The association between oral hygiene and periodontitis: a systematic review and meta-analysis

Bisphosphonates in Dentistry – State of the Art

Bisphosphonates remain the most used and most effective drugs for the treatment of systemic bone diseases followed by bone resorption. Although their side effects in a form of alveolar bone osteonecrosis have been reported, bisphosphonates have a potential of being used in the treatment of the most common oral diseases followed by alveolar bone resorption such as peri-implantitis, periapical lesions, and periodontitis. The aim of this article was to review the most recent research regarding the use of bisphosphonates in the field of dentistry. The results of studies indicate that bisphosphonate use in the treatment of peri-implantitis, periapical lesions, and periodontitis can reduce alveolar bone resorption and contribute to bone preservation. However, the most beneficial way of their application in the treatment of these oral diseases remain to be determined.

Relationship between diabetes self-care practices and control of periodontal disease among type2 diabetes patients in Bangladesh

INTRODUCTION

The prevalence of periodontal disease is high in diabetes patients worldwide, including Bangladesh. Although associations of periodontal disease outcomes and clinical determinants of diabetes have been investigated, few studies have reported on the relationship between periodontal diseases outcomes with modifiable factors, such as self-care and oral hygiene practices, in patients with diabetes. Moreover, in order to develop targeted strategies, it is also important to estimate their aggregated contribution separately from that of the established sociodemographic and diabetics related clinical determinates. Therefore, this study was performed to elucidate 1) the relationship of diabetes patients' self-care and oral hygiene practices to periodontal disease and 2) the relative contributions of selected factors to periodontal disease outcome in type 2 diabetes patients.

METHODS

The data were obtained from the baseline survey of a multicentre, prospective cohort study. A total of 379 adult patients with type 2 diabetes from three diabetic centres in Dhaka, Rajshahi and Barishal, received periodontal examinations using the community periodontal index (CPI) probe, glycated haemoglobin examination, other clinical examinations, and structured questionnaires. Multiple logistics regression analyses were performed to assess the associations between selected factors and prevalence of any periodontal disease and its severity.

RESULTS

More than half of the participants were female (53.8%) and 66.8% of the total participants was 21-50 years old. The prevalence of any (CPI code 2+3+4; 75.7%) and severe form (CPI code 4; 35.1%) of periodontal disease were high in type 2 diabetes patients. In multivariate analysis, the odds of periodontal disease increased with unfavourable glycaemic control indicated by HbA1c ≥ 7%, and decreased by 64%, 85% and 92% with adherence to recommended diet, physical activity, and oral hygiene practices, respectively. Diabetes self-care practice explained the highest proportion of the variance (13.9%) followed by oral hygiene practices (10.9%) by modelling any periodontal disease versus no disease. Variables of diabetes conditions and oral hygiene practices explained 10.9% and 7.3% of the variance by modelling severe (CPI code 4) or moderate (CPI code 3) forms of periodontal disease versus mild form of periodontal disease. Findings also conferred that while poor diabetes control had an individually adverse association with any form of periodontal diseases and its severity, the risk of diseases was moderated by oral hygiene practices.

CONCLUSIONS

This study suggested that, in addition to diabetes-related clinical determinants, self-care practices, and oral hygiene practices must be taken into consideration for prevention and control of periodontal disease in patients with diabetes.

Plant-based oral care product exhibits antibacterial effects on different stages of oral multispecies biofilm development in vitro

Background

Excessive biofilm formation on surfaces in the oral cavity is amongst the main reasons for severe infection development like periodontitis and peri-implantitis. Mechanical biofilm removal as well as the use of adjuvant antiseptics supports the prevention of pathogenic biofilm formation. Recently, the antibacterial effect of the oral care product REPHA-OS^®, based on medicinal plant extracts and essential oils, has been demonstrated on oral pathogens grown on agar plates. In the present study, the effectiveness of the product on medical relevant oral biofilm development should be demonstrated for the first time.

Methods

An established in vitro oral multispecies biofilm, composed of Streptococcus oralis, Actinomyces naeslundii, Veillonella dispar and Porphyromonas gingivalis, was used to analyze the antibacterial effect of different REPHA-OS^® concentrations on planktonic bacteria, biofilm formation and mature biofilms. It was quantified using metabolic activity assays and live/dead fluorescence staining combined with three-dimensional confocal laser-scanning microscopy. Additionally, effects on species distribution inside the biofilm were assessed by means of quantitative real-time PCR.

Results

REPHA-OS^® showed statistically significant antimicrobial effects on all stages of biofilm development: a minimal inhibitory concentration of 5% could be detected for both, for planktonic bacteria and for biofilm formation. Interestingly, only a slightly higher concentration of 10% was necessary to completely kill all bacteria in mature biofilms also. In contrast, an influence on the biofilm matrix or the species distribution could not be observed. The effect could be attributed to the herbal ingredients, not to the contained ethanol.

Conclusion

The strong antibacterial effect of REPHA-OS^® on different stages of oral biofilm development strengthens its application as an alternative adjuvant in oral care therapies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01504-4.

Systemic azithromycin as an adjunct to scaling and root planing in patients with stage III/IV periodontitis: 12-month results of a randomized controlled clinical trial

OBJECTIVES

To determine whether azithromycin (AZI) as an adjunct to scaling and root planing (SRP), when compared to placebo, decreases the number of sites demonstrating pocket depth (PD) ≥ 5 mm and bleeding on probing (BOP) 12 months post-treatment in stage III/IV periodontitis patients.

MATERIALS AND METHODS

In a double-blind randomized parallel-arm placebo-controlled trial, 40 stage III/IV periodontitis patients received steps 1 and 2 of periodontal treatment in two sessions within 7 days. Patients then received systemic antibiotic therapy (n = 20; AZI 500 mg/day, 3 days) or placebo (n = 20). Additional instrumentation of residual diseased sites (DS) - sites with PD ≥ 5 mm and BOP - was performed at the 3-, 6- and 9-month follow-ups. The primary outcome variable was the number of DS at the 12-month re-evaluation. Using a multivariate multilevel logistic regression model, the effects of gender, age, antibiotic therapy, presence of Porphyromonas gingivalis or Aggregatibacter actinomycetemcomitans, smoking, tooth being a molar and interdental location were evaluated.

RESULTS

The number of DS after 12 months was similar in the test (median (Me) = 4, interquartile range (IQR) = 0-6) and control (Me = 3, IQR = 1-6.5) groups. Both groups showed substantial but equivalent improvements in periodontal parameters, with no intergroup differences at initially shallow or deep sites. The logistic regression showed a lower odds ratio (OR) for the healing of DS on molars (OR = 0.29; p < 0.001) and in smokers (OR = 0.36; p = 0.048).

CONCLUSION

Stage III/IV periodontitis patients showed significant but comparable improvements in periodontal parameters and the number of residual DS at the 12-month revaluation regardless of treatment type. This may have been the result of the additional instrumentation received by patients at residual DS in both treatment groups.

CLINICAL RELEVANCE

Treatment with AZI + SRP provided no additional benefits after 12 months in terms of periodontal parameters or the number of persisting sites with PD ≥ 5 mm + BOP as compared to SRP plus placebo.

TRIAL REGISTRATION

EUDRA-CT: 2015-004306-42; https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-004306-42/SI , registered 17. 12. 2015.

Oral Health Status, Knowledge, and Behaviours of People with Diabetes in Sydney, Australia

This study assessed self-reported oral health status, knowledge, and behaviours of people living with diabetes along with barriers and facilitators in accessing dental care. A cross sectional survey of 260 patients from four public diabetes clinics in Sydney, Australia was undertaken using a 35-item questionnaire. Data were analysed using SPSS software with descriptive and logistic regression analyses. More than half (53.1%) of respondents reported having dental problems which negatively impacted their related quality of life. Less than half (45%) had adequate oral health knowledge. Only 10.8% reported receiving any oral health information in diabetes care settings, which had higher odds of demonstrating adequate oral health knowledge (AOR, 2.60; 95% CI, 1.06-6.34). Similarly, 62.7% reported seeing a dentist in the last 12 months. Having private health insurance (AOR, 3.70; 95% CI, 1.85-7.40) had higher odds of seeing a dentist in the past 12 months. Dental costs were a major contributor to avoiding or delaying dental visit. Patients living with diabetes have unmet oral health needs particularly around the awareness of its importance and access to affordable dental services. Diabetes care providers can play a crucial role in this area by promoting oral health to their patients.

Dental Visits and Predictors of Regular Attendance Among Female Schoolchildren in Dammam, Saudi Arabia

Purpose

Regular dental visits are important for the maintenance of optimal oral health and improved quality of life. The purpose of the study was to evaluate patterns of dental visits and factors associated with routine dental attendance among female schoolchildren in Dammam, Saudi Arabia.

