment efficacy was evaluated by measuring turbidity up to 72 h for bacterial re-growth or spreading of osteoblast-like cells (MG-63) after 5 days with scanning electron microscopy. With respect to application safety, the WJ and CAP instruments were examined according to basic regulations for medical devices. Results: After 96 h of incubation all WJ and CC treated disks were turbid but 67% of WJ + CAP and 46% CC + CAP treated specimens were still clear. The increase in turbidity after WJ treatment was delayed by about 20 h compared to CC treatment. In combination with CAP the cell coverage significantly increased to 82% (WJ + CAP) or 72% (CC + CAP), compared to single treatment 11% (WJ) or 10% (CC). Conclusion: The newly developed water jet device effectively removes biofilm from rough titanium surfaces in vitro and, in combination with the new CAP device, biologically acceptable surfaces allow osteoblasts to grow. WJ in combination with CAP leads to cleaner surfaces than the usage of curette and cotton swabs with or without subsequent plasma treatment. Our next step will be a clinical pilot study with these new devices to assess the clinical healing process. [ABSTRACT FROM AUTHOR]

Aim This cross-sectional study was repeated at two time points and investigated the influence of gingivitis, smoking and body mass index (BMI) on the systemic inflammatory markers high-sensitivity C-reactive protein (hs-CRP) and interleukin 6 (IL6) in 10- and 15-year-olds. Materials and Methods The study sample of two birth cohorts, i.e. GINIplus and LISAplus, from the Munich centre consisted of 806 and 846 subjects who were evaluated at 10- and 15-year follow-ups respectively. Children and their parents completed questionnaires on participant-related lifestyle information. Gingivitis was measured at the sextant level using a simplified sulcus-bleeding index. Serum hs-CRP and IL6 levels were obtained from blood samples. Multiple logistic regressions adjusting for lifestyle-related factors and other confounders were performed to assess associations between the specified variables. Results There were no associations between gingivitis and the inflammatory markers hs-CRP and IL6 in 10-year-olds. In 15-year-olds, gingivitis (aOR: 2.17; 95% CI: 1.25-3.77); daily smoking (aOR: 6.27; 95% CI: 1.39-28.39); and being overweight/obese (aOR: 4.95; 95% CI: 0.73-33.68) were identified as significantly influencing factors for elevated hs-CRP values. Oral hygiene did not influence hs-CRP. Conclusion In this study, hs-CRP was positively associated with gingivitis, smoking daily and overweight/obesity among 15-year-olds. [ABSTRACT FROM AUTHOR]

Objectives Evidence on possible associations between facial morphology, attachment loss and gingival recession is lacking. We analysed whether the facial type, which can be described by the ratio of facial width and length (facial index), is related to periodontal loss of attachment, hypothesizing that a broad face might be associated with less gingival recession ( GR) and less clinical attachment loss ( CAL) than a long face. Materials and methods Data from the 11-year follow-up of the population-based Study of Health in Pomerania were used. Periodontal loss of attachment was assessed by GR and CAL. Linear regression models, adjusted for age and gender, were used to assess associations between specific landmark based distances extracted from magnetic resonance imaging head scans and clinically assessed GR or CAL ( N = 556). Results Analysing all teeth, a higher maximum cranial width was associated with a lower mean GR ( B = −0.016, 95% CI: −0.030; −0.003, p = 0.02) and a lower mean CAL ( B = −0.023, 95% CI: −0.040; −0.005, p = 0.01). Moreover, a long narrow face was significantly associated with increased mean GR and CAL (facial index, P for trend = 0.02 and p = 0.01, respectively). Observed associations were more pronounced for incisors and canines than for premolars and molars. Conclusion This study revealed craniofacial morphology, specifically the cranial width and the facial index, as a putative risk factor for periodontal loss of attachment. [ABSTRACT FROM AUTHOR]

