1
|
Laforgia A, Inchingolo AD, Piras F, Colonna V, Giorgio RV, Carone C, Rapone B, Malcangi G, Inchingolo AM, Inchingolo F, Palermo A, Dipalma G. Therapeutic Strategies and Genetic Implications for Periodontal Disease Management: A Systematic Review. Int J Mol Sci 2024; 25:7217. [PMID: 39000324 PMCID: PMC11242487 DOI: 10.3390/ijms25137217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 06/23/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024] Open
Abstract
The objective of this review is to identify the microbiological alterations caused by various therapy modalities by critically analyzing the current findings. We limited our search to English-language papers published between 1 January 2004 and 7 May 2024 in PubMed, Scopus, and Web of Science that were relevant to our topic. In the search approach, the Boolean keywords "microbio*" AND "periodontitis" were used. A total of 5152 papers were obtained from the databases Web of Science (2205), PubMed (1793), and Scopus (1154). This resulted in 3266 articles after eliminating duplicates (1886), and 1411 entries were eliminated after their titles and abstracts were examined. The qualitative analysis of the 22 final articles is included in this study. Research on periodontal disease shows that periodontitis alters the oral microbiome and increases antibiotic resistance. Treatments like scaling and root planing (SRP), especially when combined with minocycline, improve clinical outcomes by reducing harmful bacteria. Comprehensive mechanical debridement with antibiotics, probiotics, EMD with bone grafts, and other adjunctive therapies enhances periodontal health. Personalized treatment strategies and advanced microbial analyses are crucial for effective periodontal management and antibiotic resistance control.
Collapse
Affiliation(s)
- Alessandra Laforgia
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | | | - Fabio Piras
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Valeria Colonna
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Roberto Vito Giorgio
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Claudio Carone
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Biagio Rapone
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | | | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Andrea Palermo
- College of Medicine and Dentistry, CoMD Birmingham Campus, Birmingham B4 6BN, UK
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| |
Collapse
|
2
|
Hu J, Ou-Yang ZY, Zhao YQ, Zhao J, Tan L, Liu Q, Wang MY, Ye Q, Feng Y, Zhong MM, Chen NX, Su XL, Zhang Q, Feng YZ, Guo Y. Evaluation of the Efficacy of Stem Cells Therapy in the Periodontal Regeneration: A Meta-Analysis and Mendelian Randomization Study. Stem Cell Rev Rep 2024; 20:980-995. [PMID: 38388709 DOI: 10.1007/s12015-024-10690-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
Stem cell therapy for periodontal defects has shown good promise in preclinical studies. The purpose of this study was to evaluate the impact of stem cell support on the regeneration of both soft and hard tissues in periodontal treatment. PubMed, Cochrane Library, Embase, and Web of Science were searched and patients with periodontal defects who received stem cell therapy were included in this study. The quality of the included articles was assessed using Cochrane's tool for evaluating bias, and heterogeneity was analyzed using the I2 method. An Mendelian randomization investigation was conducted using abstract data from the IEU public databases obtained through GWAS. Nine articles were included for the meta-analysis. Stem cell therapy effectively rebuilds periodontal tissues in patients with periodontal defects, as evidenced by a reduction in probing depth, clinical attachment level and bone defect depth . And delta-like homolog 1 is a protective factor against periodontal defects alternative indicator of tooth loosening. The findings of this research endorse the utilization of stem cell treatment for repairing periodontal defects in individuals suffering from periodontitis. It is recommended that additional extensive clinical investigations be carried out to validate the efficacy of stem cell therapy and encourage its widespread adoption.
Collapse
Affiliation(s)
- Jing Hu
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ze-Yue Ou-Yang
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ya-Qiong Zhao
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Zhao
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li Tan
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiong Liu
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Min-Yuan Wang
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qin Ye
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yao Feng
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Meng-Mei Zhong
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ning-Xin Chen
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiao-Lin Su
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qian Zhang
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yun-Zhi Feng
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Yue Guo
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| |
Collapse
|
3
|
Caloian CS, Ciurea A, Negucioiu M, Roman A, Micu IC, Picoș A, Soancă A. Systemic Impact of Subgingival Infection Control in Periodontitis Patients with Cardiovascular Disease: A Narrative Review. Antibiotics (Basel) 2024; 13:359. [PMID: 38667035 PMCID: PMC11047730 DOI: 10.3390/antibiotics13040359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
INTRODUCTION Periodontitis, an infectious inflammatory condition, is a key contributor to sustained systemic inflammation, intricately linked to atherosclerotic cardiovascular disease (CVD), the leading cause of death in developed nations. Treating periodontitis with subgingival mechanical instrumentation with or without adjunctive antimicrobials reduces the microbial burden and local inflammation, while also potentially bringing systemic benefits for patients with both periodontitis and CVD. This review examines systemic effects of subgingival instrumentation with or without antimicrobial products in individuals with periodontitis and CVD, and explores intricate pathogenetic interactions between periodontitis and CVD. MATERIAL AND METHODS English-language databases (PubMed MEDLINE and Cochrane Library) were searched for studies assessing the effects of nonsurgical periodontal therapies in periodontitis patients with or without CVD. RESULTS While the ability of periodontal therapy to reduce mortality- and morbidity-related outcomes in CVD patients with periodontitis remains uncertain, some studies indicate a decrease in inflammatory markers and blood cell counts. Subgingival mechanical instrumentation delivered over multiple short sessions carries lower risks of adverse effects, particularly systemic inflammation, compared to the full-mouth delivery, making it a preferable option for CVD patients. CONCLUSIONS Subgingival mechanical instrumentation, ideally conducted in a quadrant-based therapeutic approach, to decontaminate periodontal pockets has the potential to reduce both local and systemic inflammation with minimal adverse effects in patients suffering from periodontitis and concurrent CVD.
Collapse
Affiliation(s)
- Carmen Silvia Caloian
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș St., No. 15, 400012 Cluj-Napoca, Romania; (C.S.C.); (A.C.); (I.C.M.); (A.S.)
| | - Andreea Ciurea
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș St., No. 15, 400012 Cluj-Napoca, Romania; (C.S.C.); (A.C.); (I.C.M.); (A.S.)
| | - Marius Negucioiu
- Department of Prosthodontics, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor St., No. 32, 400006 Cluj-Napoca, Romania;
| | - Alexandra Roman
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș St., No. 15, 400012 Cluj-Napoca, Romania; (C.S.C.); (A.C.); (I.C.M.); (A.S.)
| | - Iulia Cristina Micu
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș St., No. 15, 400012 Cluj-Napoca, Romania; (C.S.C.); (A.C.); (I.C.M.); (A.S.)
| | - Andrei Picoș
- Department of Prevention in Dental Medicine, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Avram Iancu St., No. 31, 400083 Cluj-Napoca, Romania
| | - Andrada Soancă
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș St., No. 15, 400012 Cluj-Napoca, Romania; (C.S.C.); (A.C.); (I.C.M.); (A.S.)