Patients and Methods

This cross-sectional study was performed on 449 female primary schoolchildren (6–11 years old) in Dammam, Saudi Arabia. The study included clinical examination for decay in the first permanent molars in children and questionnaire administration among their parents. The World Health Organization’s oral health questionnaire was used to collect data about children’s dental visits, oral hygiene behaviors, dental problems, and dietary practices. Bivariate and multivariate analyses were performed to evaluate factors associated with routine dental visits.

Results

Most children (64.1%) visited the dentist during the past one year, 22.1% performed no dental visit during the past one year, and 8.3% never visited the dentist. Among children who visited the dentist, the pain was the most common reason for dental visits (39.10%, N=170), followed by routine dental check-ups (18.60%, N=81). In bivariate analysis, education of parents, family income, daily tooth brushing, no decay in the first permanent molar, no toothache, no consumption of soft drinks, biscuits, cakes, and cream were significantly associated with routine dental attendance (P <0.05). However, the final logistic regression model showed that university education of mothers (OR 2.52, P = 0.005), not having toothache or discomfort (OR 2.88, P = 0.001), tooth brushing once or twice daily (OR 2.43, P= 0.034), and not consuming soft drinks (OR 1.96, P= 0.027) were significant predictors of routine dental visits.

Conclusion

The study found that higher education of mothers, daily tooth brushing, not having dental pain, and not consuming soft drinks were significantly associated with routine dental visits in this sample of female schoolchildren. Routine dental attendance may be used to improve oral hygiene and reduce dental pain and consumption of soft drinks in children.

Promoting behavioural changes to improve oral hygiene in patients with periodontal diseases: A systematic review

AIM

This systematic review investigates the impact of specific interventions aiming at promoting behavioural changes to improve oral hygiene (OH) in patients with periodontal diseases.

METHODS

A literature search was performed on different databases up to March 2019. Randomized and non-randomized controlled trials evaluating the effects of behavioural interventions on plaque and bleeding scores in patients with gingivitis or periodontitis were considered. Pooled data analysis was conducted by estimating standardized mean difference between groups.

RESULTS

Of 288 articles screened, 14 were included as follows: 4 studies evaluated the effect of motivational interviewing (MI) associated with OH instructions, 7 the impact of oral health educational programmes based on cognitive behavioural therapies, and 3 the use of self-inspections/videotapes. Studies were heterogeneous and reported contrasting results. Meta-analyses for psychological interventions showed no significant group difference for both plaque and bleeding scores. No effect was observed in studies applying self-inspection/videotapes.

CONCLUSIONS

Within the limitations of the current evidence, OH may be reinforced in patients with periodontal diseases by psychological interventions based on cognitive constructs and MI principles provided by oral health professionals. However, no conclusion can be drawn on their specific clinical efficacy as measured by reduction of plaque and bleeding scores over time.

Home care recipients have poorer oral health than nursing home residents: Results from two German studies

OBJECTIVES

To describe and compare the objective and subjective oral health of older nursing home residents and home care recipients, and to investigate whether oral health is associated with sociodemographic characteristics and the long-term care (LTC) setting.

METHODS

In two German studies, the oral health of 246 nursing home residents and 90 home care recipients aged ≥60 years was assessed objectively using the Oral Health Assessment Tool (OHAT) and subjectively using the Oral Health Impact Profile (OHIP). OHAT and OHIP scores were compared between both settings. Multivariable logistic regressions were applied to investigate whether oral health is associated with sex, age group, LTC grade, and LTC setting.

RESULTS

OHAT and OHIP mean scores in the home care setting were higher compared to the nursing home setting (OHAT: 3.13 vs. 1.28, p < .0001; OHIP: 7.81 vs. 2.15, p < .0001). The adjusted odds ratios for poor objective and subjective oral health for home care recipients vs. nursing home residents were 6.71 (95 % confidence interval 3.29-13.69) and 4.92 (2.77-8.76). No significant associations with sociodemographic characteristics were found.

CONCLUSIONS

Oral health was poor in both settings, but home care recipients were more likely to have poor oral health than nursing home residents. Interventions to improve oral health are needed in the nursing home setting and, even more importantly, in the home care setting.

CLINICAL SIGNIFICANCE

Oral health among older people in need of LTC is poor and should be improved. From a health policy perspective, home care recipients may need more attention.

Oral healthcare delivery in institutionalised older people: A health-economic evaluation

OBJECTIVES

This health-economic evaluation aimed to assess the cost-effectiveness of a number of alternatives for preventive and curative oral health care in institutionalised older people in Flanders.

METHODS

A six-state Markov model was used to compare expected costs and healthy oral years (HOYs) of four alternatives: (1) usual care; (2) on-site preventive care; (3) on-site preventive care + curative care in the community; and (4) on-site preventive care + on-site curative care. A healthcare payer perspective was adopted, and the time horizon was 10 years. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS

Incremental cost-effectiveness ratios (ICERs) of alternatives 2, 3 and 4 (all compared to alternative 1) were as follows: (2) 7944 €/HOY gained; (3) 1576 €/HOY gained; and (4) 1132 €/HOY gained. Hence, alternatives 2 and 3 were not cost-effective compared to alternative 4. The probability that oral care interventions are more effective and cost-saving than usual care was <3% for all three interventions.

CONCLUSIONS

For institutionalised older people, on-site solutions for preventive and curative oral health care might be the most cost-effective alternative. It should be kept in mind that on-site solutions require large initial investment and that the advanced age of the population and the high costs of oral health care make it unlikely that these interventions would become cost-saving, even in the long term.

Association between overtime work hours and preventive dental visits among Japanese workers

Background

This study aimed to examine the association between overtime work and the frequency of preventive dental visits among workers in Japan.

Methods

A self-administered questionnaire was completed by 14,847 daytime-workers. We used a logistic regression model stratified by sex and age and adjusted for marital status, occupation, education, and oral status to investigate the association between overtime work hours and the frequency of preventive dental visits.

Results

In total 1037 men (9.3%) and 511 women (13.9%) attended quarterly preventive dental visits, and 2672 men (23.9%) and 1165 women (31.8%) attended annual preventive dental visits. Overtime work was statistically significantly associated with quarterly preventive dental visits among men aged 50–59 years, with adjusted odds ratios (aOR) and 95% confidence intervals (CI) of 0.73 (0.56–0.95), 0.75 (0.54–1.04), and 0.55 (0.34–0.90) for < 20, 20–39, and ≥40 h overtime/month, respectively. No such trends were observed for men aged < 50 years and women of all ages. Overtime work of < 20, 20–40, and ≥40 h overtime/month was statistically significantly associated with annual preventive dental visits among men aged 40–49 years (aOR [95%CI]: 0.76 [0.61–0.95], 0.84 [0.65–1.09], and 0.72 [0.51–1.00], respectively) and 50–59 years (aOR [95%CI]: 0.75 [0.61–0.91], 0.76 [0.59–0.97], and 0.63 [0.45–0.88], respectively). No such trends were observed in men < 40 years and women of all ages.

Conclusions

Our study revealed associations between overtime and preventive dental visits among male workers aged in their 40s and 50s.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-10107-7.

Dietary Factors Affecting the Prevalence and Impact of Periodontal Disease

In the last few decades, growing evidence have shown a possible impact of diet and nutrients on oral health. This review aims to describe, in the light of current knowledge, the role of diet, nutrients, and micronutrients in periodontal health and periodontal diseases. A variety of macronutrients and micronutrients could have an impact on periodontal health. The balanced intake of unprocessed complex carbohydrates, vegetable proteins, omega-3 fatty acids, minerals, and vitamins positively affects periodontal inflammation. On the other way, refined carbohydrates, non-vegetable proteins, proinflammatory saturated fatty acids and an unbalanced supply of vitamins and minerals may increase periodontal inflammation. This review will discuss the current evidence that shows how a healthy and balanced diet has anti-inflammatory and protective effects on periodontal health. Therefore, it appears that adopting a correct lifestyle and diet should be encouraged in patients with oral and periodontal disease.

Oral Dysbiosis and Autoimmunity: From Local Periodontal Responses to an Imbalanced Systemic Immunity. A Review

The current paradigm of onset and progression of periodontitis includes oral dysbiosis directed by inflammophilic bacteria, leading to altered resolution of inflammation and lack of regulation of the inflammatory responses. In the construction of explanatory models of the etiopathogenesis of periodontal disease, autoimmune mechanisms were among the first to be explored and historically, for more than five decades, they have been described in an isolated manner as part of the tissue damage process observed in periodontitis, however direct participation of these mechanisms in the tissue damage is still controversial. Autoimmunity is affected by genetic and environmental factors, leading to an imbalance between the effector and regulatory responses, mostly associated with failed resolution mechanisms. However, dysbiosis/infection and chronic inflammation could trigger autoimmunity by several mechanisms including bystander activation, dysregulation of toll-like receptors, amplification of autoimmunity by cytokines, epitope spreading, autoantigens complementarity, autoantigens overproduction, microbial translocation, molecular mimicry, superantigens, and activation or inhibition of receptors related to autoimmunity by microorganisms. Even though autoreactivity in periodontitis is biologically plausible, the associated mechanisms could be related to non-pathologic responses which could even explain non-recognized physiological functions. In this review we shall discuss from a descriptive point of view, the autoimmune mechanisms related to periodontitis physio-pathogenesis and the participation of oral dysbiosis on local periodontal autoimmune responses as well as on different systemic inflammatory diseases.