Objectives Evaluation of the clinical effect of systemic amoxicillin and metronidazole adjunctively to mechanical debridement at furcation sites. Material and Methods This is an exploratory per-protocol collective subanalysis from a prospective, randomized, double-blind, multi-centre trial (ClinicalTrials.gov NCT00707369) on the effect of adjunctive systemic amoxicillin 500 mg plus metronidazole 400 mg (3×/day, 7 days) use on furcation involvement in moderate to severe periodontitis. Outcome was the change in frequency of classes of furcation involvement after 27.5 months. Therapy comprised mechanical debridement in conjunction with antibiotic or placebo administration, and maintenance therapy at three months intervals. Results Three hundred and forty-five patients (175 placebo, 170 antibiotics) with 6576 furcation sites (class 0 2956; class I 2370; class II 886; class III 364) were examined (3472 placebo, 3104 antibiotics). Pocket reduction/attachment gain at the furcation sites was noticeably better after antibiotics (1.2/0.6 mm) than after placebo (0.7/0.2 mm) 27.5 months after therapy. However, most furcation degrees were unchanged (placebo 61.5%/antibiotics 62.2%), more sites improved than deteriorated (20.3%/18.2%, 22.1%/15.7% respectively) and no differences in the change of furcation degrees between treatments could be detected. Conclusion Compared to placebo, prescription of adjunctive systemic antibiotics failed to show clinically relevant benefit with regard to furcation class involvement. [ABSTRACT FROM AUTHOR]

Aim Muscle strength declines and gums recede with increasing age across the life course. Possible associations exist between handgrip strength as an indicator of physical fitness and periodontitis and number of teeth. Material and Methods Handgrip strength ( GS), anthropometric measures, clinical attachment loss, number of teeth, C-reactive protein and glycated haemoglobin were assessed in 2089 participants of the Study of Health in Pomerania ( SHIP-2). Linear regression including interaction with age was used to estimate the association between clinical attachment level, number of teeth and GS. Results In multiple regression adjusted for age, body mass index ( BMI) and waist-to-hip ratio ( WHR) each mm of diminished periodontal attachment was associated with reduction in GS by 1.47 kg (95% CI −2.29 to −0.65) and 0.38 kg (−0.89 to 0.14) in men and women respectively. Correspondingly, each additional remaining tooth was significantly associated with higher GS. Using handgrip strength relative to BMI as outcome, these relationships become even more apparent. Indicators of obesity such as BMI and WHR associated with both GS and periodontitis modulate the relationship between GS and periodontitis with a different impact between the sexes. Conclusion Periodontitis is associated with GS modified mainly by anthropometric measures related to adiposity and inflammation. Putative mechanisms encompass interactions of factors declining with increasing age. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to investigate the association of serum vitamin B12 with the progression of periodontitis and risk of tooth loss in a prospective cohort study. Materials and Methods In the Study of Health in Pomerania, 1648 participants were followed from 2002-2006 to 2008-2012 (mean duration 5.9 years). Serum vitamin B12 was measured by chemiluminescent enzyme immunoassay. Probing pocket depth (PD) and clinical attachment loss (CAL) were measured to reflect periodontal status on a half-mouth basis at each survey cycle. Tooth numbers are based upon a full-mouth tooth count. Results and Conclusions In multivariate regression models, baseline vitamin B12 was inversely associated with changes in mean PD ( Ptrend = 0.06) and mean CAL ( Ptrend = 0.01), and risk ratios of tooth loss (TL; Ptrend = 0.006) over time. Compared to participants in the highest vitamin B12 quartile, those in the lowest quartile had 0.10 mm (95%CI: 0.03, 0.17; Pdifference = 0.007) greater increase in mean PD, 0.23 mm (95%CI: 0.09, 0.36; Pdifference = 0.001) greater increase in mean CAL and a relative risk of 1.57 (95%CI: 1.22, 2.03; Pdifference < 0.001) for TL. Stratified analyses showed stronger associations between vitamin B12 and changes in mean CAL among never smokers ( Pinteraction = 0.058). Further studies are needed to understand the potential mechanisms of these findings. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to determine the prospective association between sex steroid concentrations with periodontal progression and incident tooth loss in men and women. Methods We used data from 1465 women and 1838 men (age 20-81 years) with completed five-year-follow-up from the Study-of-Health-in-Pomerania, a population-based longitudinal cohort. Serum levels of total testosterone ( TT) and other sex steroids were measured. Mean clinical attachment loss ( CAL) and the number of teeth were assessed. Generalized regression models were implemented for cross-sectional and longitudinal analyses, adjusting for age, education, smoking, waist circumference, diabetes, physical activity, blood sampling time and time between baseline and follow-up. Results Fully adjusted models revealed no consistent associations between TT and mean CAL, neither in cross-sectional [men: ß = −0.0004 (−0.023;0.022), p = 0.97; women: ß = −0.033 (−0.057; −0.009), p = 0.006] nor in longitudinal analyses [men: ß = −0.033 (−0.100;0.034), p = 0.33; women: ß = −0.023 (−0.086;0.040), p = 0.47]. For tooth loss, neither cross-sectional nor longitudinal associations with any of the sex steroid concentrations were found. Conclusions No consistent associations of sexual steroids with periodontal progression or tooth loss were found. Further cohort studies are necessary to evaluate possible associations between endocrinological parameters, like supra- or subphysiologic testosterone concentrations, and periodontal progression or tooth loss. [ABSTRACT FROM AUTHOR]

