Periodontal inflamed surface area (PISA) is a new clinical index of periodontal disease that represents the inflamed area in periodontal tissue. It is considered to be a useful index even for medical professionals other than dentists, to understand the degree of inflammation of periodontal disease. However, the reference values of PISA and the criteria for both the severity of periodontal disease and the effects of treatment are still unknown. We retrospectively examined the values of PISA in each phase of periodontal treatment, based on data obtained from computerized dental records prepared by applicants for accredited dentists recognized by the Japanese Society of Periodontology (JSP) as JSP Board Certified Periodontists, and proposed reference values of PISA to show the degree of inflammation associated with periodontal treatment. PISA was calculated for 113 cases from 8 institutions by the method of Nesse et al., from the probing pocket depth and bleeding on probing (BOP). The results revealed a median value of PISA of 1,271.4 mm² at the first examination, 211.8 mm² at the end of the initial preparation, 52.1 mm² at supportive periodontal therapy (SPT) transition, and 30.0 mm² at the latest SPT. Moreover, PISA was highly correlated with BOP (p<0.001), and in fact, reflected the treatment effect more sensitively than BOP. Our findings revealed that periodontal inflammation with a PISA value of approximately 1,500 mm² at the first examination decreased to less than 100 mm² (approximately 7%) at SPT. Further accumulation of data and more detailed analysis could lead to PISA being developed as a useful index for conveying the severity of periodontal disease in cooperative medical and dental practice.

Diagnosis and treatment outcomes of periodontal disease have typically been evaluated using biomedical data such as probing depth. Recently, however, there is greater research focus on quality of life (QOL) in medical treatment. This study therefore aimed to clarify the relationship between periodontal disease severity and oral health-related QOL. Information was extracted from medical records of patients aged 30-64 years and who visited Nakai Dental Office for the first time between November 2014 to July 2017. Severity of periodontal disease was diagnosed by results of a baseline periodontal examination, and then scored in accordance with the Community Periodontal Index and classified into four groups: (C, P1, P2, P3). QOL was assessed using the total score and seven subdomain scores from the Oral Health Impact Profile Short Version (OHIP-14). The Kruskal-Wallis test was then used to compare among the four groups of the total score of OHIP-14 and the seven subdomain scores. Comparison of the groups' total OHIP-14 scores showed significant differences between P1 and P3 and between P2 and P3, while P3 had a significantly higher score than other groups. Comparison of the groups' OHIP-14 subdomain scores showed significant differences between P1 and P3 and between P2 and P3 for "functional limitation," and between P1 and P3 for "psychological discomfort," while P3 had a significantly higher total score than other groups. There were no significant between-groups differences for the other five subdomain scores. Functional limitations was assessed subjectively as difficulty in chewing and food getting caught between teeth. Anxiousness and negativity regarding the dental problem were reported among psychological discomfort. Oral function appeared to subjectively decrease, while discomfort increased with worsening of periodontal disease. In general, QOL worsened. Among the subjects, severity of periodontal disease was associated with oral-health-related QOL. It was suggested that patients with more severe periodontal disease had subjectively more impaired oral function, more discomfort, and lower QOL.

We report the case of a tuberous sclerosis complex (TSC) patient with severe chronic periodontitis, in whom we undertook intensive non-surgical periodontal treatment under general anesthesia and continuous supportive periodontal therapy (SPT) under intravenous sedation. The 43-year-old male patient visited our clinic with the chief complaint of tooth movement. He had never received periodontal treatment because of his maladaptation to dental treatment.

Periodontal examination revealed gingival inflammation with easy bleeding, deep periodontal pockets with pus discharge, and intense tooth mobility. His severe intellectual disability interfered with his brushing his teeth by himself and also caused him to refuse being assisted for brushing his teeth. We performed full-mouth scaling and root planing (SRP) under general anesthesia, in combination with antimicrobial therapy, and started the patient on SPT under intravenous sedation. These interventions led to a dramatic improvement in the patient's periodontal tissue condition and also led to improvements in his daily life, such as his beginning to allow being assisted with toothbrushing and his becoming more expressive.

People with disabilities frequently show early-onset infected periodontitis, which often becomes severe by middle age. While these patients have dental care needs, they/their families often find it difficult to identify dental clinics that would accept people with disabilities. Also, there are relatively few dental clinics that are equipped sufficiently to provide appropriate dental services for severely disabled people. We report this case to emphasize the need to recognize the current situation in relation to the problems of dentistry for the disabled, who are at a high risk of periodontal disease. We consider that it is necessary to strengthen cooperation among primary, secondary, and tertiary dental-medical institutions and local communities such as schools and other facilities, to enable dental intervention at an early stage in the disabled.