A Case-Control Study of Type 2 Diabetes Mellitus and Periodontitis in Saudi Arabian Adults

Objective

The relationship between type 2 diabetes mellitus (T2DM) and periodontitis is bidirectional and has been investigated. However, the evidence from the middle-eastern region is sparse. The current report assessed the association between uncontrolled T2DM and periodontal status from a sample of the Saudi Arabian adult population.

Methods

A case–control study was carried out. Cases were adults diagnosed with periodontitis (clinical attachment loss ≥1 mm) and controls were patients from the same dental setting with no gum conditions matched with age, sex, and location. Diabetes was recorded using HbA1c readings. The other health conditions including hypertension, epilepsy, bronchitis, thyroid disorders, and arthritis were obtained from medical records. Data on the use of tobacco and related products (smoking, khat/qat, sheesha, shammah) were gathered using a self-perceived questionnaire. Frequencies, percentages, p-values, crude and adjusted odds ratios (OR) with 95% confidence intervals were computed.

Results

Overall sample comprises 166 cases and 332 controls with a mean age of 37.5 years. Multivariable analysis indicated uncontrolled T2DM as an important predictor for periodontitis among Saudi Arabian adults, and they had nearly three times greater odds (OR: 2.779; 95% CI: 1.425–5.419; p=0.003) of being diagnosed with periodontitis in contrast to non-diabetics. Secondary findings revealed that cigarette ever-users were two times more likely to be suffering from periodontitis than never-users, and those brushing once per day or less had five times greater odds of developing periodontitis as compared to those brushing twice daily.

Conclusion

To conclude, the current evidence from Saudi Arabia is supportive of earlier studies and an awareness of this association is warranted among all healthcare providers and patients in the region for early detection of periodontitis.

Comparisons of various anthropometric indexes with localized Stage II/III periodontitis in young adults: The CHIEF oral health study

BACKGROUND

A J-shaped relationship of body mass index (BMI) with severe periodontitis has been reported. However, it is unknown for other anthropometric indexes in young adults.

METHODS

A cross-sectional study examined the relationships in 325 military men and women, aged 20 to 45 years in Taiwan. Anthropometric indexes included BMI, waist circumference (WC), and waist-to-height ratio (WHtR). The severity of localized periodontitis was defined as healthy (n = 42), Stage I (initial) (n = 228), and Stage II/III (moderate/severe) (n = 55) according to the 2017 Periodontal Diseases Classification. Smooth curve fitting and multiple logistic regression analyses adjusting for age, sex, betel nut consumption, and smoking were used to determine the threshold effect between various anthropometric and the risk of localized Stage II/III periodontitis.

RESULTS

In the spline smoothing plot, the turning points for BMI, WC, and WHtR were 26.1 kg/m² , 90.0 cm, and 0.50, respectively, and a J-shaped relationship was found for BMI (the likelihood ratio test, P <0.001). In the multiple logistic regressions, BMI ≥27.0 kg/m² , WC ≥90.0 cm and WHtR ≥0.50 were associated with higher risk of localized Stage II/III periodontitis than their counterparts (24.0 to 26.9 kg/m² for BMI) (odds ratios [OR] and 95% confidence intervals: 4.16 [1.39 to 12.49], 2.65 [1.01 to 7.11], and 2.95 [1.20 to 7.24], respectively; all P values <0.05). However, the risk for BMI <24.0 kg/m² was not significant (OR, 1.47 [0.47 to 4.54]).

CONCLUSION

In young adults, obesity defined by various anthropometrics was consistently associated with localized Stage II/III periodontitis and a J-shaped association was suggestive for BMI.

Periodontal condition and treatment in a patient with rare systemic condition: A case report for acid sphingomyelinase deficiency

BACKGROUND

Acid sphingomyelinase deficiency (ASMD) is a rare group of autosomal recessive disorders. This report provides the first detailed description of the periodontal condition and treatment response in a patient with chronic visceral ASMD.

CASE DESCRIPTION

A 49-year-old white woman with ASMD showed elevated visible plaque index (VPI), gingival bleeding index (GBI), and bleeding on probing (BOP) at 100% of sites. Periodontal pocket depths (PPD) were mostly shallow to moderate (at 96% of sites), whereas the loss of clinical attachment (CAL) was moderate to severe (54% and 46% of sites, respectively, at 4-6 mm and ≥7 mm categories). Periapical radiographs revealed the presence of furcation involvement and intra-bony defects. The periodontal diagnosis was periodontitis stage IV, generalized, grade C. Ninety days after the end of the supra and subgingival control (e.g., cause-related therapy), marked reduction was observed for all periodontal indicators: VPI (-83%), GBI (-79%), BOP (-85%), elimination of sites PPD ≥7 mm, 27% increase in sites PPD 1-3 mm (from 64% to 91%), and gain of clinical attachment (gain of 11% CAL 1-3 mm and 25% CAL 4-6 mm; and a reduction of 36% CAL ≥7 mm).

PRACTICAL IMPLICATIONS

Despite the severity of the initial periodontal condition, the patient with chronic visceral ASMD responded well to the non-surgical periodontal treatment.

Assessment of oral health status and treatment needs among people of Foklyan area, Dharan, Nepal

Background

Oral diseases are a major public health problem globally due to high prevalence and significant social impact. Foklyan is a peri urban area with people belonging to indigenous population of low socioeconomic status. This study was conducted to assess the oral health status and treatment needs among the people of Foklyan area, Dharan.

Methods

Cross-sectional house to house survey was conducted on 310 randomly selected participants. The participants were stratified into five age groups as per WHO Basic Oral Health Survey Methods 1997 and further categorized by gender. WHO Oral Health Assessment form 1997, WHO oral health assessment questionnaire for adult/children 2013 and questionnaire for oral hygiene practice and cost as a treatment barrier were used. The examinations were done as per WHO standard guidelines.

Results

Most of the participants were from low socioeconomic background (71.3%). About 40% of the participants deferred dental visit due to financial burden. Although 99% of the participants brushed their teeth, there was high caries experience (DMFT: 3.18 ± 5.85; dft: 2.40 ± 2.65). Mean sextant score for bleeding was 5.58 in 35–44 years age group and 5.61 in 65–74 years age group. Tobacco consumption was seen in 70.9% of the adults. Prevalence of alcohol consumption was 58.8% among adult age groups.

Conclusion

The prevalence of dental caries, periodontal diseases, and prosthetic needs were more compared to national data. There is a need for oral health promotion in this area.

Evaluation of the efficacy of a commercially available regimen vs brushing alone on established plaque and gingivitis on adolescents: Study protocol for a randomized, controlled, blind clinical trial

BACKGROUND

Dental biofilm accumulation and poor personal oral hygiene are known major risk factors for gingivitis and halitosis. However, it is not clear how studies compare the effectiveness of hygiene regimens, associated with outcomes centered on patients.

METHODS

A randomized, blind, controlled clinical trial involving 58 participants aged from 12 to 17 years, who search the Department of Pediatric Dentistry of Universidade Metropolitana de Santos, will be conducted. Immediately, the volunteers will be inserted into Group 1 (commercially available hygiene regimen) or Group 2 (tooth brushing alone). In Group 1, participants will receive Colgate Total 12 toothpastes, Plax mouthwashes and Colgate Ultrasoft toothbrushes, while Group 2 will use Colgate Cavity Protection toothpastes and Colgate Ultrasoft toothbrushes. The interventions will be conducted in the periods of 1, 3, and 6 months after the baseline, when the evaluations will also be performed. Biofilm and halitosis indexes will be evaluated. Data regarding discomfort, satisfaction and the socioeconomic/individual characteristics will also be computed.

DISCUSSION

Although toothbrushing has shown positive effects in decreasing biofilm and in gingival health, there is no comparison in the literature of different brushing regimens with halitosis measurement in adolescents. In addition, the effectiveness of these protocols would be confirmed from the acceptability of the volunteers.

The Association Between Oral Hygiene Behavior and Gingival Health Status with the Stage and Grade of Periodontitis: A Cross-Sectional Study

Aim:

To analyze the association between teeth brushing (TB) and interdental cleansing (IDC) frequency changes with gingival health status and the stage and grade of periodontitis.