Aim: Systemic low-grade inflammation represents a central hallmark of chronic diseases and has been proposed as the underlying mechanism linking factors like obesity or diabetes with periodontitis. However, the impact of inflammatory markers on periodontitis has not yet been investigated. Materials and Methods: The study population comprised 1784 subjects from the Study of Health in Pomerania with complete 11-year follow-up. Fibrinogen and white blood cell (WBC) counts were measured as markers of inflammation. Periodontitis was assessed by probing depth (PD), clinical attachment loss (CAL) and the CDC/AAP case definition. Results: Multilevel regression analyses revealed significant coefficients for the impact of both inflammation markers on the percentage of sites with PD/CAL ≥ 3 mm. Increases in fibrinogen about 1 g/l were associated with 3.0% and 2.7% more sites with PD/CAL ≥ 3 mm respectively. Consistent associations were found using mean values of PD/CAL but not using missing teeth or caries. Regarding the CDC/AAP case definition, 11-year changes in fibrinogen and WBC counts were significantly associated with ≥ 1 category progression (OR: 1.36 and 1.11). Conclusions: Fibrinogen levels and WBC counts showed consistent long-term associations with PD, CAL and the CDC/AAP case definition. Results indicate that systemic low-grade inflammation might indeed represent one possible pathway for effects of obesity, diabetes or other chronic inflammatory conditions on periodontitis. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to identify long-term prognostic factors for the loss of molars with different degrees of furcation involvement (FI) during supportive periodontal therapy (SPT). Methods: Three hundred and seventy-nine compliant subjects with 2373 molars at baseline were retrospectively assessed. After nonsurgical (n = 76) or surgical (n = 303) non-regenerative active periodontal therapy (APT: T0-T1), patients remained under SPT (T1-T2) for 18.3 ±5.5 (9-30.8) years. Association between tooth- and subject-related factors with tooth loss was assessed using multilevel Cox regression-analysis. Results: During APT 159 and during SPT 438 molars were extracted in 256 subjects, respectively, yielding an overall survival of 74.8% (T2). Survival probabilities after 15-years of SPT were 92.4% for molars with FI-0 compared to FI-1 = 85.6%, FI-2 = 74.9% and FI-3 = 62.3%. The risk of molar loss was significantly increased for teeth with FI-3 (hazard ratio: 2.39 [95% confidence interval: 1.54-3.70]), bone loss >50% (2.16 [1.36-3.42]), mobile teeth (2.07 [1.51-2.84]), maxillary molars (1.44 [1.12-1.85]) and endodontically treated teeth (1.89 [1.58-2.26]). For each mm of mean residual pocket probing depth, the hazard of tooth loss increased 1.89-fold (1.58-2.26). On a subject level, for each year of age, HR was 1.03 (1.01-1.05). Conclusions: Furcation involvement, bone loss, tooth mobility, mean pocket depth and age strongly predicted tooth loss during SPT. Long-term retention of periodontally compromised molars was possible via conservative non-regenerative active and supportive therapy. [ABSTRACT FROM AUTHOR]

