Syfte:Syftet med studien var att undersöka munhygien- och kostvanor hos gymnasieelever i årskurs 3. Material och metod: Studien var en kvantitativ tvärsnittsstudie. Datainsamlingen genomfördes i form av enkätundersökning med 123 deltagare i åldrarna 18-22 år. Enkäten bestod av 20 frågor med fasta svarsalternativ som berörde elevernas bakgrund, munhygien- och kostvanor. Resultat: Studiens resultat visade att majoriteten av deltagarna borstade tänderna två gånger om dagen med tandborste och fluortandkräm och 28 % använde något approximalt hjälpmedel. Mer än hälften av deltagarna åt lunch och middag varje dag, däremot var det endast hälften av deltagarna som åt frukost varje dag. Deltagarna hade ett lågt intag av sötsaker. Slutsats: Studien visade att deltagarna hade relativt goda munhygienvanor, däremot var användningen av approximala hjälpmedel och fluorpreparat bristfälliga. Vidare visade resultatet att deltagarna hade bristfälliga kostvanor då endast hälften av deltagarna åt frukost varje dag.

OBJECTIVE: There is a need to develop easy-to-use tools to screen periodontal condition in daily practice. This study aimed to evaluate the FDI World Dental Federation "Chairside Guide" (FDI-CG) developed by the Task Team of the FDI Global Periodontal Health Project (GPHP) as a potential tool for screening.

METHODS: Databases from 3 centres in Germany, Hong Kong, and Spain (n = 519) were used to evaluate the association of the FDI-CG and its individual items with the periodontitis case definitions proposed by the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) for population-based surveillance of periodontitis.

RESULTS: Statistically significant differences were observed among the databases for the prevalence of periodontitis and the items included in the FDI-CG. The FDI-CG score and its individual components were significantly associated with the periodontal status in the individual databases and the total sample, with bleeding on probing showing the strongest association with severe periodontitis (odds ratio [OR] = 12.9, 95% CI [5.9; 28.0], P < .001, for those presenting bleeding on probing >50%), followed by age (OR = 4.8, 95% CI [1.7; 4.2], P = .004, for those older than 65 years of age). Those subjects with a FDI-CG score >10 had an OR of 54.0 (95% CI [23.5; 124.2], P < .001) and presented with severe periodontitis. A significant correlation was found between the different FDI-CG scoring categories (mild, moderate, and severe) and the categories for mild, moderate, and severe periodontitis using the Centers for Disease Control and Prevention and the American Academy of Periodontology criteria (r = 0.57, Spearman rank correlation test, P < .001).

CONCLUSION: The FDI Chairside Guide may represent a suitable tool for screening the periodontal condition by general practitioners in daily dental practice.

OBJECTIVES: To assess if (I) the alveolar bone defect configuration at dental implants diagnosed with peri-implantitis is related to clinical parameters at the time of surgical intervention and if (II) the outcome of surgical intervention of peri-implantitis is dependent on defect configuration at the time of treatment.

MATERIALS AND METHODS: In a prospective study, 45 individuals and 74 dental implants with ≥ 2 bone wall defects were treated with either an autogenous bone transplant or an exogenous bone augmentation material. Defect fill was assessed at 1 year.

RESULTS: At baseline, no significant study group differences were identified. Most study implants (70.7%, n = 53) had been placed in the maxilla. Few implants were placed in molar regions. The mesial and distal crestal width at surgery was greater at 4-wall defects than at 2-wall defects (p = 0.001). Probing depths were also greater at 4-wall defects than at 2-wall defects (p = 0.01). Defect fill was correlated to initial defect depth (p < 0.001). Defect fill at 4-wall defects was significant (p < 0.05).

CONCLUSIONS: (I) The buccal-lingual width of the alveolar bone crest was explanatory to defect configuration, (II) 4-wall defects demonstrated more defect fill, and (III) deeper defects resulted in more defect fill.

OBJECTIVES: To investigate if it is possible to achieve complete decontamination of dental implant surfaces with different surface characteristics.

MATERIALS AND METHODS: Twelve implant pieces with an Osseotite^® surface and 12 implant pieces with a Ti-Unite^® surface were attached on to the complete lower dentures of six patients and were allowed to accumulate plaque for 30 days. When retrieved, the implant decontamination protocol used, involved both mechanical (PeriBrush™) and chemical (3% H₂O₂) decontamination. The number of colony forming units per millilitre was determined and the dominant micro-organisms in selected samples was identified by 16s rRNA gene amplicon sequencing. The effect of the titanium brush on the implant surface was examined by SEM.

RESULTS: Complete decontamination was achieved in five out of 24 implants (four Osseotite^® and one Ti-Unite^®). The mean CFU/ml detected after decontamination were 464.48 for Osseotite^® and 729.09 for Ti-Unite^® implants. On the surface of the implants in which complete decontamination was not achieved, all of the predominant bacteria identified were streptococci except for one which was identified as micrococcus. SEM images revealed that the surface features of the decontaminated implants were not significantly altered.

CONCLUSIONS: Mechanical decontamination using a titanium brush supplemented with chemical treatment for one minute (3% H₂O₂) can achieve complete decontamination of implant surfaces in edentulous patients.

Introduction: Fall-related injuries are prevalent in older patients and often lead to increased morbidity, medication, and impaired functions. We studied older trauma patients with the aim to describe their oral health in comparison to morbidity and medication.

Material and Methods: The study included 198 patients, ≥65 years, admitted with an orthopedic trauma. Oral examinations included number of natural teeth, dental implants, missing, decayed and restored teeth, root remnants, and pocket depth. Data on comorbidities and medication were assembled. Statistical analyses were carried out with logistic regression models, adjusted for age, gender, comorbidity, and polypharmacy.

