The patient population consisted of a maximum of 18,570 subjects who completed the NHANES III questionnaire and examination from 1988 - 1994. The physical examination included such things as body mass index and serum samples, social and medical history. The periodontal examination recorded probing depth, attachment loss and gingival bleeding. Serum samples were analyzed for CRP levels, cholesterol levels etc. Demographic, cardiovascular and oral health variables were compared in subjects with a history of heart attack. Result showed that history of heart attack is associated with increased odds ratio for elevated CRP, diabetes, hypertension, cholesterol, male gender, non-white race and smoking. Of the periodontal indicators of disease, only gingival bleeding had an increased odds ratio for association with heart attack history. The unadjusted odds ratio was 1.25 with 95% CI[0.84-1.87]. The adjusted odds ratio increase to 1.93 with 95% CI [1.02-3.71]. These findings are consistent with previous research indicating that elevated CRP is associated with increased risk of heart attack. The interesting finding of this study is that only gingival bleeding, not probing depth or attachment loss, had an increased odds ratio for an associated with self-reported history of heart attack.

Aim: The aim of this study is to determine the frequency of single nucleotide polymorphisms (SNPs) in various pattern recognition receptor (PRR) genes, including Toll like receptors (TLR) -2, -4, -9, and CD14 in chronic (CP), localized (LAP) and generalized aggressive (GAP) periodontitis and periodontally healthy (NP) patients in an African American population. Methods: A total of 205 subjects were involved in the study. The LAP group consists of 25 subjects, the GAP group 50 subjects, the CP group 73 subjects and the NP group 57subjects. Genotyping was performed in TLR2 (G2408A), TLR4 (A896G),TLR9 (T1486C) and CD14 (C260T) genes by TaqMan® allelic discrimination using Assay-by-DesignSM SNP Genotyping Assays (Applied Biosystems). Accuracy of genotyping was confirmed by known DNA samples of each genotype and by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) analyses on selected samples. Fisher’s exact test and chi-square analyses were performed to compare genotype and allele frequencies. Within disease groups, we investigated whether SNPs were related to disease severity by step-wise logistic regression adjusted for age, gender, and smoking status. Results: There was a significant difference in the distribution of specific TLR9 (T1486C) genotypes between diseased-groups versus reference group. Expression of TT genotype was more prevelant in periodontally-diseased individuals compared to periodontally-healthy subjects (p<0.0001) whereas individuals expressing C allele of the TLR9 SNP (CC&CT) were more frequently found in healthy group after adjusting for age, gender, and smoking status (p<0.0001) There was no statistically significant difference in the distribution of genotypes between groups for any other TLRs or CD 14 polymorphism. Conclusion: Based on findings of this study, homozygocity for the T allele of TLR 9 polymorphism was related to the periodontal disease susceptibility in African Americans. Additionally, presence of C allele at TLR-9 appeared to confer resistance to periodontal destruction. Our results showed that specific SNPs in TLR-2, -4 and CD 14 genes are not related to periodontitis in African Americans. However, low copy number of certain alleles warrants further investigations with increased sample size to explore the role of SNPs in periodontal disease. This study was supported by the Alexander Fellowship.

Prevalence information on excessive gingival display in post-orthodontic patients is limited. By studying one aspect, namely the size relationship of the clinical crowns of teeth, in an orthodontic population, we can begin to quantify their need for periodontal plastic surgery. In this two part study, 200 plaster models were used as subjects, followed by a clinical exam of 31 of those subjects. These models represented patients before and directly after orthodontic therapy, and the Part 2 clinical exams were performed at least five years later. The lengths and widths of the six anterior teeth were measured and these values were compared to known ideals. This study revealed a significant increase in the length of the maxillary anterior teeth over the three examinations, yet these values were still approximately 1.5mm shorter than ideal. The mean tooth width-to-length ratio was 87-88% for maxillary central incisors, clearly below the accepted "ideal." As well, 61-71% of maxillary central incisors exceeded allowable tooth width-to-length ratios, and 61% of subjects displayed asymmetry in gingival architecture. Although this study only examined one aspect of excessive gingival display, it is the first study to show that in a predominantly young, post-orthodontic population, the prevalence of non-ideal width-to-length ratios is greater than 65%, and that the presence of asymmetry is greater than 60%. Therefore, close interaction between the periodontist and the orthodontist is necessary to diagnose these conditions in order to provide patients with all options for improving their smile.

