101
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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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102
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Borgnakke WS, Ylöstalo PV, Taylor GW, Genco RJ. Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence. J Clin Periodontol 2016; 40 Suppl 14:S135-52. [PMID: 23627324 DOI: 10.1111/jcpe.12080] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Periodontal disease and diabetes mellitus are common, chronic diseases worldwide. Epidemiologic and biologic evidence suggest periodontal disease may affect diabetes. OBJECTIVE To systematically review non-experimental, epidemiologic evidence for effects of periodontal disease on diabetes control, complications and incidence. DATA SOURCES Electronic bibliographic databases, supplemented by hand searches of recent and future issues of relevant journals. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS: Longitudinal and cross-sectional epidemiologic, non-interventional studies that permit determination of directionality of observed effects were included. STUDY APPRAISAL AND SYNTHESIS METHODS Four reviewers evaluated pair-wise each study. Review findings regarding study results and quality were summarized in tables by topic, using the PRISMA Statement for reporting and the Newcastle-Ottawa System for quality assessment, respectively. From 2246 citations identified and available abstracts screened, 114 full-text reports were assessed and 17 included in the review. RESULTS A small body of evidence supports significant, adverse effects of periodontal disease on glycaemic control, diabetes complications, and development of type 2 (and possibly gestational) diabetes. LIMITATIONS There were only a limited number of eligible studies, several of which included small sample sizes. Exposure and outcome parameters varied, and the generalizability of their results was limited. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Current evidence suggests that periodontal disease adversely affects diabetes outcomes, and that further longitudinal studies are warranted.
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Affiliation(s)
- Wenche S Borgnakke
- University of Michigan School of Dentistry, Ann Arbor, MI 48109-1078, USA.
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103
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Linden GJ, Lyons A, Scannapieco FA. Periodontal systemic associations: review of the evidence. J Clin Periodontol 2016; 40 Suppl 14:S8-19. [PMID: 23627336 DOI: 10.1111/jcpe.12064] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/24/2022]
Abstract
AIM To critically appraise recent research into associations between periodontal disease and systemic diseases and conditions specifically respiratory disease, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer. METHODS A MEDLINE literature search of papers published between 2002 and April 2012 was conducted. Studies that included periodontitis as an exposure were identified. Cross-sectional epidemiological investigations on large samples, prospective studies and systematic reviews formed the basis of the narrative review. A threshold set for the identification of periodontitis was used to identify those studies that contributed to the conclusions of the review. RESULTS Many of the investigations were cross-sectional secondary analyses of existing data sets in particular the NHANES studies. There were a small number of systematic reviews and prospective studies. There was substantial variability in the definitions of exposure to periodontitis. A small number of studies met the threshold set for periodontitis and supported associations; however, in some of the chronic diseases there were no such studies. There was strong evidence from randomized controlled trials that interventions, which improve oral hygiene have positive effects on the prevention of nosocomial pneumonias. CONCLUSIONS There was substantial heterogeneity in the definitions used to identify periodontitis and very few studies met a stringent threshold for periodontitis. Published evidence supports modest associations between periodontitis and some, although not all, of the diseases and conditions reviewed. There is a need to reach a consensus on what constitutes periodontitis for future studies of putative associations with systemic diseases.
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Affiliation(s)
- Gerard J Linden
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK.
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104
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Linden GJ, Lyons A, Scannapieco FA. Periodontal systemic associations: review of the evidence. J Periodontol 2016; 84:S8-S19. [PMID: 23631586 DOI: 10.1902/jop.2013.1340010] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM To critically appraise recent research into associations between periodontal disease and systemic diseases and conditions specifically respiratory disease, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer. METHODS A MEDLINE literature search of papers published between 2002 and April 2012 was conducted. Studies that included periodontitis as an exposure were identified. Cross-sectional epidemiological investigations on large samples, prospective studies and systematic reviews formed the basis of the narrative review. A threshold set for the identification of periodontitis was used to identify those studies that contributed to the conclusions of the review. RESULTS Many of the investigations were cross-sectional secondary analyses of existing data sets in particular the NHANES studies. There were a small number of systematic reviews and prospective studies. There was substantial variability in the definitions of exposure to periodontitis. A small number of studies met the threshold set for periodontitis and supported associations; however, in some of the chronic diseases there were no such studies. There was strong evidence from randomized controlled trials that interventions, which improve oral hygiene have positive effects on the prevention of nosocomial pneumonias. CONCLUSIONS There was substantial heterogeneity in the definitions used to identify periodontitis and very few studies met a stringent threshold for periodontitis. Published evidence supports modest associations between periodontitis and some, although not all, of the diseases and conditions reviewed. There is a need to reach a consensus on what constitutes periodontitis for future studies of putative associations with systemic diseases.
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Affiliation(s)
- Gerard J Linden
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK.
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105
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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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106
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López Silva MC, Diz-Iglesias P, Seoane-Romero JM, Quintas V, Méndez-Brea F, Varela-Centelles P. [Update in family medicine: Periodontal disease]. Semergen 2016; 43:141-148. [PMID: 27068254 DOI: 10.1016/j.semerg.2016.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 01/18/2023]
Abstract
About 85-94% of the Spanish adults older than 35 experience gum problems, and about 15-30% suffer from periodontitis, being severe in up to 5-11% of them. Unlike other inflammatory conditions, periodontal disease rarely causes discomfort, or limits life or causes functional limitations until its advanced stages, when clinical signs and symptoms arise (gingival recession, pathological teeth migration, or mobility). Lack of knowledge about the disease, together with the idea that tooth loss is linked to ageing, frequently results in a late diagnosis, requiring extensive treatments with a worse prognosis. At Primary Care level, there is series of drugs have been related to periodontal disease (anticonvulsants, immunosuppressive drugs, and calcium channel blockers) as secondary effects, which vary as regards their frequency and severity depending of the amount of accumulated plaque. Stress and depression have also been reported to alter the immune response and to increase the inflammatory response as well as periodontal susceptibility. Certain systemic conditions, such as diabetes mellitus, cardiovascular disorders, respiratory diseases, as well as low-weight pre-term birth, have also been linked to periodontitis.
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Affiliation(s)
- M C López Silva
- Atención Primaria, CS Praza do Ferrol, EOXI Lugo, Cervo, e Monforte de Lemos, Servizo Galego de Saúde, Lugo, España
| | - P Diz-Iglesias
- Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - J M Seoane-Romero
- Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - V Quintas
- Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - F Méndez-Brea
- Pregrado de Odontología, Facultad de Medicina y Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - P Varela-Centelles
- Atención Primaria, CS Praza do Ferrol, EOXI Lugo, Cervo, e Monforte de Lemos, Servizo Galego de Saúde, Lugo, España; Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
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107
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Buset SL, Walter C, Friedmann A, Weiger R, Borgnakke WS, Zitzmann NU. Are periodontal diseases really silent? A systematic review of their effect on quality of life. J Clin Periodontol 2016; 43:333-44. [DOI: 10.1111/jcpe.12517] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Sabrina Lill Buset
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Anton Friedmann
- Clinic for Periodontology; University of Witten; Witten Germany
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Wenche S. Borgnakke
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry; Ann Arbor MI USA
| | - Nicola U. Zitzmann
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
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108
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Sharma P, Dietrich T, Ferro CJ, Cockwell P, Chapple IL. Association between periodontitis and mortality in stages 3-5 chronic kidney disease: NHANES III and linked mortality study. J Clin Periodontol 2016; 43:104-13. [PMID: 26717883 PMCID: PMC5324563 DOI: 10.1111/jcpe.12502] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Periodontitis may add to the systemic inflammatory burden in individuals with chronic kidney disease (CKD), thereby contributing to an increased mortality rate. This study aimed to determine the association between periodontitis and mortality rate (all-cause and cardiovascular disease-related) in individuals with stage 3-5 CKD, hitherto referred to as "CKD". METHODS Survival analysis was carried out using the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality data. Cox proportional hazards regression was employed to assess the association between periodontitis and mortality, in individuals with CKD. This association was compared with the association between mortality and traditional risk factors in CKD mortality (diabetes, hypertension and smoking). RESULTS Of the 13,784 participants eligible for analysis in NHANES III, 861 (6%) had CKD. The median follow-up for this cohort was 14.3 years. Adjusting for confounders, the 10-year all-cause mortality rate for individuals with CKD increased from 32% (95% CI: 29-35%) to 41% (36-47%) with the addition of periodontitis. For diabetes, the 10-year all-cause mortality rate increased to 43% (38-49%). CONCLUSION There is a strong, association between periodontitis and increased mortality in individuals with CKD. Sources of chronic systemic inflammation (including periodontitis) may be important contributors to mortality in patients with CKD.
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Affiliation(s)
- Praveen Sharma
- Periodontal Research GroupSchool of DentistryUniversity of BirminghamBirminghamUK
| | - Thomas Dietrich
- Periodontal Research GroupSchool of DentistryUniversity of BirminghamBirminghamUK
| | - Charles J. Ferro
- Department of NephrologyUniversity Hospital BirminghamBirminghamUK
| | - Paul Cockwell
- Department of NephrologyUniversity Hospital BirminghamBirminghamUK
| | - Iain L.C. Chapple
- Periodontal Research GroupSchool of DentistryUniversity of BirminghamBirminghamUK
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109
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Morales A, Carvajal P, Romanelli H, Gómez M, Loha C, Esper ME, Musso G, Ardila CM, Duque A, Medina M, Bueno L, Andrade E, Mendoza C, Gamonal J. Prevalence and predictors for clinical attachment loss in adolescents in Latin America: cross-sectional study. J Clin Periodontol 2015; 42:900-907. [PMID: 26356350 DOI: 10.1111/jcpe.12452] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 07/08/2024]
Abstract
AIM To describe the prevalence, severity and extension of clinical attachment loss (CAL) and to study the predictors in 15- to 19-year-old adolescents from high schools in the Latin America. MATERIALS AND METHODS A cross-sectional, epidemiological study was performed. The sample included 1070 high school adolescents 15-19 years of age from Santiago de Chile (Chile), Buenos Aires, Córdoba, Mendoza (Argentina), Montevideo (Uruguay), Quito (Ecuador) and Medellín (Colombia). Calibrated examiners performed full mouth, six sites per tooth clinical examination. RESULTS There was a response rate of 100%. The prevalence of CAL ≥3 mm in ≥1 site was 32.6%, probing pocket depth ≥4 mm was 59.3% and bleeding on probing (BoP) ≥25% was 28.6%. The logistic regression analysis adjusted for cities revealed that smoking (OR = 1.6), attending public school (OR = 2.3) and having a BoP ≥25% (OR = 4.2) were positively associated with CAL ≥3 mm in ≥ 1 site. CONCLUSION Clinical attachment loss was prevalent in Latin America adolescents and it is associated with smoking, attendance public school and BoP.
