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Autoinducer-2 detection among commensal oral streptococci is dependent on pH and boric acid. J Microbiol 2016; 54:492-502. [DOI: 10.1007/s12275-016-5507-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 05/17/2016] [Accepted: 05/23/2016] [Indexed: 12/30/2022]
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Yoon MN, Compton SM. Building professional competence in dental hygiene students through a community-based practicum. Int J Dent Hyg 2016; 15:e119-e127. [PMID: 27256858 DOI: 10.1111/idh.12233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES As Canadians age, there is an increased need for oral health professionals specializing in services for this unique population. Dental hygiene students require exposure to this population to develop professional competencies. This study investigated the dimensions of professional competence that were developed through a practicum for dental hygiene students in long-term care settings while working with older adults. METHODS Nine dental hygiene students were recruited across two cohorts. All students completed reflective journals describing their practicum experiences. Five students also participated in an audio-recorded focus group and completed a pre-focus group questionnaire. Additionally, the practicum course coordinator completed an audio-recorded interview. Transcripts and journals were coded using a constant comparative approach and themes were identified. RESULTS Students described developing client-focused skills, such as effective verbal and non-verbal communication with older adults with dementia. Context-based learning was also a large part of the competency development for the practicum students. Understanding the care environment within which these residents lived helped students to understand and empathize why oral health may not be prioritized. Students also developed an understanding of the work of other health professionals in the settings and improved their abilities to communicate with other healthcare providers. However, students recognized that the utility of those interprofessional skills in private practice may be limited. CONCLUSION Dental hygiene students developed personal and ethical competencies during practicum that are highly transferrable across professional settings. Exposure of students to older adult populations in long-term care may increase the likelihood of dental hygienists working in this area.
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Affiliation(s)
- M N Yoon
- Faculty of Medicine & Dentistry, School of Dentistry, Dental Hygiene Program, University of Alberta, Edmonton, AB, Canada
| | - S M Compton
- Faculty of Medicine & Dentistry, School of Dentistry, Dental Hygiene Program, University of Alberta, Edmonton, AB, Canada
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Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Periodontol 2016; 84:S70-84. [PMID: 23631585 DOI: 10.1902/jop.2013.134008] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The objective of this study was to systematically review the epidemiological evidence for an association between periodontitis (PD) and incident atherosclerotic cardiovascular disease (ACVD), including coronary heart disease (CHD), cerebrovascular disease and peripheral arterial disease. METHODS Systematic review of cohort and case-control studies on the association of clinically or radiographically diagnosed PD and ACVD. RESULTS Overall, 12 studies were included in this study (six studies on CHD, three studies on cerebrovascular disease, two studies on both coronary heart and cerebrovascular disease mortality and one study on peripheral arterial disease).All but one study reported positive associations between various periodontal disease measures and the incidence of ACVD, at least in specific subgroups. The association was stronger in younger adults and there was no evidence for an association between PD and incident CHD in subjects older than 65 years. Only one study evaluated the association between PD and secondary cardiovascular events. CONCLUSIONS There is evidence for an increased risk of ACVD in patients with PD compared to patients without. However, this may not apply to all groups of the population. There is insufficient evidence for an association between PD and the incidence of secondary cardiovascular events.
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Affiliation(s)
- Thomas Dietrich
- Department of Oral Surgery, The School of Dentistry, University of Birmingham, Birmingham, UK
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Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Clin Periodontol 2016; 40 Suppl 14:S70-84. [PMID: 23627335 DOI: 10.1111/jcpe.12062] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/19/2012] [Accepted: 11/14/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The objective of this study was to systematically review the epidemiological evidence for an association between periodontitis (PD) and incident atherosclerotic cardiovascular disease (ACVD), including coronary heart disease (CHD), cerebrovascular disease and peripheral arterial disease. METHODS Systematic review of cohort and case-control studies on the association of clinically or radiographically diagnosed PD and ACVD. RESULTS Overall, 12 studies were included in this study (six studies on CHD, three studies on cerebrovascular disease, two studies on both coronary heart and cerebrovascular disease mortality and one study on peripheral arterial disease). All but one study reported positive associations between various periodontal disease measures and the incidence of ACVD, at least in specific subgroups. The association was stronger in younger adults and there was no evidence for an association between PD and incident CHD in subjects older than 65 years. Only one study evaluated the association between PD and secondary cardiovascular events. CONCLUSIONS There is evidence for an increased risk of ACVD in patients with PD compared to patients without. However, this may not apply to all groups of the population. There is insufficient evidence for an association between PD and the incidence of secondary cardiovascular events.
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Affiliation(s)
- Thomas Dietrich
- Department of Oral Surgery, The School of Dentistry, University of Birmingham, Birmingham, UK
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Merdji A, Della N, Benaissa A, Bouiadjra BAB, Serier B, Mootanah R, Muslih I, Mukdadi OM. Numerical Analysis of Dental Caries Effect on the Biomechanical Behavior of the Periodontal System. J Nanotechnol Eng Med 2016. [DOI: 10.1115/1.4032689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this study was to investigate the effect of dental caries on the stability of the periodontal system. This study presents a numerical analysis performed with three-dimensional (3D) finite element (FE) method to evaluate stresses in the bone surrounding the tooth with dynamic mastication combined loadings. In this work, we present a comparative study on infected and healthy periodontal systems. The infected tooth was modeled and a caries defect was introduced to the tooth coronal part. The infected tooth was evaluated and equivalent von Mises interface stress values were obtained for comparison with the ones exhibited by the healthy tooth. Our results by 3D FE analysis indicated that maximum stresses occurred primarily at the cervical level of root and alveolar bone. In the cortical bone, the stress value was greater in infected system (21.641 MPa) than in healthy system (15.752 MPa), i.e., a 37.4% increase. However, in the trabecular bone we observed only 1.6% increase in the equivalent stress values for the infected tooth model. Stress concentration at the cervical level may cause abnormal bone remodeling or bone loss, resulting loss of tooth attachment or bone damage. Our findings showed that decayed single-rooted teeth are more vulnerable to apical root resorption than healthy teeth. The numerical method presented in this study not only can aid the elucidation of the biomechanics of teeth infected by caries but also can be implemented to investigate the effectiveness of new advanced restorative materials and protocols.
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Affiliation(s)
- Ali Merdji
- Laboratory of Mechanical Physical of Materials, Department of Mechanical Engineering, Sidi Bel Abbes University, Sidi Bel Abbes 22000, Algeria
- Medical Engineering Research Group, Faculty of Science and Technology, Anglia Ruskin University Bishop Hall Lane, Chelmsford, Essex CM1 1SQ, UK
| | - Noureddine Della
- Faculty of Science and Technology, Mascara University, Mascara 29000, Algeria
| | - Ali Benaissa
- Faculty of Science and Technology, Mascara University, Mascara 29000, Algeria
| | - Bel-Abbes Bachir Bouiadjra
- Laboratory of Mechanical Physical of Materials, Department of Mechanical Engineering, Sidi Bel Abbes University, Sidi Bel Abbes 22000, Algeria
| | - Boualem Serier
- Laboratory of Mechanical Physical of Materials, Department of Mechanical Engineering, Sidi Bel Abbes University, Sidi Bel Abbes 22000, Algeria
| | - Rajshree Mootanah
- Medical Engineering Research Group, Faculty of Science and Technology, Anglia Ruskin University Bishop Hall Lane, Chelmsford, Essex CM1 1SQ, UK
| | - Iyad Muslih
- Department of Mechanical and Industrial Engineering, Applied Science University, Amman 11931, Jordan
| | - Osama M. Mukdadi
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV 26506
- Department of Mechanical Engineering, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates e-mail:
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An E, Kim MY. Relationship between Oral Health Care Behaviors and Perceived Periodontal Disease on Hypertension Patients. ACTA ACUST UNITED AC 2016. [DOI: 10.17135/jdhs.2016.16.1.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wytrykowska A, Prosba-Mackiewicz M, Nyka WM. IL-1β, TNF-α, and IL-6 levels in gingival fluid and serum of patients with ischemic stroke. J Oral Sci 2016; 58:509-513. [DOI: 10.2334/josnusd.16-0278] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Anna Wytrykowska
- Department of Dental Techniques and Dysfunction of Masticatory System, Medical University of Gdansk
| | - Maria Prosba-Mackiewicz
- Department of Dental Techniques and Dysfunction of Masticatory System, Medical University of Gdansk
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Peres MA, Peres KG, Boing AF, Bastos JL, Silva DA, González-Chica DA. [Oral health in the EpiFloripa: a prospective study of adult health in southern Brazil]. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 17:571-5. [PMID: 24918424 DOI: 10.1590/1809-4503201400020021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/25/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe methods and challenges of oral health studies nested in a prospective cohort study of adults. METHODS A sample of 2,016 adults was investigated in 2009. Household visits were performed in order to apply a questionnaire on socioeconomic, demographic, health related variables, medicine consumption, blood donation, domestic violence and a set of questions related to women's health. Oral health data included self-reported oral health, number of remaining teeth, dental services use, perception of dental treatment needs, occurrence, intensity and impact of dental pain on daily life, xerostomia and chewing impairment due to poor oral health. In addition, participants' blood pressure, weight, height and waist circumference were measured. The second wave of the study was carried out in 2012. A questionnaire on socioeconomic factors, quality of life, discriminatory experiences, 24-hour dietary recall and oral health aspects (the same used in 2009) was applied. In addition, blood pressure, weight, and waist circumference were measured and clinical oral health status was assessed (dental caries, tooth loss, and periodontal outcomes). RESULTS Participation rate was 85.3% (n = 1,720) in 2009 and, among those, 1,222 (71.1%) were followed up in 2012. CONCLUSIONS The follow-up of this population will contribute in the elucidation of the potentially causal associations between oral outcomes and general chronic diseases.