Materials and Methods:

This cross-sectional study consisted of clinical examination and questionnaires. The questionnaires include demographic information and oral hygiene (TB and IDC) behavior. More than 18-year-old participants who underwent a periodontal treatment were randomly included. 548 individuals were classified as gingival healthy, gingivitis, and periodontitis according to the 2017 classification system. The degree of periodontitis was based on stage and grade systems. The data were analyzed by using Kruskal–Wallis and Mann–Whitney U tests.

Results:

The highest TB frequency (twice daily) was the highest in patients with gingivitis (83.7%) followed by healthy patients (82.9%) and patients with stage I periodontitis (52.2%). Compared to those who performed IDC daily, 18.9% of patients were healthy and 8.1% had stage II periodontitis. There was a statistically significant association between the oral hygiene behavior and periodontal health status of participants. Statistically significant association was seen between the TB and IDC with stage-grade of periodontitis. When the TB and IDC scores of different grade groups were compared at the same stage level, no statistically significant difference was found.

Conclusion:

This study showed that periodontal health status was positively correlated with TB and IDC frequency.

Treatment with Luteolin Improves Lipopolysaccharide-Induced Periodontal Diseases in Rats

Periodontitis is a dental disease that produces the progressive destruction of the bone surrounding the tooth. Especially, lipopolysaccharide (LPS) is involved in the deterioration of the alveolar bone, inducing the release of pro-inflammatory mediators, which cause periodontal tissue inflammation. Luteolin (Lut), a molecule of natural origin present in a large variety of fruits and vegetables, possess beneficial properties for human health. On this basis, we investigated the anti-inflammatory properties of Lut in a model of periodontitis induced by LPS in rats. Animal model predicted a single intragingival injection of LPS (10 μg/μL) derived from Salmonella typhimurium. Lut administration, was performed daily at different doses (10, 30, and 100 mg/kg, orally), starting from 1 h after the injection of LPS. After 14 days, the animals were sacrificed, and their gums were processed for biochemical analysis and histological examinations. Results showed that Lut (30 and 100 mg/kg) was equally able to reduce alveolar bone loss, tissue damage, and neutrophilic infiltration. Moreover, Lut treatment reduced the concentration of collagen fibers, mast cells degranulation, and NF-κB activation, as well as the presence of pro-inflammatory enzymes and cytokines. Therefore, Lut implementation could represent valid support in the pharmacological strategy for periodontitis, thus improving the well-being of the oral cavity.

The oral health status of patients with peripheral vascular disorders: A systematic review

Objectives

Periodontal disease and tooth loss were found to be associated with several peripheral vascular disorders. Nonetheless, an evaluation of the literature on the broader domains of oral health in individuals with peripheral vascular disorders is lacking. This systematic review aims to collate the current evidence on the oral health status of individuals with peripheral vascular disorders.

Methods

Five electronic databases were searched for studies assessing oral health parameters in individuals with peripheral vascular disorders. Outcome measures considered were periodontal health, dentition status, caries indices, oral prostheses, oral pathologies and oral hygiene behaviours. The Newcastle-Ottawa scale was used to appraise the quality of the studies.

Results

From 3025 records identified, 24 studies involving 1232 participants with peripheral vascular disorders were included in this review. In nine studies, periodontitis was significantly more prevalent in peripheral vascular disorders compared to non-peripheral vascular disorders participants. A further six studies reported individuals with peripheral vascular disorders also had significantly fewer teeth and increased rates of edentulism. Only one study reported a higher incidence of dental caries in peripheral vascular disorders participants. Other aspects of oral health such as oral prosthesis, oral pathology and oral hygiene behaviours were seldom assessed.

Conclusions

The scarcity of studies reporting on broader domains limited our ability to arrive at a conclusion regarding the oral health status of individuals with peripheral vascular disorders. Future studies ought to assess these domains in individuals with peripheral vascular disorders and controls to gain a more complete understanding of oral health and its potential association with peripheral vascular disorders.

Association between obesity and periodontitis in Australian adults: A single mediation analysis

BACKGROUND

Obesity and periodontitis are conditions with high burden and cost. This study aims to unfold the proposed pathways through which the effect of obesity in the presence of health behaviors (dental visiting behavior and diabetes) increases the risk of periodontitis?

METHODS

The effect decomposition analysis using potential outcome approach was used to determine obesity-related periodontitis risk using the Australian National Survey of Adult Oral Health 2004 to 2006. A single mediation analysis for exposure, "physical-inactivity induced obesity," mediator "dental visiting behavior (a de facto measure of healthy behaviors)," outcome "periodontitis," and confounders "age, sex, household income, level of education, self-reported diabetes, alcohol-intake and smoking," was constructed for subset of 3,715 participants, aged ≥30 years. Proposed pathways were set independently for each risk factor and in synergy. The STATA 15 Paramed library was used for analysis. Sensitivity analysis was conducted to detect unmeasured confounding using non-parametric approach.

RESULTS

The average treatment effect of physical inactivity induced obesity to periodontitis is 14%. Pathway effect analysis using potential outcomes illustrated that the effect of obesity on periodontitis that was not mediated through poor dental visiting behavior was 10%. Indirect effect of obesity-mediated through poor dental visiting behavior on periodontitis was 3%.

CONCLUSIONS

The direct effect of physical inactivity induced obesity on periodontitis was higher than the indirect effect of obesity on periodontitis through dental visiting behavior. Establishing a pathway of causal relationship for obesity and periodontitis could help in developing management strategies that focuses on mediators.

Increase in serum and salivary neutrophil gelatinase-associated lipocalin levels with increased periodontal inflammation

OBJECTIVE

This study aimed to determine serum and salivary levels of neutrophil gelatinase-associated lipocalin (NGAL) and evaluate NGAL correlation with key anti-interleukin 10 (IL-10) and pro-inflammatory (IL-1β) cytokines in different severities of periodontal diseases. We also calculated the systemic inflammation using the periodontal inflamed surface area (PISA) to evaluate its correlation with NGAL in the study groups.

METHODOLOGY

Eighty systemically healthy and non-smoking individuals were separated into four groups of 20: clinically healthy (Group 1), gingivitis (Group 2), stage I generalized periodontitis (Group 3, Grade A), and stage III generalized periodontitis (Group 4, Grade A). Sociodemographic characteristics and periodontal parameters were recorded, and PISA was calculated. The serum and salivary levels of interleukin (IL)-1β, IL-10, and NGAL were determined using the enzyme-linked immunosorbent assay (ELISA).

RESULTS

We observed a significant increase in serum and salivary NGAL levels from healthy to periodontitis groups (p=0.000). Group 2 presented significantly higher serum and salivary IL-10 levels and salivary IL-1β levels than Group 3 (p=0.000). Serum and salivary parameters (IL-1β, IL-10, and NGAL levels) were strongly positively correlated to periodontal parameters and PISA values (p=0.000). Groups 2 and 3 showed overlapping PISA values.

CONCLUSION

The overlapping PISA values found in Groups 2 and 3 suggest that gingivitis might progress to a systemic inflammatory burden somewhat comparable to stage I periodontitis. This finding is supported by the higher serum and salivary cytokines/mediators levels in the gingivitis group than in stage I periodontitis group. Serum and salivary NGAL levels increased proportionally to disease severity and PISA. NGAL seems to play a role in the pathogenesis of periodontal disease, within the limitation of our study.

The clinical and inflammatory relationships between periodontitis and chronic obstructive pulmonary disease

AIM

To investigate associations between periodontitis and chronic obstructive pulmonary disease (COPD) with and without alpha-1 antitrypsin deficiency (AATD), including neutrophil functions implicated in tissue damage.

METHODS

The presence and severity of periodontitis (using two international criteria) and lung disease were assessed in 156 COPD patients with and without AATD accounting for common confounding factors. Saliva and systemic inflammatory markers were measured by ELISA together with neutrophil migration.

RESULTS

COPD and AATD patients exhibited higher prevalence of periodontitis (COPD 95%; AATD 88%) than reported in unselected community-dwelling populations even when risk factors (age, smoking history, socio-economic status and dental habits) were considered. Periodontitis severity associated with lung disease severity (AATD, periodontitis versus no periodontitis; FEV1 = 56% versus 99% predicted; TLCO = 59% versus 81% predicted, p < .0001 for both). Neutrophil migratory accuracy declined in stage II-IV periodontitis patients with COPD or AATD compared to COPD or AATD with no or stage I periodontitis. Improved dental habits appeared to be associated with a reduction in exacerbation frequency in COPD.

CONCLUSION

The results support shared pathophysiology between periodontitis and COPD, especially when associated with AATD. This may reflect an amplification of neutrophilic inflammation and altered neutrophil functions, already described in periodontitis, COPD and AATD.