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Affiliation(s)
- Alicia Morales
- Laboratory of Periodontal Biology, Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Paola Carvajal
- Laboratory of Periodontal Biology, Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Hugo Romanelli
- School of Dentistry, Universidad de Maimónides, Buenos Aires, Argentina
| | - Mariel Gómez
- School of Dentistry, Universidad de Maimónides, Buenos Aires, Argentina
| | - Cristina Loha
- Faculty of Dentistry, Universidad Nacional de Cuyo, Mendoza, Argentina
| | - María E Esper
- Faculty of Dentistry, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Graciela Musso
- Faculty of Dentistry, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Carlos M Ardila
- Department of Periodontology, School of Dentistry, Universidad de Antioquia, Medellín, Colombia
| | - Andrés Duque
- Department of Periodontology, School of Dentistry, Universidad CES, Medellín, Colombia
| | - Marco Medina
- Faculty of Dentistry, Universidad Central del Ecuador, Quito, Ecuador
| | - Luis Bueno
- Department of Periodontology, Universidad de la República, Montevideo, Uruguay
| | - Ernesto Andrade
- Department of Periodontology, Universidad de la República, Montevideo, Uruguay
| | - Carolina Mendoza
- Oral Health Department, DIPRECE, Ministerio de Salud, Santiago, Chile
| | - Jorge Gamonal
- Laboratory of Periodontal Biology, Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
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110
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Steffens JP, Wang X, Starr JR, Spolidorio LC, Van Dyke TE, Kantarci A. Associations Between Sex Hormone Levels and Periodontitis in Men: Results From NHANES III. J Periodontol 2015; 86:1116-25. [DOI: 10.1902/jop.2015.140530] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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111
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Iwasaki M, Kimura Y, Yoshihara A, Ogawa H, Yamaga T, Sato M, Wada T, Sakamoto R, Ishimoto Y, Fukutomi E, Chen W, Imai H, Fujisawa M, Okumiya K, Taylor GW, Ansai T, Miyazaki H, Matsubayashi K. Oral health status in relation to cognitive function among older Japanese. Clin Exp Dent Res 2015; 1:3-9. [PMID: 29744134 PMCID: PMC5839238 DOI: 10.1002/cre2.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 12/25/2022] Open
Abstract
Epidemiologic data examining the relationship between oral health status and cognitive status are sparse, especially in Asian populations. This study aimed to assess whether periodontal disease and tooth loss were related to cognitive impairment among older Japanese. Study participants were 291 Japanese (101 men and 190 women, average age: 80.9 years), classified into three groups based on a clinical examination of oral health status: no periodontal disease, periodontal disease, and edentulous. Periodontal disease was defined using criteria recommended in the consensus report of the European Workshop in Periodontology with a modification. Cognitive impairment was defined using the results of the Mini-mental State Examination (MMSE) and Hasegawa Dementia Scale-Revised (HDS-R) scores. Multivariable logistic regression analyses assessed the relationship of the three-category oral health status variable (reference category = no periodontal disease) with low MMSE score (≤23) and low HDS-R score (≤20). Age, gender, years of education, body mass index, smoking status, drinking behavior, and history of cardiovascular disease were tested as potential confounders in the multivariable models. Periodontal disease and edentulous were significantly associated with greater odds of low cognitive performance after controlling for potential confounders. The multivariable adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for low MMSE score associated with periodontal disease and edentulous were 2.21 (1.01-4.84) and 2.28 (1.06-4.90), respectively. The multivariable adjusted ORs (95% CIs) for low HDS-R score associated with periodontal disease and edentulous were 4.85 (1.29-18.15) and 3.86 (1.05-14.20), respectively. Poor oral health status was significantly associated with cognitive impairment among community-dwelling older Japanese. Additional well-controlled longitudinal studies are needed to elucidate whether there may be a possible cause-and-effect relationship between oral health status and cognitive function.
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Affiliation(s)
- Masanori Iwasaki
- Division of Preventive Dentistry, Department of Oral Health ScienceNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
- Division of Community Oral Health DevelopmentKyushu Dental UniversityKitakyushuJapan
| | - Yumi Kimura
- Center for Southeast Asian StudiesKyoto UniversityKyotoJapan
| | - Akihiro Yoshihara
- Division of Oral Science for Health Promotion, Department of Oral Health and WelfareNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Hiroshi Ogawa
- Division of Preventive Dentistry, Department of Oral Health ScienceNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Takayuki Yamaga
- Division of Preventive Dentistry, Department of Oral Health ScienceNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Misuzu Sato
- Division of Preventive Dentistry, Department of Oral Health ScienceNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Taizo Wada
- Center for Southeast Asian StudiesKyoto UniversityKyotoJapan
| | - Ryota Sakamoto
- Center for Southeast Asian StudiesKyoto UniversityKyotoJapan
| | - Yasuko Ishimoto
- Center for Southeast Asian StudiesKyoto UniversityKyotoJapan
| | - Eriko Fukutomi
- Center for Southeast Asian StudiesKyoto UniversityKyotoJapan
| | - Wenling Chen
- Department of Field Medicine, School of Public HealthKyoto UniversityKyotoJapan
| | - Hissei Imai
- Department of Field Medicine, School of Public HealthKyoto UniversityKyotoJapan
| | | | | | - George W. Taylor
- Department of Preventive and Restorative Dental SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Toshihiro Ansai
- Division of Community Oral Health DevelopmentKyushu Dental UniversityKitakyushuJapan
| | - Hideo Miyazaki
- Division of Preventive Dentistry, Department of Oral Health ScienceNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Kozo Matsubayashi
- Center for Southeast Asian StudiesKyoto UniversityKyotoJapan
- Department of Field Medicine, School of Public HealthKyoto UniversityKyotoJapan
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112
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Abstract
Gingivitis and chronic periodontitis are highly prevalent chronic inflammatory diseases. Gingivitis affects the majority of people, and advanced periodontitis is estimated to affect 5-15% of adults. The detection and diagnosis of these common diseases is a fundamentally important component of oral health care. All patients should undergo periodontal assessment as part of routine oral examination. Periodontal screening using methods such as the Basic Periodontal Examination/Community Periodontal Index or Periodontal Screening Record should be performed for all new patients, and also on a regular basis as part of ongoing oral health care. If periodontitis is identified, full periodontal assessment is required, involving recording of full mouth probing and bleeding data, together with assessment of other relevant parameters such as plaque levels, furcation involvement, recession and tooth mobility. Radiographic assessment of alveolar bone levels is driven by the clinical situation, and is required to assess bone destruction in patients with periodontitis. Risk assessment (such as assessing diabetes status and smoking) and risk management (such as promoting smoking cessation) should form a central component of periodontal therapy. This article provides guidance to the oral health care team regarding methods and frequencies of appropriate clinical and radiographic examinations to assess periodontal status, to enable appropriate detection and diagnosis of periodontal conditions.
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113
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Marchesan J, Jiao Y, Schaff RA, Hao J, Morelli T, Kinney JS, Gerow E, Sheridan R, Rodrigues V, Paster BJ, Inohara N, Giannobile WV. TLR4, NOD1 and NOD2 mediate immune recognition of putative newly identified periodontal pathogens. Mol Oral Microbiol 2015; 31:243-258. [PMID: 26177212 DOI: 10.1111/omi.12116] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2015] [Indexed: 12/29/2022]
Abstract
Periodontitis is a polymicrobial inflammatory disease that results from the interaction between the oral microbiota and the host immunity. Although the innate immune response is important for disease initiation and progression, the innate immune receptors that recognize both classical and putative periodontal pathogens that elicit an immune response have not been elucidated. By using the Human Oral Microbe Identification Microarray (HOMIM), we identified multiple predominant oral bacterial species in human plaque biofilm that strongly associate with severe periodontitis. Ten of the identified species were evaluated in greater depth, six being classical pathogens and four putative novel pathogens. Using human peripheral blood monocytes (HPBM) and murine bone-marrow-derived macrophages (BMDM) from wild-type (WT) and Toll-like receptor (TLR)-specific and MyD88 knockouts (KOs), we demonstrated that heat-killed Campylobacter concisus, Campylobacter rectus, Selenomonas infelix, Porphyromonas endodontalis, Porphyromonas gingivalis, and Tannerella forsythia mediate high immunostimulatory activity. Campylobacter concisus, C. rectus, and S. infelix exhibited robust TLR4 stimulatory activity. Studies using mesothelial cells from WT and NOD1-specific KOs and NOD2-expressing human embryonic kidney cells demonstrated that Eubacterium saphenum, Eubacterium nodatum and Filifactor alocis exhibit robust NOD1 stimulatory activity, and that Porphyromonas endodontalis and Parvimonas micra have the highest NOD2 stimulatory activity. These studies allowed us to provide important evidence on newly identified putative pathogens in periodontal disease pathogenesis showing that these bacteria exhibit different immunostimulatory activity via TLR4, NOD1, and NOD2 (Clinicaltrials.gov NCT01154855).
