The purpose of this study was to examine relation between oral malodor and the clinical status, and the relationship between the improvement rate of oral malodor and the clinical periodontal parameters after initial periodontal therapy was investigated. Eighty-seven subjects diagnosed to have slight chronic periodontitis were selected from patients who visited the periodontal clinic of Matsudo hospital at Nihon University (Study 1).
Of these 87, 38 selected patients were administered initial periodontal therapy. (Study 2)
We measured oral malodor with a portable sulphide monitor (Breathtron^®)and some clinical parameters, including the probing depth (PD), bleeding on probing (BOP), plaque control record (PCR), tooth mobility, gingival recession and tongue coating. These clinical periodontal parameters were recorded pre- and post- treatment following the initial periodontal therapy. The results obtained were as follows. (1) There were significant correlations between oral malodor as measured with Breathtron^® and the BOP and PCR. No significant correlation was observed between oral malodor and tongue coating, perhaps because few patients showed tongue coating in this study. (2) The degree of oral malodor was reduced significantly following the initial periodontal treatment, and that this tendency towards reduction of the oral malodor was in accordance with the recovery of the clinical dental status. (3) It was revealed that the improvement rate of oral malodor was correlated with the recovery rate of PD, BOP and PCR at practically sites.
It has been reported that oral malodor as measured by Breathtron^® does not reflect the source and effect of the substance responsible for the oral malodor. However, our study results suggest that Breathtron^® is a useful device for a motivation to undergo initial periodontal therapy.
Nihon Shishubyo Gakkai Kaishi (J Jpn Periodontol) 49 : 191-197,2007.

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A relationship between periodontal degradation and smoking has been demonstrated by epidemiological evidence. While the mechanism of this effect remains unknown, it may be related to a host-response reaction. The aim of this study was to investigate the effects of smoking on gingival neutrophil elastase activity and biochemical markers of periodontal degradation in subjects with active/passive smoking. Sixty-eight subjects with moderate chronic periodontitis were examined. Clinical records of the periodontal probing depth (PD), plaque index (PlI), gingival index (GI) and amount of gingival crevicular fluid (GCF) were made in each individual. The extracellular elastase activity was measured in GCF samples using a chromogenic low molecular substrate, while α1-antitrypsin, elastase α1-antitrypsin complex and saliva cotinine levels were measured using ELISA. The following results were obtained. 1) Smokers had a significantly lower GI than non smokers. 2) Based on the amount of saliva cotinine, 22 of the self-reported non-smokers were actually passive smokers, and 12 were actually non-smokers. 3) The non/passive-smokers had significantly lower extracellular elastase activities than the non-smokers. 4) No significant differences in the α1-antitrypsin and elastase α1-antitrypsin complex levels were observed between non-smokers, passive smokers, and smokers. 5) The amount of saliva cotinine was weakly correlated with the α1-antitrypsin concentration in smokers. These results indicated that passive smoking/smoking altered the gingival neutrophil elastase activity and the amount of α1-antitrypsin,suggesting that passive smoking/smoking may interfere with the periodontal host defense system. Furthermore, alterations in the amount of α1-antitrypsin in the GCF appear to be a biochemical marker of periodontal degradation in individuals with a passive smoking/smoking habit. Nihon Shishubyo Gakkai Kaishi (J Jpn Periodontol) 49: 198-206, 2007.

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The aim of this study was to compare pain relief effects after periodontal flap surgery among Nd : YAG laser irradiation, Er : YAG laser irradiation and the administration of anti-inflammatory drugs in the same patients, using a Visual Analogue Scale (VAS). Ninety teeth from 11 patients were included in this study. Ninety teeth were divided into three groups. In the experimental group 1 (Exp-1) (n = 33 teeth), the root surface, bone defect and the inside of gingival flap were irradiated with an Nd : YAG laser after root planing and bone defect debridement (3.0 W, 30 sec, 3 times). In experimental Group2 (Exp-2) (n = 29 teeth), the same areas, after the same treatments, were irradiated with an Er : YAG laser (1.0 W, 30 sec, 3 times). In addtion, in the Exp-1 and Exp-2 groups, the mucogingival junction was additionally irradiated with the same lasers, (1.5 W, 1 min, 3 times) immediately after surgery. In the control Group 3 (Cont) (n = 28 teeth), neither laser was used following flap surgery and anti-inflammatory drugs were administered after surgery as soon as possible. The VAS was performed immediately after surgery and at 1, 2, 3, 4, 5 and 6 hours in the first day and at 1, 2, 3, 4, 5 and 6 hours after getting up. The results of the statistical analysis indicated that VAS of the Exp-1 was significantly higher than that of the Cont immediately after surgery at 1 hour in the first day, however, there was no statistically significant difference in the second day (p<0.05). Based on the findings of this limited study, Nd : YAG laser irradiation, Er : YAG laser irradiation and the administration of anti-inflammatory drugs may have almost the same pain relief effect after periodontal flap surgery.
Nihon Shishubyo Gakkai Kaishi (J Jpn Periodontol) 49 : 207-214,2007.