Mouthwash Effects on LGG-Integrated Experimental Oral Biofilms

In order to investigate the effects of mouthwashes on oral biofilms with probiotics, we compared in biofilms the susceptibility to mouthwashes of probiotic Lactobacillus rhamnosus GG (LGG) and oral pathogens Streptococcus mutans, Streptococcus sanguinis, and Candida albicans. We also evaluated these pathogens’ susceptibility to the mouthwashes and their recovery after mouthwash-rinsing in biofilms with/without LGG. First, 1-day-/3-day-old LGG-integrated multi-species biofilms were exposed for 1 min to mouthwashes containing chlorhexidine, essential oils, or amine fluoride/stannous fluoride. Cells were plate-counted and relative survival rates (RSRs) of LGG and pathogens calculated. Second, 1-day-/3-day-old multispecies biofilms with and without LGG were exposed for 1 min to mouthwashes; cells were plate-counted and the pathogens’ RSRs were calculated. Third, 1-day-old biofilms were treated for 1 min with mouthwashes. Cells were plate-counted immediately and after 2-day cultivation. Recovery rates of pathogens were calculated and compared between biofilms with/without LGG. Live/Dead^® staining served for structural analyses. Our results showed that RSRs of LGG were insignificantly smaller than those of pathogens in both 1-day and 3-day biofilms. No significant differences appeared in pathogens’ RSRs and recovery rates after treatment between biofilms with/without LGG. To conclude, biofilm LGG was susceptible to the mouthwashes; but biofilm LGG altered neither the mouthwash effects on oral pathogens nor affected their recovery.

Cytotoxicity of dental disclosing solution on gingival epithelial cells in vitro

OBJECTIVE

Coloring dental biofilm and plaque with a dental disclosing solution is visually effective in dental treatment and oral hygiene education. Despite continuous reports of the risk of the product ingredients, dental disclosing solution are widely used in dentistry. However, the cytotoxic mechanism of dental disclosing solution is not known. Here we elucidated the tissue dyeing range and investigated the cytotoxic mechanism of dental disclosing solution.

MATERIALS AND METHODS

Gingival epithelial cells and mouse head and neck tissue were stained with dental disclosing solution. Changes in the cell cycle distribution by the dental disclosing solution treatment were analyzed. A deoxynucleotidyl transferase dUTP nick and labeling (TUNEL) assay was performed to examine the apoptotic features of the gingival epithelial cells.

RESULTS

Dental disclosing solution stained the chromosome strongly, as well as both the hard and soft tissue of the mouse head and neck. The results of flow cytometric analysis and TUNEL analyses revealed that the cytotoxicity associated with dental disclosing solution was related to the induction of apoptosis. However, the staining of porcine skin by dental disclosing solution was not easily removed, even with a wide range of pH solutions.

CONCLUSIONS

These results suggest that dental disclosing solution had strong cytotoxicity and safer alternatives are needed.

The effectiveness of an oral hygiene program combined with health-promoting counseling for rural adults with cardiometabolic risks: A quasi-experimental design

AIM

The aim of this study was to explore the effectiveness of an oral hygiene program combined with home-phone health promoting counseling for rural adults with metabolic syndrome.

BACKGROUND

Metabolic syndrome is an important risk factor for cardiometabolic diseases. Evidence indicates that the poor oral hygiene and unhealthy lifestyles are closely related to metabolic syndrome.

METHODS

A prospective quasi-experimental design involved a total of 136 community adults, with metabolic syndrome living in two rural townships, were clustered and conveniently assigned to intervention and control group between June 2017 and December 2018. The primary outcome was the change in cardiometabolic biomarkers. The secondary outcome comprised changes in the health-promoting behaviors. The intervention effect was assessed using a generalized estimating equation model.

RESULTS

There were 80 and 56 participants in the intervention and control group, respectively. The mean age was 56 years and ranged from 33 to 70 years. The intervention group exhibited a greater improvement in body mass index (P < 0.01), waist circumference (P < 0.05), body fat percentage (P < 0.05), triglyceride level (P < 0.05), use of dental floss (P < 0.05), regular tooth scaling (P < 0.05), physical activity (P < 0.001), and total score of health-promoting behaviors (P < 0.001) than the control group.

CONCLUSION

This study supports the use of an oral hygiene program combined with home-phone counseling, which offers more advantages than its counterpart. Considering the global epidemic of cardiometabolic diseases, this is a community health nursing model worth to replicate and evaluate. Further study should consider innovative strategies to improve the awareness and adoption of a healthy lifestyle in residents with cardiometabolic risks.

Relationship between oral hygiene knowledge, source of oral hygiene knowledge and oral hygiene behavior in Japanese university students: A prospective cohort study

The aim of this prospective cohort study was to examine whether oral hygiene knowledge, and the source of that knowledge, affect oral hygiene behavior in university students in Japan. An oral exam and questionnaire survey developed to evaluate oral hygiene knowledge, the source of that knowledge, and oral hygiene behavior, such as the frequency of tooth brushing and regular dental checkups and the use of dental floss, was conducted on university student volunteers. In total, 310 students with poor tooth brushing behavior (frequency of tooth brushing per day [≤ once]), 1,963 who did not use dental floss, and 1,882 who did not receive regular dental checkup during the past year were selected. Among these students, 50, 364, and 343 in each respective category were analyzed in over the 3-year study period (follow-up rates: 16.1%, 18.5%, and 18.2%, respectively). The odds ratios (ORs) and 95% confidence intervals (CIs) for oral hygiene behavior were calculated based on oral hygiene knowledge and the source of that knowledge using logistic regression models. The results showed that dental clinics were the most common (> 50%) source of oral hygiene knowledge, and that a more frequent use of dental floss was significantly associated with dental clinics being a source of oral hygiene knowledge (OR, 4.11; 95%CI, 1.871–9.029; p < 0.001). In addition, a significant association was seen between dental clinics being a source of oral hygiene knowledge and more frequent regular dental checkups (OR, 13.626; 95%CI, 5.971–31.095; p < 0.001). These findings suggest the existence of a relationship between dental clinics being the most common source of oral hygiene knowledge and improved oral hygiene behavior in Japanese university students.

Self-Reported Oral Health, Oral Hygiene and Associated Factors in Lithuanian Adult Population, 1994-2014

This study aimed to examine 20-year trends (1994-2014) in self-reported oral health and oral hygiene and to assess the associated factors in a Lithuanian population aged 20-64 years. Nationally representative cross-sectional data on 8612 men and 11,719 women were obtained from 11 biennial postal surveys of Lithuanian health behavior monitoring. Dentate status was assessed by asking about the number of missing teeth. Over the study period, the proportion of men with all teeth increased from 17.5% to 23.0% and the same proportion increased in women-from 12.5% to 19.6%. The prevalence of edentulousness was 2.8% in 2014. The proportion of individuals brushing teeth at least twice a day increased from 14.6% to 31.9% in men and from 33.0% to 58.8% in women. Multivariate logistic regression analysis revealed that older age, lower education, living in rural areas, daily smoking, confectionary consumption (only in women), obesity, no visits to a dentist during the past year, toothache and brushing teeth less than twice a day increased the odds of missing six or more teeth. Efforts should be made to promote good oral hygiene habits, prevent and control behavioral risk factors and increase access to dental care among risk groups.

The lack of keratinized mucosa is associated with poor peri-implant tissue health: a cross-sectional study

OBJECTIVES

The aim of this cross-sectional study is to determine the association between the absence of keratinized mucosa and peri-implant tissue health.

METHODS AND MATERIALS

This cross-sectional study comprised 412 implants from 200 patients from faculty-based clinics. Demographic, medical, and clinical information were collected. The modified sulcus bleeding index, modified plaque index, mucosal recession, probing depth, bone level, the width of keratinized mucosa, and implant status were evaluated by three calibrated examiners. Each implant was categorized into either of two peri-implant mucosa groups: keratinized mucosa (KM) or non-keratinized mucosa (NKM). The chi-square test was performed to the association between the keratinized mucosa groups and peri-implant clinical parameters and peri-implant status. Multiple logistic regression models were analyzed to test potential associations between peri-implant clinical parameters and the presence or absence of keratinized mucosa.

RESULTS

Thirty-two implants (7.8%) were categorized into the NKM group. The prevalence of peri-implantitis was 12.5% and 8.3% at the subject level and implant level, respectively. The NKM group was associated with more plaque accumulation, mucosal recession, interproximal bone level ≥ 3 mm, and peri-implantitis (p < 0.05). After controlling for confounding factors, the NKM group demonstrated higher plaque accumulation, mucosal recession, and interproximal bone level ≥ 3 mm with adjusted odds ratios of 2.98 (1.33-6.66), 3.20 (95% CI, 1.03-9.90), and 4.62 (1.70-12.58), respectively.

CONCLUSION

Within the limitation of this study, the lack of keratinized mucosa around the dental implants was significantly associated with more plaque accumulation, mucosal recession, interproximal bone level ≥ 3 mm, and peri-implantitis.