| |
Collapse
|
4
|
Tonon CC, de Souza Rastelli AN, Bodahandi C, Ghosh G, Hasan T, Xu Q, Greer A, Lyons AM. Superhydrophobic Tipped Antimicrobial Photodynamic Therapy Device for the In Vivo Treatment of Periodontitis Using a Wistar Rat Model. ACS APPLIED MATERIALS & INTERFACES 2023; 15:50083-50094. [PMID: 37862708 PMCID: PMC10800031 DOI: 10.1021/acsami.3c12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Limited options exist for treatment of periodontitis; scaling and root planing (SRP) are not sufficient to eradicate P. gingivalis and the resulting inflammatory disease. Chlorhexidine (CHX), used as an adjuvant to SRP, may reduce bacterial loads but leads to pain and staining, while evidence for its efficacy is lacking. Antibiotics are effective but can lead to drug-resistance. The rising concern of antibiotic resistance limits the future use of this treatment approach. This study evaluates the efficacy of a novel superhydrophobic (SH) antimicrobial photodynamic therapy (aPDT) device as an adjuvant to SRP for the treatment of periodontitis induced in a Wistar rat in vivo model relative to CHX. The SH-aPDT device comprises an SH silicone rubber strip coated with verteporfin photosensitizer (PS), sterilized, and secured onto a tapered plastic optical fiber tip connected to a red diode laser. The superhydrophobic polydimethylsiloxane (PDMS) strips were fabricated by using a novel soluble template method that creates a medical-grade elastomer with hierarchical surface roughness without the use of nanoparticles. Superhydrophobicity minimizes direct contact of the PS-coated surface with bacterial biofilms. Upon insertion of the device tip into the pocket and energizing the laser, the device generates singlet oxygen that effectively targets and eliminates bacteria within the periodontal pocket. SH-aPDT treatment using 125 J/cm2 of red light on three consecutive days reduced P. gingivalis significantly more than SRP-CHX controls (p < 0.05). Clinical parameters significantly improved (p < 0.05), and histology and stereometry results demonstrated SH-aPDT to be the most effective treatment for improving healing and reducing inflammation, with an increase in fibroblast cells and extracellular matrix and a reduction in vascularization, inflammatory cells, and COX-2 expression. The SH-aPDT approach resulted in complete disease clearance assessed 30 days after treatment initiation with significant reduction of the periodontal pocket and re-formation of the junctional epithelium at the enamel-cementum junction. PS isolation on a SH strip minimizes the potential for bacteria to develop resistance, where the treatment may be aided by the oxygen supply retained within the SH surface.
Collapse
Affiliation(s)
- Caroline Coradi Tonon
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom St, Boston, MA 02114, United States
| | - Alessandra Nara de Souza Rastelli
- Department of Restorative Dentistry, School of Dentistry, Araraquara, Sao Paulo State University-UNESP, 1680 Humaita St., Araraquara, SP 14801-903, Brazil
| | - Chathuna Bodahandi
- Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, 365 Fifth Avenue, New York, NY 10016, United States
- Department of Chemistry, College of Staten Island, City University of New York, Staten Island, New York 10314, United States
| | - Goutam Ghosh
- SingletO2 Therapeutics LLC, VentureLink, Room 524B, 211 Warren St, Newark, NJ 07103, United States
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom St, Boston, MA 02114, United States
- Division of Health Sciences and Technology, Harvard University and Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - QianFeng Xu
- SingletO2 Therapeutics LLC, VentureLink, Room 524B, 211 Warren St, Newark, NJ 07103, United States
| | - Alexander Greer
- Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, 365 Fifth Avenue, New York, NY 10016, United States
- SingletO2 Therapeutics LLC, VentureLink, Room 524B, 211 Warren St, Newark, NJ 07103, United States
- Department of Chemistry, Brooklyn College, City University of New York, Brooklyn, NY 11210, United States
| | - Alan M. Lyons
- Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, 365 Fifth Avenue, New York, NY 10016, United States
- Department of Chemistry, College of Staten Island, City University of New York, Staten Island, New York 10314, United States
- SingletO2 Therapeutics LLC, VentureLink, Room 524B, 211 Warren St, Newark, NJ 07103, United States
| |
Collapse
|
5
|
Rathod A, Jaiswal P, Kale B, Masurkar D. Comparative Evaluation of the Effectiveness of Triphala and Chlorhexidine in Full-mouth Disinfection Treatment of Periodontitis in Type 2 Diabetes Patients. J Contemp Dent Pract 2023; 24:798-801. [PMID: 38152913 DOI: 10.5005/jp-journals-10024-3573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
AIM To evaluate and compare the efficacy of triphala and chlorhexidine (CHX) in the treatment of stages II and III periodontitis with one-stage complete mouth disinfection in type 2 diabetes mellitus (DM) patients. MATERIALS AND METHODS A total of 24 type 2 diabetic subjects with either stage II or stage III periodontitis were randomly divided into test and control groups with 12 patients in each group. For control group, full-mouth disinfection (FMD) was done using CHX and for test group, FMD was done using triphala. Clinical parameters were evaluated at baseline and at 6 months which comprised of probing pocket depth (PPD), plaque index (PI), clinical attachment level (CAL), papillary bleeding index (PBI). The primary outcomes considered were a reduction in PPD and a gain in CAL. The data were recorded, tabulated, and statistically analyzed. RESULTS The PPD reduction for the test group was 3.38 ± 0.75 mm and for the control group was 3.39 ± 0.76 mm. The CAL gain for the test group was 3.39 ± 0.76 mm and for the control group was 3.18 ± 0.74 mm. Although there was a statistically significant PPD reduction, statistically not significant CAL gain was observed. CONCLUSION Both the groups with the FMD protocol showed beneficial results in terms of PPD reduction and CAL gain but the test group showed slightly better results. CLINICAL RELEVANCE Clinically, there is more PPD reduction and CAL gain from baseline to 6 months in the test group compared to the control group. Clinically, the test group has more favorable results compared to the control group.
