Periodontitis prevalence in adults ≥ 65 years of age, in the USA

In the Dental Implant Era, Why Do We Still Bother Saving Teeth?

Teeth are vital sensory organs that contribute to our daily activities of living. Unfortunately, teeth can be lost for several reasons including trauma, caries, and periodontal disease. Although dental trauma injuries and caries are more frequently encountered in a younger population, tooth loss because of periodontal disease occurs in the older population. In the dental implant era, the trend sometimes seems to be to extract compromised teeth and replace them with dental implants. However, the long-term prognosis of teeth might not be comparable with the prognosis of dental implants. Complications, failures, and diseases such as peri-implantitis are not uncommon, and, despite popular belief, implants are not 99% successful. Other treatment options that aim to save compromised or diseased teeth such as endodontic treatment, periodontal treatment, intentional replantation, and autotransplantation should be considered on an individual basis. These treatments have competing success rates to dental implants but, more importantly, retain the natural tooth in the dentition for a longer period of time. These options are important to discuss in detail during treatment planning with patients in order to clarify any misconceptions about teeth and dental implants. In the event a tooth does have to be extracted, procedures such as decoronation and orthodontic extrusion might be useful to preserve hard and soft tissues for future dental implant placement. Regardless of the treatment modality, it is critical that strict maintenance and follow-up protocols are implemented and that treatment planning is ethically responsible and evidence based.

Prevalence of Periodontitis and its Association with Reduced Pulmonary Function: Results from the Korean National Health and Nutrition Examination Survey

Background and Objectives: The current study was performed to evaluate the prevalence of periodontitis and to examine the association between reduced pulmonary function and periodontitis using Sixth Korea National Health and Nutrition Examination Survey (KNHANES) in 2014. Materials and Methods: A cross-sectional evaluation was conducted to estimate the prevalence of periodontitis and to examine the association between periodontitis and reduced pulmonary function while adjusting for sociodemographic characteristics and current smoking status in survey participants between 40 and 79 years old. The presence of periodontitis was evaluated by community periodontal index defined by the World Health Organization, and the assessments of reduced pulmonary function data were made as "normal," "restrictive impairment," or "obstructive impairment." Results: A total of 4004 survey participants representing 25.4 million Koreans were included in the study. Overall, 41.1% of the study population were determined to have periodontitis, and 22.1% had reduced pulmonary function; 7.9% and 14.2% had restrictive- and obstructive- pulmonary impairments, respectively. Age, male gender, and current smoking status were positive predictors for periodontitis. Insurance coverage by workplace and higher education were protective factors against periodontitis. The association between periodontitis and restrictive impairment (adjusted odds ratio (OR) = 1.059, 95% CI 0.729-1.540) or obstructive impairment (adjusted OR = 1.140, 95% CI 0.849-1.530) was not significant. Conclusions: For Koreans, 40-79 years old, age, smoking status, gender, education, and insurance coverage were significant predictors of periodontitis. The prevalence of periodontitis was not significantly associated with reduced pulmonary function. To better understand the relationship between periodontitis and reduced pulmonary function, well-designed and larger scale epidemiologic studies are needed.

Longitudinal evaluation of periodontitis and tooth loss among older adults

AIM

To evaluate pattern of change in periodontal variables and tooth loss in a twelve-year follow-up study of older adults living in Sweden.

METHODS

In a prospective population study of older adults, a clinical examination and radiographic dental examination were performed at baseline (2001-2003) and after 12 years (2013-2015). In 375 individuals, the number and proportion of sites with a distance ≥4 mm and ≥5 mm from cemento-enamel junction to the bone level, the number and proportion of teeth with pockets ≥5 mm and number of teeth lost were calculated. Dental caries was registered. Periodontitis was defined as having ≥2 sites with ≥5 mm distance from cemento-enamel junction to the marginal bone level and ≥1 tooth with pockets ≥5 mm.

RESULTS

A diagnosis of periodontitis was evident in 39% of the individuals, and 23% of the individuals lost ≥3 teeth over the study period. The proportion of sites with ≥4 mm and ≥5 mm bone loss increased with age, while the proportion of teeth with pockets remained stable. Periodontitis was the strongest predictor for losing ≥3 teeth, OR 2.9 (p < .001) in the final model.

CONCLUSIONS

Periodontitis is a risk factor for future tooth loss among older adults.

Oral microbial biofilms: an update

Human oral cavity (mouth) hosts a complex microbiome consisting of bacteria, archaea, protozoa, fungi and viruses. These bacteria are responsible for two common diseases of the human mouth including periodontal (gum) and dental caries (tooth decay). Dental caries is caused by plaques, which are a community of microorganisms in biofilm format. Genetic and peripheral factors lead to variations in the oral microbiome. It has known that, in commensalism and coexistence between microorganisms and the host, homeostasis in the oral microbiome is preserved. Nonetheless, under some conditions, a parasitic relationship dominates the existing situation and the rise of cariogenic microorganisms results in dental caries. Utilizing advanced molecular biology techniques, new cariogenic microorganisms species have been discovered. The oral microbiome of each person is quite distinct. Consequently, commonly taken measures for disease prevention cannot be exactly the same for other individuals. The chance for developing tooth decay in individuals is dependent on factors such as immune system and oral microbiome which itself is affected by the environmental and genetic determinants. Early detection of dental caries, assessment of risk factors and designing personalized measure let dentists control the disease and obtain desired results. It is necessary for a dentist to consider dental caries as a result of a biological process to be targeted than treating the consequences of decay cavities. In this research, we critically review the literature and discuss the role of microbial biofilms in dental caries.

Finding a Toll on the Route: The Fate of Osteoclast Progenitors After Toll-Like Receptor Activation

M-CSF and RANKL are two crucial cytokines stimulating differentiation of mature, bone resorbing, multinucleated osteoclasts from mononucleated progenitor cells in the monocyte/macrophage lineage. In addition to the receptors for M-CSF and RANKL, osteoclast progenitor cells express receptors for several other pro- and anti-osteoclastogenic cytokines, which also regulate osteoclast formation by affecting signaling downstream M-CSF and RANKL receptors. Similar to many other cells originating from myeloid hematopoetic stem cells, also osteoclast progenitors express toll-like receptors (TLRs). Nine murine TLRs are expressed in the progenitors and all, with the exception of TLR2 and TLR4, are downregulated during osteoclastogenesis. Activation of TLR2, TLR4, and TLR9, but not TLR5, in osteoclast progenitors stimulated with M-CSF and RANKL arrests differentiation along the osteoclastic lineage and keeps the cells at a macrophage stage. When the progenitors are primed with M-CSF/RANKL and then stimulated with agonists for TLR2, TLR4, or TLR9 in the presence of M-CSF, but in the absence of RANKL, the cells differentiate to mature, bone resorbing osteoclasts. TLR 2, 4, 5, and 9 are also expressed on osteoblasts and their activation increases osteoclast differentiation by an indirect mechanism through stimulation of RANKL. In mice, treatment with agonists for TLR2, 4, and 5 results in osteoclast formation and extensive bone loss. It remains to be shown the relative importance of inhibitory and stimulatory effects by TLRs on osteoclast progenitors and the role of RANKL produced by TLR stimulated osteoblasts, for the bone resorbing effects in vivo.

