Periodontitis in US Adults: National Health and Nutrition Examination Survey 2009-2014

Peculiarities of Free-Radical Processes and Neuropsychological Status in Patients with Chronic Generalized Periodontitis and Possibility of Correcting their Impairments with Antioxidant Therapy

This clinical study included a total of 71 patients with chronic generalized periodontitis (CGP). The chemiluminescence method was used to determine the level of generation of reactive oxygen species by leukocytes (basal and stimulated), as well as the content of malonic dialdehyde in blood plasma and antiperoxide activity of plasma. The anxiety level was measured using the Spielberger’s test. Patients with chronic generalized periodontitis in the exacerbation phase were found to have a natural significant increase in both basal and stimulated PICL, as well as an increase in blood plasma malonic dialdehyde 1.6-, 3.9- and 1.4-fold, respectively, compared with apparently healthy donors (all p<0.05), and a significant 2.1-fold decrease in plasma APA compared with healthy donors (p<0.001). In the remission phase, all parameters were normalized, however, they did not reach the norm. We revealed significant dependence of reactive oxygen species generation by leukocytes, lipid peroxidation and antiperoxide activity of plasma on the severity of the course of chronic generalized periodontitis, whereas plasma antiperoxide activity decreased. In patients with the severe course, after the treatment with AO, situational and personal anxiety increased, depression deteriorated, unlike patients with mild-to-moderate course in whom this symptomatology virtually disappeared. In patients with the severe course of periodontitis after surgical manipulations, the parameter in the Hounsfield units increased gradually, on days 14, 30 and 90 on average, 1.3, 2.4 and 3.2-fold, respectively, thus suggesting that bone tissue density increased faster after surgical methods of treatment in patients with severe chronic generalized periodontitis.

Novel zafirlukast derivatives exhibit selective antibacterial activity against Porphyromonas gingivalis

Periodontal disease is an oral chronic immune-inflammatory disease highly prevalent worldwide that is initiated by specific oral bacterial species leading to local and systemic effects. The development of new preventive/therapeutic strategies to specifically target oral periodontopathogens without perturbing oral microbiome species normally colonizing the oral cavity is needed. The fast and affordable strategy of repositioning of already FDA-approved drugs can be an answer to the development of novel treatments against periodontal pathogens such as Porphyromonas gingivalis. Herein, we report the synthesis and antibacterial activity of novel zafirlukast derivatives, their bactericidal effect, and their cytotoxicity against oral epithelial cell lines. Many of these derivatives exhibited superior antibacterial activity against P. gingivalis compared to the parent drug zafirlukast. The most promising compounds were found to be selective against P. gingivalis and they were bactericidal in their activity. Finally, we demonstrated that these potent derivatives of zafirlukast provided a better safety profile against oral epithelial cells compared to zafirlukast.

Knowledge on smoking and periodontal disease: A cross-sectional survey among targeted respondents

Background:

The impact of smoking on oral health is directly related to the toxic tobacco fumes. The study aimed to investigate the awareness of the link between smoking and periodontal disease among the population seeking periodontal treatment.

Materials and Methods:

A self-administered questionnaire constructed in local Malay language consisting of 13 questions on sociodemographic details and 10 questions on the knowledge domain was distributed to eligible respondents while they were waiting for their consultation in the periodontal clinic waiting hall. There were 330 study participants aged 16 years old and above, who participated in this study from all 12 dental clinics in the state of Perlis, Malaysia. Data were entered into Statistical Package for the Social Sciences version 20.0 for analysis. Descriptive statistics were used to describe the sociodemographic data, whereas association between potential factor and the knowledge of awareness was found using the Pearson Chi-square test of independence or a Fisher's exact test, depending on the eligibility criteria.

Results:

Our study showed that 4.5% (n = 15) of the respondents were not aware that smoking did add risk for oral cancer, 14.5% (n = 48) were not aware that smoking could cause gum disease. Smoking status was significantly associated with the awareness of smoking effect on gum disease (P = 0.002). The proportion of the active smokers being aware that smoking could potentially cause gum disease was considerably less as compared to the nonsmokers (62.7% vs. 83.3%).