Collapse
Affiliation(s)
- Aishwarya Rathod
- Department of Periodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, India, Phone: +91 9834240701, e-mail:
| | - Priyanka Jaiswal
- Department of Periodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, India
| | - Bhairavi Kale
- Department of Periodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, India
| | - Deepika Masurkar
- Department of Periodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, India
| |
Collapse
|
6
|
Güvenç KK, Fentoğlu Ö, Calapoğlu M, Aksoy F, Orhan H. Periodontal and cardiovascular therapies modify specialized pro-resolving lipid mediator (sPRLM) (LPXA4, PD1, RvE1, RvD1, and MaR1)-mediated pathway: the first pilot clinical study. Clin Oral Investig 2023; 27:5549-5558. [PMID: 37535198 DOI: 10.1007/s00784-023-05174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/15/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES Cardiovascular disease (CVD) and periodontal disease have a common pathogenesis with inflammation and resolution steps. Although the relationships among periodontal disease, CVD, and specialized pro-resolving lipid mediator (sPRLM)s are well known, there is no study about the combined effects of cardiovascular and periodontal treatments on sPRLM levels. It was aimed to evaluate the effects of periodontal and cardiovascular therapies on sPRLMs (lipoxin A4, protectin (PD)1, resolvin (Rv) E1, RvD1, and maresin (MaR)1) in patients with CVD and periodontal disease. METHODS This observational study consisted of fifty-five patients with CVD and mild or moderate periodontitis. The clinical periodontal parameters (plaque index, gingival index, probing pocket depth, percentage of bleeding on probing, and clinical attachment level) and blood and unstimulated total saliva samples were obtained at baseline, at 3 months (following only cardiovascular therapy), and at 6 months (following cardiovascular and periodontal therapies). The blood count and serum levels of cardiometabolic biomarkers (white blood cell, neutrophil/lymphocyte, serum total cholesterol (TC), triglyceride, and low and high-density lipoprotein (HDL) levels) were evaluated. sPRLMs were evaluated by ELISA. RESULTS There were significant decreases in body mass index, clinical periodontal parameters, WBC, LDL, PD1, and RvD1 at 6 months compared to baseline. The decreases in TC/HDL, RvE1, and MaR1 levels were significant at 3 and 6 months compared to baseline (p < 0.05). CONCLUSION(S) The combination of cardiovascular and periodontal treatments leads to significant reductions in clinical periodontal and cardiometabolic parameters and sPRLMs. CLINICAL RELEVANCE Our report, which is the first in their field, suggested that cardiovascular and periodontal therapies provide an important contribution via decreasing the periodontal and atherosclerotic inflammation modulating sPRLMs. This finding will be a big step toward increasing the quality of life in these patients by drawing attention to importance of public health associated with oral hygiene, periodontal health, and systemic phase of periodontal treatment.
Collapse
Affiliation(s)
- Kübra Karakoç Güvenç
- Faculty of Dentistry, Department of Periodontology, Süleyman Demirel University, Isparta, Turkey
| | - Özlem Fentoğlu
- Faculty of Dentistry, Department of Periodontology, Süleyman Demirel University, Isparta, Turkey.
| | - Mustafa Calapoğlu
- Faculty of Science, Department of Biochemistry, Süleyman Demirel University, Isparta, Turkey
| | - Fatih Aksoy
- Faculty of Medicine, Department of Cardiology, Süleyman Demirel University, Isparta, Turkey
| | - Hikmet Orhan
- Faculty of Medicine, Department of Biostatistics, Süleyman Demirel Üniversitesi, Isparta, Turkey
| |
Collapse
|
7
|
Isola G, Tartaglia GM, Santonocito S, Chaurasia A, Marya A, Lo Giudice A. Growth differentiation factor-15 and circulating biomarkers as predictors of periodontal treatment effects in patients with periodontitis: a randomized-controlled clinical trial. BMC Oral Health 2023; 23:582. [PMID: 37605193 PMCID: PMC10440880 DOI: 10.1186/s12903-023-03237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND During the last decades, in patients with periodontitis, periodontal treatment has been shown to reduce the potential release of local and systemic biomarkers linked to an early risk of systemic inflammatory disorders. This study evaluated the efficacy of non-surgical-periodontal treatment (NSPT) on growth differentiation factor 15 (GDF-15) and related circulating biomarkers such as glutathione peroxidase 1 (GPx-1), c-reactive protein (hs-CRP), and surfactant protein D (SP-D) in periodontal patients and explored whether subjects who had high GDF-15 levels at baseline showed increased clinical benefits following NSPT at 6-months follow-up. METHODS For this two-arm, parallel randomized clinical trial, patients with periodontitis were randomly allocated to receive quadrant scaling and root-planing (Q-SRP, n = 23, median age 51 years old) or full-mouth disinfection (FMD, n = 23, median age 50 years old) treatment. Clinical and periodontal parameters were recorded in all enrolled patients. The primary outcome was to analyse serum concentrations changes of GDF-15 and of GPx-1, hs-CRP, and SP-D at baseline and at 30, 90, and 180-days follow-up after NSPT through enzyme-linked immunosorbent assay (ELISA) and nephelometric assay techniques. RESULTS In comparison with FMD, patients of the Q-SRP group showed a significant improvement in clinical periodontal parameters (p < 0.05) and a reduction in the mean levels of GDF-15 (p = 0.005), hs-CRP (p < 0.001), and SP-D (p = 0.042) and an increase of GPx-1 (p = 0.025) concentrations after 6 months of treatment. At 6 months of treatment, there was a significant association between several periodontal parameters and the mean concentrations of GDF-15, GPx-1, hs-CRP, and SP-D (p < 0.05 for all parameters). Finally, the ANOVA analysis revealed that, at 6 months after treatment, the Q-SRP treatment significantly impacted the reduction of GDF-15 (p = 0.015), SP-D (p = 0.026) and the upregulation of GPx-1 (p = 0.045). CONCLUSION The results evidenced that, after 6 months of treatment, both NSPT protocols improved the periodontal parameters and analyzed biomarkers, but Q-SRP was more efficacious than the FMD approach. Moreover, patients who presented high baseline GDF-15 and SP-D levels benefited more from NSPT at 6-month follow-up. TRIAL REGISTRATION NCT05720481.
Collapse
Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, Catania, 95123, Italy
| | - Gianluca Martino Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, Milan, 20100, Italy
- Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, 20100, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, Catania, 95123, Italy.
| | - Akhilanand Chaurasia
- Department of Oral Medicine, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anand Marya
- Department of Orthodontics, University of Puthisastra Phnom Penh Combodia, Phnom Penh, 55180, Cambodia.
- Center for Transdisciplinary Research, Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai, 600077, India.
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, Catania, 95123, Italy
| |
Collapse
|
8
|
Andersson OP. Is the microbiome the cause of irritable bowel syndrome and inflammatory bowel disease? Lessons to consider from odontology. Int J Colorectal Dis 2023; 38:117. [PMID: 37150763 DOI: 10.1007/s00384-023-04406-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND A substantial amount of research is pointing to the disrupted microbiome and dysfunctional host-microbiome interaction as potential causes of Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). The true cause of the diseases is still not fully elucidated, and the various treatments used are not truly effective in the long run, especially for IBD, since a true cure is not known to exist. Treatment failure and surgery are common for IBD, many times leading to a perceived lower quality of life, not to mention the enormous cost for society for treatment up until that point and after. Although it is clear that the microbiome has a major role in the disease, it seems the majority of the research and treatments are still focused on treating and understanding the inflammation and not the primary cause of the inflammation in the first place. This was also the case for many decades in the search for the cause of periodontitis (PD) and gingivitis (GV), a destructive and non-destructive inflammatory disorder, respectively, the first resulting in loss of tissue supporting the teeth. There was much uncertainty and confusion until it was fully established that the microbiome was the cause. PD treatments primarily nowadays reflect the cause, i.e. the removal of microbes. There is no doubt, however, that the inflammatory pathways are important in both diseases and the purpose of this text is not to dispute this in respect to gastrointestinal disorders too. However, a different view on inflammation and associated disorders is explored to explain the nature of extraintestinal manifestations. PURPOSE The aim of this report is not to systematically fully review the literature to try to strengthen causality, as there are many reviews that explore the microbial aspects of IBS and IBD. Instead, the objective is to above all reflect on what has been learned in the field of odontology/stomatology and discuss relevant gastrointestinal research in order to propose tentative hypotheses and questions regarding IBS and IBD aetiology. Perhaps it could help soften the confusion regarding the microbial aetiology and dysbiosis concept, while guiding future research and treatments, primarily regarding microbial transplants, antibiotics, and diet.