Risk indicators of aggressive periodontitis in a Jordanian population

BACKGROUND

Knowledge of the risk indicators of aggressive periodontitis (AgP) will help clinicians to better diagnose the disease, put a treatment plan that involves modification of modifiable risk indicators, understand non-modifiable risk indicators, and may potentially serve as an aid in developing preventive programs. The objective of the present study was to assess risk indicators of aggressive periodontitis (AgP) in Jordan including socio-demographic factors, oral hygiene habits, smoking, family history and parents' consanguinity.

METHODS

A total of 162 patients (81 AgP and 81 controls), attending the Periodontology clinic at Jordan University of Science and Technology, Dental Teaching Centre, were interviewed and examined. All AgP subjects had full periodontal and radiographic examination. The data recorded included socio-demographic and economic variables, oral hygiene and smoking habits, family history and parents' consanguinity.

RESULTS

Most AgP patients were young females, had ≤12 years of education, lived in urban areas and brushed their teeth ≥ once daily. Risk indicators of AgP included: age > 35 years, female gender and positive family history.

CONCLUSIONS

Risk indicators associated with AgP in this study population were: age > 35 years, female gender and positive family history of periodontal disease.

A nationwide survey of confidence and knowledge of assessment and management oral conditions amongst a sample of physicians, United Kingdom

Objective

This study aimed to assess current confidence and knowledge of oral conditions amongst a sample of UK physicians and doctors in training programmes using a web-based survey.

Results

131 survey responses were analysed for doctors from FY1 to consultant grade working within medical specialties. 36.6% and 35.9% of those surveyed expressed that they felt confident diagnosing and managing oral conditions respectively. The median knowledge score was 60%; 65.6% correctly identified the image that demonstrated a squamous cell carcinoma. 91.6% reported that they felt they needed additional training in the diagnosis and management of oral conditions. Neither confidence nor knowledge were affected by grade, specialty, or region of practice.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4359-0) contains supplementary material, which is available to authorized users.

Self-reported oral health and quality of life in patients with type 2 diabetes mellitus in primary care: a multi-center cross-sectional study

Background: Guidelines for primary diabetes care recommend to pay attention to oral health in patients with diabetes mellitus type 2 (T2DM). However, research about dental care utilization and the extent of problems regarding oral health in these patients is limited. Purpose: To assess self-reported oral health, general health-related quality of life (QoL) and oral health-related QoL in patients with T2DM who regularly attend a family physician office. Methods: Family physician offices were recruited in the area of Amsterdam, the Netherlands, as part of a cluster-randomized controlled trial. At these offices, patients with T2DM were included by family physicians and/or nurse practitioners. Patient data on general characteristics, self-reported oral health (including periodontitis), general health-related QoL (SF-36) and oral health-related QoL (OHIP-NL14) were collected. Results: Twenty-four family physician offices participated, who enrolled 764 patients with T2DM (mean age: 65.9±10.7 years, 56% male, 16% smoker). Almost 11% of the patients were metabolically poorly controlled (HbA1c >63 mmol/mol), 39% were obese (body mass index≥30 kg/m2), 37% had hypertension (systolic blood pressure ≥140 mmHg) and 44% had dyslipidemia (LDL-cholesterol >2.5 mmol/L). About a quarter (24%) reported not to visit a dentist regularly and 30% did not have dental insurance coverage. Furthermore, 16% of the patients were edentulous and having full dental prostheses, while 29% had a partial dental prosthesis. Pain in the mouth, dry mouth and bad breath were reported by 15%, 37% and 12% of the patients, respectively. Almost 70% suffered from periodontitis. Oral health-related QoL was impaired in 19% of the patients, and those subjects also had worse general health-related QoL. Conclusion: Almost a quarter of patients with T2DM at Dutch family physician offices does not visit the dentist regularly. The estimated prevalence of periodontitis is particularly high, but other oral health complaints and impaired oral health-related QoL are also relatively common.

Atraumatic vs conventional restorative treatment for root caries lesions in older patients: Meta- and trial sequential analysis

OBJECTIVES

We aimed to appraise the comparative clinical efficacy of atraumatic restorative treatment (ART) versus conventional restorative treatment (CT) using a meta-analysis, and assessed the robustness of evidence by trial sequential analysis (TSA).

BACKGROUND

Due to its simplified clinical approach, ART may be advantageous over CT for restoration of root caries lesions in institutionalised older patients.

METHODS

Three electronic databases (PubMed, Embase and Cochrane CENTRAL) were screened, and hand searches and cross-referencing performed to identify randomised controlled trials reporting on survival of ART vs CT for restoration of root caries in older patients. Trial selection, data extraction and risk of bias assessment were performed by two independent reviewers. ART and CT were compared using fixed- or random-effects pairwise meta-analysis for per-protocol (PP), intention-to-treat (ITT) and best-case scenarios. TSA was used to control for risk of random errors.

RESULTS

A total of 235 studies were identified, and three trials involving 130 patients (463 restorations) were included. Risk of bias was high or moderate in all but one trial. ART was associated with a significantly increased risk of failure (OR [95% CI] 2.06 [1.06/4.00]) in PP- but not in ITT analysis (1.36 [0.92/2.02]). Analyses for best-case scenarios found great uncertainty introduced by attrition. No firm evidence was reached according to TSA.

CONCLUSIONS

For restoration of root caries, there is insufficient data to clearly rule out whether differences between ART and CT exist. Limited available data indicate there might be an increased risk of failure for ART.

Characterization of periodontitis in people with type 1 diabetes of 50 years or longer duration

BACKGROUND

Periodontitis is more common and severe in people with diabetes than the general population. We have reported in the Joslin Medalist Study that people with type 1 diabetes of ≥50 years (Medalists) may have endogenous protective factors against diabetic nephropathy and retinopathy.

METHODS

In this cross-sectional study, the prevalence of periodontitis according to the Centers for Disease Control/American Academy of Periodontology classification in a subset (n = 170, mean age = 64.6 ± 6.9 years) of the Medalist cohort, and its associations to various criteria of periodontitis and diabetic complications were assessed.