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Affiliation(s)
- Marco Aurelio Peres
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Karen Glazer Peres
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Antonio Fernando Boing
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - João Luiz Bastos
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Diego Augusto Silva
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
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Vedin O, Hagström E, Budaj A, Denchev S, Harrington RA, Koenig W, Soffer J, Sritara P, Stebbins A, Stewart RH, Swart HP, Viigimaa M, Vinereanu D, Wallentin L, White HD, Held C. Tooth loss is independently associated with poor outcomes in stable coronary heart disease. Eur J Prev Cardiol 2015; 23:839-46. [PMID: 26672609 DOI: 10.1177/2047487315621978] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/21/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We investigated associations between self-reported tooth loss and cardiovascular outcomes in a global stable coronary heart disease cohort. METHODS We examined 15,456 patients from 39 countries with stable coronary heart disease (prior myocardial infarction, prior revascularisation or multivessel coronary heart disease) in the STABILITY trial. At baseline, patients reported number of teeth (26-32 (all), 20-25, 15-19, 1-14 and no teeth) and were followed for 3.7 years. Cox regression models adjusted for cardiovascular risk factors and socioeconomic status, determined associations between tooth loss level (26-32 teeth: lowest level; no teeth: highest level) and cardiovascular outcomes. RESULTS After adjustment, every increase in tooth loss level was associated with an increased risk of the primary outcome, the composite of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke (hazard ratio 1.06; 95% confidence interval 1.02-1.10), cardiovascular death (1.17; 1.10-1.24), all-cause death (1.16; 1.11-1.22) and non-fatal or fatal stroke (1.14; 1.04-1.24), but not with non-fatal or fatal myocardial infarction (0.99; 0.94-1.05). Having no teeth, compared to 26-32 teeth, entailed a significantly higher risk of the primary outcome (1.27 (1.08, 1.49)), cardiovascular death (1.85 (1.45, 2.37), all-cause death (1.81 (1.50, 2.20)) and stroke (1.67 (1.15, 2.39)). CONCLUSIONS In this large global cohort of patients with coronary heart disease, self-reported tooth loss predicted adverse cardiovascular outcomes and all-cause death independent of cardiovascular risk factors and socioeconomic status.
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Affiliation(s)
- Ola Vedin
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Andrzej Budaj
- Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Stephan Denchev
- Clinic of Cardiology, Medical Institute of Ministry of Interior, Sofia, Bulgaria
| | | | - Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany Deutsches Herzzentrum München, Technische Universität München, Munich, Germany DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Joseph Soffer
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Pennsylvania, USA
| | - Piyamitr Sritara
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Amanda Stebbins
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Ralph Ha Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital and University of Auckland, Auckland, New Zealand
| | - Henk P Swart
- Department of Cardioresearch, Antonius Ziekenhuis Sneek, The Netherlands
| | - Margus Viigimaa
- Tallinn University of Technology, North Estonia Medical Centre, Tallinn, Estonia
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Harvey D White
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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Cunningham TJ, Eke PI, Ford ES, Agaku IT, Wheaton AG, Croft JB. Cigarette Smoking, Tooth Loss, and Chronic Obstructive Pulmonary Disease: Findings From the Behavioral Risk Factor Surveillance System. J Periodontol 2015; 87:385-94. [PMID: 26537367 DOI: 10.1902/jop.2015.150370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cigarette smoking and tooth loss are seldom considered concurrently as determinants of chronic obstructive pulmonary disease (COPD). This study examines the multiplicative effect of self-reported tooth loss and cigarette smoking on COPD among United States adults aged ≥18 years. METHODS Data were taken from the 2012 Behavioral Risk Factor Surveillance System (n = 439,637). Log-linear regression-estimated prevalence ratios (PRs) are reported for the interaction of combinations of tooth loss (0, 1 to 5, 6 to 31, or all) and cigarettes smoking status (never, former, or current) with COPD after adjusting for age, sex, race/ethnicity, marital status, educational attainment, employment, health insurance coverage, dental care utilization, and diabetes. RESULTS Overall, 45.7% respondents reported having ≥1 teeth removed from tooth decay or gum disease, 18.9% reported being current cigarette smokers, and 6.3% reported having COPD. Smoking and tooth loss from tooth decay or gum disease were associated with an increased likelihood of COPD. Compared with never smokers with no teeth removed, all combinations of smoking status categories and tooth loss had a higher likelihood of COPD, with adjusted PRs ranging from 1.5 (never smoker with 1 to 5 teeth removed) to 6.5 (current smoker with all teeth removed) (all P <0.05). CONCLUSIONS Tooth loss status significantly modifies the association between cigarette smoking and COPD. An increased understanding of causal mechanisms linking cigarette smoking, oral health, and COPD, particularly the role of tooth loss, infection, and subsequent inflammation, is essential to reduce the burden of COPD. Health providers should counsel their patients about cigarette smoking, preventive dental care, and COPD risk.
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Affiliation(s)
- Timothy J Cunningham
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Paul I Eke
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Earl S Ford
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Israel T Agaku
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
| | - Anne G Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Rodriguez-Garcia A, Peixoto ITA, Verde-Star MJ, De la Torre-Zavala S, Aviles-Arnaut H, Ruiz ALTG. In Vitro Antimicrobial and Antiproliferative Activity of Amphipterygium adstringens. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:175497. [PMID: 26451151 PMCID: PMC4584240 DOI: 10.1155/2015/175497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/20/2015] [Indexed: 01/05/2023]
Abstract
Amphipterygium adstringens is a plant widely used in Mexican traditional medicine for its known anti-inflammatory and antiulcer properties. In this work, we evaluated the in vitro antimicrobial and antiproliferative activities of the methanolic extract of A. adstringens against oral pathogens such as Streptococcus mutans, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Candida albicans, and Candida dubliniensis, using microdilution (MIC) and agar diffusion methods (MBC), and the antiproliferative activity evaluating total growth inhibition (TGI) by staining the protein content with sulforhodamine B (SRB), using nine human cancer cell lines. Crude extract (CE) of A. adstringens showed some degree of activity against one or more of the strains with a MIC from 0.125 mg/mL to 63 mg/mL and MBC from 1.6 to 6.3 mg/mL and cytotoxic activity, particularly against NCI-ADR/RES, an ovarian cell line expressing multiple resistance drugs phenotype. The CE is a complex mixture of possible multitarget metabolites that could be responsible for both antimicrobial and antiproliferative activities, and further investigation is required to elucidate the identity of active compounds. Nevertheless the CE itself is useful in the development of new antimicrobial treatment based on natural products to prevent oral diseases and as alternative natural source for cancer treatment and prevention.
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Affiliation(s)
- A. Rodriguez-Garcia
- Institute of Biotechnology, Faculty of Biological Sciences, Autonomous University of Nuevo Leon, Avenida Universidad S/N, Ciudad Universitaria, CP 66455, San Nicolas de los Garza, NL, Mexico
| | - I. T. A. Peixoto
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Avenida Silveira Martins 3386, 41150 100 Salvador, BA, Brazil
| | - M. J. Verde-Star
- Institute of Biotechnology, Faculty of Biological Sciences, Autonomous University of Nuevo Leon, Avenida Universidad S/N, Ciudad Universitaria, CP 66455, San Nicolas de los Garza, NL, Mexico
| | - S. De la Torre-Zavala
- Institute of Biotechnology, Faculty of Biological Sciences, Autonomous University of Nuevo Leon, Avenida Universidad S/N, Ciudad Universitaria, CP 66455, San Nicolas de los Garza, NL, Mexico
| | - H. Aviles-Arnaut
- Institute of Biotechnology, Faculty of Biological Sciences, Autonomous University of Nuevo Leon, Avenida Universidad S/N, Ciudad Universitaria, CP 66455, San Nicolas de los Garza, NL, Mexico
| | - A. L. T. G. Ruiz
- Chemical, Biological and Agricultural Pluridisciplinary Research Center (CPQBA), University of Campinas (UNICAMP), CP 6171, 13083-970 Campinas, SP, Brazil
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Yaghobee S, Bayani M, Samiei N, Jahedmanesh N. What are the nanobacteria? BIOTECHNOL BIOTEC EQ 2015. [DOI: 10.1080/13102818.2015.1052761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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Bokhari SAH, Khan AA, Leung WK, Wajid G. Association of periodontal and cardiovascular diseases: South-Asian studies 2001-2012. J Indian Soc Periodontol 2015; 19:495-500. [PMID: 26644713 PMCID: PMC4645533 DOI: 10.4103/0972-124x.157876] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/07/2015] [Indexed: 01/22/2023] Open
Abstract
Large proportion of Asian populations have moderate to severe periodontal disease and a substantial number are anticipated to be at high risk of cardiovascular diseases (CVD). This study reviews epidemiology and association of periodontal and CVDs from the South-Asian region. Observational studies and clinical trials published during January 2001-December 2012 focusing association between periodontitis and CVDs in South-Asian countries were retrieved from various databases and studied. Current evidence suggests that both periodontal and CVDs are globally prevalent and show an increasing trend in developing countries. Global data on epidemiology and association of periodontal and CVDs are predominantly from the developed world; whereas Asia with 60% of the world's population lacks substantial scientific data on the link between periodontal and CVDs. During the search period, 14 studies (5 clinical trials, 9 case-controls) were reported in literature from South-Asia; 100% of clinical trials and 77% case-control studies have reported a significant association between the oral/periodontal parameters and CVD. Epidemiological and clinical studies from South-Asia validate the global evidence on association of periodontal disease with CVDs. However, there is a need for meticulous research for public health and scientific perspective of the Periodontal and CVDs from South-Asia.
