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Fulltext Smoking a Dangerous Addiction: A Systematic Review on an Underrated Risk Factor for Oral Diseases

Ahmed N, Arshad S, Basheer SN, Karobari MI, Marya A, Marya CM, et al.

Int J Environ Res Public Health, 2021 10 20;18(21).
PMID: 34769523 DOI: 10.3390/ijerph182111003

Despite growing knowledge of the adverse effects of cigarette smoking on general health, smoking is one of the most widely prevalent addictions around the world. Globally, about 1.1 billion smokers and over 8 million people die each year because of cigarette smoking. Smoking acts as a source for a variety of oral and systemic diseases. Various periodontal issues such as increased pocket depth, loss of alveolar bone, tooth mobility, oral lesions, ulcerations, halitosis, and stained teeth are more common among smokers. This systematic review was conducted according to the guidelines from PRISMA, and research articles were retrieved from the Web database sources on 31 May 2021. The quality of research articles was ensured by the type of evidence from combined schema incorporating as schema-13 evidence type description, Cochrane health promotion and public health field (CHPPHF), and the health gains notation framework-14 screening question for quality assessment of qualitative and quantitative studies. Smokers have been found to have bleeding on probing, periodontal pockets, and clinical attachment loss compared to nonsmokers. Oral and respiratory cancers are among the most lethal known diseases caused by cigarette smoking and other commonly occurring sequelae such as stained teeth, periodontal diseases, etc.

Matched MeSH terms: Periodontal Pocket
Fulltext Tissue response of type 2 diabetics towards non-surgical periodontal therapy: a retrospective, comparative study with non-diabetics - a preliminary investigation

Goh, Y.C., Lau, S.L., Ramanathan, A., Swaminathan, D.

Ann Dent, 2013;20(2):24-28.
MyJurnal

The purpose of this study was to assess the tissue
response of Type 2 diabetic subjects towards non surgical
periodontal therapy as compared with matched, nondiabetic
subjects. This was a retrospective, comparative
study using periodontal case notes of 40 subjects attending
undergraduates’ periodontal clinics (20 diabetics, 20 nondiabetics),
who were selected based on the inclusion
and exclusion criteria. Response towards non surgical
periodontal therapy was assessed through three clinical
periodontal parameters, namely plaque score, gingivitis
score and number of periodontal pocket ≥5mm at the
baseline and after initial non surgical periodontal therapy.
Data obtained was then analyzed by SPSS Version 12.
Both diabetic and non-diabetic subjects showed significant
improvements (p-value = 0.021; 0.000; 0.001 and 0.010;
0.014; 0.001) in all three parameters after the therapy.
However, when comparison was made between the two
groups, there was no significant difference (p-value = 0.913;
0.892 and 0.903) in any of the parameters. Periodontal
conditions improved clinically in both diabetic and nondiabetic
subjects after non-surgical periodontal therapy.
Therefore, both groups responded similarly towards the
therapy and thus it can be postulated that well-controlled
diabetic status does not have a significant effect on the
outcome of periodontal therapy.

Matched MeSH terms: Periodontal Pocket
Fulltext What expert says … periodontal abscess

Norhidayah, Khamiza

Malaysian Dental Journal, 2008;29(2):154-157.
MyJurnal

Abscess of the periodontium is a localized purulent inflammation of the periodontal tissues1. It has been classified into three categories which are gingival abscess, periodontal abscess and pericoronal abscess. A periodontal abscess can be defined as a localized purulent infection affecting the tissues surrounding a periodontal pocket that can lead to the destruction of supporting structures4 including tortuous periodontal pockets, furcation involvement, and intrabony defects. The lesion may be acute or chronic abscess. A localized acute abscess may progress to a chronic abscess if the pus drains through a fistula into the outer gingival surface or into the periodontal pocket. (Copied from article).

Matched MeSH terms: Periodontal Pocket
Fulltext A retrospective study to evaluate the effect of type 2 diabetes mellitus on the severity of periodontal disease. A preliminary investigation

Ismail, N., Mohd Ali, S. S., Swaminathan, D.