RESULTS

The prevalence of severe periodontitis in Medalists was only 13.5% which was lower than reported levels in diabetic patients of similar ages. Periodontal parameters, including bleeding on probing, plaque index, gingival index, and demographic traits, including male sex, chronological age, and age at diagnosis were significantly associated with severity of periodontitis, which did not associate with diabetes duration, hemoglobin A1c (HbA1c), body mass index, and lipid profiles. Random serum C-peptide levels inversely associated with severity of periodontitis (P = 0.03), lower probing depth (P = 0.0002), and clinical attachment loss (P = 0.03). Prevalence of cardiovascular diseases (CVD) and systemic inflammatory markers, plasma interleukin-6 (IL-6), and serum immunoglobulin G titer against Porphyromonas gingivalis positively associated with severity of periodontitis (P = 0.002 and 0.02, respectively). Antibody titer to P. gingivalis correlated positively and significantly with CVD, serum IL-6, and high-sensitivity C-reactive protein.

CONCLUSIONS

Some Medalists could be protected from severe periodontitis even with hyperglycemia. Endogenous protective factors for periodontitis could possibly be related to residual insulin production and lower levels of chronic inflammation.

MAEA rs6815464 polymorphism and periodontitis in postmenopausal Japanese females: A cross-sectional study

OBJECTIVES

Macrophage erythroblast attacher (MAEA) is a membrane protein that regulates the development of mature macrophages by mediating attachment with erythroblasts. A polymorphism rs6815464 (C/G) in MAEA gene was reported to be associated with type II diabetes. Along with diabetes, osteoporosis shows an increased prevalence in postmenopausal females, and both diseases have been reported to be associated with periodontitis. Therefore, we explored the relevance of the MAEA polymorphism to periodontitis, bone mineral density (BMD) and haemoglobin A1c (HbA1c).

DESIGN

This was a cross-sectional study with the final sample comprised of 344 postmenopausal Japanese females. Probing pocket depth (PPD) and clinical attachment level (CAL) were measured. Genotype was determined by TaqMan assay. Blood biochemical parameters and BMD of the lumbar spine were evaluated.

RESULTS

No differences were found in age, body mass index, HbA1c, BMD, number of teeth, bone metabolism parameters between the genotypes. Mean CAL and percentage of sites with PPD or CAL ≥ 5 mm were higher in the G-allele carriers than in the non-carriers. Multiple logistic regression analyses revealed that G-allele carriage was associated with severe periodontitis (odds ratio = 3.73, 95% CI = 1.36-10.19).

CONCLUSION

Our results suggested that the MAEA gene polymorphism was independently associated with severe periodontitis.

The psychometric properties of a new oral health illness perception measure for adults aged 62 years and older

BACKGROUND

Based on the Common-Sense Model of Self-Regulation (CSM), a new integrated Illness Perception Questionnaire Revised for Dental Use in Older/Elder Adults (IPQ-RDE) was developed for single and multiple dental conditions. This study describes psychometric properties of the IPQ-RDE for adults 62 years and older.

METHODS

Participants (n = 198) living in 16 subsidized housing facilities completed the IPQ-RDE and a questionnaire assessing their socio-demographics, frequency of dental visits, perceived condition of teeth/gums, depression, social support, and oral health quality of life (OHQOL). Participants received dental screening for presence/absence of teeth, coronal and root caries, and periodontitis. The 43-item IPQ-RDE was tested for internal (construct, discriminant) and external validity (concurrent, construct, discriminant, predictive) and reliability (internal consistency).

RESULTS

Confirmatory factor analysis demonstrated that a ten-factor model in accordance with the CSM framework (identity, consequences, control, timeline, illness coherence, treatment burden, prioritization, causal relationship, activity restriction, emotional representations) had good construct validity based on significant factor loadings and acceptable model fit (RMSEA = 0.065, CFI = 0.902). Edentulous participants had significantly higher mean factor scores (inaccurate perception) for overall IPQ-RDE and four constructs indicating concurrent validity. Discriminant validity was suggested by non-relationship with external measures (education, dental visit frequency). Predictive validity was indicated by the negative correlation of most constructs with OHQOL suggesting that inaccurate perception was related to lower quality of life. Internal consistency of eight IPQ-RDE constructs was excellent (Cronbach's alpha > 0.73).

CONCLUSIONS

The IPQ-RDE is a valid and reliable new measure for assessing older adult's perception of dental conditions. It can be an important tool for oral health behavioral research to restructure older adult's perception of dental conditions, and subsequently prevent tooth loss and improve oral health quality of life.

Barriers and facilitators for provision of oral health care in dependent older people: a systematic review

OBJECTIVES

Provision of oral health care (OHC), including oral hygiene (OH) or oral/dental treatment, to dependent older people (DOP) is frequently insufficient. We aimed to assess barriers and facilitators perceived by different healthcare professionals towards providing OHC to DOP.

MATERIALS AND METHODS

A systematic review was performed. Studies reporting on knowledge, attitudes, and beliefs acting as barriers and facilitators for provision of OHC were included. One database (PubMed) was searched and data extraction independently performed by two reviewers. Thematic analysis was used and identified themes translated to the domains and constructs of the theoretical domains framework (TDF) and aligned with the domains of the behavior change wheel (BCW). Analyses were stratified for the two target behaviors (providing oral hygiene and providing oral/dental treatment) and according to different stakeholders' perspective. For quantitative analysis, frequency effect sizes (FES) were calculated.

RESULTS

In total, 1621 articles were identified and 41 (32 quantitative, 7 qualitative, 2 mixed method) studies included. Within these 41 studies, there were 7333 participants (4367 formal caregivers, 67 informal caregivers, 1100 managers of care, 1322 dentists, 340 DOP). Main barriers for providing OH were "lack of knowledge" (FES 65%, COM-B domain: capability, TDF domain: knowledge) and "patients refusing care" (62%, opportunity, environmental context and resources). Main facilitators were "OHC training/education" (41%, capability, skills) and "presence of a dental professional" (21%, opportunity, environmental context and resources). Main barriers for provision of dental treatment were "lack of suitable facilities for treatment/transportation of patients" (76%) and "patients refusing care" (53%) (both: opportunity, environmental context and resources). Main facilitators were "regular visiting dentist" (35%) and "routine assessment/increased awareness by staff" (35%) (both: opportunity, environmental context and resources).

CONCLUSIONS

A number of barriers and facilitators for providing different aspects of OHC were identified for different stakeholders.

CLINICAL RELEVANCE

Our findings help provide the evidence to develop implementation strategies for providing high-quality systematic OHC to DOP.

REGISTRATION

This review was registered at Prospero (CRD42017056078).