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Affiliation(s)
- Julie Marchesan
- Department of Periodontics and Oral Medicine & Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, Michigan USA.,Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yizu Jiao
- Department of Periodontics and Oral Medicine & Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, Michigan USA
| | - Riley A Schaff
- Department of Periodontics and Oral Medicine & Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, Michigan USA
| | - Jie Hao
- Department of Periodontics and Oral Medicine & Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, Michigan USA
| | - Thiago Morelli
- Department of Periodontics and Oral Medicine & Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, Michigan USA.,Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Janet S Kinney
- Department of Periodontics and Oral Medicine & Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, Michigan USA
| | - Elizabeth Gerow
- Department of Periodontics and Oral Medicine & Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, Michigan USA
| | - Rachel Sheridan
- Department of Periodontics and Oral Medicine & Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, Michigan USA
| | - Vinicius Rodrigues
- Department of Periodontics and Oral Medicine & Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, Michigan USA
| | - Bruce J Paster
- The Forsyth Institute, Cambridge, MA, USA.,Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Naohiro Inohara
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - William V Giannobile
- Department of Periodontics and Oral Medicine & Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, Michigan USA
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114
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Grubbs V, Vittinghoff E, Taylor G, Kritz-Silverstein D, Powe N, Bibbins-Domingo K, Ishani A, Cummings SR. The association of periodontal disease with kidney function decline: a longitudinal retrospective analysis of the MrOS dental study. Nephrol Dial Transplant 2015; 31:466-72. [PMID: 26320037 DOI: 10.1093/ndt/gfv312] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/06/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Identifying modifiable risk factors for chronic kidney disease (CKD) is essential for reducing its burden. Periodontal disease is common, modifiable and has been implicated as a novel potential CKD risk factor, but evidence of its association with kidney function decline over time is limited. METHODS In a longitudinal retrospective cohort of 761 elderly men with preserved kidney function [estimated glomerular filtration rate > 60 mL/min/1.73 m(2) using a calibrated creatinine and cystatin C (eGFRcr-cys) equation] at baseline, we performed multivariable Poisson's regression to examine the association of severe periodontal disease with incident CKD, defined as incident eGFRcr-cys <60 mL/min/1.73 m(2) and rapid (>5% annualized) eGFRcr-cys decline. Severe periodontal disease was defined in two ways: (i) ≥5 mm proximal attachment loss in 30% of teeth examined (European Workshop in Periodontology Group C, European Workshop); and (ii) 2+ interproximal sites with attachment loss ≥6 mm and 1+ interproximal sites with probing depth ≥5 mm (Centers for Disease Control/American Academy of Periodontology, CDC/AAP). RESULTS At baseline, the mean age was 73.4 (SD 4.8) years, the median eGFRcr-cys was 82.4 mL/min/1.73 m(2), and 35.5 and 25.4% of participants had severe periodontal disease by European Workshop and CDC/AAP criteria, respectively. After a mean follow-up of 4.9 years (SD 0.3), 56 (7.4%) participants had incident CKD. Severe periodontal disease was associated with a 2-fold greater rate of incident CKD [incidence rate ratio (IRR) 2.01 (1.21-3.44), P = 0.007] after adjusting for confounders compared with not severe periodontal disease by European Workshop criteria but did not reach statistical significance by CDC/AAP criteria [IRR 1.10 (0.63-1.91), P = 0.9]. CONCLUSIONS Severe periodontal disease may be associated with incident clinically significant kidney function decline among a cohort of elderly men.
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Affiliation(s)
- Vanessa Grubbs
- Division of Nephrology, University of California, San Francisco/San Francisco General Hospital, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - George Taylor
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco,San Francisco, CA, USA
| | - Donna Kritz-Silverstein
- Department of Family Medicine & Public Health, University of California, San Diego, San Diego, CA, USA
| | - Neil Powe
- Department of Medicine, University of California, San Francisco/San Francisco General Hospital, San Francisco, CA, USA
| | | | - Areef Ishani
- Division of Nephrology, University of Minnesota, Minneapolis, MN, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
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115
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Sato M, Iwasaki M, Yoshihara A, Miyazaki H. Association between periodontitis and medical expenditure in older adults: A 33-month follow-up study. Geriatr Gerontol Int 2015; 16:856-64. [PMID: 26272677 DOI: 10.1111/ggi.12569] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2015] [Indexed: 01/17/2023]
Abstract
AIM Along with rapid aging, medical expenditure for older adults has been increasing in Japan. Research has shown that periodontitis is a useful predictor for excess medical expenditure; however, limited information is available on the elderly population after adequately considering confounding factors. The aim of the present study was to evaluate the association between periodontitis and long-term medical expenditure in elderly Japanese. METHODS Baseline health and periodontal examinations were carried out in June 2008. Japanese adults (n = 245) aged 80 years were classified into quartiles based on periodontal inflamed surface area (PISA), which quantifies the degree of periodontal inflammation. Medical care use and costs were monitored by assessment of the National Health Insurance claim files from the baseline survey through the end of February 2011. Multivariable analysis of the differences in medical expenditure among PISA quartiles was carried out using linear regression with robust standard errors. RESULTS The participants in the fourth (with the largest PISA) and third quartiles had significantly higher inpatient medical expenditure compared with those of the first quartile (P < 0.01 and = 0.04, respectively). Participants in the fourth quartile had significantly higher total medical expenditure (P < 0.01) compared with the first quartile. A trend was observed of higher inpatient and total medical expenditure with increasing PISA. CONCLUSIONS A significant association was found between periodontitis and future increase in medical expenditure, suggesting that periodontitis might be a modifiable factor for the reduction of excess medical expenditure among elderly Japanese. Geriatr Gerontol Int 2016; 16: 856-864.
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Affiliation(s)
- Misuzu Sato
- Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masanori Iwasaki
- Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.,Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu, Japan
| | - Akihiro Yoshihara
- Division of Oral Science for Health Promotion, Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hideo Miyazaki
- Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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116
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Akinkugbe AA, Saraiya VM, Preisser JS, Offenbacher S, Beck JD. Bias in estimating the cross-sectional smoking, alcohol, obesity and diabetes associations with moderate-severe periodontitis in the Atherosclerosis Risk in Communities study: comparison of full versus partial-mouth estimates. J Clin Periodontol 2015; 42:609-21. [PMID: 26076661 DOI: 10.1111/jcpe.12425] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess whether partial-mouth protocols (PRPs) result in biased estimates of the associations between smoking, alcohol, obesity and diabetes with periodontitis. METHODS Using a sample (n = 6129) of the 1996-1998 Atherosclerosis Risk in Communities study, we used measures of probing pocket depth and clinical attachment level to identify moderate-severe periodontitis. Adjusting for confounders, unconditional binary logistic regression estimated prevalence odds ratios (POR) and 95% confidence limits. Specifically, we compared POR for smoking, alcohol, obesity and diabetes with periodontitis derived from full-mouth to those derived from 4-PRPs (Ramfjörd, National Health and Nutrition Examination survey-III, modified-NHANES-IV and 42-site-Random-site selection-method). Finally, we conducted a simple sensitivity analysis of periodontitis misclassification by changing the case definition threshold for each PRP. RESULTS In comparison to full-mouth PORs, PRP PORs were biased in terms of magnitude and direction. Holding the full-mouth case definition at moderate-severe periodontitis and setting it at mild-moderate-severe for the PRPs did not consistently produce POR estimates that were either biased towards or away from the null in comparison to full-mouth estimates. CONCLUSIONS Partial-mouth protocols result in misclassification of periodontitis and may bias epidemiologic measures of association. The magnitude and direction of this bias depends on choice of PRP and case definition threshold used.
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Affiliation(s)
- Aderonke A Akinkugbe
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Veeral M Saraiya
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steven Offenbacher
- Department of Periodontology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James D Beck
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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117
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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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Toll-Like Receptor 9-Mediated Inflammation Triggers Alveolar Bone Loss in Experimental Murine Periodontitis. Infect Immun 2015; 83:2992-3002. [PMID: 25964477 DOI: 10.1128/iai.00424-15] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/06/2015] [Indexed: 12/15/2022] Open
Abstract
Chronic periodontitis is a local inflammatory disease induced by a dysbiotic microbiota and leading to destruction of the tooth-supporting structures. Microbial nucleic acids are abundantly present in the periodontium, derived through release after phagocytic uptake of microbes and/or from biofilm-associated extracellular DNA. Binding of microbial DNA to its cognate receptors, such as Toll-like receptor 9 (TLR9), can trigger inflammation. In this study, we utilized TLR9 knockout (TLR9(-/-)) mice and wild-type (WT) controls in a murine model of Porphyromonas gingivalis-induced periodontitis and report the first in vivo evidence that TLR9 signaling mediates the induction of periodontal bone loss. P. gingivalis-infected WT mice exhibited significantly increased bone loss compared to that in sham-infected WT mice or P. gingivalis-infected TLR9(-/-) mice, which were resistant to bone loss. Consistent with this, the expression levels of interleukin 6 (IL-6), tumor necrosis factor (TNF), and receptor-activator of nuclear factor kappa B ligand (RANKL) were significantly elevated in the gingival tissues of the infected WT mice but not in infected TLR9(-/-) mice compared to their levels in controls. Ex vivo studies using splenocytes and bone marrow-derived macrophages revealed significantly diminished cytokine production in TLR9(-/-) cells relative to the cytokine production in WT cells in response to P. gingivalis, thereby implicating TLR9 in inflammatory responses to this organism. Intriguingly, compared to the cytokine production in WT cells, TLR9(-/-) cells exhibited significantly decreased proinflammatory cytokine production upon challenge with lipopolysaccharide (LPS) (TLR4 agonist) or Pam3Cys (TLR2 agonist), suggesting possible cross talk between TLR9, TLR4, and TLR2. Collectively, our results provide the first proof-of-concept evidence implicating TLR9-triggered inflammation in periodontal disease pathogenesis, thereby identifying a new potential therapeutic target to control periodontal inflammation.
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CD36/SR-B2-TLR2 Dependent Pathways Enhance Porphyromonas gingivalis Mediated Atherosclerosis in the Ldlr KO Mouse Model. PLoS One 2015; 10:e0125126. [PMID: 25938460 PMCID: PMC4418723 DOI: 10.1371/journal.pone.0125126] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/25/2015] [Indexed: 12/11/2022] Open
Abstract
There is strong epidemiological association between periodontal disease and cardiovascular disease but underlying mechanisms remain ill-defined. Because the human periodontal disease pathogen, Porphyromonas gingivalis (Pg), interacts with innate immune receptors Toll-like Receptor (TLR) 2 and CD36/scavenger receptor-B2 (SR-B2), we studied how CD36/SR-B2 and TLR pathways promote Pg-mediated atherosclerosis. Western diet fed low density lipoprotein receptor knockout (Ldlr°) mice infected orally with Pg had a significant increase in lesion burden compared with uninfected controls. This increase was entirely CD36/SR-B2-dependent, as there was no significant change in lesion burden between infected and uninfected Ldlr° mice. Western diet feeding promoted enhanced CD36/SR-B2-dependent IL1β generation and foam cell formation as a result of Pg lipopolysaccharide (PgLPS) exposure. CD36/SR-B2 and TLR2 were necessary for inflammasome activation and optimal IL1ß generation, but also resulted in LPS induced lethality (pyroptosis). Modified forms of LDL inhibited Pg-mediated IL1ß generation in a CD36/SR-B2-dependent manner and prevented pyroptosis, but promoted foam cell formation. Our data show that Pg infection in the oral cavity can lead to significant TLR2-CD36/SR-B2 dependent IL1ß release. In the vessel wall, macrophages encountering systemic release of IL1ß, PgLPS and modified LDL have increased lipid uptake, foam cell formation, and release of IL1ß, but because pyroptosis is inhibited, this enables macrophage survival and promotes increased plaque development. These studies may explain increased lesion burden as a result of periodontal disease, and suggest strategies for development of therapeutics.