Ann Dent, 2013;20(1):8-12.
MyJurnal

A preliminary investigation to assess the relationship
in the severity of periodontal disease in diabetics when
compared with non-diabetic subjects. Materials and
Methods: A retrospective, comparative study using
periodontal case notes of 40 subjects (20 Type 2 diabetics,
20 non-diabetics) who were selected based on the
inclusion and exclusion criteria. Severity of periodontal
disease was assessed through number of periodontal
pocket ≥5mm. The results were compared between
subjects whose age, gender and plaque scores are matched
with the test group. Data obtained was then analyzed by
SPSS Version 12. Results: When comparisons were made
between test (Type 2 diabetic) and control (non-diabetic)
groups, there were no significant difference (p>0.05) in
the severity of periodontal disease. However, there was
a clinically mean difference between the two groups.
Conclusions: This preliminary investigation indicated
that the severity of chronic periodontitis, as indicated in
periodontal pocketing, increased in diabetic patients when
compared to non-diabetics clinically, although it was not
statistically significant. The finding of this investigation
was thus not conclusive as it was only a retrospective
study using patients’ case notes. However, the results
are now being further investigated with a proper clinical
trial which examines periodontal parameters and diabetic
status (HbA1c) of the subjects to determine the association
between periodontal disease and diabetes mellitus.

Matched MeSH terms: Periodontal Pocket
Fulltext Genome Sequence of Fusobacterium nucleatum Strain W1481, a Possible New Subspecies Isolated from a Periodontal Pocket

Ang MY, Dymock D, Tan JL, Thong MH, Tan QK, Wong GJ, et al.

Genome Announc, 2014;2(1).
PMID: 24526626 DOI: 10.1128/genomeA.00009-14

Fusobacterium nucleatum is a bacterial species commonly detected in dental plaque within the human oral cavity, with some strains associated with periodontal disease, one of the most common clinical bacterial infections in the human body. The exact mechanisms of its pathogenesis are still not completely understood. In this study, we present the genome sequence and annotation of F. nucleatum strain W1481, isolated from a periodontal pocket of a dental patient at the University of Bristol, United Kingdom, the 16S rRNA gene sequencing of which showed it to be markedly different from the five previously named subspecies.

Matched MeSH terms: Periodontal Pocket
Fulltext The Use Of Demineralized Freeze-dried Bovine Bone Xenograft In Reducing Post-surgical Periodontal Recession

Baharuddin, N.A., Kamin, S., Samsuddin, A.R.

Ann Dent, 2005;12(1):-.
MyJurnal

The aim of this study was to determine the effectiveness of demineralized freeze-dried bone xenograft (DFDBBX) in minimizing post-surgical recession in moderate to advanced adult periodontitis in patients. Nine patients with a total of eighteen intrabony defects were matched for the tooth type, location of defects and periodontal pocket depth (5 to 7mm). Following an initial nonsurgical treatment, recession at defects indicated for surgery was measured pre-operatively. Surgical treatment was carried out by split mouth design, where the test sites were assigned DFDBBX and the control sites were subjected to debridement without the use of DFDBBX. Recessions were measured at 3 months, 6 months and 9 months post-operatively. The results showed no statistically significant difference in mean recession at 3, 6 and 9 months post-operatively compared to baseline for both test and control groups. Thus, DFDBBX was ineffective in minimizing recession on patients with moderate to severe periodontitis, as compared to surgical debridement alone.

Matched MeSH terms: Periodontal Pocket
Fulltext The Use Demineralized Freeze-Dried Bovine Bone Xenograft In Reducing Post-Surgical Periodontal Pocket Depth

Baharuddin, N.A., Kamin, S., Samsuddin, A.R.

Ann Dent, 2003;10(1):-.
MyJurnal

This study evaluated the effectiveness of demineralized freeze-dried bone xenograft in reducing post-surgical pocket depth in moderate to advanced adult periodontitis in patients. Nine patients with a total of eighteen intrabony defects were selected for this study. The bony defects were matched for tooth type, location and pocket depth. Following an initial non-surgical treatment, only pockets of 5 to 7 mm deep were indicated for surgery. Periodontal pockets were measured pre-operatively and at 3, 6 and 9 months post-surgically. The study protocol included a split mouth design, where surgical treatment was carried out at both test and control sites. The test sites were assigned demineralized freeze-dried bone xenograft and the control sites were subjected to debridement alone without the use of demineralized freeze-dried bone xenograft. The results from this study showed a statistically significant difference in the mean pocket depth at 6 and 9 months post-operatively for both test and control groups, but there was no statistically significant difference at 3 months. In conclusion, demineralized freeze-dried bone xenograft was ineffective in reducing periodontal pocket depth in patients with moderate to severe periodontitis, as compared to surgical debridement alone.