Aim We investigated the long-term impact of adjunctive systemic antibiotics on periodontal disease progression. Periodontal therapy is frequently supplemented by systemic antibiotics, although its impact on the course of disease is still unclear. Material & Methods This prospective, randomized, double-blind, placebo-controlled multi-centre trial comprising patients suffering from moderate to severe periodontitis evaluated the impact of rational adjunctive use of systemic amoxicillin 500 mg plus metronidazole 400 mg (3x/day, 7 days) on attachment loss. The primary outcome was the percentage of sites showing further attachment loss ( PSAL) ≥1.3 mm after the 27.5 months observation period. Standardized therapy comprised mechanical debridement in conjunction with antibiotics or placebo administration, and maintenance therapy at 3 months intervals. Results From 506 participating patients, 406 were included in the intention to treat analysis. Median PSAL observed in placebo group was 7.8% compared to 5.3% in antibiotics group (Q25 4.7%/Q75 14.1%; Q25 3.1%/Q75 9.9%; p < 0.001 respectively). Conclusions Both treatments were effective in preventing disease progression. Compared to placebo, the prescription of empiric adjunctive systemic antibiotics showed a small absolute, although statistically significant, additional reduction in further attachment loss. Therapists should consider the patient's overall risk for periodontal disease when deciding for or against adjunctive antibiotics prescription. [ABSTRACT FROM AUTHOR]

Background Oral diseases rank among the most prevalent non-communicable diseases in modern societies. In Germany, oral epidemiological data show that both dental caries and periodontal diseases are highly prevalent, though significant improvements in oral health has been taking in the population within the last decades, particularly in children. It is, therefore, the aim of the Fifth German Oral Health Study (DMS V) to actualize the data on current oral health status and to gather information on oral health behavior and risk factors. In addition to current oral health monitoring, the study will also permit conclusions about trends in the development of oral health in Germany between 1989 and 2014. Methods/Design DMS V is a cross-sectional, multi-center, nationwide representative, socio-epidemiological study to investigate the oral health status und behavior of the German resident population in four age cohorts. Study participants are children (12-year-olds), adults (35- to 44-year-olds), young olds (65- to 74-year-olds), and old olds (75- to 100-year-olds) who are drawn from local residents' registration offices. Social-science investigation parameters concern subjective perceptions and attitudes regarding oral health and nutrition, sense of coherence, and socio-demographic data. Clinical oral parameters are tooth loss, caries and periodontitis, prosthodontic status, further developmental and acquired dental hard tissue and mucosal lesions. To ensure reproducibility, the dental investigators are trained and calibrated by experts and multiple reliability checks are performed throughout the field phase. Statistical analyses are calculated according to a detailed statistical analysis plan. Discussion The DMS studies first performed in 1989 and repeated in 1997 and 2005 are the only crosssectional oral health studies conducted in Germany on a population-based national representative level. Updated prevalence and trend analyses of key oral diseases are, therefore, of major epidemiological and health services research interest. [ABSTRACT FROM AUTHOR]

Aim There is a growing interest in comparing periodontal conditions between countries. This study compared periodontal disease conditions in three elderly populations- one from Japan and two from Germany. Materials and Methods We compared periodontal data of 70-year-old subjects from the Niigata Study with 65-74-year-old subjects from the Study of Health in Pomerania ( SHIP) and from West Germany ( DMS III). A total of 489, 399 and 549 dentate subjects were analysed, respectively. Recording protocols were standardized. Linear or logistic models were used to compare Niigata Study with SHIP. Results Elderly German subjects in SHIP and DMS III had significantly more severe periodontal conditions and fewer remaining teeth compared to those in Niigata Study, though differences were less pronounced for DMS III. German subjects showed a significantly different pattern of various periodontal risk factors compared to Japanese subjects. Even after adjustment for putative periodontal risk factors, SHIP subjects still presented significantly higher adjusted values for most periodontal parameters compared to Niigata Study subjects ( p < 0.05). Conclusions Periodontitis was more prevalent in SHIP compared with Niigata Study, even after comprehensive risk factor adjustment. Only to a very small extent, differences between studies could be explained by the risk factors explored. [ABSTRACT FROM AUTHOR]

Self-perceived oral health is affected not only by awareness of the clinical status but also by comparisons with people of a similar age. This study explored the relative contributions of clinical variables assessing caries, periodontal status, and prosthetic status to self-perceived oral health within two age groups. Data of 891 adults (35-44 yr of age) and 760 older people (65-74 yr of age) from the Fourth German Oral Health Study ( DMS IV, 2005) were evaluated. Self-perceived oral health was obtained from questionnaires. Numbers of decayed, filled, and unreplaced teeth, mean attachment loss, bleeding on probing ( BOP), the presence of a fixed denture, and the presence of a removable denture were assessed. Multinomial logistic regression models were developed for both age groups, separately, using stepwise methods. For adults, unreplaced teeth, filled teeth, decayed teeth, the presence of a removable denture, and mean attachment loss were added to the final model. For older people, the presence of a removable denture, unreplaced teeth, decayed teeth, mean attachment loss, filled teeth, and BOP were included in the final model. Awareness of the relative contributions of clinical variables to self-perceived oral health is important for obtaining a clearer understanding of patients' subjective and objective self-perceptions of oral health. [ABSTRACT FROM AUTHOR]