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Affiliation(s)
- Syed Akhtar Hussain Bokhari
- Department of Periodontology and Preventive Dental Sciences, University Medical and Dental College, Faisalabad, Pakistan
| | - Ayyaz Ali Khan
- Department of Oral Health Sciences, Sheikh Zayed Medical Complex, Lahore, Pakistan
| | - Wai Keung Leung
- Department of Oral Diagnosis and Polyclinics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Gohar Wajid
- Department of Medical Education, University of Dammam, Dammam, Saudi Arabia
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Periodontal disease and risk of coronary heart disease: An updated meta-analysis of prospective cohort studies. Int J Cardiol 2015; 201:469-72. [PMID: 26313869 DOI: 10.1016/j.ijcard.2015.07.087] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 07/29/2015] [Indexed: 02/05/2023]
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Hada DS, Garg S, Ramteke GB, Ratre MS. Effect of Non-Surgical Periodontal Treatment on Clinical and Biochemical Risk Markers of Cardiovascular Disease: A Randomized Trial. J Periodontol 2015. [PMID: 26205747 DOI: 10.1902/jop.2015.150249] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Various studies have shown periodontal disease is one of the risk factors for coronary heart disease (CHD), and periodontal treatment of patients with CHD has also been correlated with reduction in systemic markers of CHD. The aim of this study is to evaluate the effect of non-surgical periodontal treatment (NSPT) on the cardiovascular clinical and biochemical status of patients with CHD. METHODS Seventy known patients with CHD were allocated randomly to either a control group (C; no periodontal therapy) (n = 35) or an experimental group (E; NSPT in the form of scaling and root planing [SRP]) (n = 35). Cardiovascular status was assessed using clinical parameters such as pulse, respiratory rate, blood pressure (BP), and biochemical parameters, such as high-sensitivity C-reactive protein (hsCRP), lipid profile, and white blood cell (WBC) count, at baseline and 1, 3, and 6 months. Intergroup and intragroup comparisons were performed using Student t test, and P <0.05 was considered statistically significant. RESULTS The complete data at the end of the study were provided by only 55 patients (group C, n = 25; group E, n = 30). Highly statistically significant reduction was observed in systolic BP (7.1 mm Hg) and very-low-density lipoproteins (VLDLs; 5.16 mg/dL) in group E. Changes were also observed in other cardiovascular biochemical and clinical parameters but were not statistically significant. CONCLUSIONS NSPT (in the form of SRP) positively affects limited cardiovascular (clinical and biochemical) status of patients with CHD. Reduction in triglyceride, VLDL, total WBC, lymphocyte, and neutrophil counts and increase in hsCRP, total cholesterol, high-density lipoprotein, and low-density lipoprotein levels were observed. Highly significant reduction in VLDL cholesterol levels and systolic BP was observed among the various parameters measured.
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Affiliation(s)
- Divya Singh Hada
- Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
| | - Subhash Garg
- Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
| | - Girish B Ramteke
- Department of Medicine, Maharaja Yeshwantrao Hospital, Indore, Madhya Pradesh, India.,Department of Medicine, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Madhu Singh Ratre
- Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
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Ricardo AC, Athavale A, Chen J, Hampole H, Garside D, Marucha P, Lash JP. Periodontal disease, chronic kidney disease and mortality: results from the third National Health and Nutrition Examination Survey. BMC Nephrol 2015; 16:97. [PMID: 26149680 PMCID: PMC4492086 DOI: 10.1186/s12882-015-0101-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/28/2015] [Indexed: 11/25/2022] Open
Abstract
Background Periodontal disease is associated with increased mortality in the general population, however its prognostic significance in chronic kidney disease (CKD) is not known. We evaluated the joint effect of periodontal disease and CKD on all-cause and cardiovascular mortality. Methods Prospective observational study of 10,755 adult participants in the National Health and Nutrition Examination Survey, 1988–1994 (NHANES III). CKD was defined as estimated glomerular filtration rate < 60 ml/minute/1.73 m2 or albumin-to-creatinine ratio ≥ 30 mg/g. Periodontal disease was defined as moderate (> 4 mm attachment loss in ≥ 2 mesial sites or 5 mm pocket depth in ≥ 2 mesial sites), or severe (> 6 mm attachment loss in ≥ 2 mesial sites and > 5 mm pocket depth in ≥ 1 mesial site). All-cause and cardiovascular mortality were evaluated using Cox proportional hazards models. Results There were 1,813 deaths over a median follow-up of 14 years. In multivariate analyses, as compared to participants with neither periodontal disease nor CKD, those with periodontal disease only or CKD only had increased all-cause mortality (HR 1.39; 95 % CI, 1.06 - 1.81 and 1.55; 1.30 - 1.84, respectively). The presence of both periodontal disease and CKD was associated with HR (95 % CI) 2.07 (1.65 - 2.59) for all-cause mortality, and 2.11 (1.52 - 2.94) for cardiovascular mortality. We found no evidence of multiplicativity or additivity between periodontal disease and CKD. In stratified analyses limited to individuals with CKD, periodontal disease (vs. not) was associated with adjusted HR (95 % CI) 1.35 (1.04 - 1.76) for all-cause, and 1.36 (0.95 - 1.95) for cardiovascular mortality. Conclusions These findings confirm the well-established association between periodontal disease and increased mortality in the general population, and provide new evidence of this association among individuals with CKD.
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Affiliation(s)
- Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, 60612, Chicago, IL, USA.
| | - Ambarish Athavale
- Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA.
| | - Jinsong Chen
- Institute of Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA.
| | - Hemanth Hampole
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, 60612, Chicago, IL, USA.
| | - Daniel Garside
- Institute of Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA.
| | - Phillip Marucha
- School of Dentistry, Oregon Health and Science University, Portland, OR, USA.
| | - James P Lash
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, 60612, Chicago, IL, USA.
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67
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Sreeram M, Suryakar AN, Dani NH. Is gamma-glutamyl transpeptidase a biomarker for oxidative stress in periodontitis? J Indian Soc Periodontol 2015; 19:150-4. [PMID: 26015663 PMCID: PMC4439622 DOI: 10.4103/0972-124x.149032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 10/08/2014] [Indexed: 12/30/2022] Open
Abstract
CONTEXT Periodontal disease and oxidative stress (OS) are part of a vicious cycle with each causing a deleterious effect on the other causing changes in the levels of antioxidants, and enzymes of antioxidant defense. Biomarkers and methods used for measuring OS are very expensive. AIMS To see how gamma-glutamyltransferase (GGT) fares, as a biomarker for OS in periodontits along with other routinely used biomarkers. DESIGN A cross-sectional study involving 300 people of which 150 were cases and 150 were controls. SETTING Candidates enrolled were patients visiting the OPD of MGV's Dental College and Hospital, Nasik, India between January 2011 and December 2012. MATERIALS AND METHODS Serum samples of patients with periodontitis, and controls were analyzed for malondialdehyde, superoxide dismutase (SOD), glutathione peroxidase (GPx), uric acid, and GGT. STATISTICAL ANALYSIS USED Analysis was performed using Student's t test. P <0.05 were considered to be significant. RESULTS Malondialdehyde values were found to be significantly higher cases, while SOD, GPx and uric acid levels were found to be lower than controls. GGT levels were significantly higher in cases as compared to controls. CONCLUSIONS GGT may be used as a cheap, quick, easy and precise marker for measuring OS.
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Affiliation(s)
- Meenakshi Sreeram
- Department of Physiology and Biochemistry, MGV's KBH Dental College and Hospital, Nasik, Maharashtra, India
| | | | - Nitin Hemchandra Dani
- Department of Periodontology, MGV's KBH Dental College and Hospital, Nasik, Maharashtra, India
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68
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Jahangiri L, Choi M, Moghadam M, Jawad S. Interventions for missing teeth: Removable prostheses for the edentulous mandible. Hippokratia 2015. [DOI: 10.1002/14651858.cd011544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Leila Jahangiri
- College of Dentistry, New York University; Department of Prosthodontics; 345 East 24th Street, Room 415-S New York USA 10010
| | - Mijin Choi
- College of Dentistry, New York University; Department of Prosthodontics; 345 East 24th Street, Room 415-S New York USA 10010
| | - Marjan Moghadam
- College of Dentistry, New York University; Department of Prosthodontics; 345 East 24th Street, Room 415-S New York USA 10010
| | - Sarra Jawad
- University Dental Hospital of Manchester; Higher Cambridge Street Manchester UK M15 6FH
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69
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McKenna G, Allen PF, O'Mahony D, Cronin M, DaMata C, Woods N. Impact of tooth replacement on the nutritional status of partially dentate elders. Clin Oral Investig 2015; 19:1991-8. [PMID: 25644134 DOI: 10.1007/s00784-015-1409-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 01/21/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to compare the impact of two different tooth replacement strategies on the nutritional status of partially dentate older patients. Nutritional status was measured using the full version of the Mini Nutritional Assessment (MNA) and the short form of the Mini Nutritional Assessment (MNA-SF). MATERIALS AND METHODS A randomised controlled clinical trial was conducted (Trial Registration no. ISRCTN26302774). Partially dentate patients aged 65 years and older were recruited and randomly allocated to the two different treatment groups: the removable partial dentures (RPD) group and the shortened dental arch (SDA) group. Nutritional status was measured using the MNA and MNA-SF administered at baseline and 1, 6 and 12 months after treatment intervention by a research nurse blinded to the treatment group allocation of all participants. RESULTS Data collected using the full version of the MNA showed significant improvements in mean MNA scores over the length of the study (p < 0.05). For the entire patient group, there was a mean increase of 0.15 points at 6 months and a further increase of 0.19 points at 12 months. These increases were similar within the treatment groups (p > 0.05). For MNA-SF, the analysis showed that there were no significant differences recorded over the data collection points after treatment intervention (p < 0.05). CONCLUSION Tooth replacement using conventional and functionally orientated treatment for the partially dentate elderly showed significant improvements in MNA score 12 months after intervention. CLINICAL RELEVANCE Prosthodontic rehabilitation may play an important role in the nutritional status of partially dentate elders.