Matched MeSH terms: Periodontal Pocket
Fulltext Paradental Cyst Associated With an Unerupted Wisdom Tooth

Ngeow, W.C., Zain, R.B., Chai, W.L.

Ann Dent, 2000;7(1):-.
MyJurnal

The paradental cyst is an odontogenic cyst occurring near to the cervical margin of the lateral aspect of a root as a consequence of an inflammatory process in a periodontal pocket. A distinct form of the paradental cyst occurs not infrequently on the buccal aspects of erupted mandibular third molar, where there is an associated history of pericoronitis. A search of the literature revealed that these cysts had all been reported in relation to partially, newly or fully erupted molars. This report presents one case in which the cyst was noticed to be associated with an unerupted third molar. The histological appearance of the cyst and the gross relationship to the cemento-enamel junction is similar to those typical of paradental cysts reported in the literature. However, the radiographic and clinical appearance of the tooth being unerupted do not tally with paradental cyst and yet exclude the diagnosis of dentigerous cyst. The diagnosis of dental follicular tissue was excluded based on the histopathological presentation. The authors suggested that this case may represent an early form of paradental cyst which in the past may have been dismissed as dental follicular residues and thus, the prevalence of paradental cyst may have been under reported in the literature.

Matched MeSH terms: Periodontal Pocket
Molecular Detection of Porphyromonas gingivalis in Chronic Periodontitis Patients

Kulkarni PG, Gosavi S, Haricharan PB, Malgikar S, Mudrakola DP, Turagam N, et al.

J Contemp Dent Pract, 2018 Aug 01;19(8):992-996.
PMID: 30150503

AIM: In the current study, Porphyromonas gingivalis was identified in chronic periodontitis patients and healthy subjects by polymerase chain reaction (PCR) and its presence correlated with the severity of clinical periodontal parameters.
MATERIALS AND METHODS: Subgingival plaque samples were collected with sterile curette and subjected to deoxyribonucleic acid (DNA) extraction and subsequent PCR for detection of P. gingivalis.
RESULTS: Porphyromonas gingivalis was detected in 60% of patients of group II (pocket depth up to 5 mm), and in 93.33% of patients of group III (pocket depth more than 5 mm). One periodontally healthy subject in group I (probing depth < 3 mm) showed the presence of P. gingivalis.
CONCLUSION: Detection frequency of bacterium increased significantly with increase in probing pocket depth (PPD), loss of attachment (LOA), and gingival index (GI).
CLINICAL SIGNIFICANCE: Porphyromonas gingivalis is strongly associated with chronic periodontitis and its detection frequency positively correlates with the severity of periodontal destruction.

Matched MeSH terms: Periodontal Pocket
Influence of abutment design on clinical status of peri-implant tissues

Taiyeb-Ali TB, Toh CG, Siar CH, Seiz D, Ong ST

Implant Dent, 2009 Oct;18(5):438-46.
PMID: 22129962 DOI: 10.1097/ID.0b013e3181ad8e7a

To compare the clinical soft tissue responses around implant tooth-supported 3-unit bridges using tapered abutments with those using butt-joint abutments.

Matched MeSH terms: Periodontal Pocket/pathology*
A retrospective study of periodontal disease severity in smokers and non-smokers

Razali M, Palmer RM, Coward P, Wilson RF

Br Dent J, 2005 Apr 23;198(8):495-8; discussion 485.
PMID: 15849588

Smoking has been associated with increased risk of periodontitis. The aim of the present study was to compare the periodontal disease severity of adult heavy smokers and never-smokers referred for assessment and treatment of chronic periodontitis.