Collapse
|
9
|
Adjunctive Nd:YAG laser irradiation in the treatment of stage III/IV periodontitis: a 12-month, randomized, controlled trial. Clin Oral Investig 2023:10.1007/s00784-023-04908-4. [PMID: 36795248 DOI: 10.1007/s00784-023-04908-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical efficacy of the adjunctive use of Nd:YAG laser (1064 nm) to full-mouth scaling and root planning (FMS), in stage III/IV periodontitis patients. MATERIALS AND METHODS Sixty stage III/IV periodontitis patients were randomly assigned to three groups. The control group received FMS, laser 1 group received combined FMS/single Nd:YAG laser irradiation (3 W, 150 mJ, 20 Hz,100 μs), and laser 2 group received combined FMS/double Nd:YAG laser irradiation with 1-week interval (2.0 W, 200 mJ, 10 Hz, 100 μs). PD, CAL, FMPS, GI, FMBS, and GR were evaluated at baseline, 6 weeks, 3, 6, and 12 months after treatment. Patient-reported outcomes were evaluated 1 week after treatment. RESULTS A significant improvement (p < 0.001) for all clinical parameters was observed during the entire study period, with the exception of mean CAL gain for the laser 2 group at 12 months. The percentage of pockets ≤ 4 mm was significantly higher compared to baseline for all groups throughout the study, with no inter-group differences at any time point. Patient-reported analgesic consumption was higher for laser 1 group. CONCLUSIONS The adjunctive use of Nd:YAG laser irradiation was similarly effective to FMS alone, during the entire study period. A slightly higher, though not statistically significant improvement was reported for PD at 6 and 12 months after a single post-FMS application of Nd:YAG laser for pocket epithelium removal and coagulation. CLINICAL RELEVANCE Additional Nd:YAG laser application for sulcular epithelium removal and coagulation may provide minor long-term improvements compared to FMS or laser irradiation for pocket disinfection and detoxification. TRIAL REGISTRATION ISRCTN26692900. Registration date: 09/06/2022.
Collapse
|
10
|
Morikawa S, Watanabe K, Otsuka R, Asoda S, Nakagawa T. Periodontal therapy for localized severe periodontitis in a patient receiving fixed orthodontic treatment: a case report. J Med Case Rep 2023; 17:19. [PMID: 36658639 PMCID: PMC9854180 DOI: 10.1186/s13256-023-03751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/01/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Orthodontic treatment involves movement of teeth by compression and resorption of the alveolar bone using orthodontic forces. These movements are closely linked to the interactions between the teeth and the periodontal tissues that support them. Owing to an increase in adults seeking orthodontic treatment, orthodontists increasingly encounter patients with periodontal diseases, in whom orthodontic treatment is contraindicated. In rare cases, periodontitis may develop after treatment initiation. However, no approach for treating periodontitis after the initiation of orthodontic treatment has been established. Here, we present an approach for managing localized severe periodontitis manifesting after initiating orthodontic treatment. CASE PRESENTATION A 32-year-old Japanese woman was referred to the Department of Dentistry and Oral Surgery by an orthodontist who observed symptoms of acute periodontitis in the maxillary molars that required periodontal examination and treatment. A detailed periodontal examination, including oral bacteriological examination, revealed localized severe periodontitis (stage III, grade B) in the maxillary left first and second molars and in the mandibular right second molar. After consultation with the orthodontist, the orthodontic treatment was suspended based on the results of the bacteriological examination to allow for periodontal treatment. Full-mouth disinfection was performed with adjunctive oral sitafloxacin. Periodontal and bacteriological examinations after treatment revealed regression of the localized periodontitis with bone regeneration. Thereafter, orthodontic treatment was resumed, and good progress was achieved. CONCLUSIONS Orthodontists should recognize the risk of acute severe periodontitis in young adults. Asymptomatic patients with localized severe periodontitis may clear a screening test before orthodontic treatment but develop acute symptoms with bone resorption during orthodontic treatment. Therefore, patients requiring orthodontic treatment should be examined by their family dentist or a periodontist to rule out periodontal issues that may impede orthodontic treatment. The patients should also be informed of age-related risks. Further, periodontists, family dentists, and orthodontists who treat adults should be informed about periodontitis and the need for interdisciplinary collaboration. In patients who develop periodontitis after orthodontic treatment initiation, temporary interruption of orthodontic treatment and aggressive periodontal intervention may facilitate recovery.
Collapse
Affiliation(s)
- Satoru Morikawa
- grid.26091.3c0000 0004 1936 9959Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Kazuya Watanabe
- grid.26091.3c0000 0004 1936 9959Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan ,Watanabe Orthodontic Office, 1-11-26-2F Kichijoji-honcho, Musashino, Tokyo 180-0004 Japan
| | - Ryo Otsuka
- Familia Orthodontics, 1-7-5-12F Sakuragi-cho, Omiya-ku, Saitama, Saitama 330-0854 Japan
| | - Seiji Asoda
- grid.26091.3c0000 0004 1936 9959Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Taneaki Nakagawa
- grid.26091.3c0000 0004 1936 9959Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| |
Collapse
|
11
|
Paterson M, Johnston W, Sherriff A, Culshaw S. Periodontal instrumentation technique: an exploratory analysis of clinical outcomes and financial aspects. Br Dent J 2023:10.1038/s41415-022-5405-1. [PMID: 36624308 PMCID: PMC9838345 DOI: 10.1038/s41415-022-5405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023]
Abstract
Objective This exploratory post hoc analysis sought to investigate clinical outcomes comparing non-surgical treatment for periodontal disease using exclusively hand instruments, exclusively ultrasonic instruments or a combination approach. Differences in time efficiency and equipment use with each treatment method were evaluated.Methods In total, 55 patients with periodontitis were treated across two studies (randomised controlled trial and cohort study) with non-surgical periodontal therapy using hand instruments (HI), ultrasonic instruments (UI) or a combination approach (CI). All patients were re-evaluated 90 days after treatment. Clinical parameters, time taken and financial implications of non-surgical periodontal therapy were explored with a descriptive analysis within this post hoc analysis.Results There were no clinically relevant differences in clinical parameters across all groups at day 90. Inter-group comparisons showed no clinically relevant differences in treatment outcome between groups. UI required less time on average to complete treatment compared to HI. UI provided using a half mouth approach had fewest overall episodes of expenditure and lowest maintenance costs.Conclusions Comparison of clinical outcomes between HI, UI and CI yielded no clinically relevant differences. When comparing HI and UI, UI had a shorter treatment time on average. Full mouth treatment was associated with the least patient visits. UI was least costly on a recurring basis.
