Alcohol consumption and risk of periodontitis: a meta-analysis

Assessing the role of Porphyromonas gingivalis in periodontitis to determine a causative relationship with Alzheimer's disease

Chronic periodontitis of 10 years' duration is reported to become a twofold risk factor for the development of Alzheimer's disease (AD). Periodontitis is modifiable, and this fits with the current action plan for preventing AD. However, until periodontitis, becomes acknowledged as a firm risk factor for AD, this risk will continue. Here, we put forward our own argument based on the current literature for in vivo infection-mediated periodontal disease models supporting the antimicrobial protection hypothesis of AD and interventional studies supporting the causal links. Oral infections with Porphyromonas gingivalis, or introduction of its lipopolysaccharide (LPS), in various mouse models has demonstrated the development of key neuropathological hallmark lesions defining AD. These are extracellular amyloid-beta plaques, phosphorylated tau, neurofibrillary tangles, widespread acute and chronic inflammation, blood-brain barrier defects together with the clinical phenotype showing impaired learning and spatial memory. Live P. gingivalis and its LPS (commercial or from 'microbullets') are powerful peripheral and intracerebral inflammatory signalling initiators, and this has direct implications on memory and lesion development. Maintaining a healthy oral microbiome and managing periodontal disease with regular surveillance and good oral hygiene throughout life is likely to reduce the unnecessary burden of AD in some individuals.

Perda de inserção periodontal e associações com indicadores de risco sociodemográficos e comportamentais

Resumo Introdução A perda de inserção clínica periodontal (PIP) tem sido indicada como parâmetro determinante para o estudo de indicadores de risco de periodontite crônica. Objetivo Descrever a prevalência, severidade e extensão de PIP em um grupo populacional que se abstém de álcool e tabaco, além de avaliar associações com características sociodemográficas e comportamentais dos participantes. Método Uma amostra de 420 indivíduos adultos, participantes do Estudo Advento (São Paulo), foi submetida ao exame periodontal de seis sítios por dente e respondeu um questionário estruturado. As associações foram verificadas por meio de análise de regressão logística múltipla. Resultado A prevalência de periodontite foi de 20,7% e de gengivite, 38,8%; a PIP média foi de 1,38 mm (± 0,5) e a perda dental, 5,4 (± 9,0). A prevalência de PIP ≥ 3 mm, ≥ 4 mm e ≥ 6 mm foi de 69,7%, 31,7% e 9,6% dos indivíduos, e 11,4%, 4,4% e 1,2% dos dentes por indivíduo, respectivamente. Houve associação significativa de PIP ≥ 4 mm com sexo masculino, idade superior a 55 anos, baixa escolaridade, placa visível, autocuidado irregular, falta de orientação em higiene bucal e doença sistêmica referida. Para PIP ≥ 6 mm, foi observada maior razão de chances para as variáveis idade e doença sistêmica. Conclusão O grupo populacional estudado apresentou baixa extensão e severidade de PIP, possivelmente pelas características da amostra. As associações de risco encontradas confirmam a necessidade de atenção integral ao paciente, incluindo o incentivo à prevenção e ao controle de doenças crônicas, ao lado de orientações específicas para higiene bucal.

Reassessing the Role of Entamoeba gingivalis in Periodontitis

The protozoan Entamoeba gingivalis resides in the oral cavity and is frequently observed in the periodontal pockets of humans and pets. This species of Entamoeba is closely related to the human pathogen Entamoeba histolytica, the agent of amoebiasis. Although E. gingivalis is highly enriched in people with periodontitis (a disease in which inflammation and bone loss correlate with changes in the microbial flora), the potential role of this protozoan in oral infectious diseases is not known. Periodontitis affects half the adult population in the world, eventually leads to edentulism, and has been linked to other pathologies, like diabetes and cardiovascular diseases. As aging is a risk factor for the disorder, it is considered an inevitable physiological process, even though it can be prevented and cured. However, the impact of periodontitis on the patient's health and quality of life, as well as its economic burden, are underestimated. Commonly accepted models explain the progression from health to gingivitis and then periodontitis by a gradual change in the identity and proportion of bacterial microorganisms in the gingival crevices. Though not pathognomonic, inflammation is always present in periodontitis. The recruitment of leukocytes to inflamed gums and their passage to the periodontal pocket lumen are speculated to fuel both tissue destruction and the development of the flora. The individual contribution to the disease of each bacterial species is difficult to establish and the eventual role of protozoa in the fate of this disease has been ignored. Following recent scientific findings, we discuss the relevance of these data and propose that the status of E. gingivalis be reconsidered as a potential pathogen contributing to periodontitis.

