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Non-surgical periodontal therapy (NSPT) underpins all other restorative treatment which takes place in the mouth. Therefore a thorough understanding of the process of delivery of effective NSPT and long-term maintenance of periodontal health is essential for every dental practitioner. This article covers the steps involved and discusses the benefits and challenges which may be encountered. CPD/Clinical Relevance: This article highlights the benefits and challenges of non-surgical management of periodontal disease and the key role that the patient plays in achieving and maintaining periodontal health.

BACKGROUND The dental complications of uncontrolled diabetes include reduced salivary flow rate, candidiasis and periodontal manifestations. A recent meta-analysis concluded that diabetes patients have a significantly higher severity, but not extent, of destructive periodontal disease than non-diabetics. The authors reported that most type-1 diabetes studies using dental radiographic data have not controlled for confounding factors such as smoking. The aim of this cross-sectional study was to compare radiographic alveolar bone loss between type 1 diabetes (T1DM) and non-diabetes (NDM) participants in a Scottish non-smoking population. METHODS Digital bitewing radiographs for 174 Scottish adults never or ex-smoker (>5 years) participants (108 T1DM, 66 NDS), recruited from outpatient clinics throughout Greater Glasgow and Clyde, were included in the analysis. A single blinded, trained, and calibrated examiner recorded the radiographic bone loss seen on bitewing radiographs using the digital screen caliper (Screen Calliper ICONICO version 4.0 (Copyright (C) 2001-6 Iconico), New York). The bone loss was measured as the distance between the cemento-enamel junction (CEJ) and the deepest radiographic alveolar bone margin interproximally of each tooth. RESULTS T1DM participants had more radiographic alveolar bone loss throughout the all teeth measured (median:1.27 mm versus 1.06 mm, P < 0.001) and more than a two-fold increase in the risk of having sites with ≥2 mm periodontal destruction (OR = 2.297, 95%CI 1.058 to 4.986, P = 0.036) compared with non-diabetes subjects. CONCLUSIONS Patients suffering from type 1 diabetes are at higher risk of periodontitis even when controlling for multiple possible confounding factors and this difference can be detected on routine dental radiographs at an early stage. These data confirm radiographically the previously reported association between T1DM and periodontal bone loss.

The objective of this case report is to illustrate the diagnosis and classification of periodontitis according to the 2017 Classification system as recommended in the British Society of Periodontology (BSP) implementation plan.A 37-year-old female was diagnosed with periodontitis (Molar-Incisor-Pattern), stage III grade C - currently unstable. Several issues pertinent to the diagnosis of localised forms of periodontitis in young patients are discussed in relation to the current and previous classification systems.Periodontitis can be limited to a few sites and this case highlights the importance of a careful application of the Basic Periodontal Examination (BPE).

Case report A case of a 59-year-old female patient who attended with a history of periodontitis, who had been successfully treated and maintained for several years, is described. Following a full periodontal assessment, the patient was diagnosed with 'generalised periodontitis; stage IV; grade C; currently stable'.Conclusion The present case report exemplifies the use of the 2017 classification system in a successfully treated and well-maintained patient whose treatment need is supportive periodontal treatment. It recognises the fact that, by staging and grading, the patient is a high-risk periodontitis patient due to historical disease experience, but also that following successful therapy and maintenance she is currently 'stable' with no need for active periodontal therapy.

This case report is the fourth in a series that illustrates the application of the BSP implementation plan for diagnosing periodontitis patients according to the 2017 classification. It demonstrates the diagnostic approach and disease classification for a previously treated patient who presented with a diagnosis of unstable generalised periodontitis; stage IV, grade C. We describe a case of a 49-year-old patient who attended with a history of periodontal treatment over several years. Following a full periodontal assessment, the patient was diagnosed with 'generalised periodontitis; stage IV, grade C; currently unstable'. This case report presents an example of how to classify and diagnose a patient using the 2017 classification system and highlights challenges with the application of the new classification in patients with a previous history of periodontal therapy.

There have been numerous reports in the scientific literature investigating the possible association between alcohol-containing mouthwashes and oral cancer but relatively few epidemiological surveys have taken place and the findings have been equivocal. This article will address the controversial issue of the safety of mouthwashes and provide an objective assessment of the latest scientific evidence. CPD/Clinical Relevance: The evidence surrounding the safety of ‘over the counter’ alcohol-containing mouthwashes is evaluated. This provides guidance for dentists and dental care professionals of when it is appropriate to recommend mouthwash use to their patients.