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Affiliation(s)
- Gerald McKenna
- Centre for Public Health, Nutrition and Metabolism Research Group, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland, UK.
| | - P Finbarr Allen
- Cork University Dental School and Hospital, University College Cork, Cork, Ireland, UK
| | - Denis O'Mahony
- School of Medicine, University College Cork, Cork, Ireland, UK
| | - Michael Cronin
- School of Mathematical Sciences, University College Cork, Cork, Ireland, UK
| | - Cristiane DaMata
- Cork University Dental School and Hospital, University College Cork, Cork, Ireland, UK
| | - Noel Woods
- Centre for Policy Studies, University College Cork, Cork, Ireland, UK
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Pinilla J, Negrín-Hernández MA, Abásolo I. Time trends in socio-economic inequalities in the lack of access to dental services among children in Spain 1987-2011. Int J Equity Health 2015; 14:9. [PMID: 25636711 PMCID: PMC4316659 DOI: 10.1186/s12939-015-0132-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/06/2015] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Adult oral health is predicted by oral health in childhood. Prevention improves oral health in childhood and, consequently in adulthood, so substantial cost savings can be derived from prevention. The burden of oral disease is particularly high for disadvantaged and poor population groups in both developing and developed countries. Therefore, an appropriate and egalitarian access to dental care becomes a desirable objective if children's dental health is to be promoted irrespective of socioeconomic status. The aim of this research is to analyse inequalities in the lack of access to dental care services for children in the Spanish National Health System by socio-economic group over the period 1987-2011. METHODS Pooled data from eight editions of the Spanish National Health Survey for the years 1987-2011, as well as contextual data on state dental programmes are used. Logistic regressions are used to examine the related factors to the probability of not having ever visited the dentist among children between 6 and 14 years old. Our lack of access variable pays particular attention to the socioeconomic level of children's household. RESULTS The mean probability of having never been to the dentist falls considerably from 49.5% in 1987 to 8.4% in 2011. Analysis by socioeconomic level indicates that, in 1987, the probability of not having ever gone to the dentist is more than two times higher for children in the unskilled manual social class than for those in the upper non-manual social class (odds ratio 2.35). And this difference is not reduced significantly throughout the period analysed, rather it increases as in 1993 (odds of 2.39) and 2006 (odds of 3.03) to end in 2011 slightly below than in 1987 (odds ratio 1.80). CONCLUSION There has been a reduction in children's lack of access to dentists in Spain over the period 1987-2011. However, this reduction has not corrected the socioeconomic inequalities in children's access to dentists in Spain.
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Affiliation(s)
- Jaime Pinilla
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Miguel A Negrín-Hernández
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Ignacio Abásolo
- Departamento de Economía Aplicada y Métodos Cuantitativos, Facultad de Economía, Empresa y Turismo and IUDR, Universidad de La Laguna, Campus de Guajara, 38071 La Laguna, Tenerife, Spain.
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71
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Yu YH, Chasman DI, Buring JE, Rose L, Ridker PM. Cardiovascular risks associated with incident and prevalent periodontal disease. J Clin Periodontol 2015; 42:21-8. [PMID: 25385537 DOI: 10.1111/jcpe.12335] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 01/12/2023]
Abstract
AIM While prevalent periodontal disease associates with cardiovascular risk, little is known about how incident periodontal disease influences future vascular risk. We compared effects of incident versus prevalent periodontal disease in developing major cardiovascular diseases (CVD), myocardial infarction (MI), ischaemic stroke and total CVD. MATERIAL AND METHODS In a prospective cohort of 39,863 predominantly white women, age ≥45 years and free of cardiovascular disease at baseline were followed for an average of 15.7 years. Cox proportional hazard models with time-varying periodontal status [prevalent (18%), incident (7.3%) versus never (74.7%)] were used to assess future cardiovascular risks. RESULTS Incidence rates of all CVD outcomes were higher in women with prevalent or incident periodontal disease. For women with incident periodontal disease, risk factor adjusted hazard ratios (HRs) were 1.42 (95% CI, 1.14-1.77) for major CVD, 1.72 (1.25-2.38) for MI, 1.41 (1.02-1.95) for ischaemic stroke and 1.27 (1.06-1.52) for total CVD. For women with prevalent periodontal disease, adjusted HRs were 1.14 (1.00-1.31) for major CVD, 1.27 (1.04-1.56) for MI, 1.12 (0.91-1.37) for ischaemic stroke and 1.15 (1.03-1.28) for total CVD. CONCLUSION New cases of periodontal disease, not just those that are pre-existing, place women at significantly elevated risks for future cardiovascular events.
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Affiliation(s)
- Yau-Hua Yu
- Division of Periodontology, Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
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72
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Amar S, Engelke M. Periodontal innate immune mechanisms relevant to atherosclerosis. Mol Oral Microbiol 2014; 30:171-85. [PMID: 25388989 DOI: 10.1111/omi.12087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2014] [Indexed: 12/14/2022]
Abstract
Atherosclerosis is a common cardiovascular disease in the USA where it is a leading cause of illness and death. Atherosclerosis is the most common cause for heart attack and stroke. Most commonly, people develop atherosclerosis as a result of diabetes, genetic risk factors, high blood pressure, a high-fat diet, obesity, high blood cholesterol levels, and smoking. However, a sizable number of patients suffering from atherosclerosis do not harbor the classical risk factors. Ongoing infections have been suggested to play a role in this process. Periodontal disease is perhaps the most common chronic infection in adults with a wide range of clinical variability and severity. Research in the past decade has shed substantial light on both the initiating infectious agents and host immunological responses in periodontal disease. Up to 46% of the general population harbors the microorganism(s) associated with periodontal disease, although many are able to limit the progression of periodontal disease or even clear the organism(s) if infected. In the last decade, several epidemiological studies have found an association between periodontal infection and atherosclerosis. This review focuses on exploring the molecular consequences of infection by pathogens that exacerbate atherosclerosis, with the focus on infections by the periodontal bacterium Porphyromonas gingivalis as a running example.
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Affiliation(s)
- S Amar
- Center for Anti-inflammatory Therapeutics, School of Dental Medicine, Boston University, Boston, MA, USA
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73
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Li J, Quinque D, Horz HP, Li M, Rzhetskaya M, Raff JA, Hayes MG, Stoneking M. Comparative analysis of the human saliva microbiome from different climate zones: Alaska, Germany, and Africa. BMC Microbiol 2014; 14:316. [PMID: 25515234 PMCID: PMC4272767 DOI: 10.1186/s12866-014-0316-1] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/27/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although the importance of the human oral microbiome for health and disease is increasingly recognized, variation in the composition of the oral microbiome across different climates and geographic regions is largely unexplored. RESULTS Here we analyze the saliva microbiome from native Alaskans (76 individuals from 4 populations), Germans (10 individuals from 1 population), and Africans (66 individuals from 3 populations) based on next-generation sequencing of partial 16S rRNA gene sequences. After quality filtering, a total of 67,916 analyzed sequences resulted in 5,592 OTUs (defined at ≥97% identity) and 123 genera. The three human groups differed significantly by the degree of diversity between and within individuals (e.g. beta diversity: Africans > Alaskans > Germans; alpha diversity: Germans > Alaskans > Africans). UniFrac, network, ANOSIM, and correlation analyses all indicated more similarities in the saliva microbiome of native Alaskans and Germans than between either group and Africans. The native Alaskans and Germans also had the highest number of shared bacterial interactions. At the level of shared OTUs, only limited support for a core microbiome shared across all three continental regions was provided, although partial correlation analysis did highlight interactions involving several pairs of genera as conserved across all human groups. Subsampling strategies for compensating for the unequal number of individuals per group or unequal sequence reads confirmed the above observations. CONCLUSION Overall, this study illustrates the distinctiveness of the saliva microbiome of human groups living under very different climatic conditions.
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Affiliation(s)
- Jing Li
- Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, D-04103, Leipzig, Germany.
- Max Planck Independent Research Group on Population Genomics, Chinese Academy of Sciences and Max Planck Society (CAS-MPG) Partner Institute for Computational Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai, 200031, China.
| | - Dominique Quinque
- Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, D-04103, Leipzig, Germany.
- Current address: Department of Genetics, Harvard Medical School, 77 Louis Pasteur Avenue, Boston, MA, 02115, USA.
| | - Hans-Peter Horz
- Division of Virology, Institute of Medical Microbiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, D-52057, Aachen, Germany.
| | - Mingkun Li
- Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, D-04103, Leipzig, Germany.
| | - Margarita Rzhetskaya
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Jennifer A Raff
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Current address: Department of Anthropology, University of Texas, Austin, TX, 78712, USA.
| | - M Geoffrey Hayes
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA.
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Mark Stoneking
- Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, D-04103, Leipzig, Germany.