Assessing Information Congruence of Documented Cardiovascular Disease between Electronic Dental and Medical Records

Dentists are more often treating patients with Cardiovascular Diseases (CVD) in their clinics; therefore, dentists may need to alter treatment plans in the presence of CVD. However, it's unclear to what extent patient-reported CVD information is accurately captured in Electronic Dental Records (EDRs). In this pilot study, we aimed to measure the reliability of patient-reported CVD conditions in EDRs. We assessed information congruence by comparing patients' self-reported dental histories to their original diagnosis assigned by their medical providers in the Electronic Medical Record (EMR). To enable this comparison, we encoded patients CVD information from the free-text data of EDRs into a structured format using natural language processing (NLP). Overall, our NLP approach achieved promising performance extracting patients' CVD-related information. We observed disagreement between self-reported EDR data and physician-diagnosed EMR data.

1,25-dihydroxyvitamin-D3 promotes neutrophil apoptosis in periodontitis with type 2 diabetes mellitus patients via the p38/MAPK pathway

BACKGROUND

Abnormal neutrophils are involved in many chronic endocrine diseases, including type 2 diabetes mellitus (T2DM), and in periodontitis (PD), which is a chronic inflammatory disease in which neutrophils play a vital role. The p38 mitogen-activated protein kinase (MAPK) signaling pathway participates in the apoptosis of many inflammatory cells. Additionally, 1,25-dihydroxyvitamin-D3 (1,25VitD3) as a regulator can induce responses to infection and tumor cell apoptosis. However, the effect of 1,25VitD3 in the pathogenic relationship between T2DM and PD remains unclear. The aim of this study was to assess the effect of 1,25VitD3 on neutrophil apoptosis in patients with T2DM and PD and the p38-MAPK-relevant signaling pathway mechanism in this process in vitro.

METHODS

Neutrophils were stained with Wright's stain, and apoptosis was detected by flow cytometry and Annexin V-fluorescein isothiocyanate (FITC)/propidium iodide (PI) staining. Apoptosis- and p38-related mRNAs and proteins were examined by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR), Western blotting and ELISA. The internal relationships were analyzed using a linear regression equation and Pearson's correlation coefficient.

RESULTS

The highest rate of neutrophil apoptosis occurred in cultures treated with 10 mol/L 1,25VitD3 in the T2DM-PD group. The apoptosis rate in the T2DM-PD-p38 inhibitor group was higher than that in the healthy control group. Western blot, ELISA and qRT-PCR results showed that the mRNA and protein expression profiles of Caspase-3 and Bax were highly up-regulated and that Bcl-2 was down-regulated in the T2DM-PD-p38 inhibitor group. The expression levels of apoptotic mRNAs and proteins in the T2DM and T2DM-PD groups were significantly higher than those in the T2DM-p38 and T2DM-PD-p38 inhibitor groups. 1,25VitD3-induced neutrophil apoptosis and phosphorylated p38 (p-p38) expression were partially inhibited by the p38 inhibitor. Expression levels of apoptosis-related genes and p-p38 in neutrophils were positively associated with increasing concentrations of 1,25VitD3. p-p38 protein expression was positively associated with the level of serum 1,25VitD3.

CONCLUSION

1,25VitD3 could promote peripheral blood neutrophil apoptosis in patients with T2DM and PD through activation of the p38-MAPK signaling pathway in vitro.

Geospatial distribution of periodontists and US adults with severe periodontitis

BACKGROUND

In this study, the authors report on the geospatial distributions of periodontists and adults with severe periodontitis in the United States.

METHODS

The authors used geospatial analysis to describe the distribution of periodontists and adults, periodontists vis-à-vis estimated density of adults with severe periodontitis, and their ratios to adults with severe periodontitis. The authors identified locations of 5,415 practicing periodontists through the 2014 National Provider Identifier Registry, linked them with the weighted census number of adults, and estimated the number of adults within a series of circular distance zones.

RESULTS

Approximately 60% of adults 30 through 79 years lived within 5 miles of a periodontist, 73% within 10 miles, 85% within 20 miles, and 97% within 50 miles. Proximity to a periodontist varied widely. In urban areas, 95% of adults resided within 10 miles of a periodontist and 100% within 20 miles. Only 24% of adults in rural areas lived within 10 miles of a periodontist. Most periodontists (96.1%) practiced in urban areas, clustering along the eastern and western coasts and in the Midwest, 3.1% in urban clusters elsewhere, and 0.8% in rural areas. Ratios of fewer than 8,000 adults with periodontitis to 1 or more periodontists within 10 miles were clustered mostly in the Northeast, central East Coast, Florida, West Coast, Arizona, and Midwest.

CONCLUSIONS

In this study, the authors identified wide variations in geographic proximity to a practicing periodontist for adults with severe periodontitis.

PRACTICAL IMPLICATIONS

Dental practitioners may provide preventive care and counseling for periodontitis and referrals for specialty care. Geographic proximity to specialized periodontal care may vary widely by locality.

Periodontal disease in adults with diabetes, prevalence and risk factors. Results of an observational study

AIM

We sought (a) to assess the association between periodontal disease and diabetes, controlling for socio-demographic characteristics, comorbidities, oral health status and lifestyle variables; (b) to identify which of these variables are independently associated with periodontal disease among diabetes sufferers.

METHODS

We conducted a case-control study using data from the National/European Health Interview Surveys, conducted from 2003 to 2014 in Spain. We included 65 295 subjects ≥40 years. Diabetes status was self-reported. One non-diabetic control was matched by the year-of-survey, age and sex for each diabetic patient. The presence of periodontal disease was defined using the answer "my teeth bleed spontaneously or while brushing" or/and "my teeth move" to the following question: "Do you suffer of any of these dental and oral disorders or disease?". Independent variables included demographic, socio-economic and healthcare related variables, oral health status and comorbidities.

RESULTS

The prevalence of periodontal disease was higher among those suffering from diabetes than their non-diabetes controls (23.8% vs 19.5%; P < 0.001). Adjusted OR of periodontal disease for subjects with diabetes was 1.22 (95% CI; 1.03-1.45). Among diabetes sufferers, missing teeth status (OR 2.08, 95% CI; 1.70-2.53), suffering osteoporosis (OR 1.41, 95% CI; 1.07-1.63) and suffering depression (OR 1.39, 95% CI; 1.12-1.71) were positively associated with higher risk of periodontal disease. Older ages, using private insurance and university education level were associated with lower rates of periodontitis.

CONCLUSIONS

Diabetes subjects have an increased likelihood of periodontal disease. Dentists and physicians should increase their awareness with their diabetic patients, especially those with lower educational level, with missing teeth, osteoporosis and depression.