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120
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Holtfreter B, Albandar JM, Dietrich T, Dye BA, Eaton KA, Eke PI, Papapanou PN, Kocher T. Standards for reporting chronic periodontitis prevalence and severity in epidemiologic studies: Proposed standards from the Joint EU/USA Periodontal Epidemiology Working Group. J Clin Periodontol 2015; 42:407-12. [PMID: 25808877 PMCID: PMC7441325 DOI: 10.1111/jcpe.12392] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 01/08/2023]
Abstract
Periodontal diseases are common and their prevalence varies in different populations. However, prevalence estimates are influenced by the methodology used, including measurement techniques, case definitions, and periodontal examination protocols, as well as differences in oral health status. As a consequence, comparisons between populations are severely hampered and inferences regarding the global variation in prevalence can hardly be drawn. To overcome these limitations, the authors suggest standardized principles for the reporting of the prevalence and severity of periodontal diseases in future epidemiological studies. These principles include the comprehensive reporting of the study design, the recording protocol, and specific subject-related and oral data. Further, a range of periodontal data should be reported in the total population and within specific age groups. Periodontal data include the prevalence and extent of clinical attachment loss (CAL) and probing depth (PD) on site and tooth level according to specific thresholds, mean CAL/PD, the CDC/AAP case definition, and bleeding on probing. Consistent implementation of these standards in future studies will ensure improved reporting quality, permit meaningful comparisons of the prevalence of periodontal diseases across populations, and provide better insights into the determinants of such variation.
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Affiliation(s)
- Birte Holtfreter
- Unit of Periodontology, Department of Restorative Dentistry, Periodontology, and Endodontology, University Medicine Greifswald, Ernst Moritz Arndt University Greifswald, Greifswald, Germany
| | - J. M. Albandar
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, United States
| | - Thomas Dietrich
- Periodontal Research Group, School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Bruce A. Dye
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention (CDC), Hyattsville, MD, United States
| | - Kenneth A. Eaton
- University College London, Eastman Dental Institute, London, United Kingdom
- King’s College London Dental Institute, London, United Kingdom
- University of Kent, Centre for Professional Practice, Kent, United Kingdom
| | - Paul I. Eke
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Panos N. Papapanou
- Section of Oral and Diagnostics Sciences, Division of Periodontics, College of Dental Medicine, Columbia University, New York, NY, USA
| | - Thomas Kocher
- Unit of Periodontology, Department of Restorative Dentistry, Periodontology, and Endodontology, University Medicine Greifswald, Ernst Moritz Arndt University Greifswald, Greifswald, Germany
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121
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Eke PI, Dye BA, Wei L, Slade GD, Thornton-Evans GO, Borgnakke WS, Taylor GW, Page RC, Beck JD, Genco RJ. Update on Prevalence of Periodontitis in Adults in the United States: NHANES 2009 to 2012. J Periodontol 2015; 86:611-22. [PMID: 25688694 PMCID: PMC4460825 DOI: 10.1902/jop.2015.140520] [Citation(s) in RCA: 973] [Impact Index Per Article: 108.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This report describes prevalence, severity, and extent of periodontitis in the US adult population using combined data from the 2009 to 2010 and 2011 to 2012 cycles of the National Health and Nutrition Examination Survey (NHANES). METHODS Estimates were derived for dentate adults, aged ≥30 years, from the US civilian non-institutionalized population. Periodontitis was defined by combinations of clinical attachment loss (AL) and periodontal probing depth (PD) from six sites per tooth on all teeth, except third molars, using standard surveillance case definitions. For the first time in NHANES history, sufficient numbers of non-Hispanic Asians were sampled in 2011 to 2012 to provide reliable estimates of their periodontitis prevalence. RESULTS In 2009 to 2012, 46% of US adults, representing 64.7 million people, had periodontitis, with 8.9% having severe periodontitis. Overall, 3.8% of all periodontal sites (10.6% of all teeth) had PD ≥4 mm, and 19.3% of sites (37.4% teeth) had AL ≥3 mm. Periodontitis prevalence was positively associated with increasing age and was higher among males. Periodontitis prevalence was highest in Hispanics (63.5%) and non-Hispanic blacks (59.1%), followed by non-Hispanic Asian Americans (50.0%), and lowest in non-Hispanic whites (40.8%). Prevalence varied two-fold between the lowest and highest levels of socioeconomic status, whether defined by poverty or education. CONCLUSIONS This study confirms a high prevalence of periodontitis in US adults aged ≥30 years, with almost fifty-percent affected. The prevalence was greater in non-Hispanic Asians than non-Hispanic whites, although lower than other minorities. The distribution provides valuable information for population-based action to prevent or manage periodontitis in US adults.
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Affiliation(s)
- Paul I. Eke
- Division of Population Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Bruce A. Dye
- Division of Health and Nutrition Examination Surveys, CDC, Hyattsville, MD
| | | | - Gary D. Slade
- Department of Dental Ecology, University of North Carolina School of Dentistry, Chapel Hill, NC
| | | | - Wenche S. Borgnakke
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - George W. Taylor
- Department of Preventive and Restorative Dental Sciences, University of California School of Dentistry, San Francisco, CA
| | - Roy C. Page
- Department of Periodontics, University of Washington School of Dentistry, Seattle, WA
| | - James D. Beck
- Department of Dental Ecology, University of North Carolina School of Dentistry, Chapel Hill, NC
| | - Robert J. Genco
- Department of Oral Biology, State University of New York School of Dental Medicine, Buffalo, NY
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122
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Zong G, Scott AE, Griffiths HR, Zock PL, Dietrich T, Newson RS. Serum α-Tocopherol Has a Nonlinear Inverse Association with Periodontitis among US Adults. J Nutr 2015; 145:893-9. [PMID: 25934661 DOI: 10.3945/jn.114.203703] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/15/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous experimental models suggest that vitamin E may ameliorate periodontitis. However, epidemiologic studies show inconsistent evidence in supporting this plausible association. OBJECTIVE We investigated the association between serum α-tocopherol (αT) and γ-tocopherol (γT) and periodontitis in a large cross-sectional US population. METHODS This study included 4708 participants in the 1999-2001 NHANES. Serum tocopherols were measured by HPLC and values were adjusted by total cholesterol (TC). Periodontal status was assessed by mean clinical attachment loss (CAL) and probing pocket depth (PPD). Total periodontitis (TPD) was defined as the sum of mild, moderate, and severe periodontitis. All measurements were performed by NHANES. RESULTS Means ± SDs of serum αT:TC ratio from low to high quartiles were 4.0 ± 0.4, 4.8 ± 0.2, 5.7 ± 0.4, and 9.1 ± 2.7 μmol/mmol. In multivariate regression models, αT:TC quartiles were inversely associated with mean CAL (P-trend = 0.06), mean PPD (P-trend < 0.001), and TPD (P-trend < 0.001) overall. Adjusted mean differences (95% CIs) between the first and fourth quartile of αT:TC were 0.12 mm (0.03, 0.20; P-difference = 0.005) for mean CAL and 0.12 mm (0.06, 0.17; P-difference < 0.001) for mean PPD, whereas the corresponding OR for TPD was 1.65 (95% CI: 1.26, 2.16; P-difference = 0.001). In a dose-response analysis, a clear inverse association between αT:TC and mean CAL, mean PPD, and TPD was observed among participants with relatively low αT:TC. No differences were seen in participants with higher αT:TC ratios. Participants with γT:TC ratio in the interquartile range showed a significantly lower mean PPD than those in the highest quartile. CONCLUSIONS A nonlinear inverse association was observed between serum αT and severity of periodontitis, which was restricted to adults with normal but relatively low αT status. These findings warrant further confirmation in longitudinal or intervention studies.
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Affiliation(s)
- Geng Zong
- Unilever Research and Development, Vlaardingen, The Netherlands
| | - Ann E Scott
- Unilever Research and Development, Port Sunlight, Bebington, United Kingdom
| | - Helen R Griffiths
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom; and
| | - Peter L Zock
- Unilever Research and Development, Vlaardingen, The Netherlands
| | - Thomas Dietrich
- Department of Oral Surgery, School of Dentistry, University of Birmingham, Birmingham, United Kingdom
| | - Rachel S Newson
- Unilever Research and Development, Vlaardingen, The Netherlands;
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123
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Kuehl MN, Rodriguez H, Burkhardt BR, Alman AC. Tumor Necrosis Factor-α, Matrix-Metalloproteinases 8 and 9 Levels in the Saliva Are Associated with Increased Hemoglobin A1c in Type 1 Diabetes Subjects. PLoS One 2015; 10:e0125320. [PMID: 25915398 PMCID: PMC4411091 DOI: 10.1371/journal.pone.0125320] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/14/2015] [Indexed: 11/19/2022] Open
Abstract
Background Type 1 diabetes (T1D) is an autoimmune disease resulting in the targeted destruction of pancreatic β-cells and permanent loss of insulin production. Proper glucose management results in better clinical outcomes for T1D and provides a strong rationale to identify non-invasive biomarkers indicative or predictive of glycemic control. Therefore, we investigated the association of salivary inflammation with HbA1c in a T1D cohort. Methods Unstimulated saliva was collected from 144 subjects with T1D at the USF Diabetes Center. BMI, duration of diabetes, and HbA1c were recorded during clinical visit. Levels of interleukin (IL)-1β, -6, -8, -10, IFN-γ, TNF-α, MMP-3, -8, and -9 were measured using multiplexing immunoassay analysis. To account for smoking status, salivary cotinine levels were also determined. Results Multiple linear (HbA1c) and logistic (self-reported gingival condition) regression analyses were performed to examine the relationships between the Principal Component Analysis (PCA) components and HbA1c and gingival condition (adjusted for age, duration of diabetes, BMI, and sex; model for HbA1c also adjusted for gingival condition and model for gingival condition also adjusted for HbA1c). PCA components 1 (MMP-8 and MMP-9) and 3 (TNF-α) were significantly associated with HbA1c (β = 0.28 ±0.14, p = 0.045; β = 0.31 ±0.14, p = 0.029), while PCA component 2 (IL-6, IL-1β, and IL-8) was significantly associated with gingival condition (OR 1.60 95% CI 1.09–2.34, p = 0.016). In general, increased salivary inflammatory burden is associated with decreased glycemic control and self-reported gingival condition. Conclusions The saliva may represent a useful reservoir of novel noninvasive inflammatory biomarkers predictive of the progression and control of T1D.