Aim To develop models for periodontitis using self-reported questions and to validate them externally. Methods The Study of Health in Pomerania ( SHIP-0) was used for model development. Periodontitis was defined according to the definitions of the Center for Disease Control and Prevention-American Academy of Periodontology, the 5th European Workshop in Periodontology, and Dietrich et al. (≥2 teeth with inter-proximal clinical attachment loss of ≥4 mm and 6 mm as moderate and severe periodontitis) respectively. These models were validated in SHIP-Trend and the Fourth German Oral Health Study ( DMS IV). Results Final models included age, gender, education, smoking, bleeding on brushing and self-reported presence of mobile teeth. Concordance-statistics (C-statistics) of the final models from SHIP-0 were 0.84, 0.82 and 0.85 for the three definitions respectively. Validation in SHIP-Trend revealed C-statistics of 0.82, 0.81 and 0.82 respectively. As bleeding on brushing and presence of mobile teeth were unavailable in DMS IV, reduced models were developed. C-statistics of reduced models were 0.82, 0.81 and 0.83 respectively. Validation in DMS IV revealed C-statistics of 0.72, 0.78 and 0.72 for the three definitions respectively. All p values of the goodness-of-fit tests were >0.05. Conclusions The models yielded a moderate usefulness for prediction of periodontitis. [ABSTRACT FROM AUTHOR]

Aim To identify loci associated with chronic periodontitis through a genome-wide association study ( GWAS). Materials and Methods A GWAS was performed in 4032 individuals of two independent cross-sectional studies of West Pomerania ( SHIP n = 3365 and SHIP- TREND n = 667) with different periodontal case definitions. Samples were genotyped with the Affymetrix Genome-Wide Human SNP Array 6.0 or the Illumina Human Omni 2.5 array. Imputation of the HapMap as well as the 1000 Genome-based autosomal and X-chromosomal genotypes and short insertions and deletions ( INDELs) was performed in both cohorts. Finally, more than 17 million SNPs and short INDELs were analysed. Results No genome-wide significant associations were found for any periodontitis case definition, regardless of whether individuals aged >60 years where excluded or not. Despite no single SNP association reached genome-wide significance, the proportion of variance explained by additive effects of all common SNPs was around 23% for mean proximal attachment loss. Excluding subjects aged >60 years increased the explained variance to 34%. Conclusions No single SNPs were found to be genome-wide significantly associated with chronic periodontitis in this study. [ABSTRACT FROM AUTHOR]

Aim Interest in human saliva proteomics for disease-specific biomarker screening increased in the last decade. We used whole saliva samples from periodontally healthy and diseased subjects with chronic periodontitis to screen for disease-associated differences in the protein pattern. Material and Methods We selected 20 periodontally healthy and 20 periodontally diseased subjects from the population-based cross-sectional Study of Health in Pomerania ( SHIP-2 and SHIP-Trend). Saliva collection was performed with commercially available Salivette® (Sarstedt, Nümbrecht, Germany). Whole saliva proteins were analysed after trichloroacetic acid ( TCA) precipitation and proteolytic digestion with trypsin by LC- MS/ MS. MS-data were analysed and quantified using the Rosetta Elucidator software package. Results In whole saliva we identified 344 human protein groups across all samples. For label free quantitation we only considered 152 proteins identified with more than one unique peptide. In total, 20 proteins showed 1.5-fold difference in abundance between controls and patients ( p < 0.05); the majority of these proteins showed higher abundance in the periodontally diseased subjects. Functional annotation of proteins linked the periodontally diseased status with acute phase response and inflammatory processes. Conclusion Label free proteomic analysis of whole saliva is a powerful tool to characterize the periodontal disease status and differentiate between healthy and periodontally diseased subjects. [ABSTRACT FROM AUTHOR]