Meta-analysis of the association between serum and gingival crevicular fluid matrix metalloproteinase-9 and periodontitis

BACKGROUND

The authors of this meta-analysis evaluated whether there is a difference in the levels of serum and gingival crevicular fluid (GCF) matrix metalloproteinase (MMP)-9 between patients with periodontitis and periodontally healthy control participants.

TYPES OF STUDIES REVIEWED

The authors searched PubMed, Embase, the Cochrane Library, and the China Biology Medicine disk databases for eligible studies in which the investigators reported the relationships between MMP-9 levels in serum and GCF and periodontitis. The authors pooled the standardized mean differences (SMDs) and 95% confidence intervals (CIs) from each study to evaluate the difference in the serum and GCF MMP-9 levels between patients with periodontitis and periodontally healthy control participants.

RESULTS

Results of a meta-analysis of 6 case-control studies including a total of 923 healthy control participants and 557 patients with periodontitis indicated that serum MMP-9 levels were significantly higher in patients with periodontitis than in periodontally healthy control participants (SMD, 1.60; 95% CI, 0.17 to 3.03; P < .05). Results of a separate meta-analysis of 6 case-control studies including a total of 153 healthy control participants and 189 patients with periodontitis indicated that GCF MMP-9 levels were significantly higher in patients with periodontitis than in periodontally healthy control participants (SMD, 1.96; 95% CI, 0.76 to 3.16; P < .01).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The results of the meta-analysis revealed statistically significant differences in the MMP-9 levels in serum and GCF between patients with periodontitis and periodontally healthy control participants. These results cannot be used to confirm causality because the included studies were all case-control studies in which the investigators reported associations. Moreover, readers should view the results with caution because of the considerable heterogeneity among the studies included in the meta-analysis.

Is COPD associated with periodontal disease? A population-based study in Spain

Background

Periodontal disease is more prevalent and more severe among men and women suffering from chronic obstructive pulmonary disease (COPD) compared with healthy adults. The objectives of this paper were to assess the association between periodontal disease and COPD, controlling the effect of sociodemographic characteristics, oral health status, lifestyle variables, and comorbidities. Second, we identified which of the variables analyzed were independently associated with periodontal disease among COPD sufferers.

Methods

This descriptive study was done with data from the National/European Health Interview Surveys, conducted in years 2006, 2011/12, and 2014 in Spain. We included subjects ≥40 years of age. COPD status was self-reported. One non-COPD patient was matched by age, gender, and the year of survey for each COPD case. The presence of periodontal disease was defined using the answers "my teeth bleed spontaneously or while brushing" or/and "my teeth move" to the question: "Do you suffer of any of these dental and oral disorders or diseases?" Independent variables included demographic, socioeconomic, and health care-related variables, oral health status, and presence of comorbidities.

Results

The prevalence of periodontal disease was higher among COPD patients than their matched non-COPD controls (26.5% vs 22.2%; P<0.001). Adjusted odds ratio (AOR) of periodontal disease for subjects with COPD was 1.21 (95% CI: 1.12-1.30). Suffering mental disorders (AOR: 1.61; 95% CI: 1.32-1.97) was positively associated with higher risk of periodontal disease. Older age, having a private dental health insurance, and university education were variables associated with lower rates of periodontal disease.

Conclusion

Prevalence of periodontal disease was higher among those with COPD compared to non-COPD controls. Dentists and physicians should increase their awareness with their COPD patients, especially those who are younger, with lower education, and suffer depression and/or anxiety.

Microbiological changes of the ageing oral cavity

OBJECTIVE

Ageing is a physiological process that affects virtually all systems of the human body. Age-associated changes in the oral cavity reflect changes in the composition of its microbial inhabitants, which can be compatible with health or form dysbiotic communities that favor the establishment of disease. This paper focuses on discussing such age-driven changes of the oral microbiome, as well as their association with common oral infectious diseases, including dental caries, periodontitis, peri-implantitis and oral candidiasis.

DESIGN

This is a comprehensive narrative review of the literature.

RESULTS

The oropharyngeal microbiome of elderly individuals may foster a number of microorganisms such as enterobacteria, pseudomonads, staphylococci and yeasts that can become opportunistic pathogens in elderly individuals with weakened immunity or deteriorated general health. No considerable microbiological variations are noted with regards to common oral diseases, such as dental caries and periodontitis, between younger and elderly populations, whereas an increase in the prevalence of oral actinomycetes is noted by ageing.

CONCLUSIONS

Whether naturally occurring or driven by underlying disease, the ecology of oral cavity is dynamically modified over time, eliciting changes in the composition of the resident oral microbiome.

Chronic oral application of a periodontal pathogen results in brain inflammation, neurodegeneration and amyloid beta production in wild type mice

Background

The results from cross sectional and longitudinal studies show that periodontitis is closely associated with cognitive impairment (CI) and Alzhemer’s Disease (AD). Further, studies using animal model of periodontitis and human post-mortem brain tissues from subjects with AD strongly suggest that a gram-negative periodontal pathogen, Porphyromonas gingivalis (Pg) and/or its product gingipain is/are translocated to the brain. However, neuropathology resulting from Pg oral application is not known. In this work, we tested the hypothesis that repeated exposure of wild type C57BL/6 mice to orally administered Pg results in neuroinflammation, neurodegeneration, microgliosis, astrogliosis and formation of intra- and extracellular amyloid plaque and neurofibrillary tangles (NFTs) which are pathognomonic signs of AD.

Methods

Experimental chronic periodontitis was induced in ten wild type 8-week old C57BL/6 WT mice by repeated oral application (MWF/week) of Pg/gingipain for 22 weeks (experimental group). Another 10 wild type 8-week old C57BL/6 mice received vehicle alone (control group) MWF per week for 22 weeks. Brain tissues were collected and the presence of Pg/gingipain was determined by immunofluorescence (IF) microscopy, confocal microscopy, and quantitative PCR (qPCR). The hippocampi were examined for the signs of neuropathology related to AD: TNFα, IL1β, and IL6 expression (neuroinflammation), NeuN and Fluoro Jade C staining (neurodegeneration) and amyloid beta_1-42 (Aβ₄₂) production and phosphorylation of tau protein at Ser396 were assessed by IF and confocal microscopy. Further, gene expression of amyloid precursor protein (APP), beta-site APP cleaving enzyme 1 (BACE1), a disintegrin and metalloproteinase domain-containing protein10 (ADAM10) for α-secretase and presenilin1 (PSEN1) for ɣ-secretase, and NeuN (rbFox3) were determined by RT-qPCR. Microgliosis and astrogliosis were also determined by IF microscopy.