Conclusions:

Continuous dental health campaigns and awareness program are crucial to instil awareness and health-seeking behavior as well as to enforce public's knowledge.

A rapid, non-invasive tool for periodontitis screening in a medical care setting

BACKGROUND

Since periodontitis is bi-directionally associated with several systemic diseases, such as diabetes mellitus and cardiovascular diseases, it is important for medical professionals in a non-dental setting to be able examine their patients for symptoms of periodontitis, and urge them to visit a dentist if necessary. However, they often lack the time, knowledge and resources to do so. We aim to develop and assess "quick and easy" screening tools for periodontitis, based on self-reported oral health (SROH), demographics and/or salivary biomarkers, intended for use by medical professionals in a non-dental setting.

METHODS

Consecutive, new patients from our outpatient clinic were recruited. A SROH questionnaire (8 questions) was conducted, followed by a 30 s oral rinse sampling protocol. A complete clinical periodontal examination provided the golden standard periodontitis classification: no/mild, moderate or severe periodontitis. Total periodontitis was defined as having either moderate or severe. Albumin and matrix metalloproteinase-8 concentrations, and chitinase and protease activities were measured in the oral rinses. Binary logistic regression analyses with backward elimination were used to create prediction models for both total and severe periodontitis. Model 1 included SROH, demographics and biomarkers. The biomarkers were omitted in the analysis for model 2, while model 3 only included the SROH questionnaire. The area under the receiver operating characteristic curves (AUROCC) provided the accuracy of each model. The regression equations were used to create scoring algorithms, composed of the remaining predictors, each with its own weight.

RESULTS

Of the 156 patients participating in this study, 67% were classified with total periodontitis and 33% had severe periodontitis. The models for total periodontitis achieved an AUROCC of 0.91 for model 1, 0.88 for model 2 and 0.81 for model 3. For severe periodontitis, this was 0.89 for model 1, 0.82 for model 2 and 0.78 for model 3. The algorithm for total periodontitis (model 2), which we consider valid for the Dutch population, was applied to create a freely accessible, web-based screening tool.

CONCLUSIONS

The prediction models for total and severe periodontitis proved to be feasible and accurate, resulting in easily applicable screening tools, intended for a non-dental setting.

Tobacco-use patterns and self-reported oral health outcomes: A cross-sectional assessment of the Population Assessment of Tobacco and Health study, 2013-2014

BACKGROUND

Few studies consider simultaneously the oral health implications of nontraditional tobacco products and tobacco-use patterns. The authors aimed to evaluate self-reported gingival disease among cigarette smokers and users of other types of tobacco products.

METHODS

The authors used survey-weighted multivariable logistic regression to assess associations between different tobacco products, use patterns (for example, dual or multiple tobacco product use or product switching); and lifetime history of gingival disease diagnosis and treatment. They used the nationally representative (US) Population Assessment of Tobacco and Health study's Wave 1 (2013-2014) adult data (N = 32,320).

RESULTS

Overall, 12.1% of participants self-reported gingival disease diagnosis, and 19.1% reported receiving treatment. Groups with the highest adjusted relative odds for diagnosis (reference, lifetime tobacco never users) were pipe users (2.7; 95% confidence interval [CI], 1.3 to 5.3), e-cigarette users (2.9; 95% CI, 1.9 to 4.5), multiple tobacco product users (2.8; 95% CI, 2.4 to 3.4), and recent (< 12 months) quitters (2.8; 95% CI, 2.0 to 3.8). Similarly, odds of treatment report were highest among pipe users (2.3; 95% CI, 1.3 to 4.1), e-cigarette users (2.3; 95% CI, 1.3 to 4.1), multiple tobacco product users (1.6; 95% CI, 1.4 to 1.9), and recent quitters (1.7; 95% CI, 1.3 to 2.2).

