Review of a Journal Article on a Gingival Disease
The journal article I chose to summarize is called “Sulcular Sulfide Monitoring: An indicator of Early Dental Plaque-Induced Gingival Disease” from the Journal of Dental Hygiene. I found this article very interesting and hope that you do too!
Periodontal disease is an umbrella term that includes gingivitis and periodontitis, both of which are gingival diseases. The most common type of gingivitis is dental plaque-induced gingivitis. Research has shown that most forms of gingivitis are caused by the presence of specific pathogens in the plaque. When gram-negative bacteria enter the connective tissue of the periodontium, the cascade of events including the inflammatory response, leads to tissue destruction (periodontitis). These gram-negative bacteria “have the potential to generate volatile sulfur compounds (VSC), specifically, hydrogen sulfide (H2S), methyl mercaptan (CH3SH), and dimethyl sulfide (CH3SCH3)” as a byproduct from their metabolism (Pavolotskaya, McCombs, Darby, Marinak, Dayanand, 2006). Volatile sulfur compounds, like those mentioned, cause individuals to have bad breath also known as halitosis. Studies have shown that these byproducts are linked to periodontal disease. The toxic sulfide compounds accumulate in the periodontal pockets which can alter the solubility of the collagen fibers making it more susceptible to enzymatic destruction. The research that has been done supports the theory that there is a direct correlation between VSC’s and the severity of periodontal disease.
When plaque, bacteria, and the byproducts of the bacteria interact with the host, the inflammatory response is activated and tissue destruction may occur. By clinically recording bleeding on probing (BOP) and the gingival index (GI) clinicians are able to classify the extent of the gingival disease. Due to the correlation between VSC and gingival disease, the presence of these sulfur compounds should alert the clinician that disease may be present. A device known as the “Diamond Probe/Perio 2000 System™” (Pavolotskaya et al., 2006) can detect and measure the presence of the gram-negative bacteria’s sulfide byproducts in the gingival sulcus, giving the clinician a better understanding of the patient’s condition.
Thirty-nine individuals were chosen between the ages of 19 and 62. The requirements of the individuals were that they must be in “good general health, not pregnant, free of orthodontic and prosthetic appliances, had a Gingival Index score of 0 to 1, and were free of antibiotics for one month prior to data collection”. Of these participants, 28 were women, 11 were men and the average age was 25.67. The mandibular arch was divided into a hygiene quadrant and non-hygiene quadrant which served as the individuals control. At the start of the study, everyone received the same type of soft toothbrush and fluoride toothpaste without any added ingredients to control gingivitis or calculus formation. The individuals were instructed to avoid oral hygiene care on the non-hygiene side for 21 days and to continue their daily oral hygiene care on the hygiene side of their mandibular teeth. Mouth rinse was not indicated during the duration of the study. Periodontal probing of the full mouth was performed at four sites (distofacial, facial, mesiofacial, and midlingual) of each tooth. This full mouth PPD served to determine the baseline periodontal health status. “GI, BOP, and SUL scores were obtained at the same four sites at baseline and three subsequent data collection appointments over a 21-day period” (Pavolotskaya et al., 2006). Following the study, all of the participants were offered oral hygiene care to ensure that they returned to their baseline gingival health status. The Diamond Probe/Perio 2000 system (see image above) was used according to the manufactures directions. This system has a lighted display, an audible tone and provides quantitative sulfide levels when contacted in the GCF. "The digital format displays a measurement of sulfides ranging from 0 to 10,000 units quantified in increments of 0.5" (Pavolotskaya et al., 2006). The Diamond Probe/Perio 2000 system was used in each four of the gingival areas that were previously assessed, and were given a GI score from 0 to 3; 0 being normal gingival status and 3 being severe inflammation-marked redness and edema, ulceration and spontaneous bleeding. BOP was recorded as either 0 (absent) or 1 (present). After each measurement, the probe was removed and washed off to remove residual sulfides.
Throughout the study, the average GI, BOP, SUL scores were higher on the non-hygiene side versus the hygiene side. The results also showed that on the non-hygiene side, from baseline to day 7, the GI scores increased considerably and continued to increase, peaking at the end of the study. On the contrary, the GI scores for the hygiene side remained fairly stable, increasing slightly over the length of the study, but were far below the scores of the non-hygiene side for the duration of the entire study. BOP scores for the non-hygiene side revealed steady increase from baseline to day 14, followed by a rapid increase from days 14-21, whereas the hygiene side revealed no significant changes from baseline to day 7, a slight increase for the next week, followed by a slight decrease to day 21. Finally, the SUL concentrations on the non-hygiene side continued to be elevated throughout the duration of the study. SUL readings on the non-hygiene side showed a slow rise from baseline to day 7, followed by a continued increase to day 14, and then a fast increase until the end, day 21. SUL readings on the hygiene were significantly lower in comparison to the non-hygiene side for the duration of the study. The results of the hygiene side were steady for the first week, followed by a slight increase from day 7-14 and then persisted to increase until the end, day 21. A Pearson correlation test was performed and the “results suggest that with progression of gingivitis, there is an increase in the strength of the positive correlation between SUL, BOP, and GI” (Pavolotskaya et al., 2006) however, the analysis showed that this correlation was stronger on the non-hygiene side. The data collected during this study propose that SUL and BOP appear at the same time clinically, however they appear after gingival inflammation is clinically visible. More research and studies would need to be performed in order to show SUL as “a valid indicator of early plaque-induced gingival disease and to determine how sulfide levels in the gingival sulci relate to ongoing gingivitis” (Pavolotskaya et al., 2006).
Traditionally, when evaluating the health of the periodontium, the assessments utilized are assessing gingival inflammation, probing, clinical attachment loss, BOP, in combination with a radiographic examination to determine if bone loss in present. In order to foresee premature disease activity before clinically visible changes take place, a reliable, easy to use assessment tool would need to be used. This study used the Diamond Probe/Perio 2000 System to act as an assessment tool to detect sites that had elevated sulfide levels in the early onset of gingivitis in the absence of clinical signs. I found this article to be extremely interesting. In clinic, we do the typical assessments mentioned above, to assign the patient a case type for their visit in order to monitor changes in the future visits. The idea of incorporating another assessment tool to be used in order to detect gingival disease before it starts to damage the tissue is very exciting. I am interested to see where this will go in the future, and to see if this will be incorporated into the assessments that I perform on patients for early detection of gingival disease.
Citation:
Pavolotskaya, A., McCombs, G., Darby, M., Marinak, K., & Dayanand, N. (2006). Sulcular sulfide monitoring: an indicator of
early dental plaque-induced gingival disease. Journal Of Dental Hygiene, 80(1), 11.
**Images retrieved from google.com/images**