Results

Pg/gingipain was detected in the hippocampi of mice in the experimental group by immunohistochemistry, confocal microscopy, and qPCR confirming the translocation of orally applied Pg to the brain. Pg/gingipain was localized intra-nuclearly and peri-nuclearly in microglia (Iba1+), astrocytes (GFAP+), neurons (NeuN+) and was evident extracellularly. Significantly greater levels of expression of IL6, TNFα and IL1β were evident in experimental as compared to control group (p<0.01, p<0.00001, p<0.00001 respectively). In addition, microgliosis and astrogliosis were evident in the experimental but not in control group (p <0.01, p<0.0001 respectively). Neurodegeneration was evident in the experimental group based on a fewer number of intact neuronal cells assessed by NeuN positivity and rbFOX3 gene expression, and there was a greater number of degenerating neurons in the hippocampi of experimental mice assessed by Fluoro Jade C positivity. APP and BACE1 gene expression were increased in experimental group compared with control group (p<0.05, p<0.001 respectively). PSEN1 gene expression was higher in experimental than control group but the difference was not statistically significant (p = 0.07). ADAM10 gene expression was significantly decreased in experimental group compared with control group (p<0.01). Extracellular Aβ₄₂ was detected in the parenchyma in the experimental but not in the control group (p< 0.00001). Finally, phospho-Tau (Ser396) protein was detected and NFTs were evident in experimental but not in the control group (p<0.00001).

Conclusions

This study is the first to show neurodegeneration and the formation of extracellular Aβ₄₂ in young adult WT mice after repeated oral application of Pg. The neuropathological features observed in this study strongly suggest that low grade chronic periodontal pathogen infection can result in the development of neuropathology that is consistent with that of AD.

Evaluation of Clinical Parameters in Implant Maintenance Phase for Prevention of Peri-implantitis

Aims and Objectives

Peri-implant mucositis and peri-implantitis are one of the common biological complications affecting implant success. The present study aimed to evaluate various clinical parameters during implant maintenance phase.

Materials and Methods

The study included patients undergoing implant maintenance phase for 1-year follow-up. The study consists of a total of forty individuals with age ranging from 35 to 65 years. They were further categorized into two subgroups on the basis of their history, i.e., Group 1: patients with no history of periodontitis before implant placement and Group 2: patients with a history of periodontitis before implant placement. Among the selected patients, a total of 98 implants were studied. All were individually evaluated for clinical parameters such as gingival index, pocket probing depth (PPD), and bleeding on probing (BOP). All the data obtained were tabulated and analyzed using statistical software SPSS version 18.0 for Windows (SPSS Inc., Chicago, USA). Quantitative analysis was done using t-test and Mann-Whitney U-test.

Results

The mean age of the patients in Group 1 and Group 2 was 58.6 and 62.8 years, respectively, with not much gender difference. The mean plaque index for Group 1 was 0.17 ± 0.20, while for Group 2, it was 0.24 ± 0.14. The mean PPD and mean BOP for Group 1 came to be 2.60 ± 0.42 and 0.42 ± 0.15, respectively, whereas for Group 2, it was 4.08 ± 0.30 and 0.39 ± 0.48, respectively. Only PPD was found to be statistically significantly different between both the groups. Group 1 showed 2.0% peri-implantitis, whereas Group 2 showed 28% peri-implantitis.

Conclusion

Due to increased prevalence of peri-implantitis cases with the increase in usage of implants, it becomes imperative to look up to the etiological factors and contributing factors so that the incidence of these can be minimized.

Periodontal status among elderly inhabitants of northern Manhattan: The WHICAP ancillary study of oral health

AIM

We conducted a cross-sectional study of the prevalence, extent and severity of periodontitis in a tri-ethnic cohort of ≥65 year-old participants of the Washington-Heights Inwood Community Aging Project (WHICAP).

METHODS

1,130 individuals (57% of eligible invitees) participated in a full-mouth periodontal examination that included assessments of bleeding on probing, pocket depth and clinical attachment loss (CAL) at six sites/tooth.

RESULTS

Participants had a mean age of 75.4 years (SD 6.7), were predominantly female (66.6%) and Hispanic (44.7%), and of middle/low educational attainment (~82%). The prevalence of edentulism was 14.7%, and an average of 17.1 teeth (SD 8.0) was present among the dentate. The prevalence of moderate/severe periodontitis according to the CDC/AAP definition was 77.5%. Pockets ≥6 mm were found in 50.2% of the sample, affecting an average of 5.7% of teeth/person. Corresponding figures for CAL≥5 mm were 71.4% and 23.6%, respectively. In multivariable models, male gender, being Black or Hispanic, and no dental visit within the prior year were associated with higher proportion of teeth with CAL ≥5 mm.

CONCLUSIONS

The prevalence, extent and severity of periodontitis were higher than the US national average in this urban elderly sample, suggesting substantial unmet periodontal treatment needs.

Periodontal disease among older people and its impact on oral health-related quality of life

OBJECTIVE

The aim of the study was to evaluate the associations between degree of periodontal disease and number of teeth on oral health-related quality of life among older individuals.

MATERIAL AND METHODS

Randomly selected 804 participants aged ≥70 derived from two cohorts were included in the analysis. Dental examinations and evaluation of OHRQL using the OHIP-14 (Oral Health Impact Profile-14) were performed. After categorisation of the participants according to the extent of periodontitis in three groups (none, localised with <30% of teeth affected, generalised with ≥30% of teeth affected) and the number of teeth, associations between periodontal status and the number of teeth and the OHIP-14 scores were analysed. Multivariable regression analyses were used taking into account level of periodontitis, number of teeth, age and sex.

RESULTS

Among 70-year-old men and women, generalised periodontitis showed an association with poor OHRQL. However, a multivariable analysis failed to demonstrate this association (OR = 1.02, 95% CI: 0.72-1.44). In participants with 1-10 remaining teeth, the OHIP-14 score was significantly increased indicating poor OHRQL, compared with participants with ≥21 remaining teeth (OR = 1.57, 95% CI: 1.13-2.19). Similar findings were observed among women aged 70-92 years.

CONCLUSIONS

Periodontitis did not show an association with poor OHRQL, however, a significant association between the number of teeth and poor OHRQL was found.

Perceived oral health and its association with symptoms of psychological distress, oral status and socio-demographic characteristics among elderly in Norway

Background

There is poor knowledge about the extent to which psychological distress influences oral health in older people in Norway. The aim of this study was two-fold: i) to describe the oral health of Norwegian elderly and their levels of psychological distress; and ii) to examine the relationship of psychological distress with self-rated oral health, while controlling for oral status and socio-demographic characteristics, in Norwegian elderly.

Methods

Data were retrieved from a national cross-sectional survey conducted by Statistics Norway in 2012 and included information about self-rated oral health, psychological distress (measured using the Hopkins Symptom Checklist 25; HSCL-25), gender, age, civil status, smoking, self-reported number of teeth present and dental attendance for 949 non-institutionalised adults aged 65 years or older. Logistic regression was used to establish whether psychological distress predicts self-rated oral health, controlling for socio-demographic characteristics and oral status.

