Samples of subgingival bacteria were collected with a clean curette from two relatively normal and two periodontally diseased sites in each of 12 patients with advanced periodontal disease. The samples were suspended in physiologic saline containing 1 % gelatin and examined within 1 hour by darkfield microscopy. From 100‐200 bacteria were classified on a percentage basis into one of the following categories: (1) coccoid cells, (2) straight rods, (3) filaments, (4) fusiforms, (5) curved rods, (6) small spirochetes, (7) medium‐sized spirochetes, (8) large spirochetes, and (9) motile rods. For each area sampled the following clinical criteria were also recorded: (1) Gingival Index, (2) Plaque Index, (3) probing depth and (4) gingival fluid flow. For each patient separate mean values were calculated for the normal and the diseased sites. The results indicated that significant differences existed in the microbial flora of clinically normal and diseased sites using a paired t‐test comparison (2α= 0.001), with coccoid cells more predominant at normal sites (74.3 % vs. 22.3 %), while at diseased sites motile rods were more frequent (12.7 % vs. 0.3 %), as well as curved rods (1.7 % vs. 0 %), small spirochetes (12.6 % vs. 1.1 %), medium‐sized spirochetes (18.5 % vs. 0.5 %) and large spirochetes (6.7 % vs. 0.2 %). The ratio of motile to non‐motile cells in the normal was 1:49, whereas at diseased sites the ratio was in the vicinity of 1:1. These results clearly show that a different flora is associated with healthy and periodontally diseased sites in the same patient population and that these differences can be detected by means of a technique which is simple and readily adaptable to a clinical setting. The data obtained in this fashion may be useful in monitoring the effect of various treatment modalities on the periodontal flora and possibly in determining the presence or absence of active disease.

Twelve adult patients with severe chronic periodontitis were examined prior to treatment, and after 8 and 25 weeks following tbe start of treatment. Six subjects received tetracycline during weeks 1 and 2 and weeks 7 and 8, while the other six did not. All subjects were instructed in oral hygiene and received a series of scaling and root planing treatments on one side only of their dentition. The contralateral side received no scalings at any time. The experiment was designed to provide clinical and microbiological data at the 0‐, 8‐ and 25‐week intervals for at least six sites in each of four groups, namely untreated sites (T0S0), sites which were scaled only (T0S1), sites which received tetracycline only (T1S0) and sites which were scaled and were exposed to tetracycline (T1S1). In addition, biopsies of initially diseased sites which had been treated or left untreated were evaluated by light and electron microscopy at all time intervals. The results indicated that T0S0 sites remained more or less unchanged with respect to all parameters during the 25‐week period, with the exception of a decrease in PII scores due to improved oral hygiene. T0S1 sites showed a marked clinical improvement between time 0 and 8 weeks, i.e. reduced PII and GI scores and reduced probing depth; the microbial flora showed an increase in the proportion of coccoid cells with a concomitant decrease in motile rods and spirochetes; the plasma cell‐dominated infiltrated connective tissue (ICT) showed a significant decrease in the proportion of plasma cells with a corresponding increase in lymphocytes; evidence of collagen deposition was also observed histologically. This 8‐week status persisted after 25 weeks, but in addition the tissues showed an increase in the proportion of fibrobiasts and a decrease in the proportion of lymphoblasts. T1S0 sites showed a similar improvement in the clinical and microbiological parameters at 8 weeks, but tbe ICT showed only a moderate reduction in the proportion of dead and unidentified cells. After 25 weeks, tbe clinical parameters remained unchanged from the 8‐week interval, but the microbial composition and the tissue characteristics showed a significant rebound toward the values observed at baseline. T1S1 sites showed essentially similar changes in the clinical, microbiological and tissue characteristics as the T0S1 sites for all time intervals. However, in the presence of the antibiotic the 8‐week proportions of coccoid cells were higher and those for motile rods and spirocbetes lower. Evaluation of all biopsied sites revealed a positive correlation between the proportion of plasma cells in the ICT and the proportion of spirochetes in the associated microflora. The results suggest that the microflora of healthy and periodontally diseased sites differ and that some of these differences are associated with detectable differences in the composition of the ICT. Mechanical debridement and/or treatment with tetracycline cause changes in the clinical, microbiological and histological parameters. Disco...

A randomly selected sample of adult subjects living in a Swedish county was examined for the presence of oral mucosal lesions. Nine hundred twenty (920, 95%) of the selected sample of 967 subjects, comprising approximately 0.75% of the total adult population, were examined; lesions were registered in 596 of the 920. The registered prevalence levels were very similar to earlier reported data from Sweden. Further, the relationship between tobacco habits and mucosal lesions was analyzed and the time needed for treatment of the lesions was estimated. A positive correlation could be demonstrated between tobacco use and leukoplakia, frictional white lesion, coated tongue, hairy tongue and excessive melanin pigmentation, while a negative correlation was observed for geographic tongue and aphthous ulcers. Approximately 70% of the lesions were associated with local irritants (e.g. dentures, tobacco, cheek and lip biting etc.). The estimated mean time required for registration and management of oral mucosal lesions in the studied group of adults was 24 min per individual.