Matched MeSH terms: Periodontal Pocket/complications
Crestal bone loss and periimplant inflammatory parameters around zirconia implants: A systematic review

Vohra F, Al-Kheraif AA, Ab Ghani SM, Abu Hassan MI, Alnassar T, Javed F

J Prosthet Dent, 2015 Sep;114(3):351-7.
PMID: 26047803 DOI: 10.1016/j.prosdent.2015.03.016

STATEMENT OF PROBLEM: Zirconia implants have been used for oral rehabilitation; however, evidence of their ability to maintain crestal bone and periimplant soft tissue health is not clear.
PURPOSE: The purpose of this systematic review was to evaluate crestal bone loss (CBL) around zirconia dental implants and clinical periimplant inflammatory parameters.
MATERIAL AND METHODS: The focus question addressed was, "Do zirconia implants maintain crestal bone levels and periimplant soft tissue health?" Databases were searched for articles from 1977 through September 2014 with different combinations of the following MeSH terms: "dental implants," "zirconium," "alveolar bone loss," "periodontal attachment loss," "periodontal pocket," "periodontal index." Letters to the editor, case reports, commentaries, review articles, and articles published in languages other than English were excluded.
RESULTS: Thirteen clinical studies were included. In 8 of the studies, the CBL around zirconia implants was comparable between baseline and follow-up. In the other 5 studies, the CBL around zirconia implants was significantly higher at follow-up. Among the studies that used titanium implants as controls, 2 studies showed significantly higher CBL around zirconia implants, and in 1 study, the CBL around zirconia and titanium implants was comparable. The reported implant survival rates for zirconia implants ranged between 67.6% and 100%. Eleven studies selectively reported the periimplant inflammatory parameters.
CONCLUSIONS: Because of the variations in study design and methodology, it was difficult to reach a consensus regarding the efficacy of zirconia implants in maintaining crestal bone levels and periimplant soft tissue health.

Matched MeSH terms: Periodontal Pocket*
Proximal tooth surface quality and periodontal status

Yusof Z

J Oral Rehabil, 1991 Jan;18(1):95-102.
PMID: 2051253

The aim of this study was to determine the periodontal status in relation to the quality of the adjacent proximal tooth surface. The gingival index (GI) and probable pocket depth (PD) were measured in 144 contra-lateral pairs of sound vs. restored and 95 contra-lateral pairs of sound vs. carious surfaces in 124 patients. The restorations studied were silver amalgams and tooth-coloured filling materials, the margins of which were supragingival or level with the gingival margins. The results showed that the GI and PD were greater for both restored and carious tooth surfaces than for the contra-lateral sound surfaces. When all the teeth were grouped together, the differences in the mean values of GI and PD were statistically significant at the P less than or equal to 0.05 level. A comparison between restored and carious (non-paired) tooth surfaces revealed higher mean values of GI and PD for the latter, which were highly significant at the P less than 0.001 level. Thus the present study shows that proximal tooth surface quality influences the health status of the adjacent periodontium.

Matched MeSH terms: Periodontal Pocket/pathology
Fulltext The association between smoking and periodontal health status among army personnel in North-East Malaysia

Ruzawani Ruslan, Munirah Mohd Adnan, Normastura Abd Rahman

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):216-224.
MyJurnal

Introduction: Smoking is a common risk factor for periodontal disease and other chronic diseases. This study was conducted to determine the prevalence of smoking among army personnel and its association with periodontal health status. Methods: A cross-sectional study was carried out among randomly selected 233 army personnel in 8th Brigade Infantry, Kelantan. A face validated self-administered Bahasa Malaysia questionnaire was used for data col- lection. Periodontal examination was done using Community Periodontal Index (CPI) and coded as ‘0’ for healthy; ‘1’ for bleeding observation; ‘2’ for detection of calculus; ‘3’ for probing of 4-5mm pocketing and ‘4’ for probing of 6mm or more pocketing. Results: All respondents (n=233) were male, the majority (92.7%) Malays, not married (60.5%) with the mean (SD) age of 25.8 (5.06) years. The prevalence of smoking among army personnel was 76.0% (95% CI: 70.4, 81.5). Almost all (97.4%) have some degree of periodontal disease. The non-smoker, ex-smoker and smoker groups were highest for having calculus with a percentage of 40.5%, 57.1%, and 57.1%, respectively. No significant association was found between smoking status (ever-smoker and non-smoker) and periodontal pocketing (CPI 0-2 and CPI 3-4) (p=0.960). However, the ever-smokers (93.2%) significantly higher percentage for the need of invasive treatment (CPI >2) compared to the non-smokers (76.2%) (p=0.002). Conclusion: The prevalence of smok- ing among army personnel in North-East Malaysia was high, with most of them have some degree of periodontal disease. Smoking cessation intervention should be strategized in the military community to reduce the burden of care for chronic diseases.