CONCLUSIONS

Numerous tobacco-use patterns were associated with worse periodontal health compared with tobacco never users. These findings are consistent with previous biological and epidemiologic evidence linking tobacco use to poor periodontal health.

PRACTICAL IMPLICATIONS

Dental clinicians should anticipate various tobacco-use patterns among their patients, all of which may impact oral health. Oral health care professionals should remain informed of, screen for, and address the use of all tobacco products in practice.

BET Bromodomain Inhibitors Suppress Inflammatory Activation of Gingival Fibroblasts and Epithelial Cells From Periodontitis Patients

BET bromodomain proteins are important epigenetic regulators of gene expression that bind acetylated histone tails and regulate the formation of acetylation-dependent chromatin complexes. BET inhibitors suppress inflammatory responses in multiple cell types and animal models, and protect against bone loss in experimental periodontitis in mice. Here, we analyzed the role of BET proteins in inflammatory activation of gingival fibroblasts (GFs) and gingival epithelial cells (GECs). We show that the BET inhibitors I-BET151 and JQ1 significantly reduced expression and/or production of distinct, but overlapping, profiles of cytokine-inducible mediators of inflammation and bone resorption in GFs from healthy donors (IL6, IL8, IL1B, CCL2, CCL5, COX2, and MMP3) and the GEC line TIGK (IL6, IL8, IL1B, CXCL10, MMP9) without affecting cell viability. Activation of mitogen-activated protein kinase and nuclear factor-κB pathways was unaffected by I-BET151, as was the histone acetylation status, and new protein synthesis was not required for the anti-inflammatory effects of BET inhibition. I-BET151 and JQ1 also suppressed expression of inflammatory cytokines, chemokines, and osteoclastogenic mediators in GFs and TIGKs infected with the key periodontal pathogen Porphyromonas gingivalis. Notably, P. gingivalis internalization and intracellular survival in GFs and TIGKs remained unaffected by BET inhibitors. Finally, inhibition of BET proteins significantly reduced P. gingivalis-induced inflammatory mediator expression in GECs and GFs from patients with periodontitis. Our results demonstrate that BET inhibitors may block the excessive inflammatory mediator production by resident cells of the gingival tissue and identify the BET family of epigenetic reader proteins as a potential therapeutic target in the treatment of periodontal disease.

Oral health care for patients with Alzheimer's disease: An update

Alzheimer's disease and related disorders (ADRD) are among the age-associated chronic conditions that are most challenging to health care systems around the globe, as patients with dementia require full-time, intensive care for multiple years. Oral health care is negatively impacted by cognitive decline, and consequently poor oral health is common among people with ADRD. Poor oral health status is linked with many undesirable consequences for the well-being of people with ADRD, from excruciating local pain to life-threatening conditions, as aspiration pneumonia. In this paper, the authors provide an update on the most current concepts about Alzheimer's disease epidemiology, etiology, and management, current oral health care for patients with Alzheimer's disease, oral health promotion strategies for this population, as well as current research and future direction for improving oral health care for patients with Alzheimer's disease. It concludes that oral health care should be included in the patient's routine health care as early as possible in the progression of Alzheimer's disease for preventing rapid oral health deterioration. Establishing oral hygiene routines and providing dental treatment that is customized to the patients' individual needs and disease stage are important to achieve good oral health outcomes and prevent quality of life decline.

Functionalized nanoparticles containing MKP-1 agonists reduce periodontal bone loss

BACKGROUND

Progress over of the past several years has elucidated a role for mitogen-activated protein kinase phosphatase to regulate periodontal inflammation yielding new possibilities for treatment of periodontal diseases. These studies aimed to determine if nanoparticles (NPs) loaded with a pharmacological agent that induces mitogen-activated protein kinase phosphatase have potential clinical utility for management of periodontal inflammation and alveolar bone.