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Affiliation(s)
- Melanie N. Kuehl
- Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida, Tampa, Florida, the United States of America
| | - Henry Rodriguez
- Diabetes Center, College of Medicine, University of South Florida, Tampa, Florida, the United States of America
| | - Brant R. Burkhardt
- Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida, Tampa, Florida, the United States of America
- Diabetes Center, College of Medicine, University of South Florida, Tampa, Florida, the United States of America
- * E-mail:
| | - Amy C. Alman
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, United States of America
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Terao C, Asai K, Hashimoto M, Yamazaki T, Ohmura K, Yamaguchi A, Takahashi K, Takei N, Ishii T, Kawaguchi T, Tabara Y, Takahashi M, Nakayama T, Kosugi S, Sekine A, Fujii T, Yamada R, Mimori T, Matsuda F, Bessho K. Significant association of periodontal disease with anti-citrullinated peptide antibody in a Japanese healthy population - The Nagahama study. J Autoimmun 2015; 59:85-90. [PMID: 25819755 DOI: 10.1016/j.jaut.2015.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/01/2015] [Accepted: 03/08/2015] [Indexed: 11/16/2022]
Abstract
Anti-citrullinated peptide antibody (ACPA) is a highly specific autoantibody to rheumatoid arthritis (RA). Recent studies have revealed that periodontal disease (PD) is closely associated with RA and production of ACPA in RA. Analyses of associations between PD and ACPA production in a healthy population may deepen our understandings. Here, we analyzed a total of 9554 adult healthy subjects. ACPA and IgM-rheumatoid factor (RF) was quantified and PD status was evaluated using the number of missing teeth (MT), the Community Periodontal Index (CPI) and Loss of Attachment (LA) for these subjects. PD status was analyzed for its association with the positivity and categorical levels of ACPA and RF conditioned for covariates which were shown to be associated with PD, ACPA or RF. As a result, all of MT, CPI and LA showed suggestive or significant associations with positivity (p = 0.024, 0.0042 and 0.037, respectively) and levels of ACPA (p ≤ 0.00031), but none of the PD parameters were associated with those of RF. These association patterns were also observed when we analyzed 6206 non-smokers of the participants. The significant associations between PD parameters and positivity and levels of ACPA in healthy population support the fundamental involvement of PD with ACPA production.
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Affiliation(s)
- Chikashi Terao
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan; Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan.
| | - Keita Asai
- Department of Oral and Maxillofacial Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Motomu Hashimoto
- Department of the Control for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Toru Yamazaki
- Department of Oral and Maxillofacial Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Akihiko Yamaguchi
- Department of Oral and Maxillofacial Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Katsu Takahashi
- Department of Oral and Maxillofacial Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Noriko Takei
- The Lion Foundation for Dental Health, Tokyo 130-0004, Japan
| | - Takanori Ishii
- The Lion Foundation for Dental Health, Tokyo 130-0004, Japan
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Meiko Takahashi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto 606-8501, Japan
| | - Shinji Kosugi
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto 606-8501, Japan
| | - Akihiro Sekine
- EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Takao Fujii
- Department of the Control for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Ryo Yamada
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Kazuhisa Bessho
- Department of Oral and Maxillofacial Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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125
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Reed SG, Manz MC, Snipe SM, Ohshima M, Wagner CL. Feasibility study of a salivary occult blood test to correlate with periodontal measures as indicators of periodontal inflammation in a population of pregnant women. J Oral Sci 2015; 57:55-8. [PMID: 25807909 PMCID: PMC4519090 DOI: 10.2334/josnusd.57.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The purpose of this feasibility study was to investigate the correlation of a salivary occult blood test (SOBT) with traditional periodontal measures to assess the feasibility of the SOBT as a measure of periodontal inflammation in a population of women during pregnancy. Considering the limitations of the previous SOBT studies, this study evaluated correlation of the Perioscreen Sunstar SOBT with traditional measures from a full mouth periodontal examination. Data were collected 3 times during pregnancy (12-14, 24-28, and 36 weeks) from women participating in an ongoing study of pregnancy and inflammation. Descriptive statistics and correlations were generated for SOBT scores with periodontal measures. Preliminary data were analyzed from 7 women with 3 visits, 7 with 2, and 9 with 1 visit. For these 44 visits' data, the mean percent of sites with bleeding on probing (BOP) for SOBT scores = 0, 2, and 5 was 58% ± 18%, 68% ± 14%, and 72% ± 19%, respectively. Correlations for percent of sites with BOP and continuous SOBT score was 0.301, P-value = 0.0469 and dichotomous SOBT was 0.32, P-value = 0.0339. Results for feasibility, measured as recruitment of participants, acceptance of protocols, distribution of periodontal inflammation and preliminary correlations, support SOBT as a correlated marker of periodontal inflammation in this population of pregnant women.
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Affiliation(s)
- Susan G. Reed
- Medical University of South Carolina, College of Medicine, Department of Pediatrics - Neonatology, Charleston, SC
- Medical University of South Carolina, James B. Edwards College of Dental Medicine, Department of Stomatology, Charleston, SC
| | - Michael C. Manz
- University of Michigan, School of Dentistry, Department of Cariology, Restorative Sciences, and Endodontics, Ann Arbor, MI
| | - Shannon M. Snipe
- Medical University of South Carolina, James B. Edwards College of Dental Medicine, Department of Stomatology, Charleston, SC
| | - Mitsuhiro Ohshima
- Ohu University, School of Pharmaceutical Sciences, Department of Biochemistry Fukushima, Japan
| | - Carol L. Wagner
- Medical University of South Carolina, College of Medicine, Department of Pediatrics - Neonatology, Charleston, SC
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126
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Chu Y, Ouyang X. Accuracy of Partial-Mouth Examination Protocols for Extent and Severity Estimates of Periodontitis: A Study in a Chinese Population With Chronic Periodontitis. J Periodontol 2015; 86:406-17. [DOI: 10.1902/jop.2014.140422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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127
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Taichman LS, Griggs JJ, Inglehart MR. Periodontal health, perceived oral health, and dental care utilization of breast cancer survivors. J Public Health Dent 2015; 75:148-56. [PMID: 25648337 DOI: 10.1111/jphd.12084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 12/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This population-based analysis examined the prevalence of periodontal diseases along with the self-perceived oral health and patterns of dental care utilization of breast cancer survivors in the United States. METHODS Data from the 1999-2004 National Health and Nutrition Surveys were utilized, examining information from 3,354 women between 50 and 85 years of age. Primary outcomes were gingivitis and periodontitis, self-perceived oral health, and dental care utilization. Logistic regression analyses were used to estimate relationships of breast cancer diagnosis and primary outcomes while controlling for confounding factors. RESULTS Breast cancer survivors were more likely to be older than 55 years, white, nonsmokers, have higher levels of education and income, and a higher prevalence of osteoporosis. Breast cancer survivors were significantly less likely to have dental insurance (P = 0.04). Utilization of dental services and reason for last dental visit did not significantly differ between groups. A history of a breast cancer diagnosis did not increase the odds of gingivitis [odds ratio (OR): 1.32; 95 percent confidence interval (CI): 0.53-3.63], periodontitis (OR: 1.82; 95 percent CI: 0.89-4.01), or poor self-perceived oral health (OR: 0.89; 95 percent CI: 0.61-1.33) after adjusting for age, race, education, dental care utilization, and smoking status. CONCLUSIONS In this sample, a history of breast cancer does not significantly impact periodontal health, self-perceived oral health, and dental care utilization. However, efforts should be made to assure that breast cancer survivors have dental insurance.
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Affiliation(s)
- L Susan Taichman
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Jennifer J Griggs
- Department of Internal Medicine, Hematology and Oncology Division, University of Michigan, Ann Arbor, MI, USA.,Department of Health Management Policy, School of Public Health, Ann Arbor, MI, USA
| | - Marita R Inglehart
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Psychology, College of Literature, Science and Arts (LS&A), University of Michigan, Ann Arbor, MI, USA
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128
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Yoshihara A, Sugita N, Iwasaki M, Miyazaki H, Nakamura K. The interaction between beta-3 adrenergic receptor polymorphism and obesity to periodontal disease in community-dwelling elderly Japanese. J Clin Periodontol 2015; 41:460-6. [PMID: 24460850 DOI: 10.1111/jcpe.12235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The purpose of this study was to elucidate whether the association between beta-3 adrenergic receptor polymorphism and periodontal disease is modified by body weight. MATERIAL AND METHODS We enrolled 332 postmenopausal women and determined their HbA1C levels (%) and beta-3 adrenergic receptor (rs4994) genotypes. Periodontal parameters including clinical attachment level (CAL) were measured. After selecting subjects for each body mass index (BMI) level, the prevalence rate ratio (PRR) by multiple Poisson regression analysis was calculated to evaluate the relationship between periodontal disease and beta-3 adrenergic receptor polymorphism. The number of sites with CAL≥6 mm was used as a dependent variable, and beta-3 adrenergic receptor genotype [categorized as Arg non-carriers (reference) or Arg carriers], age (y) and HbA1C (%) were adopted as independent variables. We converted the number of probing sites (n) to an offset variable. RESULTS The PRR of the beta-3 adrenergic receptor genotype for the number of sites of CAL≥6 mm showed a positive association in subjects with BMI≥25.0 and increased markedly with BMI. The PRR in subjects with BMI≥30 was 3.10 (p < 0.0001). CONCLUSION This study indicates a positive association between periodontal disease and the beta-3 adrenergic receptor genotype in obese individuals.
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Affiliation(s)
- Akihiro Yoshihara
- Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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129
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Sanders AE, Divaris K, Naorungroj S, Heiss G, Risques RA. Telomere length attrition and chronic periodontitis: an ARIC Study nested case-control study. J Clin Periodontol 2014; 42:12-20. [PMID: 25418689 DOI: 10.1111/jcpe.12337] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2014] [Indexed: 11/28/2022]
Abstract
AIM This nested case-control study sought to determine whether an accelerated rate of leukocyte telomere length (LTL) shortening over 6 years was associated with chronic periodontitis. MATERIALS AND METHODS We sampled cases (n = 178) with severe chronic periodontitis and controls (n = 178) with no/mild chronic periodontitis from the Atherosclerosis Risk in Communities study. Controls were frequency-matched to cases by study site, age, sex and race. Age ranged from 53 to 73 years. Severe chronic periodontitis was defined using the CDC-AAP case classification. LTL was measured from DNA collected at two time points, 6 years apart, with quantitative polymerase chain reaction relative to a single-copy control gene. Multiple linear regression evaluated associations between LTL measured at baseline, follow-up and change scores with severe chronic periodontitis, adjusting for potential confounders. RESULTS Cases had shorter LTL than controls at baseline (p = 0.03) and follow-up (p = 0.04) after adjusting for confounding. Overall there was a net reduction in LTL over time (p = 0.02). The rate of LTL did not differ between cases and controls (p = 0.80). CONCLUSIONS Leukocyte telomere length shortening occurred at the same rate among adults with and without severe chronic periodontitis. This suggests that LTL shortening may have occurred earlier in the life course.