Objectives Long-term outcomes of conservative periodontal and prosthetic treatment of patients with moderate to severe periodontitis were to be evaluated. Groups of younger ( YG) and middle-aged patients ( MG) were to be compared regarding survival of fixed and removable dental prostheses ( FDP, RDP) inserted after active periodontal therapy ( APT). In addition, functional-occlusal status over more than 10 years of supportive periodontal therapy ( SPT) was analysed. Methods The present multi-case-series retrospectively analysed data of 68 patients (34 YG and 34 MG) who had received APT and regular SPT ≥10 years. Tooth loss, occlusal status and survival and complications of prosthetics were evaluated descriptively and comparatively ( t-test). Results There was no statistical difference between YG and MG concerning tooth loss/year ( p > 0.05). Functional-occlusal status was retained during SPT in 75% and 69% of YG and MG. Restorations inserted after APT showed high survival for both age groups (100%). Mean survival time until the last SPT visit was 15.2 and 11.6 years for FDP and RDP in YG, and 12.5 and 13.1 years in MG. Conclusions Prosthetic restorations in both younger and middle-aged patients with severe periodontitis showed high survival, if pre-prosthetic APT and regular SPT had been performed. [ABSTRACT FROM AUTHOR]

Objectives To assess changes in the number of functioning teeth (filled and sound teeth, FS- T index) from 1989/1992 to 2005 in West and East Germany and to evaluate survey- and region-specific associations between sociodemographic and behavioral risk factors and the FS- T index. Methods Within the German Oral Health Studies, random samples from 35-44-year-olds were drawn in 1989, 1992, 1997 and 2005. The FS- T index and a questionnaire with socioeconomic and behavioral items were assessed. Negative binomial regression models were evaluated, including all sociodemographic and behavioral factors simultaneously as independent variables. Results For West Germany, median FS- T index increased by 3 teeth between 1989 and 2005 ( Ptrend < 0.001). In East Germans, FS- T index was similar in 1992 and 1997 (median, 24), but increased by one tooth until 2005 ( Ptrend < 0.001). For West and East Germany, middle and high school education were significantly associated with higher FS- T indices in all surveys, although effects were most pronounced in 2005. Being married, reporting regular dental visits and good oral hygiene were significantly related to a higher number of functioning teeth in at least one survey year. Conclusions Dental health assessed as the number of functioning teeth improved between 1989/92 and 2005 in both German parts and across all educational levels. However, considering the educational level, dental health was less equally distributed in 2005 compared with previous surveys. [ABSTRACT FROM AUTHOR]

Aim To examine the associations between factors of socio-economic status ( SES), systemic inflammation and the progression of periodontitis and incidence of tooth loss. Material and Methods Data of 2566 participants from the Study of Health in Pomerania ( SHIP) with a 5-year follow-up were analysed. We evaluated attachment loss and tooth loss with regard to social variables including education, income, marital status and related risks such as smoking and obesity. Results Socio-economic factors were associated with the progression of attachment level and tooth loss during the follow-up period. Low education and low income were associated with tooth loss (incidence risk ratio IRR 1.63, p < 0.001 and 1.25, p < 0.001 respectively) and also progression of mean clinical attachment level ( p < 0.010 and p = 0.046 respectively). SES as well as smoking and obesity were also associated with increased levels of C-reactive protein ( CRP) with effect modifications between SES factors and CRP, also between gender and marital status. Tooth loss was associated with disadvantageous SES, particularly under conditions of high CRP levels ( p < 0.001). Conclusions The progression of periodontal disease is influenced by socio-economic factors. Effect modifications of socio-behavioural factors by CRP indicate that under conditions of systemic inflammation adverse SES effects may be aggravated. [ABSTRACT FROM AUTHOR]

Aim. Dental biofilms play a major role in the pathogenesis of many dental diseases. In this study, we evaluated the synergistic effect of atmospheric pressure plasma and different agents in dentistry on the reduction of biofilms. Methods and Results. We used monospecies (S. mutans) and multispecies dental biofilm models grown on titanium discs in vitro. After treatment with one of the agents, the biofilms were treated with plasma. Efficacy of treatment was determined by the number of colony forming units (CFU) and by live-dead staining. For S. mutans biofilms no colonies could be detected after treatment with NaOCl or H2O2. For multispecies biofilms the combination with plasma achieved a higher CFU reduction than each agent alone. We found an additive antimicrobial effect between argon plasma and agents irrespective of the treatment order with cultivation technique. For EDTA and octenidine, antimicrobial efficacy assessed by live-dead staining differed significantly between the two treatment orders (p < 0.05). Conclusions. The effective treatment of dental biofilms on titanium discs with atmospheric pressure plasma could be increased by adding agents in vitro. [ABSTRACT FROM AUTHOR]