Results

Around 27% of the elderly reported having poor oral health, and 8 % had a HSCL-25 mean score ≥ 1.75, which indicates higher levels of psychological distress. Among the symptoms listed in the HSCL-25, the most frequently reported problems were lack of energy (1.7 ± 0.8) and difficulties falling and staying asleep (1.6 ± 0.7). The likelihood of reporting poor oral health was independently associated with having a mean HSCL-25 score ≥ 1.75 (OR = 1.89; 95% CI = 1.14–3.15), even when smoking (OR = 1.83; 95% CI = 1.17, 2.87) and having fewer than 20 teeth (OR = 3.49; 95% CI = 2.56, 4.76) were taken into account.

Conclusion

Most of the Norwegian elderly in our sample perceived themselves to have good oral health and reported relatively low levels of psychological distress. Higher levels of psychological distress can influence the oral health of the elderly independently of other factors such as smoking and having reduced number of teeth. Dental care professionals should consider screening their elderly patients for psychological distress and individualise the information about dental care for this specific population.

Periodontitis: facts, fallacies and the future

This volume of Periodontology 2000 represents the 25th anniversary of the Journal, and uses the occasion to assess important advancements in periodontology over the past quarter-century as well as the hurdles that remain. Periodontitis is defined by pathologic loss of the periodontal ligament and alveolar bone. The disease involves complex dynamic interactions among active herpesviruses, specific bacterial pathogens and destructive immune responses. Periodontal diagnostics is currently based on clinical rather than etiologic criteria, and provides limited therapeutic guidance. Periodontal causative treatment consists of scaling, antiseptic rinses and occasionally systemic antibiotics, and surgical intervention has been de-emphasized, except perhaps for the most advanced types of periodontitis. Plastic surgical therapy includes soft-tissue grafting to cover exposed root surfaces and bone grafting to provide support for implants. Dental implants are used to replace severely diseased or missing teeth, but implant overuse is of concern. The utility of laser treatment for periodontitis remains unresolved. Host modulation and risk-factor modification therapies may benefit select patient groups. Patient self-care is a critical part of periodontal health care, and twice-weekly oral rinsing with 0.10-0.25% sodium hypochlorite constitutes a valuable adjunct to conventional anti-plaque and anti-gingivitis treatments. A link between periodontal herpesviruses and systemic diseases is a strong biological plausibility. In summary, research during the past 25 years has significantly changed our concepts of periodontitis pathobiology and has produced more-effective and less-costly therapeutic options.

Genetic exchange and reassignment in Porphyromonas gingivalis

Porphyromonas gingivalis is considered a keystone pathogen in adult periodontitis but has also been associated with systemic diseases. It has a myriad of virulence factors that differ between strains. Genetic exchange and intracellular genome rearrangements may be responsible for the variability in the virulence of P. gingivalis. The present review discusses how the exchange of alleles can convert this bacterium from commensalistic to pathogenic and potentially shapes the host-microbe environment from homeostasis to dysbiosis. It is likely that genotypes of P. gingivalis with increased pathogenic adaptations may spread in the human population with features acquired from a common pool of alleles. The exact molecular mechanisms that trigger this exchange are so far unknown but they may be elicited by environmental pressure.

Geriatric periodontology: how the need to care for the aging population can influence the future of the dental profession

The world's population is aging, and it has been estimated that by 2050, the number of people 65 years of age and older will reach 1.5 billion. The aging population will be affected by noncommunicable chronic diseases, including diabetes mellitus, cardiovascular disease and cognitive impairment. This important demographic shift includes a reduction in tooth loss/edentulism, particularly in older adults of the developed countries in North America, western Europe and north-east Asia. Therefore, in the future, dental providers will be required to care for an expanded number of older adults who have retained teeth and are medically complex. As the linkage of oral disease and systemic disease has focused on the relationship of periodontitis and noncommunicable chronic diseases, a broad review of 'geriatric periodontology' is both timely and important. This volume of Periodontology 2000 covers a range of subjects under this heading. Included are the demographics of an aging world; the effect of aging on stem cell function in the periodontium; the periodontal microbiota associated with aging; the host response in the periodontium of aging individuals; an analysis of the prevalence of periodontitis in the USA on a national, state-wide and community basis; differentiation of physiologic oral aging from disease; treatment of periodontal disease in older adults; implant therapy for older patients; oral disease and the frailty syndrome; the relationship of tooth loss to longevity and life expectancy; and the relationship of periodontal disease to noncommunicable chronic diseases. Although 'geriatric dentistry' is not a recognized specialty in dentistry, and 'geriatric periodontology' is a descriptive title, the subject of this volume of Periodontology 2000 is critical to the future of clinical dentistry, dental public health and dental research. Any comprehensive focus on older patients can only be accomplished with an emphasis on interprofessional education and practice. If embraced, this shift will allow the dental profession to be more closely aligned with the larger health-care environment, and can improve both oral health and health outcomes for patients seen in the dental office.

A Teaching Tool for Establishing Risk of Oral Health Deterioration in Elderly Patients: Development, Implementation, and Evaluation at a U.S. Dental School

The aim of this study was to develop and evaluate a learning strategy using critical thinking to teach dental students how to assess the risk of rapid oral health deterioration (ROHD) among elderly patients. A learning guide was developed using risk factors identified in the literature and the steps that expert faculty members apply in their clinical decision making, summarized in a set of ten steps. A new system of labeling risk was developed for the elderly population, which correlates the level of risk with the amount of disease. Participants in the study were all 91 fourth-year dental students in two subsequent classes who took part in a five-week Geriatrics and Special Needs Clinic rotation in the spring of 2015 and 2016. The students were introduced to the ROHD concept and asked to use the guide in a presentation during their rotation. The students were graded on an A, G, or M scale (Applied concept, Grasped and applied concept, or Missed application of concept). Students were also asked to assess their learning experience, and their answers were thematically grouped and analyzed. For eight of the ten steps, at least 93% of the students were graded A or G. The exceptions were the steps about developing a communications plan, which was missed by 23.1%, and self-assessment, which was missed by 30.8%. Interexaminer agreement on students' applying (A + G grades) versus missing the step was moderate or high on six of ten items. Nearly all the students (98.7%) considered assessing the risk of ROHD an important or very important skill. In this study, a learning strategy to teach dental students how to assess the risk of ROHD among elderly patients was developed and successfully implemented.