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The relationship between various clinical parameters and probing attachment loss during periodontal therapy was retrospectively evaluated in habitual smokers. Twelve habitual smokers (smoking group : 1 woman, 11 men; mean age 54.5 ± 12.4 years) and 12 non-smokers (non-smoking group : 3 women and 9 men; mean age, 54.4 ± 9.8 years) who had received active periodontal therapy and maintenance care for at least 2 years at the dental hospital of Ohu University were enrolled. All subjects were clinically examined at baseline for the number of missing teeth (MT), probing pocket depths (PPD), clinical attachment levels (CAL), bleeding on probing scores (BOP), and plaque scores (PCR). Following the examination, all the patients received oral hygiene instructions and cause-related periodontal therapy. After treatment, all the subjects were followed up at regular intervals of 1 to 3 months. A re-examination, including an assessment of the same parameters as those studied at baseline, was performed after 2 years. The clinical parameters during the treatment period were investigated for their association with the percentage of sites with a probing attachment loss ≥ 2 mm over the 2-year period for each group of patients. The data were evaluated using the Spearman rank correlation. In the smoking group, little or weak relationships were observed for all clinical parameters. On the other hand, the number of missing teeth at re-examination, the percentage of sites with a CAL ≥ 5mm at baseline and at re-examination and / or the percentage of sites with a PPD ≥ 6mm at re-examination were significantly correlated with probing attachment loss in the non-smoking group. Thus,smoking may make Prediction of prognosis of periodontal therapy more difficult, and strict periodontal evaluations are necessary for habitual smokers.
Nihon Shishubyo Gakkai Kaishi (J Jpn Periodontol) 49 : 215-223, 2007.

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Calprotectin, a heterodimeric complex of S100A8 and S100A9, is an antimicrobial peptide (AMP) expressed in healthy or inflamed epithelium and epidermis. The expression of calprotectin and other AMPs in keratinocytes is regulated by proinflammatory cytokines, bacterial products and keratinocyte differentiation modulators. Interleukin-1α (IL-1α), an autonomous cytokine in keratinocytes, induces keratinocyte differentiation and up-regulates calprotectin expression. Since keratinocyte differentiation is also specifiedby interactions with the basement membrane and connective tissue proteins, we sought to learn whether calprotectin expression is affected by extracellular matrix (ECM) proteins in the presence or absence of IL-1α. Human immortalized epidermal keratinocytes (HaCaT cells) were grown in vitro on different ECM substrates including type I collagen (Col I), type IV collagen (Col IV), fibronectin (FN) and laminin (LM) with or without IL-1α and were then cultured in basement membrane extract (Matrigel)-coated dishes or on a feeder layer of fibroblasts. Calprotectin expression in the cultured cells was investigated using immunohistochemical and northern blot analyses, and an enzyme-linked immunosorbent assay. The four ECM proteins (Col I, Col IV, FN and LM) had little effect on calprotectin expression. IL-1α significantly increased the expression of S100A8/ S100A9 mRNAs and calprotecin protein in the cells cultured on each of the ECM(Col I, Col IV, FN and LM)-coated dishes,but these ECM protein substrates did not show a further effect on calprotectin expression in the presence of IL-1α. On the other hand, Matrigel and the fibroblast-feeder layer slightly decreased the expression of S100A8/S100A9 mRNAs in HaCaT cells. These results suggest that calprotectin expression in keratinocytes is regulated by cytokines during epithelial-mesenchymal interactions.Nihon Shishubyo Gakkai Kaishi (J Jpn Periodontol) 49 : 224-232,2007.