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Affiliation(s)
- Anne E Sanders
- Department of Dental Ecology, School of Dentistry, University of North Carolina-Chapel Hill, NC, USA
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130
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Noble JM, Scarmeas N, Celenti RS, Elkind MSV, Wright CB, Schupf N, Papapanou PN. Serum IgG antibody levels to periodontal microbiota are associated with incident Alzheimer disease. PLoS One 2014; 9:e114959. [PMID: 25522313 PMCID: PMC4270775 DOI: 10.1371/journal.pone.0114959] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/07/2014] [Indexed: 02/07/2023] Open
Abstract
Background Periodontitis and Alzheimer disease (AD) are associated with systemic inflammation. This research studied serum IgG to periodontal microbiota as possible predictors of incident AD. Methods Using a case-cohort study design, 219 subjects (110 incident AD cases and 109 controls without incident cognitive impairment at last follow-up), matched on race-ethnicity, were drawn from the Washington Heights-Inwood Columbia Aging Project (WHICAP), a cohort of longitudinally followed northern Manhattan residents aged >65 years. Mean follow-up was five years (SD 2.6). In baseline sera, serum IgG levels were determined for bacteria known to be positively or negatively associated with periodontitis (Porphyromonas gingivalis, Tannerella forsythia, Actinobacillus actinomycetemcomitans Y4, Treponema denticola, Campylobacter rectus, Eubacterium nodatum, and Actinomyces naeslundii genospecies-2). In all analyses, we used antibody threshold levels shown to correlate with presence of moderate-severe periodontitis. Results Mean age was 72 years (SD 6.9) for controls, and 79 years (SD 4.6) for cases (p<0.001). Non-Hispanic Whites comprised 26%, non-Hispanic Blacks 27%, and Hispanics 48% of the sample. In a model adjusting for baseline age, sex, education, diabetes mellitus, hypertension, smoking, prior history of stroke, and apolipoprotein E genotype, high anti-A. naeslundii titer (>640 ng/ml, present in 10% of subjects) was associated with increased risk of AD (HR = 2.0, 95%CI: 1.1–3.8). This association was stronger after adjusting for other significant titers (HR = 3.1, 95%CI: 1.5–6.4). In this model, high anti-E. nodatum IgG (>1755 ng/ml; 19% of subjects) was associated with lower risk of AD (HR = 0.5, 95%CI: 0.2–0.9). Conclusions Serum IgG levels to common periodontal microbiota are associated with risk for developing incident AD.
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Affiliation(s)
- James M. Noble
- Taub Institute for Alzheimer Disease and the Aging Brain, Columbia University, New York, New York, United States of America
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Nikolaos Scarmeas
- Taub Institute for Alzheimer Disease and the Aging Brain, Columbia University, New York, New York, United States of America
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Department of Social Medicine, Psychiatry, and Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Romanita S. Celenti
- Division of Periodontics, Section of Oral and Diagnostic Sciences, Columbia University College of Dental Medicine, New York, New York, United States of America
| | - Mitchell S. V. Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Clinton B. Wright
- Evelyn F. McKnight Brain Institute, Departments of Neurology and Epidemiology & Public Health Sciences, and the Neuroscience Program, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Nicole Schupf
- Taub Institute for Alzheimer Disease and the Aging Brain, Columbia University, New York, New York, United States of America
| | - Panos N. Papapanou
- Division of Periodontics, Section of Oral and Diagnostic Sciences, Columbia University College of Dental Medicine, New York, New York, United States of America
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Salimi S, Ng N, Seliger SL, Parsa A. Periodontal Disease, Renal Dysfunction and Heightened Leukocytosis. ACTA ACUST UNITED AC 2014; 128:107-14. [DOI: 10.1159/000366445] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/04/2014] [Indexed: 11/19/2022]
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132
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Gil-Montoya JA, Sanchez-Lara I, Carnero-Pardo C, Fornieles F, Montes J, Vilchez R, Burgos JS, Gonzalez-Moles MA, Barrios R, Bravo M. Is periodontitis a risk factor for cognitive impairment and dementia? A case-control study. J Periodontol 2014; 86:244-53. [PMID: 25345338 DOI: 10.1902/jop.2014.140340] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Dementia is a multi-etiologic syndrome characterized by multiple cognitive deficits but not always by the presence of cognitive impairment. Cognitive impairment is associated with multiple non-modifiable risk factors but few modifiable factors. Epidemiologic studies have shown an association between periodontitis, a potentially modifiable risk factor, and cognitive impairment. The objective of this study is to determine whether clinical periodontitis is associated with the diagnosis of cognitive impairment/dementia after controlling for known risk factors, including age, sex, and education level. METHODS A case-control study was conducted in Granada, Spain, in two groups of dentate individuals aged >50 years: 1) cases with a firm diagnosis of mild cognitive impairment or dementia of any type or severity and 2) controls with no subjective memory loss complaints and a score >30 in the Phototest cognitive test (screening test for cognitive impairment). Periodontitis was evaluated by measuring tooth loss, plaque and bleeding indexes, probing depths, and clinical attachment loss (AL). RESULTS The study included 409 dentate adults, 180 with cognitive impairment and 229 without. A moderate and statistically significant association was observed between AL and cognitive impairment after controlling for age, sex, education level, oral hygiene habits, and hyperlipidemia (P = 0.049). No significant association was found between tooth loss and cognitive impairment. CONCLUSION Periodontitis appears to be associated with cognitive impairment after controlling for confounders such as age, sex, and education level.
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133
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Iwasaki M, Taylor GW, Sato M, Nakamura K, Yoshihara A, Miyazaki H. Cystatin C-based estimated glomerular filtration rate and periodontitis. Gerodontology 2014; 33:328-34. [PMID: 25294234 DOI: 10.1111/ger.12159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Accumulating evidence suggests that decreased kidney function characterised by low estimated glomerular filtration rate (eGFR) may be associated with periodontitis. Recent studies have suggested that the use of cystatin C strengthens the association between the eGFR and the risks of adverse outcomes in decreased kidney function. The aim of this cross-sectional study was to investigate the association of cystatin C-based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcreat), the commonly used method to assess kidney function, with periodontitis in 502 Japanese women (average age, 68.6 years). MATERIALS AND METHODS GFR was estimated from serum cystatin C and serum creatinine, respectively, using the Japanese equation for GFR. Participants were classified into five groups according to their eGFRcys and eGFRcreat values. Poisson regression models with robust error variance assessed the associations of eGFRcys and eGFRcreat with periodontitis. Tests for trends were performed by fitting the five-category eGFR variables in their continuous form to the regression models. RESULTS Participants with eGFRcys < 50 ml/min/1.73 m(2) were at significantly higher risk of periodontitis compared with the reference group (≥90 ml/min/1.73 m(2) ) (adjusted relative risk = 2.12, 95% confidence interval = 1.12 to 4.02). Additionally, there was a trend towards a higher risk of periodontitis among participants with lower eGFRcys values (p for trend in the multivariable model = 0.008). In contrast, eGFRcreat did not show a significant association with periodontitis. CONCLUSION The findings of this study of Japanese older women showed that eGFRcys had a stronger and more linear association with periodontitis than eGFRcreat.
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Affiliation(s)
- Masanori Iwasaki
- Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - George W Taylor
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Misuzu Sato
- Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Kazutoshi Nakamura
- Department of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Akihiro Yoshihara
- Division of Oral Science for Health Promotion, Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Hideo Miyazaki
- Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
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134
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Charalampakis G, Jansåker E, Roos-Jansåker AM. Definition and Prevalence of Peri-Implantitis. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s40496-014-0031-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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135
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Tran DT, Gay I, Du XL, Fu Y, Bebermeyer RD, Neumann AS, Streckfus C, Chan W, Walji MF. Assessment of partial-mouth periodontal examination protocols for periodontitis surveillance. J Clin Periodontol 2014; 41:846-52. [PMID: 25041094 DOI: 10.1111/jcpe.12285] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate bias associated with nine identified partial-mouth periodontal examination (PMPE) protocols in estimating periodontitis prevalence using the periodontitis case definition given by the Centers of Disease Control and Prevention and American Academy of Periodontology (CDC/AAP). MATERIAL AND METHODS Prevalence from full-mouth examination was determined in a sample of 3667 adults ≥30 years old from the National Health and Nutrition Examination Survey (NHANES) 2009-2010. Prevalence, absolute bias, relative bias, sensitivity and inflation factor were derived for these protocols according to the CDC/AAP definition and half-reduced CDC/AAP definition as ≤50% of sites were measured. RESULTS Bias in moderate and severe periodontitis prevalence ranged between 11.1-52.5% and 27.1-76.3% for full-mouth mesiobuccal-distolingual protocol and half-mouth mesiobuccal protocol respectively; according to the CDC/AAP definition. With half-reduced CDC/AAP definition, half-mouth four sites protocol provided small absolute bias (3.2%) and relative bias (9.3%) for the estimates of moderate periodontitis prevalence; corresponding biases for severe periodontitis were -1.2% and -10.2%. CONCLUSION Periodontitis prevalence can be estimated with limited bias when a half-mouth four sites protocol and a half-reduced CDC/AAP case definition are used in combination.
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Affiliation(s)
- Duong T Tran
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
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136
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Dye BA, Li X, Lewis BG, Iafolla T, Beltran-Aguilar ED, Eke PI. Overview and quality assurance for the oral health component of the National Health and Nutrition Examination Survey (NHANES), 2009-2010. J Public Health Dent 2014; 74:248-56. [PMID: 24849242 DOI: 10.1111/jphd.12056] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In 2009-2010, the oral health component for the National Health and Nutrition Examination Survey (NHANES) focused on adult periodontal health and included a full mouth periodontal examination as well as a series of questions adminis during the home interview. During this period, intraoral assessments were conducted by dental hygienists. METHODS This report provides oral health content information and results of dental examiner reliability for data collected during NHANES 2009-2010 on 7,189 persons aged 3-19 years and 30 years and older representing the US civilian, noninstitutionalized population in these age groups. RESULTS For caries and dental sealant assessments, Kappa statistics ranged from 0.71 to 1.00. Kappa scores for moderate and severe periodontitis using the Centers for Disease Control and Prevention/American Academy of Periodontology case definition guidelines was 0.70, but were lower for other periodontal status definitions. When defining moderate or severe periodontitis based on the NHANES 2003-2004 study, protocols using data from only three facial periodontal sites, the Kappa scores were 0.64 and 0.55. Interclass correlation coefficients (ICCs) for mean attachment loss were 0.80 or higher for both examiners. Site-specific mean attachment loss ICCs were generally higher for interproximal measurements compared with mid-facial and mid-lingual measurements. CONCLUSION Overall, the data reliability analyses conducted for 2009-2010 indicate an acceptable level of data quality and that examiner (dental hygienist) performance in this data collection cycle is similar to prior survey periods since the NHANES continuous survey began in 1999.