A random sample of 967 subjects selected from the total population in a Swedish county were examined radiographically regarding prevalence and quality of endodontic treatment and occurrence of periapical lesions. The relationship between the technical standard of endodontic treatment and the occurrence of periapical lesions was also analyzed. Of the selected individuals, 95% attended examination (751 dentate and 169 edentulous individuals). Of the 17,430 teeth examined, 1,492 (8.6%) were endodontically treated. Approximately 70% of the treated root canals were inadequately obturated; 10% showed excess of root filling beyond the apex. The prevalence of periapical lesions was 2.9%, and 24.5% of the endodontically treated roots demonstrated periapical lesions. Root fillings ending more than 2 mm from apex had a significantly lower frequency of periapical lesions than root fillings ending within 2 mm of the apex. No difference in the frequency of periapical lesions was found between properly and improperly obturated root canals. Excess of root filling material beyond the apex was related to a significantly higher frequency of periapical lesions.

The prevalence of malocclusion, the need for and the demand for orthodontic treatment was studied in a randomly selected adult Swedish population > or = 20 years of age. Nine-hundred-and-twenty subjects were examined of whom 669 had their own teeth in occlusion. From those a group of 157 subjects was selected on the basis of objective need and/or subjective demand for orthodontic treatment. The various regimens of treatment required in this group were investigated. The prevalence of malocclusion ranged from 17 to 53 per cent in the various age groups. The spectrum of malocclusion was similar to that previously reported in Swedish children. The awareness of their malocclusion was higher among younger than older subjects and among those who had severe malocclusion. Objective treatment need, evaluated by two experienced orthodontists, was estimated at 11 per cent of the total population, whilst orthodontic treatment was requested by approximately 5 per cent of the population studied.

The aim of this study was to determine the prevalence and localization of interproximal periodontal intrabony defects (IPIDs) in the total adult population of a Swedish county. On each interproximal tooth surface (third molars excluded) in 733 randomly selected dentate individuals aged 20 years and over, one examiner recorded from x5-magnified periapical radiographs, the presence or absence of IPID with a width and depth of at least 5 and 10 mm, respectively, representing 1 and 2 mm unmagnified. Intra-examiner reproducibility determined from double recordings was substantial (kappa = 0.66). Recordings of IPID were compared with those performed by 24 specialist periodontists using their own diagnostic criteria. IPIDs were recorded in 32% of the 733 examined individuals; the number of defects per individual ranged from 1 to 15. The prevalence of IPID increased with increasing age and IPID occurred more frequently in men than in women. IPID was observed more frequently on mesial than on distal tooth surfaces, whereas there was no difference between maxillary and mandibular tooth surfaces. Symmetrical localizations of IPID in relation to the sagittal plane were observed.

The present study evaluated the long-term prognosis of tunnel preparations performed in a large number of teeth with advanced periodontal furcation defects. One hundred seven (107) patients, in which 156 teeth had been treated by tunnel preparations, were recalled for an evaluation, which was based on a questionnaire, a clinical examination, and radiographs; 102 patients attended (149 teeth = 95%). The mean observation time per tooth was 37.5 months (range 10 to 107 months). The results showed that 10 teeth (6.7%) had been extracted and 7 teeth (4.7%) hemisected. The indication for 12 of these extractions or hemisections was root caries. Among the remaining 132 teeth, 23 (15.4%) showed initial or established caries. There was no relationship between caries development and length of the observation time. Thus, approximately 75% of the teeth were still caries-free and in function. The findings demonstrated that tunnel preparations have a considerably better prognosis than previously reported and should be considered a valid treatment alternative.

In the present investigation an in vivo method is described for studying the chemotactic activity elaborated by factors in human dental plaque. Plaque was sampled from the buccal and lingual surfaces of teeth from dental students, who had refrained from mechanical tooth cleansing during one 4 and one 8 day period. The plaque samples were suspended in 0.15 M NaCl, homogenized, and centrifuged at 12,100 × g for 30 minutes at 4°C. The plaque supernatant was then separated from the cellular pellet and sterile filtered through a 0.45 μ Millipore filter. The chemotactic activity elaborated by the filtrates was examined in (i) Boyden's in vitro chamber (ii) a wound chamber model described by Lundgren and Lindhe (1970). The results showed (i) that the wound chamber method is well suited for studying leukocyte chemotactic activity elaborated by dental plaque (ii) that factors in dental plaque stimulate the emigration mainly of neutrophils (iii) that there is no increase in the amount of chemotactic factors/mg plaque with increasing age of the plaque. Data from the wound chamber experiments further revealed that the plaque filtrates tested do not markedly influence the permeability to plasmaproteins and water of granulation tissue vessels.