Collapse
Affiliation(s)
- Michael Paterson
- Oral Sciences, Glasgow Dental Hospital and School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK.
| | - William Johnston
- Oral Sciences, Glasgow Dental Hospital and School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK
| | - Andrea Sherriff
- Community Oral Health, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK
| | - Shauna Culshaw
- Oral Sciences, Glasgow Dental Hospital and School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK
| |
Collapse
|
12
|
Tomasi C, Liss A, Welander M, Alian AY, Abrahamsson KH, Wennström JL. A randomized multi-centre study on the effectiveness of non-surgical periodontal therapy in general practice. J Clin Periodontol 2022; 49:1092-1105. [PMID: 35833528 PMCID: PMC9796759 DOI: 10.1111/jcpe.13703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/25/2022] [Accepted: 07/10/2022] [Indexed: 01/07/2023]
Abstract
AIM To evaluate the effectiveness of two non-surgical treatment protocols for periodontitis patients in general dental practice. MATERIALS AND METHODS Ninety-five dental hygienists (59 dental clinics) were randomly assigned to one of two treatment protocols: (i) establishment of adequate self-performed oral hygiene prior to a single session of ultrasonic instrumentation (guided periodontal infection control [GPIC]) or (ii) conventional non-surgical therapy (CNST) including patient education and scaling and root planing integrated in multiple sessions. Residual pockets at 3 months were retreated in both groups. The primary outcome was pocket closure (probing pocket depth ≤ 4 mm) at 6 months. Multilevel models were utilized. RESULTS Based on data from 615 patients, no significant differences with regard to clinical outcomes were observed between treatment protocols. Treatment-related costs (i.e., chair time, number of sessions) were significantly lower for GPIC than CNST. Smoking and age significantly affected treatment outcomes. CONCLUSIONS No significant differences between the two approaches were observed in regard to clinical outcomes. GPIC was more time-effective. Patient education should include information on the detrimental effects of smoking. CLINICALTRIALS gov (NCT02168621).
Collapse
Affiliation(s)
- Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Anna Liss
- Department of Periodontology, Institute of Odontology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Clinic of PeriodonticsPublic Dental ServiceGothenburgSweden
| | - Maria Welander
- Department of Periodontology, Institute of Odontology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Clinic of PeriodonticsPublic Dental ServiceGothenburgSweden
| | - Anna Ydenius Alian
- Department of Periodontology, Institute of Odontology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Clinic of PeriodonticsPublic Dental ServiceGothenburgSweden
| | - Kajsa H. Abrahamsson
- Department of Periodontology, Institute of Odontology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Clinic of PeriodonticsPublic Dental ServiceGothenburgSweden
| | - Jan L. Wennström
- Department of Periodontology, Institute of Odontology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| |
Collapse
|
13
|
Intensive Periodontal Treatment Does Not Affect the Lipid Profile and Endothelial Function of Patients with Type 2 Diabetes: A Randomized Clinical Trial. Biomedicines 2022; 10:biomedicines10102524. [PMID: 36289786 PMCID: PMC9599760 DOI: 10.3390/biomedicines10102524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/23/2022] [Accepted: 10/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Local eradication of periodontal infection could potentially have a much broader impact on the diabetic condition by also contributing to the modification of the lipid profile, which is directly compromised in the alteration of endothelium-dependent vasodilation. The aim of this trial was to assess the benefits of intensive periodontal treatment (IPT) on the lipid profile and endothelial function of diabetic patients. Methods: This was a 6-month, randomized controlled trial involving diabetic patients with generalized periodontitis. The study group comprised 290 individuals who were randomly assigned to receive Intensive Periodontal Treatment (IPT, Intervention Group) or conventional adult prophylaxis (Control Periodontal Treatment, CPT, Control Group). Outcomes encompassed lipid profile involving serum total cholesterol, serum triglyceride, low-density lipoprotein cholesterol, high-density lipo-protein cholesterol, and flow-mediated vasodilation (FMD) as an index of endothelium-dependent vasodilation (primary outcomes); periodontal indices and high-sensitive C-reactive protein were evaluated at baseline, 3 and 6 months after periodontal treatment. Results: An increase in endothelium-dependent flow-mediated dilatation (FMD) was observed in the Intensive Periodontal Treatment group in comparison with Control (p < 0.001), but results are not statistically different. There were no differences in lipid profile in individuals of both groups. Conclusions: An intensive periodontal treatment might improve endothelial function, suggesting a direct beneficial effect on the vasculature, possibly mediated by systemic inflammatory reduction. However, no statistically significant differences between groups were observed, and no benefits were proved on lipid profile.
Collapse
|
14
|
Ye Z, Cao Y, Miao C, Liu W, Dong L, Lv Z, Iheozor-Ejiofor Z, Li C. Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis. Cochrane Database Syst Rev 2022; 10:CD009197. [PMID: 36194420 PMCID: PMC9531722 DOI: 10.1002/14651858.cd009197.pub5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND There may be an association between periodontitis and cardiovascular disease (CVD); however, the evidence so far has been uncertain about whether periodontal therapy can help prevent CVD in people diagnosed with chronic periodontitis. This is the third update of a review originally published in 2014, and most recently updated in 2019. Although there is a new multidimensional staging and grading system for periodontitis, we have retained the label 'chronic periodontitis' in this version of the review since available studies are based on the previous classification system. OBJECTIVES To investigate the effects of periodontal therapy for primary or secondary prevention of CVD in people with chronic periodontitis. SEARCH METHODS An information specialist searched five bibliographic databases up to 17 November 2021 and additional search methods were used to identify published, unpublished, and ongoing studies. We also searched the Chinese BioMedical Literature Database, the China National Knowledge Infrastructure, the VIP database, and Sciencepaper Online to March 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared active periodontal therapy to no periodontal treatment or a different periodontal treatment. We included studies of participants with a diagnosis of chronic periodontitis, either with CVD (secondary prevention studies) or without CVD (primary prevention studies). DATA COLLECTION AND ANALYSIS Two review authors carried out the study identification, data extraction, and 'Risk of bias' assessment independently and in duplicate. They resolved any discrepancies by discussion, or with a third review author. We adopted a formal pilot-tested data extraction form, and used the Cochrane tool to assess the risk of bias in the studies. We used GRADE criteria to assess the certainty of the evidence. MAIN RESULTS There are no new completed RCTs on this topic since we published our last update in 2019. We included two RCTs in the review. One study focused on the primary prevention of CVD, and the other addressed secondary prevention. We evaluated both as being at high risk of bias. Our primary outcomes of interest were death (all-cause and CVD-related) and all cardiovascular events, measured at one-year follow-up or longer. For primary prevention of CVD in participants with periodontitis and metabolic syndrome, one study (165 participants) provided very low-certainty evidence. There was only one death in the study; we were unable to determine whether scaling and root planning plus amoxicillin and metronidazole could reduce incidence of all-cause death (Peto odds ratio (OR) 7.48, 95% confidence interval (CI) 0.15 to 376.98), or all CVD-related death (Peto OR 7.48, 95% CI 0.15 to 376.98). We could not exclude the possibility that scaling and root planning plus amoxicillin and metronidazole could increase cardiovascular events (Peto OR 7.77, 95% CI 1.07 to 56.1) compared with supragingival scaling measured at 12-month follow-up. For secondary prevention of CVD, one pilot study randomised 303 participants to receive scaling and root planning plus oral hygiene instruction (periodontal treatment) or oral hygiene instruction plus a copy of radiographs and recommendation to follow-up with a dentist (community care). As cardiovascular events had been measured for different time periods of between 6 and 25 months, and only 37 participants were available with at least one-year follow-up, we did not consider the data to be sufficiently robust for inclusion in this review. The study did not evaluate all-cause death and all CVD-related death. We are unable to draw any conclusions about the effects of periodontal therapy on secondary prevention of CVD. AUTHORS' CONCLUSIONS For primary prevention of cardiovascular disease (CVD) in people diagnosed with periodontitis and metabolic syndrome, very low-certainty evidence was inconclusive about the effects of scaling and root planning plus antibiotics compared to supragingival scaling. There is no reliable evidence available regarding secondary prevention of CVD in people diagnosed with chronic periodontitis and CVD. Further trials are needed to reach conclusions about whether treatment for periodontal disease can help prevent occurrence or recurrence of CVD.