Introduction: The objective of this case report is to illustrate the diagnosis and classification of periodontitis according to the 2017 Classification system as recommended in the British Society of Periodontology (BSP) implementation plan.Case report: We describe two cases in the form of a pair of siblings, who developed periodontitis very early in life. A 19-year-old female was diagnosed with “Generalised periodontitis; Stage III/Grade C; currently unstable”. Her 14year-old sister was diagnosed with “Localised periodontitis; Stage II, Grade C; currently unstable”.Conclusion: The present case report presents an example for the application of the new classification system and illustrates the importance of a periodontal check for children and adolescents and/or their relatives

Introduction: The objective of this case report is to illustrate the diagnosis and classification of periodontitis according to the 2017 Classification system as recommended in the British Society of Periodontology (BSP) implementation plan.Case report: We describe a case of a patient who was diagnosed with “Localised periodontitis; Stage II, Grade B; currently unstable”.Conclusion: The present case report presents an example for the application of the new classification system and illustrates how the new classification system captures disease severity, extent and disease susceptibility by staging and grading periodontitis

Since 1949 the British Society of Periodontology (BSP) has been working hard to research, debate and involve themselves in all issues that affect its members. The aim of the BSP is to raise public, patient, dental and medical professionals' awareness of periodontology. Last year's president of the BSP, Dr Penny Hodge, here explains the structure, role and activities of the society.

Background: Periodontal disease is a major complication of type 1 diabetes mellitus (T1DM). The aim of the present study is to investigate the relationship between glycated hemoglobin and circulating levels of interleukin (IL)-6, IL-8, and C-X-C motif chemokine ligand 5 (CXCL5) in non-smoking patients suffering from T1DM, with and without periodontitis. In addition, to determine the effect of advanced glycation end products (AGE) in the presence and absence of Porphyromonas gingivalis lipopolysaccharide (LPS) on IL-6, IL-8, and CXCL5 expression by THP-1 monocytes and OKF6/TERT-2 cells. Methods: There were 104 participants in the study: 19 healthy volunteers, 23 patients with periodontitis, 28 patients with T1DM, and 34 patients with T1DM and periodontitis. Levels of blood glucose/glycated hemoglobin (International Federation of Clinical Chemistry [IFCC]) were determined by high-performance liquid chromatography. Levels of IL-6, IL-8, and CXCL5 in plasma were determined by enzyme-linked immunosorbent assay (ELISA). In vitro stimulation of OKF6/TERT-2 cells and THP-1 monocytes was performed with combinations of AGE and P. gingivalis LPS. Changes in expression of IL-6, IL-8, and CXCL5 were monitored by ELISA and real-time polymerase chain reaction. Results: Patients with diabetes and periodontitis had higher plasma levels of IL-8 than patients with periodontitis alone. Plasma levels of IL-8 correlated significantly with IFCC units, clinical probing depth, and attachment loss. AGE and LPS, alone or in combination, stimulated IL-6, IL-8, and CXCL5 expression in both OKF6/TERT-2 cells and THP-1 monocytes. Conclusions: Elevated plasma levels of IL-8 potentially contribute to the cross-susceptibility between periodontitis and T1DM. P. gingivalis LPS and AGE in combination caused significantly greater expression of IL-6, IL-8, and CXCL5 from THP-1 monocytes and OKF6/TERT-2 cells than LPS alone.

IL-17A is implicated in periodontitis pathogenesis. The roles of IL-17B–IL-17F and IL-17A/F are unknown. This study aimed to determine clinical associations between IL-17 family cytokines and periodontitis and to investigate the biological roles of IL-17A and IL-17E using in vitro model systems. Samples from 97 patients with periodontitis and 77 healthy volunteers were used in the study. Serum, saliva and gingival crevicular fluid (GCF) levels of IL-17 family cytokines were measured by ELISA. Oral keratinocytes were stimulated with a P. gingivalis biofilm, or IL-17A, in the presence and absence of IL-17E and the expression of IL-8 and CXCL5 were investigated by ELISA and real-time-PCR. NF-κB phosphorylation in similar experiments was also measured using a cell-based ELISA. Serum, saliva and GCF IL-17A levels were higher in periodontitis patients and correlated positively with clinical parameters of attachment loss, pocket depth and bleeding on probing. Serum IL-17E levels were lower in periodontitis patients and the serum IL-17A:IL-17E ratio correlated positively with clinical parameters. In vitro, IL-17E inhibited Porphyromonas gingivalis and IL-17A induced expression of chemokines by reducing phosphorylation of the NF-κB p65 subunit. Serum IL-17A:IL-17E may be a marker of disease severity. IL-17E may have opposing roles to IL-17A in periodontitis pathogenesis. IL-17E can negatively regulate IL-17A and periodontal pathogen induced expression of chemokines by oral keratinocytes.