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Goyal L, Bey A, Gupta ND, Sharma VK. Comparative evaluation of serum C-reactive protein levels in chronic and aggressive periodontitis patients and association with periodontal disease severity. Contemp Clin Dent 2014; 5:484-8. [PMID: 25395764 PMCID: PMC4229757 DOI: 10.4103/0976-237x.142816] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE C-reactive protein (CRP) is an acute-phase reactant and has been proved to be a significant predictor of future cardiovascular events. Recent studies have demonstrated a correlation between periodontitis and elevated CRP levels. However, most of the studies have focused on chronic periodontitis and very few studies are done in patients with aggressive periodontitis. The aim of this study was to determine and compare the relative levels of serum CRP in aggressive and chronic periodontitis patients. MATERIALS AND METHODS A total of 75 systemically healthy subjects were divided into three groups: Group I, nonperiodontitis subjects; group II, chronic generalized periodontitis patients and group III, generalized aggressive periodontitis patients. All participants were subjected to quantitative CRP analysis using enzyme-linked immunosorbent assay. RESULTS Mean CRP levels were significantly greater in both group II and III as compared to group I and group III having greater level than group II. Furthermore, CRP levels positively correlated with the amount of periodontal destruction as measured by probing depth and clinical attachment loss. CONCLUSION The present study indicates a positive correlation between CRP and periodontal disease severity with particular concern in younger individuals that could be a possible underlying pathway in the association between periodontal disease and the observed higher risk for cardiovascular disease in periodontitis patients.
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Affiliation(s)
- Lata Goyal
- Departments of Periodontics and Community Dentistry, Dr. Z. A. Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Afshan Bey
- Departments of Periodontics and Community Dentistry, Dr. Z. A. Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - N D Gupta
- Departments of Periodontics and Community Dentistry, Dr. Z. A. Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Vivek Kumar Sharma
- Departments of Periodontics and Community Dentistry, Dr. Z. A. Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Prevalence of loss of all teeth (edentulism) and associated factors in older adults in China, Ghana, India, Mexico, Russia and South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:11308-24. [PMID: 25361046 PMCID: PMC4245614 DOI: 10.3390/ijerph111111308] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/08/2014] [Accepted: 10/14/2014] [Indexed: 12/05/2022]
Abstract
Little information exists about the loss of all one’s teeth (edentulism) among older adults in low- and middle-income countries. This study examines the prevalence of edentulism and associated factors among older adults in a cross-sectional study across six such countries. Data from the World Health Organization (WHO’s) Study on global AGEing and adult health (SAGE) Wave 1 was used for this study with adults aged 50-plus from China (N = 13,367), Ghana (N = 4724), India (N = 7150), Mexico (N = 2315), Russian Federation (N = 3938) and South Africa (N = 3840). Multivariate regression was used to assess predictors of edentulism. The overall prevalence of edentulism was 11.7% in the six countries, with India, Mexico, and Russia has higher prevalence rates (16.3%–21.7%) than China, Ghana, and South Africa (3.0%–9.0%). In multivariate logistic analysis sociodemographic factors (older age, lower education), chronic conditions (arthritis, asthma), health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (functional disability and low social cohesion) were associated with edentulism. The national estimates and identified factors associated with edentulism among older adults across the six countries helps to identify areas for further exploration and targets for intervention.
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76
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Noguchi S, Toyokawa S, Miyoshi Y, Suyama Y, Inoue K, Kobayashi Y. Five-year follow-up study of the association between periodontal disease and myocardial infarction among Japanese male workers: MY Health Up Study. J Public Health (Oxf) 2014; 37:605-11. [PMID: 25293424 DOI: 10.1093/pubmed/fdu076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND An association between chronic oral infections and coronary heart disease has been suggested. METHODS The study participants were male employees aged 36-59 years. Data were extracted from the MY Health Up Study, comprising a baseline questionnaire survey and succeeding annual health examinations for financial firm workers in Japan. Using a self-administered questionnaire at baseline, participants' oral status was classified into three types of periodontal indicators: (i) periodontal score, (ii) periodontitis and (iii) tooth loss (<5 and ≥5 teeth). An incidence of myocardial infarction (MI) was determined by annual health examination records. RESULTS Of the 4037 candidates for follow-up in the baseline year of 2004, 3081 males were eligible for the analysis, 17 of whom experienced MI in the subsequent 5 years. The periodontal score model was associated with an increase in developing MI [odds ratio (OR) = 2.11, 95% confidence interval (CI) = 1.29-3.44], after adjusting for other confounding variables. The periodontitis (OR = 2.26, 95% CI = 0.84-6.02) and tooth loss (OR = 1.97, 95% CI = 0.71-5.45) models showed similar trends, although the difference was not significant. CONCLUSIONS Periodontal disease may be a mild but independent risk factor for MI among Japanese male workers.
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Affiliation(s)
- Satomi Noguchi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan Department of Health Policy and Technology Assessment, National Institute of Public Health, Saitama, Japan
| | - Satoshi Toyokawa
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yuji Miyoshi
- Division of Health Promotion, Meiji Yasuda Life Insurance Company, Tokyo, Japan
| | - Yasuo Suyama
- Meiji Yasuda Shinjuku Medical Center, Meiji Yasuda Life Foundation of Health and Welfare, Tokyo, Japan
| | - Kazuo Inoue
- Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Chiba, Japan
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Bokhari SAH, Khan AA, Butt AK, Hanif M, Izhar M, Tatakis DN, Ashfaq M. Periodontitis in coronary heart disease patients: strong association between bleeding on probing and systemic biomarkers. J Clin Periodontol 2014; 41:1048-54. [PMID: 24946826 DOI: 10.1111/jcpe.12284] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 11/28/2022]
Abstract
AIM Few studies have examined the relationship of individual periodontal parameters with individual systemic biomarkers. This study assessed the possible association between specific clinical parameters of periodontitis and systemic biomarkers of coronary heart disease risk in coronary heart disease patients with periodontitis. MATERIALS AND METHODS Angiographically proven coronary heart disease patients with periodontitis (n = 317), aged >30 years and without other systemic illness were examined. Periodontal clinical parameters of bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) and systemic levels of high-sensitivity C-reactive protein (CRP), fibrinogen (FIB) and white blood cells (WBC) were noted and analyzed to identify associations through linear and stepwise multiple regression analyses. RESULTS Unadjusted linear regression showed significant associations between periodontal and systemic parameters; the strongest association (r = 0.629; p < 0.001) was found between BOP and CRP levels, the periodontal and systemic inflammation marker, respectively. Stepwise regression analysis models revealed that BOP was a predictor of systemic CRP levels (p < 0.0001). BOP was the only periodontal parameter significantly associated with each systemic parameter (CRP, FIB, and WBC). CONCLUSION In coronary heart disease patients with periodontitis, BOP is strongly associated with systemic CRP levels; this association possibly reflects the potential significance of the local periodontal inflammatory burden for systemic inflammation.
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78
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Siqueira JF, Rôças IN. Present status and future directions in endodontic microbiology. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/etp.12060] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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79
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Kajikawa M, Nakashima A, Maruhashi T, Iwamoto Y, Iwamoto A, Matsumoto T, Hidaka T, Kihara Y, Chayama K, Goto C, Taguchi A, Noma K, Higashi Y. Poor Oral Health, That Is, Decreased Frequency of Tooth Brushing, Is Associated With Endothelial Dysfunction. Circ J 2014; 78:950-4. [DOI: 10.1253/circj.cj-13-1330] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masato Kajikawa
- Department of Cardiovascular Medicine, Institute of Biomedical & Health Sciencies, Hiroshima University
| | - Ayumu Nakashima
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital
| | - Tatsuya Maruhashi
- Department of Cardiovascular Medicine, Institute of Biomedical & Health Sciencies, Hiroshima University
| | - Yumiko Iwamoto
- Department of Cardiovascular Medicine, Institute of Biomedical & Health Sciencies, Hiroshima University
| | - Akimichi Iwamoto
- Department of Cardiovascular Medicine, Institute of Biomedical & Health Sciencies, Hiroshima University
| | - Takeshi Matsumoto
- Department of Cardiovascular Medicine, Institute of Biomedical & Health Sciencies, Hiroshima University
| | - Takayuki Hidaka
- Department of Cardiovascular Medicine, Institute of Biomedical & Health Sciencies, Hiroshima University
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Institute of Biomedical & Health Sciencies, Hiroshima University
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical & Health Sciencies, Hiroshima University
| | | | - Akira Taguchi
- Department of Oral and Maxillofacial Radiology, Matsumoto Dental University
| | - Kensuke Noma
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Yukihito Higashi
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
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80
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The relationship between metabolic conditions and prevalence of periodontal disease in rural Korean elderly. Arch Gerontol Geriatr 2014; 58:125-9. [DOI: 10.1016/j.archger.2013.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 07/17/2013] [Accepted: 08/31/2013] [Indexed: 11/22/2022]
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81
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Microbiota and nonalcoholic steatohepatitis. Semin Immunopathol 2013; 36:115-32. [PMID: 24337650 DOI: 10.1007/s00281-013-0404-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 10/15/2013] [Indexed: 02/07/2023]
Abstract
The recent rise in obesity-related diseases, such as nonalcoholic fatty liver disease and its strong association with microbiota, has elicited interest in the underlying mechanisms of these pathologies. Experimental models have highlighted several mechanisms connecting microbiota to the development of liver dysfunction in nonalcoholic steatohepatitis (NASH) such as increased energy harvesting from the diet, small intestine bacterial overgrowth, modulation of the intestinal barrier by glucagon-like peptide-2 secretions, activation of innate immunity through the lipopolysaccharide-CD14 axis caused by obesity-induced leptin, periodontitis, and sterile inflammation. The manipulation of microbiota through probiotics, prebiotics, antibiotics, and periodontitis treatment yields encouraging results for the treatment of obesity, diabetes, and NASH, but data in humans is scarce.