Identification of a discriminative metabolomic fingerprint of potential clinical relevance in saliva of patients with periodontitis using 1H nuclear magnetic resonance (NMR) spectroscopy

Periodontitis is characterized by the loss of the supporting tissues of the teeth in an inflammatory-infectious context. The diagnosis relies on clinical and X-ray examination. Unfortunately, clinical signs of tissue destruction occur late in the disease progression. Therefore, it is mandatory to identify reliable biomarkers to facilitate a better and earlier management of this disease. To this end, saliva represents a promising fluid for identification of biomarkers as metabolomic fingerprints. The present study used high-resolution ¹H-nuclear magnetic resonance (NMR) spectroscopy coupled with multivariate statistical analysis to identify the metabolic signature of active periodontitis. The metabolome of stimulated saliva of 26 patients with generalized periodontitis (18 chronic and 8 aggressive) was compared to that of 25 healthy controls. Principal Components Analysis (PCA), performed with clinical variables, indicated that the patient population was homogeneous, demonstrating a strong correlation between the clinical and the radiological variables used to assess the loss of periodontal tissues and criteria of active disease. Orthogonal Projection to Latent Structure (OPLS) analysis showed that patients with periodontitis can be discriminated from controls on the basis of metabolite concentrations in saliva with satisfactory explained variance (R2X = 0.81 and R2Y = 0.61) and predictability (Q2Y = 0.49, CV-AUROC = 0.94). Interestingly, this discrimination was irrespective of the type of generalized periodontitis, i.e. chronic or aggressive. Among the main discriminating metabolites were short chain fatty acids as butyrate, observed in higher concentrations, and lactate, γ-amino-butyrate, methanol, and threonine observed in lower concentrations in periodontitis. The association of lactate, GABA, and butyrate to generate an aggregated variable reached the best positive predictive value for diagnosis of periodontitis. In conclusion, this pilot study showed that 1H-NMR spectroscopy analysis of saliva could differentiate patients with periodontitis from controls. Therefore, this simple, robust, non-invasive method, may offer a significant help for early diagnosis and follow-up of periodontitis.

Association of NOD2 Mutations with Aggressive Periodontitis

Aggressive periodontitis (AgP) is characterized by rapid alveolar bone destruction and tooth loss early in life, and its etiology remains unclear. To explore the genetic risk factors of AgP, we performed genome-wide single-nucleotide polymorphism genotyping for identity-by-descent mapping and identified 32 distinct candidate loci, followed by whole exome sequencing with 2 pedigrees of AgP consisting of 3 cases and 1 control in 1 family and 2 sibling cases in the other. After variant filtering procedures and validation by targeted Sanger sequencing, we identified 2 missense mutations at 16q12 in NOD2 (p.Ala110Thr and p.Arg311Trp), which encodes nucleotide-binding oligomerization domain protein 2. We further examined 94 genetically unrelated AgP patients by targeted sequencing of NOD2 and found that 2 patients among them also carried the p.Arg311Trp variant. Furthermore, we found 3 additional missense mutations in this gene (p.His370Tyr, p.Arg459Cys, and p.Ala868Thr). These mutations either had not been previously observed or are extremely rare (frequency <0.001) in Asian populations. NOD2 plays a crucial role in innate immunity as an intracellular receptor initiating nuclear factor κB-dependent and mitogen-activated protein kinase-dependent gene transcription. These results demonstrated NOD2 as a novel gene involved in AgP.

Is there an association between IFN-γ +874A/T polymorphism and periodontitis susceptibility?: A meta-analysis

BACKGROUND

Interferon-γ (IFN-γ) is a key proinflammatory cytokine which plays a critical role in the pathogenesis and progression of periodontitis. The single nucleotide polymorphism of +874A/T in human IFN-γ gene can influence the secretion of IFN-γ and affect periodontitis susceptibility. However, the findings of published studies are inconsistent. Therefore, the goal of this meta-analysis is to investigate whether there is an association between IFN-γ +874A/T polymorphism and periodontitis susceptibility.

METHODS

PubMed and the Cochrane Library were searched for eligible clinical studies. The odds ratio (OR) and 95% confidence interval (CI) of each study were pooled to estimate the strength of association between +874A/T and periodontitis. Subgroup analyses were performed to explore whether particular characteristics of studies were related to the overall results.

RESULTS

Seven studies and a total of 1252 periodontitis patients and 1622 periodontitis-free control subjects were included. No difference was observed in genotype distribution and allele frequency between periodontitis patients and control (T vs A: OR  =  1.01, 95% CI: 0.90-1.13, P  =  .878; TT vs AA: OR  =  1.07, 95% CI: 0.87-1.32, P  =  .537; AT vs AA: OR  =  1.00, 95% CI: 0.81-1.23, P  =  .996; TT+AT vs AA: OR  =  1.00, 95% CI: 0.84-1.19, P  =  .990; TT vs AA+AT: OR  =  1.03, 95% CI: 0.86-1.23, P  =  .733). Besides, the subgroup analysis based on ethnicity, type of periodontitis, and smoking status failed to identify significant differences in each model, either.

CONCLUSIONS

The results of this meta-analysis suggest that IFN-γ +874 A/T polymorphism may not contribute to periodontitis susceptibility. High quality and well-designed studies which combine genetic and other environmental risk factors are needed to validate this conclusion in the future.

Association between Myocardial Infarction and Periodontitis: A Meta-Analysis of Case-Control Studies

Background and Objective: Many clinical researches have been carried out to investigate the relationship between myocardial infarction (MI) and periodontitis. Despite most of them indicated that the periodontitis may be associated with an increased risk of MI, the findings and study types of these studies have been inconsistent. The goal of this meta-analysis was to critically assess the strength of the association between MI and periodontitis in case-control studies.

Methods: PubMed and the Cochrane Library were searched for eligible case-control studies reporting relevant parameters that compared periodontal status between MI and control subjects. The odds ratios (ORs) and 95% confidence intervals (CIs) from each study were pooled to estimate the strength of the association between MI and periodontitis. The mean differences and 95% CIs for periodontal-related parameters were calculated to determine their overall effects.

Results: Seventeen studies including a total of 3456 MI patients and 3875 non-MI control subjects were included. The pooled OR for the association between MI and periodontitis was 2.531 (95% CI: 1.927–3.324). The mean differences (95% CIs) for clinical attachment loss, probing depth, bleeding on probing, plaque index, and the number of missing teeth were 1.000 (0.726–1.247), 1.209 (0.538–1.880), 0.342 (0.129–0.555), 0.383 (0.205–0.560), and 4.122 (2.012–6.232), respectively.

Conclusion: With the current evidence, the results support the presence of a significant association between MI and periodontitis. Moreover, MI patients had worse periodontal and oral hygiene status and fewer teeth than did control subjects. More high-quality and well-designed studies focusing on the casual relationship between MI and periodontitis should be conducted in the future.