No abstract

Papillon Lefèvre syndrome (PLS) is an autosomal recessive disorder characterized by palmoplantar hyperkeratosis and severe periodontitis. The disease is caused by mutations in the cathepsin C gene (CTSC) that maps to chromosome 11q14. CTSC gene mutations associated with PLS have been correlated with significantly decreased enzyme activity. Mutational analysis of the CTSC gene in three North American families segregating PLS identified four mutations, including a novel mutation p.G139R. All mutations were associated with dramatically reduced CTSC protease enzyme activity. A homozygous c.96T>G transversion resulting in a p.Y32X change was present in a Mexican PLS proband, while one Caucasian PLS proband was a compound heterozygote for the p.Y32X and p.R272P (c.815G>C) mutations. The other Caucasian PLS proband was a compound heterozygote for c.415G>A transition and c.1141delC mutations that resulted in a p.G139R and a frameshift and premature termination (p.L381fsX393), respectively. The c.415G>A was not present in more than 300 controls, suggesting it is not a CTSC polymorphism. Biochemical analysis demonstrated almost no detectable CTSC activity in leukocytes of all three probands. These mutations altered restriction enzyme sites in the highly conserved CTSC gene. Sequence analysis of CTSC exon 3 confirmed the previously reported p.T153I polymorphism in 4 of the 5 ethnically diverse populations studied.

Interdental gingival tissues are designated inflamed on the basis of their color and bleeding after stimulation. Gingival bleeding was previously shown in histological studies to indicate the presence of inflammatory lesions. The present study was undertaken to determine associations between bleeding and visual signs of interdental gingival inflammation. Each interdental site in 82 males, aged 18 to 30, was evaluated for the presence or absence of visual signs of inflammation. The interdental sites on one side of the mouth were evaluated for bleeding tendency using the Papilla Bleeding Index (PBI), while the other half was evaluated using the Eastman Interdental Bleeding Index (EIBI). The percentage of inflamed areas detected with the EIBI and visual method was similar and significantly higher than with the PBI. When the visually noninflamed sites were examined, 38.5% of these areas bled, indicating that interdental inflammatory lesions existed in the absence of visual signs of inflammation. Of the sites that bled but were visually noninflamed, 33.1% were detected using the PBI, while 66.9% were detected using the EIBI. The Eastman Interdental Bleeding Index was a more reliable clinical indicator for detecting interdental inflammatory lesions than the Papilla Bleeding Index.

The aim of this study was to determine the effects of personal oral hygiene and subgingival scaling on bleeding interdental gingiva. The Eastman Interdental Bleeding Index (EIBI) was used to clinically evaluate interdental gingival status. Forty-seven bleeding interdental sites in 47 patients were divided into three groups. Sites in Group I bled on stimulation with wooden interdental cleaners. Groups II and III initially bled but were converted to nonbleeding with oral hygiene alone or oral hygiene combined with subgingival scaling, respectively. Interdental gingival biopsies were obtained and subjected to morphometric analysis to compare the three groups. The findings from this study indicated that: (A) personal oral hygiene reduced the magnitude and extent of the interdental inflammatory lesion; (B) subgingival scaling plus oral hygiene decreased the interdental inflammatory lesion to a greater extent than oral hygiene alone; (C) significant repair of the interdental lesion occurred within four weeks; and (D) the EIBI was an effective method for monitoring the effects of therapy directed towards resolution of the interdental inflammatory lesion.

Ultrasonic and sonic scalers appear to attain similar results as hand instruments for removing plaque, calculus, and endotoxin. Ultrasonic scalers used at medium power seem to produce less root surface damage than hand or sonic scalers. Due to instrument width, furcations may be more accessible using ultrasonic or sonic scalers than manual scalers. It is not clear whether root surface roughness is more or less pronounced following power-driven scalers or manual scalers. It is also unclear if root surface roughness affects long-term wound healing. Periodontal scaling and root planing includes thorough calculus removal, but complete cementum removal should not be a goal of periodontal therapy. Studies have established that endotoxin is weakly adsorbed to the root surface, and can be easily removed with light, overlapping strokes with an ultrasonic scaler. A significant disadvantage of power-driven scalers is the production of contaminated aerosols. Because ultrasonics and sonics produce aerosols, additional care is required to achieve and maintain good infection control when incorporating these instrumentation techniques into dental practice. Preliminary evidence suggests that the addition of certain antimicrobials to the lavage during ultrasonic instrumentation may be of minimal clinical benefit. However, more randomized controlled clinical trials need to be conducted over longer periods of time to better understand the long-term benefits of ultrasonic and sonic debridement.