Comprehensive Evaluation of the Oral Health Status, Salivary Gland Function, and Oxidative Stress in the Saliva of Patients with Subacute Phase of Stroke: A Case-Control Study

This is the first study to assess, comprehensively, the oral health status; salivary glands’ function and enzymatic and non-enzymatic antioxidant defense; and oxidative damage to proteins and lipids in the non-stimulated (NWS) and stimulated (SWS) whole saliva of stroke patients. The study included 30 patients in the subacute phase of the stroke and an age and gender-matched control group. We showed that the activity of antioxidant enzymes (catalase and salivary peroxidase) was significantly higher in both NWS and SWS of stroke patients, similarly to uric acid concentration. However, in the study group, the reduced glutathione (GSH) concentration in SWS decreased. The contents of protein glycooxidation products (advanced glycation end products (AGE) and protein oxidation products (AOPP)) and lipid hydroperoxides were significantly higher in NWS and SWS of stroke patients. In the study group there was also a decrease in stimulated saliva secretion and total protein content. Interestingly, products of protein and lipid oxidation correlate negatively with SWS flow. The ROC analysis showed that salivary GSH with 100% specificity and 100% sensitivity differentiates the analyzed groups (AUC = 1.0). To sum up, in subacute stroke patients there are redox imbalances and oxidative damage to proteins and lipids in non-stimulated and stimulated saliva. Stroke patients also suffer from salivary gland dysfunction.

Plaque Index, Oral Hygiene Habits, and Depressive Symptomatology as Predictors of Clinical Attachment Loss: A Pilot Study

Background. The effect of depressive symptomatology on periodontitis is not clear in its path of action. Objective. To test a model to predict clinical attachment loss by direct effect of the dental plaque accumulation, which is a direct effect of worse oral hygiene habits and an indirect effect of greater depressive symptomatology. Methods. Three incidental samples were collected: 35 dental patients with periodontitis, 26 mental health patients with depressive symptomatology, and 29 people from the general population. The Beck Depression Inventory-II and the Oral Hygiene Habits Scale were applied. Plaque index and clinical attachment loss were assessed. Path analysis was used to test the model. The parameters were estimated by the maximum-likelihood method. Results. Depressive symptomatology had no direct effect on oral hygiene habits nor an indirect effect (mediated by oral hygiene habits) on the plaque index in any of the 3 samples. Oral hygiene habits had a large-size direct effect on plaque index and a medium-size indirect effect on clinical attachment loss in the general population sample. The plaque index had a direct effect on clinical attachment loss with a large effect size in general population sample and with a medium effect size in dental patients and depressive symptomatology patients. Conclusion. The model shows that dental plaque accumulation has a direct effect on clinical attachment loss in the 3 samples, and oral hygiene habits have an indirect effect on attachment loss mediated by dental plaque accumulation only in the general population sample. However, depressive symptomatology is not a relevant variable.

Corticosteroid Use and Periodontal Disease: A Systematic Review

Periodontitis affects the teeth supporting structures, such as periodontal tissues. We aimed to evaluate the association between periodontal disease and corticosteroid use. We searched in MEDLINE, Web of Sciences, SCOPUS, LILACS, and Cochrane databases, using the descriptors "Periodontal diseases" AND ("adrenal cortex hormones" OR "adrenal cortex hormones" OR ("adrenal" AND "cortex" AND "hormones") OR "adrenal cortex hormones" OR "corticosteroid"). We selected the summaries of observational studies, addressing periodontal disease in patients using corticosteroids. The search resulted in 403 articles. After applying the selection criteria, eight studies remained; being two retrospective cohorts and six cross-sectional studies. There are few studies with appropriate methodology to produce sound evidence about the causal relationship between the use of corticosteroids and periodontitis. However, two retrospective cohorts confirmed that chronic corticosteroid use is associated with the incidence of periodontal disease. Dental staff must be aware of this association for better management of periodontal disease therapy in patients using corticosteroids.

The oral health and periodontal diseases awareness and knowledge in the Iraqi population: Online-based survey

OBJECTIVES

This study aimed to evaluate oral health (OH) and periodontal diseases (PD) awareness in the Iraqi population.

MATERIAL AND METHODS

This study was a questionnaire-based online survey of two weeks duration. The questionnaire was built using a Google platform and was distributed randomly via social media (Facebook and Telegram). The questionnaire consisted of a demographic data section and two other main sections for the evaluation of OH and PD awareness. Each response was marked with "1" for a positive answer and "0" for the other answers. For each respondent, answers were summed to give an overall score. The frequency of positive responses was used to determine the association of awareness with demographic data and the level of awareness into low, moderate, and high levels.

RESULTS

A total of 1,465 were included in the final analysis after application of exclusion criteria. The respondents showed significantly higher levels of awareness about PD (mean ± SD = 3.66 ± 1.42) than OH awareness (mean ± SD = 2.19 ± 1.29). Analysis of data showed that OH awareness was mainly associated with high degree holders (OR 1.851) and age > 45 years (OR 1.730). However, PD awareness did not show any evident association with demographic variables investigated. In general, the respondents exhibited low levels of OH knowledge and low to moderate level of PD knowledge.

CONCLUSIONS

Despite limitations, this study revealed inappropriate levels of OH and PD awareness and knowledge in the Iraqi population and provided the baseline data necessary for the development of Governmental educational programs and health awareness campaigns which are highly suggested particularly focusing on the primary and high schools, in an attempt to improve the levels of awareness.

Cytokines and Chemokines in Periodontitis

Periodontitis is a common inflammatory periodontal disease affecting a wide range of population all over the world. The causing bacteria releases chemicals which activate the innate immune system to release proinflammatory cytokines contributing to more progression. This activates the acquired immune system leading to more progression of periodontitis. As the immune response goes on, released cytokines and chemokines can damage the periodontal ligaments, gingiva, and alveolar bone. There are many types of cytokines and chemokines in periodontitis. Cytokines are peptide mediators who are responsible for cell signaling and communication. Chemokines are a large subfamily of cytokines having the ability to coordinate leukocyte recruitment and activation. This paper is a narrative review of the literature.This review ensures that inflammatory mediators in the case of periodontitis can cause a noticeable damage in the whole apparatus of the periodontium. It causes soft tissue inflammation and bone damage affected by the mediators of both innate and acquired immune system.The inflammatory process is accompanied by large network of cytokines and chemokines. There is high expression of proinflammatory cytokines such as interleukin (IL)-1α, IL-1β, IL-6, IL-12, tumor necrosis factor (TNF)-α, and regulatory cytokines such as IL-4, IL-1(RA) receptor antagonist, IL-10, and induced protein (IP)-10. There is also increased production of cytokines IL-10, IL-12, interferon-γ, IP-10, IL-1RA, and IL-4. Cytokines IL-17, IL-6, IL-1β, TNF-α, macrophage colony-stimulating factor, and prostaglandin E ₂ trigger the osteoclast activity causing bone resorption.

Large Gender Gap in Oral Hygiene Behavior and Its Impact on Gingival Health in Late Adolescence

Background: Epidemiologic studies provide broad-based evidence that males are at greater risk of severe periodontal diseases than females. Our recent findings further revealed that male gender was an independent risk factor for gingival bleeding in late adolescents in Japan. Gingival health status has been reported to be affected by oral hygiene behavior. However, gender difference in this regard has not yet been clarified. Methods: We conducted a retrospective review of mandatory medical questionnaires administered as part of a legally required freshman medical checkup between April 2017 and 2019 at the University of Tokyo. Results: Among a total of 9376 sets of responses, chosen subjects were 9098 students aged 17-19. For frequency of daily brushing, males brushed less frequently than females (p < 0.001): 1 time or less (male: 22.9%, female: 11.2%), twice (65.0%, 69.2%), 3 times or more (12.1%, 19.6%). For the duration of brushing each time, males brushed for a shorter period of time than females (p = 0.005): 1 min or less (male: 17.2%, female: 14.1%), 2-3 min (46.9%, 49.2%), 4 min or more (35.9%, 36.7%). (1) Male gender, (2) lower frequency of daily brushing and (3) shorter duration of brushing each time, were significantly associated with the presence of gingival bleeding (p < 0.001 for all). Multivariate regression analysis showed that: (1) male gender (odds ratio 1.29, 95% confidence interval 1.15-1.44); (2) frequency of daily brushing: 1 time or less (2.36, 2.02-2.76), twice (1.45, 1.27-1.67); and (3) brushing duration each time: 1 min or less (1.57, 1.39-1.78), 2-3 min (1.26, 1.14-1.39), were independent risk factors for gingival bleeding (p < 0.001 for all). Conclusions: Males showed poorer oral hygiene behavior than females in late adolescents in Japan. Male gender was an independent risk factor for gingival bleeding, as well as poor oral hygiene behavior.