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82
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Dawson DR, Branch-Mays G, Gonzalez OA, Ebersole JL. Dietary modulation of the inflammatory cascade. Periodontol 2000 2013; 64:161-97. [DOI: 10.1111/j.1600-0757.2012.00458.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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83
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Hong P, Liu CM, Nordstrom L, Lalwani AK. The role of the human microbiome in otolaryngology-head and neck surgery: a contemporary review. Laryngoscope 2013; 124:1352-7. [PMID: 24178066 DOI: 10.1002/lary.24490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVES/HYPOTHESIS The human microbiome represents the collective genomes and gene products of microbes living within and on humans. The objective of this review is to provide a summary of the current microbiome literature pertaining to otolaryngology-head and neck surgery. DATA SOURCE Ovid MEDLINE. METHODS Scientific publications with clinical correlates. RESULTS Human microbiome studies have been facilitated by culture-independent, high-throughput sequencing methods. Data from the Human Microbiome Project has shown that the composition of the human microbiome is specific to each body site and that each individual has a unique microbiome. Alterations in the human microbiome are associated with some disease states; thus, novel therapeutic strategies are being developed based on concepts and findings stemming from microbiome research. CONCLUSIONS Although a growing body of research shows potential significance of the human microbiome for human health and disease, there is a paucity of microbiome studies in otolaryngology. More studies are required to increase our understanding of the indigenous microbiota and their effects on diseases of the head and neck.
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Affiliation(s)
- Paul Hong
- IWK Health Centre, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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84
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Aminzadeh A, Ahmadi M, Hosseini SM. Relation between Oral Health Status and Electrocardiogram ST Segment Changes in a Group of Patients with Myocardial Infarction. J Dent Res Dent Clin Dent Prospects 2013; 7:169-73. [PMID: 24082989 PMCID: PMC3779377 DOI: 10.5681/joddd.2013.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 06/23/2013] [Indexed: 11/17/2022] Open
Abstract
Background and aims. Only half to two-thirds of cardiovascular diseases can be explained by the classic risk factors. It is believed that chronic oral inflammation is a potent risk factor for systemic diseases. Studies show that electrocardiogram ST segment changes can be predictive of myocardial infarction outcome. In this study the relation between electrocardio-gram ST segment changes and oral health is evaluated. Materials and methods. In this cross-sectional study, thirty-six patients (14 females and 22 males) with myocardial infarction were enrolled. Oral health indices including DMFT index, probing depth, clinical attachment loss and bleeding on probing were recorded for each patient. DMFT index, PD, CAL as continuous variables and BOP as a categorical variable were compared with ST segment changes by independent t-test and chi-squared test, respectively (α=0.05). Results. DMFT index, BOP and PD revealed no statistically significant relation with ST segment groups. CAL showed a statistically significant difference within ST segment groups (P=0.003, OR=1.68). Conclusion. Clinical attachment loss was significantly higher in patients with ST segment depression, while no correla-tion was seen between probing depth, bleeding on probing and DMFT index with ST segment elevation or depression.
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Affiliation(s)
- Atousa Aminzadeh
- Assistant Professor, Department of Oral Pathology, Khorasgan (Isfahan) Branch, Islamic Azad University, Isfahan, Iran
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85
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Kumar S, Shah S, Budhiraja S, Desai K, Shah C, Mehta D. The effect of periodontal treatment on C-reactive protein: A clinical study. J Nat Sci Biol Med 2013; 4:379-82. [PMID: 24082736 PMCID: PMC3783784 DOI: 10.4103/0976-9668.116991] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic periodontitis in amultifactorial inflammatory disease which is caused by various microorganisms. Many studies have found close association between chronic periodontitis and C-reactive protein (CRP). CRPis an inflammatory marker which increases in all inflammatory condition. AIMS AND OBJECTIVE The present clinical study was designed to show the effect of periodontal treatment on the CRP levels of gingival crevicular fluid and to determine the effect of nonsurgical therapy in minimizing the CRP levels in chronic generalized periodontitis. MATERIAL AND METHOD Gingival crevicular fluid was collected using a micro capillary pipette that was hand calibrated at every 1 mm till 10 mm, from selected sites in the subjects on the 1st, 14th and 45th days. RESULTS AND CONCLUSION Decreased CRP levels of gingival crevicular fluid were observed at the end of the study. There was a 37% reduction in probing pocket depth and 45% gain in clinical attachment level and a reduction of about 57% after 14 days and 90% reduction of CRP levels in gingival crevicular fluid after 45 days. Thus, the results show that the presence of CRP level is more significant in gingival crevicular fluid and confirms the underlying inflammatory component of the disease activity in chronic periodontitis.
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Affiliation(s)
- Santosh Kumar
- Department of Periodontics, Karnavati School of Dentistry, Uvarsad, Gandhinagar, Gujarat, India
| | - Samir Shah
- Department of Periodontics, Karnavati School of Dentistry, Uvarsad, Gandhinagar, Gujarat, India
| | - Shilpa Budhiraja
- Department of Periodontics, Karnavati School of Dentistry, Uvarsad, Gandhinagar, Gujarat, India
| | - Khushboo Desai
- Department of Periodontics, Karnavati School of Dentistry, Uvarsad, Gandhinagar, Gujarat, India
| | - Chirag Shah
- Department of Periodontics, Karnavati School of Dentistry, Uvarsad, Gandhinagar, Gujarat, India
| | - Dhaval Mehta
- Department of Oral Medicine and Radiology, Karnavati School of Dentistry, Uvarsad, Gandhinagar, Gujarat, India
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86
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Ariyamuthu VK, Nolph KD, Ringdahl BE. Periodontal disease in chronic kidney disease and end-stage renal disease patients: a review. Cardiorenal Med 2013; 3:71-78. [PMID: 23802000 DOI: 10.1159/000350046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Periodontal disease is a chronic inflammatory disorder and being so it has been associated with accelerated atherosclerosis and malnutrition. Cardiovascular diseases are the leading cause of mortality in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients [National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Annual Data Report, 2010]. A recent scientific statement released by the American Heart Association [Lockhart et al.: Circulation 2012;125:2520-2544] claims that, even though evidence exists to believe that periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction, there is little evidence that those interventions prevent atherosclerotic vascular disease or modify the outcomes. In this review, we discuss the periodontal findings and their association with an increased prevalence of inflammatory markers and cardiovascular mortality in ESRD patients and CKD.
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87
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Abstract
The impact of dietary behaviors and food consumption and their relation to oral health are significant public health issues. Women and men exhibit different dietary behaviors. Understanding the influences of dietary behaviors on oral health from the perspective of gender disparities, however, is limited. This article provides the intersections of dietary factors and oral-systemic health for which women are at greater risk than men. Topics include the effect of dietary choices on oral health disparities seen in female patients. Interventional strategies at the local and community level that are designed to influence the balance between dietary habits and oral-systemic health are discussed.
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Affiliation(s)
- Juhee Kim
- Department of Public Health, Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
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88
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Wehmeyer MMH, Kshirsagar AV, Barros SP, Beck JD, Moss KL, Preisser JS, Offenbacher S. A randomized controlled trial of intensive periodontal therapy on metabolic and inflammatory markers in patients With ESRD: results of an exploratory study. Am J Kidney Dis 2013; 61:450-8. [PMID: 23261122 PMCID: PMC3578050 DOI: 10.1053/j.ajkd.2012.10.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 10/10/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Periodontitis is a novel risk factor for inflammation and cardiovascular disease in the dialysis population. Limited information exists about the impact of periodontal therapy in patients receiving dialysis. STUDY DESIGN Randomized controlled trial to assess feasibility and gather preliminary data. SETTING & PARTICIPANTS Dialysis patients with moderate/severe chronic periodontitis. INTERVENTION Intensive treatment, consisting of scaling and root planing, extraction of hopeless teeth, and placement of local-delivery antibiotics, was performed at the baseline visit for treatment-group patients and after study completion for control-group patients. OUTCOMES Outcomes were feasibility (screening, recruitment, enrollment, adverse events, and study withdrawal/completion), clinical periodontal parameters (probing depth, clinical attachment level, bleeding on probing, gingival index, and plaque index), and serum albumin and interleukin 6 levels at 3 and 6 months postintervention. RESULTS 342 dialysis patients were approached for participation: 53 were randomly assigned, with 26 participants assigned to immediate treatment and 27 assigned to a control arm for treatment after 6 months. 51 patients completed baseline appointments; 46 were available for 3-month follow-up, 45 were available for 6-month follow-up examinations, and 43 completed all visits. At 3 months, there was a statistically significant improvement for the treatment group compared to the control group for 3 periodontal parameters: mean probing depth (P = 0.008), extent of probing depth ≥4 mm (P = 0.02), and extent of gingival index ≥1 (P = 0.01). However, by 6 months, the difference between groups was no longer present for any variable except probing depth ≥4 mm (P = 0.04). There was no significant difference between groups for serum albumin or high-sensitivity interleukin 6 level at any time when adjusted for body mass index, diabetic status, and plaque index. LIMITATIONS Small sample size and relatively healthy population, imbalance in diabetes. CONCLUSIONS This small trial demonstrates successful cooperation between dentists and nephrologists and successful recruitment, treatment, and retention of dialysis patients with periodontitis. Larger studies with longer follow-up are needed to determine whether treatment can improve markers of inflammation and morbidity.
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Affiliation(s)
- Meggan M H Wehmeyer
- Department of Periodontics, University of Texas School of Dentistry at Houston, Houston, TX, USA.
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89
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Chatzidimitriou D, Kirmizis D, Gavriilaki E, Chatzidimitriou M, Malisiovas N. Atherosclerosis and infection: is the jury still not in? Future Microbiol 2013; 7:1217-30. [PMID: 23030426 DOI: 10.2217/fmb.12.87] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Atherosclerosis is a chronic inflammatory process accounting for increased cardiovascular and cerebrovascular morbidity and mortality. A wealth of recent data has implicated several infectious agents, mainly Chlamydophila pneumoniae, Helicobacter pylori, CMV and periodontal pathogens, in atherosclerosis. Thus, we sought to comprehensively review the available data on the topic, exploring in particular the pathogenetic mechanisms, and discuss anticipated future directions.