This article will focus on the antiplaque efficacy of mouthwashes. An antiplaque agent inhibits the formation of plaque and also reduces gingivitis. There is good evidence that chlorhexidine digluconate, used in the correct concentrations, is the gold standard agent against which all others should be measured. It does, however, have some unwanted side-effects. One of the major problems for antiplaque mouthwashes is that they have a much reduced effect on established plaque within the oral environment. Although they can flow into the biofilm channels and kill bacteria in the superficial layers of dental plaque, they cannot penetrate the biomass and inhibit the pathogenic bacteria adjacent to the tooth surface and gingival margin. There is no evidence that they prevent the progression of periodontitis. Clinical relevance: The evidence supporting the use of ‘over the counter’ antiplaque mouthwashes is evaluated. This provides guidance for dentists and dental care professionals of when it is appropriate to recommend mouthwash use to their patients.

OBJECTIVES: To compare the effects of scaling and root planing (SRP) on clinical and microbiological parameters at selected sites in smoker and non-smoker chronic and generalized aggressive periodontitis patients. MATERIALS AND METHODS: Clinical parameters including probing depth (PD), relative attachment level (RAL), and bleeding upon probing (BOP), and subgingival plaque samples were taken from four sites in 28 chronic periodontitis (CP) and 17 generalized aggressive periodontitis (GAgP) patients before and after SRP. Polymerase chain reaction assays were used to determine the presence of A. actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, Prevotella intermedia and Treponema denticola. RESULTS: Both CP and GAgP non-smokers had significantly greater reduction in pocket depth (1.0+/-1.3 mm in CP smokers versus 1.7+/-1.4 mm in non-smokers, p=0.007 and 1.3+/-1.0 in GAgP smokers versus 2.4+/-1.2 mm in GAgP non-smokers, p lt 0.001) than respective non-smokers, with a significant decrease in Tannerella forsythensis in CP sites (smokers 25% increase and non-smokers 36.3% decrease, p lt 0.001) and Prevotella intermedia at GAgP sites (smokers 25% reduction versus 46.9% in non-smokers, p=0.028). CONCLUSION: SRP was effective in reducing clinical parameters in both groups. The inferior improvement in PD following therapy for smokers may reflect the systemic effects of smoking on the host response and the healing process. The lesser reduction in microflora and greater post-therapy prevalence of organisms may reflect the deeper pockets seen in smokers and poorer clearance of the organisms. These detrimental consequences for smokers appear consistent in both aggressive and CP. (c) Blackwell Munksgaard, 2005.

Objectives: In order to elucidate the genetic background to EOP it is useful to investigate associations with genetic polymorphisms of immune response genes, whose products play a role in the inflammatory process. The aim of this study was to examine IL1A and IL1B genetic polymorphisms in unrelated European white Caucasian patients with generalised early-onset periodontitis (GEOP). Material and methods: Polymerase chain reaction (PCR) amplification of the IL1A (−889) gene and IL1B (+3953) gene (56 patients, 56 controls) was carried out and PCR products subjected to restriction fragment length polymorphism (RFLP) analysis. Results: There were no significant differences between patients and controls for any of the genotype or allele frequencies investigated (p=1.0). Smoking status was also included as a covariate but this did not alter the results. Furthermore, expression of the composite genotype described by Kornman and coworkers was also investigated in these subjects. No significant differences were found between patients and controls whether smoking was included as a covariate or not. Conclusion: The lack of any association between the IL1 polymorphisms and GEOP, in the population presented here, brings into doubt the usefulness of these candidate genes as markers of susceptibility to this form of periodontitis.

Background Periodontal disease is the most common oral disease affecting adults, and although it is largely preventable it remains the major cause of poor oral health worldwide. Accumulation of microbial dental plaque is the primary aetiological factor for both periodontal disease and caries. Effective self-care (tooth brushing and interdental aids) for plaque control and removal of risk factors such as calculus, which can only be removed by periodontal instrumentation (PI), are considered necessary to prevent and treat periodontal disease thereby maintaining periodontal health. Despite evidence of an association between sustained, good oral hygiene and a low incidence of periodontal disease and caries in adults there is a lack of strong and reliable evidence to inform clinicians of the relative effectiveness (if any) of different types of Oral Hygiene Advice (OHA). The evidence to inform clinicians of the effectiveness and optimal frequency of PI is also mixed. There is therefore an urgent need to assess the relative effectiveness of OHA and PI in a robust, sufficiently powered randomised controlled trial (RCT) in primary dental care. Methods/Design This is a 5 year multi-centre, randomised, open trial with blinded outcome evaluation based in dental primary care in Scotland and the North East of England. Practitioners will recruit 1860 adult patients, with periodontal health, gingivitis or moderate periodontitis (Basic Periodontal Examination Score 0–3). Dental practices will be cluster randomised to provide routine OHA or Personalised OHA. To test the effects of PI each individual patient participant will be randomised to one of three groups: no PI, 6 monthly PI (current practice), or 12 monthly PI. Baseline measures and outcome data (during a three year follow-up) will be assessed through clinical examination, patient questionnaires and NHS databases. The primary outcome measures at 3 year follow up are gingival inflammation/bleeding on probing at the gingival margin; oral hygiene self-efficacy and net benefits. Discussion IQuaD will provide evidence for the most clinically-effective and cost-effective approach to managing periodontal disease in dentate adults in Primary Care. This will support general dental practitioners and patients in treatment decision making. Trial registration Protocol ID: ISRCTN56465715