Results: Overall, 198 patients participated, 71% women, mean age 81 years (±7.9), 85% resided in their own homes, 86% had hip fractures. Chronic diseases and drug use were present in 98.9%, a mean of 6.67 in Charlson comorbidity index (CCI), 40% heart diseases, 17% diabetes, and 14% dementia. Ninety-one percent were dentate (181), mean number of teeth 19.2 (±6.5), 24% had decayed teeth, 97% filled teeth, 44% <20 teeth, and 26% oral dryness. DFT (decayed, filled teeth) over mean were identified in patients with diabetes (p=0.037), COPD (p=0.048), polypharmacy (p=0.011), diuretics (p=0.007), and inhalation drugs (p=0.032). Use of ≥2 strong anticholinergic drugs were observed in patients with <20 teeth and DFT over mean (p=0.004, 0.003). Adjusted for age, gender, CCI, and polypharmacy.

Conclusion: The study showed that impaired oral health was prevalent in older trauma patients and that negative effects on oral health were significantly associated with chronic diseases and drug use. The results emphasize the importance of identifying orthogeriatric patients with oral health problems and to stress the necessity to uphold good oral care during a period when functional decline can be expected.

Syftet med studien var att kartlägga kostvanor och munhygienvanor samt uppfattning av den egna munhälsan hos skiftarbetare. Studien har utförts som en kvantitativ tvärsnittsstudie med användning av enkät. Undersökningsgruppen bestod av sammanlagt 100 skiftarbetare från industri- och vård- och omsorgssektorn i Skåne. Det insamlade materialet analyserades i statistikprogrammet Statistical Package for the Social Sciences (SPSS) version 23.0. Resultatet av studien visade att skiftarbetarnas kostvanor påverkades negativt av skiftarbete genom ökat småätande, intag av sötad dryck och oregelbundna måltider på grund av varierande arbetstider.  När det gäller munhygienvanor påverkades inte tandborstningen på samma sätt, däremot rengöringen mellan tänderna utförs inte regelmässigt. Studiens slutsats visade att skiftarbetarna hade goda munhygienvanor när det gäller tandborstning och fluoranvändning dock med mindre regelbunden rengöring mellan tänderna. Kostvanorna var bristfälliga med ökat småätande och sötade drycker mellan måltiderna.

Aim: To investigate the extent to which the Revised Oral Assessment Guide–Jönköping (ROAG-J) is used by nursing staff routinely in nursing homes in Swedenand to describe oral health status of the residents.

Design: An observational, retrospective register-based study.

Methods: Data from different validated health assessments instruments, includingROAG-J, for the period 2011–2016 were obtained from the Web-based nationalquality register Senior Alert. The basis for the analyses was 190,016 assessments.

Results: About half of all residents had underwent at least one annual ROAG-J assessment (2014–2016). During the period 2011–2016, 42% of the residents (n = 92,827) were registered to have oral health problems. Significantly more oral health problemswere found for men and for those with younger age, poorer physical condition, neurophysiological problems, underweight, impaired mobility and many medications. Inconclusion, poorer oral health was found for more care-dependent individuals, whichshows a need of preventive actions.

A classification for peri-implant diseases and conditions was presented. Focused questions on the characteristics of peri-implant health, peri-implant mucositis, peri-implantitis, and soft- and hard-tissue deficiencies were addressed. Peri-implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri-implant health can exist around implants with reduced bone support. The main clinical characteristic of peri-implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri-implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri-implant mucositis. Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Peri-implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss. The evidence is equivocal regarding the effect of keratinized mucosa on the long-term health of the peri-implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal. Case definitions in day-to-day clinical practice and in epidemiological or disease-surveillance studies for peri-implant health, peri-implant mucositis, and peri-implantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant-supported prosthesis.

The aim of this study was to compare the effect of an autogenous blood concentrate (L-PRF) with the effect of white porous titanium granules (WPTG) on buccal bone remodeling. These materials were used to graft the void between the implant and the buccal bone following immediate implant placement. Clinical measurements were made at two time points, and the mean buccal bone horizontal dimension at placement was 2.94 ± 0.59 mm for L-PRF and 3.49 ± 0.99 mm for WPTG. At reentry, the values were 1.19 ± 0.90 mm and 2.12 ± 0.87 mm, respectively. Overall, there was no difference observed in the performance of the two materials regarding buccal bone resorption.

PURPOSE: The aim of this review is to describe the current guidelines for the differential diagnosis of periimplant diseases.

MATERIALS AND METHODS: Synopsis reviews were conducted to define the differential diagnosis of periimplant disease through an electronic literature search in MEDLINE up to February 2018.

DISCUSSION: Periimplant mucositis is defined by the presence of bleeding and/or suppuration on gentle probing with or without an increased probing depth compared with previous examinations and by the absence of bone loss beyond crestal bone-level changes resulting from initial bone remodeling. Periimplantitis is defined by the presence of bleeding and/or suppuration on gentle probing with an increased probing depth compared with previous examinations and by the presence of bone loss beyond crestal bone-level changes resulting from initial bone remodeling. Thus, a combination of clinical registrations (probing pocket depth, bleeding on probing, and presence of pus) combined with radiographic signs of possible bone loss is needed for differential diagnosis.

CONCLUSIONS: An accurate baseline registration at the time of placement of the prosthesis (probing pocket depth and bone level) with ongoing yearly monitoring is essential for diagnosis and appropriate disease management.

Periodontal disease, periodontitis as well as the preceding gingivitis, has been associated with both obesity and diabetes. Studies have shown that diet changes can lead to a lower incidence of such inflammation. The aim of the present case series over four weeks was to study the effects on medical and dental conditions in patients with type 2 diabetes of the consumption of the Okinawan-based Nordic Diet (OBND^&reg;). Medical and dental examinations were performed to estimate the general health and gingivitis/periodontitis. Serum cytokine levels were assessed using Luminex technology. Eight of ten study participants completed the study. All participants lost weight (p = 0.012). Six out of seven that were treated with insulin could reduce their insulin intake after two weeks with OBND^&reg;. The reduction was about 16 units which corresponds to a 34% relative reduction compared to the starting point (range 15⁻63%). Fasting blood glucose values fell (p = 0.035). Hemoglobin A1c (HbA1c) (p = 0.01), triglycerides (p = 0.05), and low-density lipoprotein (LDL) (p = 0.05) were also reduced. Bleeding on probing changed from ~28% before any dietary changes to ~13% after two weeks with OBND^&reg; (p = 0.01). The reduction in gingival bleeding was as substantial as might be expected from one session of professional tooth cleaning. Markers of inflammation were also reduced. The OBND^&reg; thus showed significant promise in alleviating the impact of diabetes on dental as well as general health.