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90
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Pessi T, Karhunen V, Karjalainen PP, Ylitalo A, Airaksinen JK, Niemi M, Pietila M, Lounatmaa K, Haapaniemi T, Lehtimäki T, Laaksonen R, Karhunen PJ, Mikkelsson J. Bacterial signatures in thrombus aspirates of patients with myocardial infarction. Circulation 2013; 127:1219-28, e1-6. [PMID: 23418311 DOI: 10.1161/circulationaha.112.001254] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Infectious agents, especially bacteria and their components originating from the oral cavity or respiratory tract, have been suggested to contribute to inflammation in the coronary plaque, leading to rupture and the subsequent development of coronary thrombus. We aimed to measure bacterial DNA in thrombus aspirates of patients with ST-segment-elevation myocardial infarction and to check for a possible association between bacteria findings and oral pathology in the same cohort. METHODS AND RESULTS Thrombus aspirates and arterial blood from patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention (n=101; 76% male; mean age, 63.3 years) were analyzed with real-time quantitative polymerase chain reaction with specific primers and probes to detect bacterial DNA from several oral species and Chlamydia pneumoniae. The median value for the total amount of bacterial DNA in thrombi was 16 times higher than that found in their blood samples. Bacterial DNA typical for endodontic infection, mainly oral viridans streptococci, was measured in 78.2% of thrombi, and periodontal pathogens were measured in 34.7%. Bacteria-like structures were detected by transmission electron microscopy in all 9 thrombus samples analyzed; whole bacteria were detected in 3 of 9 cases. Monocyte/macrophage markers for bacteria recognition (CD14) and inflammation (CD68) were detected in thrombi (8 of 8) by immunohistochemistry. Among the subgroup of 30 patients with myocardial infarction examined by panoramic tomography, a significant association between the presence of periapical abscesses and oral viridans streptococci DNA-positive thrombi was found (odds ratio, 13.2; 95% confidence interval, 2.11-82.5; P=0.004). CONCLUSIONS Dental infection and oral bacteria, especially viridans streptococci, may be associated with the development of acute coronary thrombosis.
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Affiliation(s)
- Tanja Pessi
- Department of Forensic Science, School of Medicine, FIN-33014 Tampere University, Finland.
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91
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Parkar SM, Modi GN, Jani J. Periodontitis as risk factor for acute myocardial infarction: A case control study. Heart Views 2013; 14:5-11. [PMID: 23580918 PMCID: PMC3621229 DOI: 10.4103/1995-705x.107113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To assess the periodontal status among the patients suffering from acute myocardial infarction (AMI) and to investigate whether periodontitis is a risk factor for AMI or not. MATERIALS AND METHODS A cross-sectional study of 60 subjects, 30 subjects in each AMI group and control group was conducted. Details of risk factors like age, sex, smoking, and alcohol consumption were obtained through a personal interview. Medical history was retrieved from the medical file. The oral hygiene status was assessed by using a simplified oral hygiene index (OHI-S) and the periodontal status was assessed by community periodontal index (CPI) and loss of attachment (LOA) as per World Health Organization (WHO) methodology 1997. Chi-square test was used to analyze qualitative data whereas t-test and one way analysis of variance (ANOVA) test was used for quantitative data. Multiple regression model was applied to check the risk factors for AMI. RESULTS The mean OHI-S score for case and control group was 3.98 ± 0.70 and 3.11 ± 0.68, respectively, which was statistically highly significant ( P < 0.001). There was high severity of periodontitis (for both in terms of CPI and LOA) in the case group as compared with control group, that was found to be statistically highly significant ( P < 0.001). There was a significant result for OHI-S and LOA score with odds ratio of 0.13 and 0.79, respectively, when the multiple logistic regression model was applied. CONCLUSION The results of the present study show evidence that those patients who have experienced myocardial infarction exhibit poor periodontal conditions in comparison to healthy subjects and suggest an association between chronic oral infections and myocardial infarction.
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Affiliation(s)
- Sujal M. Parkar
- Department of Public Health Dentistry, Ahmedabad Dental College and Hospital, Gujarat, India
| | - Gunjan N. Modi
- Department of Public Health Dentistry, Ahmedabad Dental College and Hospital, Gujarat, India
| | - Jalak Jani
- Department of Oral Medicine and Radiology, Ahmedabad Dental College and Hospital, Gujarat, India
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92
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The first-choice standard of care for an edentulous mandible: a Delphi method survey of academic prosthodontists in the United States. J Am Dent Assoc 2012; 143:881-9. [PMID: 22855902 DOI: 10.14219/jada.archive.2012.0292] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In 2002 and 2009, two consensus statements-one from a symposium in Canada and one from England-were issued that recommended that the first-choice standard of care for an edentulous mandible should be the two implant-retained mandibular overdenture (IRMOD). The authors conducted a survey to determine if, in 2011, U.S. academic prosthodontic experts' opinions were aligned with those in the two consensus statements. METHODS The authors administered a Delphi method survey to an expert panel of 16 nationally representative academic prosthodontists to determine if there is consensus on the first-choice standard of care for an edentulous mandible between the IRMOD and a conventional mandibular complete denture (CD). Consensus agreement was defined as a 70 percent agreement level among the panelists. RESULTS The panel attained consensus favoring the IRMOD for nine of the 10 parameters assessed-retention, stability, speech, masticatory efficiency, comfort while eating soft foods and hard foods, confidence in intimate situations, satisfaction and self-esteem. The exception was esthetics for which only a majority (51-69 percent) favored the IRMOD. CONCLUSIONS The panelists reached consensus that they would recommend an IRMOD instead of a CD as the first-choice standard of care for patients who are healthy or have mild systemic disease, but not for patients with severe systemic disease. CLINICAL IMPLICATIONS Surveyed academic prosthodontists recommend an IRMOD as the first choice standard of care when restoring an edentulous mandible of a healthy patient or a patient with mild systemic disease.
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93
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Association among Oral Health, Apical Periodontitis, CD14 Polymorphisms, and Coronary Heart Disease in Middle-aged Adults. J Endod 2012; 38:1570-7. [DOI: 10.1016/j.joen.2012.08.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 08/15/2012] [Accepted: 08/21/2012] [Indexed: 11/22/2022]
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94
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Jimenez M, Hu FB, Marino M, Li Y, Joshipura KJ. Type 2 diabetes mellitus and 20 year incidence of periodontitis and tooth loss. Diabetes Res Clin Pract 2012; 98:494-500. [PMID: 23040240 PMCID: PMC3551264 DOI: 10.1016/j.diabres.2012.09.039] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/06/2012] [Accepted: 09/17/2012] [Indexed: 11/28/2022]
Abstract
AIMS The objective of this study was to evaluate the prospective associations between type 2 diabetes mellitus (T2DM) and the risk of periodontitis and tooth loss. METHODS 35,247 male participants of the Health Professionals Follow-Up Study who were dentate, free of periodontitis and cancer at baseline, were followed from 1986 to 2006. Data on self-reported diabetes, periodontitis, tooth loss and potential confounders were collected at baseline and biennially through mailed questionnaires. The multivariable adjusted relationships between diabetes and first report of periodontitis and tooth loss were estimated using time-varying Cox models. RESULTS There were 3009 incident self-reported periodontitis and 10,017 tooth loss events over 591,941 person-years. Men with T2DM showed a 29% (HR=1.29; 95% CI: 1.13-1.47) increased risk of periodontitis compared to those without, when adjusted for age, race, smoking, BMI, fruit and vegetable intake, physical activity, alcohol consumption and dental profession. Men with T2DM with total fruit and vegetable intake < median were 49% as likely to report incident periodontitis compared to those without T2DM (HR=1.49; 95% CI: 1.23-1.80; p-value for interaction=0.03). The multivariable adjusted risk of tooth loss was 1.10 (95% CI: 1.02-1.18). CONCLUSIONS Type 2 diabetes mellitus was associated with a significantly greater risk of self-reported periodontitis.
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Affiliation(s)
- Monik Jimenez
- Brigham and Women's Hospital, Division of Preventive Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA 02215, United States
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95
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Shetty D, Dua M, Kumar K, Dhanapal R, Astekar M, Shetty DC. Oral hygiene status of individuals with cardiovascular diseases and associated risk factors. Clin Pract 2012; 2:e86. [PMID: 24765485 PMCID: PMC3981199 DOI: 10.4081/cp.2012.e86] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 07/30/2012] [Accepted: 08/30/2012] [Indexed: 12/21/2022] Open
Abstract
Dentist and oral health screening may be the latest weapon in identifying persons at risk of cardiovascular disease. Oral infections, specifically periodontitis, may confer independent risks for different systemic conditions. The risk factors associated with cardiovascular diseases also suggest that the relationship between periodontal disease and diabetes works in both ways. The aim of this study was to support and strengthen the association and relationship between oral hygiene status of individuals with cardiovascular diseases and its associated risk factors. A simple random sampling was carried out in 200 inhabitants of Western Utter Pradesh, India. An oral health visit and examination was made for an equal number of males and females of different age groups with cardiovascular diseases. Evaluation of the oral status was made by means of an oral hygiene index, community periodontal index of treatment needs and loss of attachment. Evaluation of oral status in patients with cardiovascular diseases and in the control group has shown a statistically significant low level of oral health in patients with cardiovascular diseases as compared to control. Prevalence of systemic diseases in different age groups significantly correlated with the prevalence of severe periodontal diseases. Treating gum disease may reduce the risk of heart disease and improve health outcomes for patients with periodontal disease and vascular heart problems.