Oral candidosis is common in patients with diabetes mellitus, as yeasts, particularly Candida albicans, have the propensity to colonise, form biofilms and release hydrolytic enzymes which cause inflammation. This study aimed to investigate these characteristics in isolates from three groups of patients with type 1 diabetes: individuals with better controlled diabetes (BCD;or=68%), individuals with poorly controlled diabetes (PCD;or=8%) and non-diabetics (ND; HbA(1c)5.9%). The biomass (Bm), phospholipase (P(z)), haemolysin (H(z)) and proteinase (Pr(z)) were assessed using a microtitre biofilm assay and agar-based hydrolytic enzyme assays. Biofilm formation was significantly increased in the PCD group compared to ND and BCD groups (P0.05). No significant differences in P(z) levels were observed between groups, whereas both H(z) and Pr(z) were significantly greater in the diabetes groups than in the healthy control group (P0.05). Statistically significant correlations were found to exist between the HbA(1c) levels of the patients and the Bm (R = 0.384; P = 0.033), haemolysin activity (R = -0.455; P = 0.010) and proteinase activity (R = -0.531; P = 0.002). There was no apparent correlation between the Bm and P(z) activity (R = -0.305; P = 0.053) or H(z) activity (R = -0.100; P = 0.296). However, a negative correlation was found between Bm and Pr(z) values (R = -0.343; P = 0.030). These data suggest that biofilm formation is likely to play a role in the pathogenicity of oral candidosis, and in patients with diabetes, this may be due to the ability of C. albicans to adapt to the altered physiological environment. The production of hydrolytic enzymes is independently associated with this growth modality.

Objective: To develop and apply a detailed clinical protocol for screening and assessing subjects with a complaint of halitosis. Design: Cross-sectional. Subjects and methods: Several methods were used to recruit subjects with a complaint of halitosis, including a newspaper advertisement. A definition of halitosis arising from within the oral cavity, which is not related to generalized chronic gingivitis, chronic periodontitis or pathology of the oral mucosa was used. An extensive list of exclusion criteria was applied at the initial visit. Eligible subjects were asked to follow strict instructions and complete a questionnaire prior to their second visit for data collection. The clinical examination consisted of an organoleptic assessment, Halimeter® reading and periodontal examination. Results: The best method of recruiting subjects was advertising. Of 66 individuals recruited, four failed to attend the screening visit and 25 were excluded. The main reasons for exclusion were poor oral hygiene and existing periodontal disease. Thirty-seven completed the full protocol, resulting in identification of 18 with halitosis and 19 controls. Conclusions: Application of the exclusion criteria resulted in significant attrition of eligible participants. Our results suggest that organoleptic assessment should be regarded as a useful standard for defining subjects with halitosis.

This was a cohort study. A longstanding prospective study was carried out of a birth cohort born in Dunedin (New Zealand) in 1972–1973. Periodontal examinations of the study participants were carried out when they reached the age of 26 and 32 years by calibrated examiners; smoking exposure was measured by questioning at ages 15, 18, 21, 26 and 32 years. Socioeconomic status (SES) was measured at the age of 26 years by categorising adult occupation using standard New Zealand occupation indices. Dental visiting behaviour was assessed by questioning at age 25 and 32 years. Chi-square tests were used to examine the statistical significance of differences observed with categorical dependent variables. Analysis of variance was used for continuous variables. Logistic regression modelling was used to examine smoking exposure and periodontitis prevalence and incidence while controlling for sex, SES, dental plaque accumulation and the use of dental services. Complete data were available for 810 individuals of whom 48.9% had smoked at some point (31.5% were current smokers). Table 1 shows the prevalence, for a selection of smoking exposure groups of attachment loss at age 32 and the odds ratio compared with never-smokers and Table 2 the incidence of 3+ mm attachment loss. Sites with >5 mm attachment loss and were more likely to be incident cases after age 26 (OR, 5.2 and 3.2, respectively). Two thirds of new cases in individuals older than 26 years were attributable to smoking. There were no significant differences in periodontal health between never-smokers and those who had quit smoking after age 26. Current and long-term smoking in young adults is detrimental to periodontal health, but smoking cessation may be associated with a relatively rapid improvement in the periodontium.