Objectives To compare the prevalence of periodontal disease between two randomly selected population-based studies (the Oral Infections and Vascular Disease Epidemiology Study ( INVEST) and the Study of Health in Pomerania ( SHIP)) and address relevant methodological issues. Methods Comparison was restricted to 55- to 81-year olds. Attachment loss ( AL), probing depth ( PD) and tooth count were assessed in INVEST (full-mouth, six sites) and SHIP (half-mouth, four sites). Subjects were classified according to the CDC/ AAP case definition. Recording protocols were standardized. Mixed linear or logistic models were used to compare INVEST with SHIP. Results Mean half-mouth AL was lower in INVEST versus SHIP ( INVEST: 2.9 mm versus SHIP: 4.0 mm, p < 0.05). Findings were similar across multiple periodontal disease definitions. After equalization of recording protocols and adjustment for periodontal risk factors, mean AL and PD were 1.2 and 0.3 mm lower in INVEST versus SHIP ( p < 0.001). The odds for severe periodontitis ( CDC/ AAP) was 0.2-fold in INVEST versus SHIP ( p < 0.001). Confounding effects of age, gender, race/ethnicity, education and use of interdental care devices were highest as indicated by change-in-estimate for study. Conclusion Implementation of the proposed method for comparison of epidemiological studies revealed that periodontitis was less prevalent in INVEST compared with SHIP, even after extensive risk-factor adjustment. [ABSTRACT FROM AUTHOR]

Aim To evaluate the association of Insulin-like Growth Factor ( IGF) I-related variables with periodontitis in the population-based Study of Health in Pomerania ( SHIP). Material and Methods From the cross-sectional SHIP, 2293 subjects with clinical attachment loss ( CAL) data and 2398 subjects with tooth count data aged 20-59 years were analysed. Serum IGF-I and IGF-binding protein ( BP)-3 levels were determined by chemiluminescence immunoassays. Linear and logistic regressions with fractional polynomials were used to study associations between IGF-related variables and mean CAL or high tooth loss. For non-linear relations between IGFBP-3 and mean CAL, graphical presentations of fractional polynomials were used to deduce knots for linear splines. Results In fully adjusted models, for serum IGFBP-3 values ≤1200 ng/ml, mean CAL increased significantly for decreasing serum IGFBP-3 levels [B = −0.027 (95% CI, −0.049; −0.005), p = 0.02]. The odds for high tooth loss decreased significantly for high serum IGFBP-3 values [ OR = 0.97 (0.95; 0.99), p = 0.02]. Serum IGF-I levels and the IGF-I/ IGFBP-3 ratio were not related to mean CAL or tooth loss after full adjustment. Conclusions Low serum IGFBP-3 levels might be associated with higher levels of periodontal disease. Neither serum IGF-I nor IGF-I/ IGFBP-3 ratios were associated with periodontitis. [ABSTRACT FROM AUTHOR]

Aim To assess the suitability of different definitions of caries and periodontitis for inclusion in tooth loss prediction models. Materials and Methods The Study of Health in Pomerania ( SHIP) is a population-based cohort study conducted in 1997-2001 ( SHIP-0) and 2002-2006 ( SHIP-1). This sample comprised 2,780 subjects aged 20-81 years with complete information on dental and periodontal status [ DMFS status, clinical attachment loss ( CAL) and probing depth ( PD)]. Analyses on five-year tooth loss were limited to half-mouth data. Results The predictive value of tested definitions was markedly age- and gender-dependent: in 20-39-aged men, the number of decayed or filled surfaces best predicted the number of lost teeth, whereas in young women CAL≥4 mm performed best. In older subjects, periodontal definitions were superior to caries definitions: mean CAL performed best in 40-59-year olds, whereas AL- or PD-related definitions predicted best in 60-81-year olds. On tooth level, mean CAL was the superior definition to assess 5-year incident tooth loss in all strata except for young men. Conclusions Caries parameters best predicted incident tooth loss in men aged 20-39 years; in the intermediate and oldest age group and in young women, mean AL was most informative. Therefore, prediction models need to be developed for different age and gender groups. [ABSTRACT FROM AUTHOR]