Personalized periodontal treatment for the tobacco- and alcohol-using patient

The use of various forms of tobacco is one of the most important preventable risk factors for the incidence and progression of periodontal disease. Tobacco use negatively affects treatment outcomes for both periodontal diseases and conditions, and for dental implants. Tobacco-cessation programs can mitigate these adverse dental treatment outcomes and may be the most effective component of a personalized periodontal treatment approach. In addition, heavy alcohol consumption may exacerbate the adverse effects of tobacco use. In this review, the microbiology, host/inflammatory responses and genetic characteristics of the tobacco-using patient are presented as a framework to aid the practitioner in developing personalized treatment strategies for these patients. These personalized approaches can be used for patients who use a variety of tobacco products, including cigarettes, cigars, pipes, smokeless tobacco products, e-cigarettes and other tobacco forms, as well as patients who consume large amounts of alcohol. In addition, principles for developing personalized tobacco-cessation programs, using both traditional and newer motivational and pharmacological approaches, are presented.

Association between alcohol dependence and both periodontal disease and tooth loss: a cross-sectional study

The impact of alcohol consumption on periodontal disease and tooth loss is still under debate. The aim of this cross-sectional study was to evaluate the association between alcohol dependence and both periodontal diseases and tooth loss in Brazilian native Indians. Full mouth periodontal examination was performed and tooth loss was clinically evaluated in a representative sample of 225 Indians (≥ 19 years). Sociodemographic, oral health-related data, and alcohol dependence were evaluated using structured questionnaires. The subjects were categorized as either alcohol-dependent or non-dependent according to the Alcohol Use Disorders Identification Test results. Severe periodontal disease was defined in individuals with ≥ 2 proximal sites with a clinical attachment level ≥ 6 mm, not on the same tooth, and ≥ 1 proximal site with a probing depth ≥ 5 mm. Tooth loss was categorized as one or more missing teeth, or no missing teeth. Bivariate models followed by logistic regression were used to assess the association between alcohol dependence and both periodontal disease and tooth loss. Prevalence ratio (PR) was calculated using Mantel-Haenszel analysis. Alcohol dependence increased 2.5 times the risk for tooth loss (prevalence ratio [PR] =2.49, 95% confidence interval [CI] = 1.01-9.04, p = 0.05). Severe periodontal disease was not associated with alcohol dependence (OR = 0.54, 95% CI = 0.22-1.31, p = 0.23). In conclusion, alcohol dependence was associated with tooth loss in the present population, but severe periodontal disease was not. Questions on alcohol dependence should be included in dental anamnesis questionnaires, and patients diagnosed with alcohol dependence should be referred for dental evaluation.

Stress, salivary cortisol and periodontitis: A systematic review and meta-analysis of observational studies

OBJECTIVE

This meta-analysis aims to systematically assess whether periodontitis has a meaningful effect on salivary cortisol, reflecting changes on free blood cortisol levels.

DESIGN

The Cochrane Handbook and the PRISMA statement were used as reporting guidelines. The MEDLINE-PubMed, Google Scholar, EMBASE, and CENTRAL databases were searched until September 2017 to identify eligible studies, screened by seven independent authors and verified by an eighth. Studies comparing salivary cortisol level of periodontitis cases to controls were included. Data were extracted using a predefined table and since all papers were non-randomized clinical trials they were appraised using Downs and Black tool. DerSimonian random effects meta-analysis was performed using OpenMetaAnalyst.

RESULTS

Six cross-sectional studies were included, with 258 participants with chronic periodontitis and 72 with aggressive periodontitis, in a total of 573 participants. Overall results showed that aggressive periodontitis patients have, on average, 53% higher salivary cortisol levels than healthy controls 1.53 (1.11-2.12). Meta-regression exploring the relationship among salivary cortisol levels and periodontal measures, i.e., periodontitis severity, showed a global neutral effect, although this result requires future confirmation due to the low power of the model.

CONCLUSION

Observational studies results suggest that subjects with aggressive periodontitis have higher salivary cortisol levels than healthy ones or patients with chronic periodontitis. Such salivary cortisol response difference may have a negative impact on the periodontium, contributing to worse the burden of aggressive periodontitis disease. In the future, wide and well-designed longitudinal studies should be carried out in order to extensively confirm this possible effect, considering the complex nature of periodontitis and its many confounders factors that may contribute to this outcome.