METHODS

Polyethylene glycol (PEG)-polylactide (PLA) (PEG-PLA) NPs were loaded with auranofin (ARN), an antirheumatic drug, to induce mitogen-activated protein kinase phosphatase (MKP)-1 expression in vitro and in vivo. Release kinetics of ARN from NPs was performed by high performance liquid chromatography (HPLC). Fluorescent-labeled NPs were used to show uptake into macrophages by flow cytometry. Real-time quantitative polymerase chain reaction (qPCR) was used to determine dual specificity protein phosphatase (Dusp)-1 mRNA induction by Auranofin-loaded nanoparticles (ARN-NPs) and viability of ARN-NPs was determined by colorimetric in vitro assays. Functional in vitro assays were used to measure functional MKP-1 induction and preclinical models using Aggregatibacter actinomycetemcomitans lipopolysaccharide-induced alveolar bone loss and microcomputed tomography was used to determine in vivo efficacy of functionalized ARN-NPs.

RESULTS

Data indicated that ARN-NPs had reduced cytotoxicity compared with free ARN and Dusp1 mRNA and MKP-1 activity was significantly increased by ARN-NPs in vitro. Flow cytometry indicated rapid uptake into macrophages. Finally, significant bone loss reduction was observed with ARN-NPs compared with control NPs in vivo using an lipopolysaccharide-induced rat model of periodontitis.

CONCLUSION

Results from these studies suggest that developing NPs functionalized with ARN have anti-inflammatory activities and may be a novel adjuvant therapeutic strategy to significantly improve periodontitis therapy and outcomes.

A provider-observed tool to assess Oral Hygiene Skill Mastery (OHSIM) in human immunodeficiency virus-positive (HIV+) adults

AIMS

Periodontal diseases (PDs) affect nearly half of Americans ≥30 years old and are common in human immunodeficiency virus-positive (HIV+) adults. A validated measure of oral hygiene skill could improve tailored prevention-focused health communication.

METHODS

We developed Oral Hygiene Skill Mastery (OHSIM), a provider-observed measure of toothbrushing and flossing ability. We examined OHSIM's inter-rater reliability (IRR) and concurrent validity using a blinded, cross-sectional study design with a convenience sample of HIV+/- adults. Clinical outcome measures included bleeding on probing (BOP) and abbreviated plaque and gingival indices. Analyses included IRR and, after identifying relevant predictor variables for each outcome, backward elimination regression and structural equation modeling (SEM) were used to demonstrate concurrent validity.

RESULTS

We saw 173 research participants (reliability: n = 61; validity: n = 112). The average IRR was α = 0.73 for toothbrushing and α = 0.84 for flossing. Toothbrushing and flossing skill were moderately correlated (r = 0.49, P < 0.001). SEM analyses demonstrated that OHSIM toothbrushing significantly and independently predicted variance in plaque and gingival indices and BOP, while OHSIM flossing skill significantly and independently predicted plaque index and BOP.

CONCLUSION

OHSIM is a provisionally reliable and valid provider-observed measure of toothbrushing and flossing skill. Most predictors of clinical outcomes were modifiable behaviors. Toothbrushing quality is a critical component of oral health.

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.

Neutrophil Interaction with Emerging Oral Pathogens: A Novel View of the Disease Paradigm

Periodontitis is a multifactorial chronic inflammatory infectious disease that compromises the integrity of tooth-supporting tissues. The disease progression depends on the disruption of host-microbe homeostasis in the periodontal tissue. This disruption is marked by a shift in the composition of the polymicrobial oral community from a symbiotic to a dysbiotic, more complex community that is capable of evading killing while promoting inflammation. Neutrophils are the main phagocytic cell in the periodontal pocket, and the outcome of the interaction with the oral microbiota is an important determinant of oral health. Novel culture-independent techniques have facilitated the identification of new bacterial species at periodontal lesions and induced a reappraisal of the microbial etiology of periodontitis. In this chapter, we discuss how neutrophils interact with two emerging oral pathogens, Filifactor alocis and Peptoanaerobacter stomatis, and the different strategies deploy by these organisms to modulate neutrophil effector functions, with the goal to outline a new paradigm in our knowledge about neutrophil responses to putative periodontal pathogens and their contribution to disease progression.

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.