Aim To assess the extent of remission and progression of periodontal diseases among adults in a Northeast German Region. Materials and Methods The Study of Health in Pomerania ( SHIP) is a population-based cohort study with baseline examinations conducted in 1997-2001 and 5-year-follow-up in 2002-2006. The study comprised 2558 subjects aged 20-81 years. Periodontal status was assessed by probing depth ( PD) and attachment level ( AL), measured at four surfaces per tooth, half-mouth. An event was defined as AL progression or remission of ≥3 mm on ≥2 sites. Results Average change in mean AL (mean PD) was 0.10 mm (−0.05 mm) during follow-up, equalling 0.02 mm/year (−0.01 mm/year). Adjusted for gender and follow-up time, change in mean AL was significantly higher in 20-29- and 60-69-year-old patients compared with 50-59-year-old patients ( p < 0.05). 6.5 (7.5) events of progression (remission) in AL per 100 person-years were observed. In multivariate models, risk factors for progression comprised current smoking, middle or low education, being single or divorced and diabetes ( p < 0.05). Enhanced progressive attachment loss seen in 20-29- and 60-81-year-old patients was explained through unfavourable risk factors distributions. Conclusions Periodontal progression was moderate. Periodontal prophylaxis and motivation to reduce risk factors should especially be addressed to patients having unfavourable risk factor distributions. [ABSTRACT FROM AUTHOR]

Aim. The aim was to compare the periodontal status of the acromegalic patients with healthy subjects from a large populationbased cohort (Study of Health in Pomerania, SHIP). Materials and Methods. We studied 32 acromegalic patients (16 females) and 128 randomly selected SHIP subjects (controls) using a 1 : 4 matching. Serum IGF-I and IGFBP-3 levels were measured using the Immulite 2500 system. Periodontitis was assessed by clinical attachment loss (CAL), probing depth (PD), and number of missing teeth. Linear and logistic regression models were used to assess differences in periodontal variables between acromegalic patients and controls. Results. IGF-I levels were comparable in acromegalic patients and controls, whereas IGFBP-3 levels were significantly higher in acromegalic patients (P = 0.004). In multivariate modelling, both groups did not differ significantly with respect to mean CAL (P = 0.12) and high tooth loss (P = 0.36). Mean PD was higher in acromegalic patients by trend (B = 0.28 (-0.00; 0.56)). Conclusion. In acromegalic patients, periodontal disease severity did not differ from their healthy SHIP controls. [ABSTRACT FROM AUTHOR]

Objective: A recent study suggested that the anti-inflammatory effect of immunonutrition starts after only two d. We therefore investigated the effect of an immunoenriched oral diet administered for three d preoperatively. Methods: In this prospective, randomized, double-blind, placebo-controlled study, well-nourished patients (Nutrition Risk Screening 2002 <3) with gastrointestinal cancer who were scheduled for major elective abdominal cancer surgery were randomly assigned to either 750 mL of an immunoenriched formula (IEF group) or 750 mL of an isocaloric, isonitrogenous placebo diet (Con group) for 3 consecutive d preoperatively. Results: A total of 108 patients (IEF group: n = 55; Con group: n = 53) were randomized. The two groups were comparable for all baseline and surgical characteristics. The overall mortality was 2.8% and not significantly different between the two groups (IEF group: 3.6% vs. Con group: 1.9%, P = 1.00). Intention-to-treat analysis showed no difference for the incidence of postoperative overall (IEF group: 29% vs. Con group: 30%; P = 1.00) and infectious (IEF group: 15% vs. Con group: 17%; P = 0.79) complications. Length of hospital stay was 12 ± 4.9 d in the IEF group and 11.6 ± 5.3 d in the Con group (P = 0.68). Conclusions: Preoperative oral supplementation with an immunoenriched diet for 3 d preoperatively did not improve postoperative outcome compared with the placebo in well-nourished patients with elective gastrointestinal cancer surgery. [ABSTRACT FROM AUTHOR]