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Affiliation(s)
- Bruce A Dye
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
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Sharma P, Dietrich T, Sidhu A, Vithlani V, Rahman M, Stringer S, Jesky M, Kaur O, Ferro C, Cockwell P, Chapple ILC. The periodontal health component of the Renal Impairment In Secondary Care (RIISC) cohort study: a description of the rationale, methodology and initial baseline results. J Clin Periodontol 2014; 41:653-61. [PMID: 24738870 DOI: 10.1111/jcpe.12263] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2014] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is associated with significant morbidity and mortality. There is a need to identify novel and modifiable risk factors in such patients. The periodontal component of the Renal Impairment In Secondary Care (RIISC) study aims to evaluate the association between chronic periodontitis and CKD progression. METHODS The RIISC study is a prospective, observational cohort study of patients with CKD from a renal clinic at a hospital in the West Midlands region of the UK. Patients undergo a periodontal examination and plaque and saliva sampling. To benchmark the oral health status of the RIISC cohort, we compared it to the Adult Dental Health Survey 2009 (ADHS), a representative survey of the oral health of community dwelling adults in the UK. RESULTS Of the first 500 patients recruited into the RIISC study, 469 patients underwent a dental examination and 80 (17%) were edentulous. Among dentate subjects, patients within RIISC were significantly more likely to have any (OR 4.0 95% CI 2.7-5.9) or severe (OR 3.8 95% CI 2.5-5.6) periodontitis compared to the ADHS sample. CONCLUSION The prevalence and severity of chronic periodontitis in this cohort of CKD patients is markedly higher than a geographically matched control population.
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Affiliation(s)
- Praveen Sharma
- Periodontal Research Group, School of Dentistry, University of Birmingham, Birmingham, UK
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Abstract
The occurrence of chronic inflammatory periodontal disease due to dental plaque in adults over 30 years of age was noticed in 47.2% of the 3,742 subjects studied, representing a 64.7 million people population in the 50 states of the U.S. and the District of Columbia. The methods used by the authors were uniquely precise and the results brought us to great insight on the correlation between orthodontic treatment and periodontal health, which is described below.
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139
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Abstract
Risk factors play an important role in an individual's response to periodontal infection. Identification of these risk factors helps to target patients for prevention and treatment, with modification of risk factors critical to the control of periodontal disease. Shifts in our understanding of periodontal disease prevalence, and advances in scientific methodology and statistical analysis in the last few decades, have allowed identification of several major systemic risk factors for periodontal disease. The first change in our thinking was the understanding that periodontal disease is not universal, but that severe forms are found only in a portion of the adult population who show abnormal susceptibility. Analysis of risk factors and the ability to statistically adjust and stratify populations to eliminate the effects of confounding factors have allowed identification of independent risk factors. These independent but modifiable, risk factors for periodontal disease include lifestyle factors, such as smoking and alcohol consumption. They also include diseases and unhealthy conditions such as diabetes mellitus, obesity, metabolic syndrome, osteoporosis, and low dietary calcium and vitamin D. These risk factors are modifiable and their management is a major component of the contemporary care of many periodontal patients. Genetic factors also play a role in periodontal disease and allow one to target individuals for prevention and early detection. The role of genetic factors in aggressive periodontitis is clear. However, although genetic factors (i.e., specific genes) are strongly suspected to have an association with chronic adult periodontitis, there is as yet no clear evidence for this in the general population. It is important to pursue efforts to identify genetic factors associated with chronic periodontitis because such factors have potential in identifying patients who have a high susceptibility for development of this disease. Many of the systemic risk factors for periodontal disease, such as smoking, diabetes and obesity, and osteoporosis in postmenopausal women, are relatively common and can be expected to affect most patients with periodontal disease seen in clinics and dental practices. Hence, risk factor identification and management has become a key component of care for periodontal patients.
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140
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Jung YS, Shin MH, Kim IS, Kweon SS, Lee YH, Kim OJ, Kim YJ, Chung HJ, Kim OS. Relationship between periodontal disease and subclinical atherosclerosis: the Dong-gu study. J Clin Periodontol 2013; 41:262-8. [PMID: 24256094 DOI: 10.1111/jcpe.12204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2013] [Indexed: 12/01/2022]
Abstract
AIM We assessed the association of periodontal disease and number of missing teeth with subclinical atherosclerosis in an adult Korean population. MATERIALS AND METHODS Cross-sectional data from 5404 individuals aged ≥50 years were obtained from the 2008-2010 Dong-gu study. Periodontal examinations were conducted to determine the number of missing teeth, pocket depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP). The percentages of sites with PD ≥ 4 mm (PD 4%), CAL ≥ 4 mm (CAL 4%), and BOP (BOP%) were recorded for each participant. B-mode ultrasound was performed to determine common carotid artery intima-media thickness (CCA IMT) and the presence of carotid plaques. Multivariate linear regression models were used to assess the associations between periodontal parameters and CCA IMT and carotid plaque. RESULTS Number of missing teeth was associated with increased CCA IMT, and BOP% was associated with increased CCA IMT in females only. This association was robust in never smokers. CONCLUSIONS The number of missing teeth was associated with CCA IMT, and BOP% was associated with CCA IMT in females only. These associations were robust in never smokers. Our results suggest that tooth loss due to oral disease may play a role in subclinical carotid atherosclerosis.
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Affiliation(s)
- Young-Suk Jung
- Department of Periodontology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, South Korea
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141
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Pradhan-Palikhe P, Mäntylä P, Paju S, Buhlin K, Persson GR, Nieminen MS, Sinisalo J, Pussinen PJ. Subgingival Bacterial Burden in Relation to Clinical and Radiographic Periodontal Parameters. J Periodontol 2013; 84:1809-17. [DOI: 10.1902/jop.2013.120537] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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142
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Tran DT, Gay I, Du XL, Fu Y, Bebermeyer RD, Neumann AS, Streckfus C, Chan W, Walji MF. Assessing periodontitis in populations: a systematic review of the validity of partial-mouth examination protocols. J Clin Periodontol 2013; 40:1064-71. [PMID: 24192071 PMCID: PMC3859863 DOI: 10.1111/jcpe.12165] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/29/2013] [Accepted: 09/01/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To estimate bias associated with partial-mouth periodontal examination (PMPE) protocols regarding estimates of prevalence, severity and extent of clinical attachment loss (CAL), pocket depth (PD) and gingival recession (REC). MATERIAL AND METHODS A search was made for articles published in English, from 1946 to 2012, which compared PMPE versus full-mouth periodontal examination protocols for CAL or PD ≥ 4 mm or REC ≥3 mm thresholds. PMPE protocols were evaluated for sensitivity of estimates of periodontitis prevalence, relative biases for severity and extent estimates. RESULTS A review of the literature identified 12 studies which reported 32 PMPE protocols. Three PMPE protocols which had sensitivities ≥85% and relative biases ≤0.05 in absolute values for severity and extent estimates were as follows: (1) half-mouth six-sites, (2) diagonal quadrants six-sites and (3) full-mouth mesiobuccal-midbuccal-distobuccal (MB-B-DB). Two other PMPE protocols (full-mouth and half-mouth mesiobuccal-midbuccal-distolingual) performed well for prevalence and severity of periodontitis; however, their performance in estimates of extent was unknown. CONCLUSIONS Among the 32 PMPE protocols listed, the half-mouth six-sites and full-mouth MB-B-DB protocols had the highest sensitivities for prevalence estimates and lowest relative biases for severity and extent estimates.
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Affiliation(s)
- Duong T. Tran
- School of Dentistry, The University of Texas Health Science Center at Houston, USA
| | - Isabel Gay
- School of Dentistry, The University of Texas Health Science Center at Houston, USA
| | - Xianglin L. Du
- School of Public Health, The University of Texas Health Science Center at Houston, USA
| | - Yunxin Fu
- School of Public Health, The University of Texas Health Science Center at Houston, USA
| | | | - Ana S. Neumann
- School of Dentistry, The University of Texas Health Science Center at Houston, USA
| | - Charles Streckfus
- School of Dentistry, The University of Texas Health Science Center at Houston, USA
| | - Wenyaw Chan
- School of Public Health, The University of Texas Health Science Center at Houston, USA
| | - Muhammad F. Walji
- School of Dentistry, The University of Texas Health Science Center at Houston, USA
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, USA
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143
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Iwasaki M, Taylor GW, Nakamura K, Yoshihara A, Miyazaki H. Association Between Low Bone Mineral Density and Clinical Attachment Loss in Japanese Postmenopausal Females. J Periodontol 2013; 84:1708-16. [DOI: 10.1902/jop.2013.120613] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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144
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Vernon LT, Demko CA, Babineau DC, Wang X, Toossi Z, Weinberg A, Rodriguez B. Effect of Nadir CD4+ T cell count on clinical measures of periodontal disease in HIV+ adults before and during immune reconstitution on HAART. PLoS One 2013; 8:e76986. [PMID: 24146949 PMCID: PMC3795634 DOI: 10.1371/journal.pone.0076986] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/04/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The contribution of HIV-infection to periodontal disease (PD) is poorly understood. We proposed that immunological markers would be associated with improved clinical measures of PD. METHODS We performed a longitudinal cohort study of HIV-infected adults who had started highly active antiretroviral therapy (HAART) <2 years. PD was characterized clinically as the percent of teeth with ≥ 1 site with periodontal probing depth (PPD) ≥ 5.0mm, recession (REC) >0mm, clinical attachment level (CAL) ≥ 4.0mm, and bleeding on probing (BOP) at ≥ 4 sites/tooth and microbiologically as specific periodontopathogen concentration. Linear mixed-effects models were used to assess the associations between immune function and PD. RESULTS Forty (40) subjects with median 2.7 months on HAART and median nadir CD4+ T-cell count of 212 cells/μl completed a median 3 visits. Over 24 months, CD4+ T-cell count increased by a mean 173 cells/µl (p<0.001) and HIV RNA decreased by 0.5 log10 copies/ml (p<0.001); concurrently, PPD, CAL and BOP decreased by a mean 11.7%, 12.1%, and 14.7% respectively (all p<0.001). Lower nadir CD4+ T-cell count was associated with worse baseline REC (-6.72%; p=0.04) and CAL (9.06%; p<0.001). Further, lower nadir CD4+ T-cell count was associated with a greater relative longitudinal improvement in PPD in subjects with higher baseline levels of Porphyromonas gingivalis (p=0.027), and BOP in subjects with higher baseline levels of Porphyromonas gingivalis or Treponema denticola (p=0.001 and p=0.006 respectively). Longitudinal changes from baseline in CD4+ T-cell count and level of HIV RNA were not independently associated with longitudinal changes in any clinical markers of PD. CONCLUSION Degree of immunosuppression was associated with baseline gingival recession. After HAART initiation, measures of active PD improved most in those with lower nadir CD4+ T-cell counts and higher baseline levels of specific periodontopathogens. Nadir CD4+ T-cell count differentially influences periodontal disease both before and after HAART in HIV-infected adults.