Collapse
Affiliation(s)
- Zelin Ye
- Department of Imaging, West China School of Stomatology, Chengdu, China
| | - Yubin Cao
- Department of Head and Neck Oncology, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Cheng Miao
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wei Liu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Li Dong
- Department of Cardiovascular Medicine, Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University, Luzhou, China
| | - Zongkai Lv
- Department of Stomatology, Nan Chong Central Hospital, Second Clinical Medical College of Chuan Bei Medical College, Nanchong, China
| | | | - Chunjie Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| |
Collapse
|
15
|
Tonon CC, Ashraf S, de Souza Rastelli AN, Ghosh G, Hasan T, Xu Q, Greer A, Lyons AM. Evaluation of photosensitizer-containing superhydrophobic surfaces for the antibacterial treatment of periodontal biofilms. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2022; 233:112458. [PMID: 35691161 PMCID: PMC10373426 DOI: 10.1016/j.jphotobiol.2022.112458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Antimicrobial photodynamic therapy (aPDT) is a promising approach to control biofilms involved in periodontal diseases. However, certain challenges, such as staining of teeth, preferential interaction of photosensitizer (PS) with Gram-positive versus Gram-negative bacteria, and insufficient oxygen in hypoxic periodontal pockets have presented barriers to its use in the clinic. To overcome these challenges, a novel superhydrophobic (SH) film that generates airborne singlet oxygen has been developed. The SH-aPDT approach isolates the PS onto a topologically rough solid SH film on which channels allow air to diffuse to the PS surface, thus ensuring sufficient oxygen supply. Upon illumination, gas phase singlet oxygen (1O2) is produced and diffuses from the SH surface to the underlying biofilm. The killing efficacy was assessed as a function of transmitted fluence (17.9-89.5 J/cm2) and chorin e6 loading (96-1110 nmol/cm2) by counting of colony forming units, biofilm metabolism by XTT and confocal microscopy. The decrease in viability of both Gram-positive and Gram-negative bacteria in a multi-species biofilm was found to be linearly dependent on the fluence as well as the loading of the PS up to 71.6 J/cm2 when 1110 nmols/cm2 of chlorin e6 was used. A > 4.6 log bacterial reduction was observed under these conditions (p < 0.05). This novel SH-aPDT approach shows promise as an effective method to disinfect multi-species bacterial biofilms associated with periodontal disease and will be evaluated in animal models in future studies.
Collapse
Affiliation(s)
- Caroline Coradi Tonon
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom St, Boston, MA 02114, United States
| | - Shoaib Ashraf
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom St, Boston, MA 02114, United States
| | - Alessandra Nara de Souza Rastelli
- Department of Restorative Dentistry, School of Dentistry, Araraquara, São Paulo State University-UNESP, 1680 Humaitá St., Araraquara, SP 14801-903, Brazil
| | - Goutam Ghosh
- SingletO(2) Therapeutics LLC, TechBox, Suite 3, 75 Clinton St, Staten Island, NY 10304, United States
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom St, Boston, MA 02114, United States; Division of Health Sciences and Technology, Harvard University and Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - QianFeng Xu
- SingletO(2) Therapeutics LLC, TechBox, Suite 3, 75 Clinton St, Staten Island, NY 10304, United States
| | - Alexander Greer
- SingletO(2) Therapeutics LLC, TechBox, Suite 3, 75 Clinton St, Staten Island, NY 10304, United States; Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, 365 Fifth Avenue, New York, NY 10016, United States; Department of Chemistry, Brooklyn College, City University of New York, Brooklyn, NY 11210, United States.
| | - Alan M Lyons
- SingletO(2) Therapeutics LLC, TechBox, Suite 3, 75 Clinton St, Staten Island, NY 10304, United States; Department of Chemistry, College of Staten Island, City University of New York, Staten Island, New York 10314, United States; Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, 365 Fifth Avenue, New York, NY 10016, United States.
| |
Collapse
|
16
|
Rapone B, Ferrara E, Qorri E, Dipalma G, Mancini A, Corsalini M, Fabbro MD, Scarano A, Tartaglia GM, Inchingolo F. The Impact of Periodontal Inflammation on Endothelial Function Assessed by Circulating Levels of Asymmetric Dimethylarginine: A Single-Blinded Randomized Clinical Trial. J Clin Med 2022; 11:jcm11144173. [PMID: 35887937 PMCID: PMC9316194 DOI: 10.3390/jcm11144173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Endothelial dysfunction is one of the early pathogenic events of the atherosclerotic process. Severe periodontitis is considered to be an independent contributing risk factor for the pathophysiology of endothelial dysfunction. High blood concentration of asymmetric dimethylarginine (ADMA), an L-arginine analogue that inhibits nitric oxide (NO) formation, has emerged as one of the most powerful independent risk predictors of cardiovascular disease. Abrogation of periodontal inflammation might have clinical relevance, affecting the ADMA. Insufficient clinical evidence exists for drawing clear conclusions regarding the long-term effects of periodontal disease on endothelial function, and even less evidence is available specifically on ADMA concentrations and their relationship with periodontitis. The objective of this study was to evaluate the effects of intensive periodontal treatment in modulating the endothelial function via the assessment of plasma ADMA concentration in patients diagnosed severe periodontitis. Methods: This was a 6-month randomized controlled trial, including 140 patients between 41 and 63 years old who were diagnosed with severe periodontitis, free from cardiovascular disease (CVD), and had traditional cardiovascular risk factors. All patients underwent a complete medical and clinical periodontal examination, a laboratory analysis of ADMA, and an ultrasound assessment of FMD of the right brachial artery. After the screening, they were randomly assigned to receive either intensive periodontal treatment (test group, n = 70) or community-based periodontal care (control group, n = 70). A full examination was carried out at baseline, 3 and 6 months after the periodontal treatment. Results: A total of 236 individuals diagnosed with periodontitis were screened. One hundred forty participants were enrolled. No statistically significant difference was observed over the time in ADMA concentration after the intensive periodontal treatment within the test group. No differences were revealed between the groups in the ADMA concentration at baseline and during follow-up. Conclusions: Intensive periodontal treatment does not affect the plasma levels of ADMA in patients without any risk for cardiovascular disease.