Prevalence and extent of chronic periodontitis and its risk factors in a Portuguese subpopulation: a retrospective cross-sectional study and analysis of Clinical Attachment Loss

Objectives

To assess the prevalence and extent of chronic periodontitis, and its risk factors in a Portuguese subpopulation referred to periodontal examination.

Methods

This retrospective cross-sectional study used a subset of data from patients who sought dental treatment in a university dental clinic in the Lisbon metropolitan area. The sample consisted of 405 individuals (225 females/180 males), aged 20–90 years. All patients underwent a full-mouth periodontal examination and chronic periodontitis was defined as Clinical Attachment Loss (CAL) ≥ 3 mm affecting two or more teeth. Aggressive periodontitis cases were excluded from the analysis.

Results

Prevalence of chronic periodontitis was 83.5% (95% CI [80.4–86.6%]). For these subjects, CAL ≥ 3 mm affected 86.0% (95% CI [84.7–87.2]) of sites and 83.7% (95% CI [81.7–85.6]) of teeth, respectively. Mean CAL ranged from 3.6 to 4.3 mm, according to age. In the multivariate logistic regression model, smoking (OR = 3.55, 95% CI [1.80–7.02]) and older age (OR = 8.70, 95% CI [3.66–20.69] and OR = 4.85, 95% CI [2.57–9.16]), for 65+ and 45–64 years old, respectively, were identified as risk indicators for CAL ≥ 3 mm.

Conclusions

This particular Portuguese adult subpopulation had a high prevalence of chronic periodontitis, with severe and generalized clinical attachment loss, and its presence was significantly associated with age and smoking. This data should serve to prepare future detailed epidemiological studies and appropriate public health programs.

Risk factors for chronic periodontitis in Sri Lankan adults: a population based case-control study

OBJECTIVE

To determine risk factors for chronic periodontitis in 30-60 year olds in Sri Lanka. Cases and controls for this population based unmatched case-control study were identified from a broader cross-sectional study which was conducted to determine the prevalence of chronic periodontitis in 30-60 year old adults in Colombo district Sri Lanka. The study included 694 cases and 706 controls. Data were collected by means of a pre-tested interviewer administered questionnaire to obtain information about socio-demographic and behavioural factors, a physical examination to record anthropometric measurements and an oral examination.

RESULTS

Being a male, a Muslim, belonging to the 45-60 year old age group, having less than 12 years of education, using the finger to clean teeth, current smoking, current betel quid chewing, self-reported diabetes and hypertension emerged as risk factors for chronic periodontitis.

CONCLUSIONS

Several socio-demographic and behavioural factors as well as co-morbid conditions emerged as independent risk factors for chronic periodontits in this population. The findings could be used for planning programmes to reduce the burden of chronic periodontits in Colombo district Sri Lanka.

Alcohol consumption and risk of gallstone disease: a meta-analysis

Epidemiology studies have been carried out to investigate the association between alcohol consumption and the risk of gallstone disease, but the results remain controversial. We carried out a meta-analysis to quantitatively summarize the evidences from observational studies on alcohol consumption and the risk of gallstone disease. Eligible studies published in English were identified by searching PubMed, Web of Science, and Embase databases. The random-effect model was used to calculate the pooled relative risks (RRs) with 95% confidence intervals (CIs). Restricted cubic splines were used to assess the dose-response relationship. Eight cohort studies and 10 case-control studies were included in our meta-analysis. The pooled RR of gallstone disease for the highest versus the lowest alcohol consumption was 0.62 (95% CI: 0.49-0.78). Statistically significant associations were also found in stratified analysis by study design (cohort studies: RR=0.66, 95% CI: 0.48-0.91 and case-control studies: RR=0.58, 95% CI: 0.45-0.73). With respect to sex, both men (RR=0.57, 95% CI: 0.4-0.8) and women (RR=0.64, 95% CI: 0.53-0.77) showed statistically significant associations between alcohol consumption and the risk of gallstone disease. A linear dose-response relationship was found between alcohol consumption and gallstone disease risk and the risk of gallstone disease decreased by 12% (RR=0.88, 95% CI: 0.84-0.92; Pnonlinearity=0.079) for each 10 g/day increment in alcohol consumption. This meta-analysis suggests that alcohol consumption is associated with significantly decreased risk of gallstone disease.