Association Between Self-Reported Dental Hygiene Practices and Dental Procedure-Related Recurrent Angioedema Attacks in HAE Subjects: A Multicenter Survey

BACKGROUND

Hereditary angioedema (HAE) symptoms may be triggered by dental procedures, thereby complicating dental care in individuals affected by the condition.

OBJECTIVE

This study investigated the self-perceived dental care needs, perceived susceptibility to acute angioedema (AE) attacks after dental procedures, and dental care behavior of patients with HAE.

METHODS

A self-administered semistructured web-based questionnaire was distributed to 250 adult patients with HAE (type 1 or 2; 88% type 1) and 256 matched non-HAE controls. Data were analyzed using stratified χ² tests, logistic regression, and classification trees.

RESULTS

A total of 46.4% of HAE versus 55.5% of control patients had dental visits within 6 months (P = .04). Dental insurance was a barrier to seeking routine dental visits among both groups. However, significantly fewer patients with HAE had routine dental visits within 6 months despite having dental insurance compared with control patients (48% vs 60%, P = .01). Within the HAE group, a significantly greater number of patients with dental visits at intervals greater than 6 months had a history of recurrent postprocedural AE attacks (odds ratio [OR]: 3.9 [1.7, 8.8], P = .0005) and used antibacterial toothpaste more frequently than those without recurrent AE attacks (OR: 4.7 [1.5, 15.4], P = .005).

CONCLUSIONS

These data support the hypothesis that patients with HAE who are predisposed to having AE episodes in response to medical or physical trauma visit the dentist less and engage in specific oral hygiene practices more frequently than matched control patients and patients with HAE who reported that they were less likely to swell after a dental procedure.

Low-intensity pulsed ultrasound activates autophagy in periodontal ligament cells in the presence or absence of lipopolysaccharide

OBJECTIVE

This study aims to determine if low-intensity pulsed ultrasound (LIPUS) activates autophagy in human periodontal ligament cells (PDLCs) irrespective of lipopolysaccharide.

DESIGN

Six groups were designed: control, LIPUS, lipopolysaccharide, LIPUS + lipopolysaccharide, LIPUS+3-Methyladenine, LIPUS + lipopolysaccharide+3-Methyl- adenine. LIPUS pretreated PDLCs for 2 h and lipopolysaccharide treated for different times. Real-time PCR and Western-blot were performed to evaluate mRNA and protein expression levels of autophagic genes Beclin-1 and LC3 respectively. A transmission electronic microscope was used to observe the autophagosome. ELISA was used to test interleukin-6 expression.

RESULTS

Compared with the non-treatment, LIPUS pretreatment increased mRNA expression levels of LC3 (P < 0.05) and Beclin-1 (P < 0.05) at 4 h and 8 h, and enhanced the protein expression levels of LC3-Ⅱ at 8 h (P<0.05) and Beclin-1 at 4 h, 8 h and 16 h(P<0.05). After LIPUS pretreatment and lipopolysaccharide treatment for 8 h, LC3-Ⅱ and Beclin-1 protein expression levels were elevated (P < 0.05) compared with the control. Following further treatment by 3-Methyladenine, Beclin-1 protein expression was decreased (P < 0.05) compared with the LIPUS plus lipopolysaccharide group, but LC3-Ⅱ protein expression was not. Autophagosomes were not found in the LIPUS+3-Methyladenine and LIPUS+lipopolysaccharide+3-Methyladenine groups. After LIPUS pretreatment and lipopolysaccharide treatment for 36 h, intreleukin-6 expression was decreased (P<0.05) compared with the lipopolysaccharide group. However, after addition of 3-Methyladenine, intreleukin-6 expression was elevated (P < 0.05) compared with the LIPUS +lipopolysaccharide group.

CONCLUSIONS

LIPUS can promote autophagy in PDLCs irrespective of lipopolysaccharide. Autophagy might be involved in LIPUS anti-inflammatory mechanism in PDLCS.

Workers' Healthcare Assistance Model (WHAM): Development, Validation, and Assessment of Sustainable Return on Investment (S-ROI)

The present study aimed to present and validate the Worker´s Healthcare Assistance Model (WHAM), which includes an interdisciplinary approach to health risk management in search of integral and integrated health, considering economic sustainability. Through the integration of distinct methodological strategies, WHAM was developed in the period from 2011 to 2018, in a workers' occupational health centre in the oil industry in Bahia, Brazil. The study included a sample of 965 workers, 91.7% of which were men, with a mean age of 44.9 years (age ranged from 23 to 73 years). The Kendall rank correlation coefficient and hierarchical multiple regression analysis were used for the validation of WHAM. The assessment of sustainable return on investment (S-ROI) was made using the WELLCAST ROI™ decision support tool, covering workers with heart disease and diabetes. WHAM can be considered an innovative healthcare model, as there is no available comparative model. WHAM is considered robust, with 86% health risk explanatory capacity and with an 85.5% S-ROI. It can be concluded that WHAM is a model capable of enhancing the level of workers' health in companies, reducing costs for employers and improving the quality of life within the organization.

Prevalence of Periodontal Disease among Obese Young Adult Population in Saudi Arabia-A Cross-Sectional Study

Background and objectives: We aimed to assess the prevalence of periodontal disease among obese young adults in Saudi Arabia and to analyze the association between different body mass indexes and the severity of periodontal disease. Materials and methods: This descriptive cross-sectional study consisted of 307 obese patients aged 18-39 years, with body mass index (BMI) ≥30. Demographic variables for periodontal disease, anthropometric parameters such as BMI along with clinical parameters such as oral hygiene index-simplified, community periodontal index (CPI) score and loss of attachment (LOA), were assessed. Multivariate binary logistic regression analysis was used to identify the predictors for chronic periodontitis in obese young adults between 18-40 years of age. Results: The majority of the participants (71.3%) had periodontal disease. Obese and extremely obese patients together showed a statistically significant difference in the age group of 21-30 years in terms of CPI score for inflammation (p < 0.05) and LOA (p < 0.001). Logistic regression analysis showed age (OR: 3.180; 95%CL: 1.337-7.561; p <.001), occasional dental visit (OR: 5.965; 95%CL: 3.130-11.368; p < 0.001), smoking >10 cigarettes (OR: 11.868; 95%CL: 3.588-39.254; p < 0.001) and poor oral hygiene status (OR: 17.250; 95%CL: 6.958-42.764; p < 0.001) were associated with a significantly higher risk of having periodontal disease. Conclusions: This study showed a high prevalence of periodontal disease in obese patients among the Saudi Arabian population.

Predictive Model of Clinical Attachment Loss and Oral Health-Related Quality of Life through Depressive Symptomatology, Oral Hygiene Habits, and Proinflammatory Biomarkers: A Pilot Study

Subjective aspects such as oral health-related quality of life (OHRQoL) and depression are important aspects in the periodontal care. The objectives of the study were to test a predictive model of clinical attachment loss and OHRQoL in a pooled sample of dental patients with periodontitis and mental health patients with depressive symptomatology, and test the invariance of the model across both types of patients. Three self-report scales were applied to assess depression, OHRQoL and oral hygiene habits, saliva samples were collected for three proinflammatory biomarkers, and the clinical attachment loss was measured in 35 patients with periodontitis and 26 patients with depressive symptomatology. Data were analyzed through structural equation modeling. The one-group analysis revealed a psychosomatic complaint model of disagreement between the complaint and the clinically observable. In the multi-group analysis, the model was not invariant. It was necessary to introduce a singularity in relation to depressive symptomatology for each population. Thus, a good and equivalent fit was achieved between the six nested models in constraints, as well as equivalent parameters between both types of patients. The study of a dental population in conjunction with a mental health population with a psychosomatic risk factor reveals interesting and unexpected results.

Non-significant association between - 330 T/G polymorphism in interleukin-2 gene and chronic periodontitis: findings from a meta-analysis

BACKGROUND

Chronic periodontitis (CP) is an immune-inflammatory disease that promotes tissue damage around the teeth. Among the several inflammatory mediators that orchestrate the periodontitis, there is the interleukin (IL)-2. Genetic variations in IL2 gene may be associated with the risk and severity of the disease. Contrary results are available in the literature with inconclusive findings and none meta-analysis to gather these data.

METHODS

A literature search was performed for studies published before June 11, 2019 in diverse scientific and educational databases. The data was extracted by two investigators and the statistical evaluation was performed by Review Manager statistical program with heterogeneity (I²) and Odds Ratio (OR) with 95% of Confidence Intervals (CI) calculations and a sensitive analysis to assess the accuracy of the obtained results. The publication bias was evaluated by Begg' and Egger's test with Comprehensive meta-analysis software. The value of P < 0.05 was considered as significant.

RESULTS

Five studies were identified in diverse ethnical groups with 1425 participants. The - 330 T/G polymorphism in IL2 gene was not significantly associated with CP in allelic evaluation (P > 0.05) as well as in the genotypic comparisons (P = 0.15). The Begg's test and the linear regression Egger's test did not show any evidence of publication bias risk (P > 0.05) which was corroborated by the absence of obvious asymmetry in Funnel plot graphic.