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This case report describes the treatment of a patient with severe chronic periodontitis who initially refused scheduled periodontal treatments but eventually began attending them after experiencing occlusal collapse of the mandibular posterior areas and a change in her living environment. The patient was 43-year-old woman who visited a clinic complaining of tooth crown collapse and gingival bleeding of the left mandibular premolar tooth. A periodontal tissue examination indicated that scheduled periodontal treatments were necessary. However, the patient refused to attend the treatments after her symptoms improved. Seven years later, the patient returned because of severe periodontitis in the mandibular posterior areas. The patient finally agreed to undergo regenerative treatments and implant therapy in addition to basic periodontal treatments. After the periodontal treatment, her periodontal tissue is good condition under the maintenance. And the patient's behavioral changes occurred for her systemic health. The patient started exercising to maintain her physical fitness and began attending regular health check-ups. Improving health awareness during dental care seems to be an important role of dental hygienists working in regional health care settings.
Nihon Shishubyo Gakkai Kaishi (J Jpn Periodontol) 49 : 233-238,2007.

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Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive disease characterized by palmoplantar hyperkeratosis and severe periodontal disease. We reported two siblings with PLS who were diagnosed using a mutation analysis of the cathepsin C gene. The siblings were a 24 year-old woman and a 21 year-old man. They had been referred to the Department of Dentistry and Oral Surgery from the Department of Dermatology, Aomori Prefectural Central Hospital, for a close examination and treatment of their periodontal disease. Both the patients exhibited keratinized erythema on their palms, plantar arches, cubiti, and patellae. The sister had mild plaque-induced gingivitis. However, the brother exhibited profound gingival inflammation and periodontal disease with advanced alveolar bone loss and severe tooth mobility and was subsequently diagnosed as having generalized periodontitis associated with a genetic disorder. Seventeen teeth were extracted, and periodontal surgery under a general anesthesia was performed for ten teeth. Consequently, the pocket depths of his remaining teeth decreased to less than 3 mm at most sites. Although more than 6 years have passed since the initial dental examination, his periodontal tissue has been well maintained and no further periodontal disease has occurred. The absence of severe periodontal destruction in the sister,who carried the same mutation in the cathepsin C gene, suggests that this mutation was not necessarily associated with severe periodontal disease. Moreover, as the brother achieved a favorable improvement after the initial treatment and periodontal surgery,patients with strong disposing genetic factors may be able to slow the progression of periodontal disease by receiving conventional periodontal treatments.
Nihon Shishubyo Gakkai Kaishi (J Jpn Periodontol) 49 : 239-249, 2007.

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A 45-year-old male with a noncontributory medical history was referred to our hospital in June of 1989, with a chief complaint of gingival bleeding of maxillary right lateral incisor. This case was diagnosed as chronic periodontitis with maxillary anterior teeth pathologic migration by secondary occlusal trauma, and was also leading to midline diastema, and posterior bite collapse. Following completion of the initial periodontal therapy by both periodontist and dental hygienist, the anterior diastema was spontaneously closed and supportive periodontal therapy started. The mean clinical attachment level, probing depth (PD) and the sites more than 4 mm PD were improved and maintained from 3.0mm, 2.9mm and 37 sites (22.2%) to 2.7mm, 2.3mm and no site in October of 2006 respectively. Periodontal conditions were stable and fulfilled the patient's desire to retain the teeth healthy for about 17 years from an initial visit without discontinuation of therapy.
Nihon Shishubyo Gakkai Kaishi (J Jpn Periodontol) 49 : 250-256,2007.

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Proteomics is the comprehensive study of all proteins, particularly their structures and functions. Additionally, proteomics aims to obtain functional information on proteins, building on the completion of the human genome project. One of the main tools used for studying proteomics is mass spectrometery, which measures the molecular weights of proteins. Mass spectrometery has been used to elucidate the causes, mechanisms and markers of many kinds of diseases. Very small amounts of proteins and their roles in systemic diseases can now be identified using mass spectrometery. We hope that proteomics will be applied as a new and excellent tool for the research and diagnosis of periodontal disease. To this end, we have optimized a mass spectrometry technique(MALDI-TOF-MS)for the research of periodontal disease using bovine serum albumin(BSA). We succeeded in determining the amino acid sequence of 1.52 pmol of BSA. Using this assay, the amino acid sequence of a protein can be determined using mass spectrometry if a protein concentration of at least 1.52 pmol(100 ng/μL)can be obtained. Therefore,these results show that very small amounts of protein in oral samples can be identified using mass spectrometry.
Nihon Shishubyo Gakkai Kaishi(J Jpn Periodontol)49: 257-263, 2007.

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