Matched MeSH terms: Periodontal Pocket
Fulltext The expert says...... oral microbiology, periodontal disease and cardiovascular disease

Nor Adinar Baharuddin

Malaysian Dental Journal, 2007;28(2):97-98.
MyJurnal

There are evidences that chronic oral infections are associated with cardiovascular disease (CVD). Periodontal disease is a common, mixed oral infection affecting the supporting structures around the teeth. It was reported that 75% of the adult population has gingivitis and 20% to 30% exhibits the severe destructive form of periodontitis. Although more than 500 bacterial species inhabit the human oral cavity, only a few Gram negative bacteria such as Prevotella intermedia, Fusobacterium nucleatum, Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola and Actinobacillus actinomycetamcomitans causes gingivitis and periodontitis. These periodontal pathogen occupy the subgingival space and organize as a bacterial biofilm. The bacterial biofilm will be in direct contact with host tissues along an ulcerated epithelial interface, called periodontal pocket. The break in the epithelial integrity directly exposes the host to bacteria and their products eg. lipopolysaccharide (LPS) endotoxin. (Copied from article).

Matched MeSH terms: Periodontal Pocket
Fulltext Retrospective Study Of Periodontal Patients Profile In A Teaching Institution

Taiyeb Ali, T.B., Razak, I.A.

Ann Dent, 2000;7(1):-.
MyJurnal

The purpose of the present study was to determine the periodontal profile, toothbrushing habits and oral hygiene status of patients referred to a teaching institution for periodontal treatment, based on patients' treatment records. A total of 207 consecutive patients diagnosed with periodontitis who had been interviewed and clinically examined over a period of approximately one year were included in this study. The assessments of plaque levels, bleeding on probing (BOP) scores, probing pocket depth (PPD) and degree of bone loss from radiographs were made. The average age of this study group was 45 ± 12.8 years old with an age range of 20 to 76 years. The subjects comprised of 40% Malays, 34% Chinese and 26% Indians. The male to female ratio was almost 1.5: 1. These patients presented with high plaque and BOP scores. These findings do not concur with the high frequency of toothbrushing reported (86.5 % of subjects brushing twice or more times per day). This may reflect on the ineffectiveness of brushing as evident from their high plaque scores. Periodontal pockets were detected in 69 % of the teeth in these patients with an average of 17 teeth per patient being involved. Probing pocket depths of >6mm was found on the average in 3 teeth per patient. Alveolar bone loss as assessed from radiographs was detected in 52 % of the teeth in this study group of which 12 teeth per patient on the average exhibited this. Advanced bone loss involving about 2/3 and more of the root length was detected on the average on 1 tooth per patient. Early onset periodontitis accounted for about 5% of the total cases seen. About 21 % of subjects suffered from advanced adult periodontitis. Hence about a-quarter of the patients referred already had marked periodontal destruction.

Matched MeSH terms: Periodontal Pocket
Fulltext Effects of lower third molar removal on attachment level and alveolar bone height of the adjacent second molar

Wong, Soo Yee, Roselinda Ab. Rahman, Haslina Taib

Archives of Orofacial Sciences, 2009;4(2):36-40.
MyJurnal

The purpose of this study was to evaluate the periodontal status distal to the adjacent second molar following the extraction of a partially or fully impacted mandibular third molar at Klinik Pergigian Pakar Hospital Universiti Sains Malaysia (KPPHUSM) from April of 2008 until June of 2008.This was a prospective study which involved the clinical and radiological study of patients. In this study, convenience sampling method had been used. The sample size was 22 patients aged 18-32 years old with inclusion criteria. The outcomes measured in this study were periodontal pocket depth (PPD), clinical attachment level (CAL) and alveolar bone height (ABH). Subjects were examined at distal surface (disto-buccal, mid-distal and disto-lingual) of second molar for PPD and CAL before and 3 months after the impacted adjacent lower third molar extraction. OPG was taken each before and after the third molar removal. These data were analyzed using SPSS version 16 and Wilcoxon-signed-ranks test was used to compare the PPD, CAL and ABH pre and post operatively. All the results were not significant with p >0.05. For PPD, median = 3mm pre and post extraction. CAL median= 2mm pre and post operatively and ABH median of 3.10mm (before) and 2.8mm (after) the third molar removal. From our study, we concluded that there were no significant changes of PPD, CAL and ABH at distal side of second molar after 3 months of the adjacent impacted lower third molar removal.
Study site: Dental clinics, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia

Matched MeSH terms: Periodontal Pocket
Long-term clinical effect of adjunctive antimicrobial photodynamic therapy in periodontal treatment: a randomized clinical trial

Alwaeli HA, Al-Khateeb SN, Al-Sadi A

Lasers Med Sci, 2015 Feb;30(2):801-7.
PMID: 24037036 DOI: 10.1007/s10103-013-1426-y

Mechanical removal of microbial biofilm dental plaque from tooth surfaces is important for treatment of periodontal diseases. However, the effectiveness of conventional scaling and root planing (SRP) is affected by the local conditions and residual bacteria which may affect the healing process. We performed a randomized clinical trial to test our hypothesis that adjunctive antimicrobial photodynamic therapy (aPDT) plus SRP has significant effect compared with SRP alone, which can last for 1 year. The study included 136 sites in 16 patients with previously untreated chronic periodontitis, at least one premolar and one molar in every quadrant (minimum, four teeth/quadrant) and at least one tooth with attachment loss of ≥4 mm in every quadrant. In all patients, two randomly assigned quadrants were treated with SRP and the other two were treated with SRP + aPDT. The clinical parameters of probing pocket depth (PPD), bleeding on probing (BOP), and clinical attachment level (CAL) were evaluated at baseline and after 3, 6, and 12 months. There were no significant differences between the two groups at baseline. PPD and BOP showed significant reduction, and CAL showed significant gain from baseline for all three time points in both groups. In addition, there were significantly greater reduction and gain for SRP + aPDT than for SRP at all three time points. No adverse effects of aPDT were observed. These data demonstrate significant improvement in all evaluated clinical parameters for at least 1 year and suggest that aPDT as an adjunctive therapy to SRP represents a promising therapeutic concept for persistent periodontitis.

Matched MeSH terms: Periodontal Pocket*
Fulltext Effect of periodontal therapy on circulating levels of endotoxin in women with periodontitis: a pilot clinical trial

Jacob SP, Nath S, Zade RM

Indian J Dent Res, 2012 Nov-Dec;23(6):714-8.
PMID: 23649051 DOI: 10.4103/0970-9290.111244

Periodontitis is a potential risk factor for adverse pregnancy outcomes due to the presence of a subgingival load of pathogenic bacteria. Instrumentation of periodontal pockets during treatment may result in bacteremia and/or endotoxemia.

Matched MeSH terms: Periodontal Pocket/therapy
Moderate- to long-term periodontal outcomes of subjects failing to complete a course of periodontal therapy

Goh V, Hackmack PP, Corbet EF, Leung WK

Aust Dent J, 2017 Jun;62(2):152-160.
PMID: 27391220 DOI: 10.1111/adj.12440

BACKGROUND: The current retrospective cross-sectional study investigated 5-18-year treatment outcomes in subjects who did not complete a recommended course of periodontal therapy.
METHODS: Sixty-five subjects who voluntarily discontinued therapy were recalled. The subjects' demographic data and dental history since discontinuation of periodontal treatment were collected via questionnaires. The subjects' periodontal condition, radiographic data and individual tooth-based prognosis at pre-discontinuation and recall were compared.
RESULTS: A total of 229 teeth had been lost over time, mainly due to periodontal reasons. Upper and lower molars were most frequently lost. Rate of tooth loss (0.38/patient per year) was comparable to untreated patients. Deterioration in periodontal health in terms of increased percentage of sites with bleeding on probing (BOP) and sites with probing pocket depths (PPD) of 6 mm or more at re-examination was observed. Positive correlations were found between tooth loss and: (i) years since therapy discontinued; (ii) percentage of sites with PPD of 6 mm or more at pre-discontinuation; and (iii) at re-examination. Percentage of sites with PPD of 6 mm or more at recall was positively correlated with periodontal tooth loss and negatively correlated with percentage of sites without BOP.
CONCLUSIONS: Patients not completing a course of periodontal therapy are at risk of further tooth loss and deterioration in periodontal conditions over time.

Matched MeSH terms: Periodontal Pocket/surgery*

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