RESUMEN
BACKGROUND: A previous study reported by this group found that patients in periodontal maintenance programs taking vitamin D and calcium supplementation had a trend for better periodontal health compared to patients not taking supplementation. The objective of the present study is to determine, for the same cohort of subjects, whether such differences persist over a 1-year period. METHODS: Fifty-one patients enrolled in maintenance programs from two dental clinics were recruited. Of these, 23 were taking vitamin D (≥400 IU/day) and calcium (≥1,000 mg/day) supplementation, and 28 were not. All subjects had at least two interproximal sites with ≥3 mm clinical attachment loss. For mandibular-posterior teeth, gingival index, plaque index, probing depth, attachment loss, bleeding on probing, calculus index, and furcation involvement were evaluated. Photostimulable-phosphor, posterior bitewing radiographs were taken to assess alveolar bone. Daily vitamin D and calcium intakes were estimated by nutritional analysis. Data were collected at baseline, 6 months, and 12 months. RESULTS: Total daily calcium and vitamin D intakes were 1,769 mg (95% confidence interval, 1,606 to 1,933) and 1,049 IU (781 to 1,317) in the taker group, and 642 mg (505 to 779) and 156 IU (117 to 195) in the non-taker group, respectively (P <0.001 for both). Clinical parameters of periodontal health improved with time in both groups (P <0.001). When clinical measures were considered collectively, the differences between supplement takers and non-takers had the following P values: baseline (P = 0.061); 6 months (P = 0.049); and 12 months (P = 0.114). After adjusting for covariates, the P values for the effect of supplementation were as follows: baseline (P = 0.028); 6 months (P = 0.034); and 12 months (P = 0.058). CONCLUSIONS: Calcium and vitamin D supplementation (≤1,000 IU/day) had a modest positive effect on periodontal health, and consistent dental care improved clinical parameters of periodontal disease regardless of such supplements. Our findings support the possibility that vitamin D may positively impact periodontal health and confirm the need for randomized clinical trials on the effects of vitamin D on periodontitis.
Asunto(s)
Calcio de la Dieta/uso terapéutico , Periodontitis Crónica/prevención & control , Suplementos Dietéticos , Vitamina D/uso terapéutico , Vitaminas/uso terapéutico , Anciano , Anciano de 80 o más Años , Pérdida de Hueso Alveolar/clasificación , Pérdida de Hueso Alveolar/prevención & control , Calcio de la Dieta/administración & dosificación , Calcio de la Dieta/análisis , Periodontitis Crónica/clasificación , Estudios de Cohortes , Cálculos Dentales/clasificación , Índice de Placa Dental , Profilaxis Dental , Raspado Dental , Femenino , Estudios de Seguimiento , Análisis de los Alimentos , Defectos de Furcación/clasificación , Defectos de Furcación/prevención & control , Hemorragia Gingival/clasificación , Hemorragia Gingival/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Higiene Bucal , Pérdida de la Inserción Periodontal/clasificación , Pérdida de la Inserción Periodontal/prevención & control , Índice Periodontal , Bolsa Periodontal/clasificación , Bolsa Periodontal/prevención & control , Estudios Prospectivos , Radiografía de Mordida Lateral , Aplanamiento de la Raíz , Vitamina D/administración & dosificación , Vitamina D/análisis , Vitaminas/administración & dosificación , Vitaminas/análisisRESUMEN
BACKGROUND: It has been suggested that eccentric occlusal forces may be an etiologic factor for abfraction lesions. It has also been suggested that traumatic occlusal forces may have a damaging effect on the periodontal tissues. The purpose of this study was to determine whether associations were present between premature contacts in centric relation (PCCR), clinical attachment loss, and abfraction lesions. METHODS: Forty-six subjects were examined. Within subjects, the mean attachment loss was determined for teeth with and without PCCR and for teeth with and without abfractions. In addition, teeth with PCCR (experimental group) were matched with contralateral teeth without PCCR (control group). Comparisons between groups were made with the Wilcoxon signed rank test, Wilcoxon rank sums test, and the Spearman rho correlation coefficient. RESULTS: The results demonstrated that attachment loss increased with age. Within subjects, teeth with abfraction lesions had significantly more buccal attachment loss than teeth without abfraction lesions (P <0.01). The majority of abfractions and PCCR occurred in premolars. The presence of PCCR had no influence on the appearance of an abfraction lesion or increased attachment loss. Similarly, subjects who exhibited abfractions had similar attachment loss as those subjects without abfraction lesions. CONCLUSIONS: Within the same patient, teeth with abfractions presented more attachment loss than those without abfractions. However, associations were not demonstrated between PCCR and the presence of abfractions or increased attachment loss. Future studies are needed to improve the knowledge regarding interactions among occlusal factors, attachment loss, and abfractions.