CONCLUSIONS

This meta-analysis showed a non-significant association between - 330 T/G polymorphism in IL2 gene and CP in any allelic evaluation.

Prophylactic extraction of non-impacted third molars: is it necessary?

BACKGROUND

The decision of removing a non-impacted 3rd molar, unlike extraction of an impacted 3rd molar, is challenging for dentists as well as patients. This study investigates the pathologies affecting second molars situated adjacent to asymptomatic non-impacted 3rd molars.

METHODS

This retrospective study included digital radiographs of 749 patients taken between April to October 2015. Panoramic radiographs were evaluated for the presence of erupted asymptomatic non-impacted 3rd molars and pathologies on adjacent second molars. The patients were reviewed according to age and gender.

RESULTS

A total of 2342 asymptomatic 3rd molars were assessed in the study based on the inclusion and exclusion criteria, and 2112 of them were found to be non-impacted. The second molars adjacent to non-impacted 3rd molars were shown to be significantly associated with distal caries (25.2%), mesial bone loss (10.5%) and total bone loss (37.2%), i.e., mesial as well as distal bone loss.

CONCLUSIONS

Pathologies of the 3rd molars and teeth adjacent to 3rd molars can occur as a result of multiple factors. Caries and periodontal disease may also occur due to the inaccessibility to maintain oral hygiene. With a regular follow-up schedule, reinforced by the dentist and good oral hygiene, several pathologies that are significantly associated with non-impacted 3rd molars can be prevented and may not require prophylactic extraction.

Oral Health Knowledge Level of Nursing Staff Working in Semi-Intensive Heart Failure Units

PURPOSE

Critical care units, such as heart failure units, house inpatients with a compromised general health status that requires rigorous prevention of further complications. Oral health infections that gain access through the bloodstream or airway might represent such potential complications (eg, endocarditis pneumonia). Avoiding these critical occurrences requires that adequate oral health care be provided by nursing personnel. Here we assessed the knowledge of oral health care practices by nurses working in three Italian heart failure units in Umbria, Italy.

DESIGN

This was a cross-sectional study.

METHODS

Forty-four nurses were interviewed using a six-item modified Adams' questionnaire on the topic of oral health care. A multidisciplinary panel of experts established the criteria for answer correctness based on the most relevant dentistry literature evidence and judged each reply. The expected percentage of correctly replying nurses was 75%, and significant differences from this expected probability were calculated with one-sided binomial probability tests. Cronbach's α method was used to establish the questionnaire's internal consistency (reliability).

RESULTS

For five out of six questionnaire items, the percentage of nurses who correctly answered was significantly lower than the expected value of probability. Lack of knowledge was found for usefulness of checking the patients' mouths (p=0.003), the most relevant lesions affecting the mouth (p=0.0001), the tools/solutions for cleaning the mouth and dentures (p= 0.0416), and drugs that affect the mouth and their side effects (p<0.0001).

CONCLUSION

In this study, few nurses working in heart failure units showed both an adequate willingness to check inpatients and a good knowledge of oral health care (significantly lower than the expected 75%). Further studies that use validated questionnaires and include more participants should be conducted to confirm and elaborate on our preliminary data.

Camrelizumab (SHR-1210) leading to reactive capillary hemangioma in the gingiva: A case report

BACKGROUND

Oncologic immunotherapy is attracting attention as an effective strategy for cancer treatment. Currently, there are two kinds of inhibitors: Anti-PD-1 antibodies and anti-PD-L1 antibodies. These inhibitors have shown significant implications in improving the outcomes of certain cancer types in recent years. However, along with its effectiveness, adverse events cannot be ignored. As an anti-PD-1 antibody, camrelizumab (SHR-1210) has some side effects in tumor immunotherapy. The most common adverse event is reactive capillary hemangioma. While it is widely reported to occur in the skin, gingival reactive capillary hemangioma is rarely reported.

CASE SUMMARY

A 54-year-old man complained of gingival overgrowth on the anterior aspect of the maxilla and mandible for more than 6 mo. He had been placed on SHR-1210 for lung cancer for 7 mo. A gingival mass extending from canine to canine was noted on the lingual surfaces of the mandible. Gingival enlargement was noted in the front teeth. A clinical diagnosis of gingival reactive capillary hemangioma and chronic periodontitis was made. The treatment involved a complex local treatment (repeated local applications of an antibiotic paste, scaling and root planning, and surgery). The excised tissue was sent for histopathological examination, which confirmed the diagnosis of capillary hemangioma. After the operation, most of the gingival enlargement was reduced. At the 2-mo follow-up, it was noted that the gingival overgrowth was immediately reduced after the replacement of the anti-PD-1 agent with an anti-PD-L1 agent.

CONCLUSION

As the prescription for SHR-1210 has increased considerably in recent years, the occurrence of its possible side effects, including gingival reactive capillary hemangioma, has increased. It is recommended that regular oral examinations be performed before and during the treatment of tumors with SHR-1210.

Periodontal status and dental behaviour of heart transplant recipients and healthy controls

Objective: The aim of this study was to compare the periodontal status and dental behaviour of heart transplant recipients with systemically healthy controls.Material and Methods: Forty heart transplant recipients and 40 systemically healthy patients were included. A questionnaire was used to record demographic, systemic health and dental behaviour data, and the following clinical parameters were recorded: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level.Results: Mean probing depth (p = .045), mean gingival recession (p = .016), mean clinical attachment level (p = .021) and mean plaque index scores (p = .001) were higher in heart transplant recipients than the systemically healthy group. However, bleeding on probing was similar in both groups (p > .05). Tooth brushing frequency and number of participants who used dental floss/interdental brush was lower in the heart transplant group.Conclusion: Considering the poor oral hygiene and high clinical periodontal parameters of heart transplant recipients, periodontal evaluation should be done regularly before and after transplantation. The patient's daily oral hygiene regimens should be evaluated carefully in this evaluation session and modified based on their gingival health, manual skill and motivational levels. The importance of oral health and its effects on systemic health should also be explained to the transplant recipients in detail.

Teeth: Small but Mighty and Mighty Important. A Comprehensive Review of Children's Dental Health for Primary Care Clinicians

Healthy teeth allow us to eat and stay well-nourished. Although primary care clinicians receive limited training about teeth, given the common nature of dental problems, it is important that they understand and recognize normal and abnormal dental conditions and can implement primary and secondary prevention of dental conditions in their practice. PubMed has been used to search the scientific literature for evidence on the following topics: normal dental development, dental abnormalities, malocclusion, teething, dental caries and related epidemiology and prevention, fluoride, dental injury and its management and prevention; and identification, prevention and treatment of gingivitis and periodontal disease. Literature review relied on randomized controlled trials, meta-analyses, systematic reviews, and Cochrane reviews when relevant and available. Other sources of evidence included cohort and case-control studies. Consensus statements and expert opinion were used when there was a paucity of high-quality research studies. The literature has been synthesized on these topics to make them relevant to pediatric primary care clinicians, and as available, the strength of evidence has been characterized when making clinical recommendations.

Low concern rate with oral health and associated factors among older persons: a cross-sectional study

OBJECTIVE: This study aimed to assess the prevalence of concern with oral health and associated factors among older adults. METHODS: Individuals aged ≥60 years were included from the cities Cruz Alta and Veranópolis, Brazil. Oral health examination and a structured questionnaire were applied in 569 individuals. The main outcome was concern with oral health (yes or no), which was determined by a validated questionnaire. Uni- and multivariate analyses were conducted by Poisson regression with robust variance to assess the association between outcome and independent variables. RESULTS: The prevalence of concern with oral health was 30.58% (n = 174). Non-white individuals presented significantly higher prevalence ratio (PR) of being concerned about their oral health (PR = 1.28; 95% confidence interval [CI] 1.01–1.62). Individuals with medium or high level of education, not retired and without any health problems presented higher PR of being concerned with their oral health when compared to their controls (p < 0.05). Moreover, those that reported toothbrushing frequency ≥ 2 times/day (PR = 1.58; 95%CI 1.01 – 2.48) and non-edentulous (PR = 1.50; 95%CI 1.12 –2.01) also presented higher PR of being concern with their oral health. Older adults that were not concerned with tooth alignment (PR = 0.57; 95%CI 0.44 – 0.74) or tooth color (PR = 0.41; 95%CI 0.31 – 0.54) demonstrated lower concern with their oral health. CONCLUSION: Prevalence of concern with oral health among the older adults was low and associated with non-white individuals, medium and high level of education, individuals not retired, absence of health problems, higher toothbrushing frequency, mild temporomandibular disorder (TMD) and non-edentulism. Additionally, concern with esthetical aspects may be related with this outcome.