Syfte: Syftet med studien var att kartlägga munhygienvanor och tandvårdskontakten bland undervisande personal på Högskolan Kristianstad. Material och metod: Studien är en kvantitativ tvärsnittsstudie. Datainsamlingen genomfördes i form av enkätundersökning med 116 respondenter. Webbenkäten bestod av 11 frågor med fasta svarsalternativ som berörde den undervisande personalens munhygienvanor och tandvårdskontakt. Resultat: Majoriteten av respondenterna borstade tänderna två gånger om dagen med manuell tandborste och med fluortandkräm. Sextio procent använde inget annat fluortillskott. Plackers var det vanligaste hjälpmedlet som användes för att göra rent mellan tänderna. Drygt hälften av respondenterna besökte tandvården en gång om året. Slutsats: Studien visade att merparten av respondenterna i studien hade goda munhygienvanor och en relativt god tandvårdskontakt.

BACKGROUND AND AIMS: Bone augmentation procedures to enable dental implant placement are frequently performed. The remit of this working group was to evaluate the current evidence on the efficacy of regenerative measures for the reconstruction of alveolar ridge defects.

MATERIAL AND METHODS: The discussions were based on four systematic reviews focusing on lateral bone augmentation with implant placement at a later stage, vertical bone augmentation, reconstructive treatment of peri-implantitis associated defects, and long-term results of lateral window sinus augmentation procedures.

RESULTS: A substantial body of evidence supports lateral bone augmentation prior to implant placement as a predictable procedure in order to gain sufficient ridge width for implant placement. Also, vertical ridge augmentation procedures were in many studies shown to be effective in treating deficient alveolar ridges to allow for dental implant placement. However, for both procedures the rate of associated complications was high. The adjunctive benefit of reconstructive measures for the treatment of peri-implantitis-related bone defects has only been assessed in a few RCTs. Meta-analyses demonstrated a benefit with regard to radiographic bone gain but not for clinical outcomes. Lateral window sinus floor augmentation was shown to be a reliable procedure in the long-term for the partially and fully edentulous maxilla.

CONCLUSIONS: The evaluated bone augmentation procedures were proven to be effective for the reconstruction of alveolar ridge defects. However, some procedures are demanding and bear a higher risk for postoperative complications. This article is protected by copyright. All rights reserved.

AIM: To cross-sectionally analyze the submucosal microbiome of peri-implantitis (PI) lesions at different severity levels.

MATERIALS AND METHODS: Microbial signatures of 45 submucosal plaque samples from untreated peri-implantitis lesions obtained from 30 non-smoking, systemically healthy subjects were assessed by 16s sequencing. Linear mixed models were used to identify taxa with differential abundance by probing depth, after correction for age, gender, and multiple samples per subject. Network analyses were performed to identify groups of taxa with mutual occurrence or exclusion. Subsequently, the effects of peri-implant probing depth on submucosal microbial dysbiosis was calculated using the microbial dysbiosis index.

RESULTS: In total, we identified 337 different taxa in the submucosal microbiome of peri-implantitis. Total abundance of 12 taxa correlated significantly with increasing probing depth; a significant relationship with lower probing depth was found for 16 taxa. Network analysis identified two mutually exclusive complexes associated with shallow pockets and deeper pockets, respectively. Deeper peri-implant pockets were associated with significantly increased dysbiosis.

CONCLUSION: Increases in peri-implant pocket depth are associated with substantial changes in the submucosal microbiome and increasing levels of dysbiosis. This article is protected by copyright. All rights reserved.

Syfte: Syftet med studien var att belysa hur studenter som dagligen röker minst tio cigaretter upplever det egna tobaksbruket. Ett ytterligare syfte var att belysa studenternas uppfattning om cigarettrökningens påverkan på den orala hälsan. Material och metod: En empirisk studie med kvalitativ design tillämpades. Datamaterial samlades in genom intervjuer där åtta studenter från Högskolan Kristianstad deltog. Intervjuerna baserades på en intervjuguide på tolv frågor, som varade i cirka 10-15 minuter. Data analyserades genom kvalitativ innehållsanalys. Resultat: I studiens resultat framgick att deltagarna upplevde lugnande och avslappnande känslor i samband med sin cigarettrökning. Dessa känslor framgick främst vid rökning under stressfulla situationer och var huvudanledningen till att deltagarna fortsatte röka. I samband med sin rökning upplevde majoriteten av deltagarna försämrad kondition och svårigheter att vara ifrån rökningen i fem timmar eller mer.  Studenternas uppfattningar om hur rökning påverkar oral hälsa var att det medförde främst gula tänder och dålig andedräkt. Slutsats: Studenterna hade en positiv syn på sin cigarettrökning där de upplevde främst avslappnande och lugnande känslor. Deras uppfattningar om rökningens effekter på orala hälsan var bristande där främst missfärgningar och dålig andedräkt framgick. 

AIM: to determine whether having periodontitis is associated with cognitive decline among older adults.

MATERIAL AND METHODS: A prospective population study of older adults, Swedish National Study on Ageing and Care, (SNAC) provided repeated registrations of cognitive functions. Cognitive decline was defined as ≥ 3-points deterioration from a predetermined level at baseline, using the Mini-Mental State Examination (MMSE). Between 2001 and 2003, 715 individuals had a medical as well as a clinical and radiographic dental examination. The individuals were re-examined after 6 years. Periodontitis was defined as ≥ 4mm bone loss at ≥ 30% of tooth sites. Social variables were captured from questionnaires.

RESULTS: The multivariate logistic regression analysis demonstrated a statistically significant association between prevalence of periodontitis and cognitive decline after adjustments of confounding factors of importance.

CONCLUSIONS: A history of periodontitis may be of importance for cognitive functions among older adults. This article is protected by copyright. All rights reserved.

AIM: To evaluate pattern of change in periodontal variables and tooth loss in a twelve-year follow-up study of older adults living in Sweden.