Asunto(s)
Relación Céntrica , Oclusión Dental Traumática/complicaciones , Pérdida de la Inserción Periodontal/etiología , Desgaste de los Dientes/etiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Diente Premolar/patología , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Registro de la Relación Maxilomandibular/métodos , Masculino , Persona de Mediana Edad , Diente Molar/patología , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: A low dietary intake of vitamin D and calcium hastens bone loss and osteoporosis. Because vitamin D metabolites may also alter the inflammatory response and have antimicrobial effects, we studied whether the use of vitamin D and calcium supplements affects periodontal disease status. METHODS: A cohort of 51 subjects receiving periodontal maintenance therapy was recruited from two dental clinics; 23 were taking vitamin D (>or=400 IU/day) and calcium (>or=1,000 mg/day) supplementation, and 28 were not taking such supplementation. All subjects had at least two interproximal sites with >or=3 mm clinical attachment loss. Daily calcium and vitamin D intake (from food and supplements) were estimated by nutritional analysis. The following clinical parameters of periodontal disease were recorded for the mandibular posterior teeth: gingival index, probing depth, cemento-enamel junction-gingival margin distance (attachment loss), bleeding on probing, and furcation involvement. Posterior photostimulable-phosphor bitewing radiographs were taken to determine cemento-enamel junction-alveolar crest distances (alveolar crest height loss). Data were analyzed with a repeated-measures multivariate analysis of variance. RESULTS: Compared to subjects who did not take vitamin D and calcium supplementation, supplement takers had shallower probing depths, fewer bleeding sites, lower gingival index values, fewer furcation involvements, less attachment loss, and less alveolar crest height loss. The repeated-measures analysis indicated that collectively these differences were borderline significant (P = 0.08). CONCLUSIONS: In these subjects receiving periodontal maintenance therapy, there was a trend for better periodontal health with vitamin D and calcium supplementation. More expanded longitudinal studies are required to determine the potential of this relationship.
Asunto(s)
Calcio de la Dieta/uso terapéutico , Periodontitis Crónica/prevención & control , Suplementos Dietéticos , Vitamina D/uso terapéutico , Vitaminas/uso terapéutico , Anciano , Anciano de 80 o más Años , Pérdida de Hueso Alveolar/clasificación , Pérdida de Hueso Alveolar/prevención & control , Proceso Alveolar/patología , Periodontitis Crónica/clasificación , Estudios de Cohortes , Estudios Transversales , Femenino , Defectos de Furcación/clasificación , Defectos de Furcación/prevención & control , Encía/patología , Hemorragia Gingival/clasificación , Hemorragia Gingival/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Pérdida de la Inserción Periodontal/clasificación , Pérdida de la Inserción Periodontal/prevención & control , Índice Periodontal , Bolsa Periodontal/clasificación , Bolsa Periodontal/prevención & control , Radiografía de Mordida Lateral , Cuello del Diente/patologíaRESUMEN
OBJECTIVES: The aim was to demonstrate methods for determining measurement precision and to determine the precision of alveolar bone measurements made with a vacuum-coupled positioning device and phosphor plate images. STUDY DESIGN: Subjects were rigidly attached to the x-ray tube by means of a vacuum coupling device and custom cross-arch bite plates. Original and repeat radiographs (taken within minutes of each other) were obtained of the mandibular posterior teeth of 51 subjects, and cementoenamel junction-alveolar crest (CEJ-AC) distances were measured on both sets of images. In addition, x-ray transmission (radiodensity) and AC height differences were determined by subtracting one image from the other. Image subtractions and measurements were performed twice. Based on duplicate measurements, the root mean square standard deviation (precision) and least significant change (LSC) were calculated. LSC is the magnitude of change in a measurement needed to indicate that a true biologic change has occurred. RESULTS: The LSCs were 4% for x-ray transmission, 0.49 mm for CEJ-AC distance, and 0.06 mm for crest height. CONCLUSION: The LSCs for our CEJ-AC and x-ray transmission measurements were similar to what has been previously reported. The LSC for AC height (determined with image subtraction) was <0.1 mm. Compared with findings from earlier studies, this represents a highly precise measurement of AC height. The methods demonstrated for calculating LSC can be used by investigators to determine how large changes in radiographic measurements need to be before the changes can be considered to be (with 95% confidence) true biologic changes and not noise (i.e., equipment/observer error).