BackgroundWithin dentistry, a limited body of literature exists regarding the referral relationships between general practitioners (GPs) and specialists. The purpose of this study was to investigate the referral relationship between GPs and periodontists within the state of Virginia. MethodsA survey focused on the demographic variables in the referral relationship between GPs and periodontists was developed. The survey was mailed to 800 dentists throughout the state of Virginia. Descriptive statistics was completed along with multivariate logistic regression analysis comparing the responses with the number of patients referred per month to a periodontist. ResultsFemale respondents were more likely to refer three or more patients per month to a periodontist than a male respondent (pConclusion This study indicates that four demographic variables have a statistical influence on the number of referrals per month from a GP to a periodontist. These variables are: female gender, practicing with one other dentist, employing two or more hygienists, and being greater than five miles away from the nearest periodontist.

The problem of excess gingival display is difficult to diagnose and treat. By studying one aspect of excess gingival display, namely the size relationships of the clinical crowns of teeth, we can begin to quantify reasonable goals of therapy. In this study, two hundred plaster models were used as subjects. These represented two hundred patients before and after orthodontic therapy. The six anterior teeth were measured for length and width and compared to known ideals. Teeth that did not meet ideal standards may require treatment. It was found that the mean tooth length after orthodontic therapy was approximately two millimeters shorter than ideal. The length of maxillary central incisors did not increase over the course of therapy. Eighty-five to ninety percent of maxillary central incisors exceeded allowable tooth width-to-length ratios. Twenty-nine to thirty percent of central incisors exceeded one hundred percent in their width-to-length ratio. Sixty-eight percent of patients displayed asymmetry in gingival architecture.

Abstract FACTORS AFFECTING GINGIVAL EXCESS, ALTERED PASSIVE ERUPTION AND RECESSION IN THE MANDIBULAR ANTERIOR AND PREMOLAR SITES By William F Bohlen, D.M.D. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University. Virginia Commonwealth University, 2010 Major Director: Thomas Waldrop, DDS, MS Program director, Department of Periodontics, Virginia Commonwealth University AIM: The aim of this study was to determine the factors affecting gingival excess, altered passive eruption and recession. METHODS: 100 subjects were examined clinically and models of their mandible were fabricated. Demographic, periodontal and cast measurements were recorded for each subject. Measurements were made on casts with digital calipers and included clinical crown length, clinical crown width, papillary height and gingival width. The W:L ratio was calculated and the proportion compared to the maxillary arch ideal of .80. Values greater than .80 were used as a cutoff point for defining gingival excess. Measures of periodontal health were also examined and included probing depths, clinical attachment loss and bleeding on probing. Other patient variables examined were history of orthodontics, presence of occlusal and incisal wear, presence of parafunctional habits, subjective appearance of gummy smile and biotype. RESULTS: The mean W:L ratio was found to be 79.6 %. Tooth type (p<0.001), gender (p<0.0237) and biotype (p<0.0081) were found to significantly contribute to a W:L ratio >.80. There was a significant correlation between the subjective appearance of gingival excess and the W:L ratio, regardless of biotype. There was no association between recession and gingival excess. CONCLUSION: Subjectively, 17% of the study subjects had gingival excess. When the author (WB) made the determination that gingival excess was present, there was a significant increase in the W:L ratio for all teeth, regardless of biotype versus teeth without the presence of gingival excess. Proposed ideal W:L ratios for the mandibular anterior teeth from the second premolar to central incisor are listed in Table 11.

Estudos mostram um baixo grau de cooperação aos retornos de pacientes em controle e manutenção. Com o intuito de avaliar a cooperação dos pacientes da FOUSP, este trabalho foi dividido em duas fases: estudo transversal e estudo intervencional. A primeira análise revelou uma participação insatisfatória dos pacientes no Programa de Controle e Manutenção da Disciplina de Periodontia, durante 5 anos. Dos 402 indivíduos avaliados, 18,2% eram cooperadores completos, 8,2% eram irregulares e 73,6% abandonaram o programa. A partir desses grupos, foi realizado um estudo intervencional em 137 pacientes, que objetivou avaliar a influência de um método para melhorar a cooperação com o controle e manutenção. Durante 12 meses, o grupo Cooperação Completa recebeu os procedimentos habituais de uma consulta de Controle e Manutenção; o grupo Cooperação Irregular recebeu procedimentos habituais e motivação para aumentar sua cooperação; o grupo Nenhuma Cooperação recebeu cartas para incentivar seu retorno, sendo que, aqueles que retornaram ao programa receberam o mesmo tratamento do grupo Cooperação Irregular. Neste período de intervenção, a taxa de cooperação completa aumentou de 50,4% para 67,9%. Não houve associação entre gênero e grau de cooperação, não houve diferença significante entre os grupos de cooperação em relação à idade. Os resultados mostraram que o método empregado teve influência favorável sobre o grau de cooperação dos pacientes. / Previous studies have found poor patient compliance with periodontal maintenance therapy. In order to assess compliance with periodontal maintenance in University of São Paulo, this study was divided in two parts: cross-sectional study and intervention study. The cross-sectional analysis showed unsatisfactory compliance with maintenance program from the Graduate Periodontal Clinic, during 5 years. From 402 subjects evaluated, 18.2% were complete compliers, 8.2% were irregular compliers and 73.6% were non-compliers. A intervention study was undertaken with 137 patients chosen from those groups. The aim of this study was to assess the influence of a method to improve patient’s compliance with periodontal maintenance. In a period of 12 months, the complete compliance group received usual procedures of a maintenance visit; the irregular compliance group received usual procedures and motivation to change its behavior; to the non-compliers patients letters were sent in order to motivate them to resume the program, and those who returned received the same procedures as the irregular group. The degree of complete compliance increased from 50,4% to 67,9%, during the course of the second study. There was no correlation between gender and compliance. There was no significant difference in compliance in relation to age. The results showed that the method applied had favorable influence over the patient’s compliance.