METHODS: In a prospective population study of older adults, a clinical examination and radiographic dental examination were performed at baseline (2001-2003) and after 12 years (2013-2015). In 375 individuals, the number and proportion of sites with a distance ≥4 mm and ≥5 mm from cemento-enamel junction to the bone level, the number and proportion of teeth with pockets ≥5 mm and number of teeth lost were calculated. Dental caries was registered. Periodontitis was defined as having ≥2 sites with ≥5 mm distance from cemento-enamel junction to the marginal bone level and ≥1 tooth with pockets ≥5 mm.

RESULTS: A diagnosis of periodontitis was evident in 39% of the individuals, and 23% of the individuals lost ≥3 teeth over the study period. The proportion of sites with ≥4 mm and ≥5 mm bone loss increased with age, while the proportion of teeth with pockets remained stable. Periodontitis was the strongest predictor for losing ≥3 teeth, OR 2.9 (p < .001) in the final model.

CONCLUSIONS: Periodontitis is a risk factor for future tooth loss among older adults.

Background: The association between rheumatoid arthritis (RA) and periodontitis remains unclear.

Methods: We studied oral health and periodontitis in a population-based case-control study of individuals with ≥10 remaining teeth ≥61 years of age and either with, or without a diagnosis of RA. 126 dentate individuals with RA were recruited together with age-matched control individuals without RA. The control individuals were recruited from the general population from the same city (n = 249). A dental examination including a panoramic radiograph was performed on all participants. All individuals with RA were examined and medical records were reviewed by a rheumatologist. In the control group, none of the participants presented with symptoms of RA and their medical records were also negative.

Results: The RA group included more women (66.7% vs. 55.8%) (p < 0.01). Individuals in the RA group had a higher body mass index (BMI) (p < 0.001). A diagnosis of periodontitis was more common in the RA group (61.1%) than in the control group (33.7%) (p = 0.001). Binary logistic regression analysis identified that a BMI > 25 (OR 6.2, 95% CI 3.6, 10.5, p = 0.000), periodontitis (OR 2.5 95% CI 1.5, 4.2 p = 0.000), and female gender (OR 2.3, 95% CI 1.3-4.0, p = 0.003) were associated with RA.

Conclusion: RA was associated a diagnosis of periodontitis.

AIM: To assess whether the use of deproteinized bovine bone mineral (DBBM) and native bilayer collagen membrane (NBCM) improved healing of peri-implantitis-related bone defects at 12 months.

MATERIALS AND METHODS: In a multicentre randomized clinical trial, 32 individuals received surgical debridement (CG), and 34 adjunct use of DBBM and NBCM (TG). Radiographic defect fill (RDF), probing pocket depth (PPD), bleeding on probing (BOP) suppuration (SUP), recession (REC), cytokines (IL-1β, IL-1ra, IL-6, IL-8, IL-12, IP10, PDGF-BB, TNF-α, VEGF), and patient-reported outcomes (PROs) were evaluated at 3, 6, 9 and 12 months.

RESULTS: RDF at deepest site amounted 2.7 ± 1.3 mm in TG and 1.4 ± 1.2 mm in CG (p < 0.0001). PPD was reduced by 1.9 mm in TG and 2.3 mm in CG (p =0.5783). There were no significant differences between groups regarding reductions of BOP, SUP, REC, cytokines levels, or OHIP 14 scores at 12 months. Successful treatment (RDF ≥1.0 mm, PPD ≤5 mm, ≤1/4 site with BOP grade 1, no SUP) were identified in 32% in TG and 21 % in CG.

CONCLUSIONS: DBBM and NBCM resulted in significantly more RDF than debridement alone. No difference was found in any clinical parameters or PROs between groups.

The following consensus report is based on four background reviews. The frequency of maintenance visits is based on patient risk indicators, homecare compliance and prosthetic design. Generally, a 6-month visit interval or shorter is preferred. At these visits, peri-implant probing, assessment of bleeding on probing and, if warranted, a radiographic examination is performed. Diagnosis of peri-implant mucositis requires: (i) bleeding or suppuration on gentle probing with or without increased probing depth compared with previous examinations; and (ii) no bone loss beyond crestal bone level changes resulting from initial bone remodelling. Diagnosis of peri-implantitis requires: (i) bleeding and/or suppuration on gentle probing; (ii) an increased probing depth compared with previous examinations; and (iii) bone loss beyond crestal bone level changes resulting from initial bone remodelling. If diagnosis of disease is established, the inflammation should be resolved. Non-surgical therapy is always the first choice. Access and motivation for optimal oral hygiene are key. The patient should have a course of mechanical therapy and, if a smoker, be encouraged not to smoke. Non-surgical mechanical therapy and oral hygiene reinforcement are useful in treating peri-implant mucositis. Power-driven subgingival air-polishing devices, Er: YAG lasers, metal curettes or ultrasonic curettes with or without plastic sleeves can be used to treat peri-implantitis. Such treatment usually provides clinical improvements such as reduced bleeding tendency, and in some cases a pocket-depth reduction of ≤ 1 mm. In advanced cases, however, complete resolution of the disease is unlikely.

AIM: to determine the prevalence and development of peri-implant mucositis and peri-implantitis and to assess risk factors over time.

MATERIALS AND METHODS: The study is a longitudinal case series assessing the occurrence and diagnosis of peri-implant mucositis and peri-implantitis.

RESULTS: 218/294 patients who had received dental implants between 1988-1992 were examined between 2000-2002 (exam II; 9-14 years after the first exam). At exam III (20-26 years after exam I, on average 23.3 years), 86 individuals were re-examined. The diagnosis of peri-implant mucositis and peri-implantitis at exam III was 23.8% and 13.7% respectively. Surgical treatment of peri-implantitis after exam II resulted in a bone gain for 2/12 individuals. Individuals with ≥ 3 implants at exam II were at risk for peri-implantitis at exam III (χ2=7.9, p <0.01, LR: 11.6, 95%CI: 1.5, 92.5, p < 0.01). A history of periodontitis (p=0.07), a diagnosis of peri-implant mucositis (p =0.77), or smoking (p=0.86) at exam II, were not predictive of peri-implantitis at exam III.