Collapse
Affiliation(s)
- Biagio Rapone
- Interdisciplinary Department of Medicine, “Aldo Moro” University of Bari, 70121 Bari, Italy; (G.D.); (A.M.); (M.C.); (F.I.)
- Correspondence: ; Tel.: +39-3477619817
| | - Elisabetta Ferrara
- Complex Operative Unit of Odontostomatology, Hospital S.S. Annunziata, 66100 Chieti, Italy;
| | - Erda Qorri
- Dean Faculty of Medical Sciences, Albanian University, Bulevardi Zogu I, 1001 Tirana, Albania;
| | - Gianna Dipalma
- Interdisciplinary Department of Medicine, “Aldo Moro” University of Bari, 70121 Bari, Italy; (G.D.); (A.M.); (M.C.); (F.I.)
| | - Antonio Mancini
- Interdisciplinary Department of Medicine, “Aldo Moro” University of Bari, 70121 Bari, Italy; (G.D.); (A.M.); (M.C.); (F.I.)
| | - Massimo Corsalini
- Interdisciplinary Department of Medicine, “Aldo Moro” University of Bari, 70121 Bari, Italy; (G.D.); (A.M.); (M.C.); (F.I.)
| | - Massimo Del Fabbro
- UOC Maxillo-Facial Surgery and Dentistry, Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy; (M.D.F.); (G.M.T.)
| | - Antonio Scarano
- Department of Oral Science, Nano and Biotechnology and CeSi-Met University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Gianluca Martino Tartaglia
- UOC Maxillo-Facial Surgery and Dentistry, Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy; (M.D.F.); (G.M.T.)
| | - Francesco Inchingolo
- Interdisciplinary Department of Medicine, “Aldo Moro” University of Bari, 70121 Bari, Italy; (G.D.); (A.M.); (M.C.); (F.I.)
| |
Collapse
|
17
|
Jervøe-Storm PM, Eberhard J, Needleman I, Worthington HV, Jepsen S. Full-mouth treatment modalities (within 24 hours) for periodontitis in adults. Cochrane Database Syst Rev 2022; 6:CD004622. [PMID: 35763286 PMCID: PMC9239328 DOI: 10.1002/14651858.cd004622.pub4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Periodontitis is a highly prevalent, chronic inflammation that causes damage to the soft tissues and bones supporting the teeth. Conventional treatment is quadrant scaling and root planing (the second step of periodontal therapy), which comprises scaling and root planing of teeth in one quadrant of the mouth at a time, with the four different sessions separated by at least one week. Alternative protocols for anti-infective periodontal therapy have been introduced to help enhance treatment outcomes: full-mouth scaling (subgingival instrumentation of all quadrants within 24 hours), or full-mouth disinfection (subgingival instrumentation of all quadrants in 24 hours plus adjunctive antiseptic). We use the older term 'scaling and root planing' (SRP) interchangeably with the newer term 'subgingival instrumentation' in this iteration of the review, which updates one originally published in 2008 and first updated in 2015. OBJECTIVES To evaluate the clinical effects of full-mouth scaling or full-mouth disinfection (within 24 hours) for the treatment of periodontitis compared to conventional quadrant subgingival instrumentation (over a series of visits at least one week apart) and to evaluate whether there was a difference in clinical effects between full-mouth disinfection and full-mouth scaling. SEARCH METHODS An information specialist searched five databases up to 17 June 2021 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) lasting at least three months that evaluated full-mouth scaling and root planing within 24 hours, with or without adjunctive use of an antiseptic, compared to conventional quadrant SRP (control). Participants had a clinical diagnosis of (chronic) periodontitis according to the International Classification of Periodontal Diseases from 1999. A new periodontitis classification was launched in 2018; however, we used the 1999 classification for inclusion or exclusion of studies, as most studies used it. We excluded studies of people with systemic disorders, taking antibiotics or with the older diagnosis of 'aggressive periodontitis'. DATA COLLECTION AND ANALYSIS Several review authors independently conducted data extraction and risk of bias assessment (based on randomisation method, allocation concealment, examiner blinding and completeness of follow-up). Our primary outcomes were tooth loss and change in probing pocket depth (PPD); secondary outcomes were change in probing attachment (i.e. clinical attachment level (CAL)), bleeding on probing (BOP), adverse events and pocket closure (the number/proportion of sites with PPD of 4 mm or less after treatment). We followed Cochrane's methodological guidelines for data extraction and analysis. MAIN RESULTS We included 20 RCTs, with 944 participants, in this updated review. No studies assessed the primary outcome tooth loss. Thirteen trials compared full-mouth scaling and root planing within 24 hours without the use of antiseptic (FMS) versus control, 13 trials compared full-mouth scaling and root planing within 24 hours with adjunctive use of an antiseptic (FMD) versus control, and six trials compared FMS with FMD. Of the 13 trials comparing FMS versus control, we assessed three at high risk of bias, six at low risk of bias and four at unclear risk of bias. We assessed our certainty about the evidence as low or very low for the outcomes in this comparison. There was no evidence for a benefit for FMS over control for change in PPD, gain in CAL or reduction in BOP at six to eight months (PPD: mean difference (MD) 0.03 mm, 95% confidence interval (CI) -0.14 to 0.20; 5 trials, 148 participants; CAL: MD 0.10 mm, 95% CI -0.05 to 0.26; 5 trials, 148 participants; BOP: MD 2.64%, 95% CI -8.81 to 14.09; 3 trials, 80 participants). There was evidence of heterogeneity for BOP (I² = 50%), but none for PPD and CAL. Of the 13 trials comparing FMD versus control, we judged four at high risk of bias, one at low risk of bias and eight at unclear risk of bias. At six to eight months, there was no evidence for a benefit for FMD over control for change in PPD or CAL (PPD: MD 0.11 mm, 95% CI -0.04 to 0.27; 6 trials, 224 participants; low-certainty evidence; CAL: 0.07 mm, 95% CI -0.11 to 0.24; 6 trials, 224 participants; low-certainty evidence). The analyses found no evidence of a benefit for FMD over control for BOP (very low-certainty evidence). There was no evidence of heterogeneity for PPD or CAL, but considerable evidence of heterogeneity for BOP, attributed to one study. There were no consistent differences in these outcomes between intervention and control (low- to very low-certainty evidence). Of the six trials comparing FMS and FMD, we judged two trials at high risk of bias, one at low risk of bias and three as unclear. At six to eight months, there was no evidence of a benefit of FMD over FMS for change in PPD or gain in CAL (PPD: MD -0.11 mm, 95% CI -0.30 to 0.07; P = 0.22; 4 trials, 112 participants; low-certainty evidence; CAL: MD -0.05 mm, 95% CI -0.23 to -0.13; P = 0.58; 4 trials, 112 participants; low-certainty evidence). There was no evidence of a difference between FMS and FMD for BOP at any time point (P = 0.98; 2 trials, 22 participants; low- to very low-certainty evidence). There was evidence of heterogeneity for BOP (I² = 52%), but not for PPD or CAL. Thirteen studies predefined adverse events as an outcome; three reported an event after FMD or FMS. The most important harm identified was an increase in body temperature. We assessed the certainty of the evidence for most comparisons and outcomes as low because of design limitations leading to risk of bias, and the small number of trials and participants, leading to imprecision in the effect estimates. AUTHORS' CONCLUSIONS The inclusion of nine new RCTs in this updated review has not changed the conclusions of the previous version of the review. There is still no clear evidence that FMS or FMD approaches provide additional clinical benefit compared to conventional mechanical treatment for adult periodontitis. In practice, the decision to select one approach to non-surgical periodontal therapy over another should include patient preference and the convenience of the treatment schedule.