Estudos mostram um baixo grau de cooperação aos retornos de pacientes em controle e manutenção. Com o intuito de avaliar a cooperação dos pacientes da FOUSP, este trabalho foi dividido em duas fases: estudo transversal e estudo intervencional. A primeira análise revelou uma participação insatisfatória dos pacientes no Programa de Controle e Manutenção da Disciplina de Periodontia, durante 5 anos. Dos 402 indivíduos avaliados, 18,2% eram cooperadores completos, 8,2% eram irregulares e 73,6% abandonaram o programa. A partir desses grupos, foi realizado um estudo intervencional em 137 pacientes, que objetivou avaliar a influência de um método para melhorar a cooperação com o controle e manutenção. Durante 12 meses, o grupo Cooperação Completa recebeu os procedimentos habituais de uma consulta de Controle e Manutenção; o grupo Cooperação Irregular recebeu procedimentos habituais e motivação para aumentar sua cooperação; o grupo Nenhuma Cooperação recebeu cartas para incentivar seu retorno, sendo que, aqueles que retornaram ao programa receberam o mesmo tratamento do grupo Cooperação Irregular. Neste período de intervenção, a taxa de cooperação completa aumentou de 50,4% para 67,9%. Não houve associação entre gênero e grau de cooperação, não houve diferença significante entre os grupos de cooperação em relação à idade. Os resultados mostraram que o método empregado teve influência favorável sobre o grau de cooperação dos pacientes. / Previous studies have found poor patient compliance with periodontal maintenance therapy. In order to assess compliance with periodontal maintenance in University of São Paulo, this study was divided in two parts: cross-sectional study and intervention study. The cross-sectional analysis showed unsatisfactory compliance with maintenance program from the Graduate Periodontal Clinic, during 5 years. From 402 subjects evaluated, 18.2% were complete compliers, 8.2% were irregular compliers and 73.6% were non-compliers. A intervention study was undertaken with 137 patients chosen from those groups. The aim of this study was to assess the influence of a method to improve patient’s compliance with periodontal maintenance. In a period of 12 months, the complete compliance group received usual procedures of a maintenance visit; the irregular compliance group received usual procedures and motivation to change its behavior; to the non-compliers patients letters were sent in order to motivate them to resume the program, and those who returned received the same procedures as the irregular group. The degree of complete compliance increased from 50,4% to 67,9%, during the course of the second study. There was no correlation between gender and compliance. There was no significant difference in compliance in relation to age. The results showed that the method applied had favorable influence over the patient’s compliance.

No description available.

It is estimated that Periodontal Diseases effects up to 90% of the adult population. Given the complexity of the host environment, many factors contribute to expression of the disease. Age, Gender, Socioeconomic Status, Smoking Status, and Race/Ethnicity are all known risk factors, as well as a handful of known comorbidities. Certain vitamins and minerals have been shown to be protective for the disease, while some toxins and chemicals have been associated with an increased prevalence. The role of toxins, chemicals, vitamins, and minerals in relation to disease is believed to be complex and potentially modified by known risk factors. A large comprehensive dataset from 1999-2003 from the National Health and Nutrition Examination Survey (NHANES) contains full and partial mouth examinations on subjects for measurement of periodontal diseases as well as patient demographic information and approximately 150 environmental variables. In this dissertation, a Feasible Solution Algorithm (FSA) will be used to investigate statistical interactions of these various chemical and environmental variables related to periodontal disease. This sequential algorithm can be used on traditional statistical modeling methods to explore two and three way interactions related to the outcome of interest. FSA can also be used to identify unique subgroups of patients where periodontitis is most (or least) prevalent. In this dissertation, FSA is used to explore the NHANES data and suggest interesting relationships between the toxins, chemicals, vitamins, minerals and known risk factors that have not been previously identified.