CONCLUSIONS: The diagnosis and occurrence of peri-implantitis and peri-implant mucositis was high. Healthy conditions at implants after 9-14 years were predictive of future implant health. This article is protected by copyright. All rights reserved.

Approximately 90% of halitosis cases originate within the oral cavity (intra-oral halitosis). With a focus on intra-oral halitosis, this narrative review article provides a current summary of the epidemiology, diagnosis and management of halitosis and discusses practical considerations for healthcare professionals (HCPs), including dentists, dental hygienists, general practitioners, community pharmacists, nurses and medical specialists. MEDLINE and PubMed were searched up to 31 December 2019. Additional information was sourced from reference lists of relevant published literature. Full-text articles which reported on the epidemiology, diagnosis and management of halitosis were considered for inclusion. Halitosis affects substantial numbers of individuals globally and is an underestimated problem in dental practice. Current estimates of the prevalence of halitosis, in addition to diagnostic methods and management considerations for halitosis, are discussed. Although not a life-threatening condition, halitosis has a significant impact on patients’ quality of life and can result in psychological consequences including social, professional and affective limitations. Using a simple step-wise approach for diagnosis and treatment, dentists and dental hygienists are ideally placed to respond to an initial consultation for halitosis

The objective of this review is to identify case definitions and clinical criteria of peri-implant healthy tissues, peri-implant mucositis, and peri-implantitis. The case definitions were constructed based on a review of the evidence applicable for diagnostic considerations. In summary, the diagnostic definition of peri-implant health is based on the following criteria: 1) absence of peri-implant signs of soft tissue inflammation (redness, swelling, profuse bleeding on probing), and 2) the absence of further additional bone loss following initial healing. The diagnostic definition of peri-implant mucositis is based on following criteria: 1) presence of peri-implant signs of inflammation (redness, swelling, line or drop of bleeding within 30 seconds following probing), combined with 2) no additional bone loss following initial healing. The clinical definition of peri-implantitis is based on following criteria: 1) presence of peri-implant signs of inflammation, 2) radiographic evidence of bone loss following initial healing, and 3) increasing probing depth as compared to probing depth values collected after placement of the prosthetic reconstruction. In the absence of previous radiographs, radiographic bone level ≥3 mm in combination with BOP and probing depths ≥6 mm is indicative of peri-implantitis.

AIM: To assess whether the treatment outcome differed between surgical debridement, with or without a bone substitute.

MATERIALS AND METHODS: 41 adults with 3 or 4 wall peri-implant bone defects were enrolled in a 1-year RCT. Surgical debridement (control group), or in combination with a bone substitute (Endobon^® ) (test group) was performed.

RESULTS: Radiographic evidence of defect fill (primary outcome) was only significant in the test group (p = 0.004). At year 1, no bleeding on probing (BOP) in the control and test groups were 7/20 (35%) and 10/21 (47.6%), respectively (χ2=0.67, p=0.41). Plaque scores did not differ by study group at baseline (p=0.31), or at year 1 (p=0.08). Mid-buccal soft tissue recession changes did not differ by groups (p=0.76). Successful treatment outcome (defect fill ≥ 1.0 mm, PPD values at implant ≤5 mm, no BOP, and no suppuration was identified in 1/20 (5.0%) control, and 9/21 (42.9%) test individuals (F= 7,9, p <0.01). Number needed to treat analysis identified an absolute risk reduction of 32.8% in benefit of the test procedure. (F= 7,9, p <0.01).

CONCLUSIONS: Successful treatment outcome using a bone substitute was more predictable when a composite therapeutic endpoint was considered. This article is protected by copyright. All rights reserved.

Objectives: To report a follow-upof patients following the surgical anti-infective treatment of peri-implantitis and to identify possible risk indicators for the progression of disease during supportive peri-implant therapy. Material and Methods: Following peri-implant surgery, 41 patients (213 implants) were enrolled in a supportive peri-implant therapy. At the 2-year follow-up, two groups of patients were identified, with or without residual peri-implant pockets (responding and non-responding group). Eighteen patients (85 implants) of the non-responding group were followed for further 8 years. Results: At the 2-year examination, 73 of the 117 treated implants (62.4%) presented healthy peri-implant condition, while 44 (37.6%) presented persisting peri-implantitis associated with substantial bone loss before treatment. The 10-year examination of the non-responding group revealed that 1) 84% of the implants that regained health following surgery remained healthy during the entire observation period; 2) 66% of the implants with residual pockets following surgery maintained stable peri-implant condition; and 3) 29% of all treated implants showed disease progression, and 11 of those were extracted. Presence of pockets at 3–4 sites of the implants was identified as risk indicator for progression of peri-implantitis. Conclusion: The peri-implant health achieved following therapy was maintained formost of the implants during the follow-up. Residual pockets were a frequent finding at implants with substantial bone loss before treatment. Presence of pockets around the entire circumference of the implants resulted as a risk indicator for further disease progression. The probability of progression of peri-implant disease increased with increased observation time.

Syftet med denna studie var att undersöka hur gastric bypass-opererade individer upplever sin orala hälsa efter kirurgin. En empirisk studie med en kvalitativ ansats genomfördes. Datainsamlingen som användes var semistrukturerade intervjuer med en intervjuguide som underlag. Urvalet bestod av åtta informanter i åldrarna 24–64 och som valdes genom ett snöbollsurval. En kvalitativ innehållsanalys användes för att analysera intervjuerna. Resultatet redovisas utifrån temat Förändringar efter gastric bypass-operation relaterat till oral hälsa. Informanterna upplevde att de fått erosionsskador, karies, muntorrhet, oral halitosis och parodontala problem postoperativt. Samtliga informanter upplevde en försämrad allmänhälsa efter operationen och förändrade kostvanor som innebar att de började äta regelbundna måltider med korta tidsintervall. Slutsatsen av studien visar att informanterna upplevde en försämrad oral hälsa efter gastric bypass-operationen, där erosionsskador, karies, muntorrhet, oral halitosis och parodontala problem angavs till följd av de förändrade kostvanorna samt den påverkan på den allmänna hälsan som uppstod till följd av operationen. 

