Periodontology

1.Endo-perio probe

This study compared the interproximal bone level of root canal-filled teeth (RCF+) and non-root canal-filled teeth (RCF-) using the records of patients screened from January 2009 to October 2011. The distance between the coronal reference point and the alveolar bone crest (AC) was assessed at the mesial and distal aspects of (RCF+) and their contralateral (RCF-) equivalents using periapical radiographs. The sample consisted of 128 pairs of teeth comprising data from 72 patients. The results for AC revealed a median distance of 3.2 mm for RCF+ and 3.4 mm for RCF-. Using the maximal distance on either the distal or the mesial tooth surface, a median distance of 3.6 mm was detected for RCF+ and 3.8 mm for RCF-, respectively. Even after taking several tooth- and subject-specific variables into account, the differences between AC on RCF+ and RCF- were statistically not significant. Existence of appropriately completed root canal fillings in periodontitis patients has no effect on the prognosis of periodontal disease. 

Rodriguez FR et al. Presence of root canal treatment has no influence on periodontal bone loss. Clinical Oral Investigations 2017 Feb 17 doi: 10.1007/s00784-017-2076-4.

Q Which of the following statements can be made based on this research?
A Root-canal filled teeth have greater interproximal bone loss than non-root canal filled equivalents
B Root canal-filled teeth should be extracted as soon as any bone loss takes place around them
C Non-root canal filled teeth are not at risk of periodontal disease
D There is no difference in the risk of alveolar bone loss between endodontically treated and non-treated teeth

2.Carers caring works

The aim of this research was to investigate whether twice-daily use of a rotating-oscillating power toothbrush (PB) (Oral-B Professional Care 1000TM) in 59 nursing home (NH) residents over a 6-week period, compared to usual care (UC), would reduce periodontal inflammation.
The residents were randomised to receive either twice-daily tooth brushing with a PB or UC by caregivers. Participants had some natural teeth, periodontal inflammation, non-aggressive behaviour, no communicable diseases, were non-smokers and non-comatose. Outcomes were measured at baseline and 6 weeks, which included: inflammation, bleeding and plaque. Of the original participants, one withdrew, one died prior to study commencement and three died before study completion. All oral parameters improved significantly for the remaining 54 residents over time with no differences between groups. These results demonstrate that it is possible for caregivers to improve periodontal inflammation of residents over a 6-week period. Despite no significant group differences, periodontal inflammation of all study participants improved significantly, particularly in the reduction of bleeding.
 
Lavigne SE et al. The effects of power toothbrushing on periodontal inflammation in a Canadian nursing home population: A randomized controlled trial. Int J Dent Hygiene 2017 Jan 19. doi: 10.1111/idh.12268.

Q Participants in this study:
A Failed to improve their oral hygiene using either method of tooth brushing
B All showed improved periodontal health 
C Had previously received no oral hygiene care at all
D Showed improved oral health only by using a power brush

3.Rheumatics, drugs and periodontal health

To investigate the possible association between rheumatoid arthritis (RA) and periodontitis with emphasis on the role of antirheumatic drugs in periodontal health, patients with early untreated rheumatoid arthritis (ERA) and chronic active (CRA) were examined at baseline and 16 months. Of the 124 participants: 53 had an early disease-modifying antirheumatic drug, 28 with CRA with insufficient response to conventional drugs and the others were controls. Moderate periodontitis was present in 67.3% ERA patients, 64.3% CRA patients and 39.5% of controls. Further, patients with RA had significantly more periodontal findings compared with controls, recorded with common periodontal indexes. In the re-examination, patients with RA still showed poor periodontal health in spite of treatment with drugs after baseline examination. Moderate periodontitis was more frequent in patients with RA than in controls. Patients with ERA and CRA exhibited poorer periodontal health parameters when compared with controls. There was no association between antirheumatic treatment and periodontal parameters.

Ayravainen L et al. Periodontitis in early and chronic rheumatoid arthritis: a prospective follow-up study in Finnish population. BMJ Open 2017 7:e011916.

Q Periodontitis is:
A Unaffected by rheumatoid arthritis
B Improved by the side effects of drugs used to treat rheumatoid arthritis
C More frequent in patients with rheumatoid arthritis
D Less frequent in patients with rheumatoid arthritis

4.Weeding out the evidence

Does the frequent recreational use of cannabis (FRC), following its legalisation in some countries, pose oral and periodontal health concerns? The objective of this study was to examine the relationship between FRC (marijuana and hashish) use and periodontitis prevalence among adults in the United States using data from the National Health and Nutrition Examination Survey (NHANES). Periodontitis was defined using probing depth (PD) and clinical attachment loss (AL). Of 1,938 participants with available cannabis use data, 26.8% were FRC users. The mean number of sites per participant with PD >4, >6, and >8 mm and AL >3, >5, and >8 mm was significantly higher among FRC users than among non-FRC users and the average AL was higher among FRC users than among non-FRC users. Analysis revealed a positive (harmful) association between FRC use and severe periodontitis in the entire sample. FRC use is associated with deeper PDs, more clinical AL, and higher odds of having severe periodontitis.

Shariff JA et al. Relationship between frequent recreational cannabis (marijuana and hashish) use and periodontitis in adults in the United States: National Health and Nutrition Examination Survey 2011 to 2012. J Periodontol 2017 88: 273-280.

Q Does frequent recreational use of cannabis result in? 
A A lower number of periodontal pockets and lower attachment loss
B No difference in attachment loss but deeper pockets
C A higher number of deeper pockets and greater attachment loss
D Less severe periodontitis than non-use