J Korean Acad Oral Health.  2012 Dec;36(4):333-340.

Effect of regular oral health care on aggressive periodontitis using Watanabe's tooth brushing method: case report

• Jo BD
• Jeong SK
• Lee KH
• Kim AH
• Lee BJ
• Kim DK

Abstract

OBJECTIVES
The purpose of this study was to evaluate the effect of regular oral health care using Watanabe's tooth brushing method on aggressive periodontitis.
METHODS
A 14-year-old female visited our clinic with the chief complaint of gingival swelling and teeth mobility in 2008. The present illness on the day of visit was gingivitis with swelling and redness on marginal gingiva, root exposure due to the attachment loss and gingival recession and the degree 3 mobility of #26, 36, 46 with no systemic disease and familial tendency. The panoramic radiograph showed the severe vertical and horizontal alveolar bone loss in the first molars. For the treatment, preventive care including tooth brushing instruction and professional tooth brushing using Watanabe's method and periodontal treatment using scaling and root planing, plaque control and antibiotics prescription were performed from the July, 2008 to September, 2012.
RESULTS
The patient could maintain all of her teeth without extraction except for one molar during the treatment period and symptoms of gingivitis decreased all over the oral region. But dental plaque level was not decreased.
CONCLUSIONS
The regular oral health care with professional toothbrushing by Watanabe's method was effective in relieving the gingival inflammation of patients with aggressive periodontitis.

Keyword

Aggressive periodontitis; Care; Oral health; Professional; Tooth cleaning; Toothbrushing

MeSH Terms

Aggressive Periodontitis
Alveolar Bone Loss
Anti-Bacterial Agents
Dental Plaque
Female
Gingiva
Gingival Recession
Gingivitis
Humans
Inflammation
Molar
Oral Health
Prescriptions
Root Planing
Tooth
Toothbrushing
Anti-Bacterial Agents

Figure

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  Fig. 1 Panoramic radiograph at first visit (2006. 8. 9) showing generalized and rapid resorption state of alveolar bone.

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  Fig. 2 Panoramic radiograph at re-visit (2008. 7. 29) showing more alveolar bone resorption and decreased amount of alveolar bone.

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  Fig. 3 Clinical photograph at initial preventive care (2008. 12. 30) showing no improvement in periodontitis despite the treatment including calculus removal, root planning and antibiotics prescription.

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  Fig. 4 Clinical photograph after 5 times of the second intensive preventive care (2009. 2. 5) showing no improvement in gingival swelling and gingival margin redness and ulceration.

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  Fig. 5 Clinical photographs at re-visit after 14 months without receiving preventive care (2010. 4. 22) showing progression of ulcerative gingivitis on gingival margins of buccal side of teeth.

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  Fig. 6 Clinical photograph after 11 months (2011. 3. 17) of second intensive preventive care showing improvement in upper and lower anterior gingivitis with some redness left on gingival margin.

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  Fig. 7 Clinical photos after 18 months (2011. 9. 22) of second intensive preventive care showing improved state of gingivitis on anterior and posterior gingival margin with gingival swelling left on premolar area.

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  Fig. 8 Panoramic radiograph after 18 months of second intensive preventive care (2011. 9. 22) showing more resorption pattern of alveolar bone around left first molars of maxillae and mandible.

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  Fig. 9 Clinical photos after 30 months (28 times) of second intensive preventive care (2012. 9. 27) with substantial decrease of gingivitis and swelling on anterior and posterior teeth and no ulcerative inflammation on marginal area.

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  Fig. 10 Changes of plaque control rate (100 - O'Leary plaque index) (%).

Reference

1. Lang N, Bartold PM, Cullinan M, Jeffcoat M, Mombelli A, Murakami S, et al. Consensus report: aggressive periodontitis. Ann Periodontol. 1999. 4:53.

2. Novak KF, Novak MJ. Newman MG, Takei HH, Klokkevold PR, Carranza FA, editors. Aggressive Periodontitis. Carranza's Clinical periodontology. 2006. 10th ed. St. Louis, Missouri: Saunders;506–512.

3. Page RC, Altman LC, Ebersole JL, Vandesteen GE, Dahlberg WH, Williams BL, et al. Rapidly progressive periodontitis. A distinct clinical condition. J Periodontol. 1983. 54:197–209.

4. Deas DE, Mealey BL. Response of chronic and aggressive periodontitis to treatment. Periodontol 2000. 2010. 53:154–166.

5. Gunsolley JC, Califano JV, Koertge TE, Burmeister JA, Cooper LC, Schenkein HA. Longitudinal assessment of early onset periodontitis. J Periodontol. 1995. 66:321–328.