OBJECTIVES: To report a follow-up of patients following the surgical anti-infective treatment of peri-implantitis and to identify possible risk indicators for the progression of disease during supportive peri-implant therapy.

MATERIAL AND METHODS: Following peri-implant surgery, 41 patients (213 implants) were enrolled in a supportive peri-implant therapy. At the 2-years follow up, two groups of patients were identified, with or without residual peri-implant pockets (responding and non-responding group). Eighteen patients (85 implants) of the non-responding group were followed for further 8 years.

RESULTS: at the 2-years examination, 73 of the 117 treated implants (62.4%) presented healthy peri-implant condition, while 44 (37.6%) presented persisting peri-implantitis associated with substantial bone loss before treatment. The 10-years examination of the non-responding group revealed that 1) 84% of the implants that regained health following surgery remained healthy during the entire observation period; 2) 66% of the implants with residual pockets following surgery, maintained stable peri-implant condition; 3) 29% of all treated implants showed disease progression and 11 of those were extracted. Presence of pockets at 3 - 4 sites of the implants were identified as risk indicator for progression of peri-implantitis.

CONCLUSION: The peri-implant health achieved following therapy was maintained for most of the implants during the follow up. Residual pockets were a frequent finding at implants with substantial bone loss before treatment. Presence of pockets around the entire circumference of the implants resulted as a risk indicator for further disease progression. The probability of progression of peri-implant disease increased with increased observation time.

OBJECTIVES: The aim of the present study was to investigate whether peri-implant clinical parameters (modified plaque index (mPI), bleeding and/or suppuration on probing (B/SOP)) and local factors (type of prostheses, screw emergence, platform diameter, and abutment angulation) might contribute to the development of additional bone loss and peri-implantitis around dental implants.

MATERIALS AND METHODS: Two hundred seventy-seven external hex connection implants placed in the posterior maxilla of 124 patients were retrospectively evaluated. They were divided into two groups: physiologic bone loss < 2 mm (PBL) or additional bone loss ≥ 2 mm (ABL). GEE logistic regression was applied to evaluate the influence of type of prostheses (implant-supported single crown (ISSC), fixed partial denture (ISFPD), and full denture (ISFD)) and clinical parameters (mPI and S/BOP) on bone loss.

RESULTS: Among the 277 implants, 159 (57.4%) presented PBL and 118 (42.6%) presented ABL. Within the ABL group, 20.6% implants were diagnosed with peri-implantitis. mPI significantly correlated with the type of prosthesis and the highest value of mPI (index = 3) was observed in ISFD (23.8%). Moreover, peri-implantitis was more frequently associated with ISFD (32.79%) than ISSC and ISFDP (13.79% and 13.48, respectively) CONCLUSIONS: ISFD in the posterior maxilla presented high rates of ABL and showed a higher prevalence of peri-implantitis. None of the local factors seemed to contribute to the development of these conditions. Further investigations are needed to prospectively support the results of the present study.

CLINICAL RELEVANCE: Patients rehabilitated with ISFD should be carefully monitored and have more frequent maintenance visits to prevent or control peri-implant bone loss.

OBJECTIVES: A connection between prevalence of rheumatoid arthritis (RA) and periodontitis has been reported. The hypothesis for this association involves increased citrullination in the oral mucosa in patients with periodontitis. Whether ongoing periodontitis has an effect on IgA antibodies to citrullinated peptides (ACPA) in saliva is unknown. We studied IgA ACPA in saliva and serum and their relation to periodontitis and smoking in a population-based elderly RA cohort.

METHODS: A population-based cohort of patients with RA ≥61 years of age (n=132) was examined by rheumatologists and a dental hygienist. Analyses of IgG ACPA in serum and IgA ACPA in serum and saliva were performed. The presence of ACPA was compared in patients with RA with and without periodontitis.

RESULTS: IgA ACPA in serum occurred in 35% of RA patients with periodontitis and in 43% of RA patients without periodontitis (p=0.740). IgG ACPA in serum was found in 66% of RA patients with periodontitis, and in 69% without periodontitis (p=0.740). IgA ACPA in saliva occurred in 20% with periodontitis and 55% without periodontitis (p=0.062). A logistic regression analysis adjusting for age, gender and smoking gave an odds ratio (OR) of 0.456 (95% CI=0.183-1.137, p=0.092) for saliva IgA ACPA positive individuals to have periodontitis.

CONCLUSIONS: IgA ACPA in serum or saliva was not more common in RA patients with periodontitis. This implies that local production of ACPA by the oral mucosa is not enhanced by periodontal inflammation, in patients with established RA.

OBJECTIVE: We studied cytokines in gingival crevicular fluid (GCF) in a cross-sectional population-based cohort of rheumatoid arthritis (RA) patients ≥61 years of age with and without a diagnosis of periodontitis.

BACKGROUND DATA: Earlier studies on cytokines in GCF in RA patients have not given clear results.

METHODS: In a population-based cross-sectional study of patients ≥61 years of age, 233 RA patients were identified. 132 (57%) dentate RA patients participated. All participants received rheumatological and dental examinations, and had a panoramic radiograph taken. GCF was sampled on each patient. Interleukins 1-β (IL-1β), IL-4, IL-6, IL-10, IL-17A, tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), and chemokines RANTES/CCL5, eotaxin and monocyte chemoattractant protein (MCP-1) were analyzed in GCF. These cytokines were stratified for periodontitis, age, gender, body mass index (BMI), smoking, and anti-cyclic citrullinated protein (anti-CCP) status. Binary logistic regression analyses with periodontitis as outcome were performed adjusting for the above mentioned confounding factors including anti-rheumatic medication, disease duration and the cytokine in question.

RESULTS: Periodontitis was diagnosed in 80/132 (61%) of study participants. The 110 RA patients not participating were older, had a higher mean erythrocyte sedimentation rate (ESR), had a higher mean DAS28ESR (Disease Activity Score 28 using ESR) and were less often on biologic treatment. Only RANTES was associated with periodontitis (p = .049, OR 1.001, 95% CI 1.000-1.002) in the binary logistic regression analyses.

CONCLUSION: In this population-based elderly RA cohort, neither pro-inflammatory nor anti-inflammatory cytokines in GCF were clearly associated with a diagnosis of periodontitis.