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Affiliation(s)
- Lance T. Vernon
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Catherine A. Demko
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Denise C. Babineau
- Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Xuelei Wang
- Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Zahra Toossi
- Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Aaron Weinberg
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Benigno Rodriguez
- Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio, United States of America
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145
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Eke PI, Dye BA, Wei L, Slade GD, Thornton-Evans GO, Beck JD, Taylor GW, Borgnakke WS, Page RC, Genco RJ. Self-reported measures for surveillance of periodontitis. J Dent Res 2013; 92:1041-7. [PMID: 24065636 DOI: 10.1177/0022034513505621] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to evaluate the performance of self-reported measures in predicting periodontitis in a representative US adult population, based on 2009-2010 National Health and Nutrition Examination Survey (NHANES) data. Self-reported gum health and treatment history, loose teeth, bone loss around teeth, tooth not looking right, and use of dental floss and mouthwash were obtained during in-home interviews and validated against full-mouth clinically assessed periodontitis in 3,743 US adults 30 years and older. All self-reported measures (> 95% item response rates) were associated with periodontitis, and bivariate correlations between responses to these questions were weak, indicating low redundancy. In multivariable logistic regression modeling, the combined effects of demographic measures and responses to 5 self-reported questions in predicting periodontitis of mild or greater severity were 85% sensitive and 58% specific and produced an 'area under the receiver operator characteristic curve' (AUROCC) of 0.81. Four questions were 95% sensitive and 30% specific, with an AUROCC of 0.82 in predicting prevalence of clinical attachment loss ≥ 3 mm at one or more sites. In conclusion, self-reported measures performed well in predicting periodontitis in US adults. Where preferred clinically based surveillance is unattainable, locally adapted variations of these self-reported measures may be a promising alternative for surveillance of periodontitis.
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Affiliation(s)
- P I Eke
- Division of Population Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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146
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Periodontal disease and rheumatoid arthritis: the evidence accumulates for complex pathobiologic interactions. Curr Opin Rheumatol 2013; 25:345-53. [PMID: 23455329 DOI: 10.1097/bor.0b013e32835fb8ec] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW This review was conducted to focus on the recent clinical and translational research related to the associations between periodontal disease and rheumatoid arthritis. RECENT FINDINGS There is a growing interest in the associations between oral health and autoimmune and inflammatory diseases. A number of epidemiologic studies have described associations between rheumatoid arthritis and periodontal disease. Recent clinical studies continue to support these reports, and are increasingly linked with biological assessments to better understand the nature of these relationships. A number of recent studies have evaluated the periopathogenic roles of Porphyromonas gingivalis, the oral microbiome, and mechanisms of site-specific and substrate-specific citrullination. These are helping to further elucidate the interactions between these two inflammatory disease processes. SUMMARY Studies of clinical oral health parameters, the gingival microenvironment, autoantibodies and biomarkers, and rheumatoid arthritis disease activity measures are providing a better understanding of the potential mechanisms responsible for rheumatoid arthritis and periodontal disease associations. The cumulative results and ongoing studies have the promise to identify novel mechanisms and interventional strategies to improve patient outcomes for both conditions.
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147
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Martin JA, Grill AC, Matthews AG, Vena D, Thompson VP, Craig RG, Curro FA. Periodontal diagnosis affected by variation in terminology. J Periodontol 2013; 84:606-13. [PMID: 22702518 PMCID: PMC4392916 DOI: 10.1902/jop.2012.110743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The randomized case presentation (RCP) study is designed to assess the degree of diagnostic accuracy for described periodontal cases. This is to lay the basis for practitioner calibration in the Practitioners Engaged in Applied Research and Learning (PEARL) Network for future clinical studies. METHODS The RCP consisted of 10 case scenarios ranging from periodontal health to gingivitis and mild, moderate, and severe periodontitis. Respondents were asked to diagnose the described cases. Survey diagnoses were compared to two existing classifications of periodontal disease status. The RCP was administered via a proprietary electronic data capture system maintained by the PEARL Data Coordinating Center. Standard analytic techniques, including frequency counts and cross-tabulations, were used for categorical data with mean and standard deviation and median values reported for continuous data elements. RESULTS Demonstrable variations in periodontal assessment for health, gingivitis, and mild, moderate, and severe periodontitis were found among the 130 PEARL general practitioners who participated in the RCP survey. The highest agreement for diagnosis among dentists was for severe periodontitis (88%) and the lowest for gingivitis (55%). The highest percentage of variation was found in cases with health and gingivitis. CONCLUSIONS There was variation among PEARL practitioners in periodontal diagnosis that may affect treatment outcomes. Our findings add clinical support to recent publications suggesting a need for standardization of terminology in periodontitis diagnosis.
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Affiliation(s)
- John A. Martin
- Practitioners Engaged in Applied Research and Learning (PEARL) Network, private practice, State College, PA
- PreViser, Mt. Vernon, WA
| | - Ashley C. Grill
- Department of Dental Hygiene, New York City College of Technology, City University of New York, Brooklyn, NY
- PEARL Network, College of Dentistry, New York University, New York, NY
| | | | - Don Vena
- PEARL Network, EMMES Corporation, Rockville, MD
| | - Van P. Thompson
- Currently, PEARL Network, King’s College London Dental Institute, London, UK; previously, PEARL Network, Department of Biomaterials and Biomimetics, College of Dentistry, New York University
| | - Ronald G. Craig
- PEARL Network, Department of Basic Science and Craniofacial Biology, College of Dentistry, New York University
| | - Frederick A. Curro
- PEARL Network, Department of Oral Pathology, Medicine and Radiology, College of Dentistry, New York University
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148
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Curro FA, Thompson VP, Grill A, Vena D, Terracio L, Naftolin F. Practice based research networks impacting periodontal care: PEARL Initiative. J Periodontol 2013; 84:567-71. [PMID: 22702516 PMCID: PMC4264584 DOI: 10.1902/jop.2012.120116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 2005, the National Institute of Dental and Craniofacial Research /National Institutes of Health funded the largest initiative to date to affect change in the delivery of oral care. This commentary provides the background for the first study related to periodontics in a Practice Based Research Network (PBRN). It was conducted in the Practitioners Engaged in Applied Research & Learning (PEARL) Network. The PEARL Network is headquartered at New York University College of Dentistry. The basic tenet of the PBRN initiative is to engage clinicians to participate in clinical studies, where they will be more likely to accept the results and to incorporate the findings into their practices. This process may reduce the translational gap that exists between new findings and the time it takes for them to be incorporated into clinical practice. The cornerstone of the PBRN studies is to conduct comparative effectiveness research studies to disseminate findings to the profession and improve care. This is particularly important because the majority of dentists practice independently. Having practitioners generate clinical data allows them to contribute in the process of knowledge development and incorporate the results in their practice to assist in closing the translational gap. With the advent of electronic health systems on the horizon, dentistry may be brought into the mainstream health care paradigm and the PBRN concept can serve as the skeletal framework for advancing the profession provided there is consensus on the terminology used.
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Affiliation(s)
- Frederick A. Curro
- Practitioners Engaged in Applied Research & Learning (PEARL) Network, Department of Oral Pathology, Medicine, and Radiology, College of Dentistry, New York University, New York, NY
| | | | - Ashley Grill
- Department of Dental Hygiene, New York City College of Technology, City University of New York, Brooklyn, NY
- PEARL Network, Department of Dental Hygiene, College of Dentistry, New York University
| | - Don Vena
- PEARL Network, EMMES Corporation, Rockville, MD
| | - Louis Terracio
- PEARL Network, Department of Basic Science and Craniofacial Biology, College of Dentistry, New York University
| | - Frederick Naftolin
- PEARL Network, Department of Obstetrics and Gynecology, School of Medicine, New York University
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149
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Abstract
BACKGROUND and Overview The use of salivary diagnostics continues to develop and advance the field of risk determination for periodontal diseases. Researchers are investigating genetic, microbial and protein biomarkers with the objective of translating findings to such aspects of clinical care as broad patient screening, monitoring and treatment planning. METHODS /st> In this review, the author briefly explores currently available salivary diagnostics used to identify bacteria prevalent in periodontal disease, and focuses on the future development and use of a variety of rapid disease detection platforms, such as lab-on-a-chip, as a point-of-care device for identification of patients' risk. CONCLUSIONS and CLINICAL IMPLICATIONS /st> Several diagnostic tests are commercially available, and point-of-care tests are under development. However, challenges remain regarding the introduction of these technologies to clinical practice and adoption by dental practitioners for promotion of personalized oral health care.
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150
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Berkey DB, Scannapieco FA. Medical considerations relating to the oral health of older adults. SPECIAL CARE IN DENTISTRY 2013; 33:164-76. [PMID: 23795637 DOI: 10.1111/scd.12027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review paper was written in conjunction with the 2010 National Coalition Consensus Conference: Oral Health of Vulnerable Older Adults and Persons with Disabilities. It provides an overview of specific medical considerations involved with dental diagnosis and treatment of this "at risk population." The role of oral inflammation is referenced within the context of the oral/systemic paradigm (e.g., diabetes, cardiovascular disease/stroke, respiratory diseases, and cognition). Oral manifestations associated with multi-organ diseases, tobacco/alcohol use, and medications are additionally discussed. Finally, the paper encourages development of interdisciplinary approaches to positively influence health outcomes.
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Affiliation(s)
- Douglas B Berkey
- University of Colorado, School of Dental Medicine, Aurora, CO, 80045, USA.
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