6. Morita M, Nishi K, Watanabe T. Comparison of 2 toothbrushing methods for efficacy in supragingival plaque removal. The toothpick method and the bass method. J Clin Periodontol. 1998. 25:829–831.

7. Kang EH, Lim HS, Kim DK, Seong JH. Effectiveness of toothpick method on the reduction of oral malodor. J Korean Acad Oral Health. 2004. 28:127–138.

8. Ekuni D, Yamanaka R, Yamamoto T, Miyauchi M, Takata T, Watanabe T. Effects of mechanical stimulation by a powered toothbrush on the healing of periodontal tissue in a rat model of periodontal disease. J Periodontal Res. 2010. 45:45–51.

9. Horiuchi M, Yamamoto T, Tomofuji T, Ishikawa A, Morita M, Watanabe T. Toothbrushing promotes gingival fibroblast proliferation more effectively than removal of dental plaque. J Clin Periodontol. 2002. 29:791–795.

10. Chang KW. Dental plaque control by professional toothbrushing. J Korean Dent Assoc. 2001. 39:443–449.

11. Löe H, Anerud A, Boysen H, Morrison E. Natural history of periodontal disease in man. Rapid, moderate and no loss of attachment in Sri Lankan laborers 14 to 46 years of age. J Clin Periodontol. 1986. 13:431–445.

12. Löe H, Brown LJ. Early onset periodontitis in the United States of America. J Periodontol. 1991. 62:608–616.

13. Nagy RJ, Newman MG. Newman MG, Takei HH, Carranza FA, editors. Treatment of refractory periodontitis, aggressive periodontitis, necrotizing ulcerative periodontitis, and periodontitis associated with systemic diseases. Carranza's clinical periodontology. 2002. 9th ed. Philidelphia, PA: WB Saunders;558–566.

14. Lim SJ, Yun WH, Pi SH, You HK. Periodontal regeneration of aggressive periodontitis approached by surgical periodontal treatment combined with adjunctive systemic antibiotics: Cases report. Oral Biol Res. 2011. 35:152–160.

15. Klokkevold PR, Nagy RJ. Newman MG, Takei HH, Klokkevold PR, Carranza FA, editors. Treatment of aggressive and atypical forms of periodontitis. Carranza's clinical periodontology. 2006. 10th ed. St. Louis, Missouri: Saunders;693–705.

16. Ford PJ, Gamonal J, Seymour GJ. Immunological differences and similarities between chronic periodontitis and aggressive periodontitis. Periodontol 2000. 2010. 53:111–123.

17. Stabholz A, Soskolne WA, Shapira L. Genetic and environmental risk factors for chronic periodontitis and aggressive periodontitis. Periodontol 2000. 2010. 53:138–153.

18. Fine DH, Markowitz K, Furgang D, Fairlie K, Ferrandiz J, Nasri C, et al. Aggregatibacter actinomycetemcomitans and its relationship to initiation of localized aggressive periodontitis: longitudinal cohort study of initially healthy adolescents. J Clin Microbiol. 2007. 45:3859–3869.

19. Casarin RC, Peloso Ribeiro ED, Sallum EA, Nociti FH Jr, Gonçalves RB, Casati MZ. The combination of amoxicillin and metronidazole improves clinical and microbiologic results of one-stage, full-mouth, ultrasonic debridement in aggressive periodontitis treatment. J Periodontol. 2012. 83:988–998.

20. Hicks J, Flaitz CM. Langerhans cell histiocytosis: current insights in a molecular age with emphasis on clinical oral and maxillofacial pathology practice. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005. 100:Suppl 2. S42–S66.

21. Kim JB, Morita M, Kusumoto M, Watanabe T, Takagi S, Nishijima K. Preservation of permanent teeth in a patient with Papillon-Lefèvre syndrome by professional tooth-cleaning. ASDC J Dent Child. 1997. 64:222–226.

22. Buchmann R, Nunn ME, Van Dyke TE, Lange DE. Aggressive periodontitis: 5-year follow-up of treatment. J Periodontol. 2002. 73:675–683.

23. Ekuni D, Yamanaka R, Yamamoto T, Miyauchi M, Takata T, Watanabe T. Effects of mechanical stimulation by a powered toothbrush on the healing of periodontal tissue in a rat model of periodontal disease. J Periodontal Res. 2010. 45:45–51.

24. Kusano H, Tomofuji T, Azuma T, Sakamoto T, Yamamoto T, Watanabe T. Proliferative response of gingival cells to ultrasonic and/or vibration toothbrushes. Am J Dent. 2006. 19:7–10.

25. Horiuchi M, Yamamoto T, Tomofuji T, Ishikawa A, Morita M, Watanabe T. Toothbrushing promotes gingival fibroblast proliferation more effectively than removal of dental plaque. J Clin Periodontol. 2002. 29:791–795.