OBJECTIVE: To assess if carotid calcifications detected in panoramic radiographs are associated with future events of stroke, and/or ischemic heart diseases over 10-13 years in individuals between 60 and 96 years.

MATERIALS AND METHODS: Baseline (2001-2004) panoramic radiographs were assessed for evidence of carotid calcifications from individuals with no previous history of stroke and/or ischemic heart diseases. A radiopaque nodular mass adjacent to the cervical vertebrae, at or below the intervertebral space C3-C4, was interpreted as carotid calcification. Annual medical records were searched for ICD 10 codes through 2014.

RESULTS: Signs of carotid calcification was demonstrated in 238/635 (37.5%) of the study individuals. Signs of carotid calcification was associated with future stroke and/or ischemic heart diseases (χ² = 9.1, OR 1.6, 95% CI 1.2, 2.2, p < 0.002). In individuals 60-72 years, a significant association between radiographic signs of carotid calcification and stroke and/or ischemic heart diseases (χ² = 12.4, OR 2.4, 95% CI 1.5, 4.0, p < 0.000) (adjusted for high blood pressure, diabetes type 2, BMI; OR 1.9, 95% CI 1.1, 3.5, p = 0.03). Individuals (60-72 years) with radiographic evidence of carotid calcifications had a mean cumulative stroke and/or ischemic heart diseases survival time of 12.1 years compared to those without such evidence (13.0 years) (log rank Mantel-Cox χ² = 10.7, p = 0.001).

CONCLUSIONS: Evidence of carotid calcifications in panoramic radiographs is associated with an event of stroke and/or ischemic heart diseases in 60-96-year-old individuals.

CLINICAL RELEVANCE: Radiographic evidence of carotid calcifications is associated with stroke and/or ischemic heart diseases. Patients with signs of carotid calcifications should therefore be referred for medical examination.

OBJECTIVE: The present study assessed if individuals ≥ 60 years of age with periodontitis are more likely to develop stroke or ischemic heart diseases, or at a higher risk of death for 17 years.

MATERIAL AND METHODS: At baseline individuals ≥ 60 received a dental examination including a panoramic radiograph. Periodontitis was defined as having ≥ 30% sites with ≥ 5-mm distance from the cementoenamel junction to the marginal bone level. Medical records were annually reviewed from 2001 to 2018. Findings from the medical records identifying an ICD-10 code of stroke and ischemic heart diseases or death were registered.

RESULTS: Associations between periodontitis and incidence of ischemic heart disease were found in this 17-year follow-up study in all individuals 60-93 years (HR: 1.5, CI: 1.1-2.1, p = 0.017), in women (HR: 2.1, CI: 1.3-3.4, p = 0.002), and in individuals 78-96 years (HR: 1.7, CI: 1.0-2.6, p = 0.033). Periodontitis was associated with mortality in all individuals (HR: 1.4, CI: 1.2-1.8, p = 0.002), specifically in men (HR: 1.5, CI: 1.1-1.9, p = 0.006) or in ages 60-72 years (HR: 2.2, CI: 1.5-3.2, p = 0.000). Periodontitis was more prevalent among men (OR: 1.8, CI: 1.3-2.4, p = 0.000).

CONCLUSIONS: Individuals with periodontitis have an increased risk for future events of ischemic heart diseases and death.

CLINICAL RELEVANCE: Improving periodontal health in older individuals may reduce overall mortality and ischemic heart diseases. Both dental and medical professionals should be aware of the associations and ultimately cooperate.

Background. Periodontitis is a chronic inflammatory disease with a microbiological etiology affecting the supporting tissues of the tooth. The disease affects approximately 50% of the adult population. The prevalence of periodontitis increases with age. The complex bacterial infection, as well as an exaggerated host inflammatory reaction, may trigger subclinical atherosclerosis. Aims. The overall aim of the present thesis was to study the associations between periodontitis, cardiovascular diseases and mortality. The specific aims were: I) to evaluate the use and value of panoramic radiographs in assessing carotid calcifications in relation to other used methods (gold standards) and to assess the literature on carotid calcifications defined from panoramic radiographs and concurrent diagnosis of stroke and periodontitis, II) to evaluate if periodontitis is associated with the presence of carotid arterial calcifications diagnosed on panoramic radiographs in an elderly population, III) to assess if carotid calcifications detected on panoramic radiographs are associated with future events of stroke, and/or ischemic heart diseases over 10–13 years in individuals between 60 and 96 years, IV) to assess if individuals ≥ 60 years of age with periodontitis are more likely to develop stroke or ischemic heart diseases or are at higher risk of death over a period of 17 years. Methods: A literature review based on peer-reviewed studies was performed evaluating the use of panoramic radiographs in assessing carotid calcifications compared to other methods. In study II, III, IV older individuals, 60 years and older participating in the Swedish National Study of Aging and Care (SNAC) were included in the studies. A dental hygienist performed a dental clinical and radiographic examination. Probing depths (PD) and bleeding on probing (BOP) was registered. From radiographic panoramic images, the distances between the alveolar bone level and the cement enamel junction (CEJ) were measured. In study II, a diagnosis of periodontitis was declared, using a composite definition; if a distance between the alveolar bone level and the CEJ ≥5 mm on panoramic radiographs at >10% of sites and PD ≥5 mm at one or more teeth and with BOP >20% of teeth. In study IV, an indicator of a history of periodontal disease was declared if a distance between the alveolar bone level and the CEJ ≥5 mm on panoramic radiographs at ≥30% of sites. Evidence of a radiopaque nodular mass in the intervertebral space at or below the vertebrae C3-C4 was identified as carotid calcification. In addition, a medical research team performed the medical examinations, and a medical doctor (JB) reviewed all medical records for information about events of stroke and ischemic heart diseases. Stroke and ischemic heart diseases were registered according to the ICD 10 codes: ICD 60-69 for stroke and ICD: 20-25 for ischemic heart diseases. Study I was a review of the literature, in study II, a cross-sectional study design was employed. In studies III and IV, a longitudinal prospective study design was used. Results: On the use of panoramic radiographs in assessing carotid calcifications in relation to other used methods, the sensitivity and specificity varied between studies published. Furthermore, only a small number of studies were found concerning carotid calcifications and stroke. These studies were primarily retrospective. Four studies were found on the association between periodontitis and carotid calcification. Study II identified that older individuals with periodontitis had a significantly higher prevalence of carotid calcifications than individuals who did not have a diagnosis of periodontitis. In study III, a significant association was found between carotid calcifications on panoramic radiographs and 13- year incidence of stroke using a logistic regression analysis adjusted for confounders (BMI, diabetes type 2, hypertension) in the 60-72 years. A statistically significant crude association between radiographic evidence of carotid calcifications and incidence of ischemic heart diseases was found in individuals between 60-72 years. Such an association was, however, not identified among individuals older than 72 years. In study IV, Cox regression analysis was used, adjusted for confounders (age group, BMI >30, diabetes type 2, gender, hypertension, history of AMI, history of stroke, periodontitis, smoking) and with a definition of periodontitis as having a distance between the alveolar bone level and the CEJ ≥5 mm in panoramic radiographs at ≥ 30% of sites. Periodontitis increased the risk for ischemic heart diseases in all individuals, in women and in the 78-96 years age group (OO). Associations between periodontitis, and mortality were found in all individuals, in men and in the 60-72 years age group (YO) in the long term follow-up. Conclusions: 1. 1. Study I identified that there are studies which have assessed the value of panoramic radiographs in relation to other used methods (gold standards). The sensitivity and the specificity varied, with the specificity being more often higher. Few studies have considered the relationship between radiographic evidence of carotid calcifications and stroke. Four studies identified a relationship between a diagnosis of periodontitis and carotid calcifications on panoramic radiographs. 2. Study II identified a significant association between periodontitis and carotid calcification in individuals 60-96 years. 3. Study III identified that signs of carotid calcifications assessed from panoramic radiographs from the 60-96-year-old individuals were consistent with an incident of stroke and/or ischemic heart diseases over 13 years follow-up. 4. Study IV identified that periodontitis was associated with future ischemic heart diseases in all individuals, in women and in the 78- 96 years age group. Periodontitis was associated with mortality in all indviduals, in men and in the 60-72 years age group.