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Affiliation(s)
- Divya Shetty
- Department of Orthodontics, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad (U.P)
| | - Mahima Dua
- Oral and Maxillofacial Pathology and Microbiology, Inderprastha Dental College, Sahibabad, Ghaziabad (U.P)
| | - Kiran Kumar
- Oral and Maxillofacial Pathology and Microbiology, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad (U.P)
| | - Raghu Dhanapal
- Oral and Maxillofacial Pathology and Microbiology, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad (U.P)
| | - Madhusudan Astekar
- Oral and Maxillofacial Pathology and Microbiology, Pacific Dental College and Hospital, Debari, Udaipur, Rajasthan, India
| | - Devi Charan Shetty
- Oral and Maxillofacial Pathology and Microbiology, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad (U.P)
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96
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Stenman U, Wennström A, Ahlqwist M, Bengtsson C, Björkelund C, Lissner L, Hakeberg M. Association between periodontal disease and ischemic heart disease among Swedish women: a cross-sectional study. Acta Odontol Scand 2012; 67:193-9. [PMID: 19301159 DOI: 10.1080/00016350902776716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this cross-sectional study was to analyze the relationship between chronic periodontitis and ischemic heart disease (IHD). MATERIAL AND METHODS A cross-section of women aged 38 to 84 years were examined in 1992-93 (analysis based on n=1056). Medical and dental examinations were included in the analysis specifically with regard to IHD and periodontitis. Other well-known risk factors for IHD were used as covariates in multivariable statistical analysis. RESULTS Among the dentate women in this study (n=847), 74 had IHD and 773 did not. There was no statistically significant difference between numbers of pathological gingival pockets between these groups (58.1% had one or more pathological pockets in the IHD group compared to 57.6% in the non-IHD group). Bivariate analysis of dentate individuals showed significant associations between IHD and number of missing teeth, age, body mass index, waist/hip ratio, life satisfaction, hypertension, and levels of cholesterol and triglycerides. However, in the final multivariable logistic regression model, with the exception of age, only number of teeth (<17 teeth) OR = 2.13 (CI 1.20; 3.77) was found to be significantly associated with IHD. Moreover, edentulous women had an OR of 1.94 (CI 1.05; 3.60) in relation to IHD (age-adjusted model). CONCLUSIONS In the present study, periodontitis did not seem to have a statistically significant relationship with IHD. The number of missing teeth showed a strong association with IHD, and this may act as a proxy variable tapping an array of different risk factors and behaviors.
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97
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Gomes MS, Chagas P, Padilha DMP, Caramori P, Hugo FN, Schwanke CHA, Hilgert JB. Association between self-reported oral health, tooth loss and atherosclerotic burden. Braz Oral Res 2012; 26:436-42. [PMID: 22892878 DOI: 10.1590/s1806-83242012005000019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 07/12/2012] [Indexed: 11/21/2022] Open
Abstract
Previous studies have suggested that oral diseases may influence the development of atherosclerosis. The aim of this study was to test the hypothesis that poor self-reported oral health (SROH) and tooth loss are positively associated with coronary atherosclerotic burden (CAB). 382 consecutive subjects undergoing coronary angiography were included. Socio-demographic characteristics, cardiovascular risk factors and oral health status were collected using a standardized questionnaire, including data on SROH and use of dental prosthesis. Number of teeth and anthropometric measures were collected through clinical examinations. CAB at coronary angiography was quantified using the Friesinger score (FS). Prevalence ratios (PR) were calculated with Poisson regression analyses. Mean age was 60.3 ± 10.8 years, with 63.2% males. In the bivariate analysis, there was a significant association (p < 0.05) between CAB and age (> 60y) (PR = 1.01, 95%CI = 1.02-1.16), male gender (PR = 1.11, 95%CI = 1.03-1.19), smoking (PR = 1.08, 95%CI = 1.01- 1.16), hypertension (PR = 1.12, 95%CI = 1.03-1.22), diabetes (PR = 1.17, 95%CI = 1.05-1.21), poor SROH (PR = 1.22, 95%CI = 1.02-1.46) and tooth loss (< 20 teeth present) (PR = 1.10, 95%CI = 1.02-1.19). The use of dental prosthesis was not associated with CAB. The multivariate models, adjusted for age, gender, smoking, hypertension, diabetes and dyslipidemia showed that poor SROH (p = 0.03) and tooth loss (p = 0.02) were independently associated with CAB, confirming the study hypothesis.
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Affiliation(s)
- Maximiliano Schünke Gomes
- Postgraduate Program, School of Dentistry, Univ Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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98
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Jimenez M, Hu FB, Marino M, Li Y, Joshipura KJ. Prospective associations between measures of adiposity and periodontal disease. Obesity (Silver Spring) 2012; 20:1718-25. [PMID: 21979390 PMCID: PMC3727227 DOI: 10.1038/oby.2011.291] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Obesity induced inflammation may promote periodontal tissue destruction and bone resorption inducing tooth loss. We examined the association between measures of adiposity and self-reported periodontal disease, using data from 36,910 healthy male participants of the Health Professionals Follow-Up Study (HPFS) who were free of periodontal disease at baseline and followed for ≤20 years (1986-2006). Self-reported height, weight, and periodontal disease data were collected at baseline, weight and periodontal disease were additionally collected on biennial follow-up questionnaires and waist and hip circumference were self-reported in 1987. These self-reported measures have been previously validated. The multivariable adjusted associations between BMI (kg/m(2)), waist circumference (WC), waist-to-hip ratio (WHR), and first report of periodontal disease diagnosis were evaluated using time-varying Cox models. We observed 2,979 new periodontal disease diagnoses during 596,561 person-years of follow-up. Significant associations and trends were observed between all measures of adiposity and periodontal disease after adjusting for age, smoking, race, dental profession, physical activity, fruit and vegetable intake, alcohol consumption, and diabetes status at baseline. BMI ≥30 kg/m(2) compared to BMI 18.5-24.9 kg/m(2) was significantly associated with greater risk of periodontal disease (hazard ratios (HR) = 1.30; 95% confidence interval (CI): 1.17-1.45). Elevated WC and WHR were significantly associated with a greater risk of periodontal disease (HR for extreme quintiles: WC = 1.27, 95% CI: 1.11-1.46; WHR = 1.34, 95% CI: 1.17-1.54). The associations of BMI and WC were significant even among nondiabetics and never smokers. Given the high prevalence of overweight, obesity, and periodontal disease this association may be of substantial public health importance.
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Affiliation(s)
- Monik Jimenez
- Brigham and Women’s Hospital, Division of Preventive Medicine, Boston, Massachusetts, USA
| | - Frank B. Hu
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Miguel Marino
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Yi Li
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kaumudi J. Joshipura
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- University of Puerto Rico School of Dentistry, Center for Clinical Research and Health Promotion, San Juan, Puerto Rico, USA
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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99
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Rodrigues WF, Madeira MFM, da Silva TA, Clemente-Napimoga JT, Miguel CB, Dias-da-Silva VJ, Barbosa-Neto O, Lopes AH, Napimoga MH. Low dose of propranolol down-modulates bone resorption by inhibiting inflammation and osteoclast differentiation. Br J Pharmacol 2012; 165:2140-51. [PMID: 21950592 DOI: 10.1111/j.1476-5381.2011.01686.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND AND PURPOSE Bones are widely innervated, suggesting an important role for the sympathetic regulation of bone metabolism, although there are controversial studies. We investigated the effects of propranolol in a model of experimental periodontal disease. EXPERIMENTAL APPROACH Rats were assigned as follows: animals without ligature; ligated animals receiving vehicle and ligated animals receiving 0.1, 5 or 20 mg·kg(-1) propranolol. After 30 days, haemodynamic parameters were measured by cardiac catheterization. Gingival tissues were removed and assessed for IL-1β, TNF-α and cross-linked carboxyterminal telopeptides of type I collagen (CTX) by elisa, or intercellular adhesion molecule 1 (ICAM-1), receptor activator of NF-κ B ligand (RANKL) and osteoprotegerin (OPG) by Western blot analysis. Sections from the mandibles were evaluated for bone resorption. Also, we analysed the ability of propranolol to inhibit osteoclastogenesis in vitro. RESULTS Propranolol at 0.1 and 5 mg·kg(-1) reduced the bone resorption as well as ICAM-1 and RANKL expression. However, only 0.1 mg·kg(-1) reduced IL-1β, TNF-α and CTX levels as well as increased the expression of OPG, but did not alter any of the haemodynamic parameters. Propranolol also suppressed in vitro osteoclast differentiation and resorptive activity by inhibiting the nuclear factor of activated T cells (NFATc)1 pathway and the expression of tartrate-resistant acid phosphatase (TRAP), cathepsin K and MMP-9. CONCLUSIONS AND IMPLICATIONS Low doses of propranolol suppress bone resorption by inhibiting RANKL-mediated osteoclastogenesis as well as inflammatory markers without affecting haemodynamic parameters.
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Affiliation(s)
- W F Rodrigues
- Laboratory of Biopathology and Molecular Biology, University of Uberaba, Uberaba, MG, Brazil
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Wang X, Zhong B, Chen Z, Stewart M, Zhang C, Zhang K, Ni J, Dodds M, Hanley A, Miller L. History of Frequent Gum Chewing Is Associated with Higher Unstimulated Salivary Flow Rate and Lower Caries Severity in Healthy Chinese Adults. Caries Res 2012; 46:513-8. [DOI: 10.1159/000339660] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 05/22/2012] [Indexed: 01/20/2023] Open
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