Periodontology

1. Raising a glass to periodontitis

What are the effects of alcohol consumption on periodontal status? This observational analytic study aimed to find out by determining the levels of subgingival periodontal pathogens and proinflammatory cytokines (interleukin [IL]-1beta and tumour necrosis factor [TNF]-alpha) in the gingival fluid among individuals with and without periodontitis and with various alcohol consumption patterns. Four equal groups (n = 22 each) of volunteers were studied: individuals with alcohol dependence and periodontitis, individuals with alcohol dependence and without periodontitis, individuals not or occasionally using alcohol with periodontitis, and individuals not or occasionally using alcohol without periodontitis. Levels of various known periodontal pathogens were measured using subgingival biofilm, and of the cytokines using gingival fluid samples. Individuals with alcohol dependence showed worse periodontal status and higher levels of three pathogens and of IL-1beta than non-users. No significant correlations between TNF-alpha and bacterial levels were observed. A negative influence of alcohol consumption was observed on clinical and microbiologic periodontal parameters, as well as a slight influence on immunologic parameters.

Lages EJ et al. Alcohol consumption and periodontitis: quantification of periodontal pathogens and cytokines. J Periodontol 2015 86: 1058-1068.

Q Based on the results of this study, what advice would you give to your patients?

A That alcohol consumption has no measurable effect on periodontal bacteria

B Evidence suggests that periodontal disease drives people towards alcoholism

C Alcohol dependence may lead to deteriorating periodontal status

D To drink as much alcohol as they like as it has no effect on periodontal disease

2. Gum and kidney coalescence

This huge study over a number of years involved 10,755 adult participants in the National Health and Nutrition Examination Survey and analysed data on periodontal disease and its prognostic significance in relation to chronic kidney disease (CKD). It evaluated the joint effect of periodontal disease and CKD on all-cause, and on cardiovascular mortality. Periodontal disease was defined as moderate (> 4 mm attachment loss in > 2 mesial sites or 5 mm pocket depth in > 2 mesial sites), or severe (> 6 mm attachment loss in > 2 mesial sites and > 5 mm pocket depth in > 1 mesial site). There were 1,813 deaths over a median follow-up of 14 years. In multivariate analyses, as compared to participants with neither periodontal disease nor CKD, those with periodontal disease only or CKD only had increased all-cause mortality. There was no evidence of additivity between periodontal disease and CKD. The findings confirm the well-established association between periodontal disease and increased mortality in the general population, and provide new evidence of this association among individuals with CKD.

Ricardo AC et al. Periodontal disease, chronic kidney disease and mortality: results from the third National Health and Nutrition Examination Survey. BMC Nephrology 2015 16: 97.

Q Do the findings of this survey:

A Confirm that there is no connection between periodontal disease and mortality in the general population

B Suggest that chronic kidney disease causes periodontal disease

C Provide no evidence of the association between periodontal and chronic kidney disease

D Negate the previously held view that periodontal disease and kidney disease are associated

3. Support for therapy

Following patients in a private specialist periodontal clinic for up to 18 years enabled these researchers to retrospectively assess tooth-survival rate and its association with patient and oral variables. Patient records which included initial examination (T0), re-evaluation (TRe) and >10 years after T0 (TF) chartings, and who received periodontal therapy and supportive periodontal therapy (SPT) after TRe were included. Data on general health, plaque scores (PI), probing depth (PPD), bleeding on probing (BOP) at six points/tooth, tooth extractions, and SPT visits were extracted from patient files at all three time intervals. Fifty patients (mean 26 +/- 4 teeth/patient, and 1,301 teeth) fulfilled the inclusion criteria. About 20 and 129 teeth respectively were extracted before/after TRe, 96 of them for periodontal causes. The best prognostic factors for tooth loss during follow-up were, PPD>7 mm at TRe, age >60 years, multi-rooted teeth and SPT<3 times/year. Regular SPT was associated with low tooth-loss rates and continuous reductions in probing depth and thus improved the prognosis for long-term tooth survival among periodontal patients.

Saminsky M et al. Variables affecting tooth survival and changes in probing depth: a long-term follow-up of periodontitis patients. J Clin Periodontol 2015 42: 513-519.

Q One of the following factors was NOT predictive of tooth loss in this study; which?

A Patient age greater than 60 years

B Single rooted teeth 

C Pocket probing depth of greater than 7mm at a re-evaluation visit

D Supportive periodontal therapy less than three times a year

4. Don’t forget to brush

The aims of this study were to assess the inter-relationships between gingival condition, tooth-brushing behaviour after drinking alcohol and alcohol sensitivity in university students who drank more than once per week on average. A total of 808 students (541 males, 267 females) who habitually consumed alcohol were analysed. Gingival condition was assessed as the percentage of bleeding on probing (%BOP). Additional information regarding alcohol sensitivity and oral health behaviours, including tooth-brushing behaviour after drinking, was also collected. Neglecting tooth-brushing after drinking was reported by 13% of the participants; their alcohol consumption being higher than those who did not neglect tooth-brushing. Analysis showed that a high score of %BOP > 20 was associated with males, neglect of tooth-brushing after drinking and debris index in participants with low alcohol sensitivity. In participants with high alcohol sensitivity, high %BOP was associated with debris index but not with any oral health behaviours. The study revealed that alcohol consumption was indirectly related to gingival disease activity through the neglect of tooth-brushing after drinking alcohol in this cohort.

Mizutani S et al. Gingival condition and tooth-brushing behavior after alcohol consumption. J Periodontal Res 2015 50: 494-499.

Q Neglect of tooth-brushing:

A Is most common in males irrespective of alcohol consumption

B Has no detrimental effect after drinking alcohol as the alcohol denatures microorganisms

C Always causes a %BOP< 20

D Is indirectly related to gingival disease as a result of alcohol consumption