Purpose: Periimplantitis has become an emerging challenge faced by practicing dentists worldwide. When treating periimplantitis, we should attempt to manage this problem via nonsurgical therapies that include addressing all modifiable systemic risk factors and local contributing factors. Hence, the aim of this narrative review was to examine published studies on nonsurgical treatment of periimplantitis and evaluate their effectiveness and limitations.

Materials and Methods: A literature search was performed in MEDLINE via PubMed database up to December 31, 2017. Current published clinical approaches focused on mechanical debridement, adjunctive antiseptictherapy, adjunctive antibiotic therapy, laser-assisted therapy, and combination approaches were included in this analysis.

Results: Nonsurgical therapy of periimplantitis may result in complete healing of the disease and the patient is then placed on a supportive maintenance program. If the disease is not resolved and surgical intervention is not an option, active nonsurgical retreatment may be considered. In many cases where disease is not resolved, surgical therapy or implant removal could be considered.

Conclusions: Nonsurgical treatment of periimplantitis usually provides clinical improvements in reducing bleeding tendency and in some cases pocket reduction. Early diagnosis, detection, and intervention remain the key for managing periimplantitis.

BACKGROUND: The prevalence of diabetes is high and increasing. Periodontitis has been identified as a risk factor in both type 1 and 2 diabetes. The study purpose was to assess periodontal conditions, retinopathy, and serum glutamic acid decarboxylase antibody (GADA) titers in relation to retinopathy in individuals with Type 1 Diabetes (T1D).

METHODS: The study is a case series. Adult individuals with a diagnosis of T1D (n = 85) monitored ≥five years were recruited from an endocrinology clinic. Peripheral venous blood samples were analyzed including assessments of serum HbA1c levels and GADA titers. Medical and periodontal conditions were examined, and the data assessed. Independent t-tests, binary and multivariate analyses, chi square and odds ratios were employed.

RESULTS: Gingivitis was found in 68.2%, periodontitis in 21.2%, and retinopathy in 64.7%, GADA (≥35 U/ml) in 54.1%, and serum HbA1c > 48 mmol/mol in 94.3% of the individuals. The unadjusted odds ratio for periodontitis to differentiate a diagnosis of retinopathy was 7.3 (95%CI 1.6, 4.4, p <0.01). Multivariate analyses identified the following dependent factors to differentiate retinopathy; age, T1D duration, gingivitis, periodontitis at p < 0.001, gender, and serum GADA at P < 0.01, and by the number of remaining teeth at P < 0.05.

CONCLUSION: Retinopathy as a complication to T1D is linked to the duration of diabetes, age of the individual and with increasing severity to periodontitis. Periodontal intervention studies are warranted. This article is protected by copyright. All rights reserved.

AIM: To investigate whether there was an association between periodontitis and air flow limitation in older Swedish individuals.

MATERIALS AND METHODS: Study individuals were randomly selected from the Swedish civil registration database representing the aging population in Karlskrona, Sweden. Clinical and radiographic examinations were performed, alongside which participants completed questionnaires gathering information on their medical history, social circumstances, demographic background and tobacco use. A physical examination assessed anthropometric measures. Standard spirometry was performed to identify subjects with air flow limitation. Periodontitis was defined based on radiographic periodontal bone loss. Analysis included multiple logistic regression with adjustment for various confounders.

RESULTS: 826 Caucasian dentate subjects were included in the analysis. The median age of participants was 73.2 (IQR 66-81) years, and 443 (54.6%) subjects were female. 86 (10.4%) individuals presented with air flow limitation. The proportion of participants presenting with periodontitis in the air flow limitation group was 65.1% compared to 41.5% with normal respiratory function (p<0.001). Multiple logistic regression analysis showed that periodontitis was independently associated with air flow limitation with an odds ratio of 2.31 (95% CI 1.27-4.22) p<0.01.

CONCLUSION: In this group of older dentate individuals, periodontitis was significantly associated with airflow limitation independent of other known risk factors.