Collapse
Affiliation(s)
- Pia-Merete Jervøe-Storm
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany
| | - Jörg Eberhard
- Faculty of Dentistry, The University of Sydney, Sydney Dental Hospital, Sydney, Australia
| | - Ian Needleman
- Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, London, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
18
|
Lorusso F, Tartaglia G, Inchingolo F, Scarano A. Early Response and Clinical Efficacy of a Mouthwash Containing Chlorhexidine, Anti Discoloration System, Polyvinylpyrrolidone/Vinyl Acetate and Sodium DNA in Periodontitis Model: A Triple-Blind Randomized Controlled Clinical Trial. Dent J (Basel) 2022; 10:dj10060101. [PMID: 35735643 PMCID: PMC9221572 DOI: 10.3390/dj10060101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/26/2022] [Accepted: 06/01/2022] [Indexed: 12/18/2022] Open
Abstract
Polyvinylpyrrolidone/vinyl acetate (PVP/VA) is a molecule with increased adhesion capacity, and can be associated in the bacterial plaque control with sodium DNA, a natural anti-aging molecule able to improve gingival trophism. The aim of the study is to test at two weeks the antimicrobial and antiplaque properties, subjects affected by chronic periodontitis, showed by a mouthwash containing Chlorhexidine (CHX) 0.2% with Anti Discoloration System (ADS), PVP-VA, and Sodium DNA in comparison with a placebo mouthwash. A single center randomized controlled trial was conducted on a total of fifty-four (54) subjects. In the test Group (n = 27) patients were treated by a 0.2% Chlorhexidine (CHX) mouthwash with ADS, PVP-VA, and Sodium DNA, while a placebo mouthwash was used in the control Group (B). The full mouth plaque score (FMPS), full mouth bleeding score (FMBS), and gingival index (GI) were assessed at baseline, and at 1 and 2 weeks after treatment. FMPS score recorded at baseline (V2) was 52.7 ± 9.2 in the Group Test and 58.2 ± 6.1 in the Group Control (p > 0.05). After 1 week (V3), FMPS was 13.3 ± 5.6 in the Group Test and 18.7 ± 4.3 in the Group Control (p < 0.05), while at V4 (2 weeks), FMPS was 14.2 ± 4.1 in the Group Test and 20.3 ± 5.2 in the Group Control (p < 0.05). FMBS score recorded at baseline (V2) was 46.7 ± 8.7 in the Group Test and 49.2 ± 6.2 in the Group Control (p > 0.05). After 1 week (V3), FMBS was 12.7 ± 4.2 in the test Group Test and 18.5 ± 5.9 in the control Group Control (p < 0.05), while after 2 weeks (V4), it was 13.1 ± 3.2 in the Group Test and 19.8 ± 4.9 Group Control (p < 0.05). This trial has clinically showed the efficacy of a new formulation of chlorhexidine mouthwash in reducing bacterial plaque and gingival inflammation. A significant reduction of inflammation and bleeding scores was found in periodontal patients treated by a mouthwash containing CHX 0.2% with ADS, PVP-VA, and Sodium DNA compared to those treated with a placebo mouthwash.
Collapse
Affiliation(s)
- Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Gianluca Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20122 Milan, Italy;
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy;
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
- Department of Oral Implantology, Dental Research Division, College Ingà, UNINGÁ, Cachoeiro de Itapemirim 29312, Brazil
- Correspondence: ; Tel.: +39-087-1355-4084 (ext. 4099)
| |
Collapse
|
19
|
Abdelbary MMH, Schittenhelm F, Yekta-Michael SS, Reichert S, Schulz S, Kasaj A, Braun A, Conrads G, Stein JM. Impact of Three Nonsurgical, Full-Mouth Periodontal Treatments on Total Bacterial Load and Selected Pathobionts. Antibiotics (Basel) 2022; 11:686. [PMID: 35625330 PMCID: PMC9138013 DOI: 10.3390/antibiotics11050686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/21/2022] [Accepted: 05/16/2022] [Indexed: 11/25/2022] Open
Abstract
For the treatment of periodontitis stage III/IV, a quadrant/week-wise debridement (Q-SRP) was compared with three full-mouth approaches: full-mouth scaling (FMS, accelerated Q-SRP within 24 h), full-mouth scaling with chlorhexidine-based disinfection (FMD), and FMD with adjuvant erythritol air polishing (FMDAP). The objective of this prospective, randomized study (a substudy of ClinicalTrials.gov, identifier: NCT03509233) was to compare the clinical and microbiological effects of the treatments. In total, 105 patients were randomized to one of the four aforementioned treatment groups, with n = 25, 28, 27, and 25 patients allocated to each group, respectively. At baseline and 3 and 6 months after treatment, the clinical parameters, including the pocket probing depths, clinical attachment level, and bleeding on probing, were recorded, and the prevalence of the total bacteria and four periodontal pathobionts (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Tannerella forsythia) was determined using real-time quantitative PCR. Concerning the clinical outcomes, all the treatment modalities were effective, but the full-mouth approaches, especially FMDAP, were slightly superior to Q-SRP. Using the FMD approach, the reduction in the bacterial load and the number of pathobionts was significantly greater than for FMS, followed by Q-SRP. FMDAP was the least effective protocol for microbial reduction. However, after a temporary increase 3 months after therapy using FMDAP, a significant decrease in the key pathogen, P. gingivalis, was observed. These findings were not consistent with the clinical results from the FMDAP group. In conclusion, the dynamics of bacterial colonization do not necessarily correlate with clinical outcomes after full-mouth treatments for periodontitis stage III/IV.
Collapse
Affiliation(s)
- Mohamed M. H. Abdelbary
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, 52074 Aachen, Germany;
| | - Florian Schittenhelm
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, 52074 Aachen, Germany; (F.S.); (A.B.); (J.M.S.)
- Private Practice, 52062 Aachen, Germany
| | - Sareh Said Yekta-Michael
- Department of Orthodontics, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, 52074 Aachen, Germany;
| | - Stefan Reichert
- Department of Operative Dentistry and Periodontology, Martin Luther University, 06108 Halle (Saale), Germany; (S.R.); (S.S.)
| | - Susanne Schulz
- Department of Operative Dentistry and Periodontology, Martin Luther University, 06108 Halle (Saale), Germany; (S.R.); (S.S.)
| | - Adrian Kasaj
- Department of Periodontology and Operative Dentistry, University Medical Center, 55131 Mainz, Germany;
| | - Andreas Braun
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, 52074 Aachen, Germany; (F.S.); (A.B.); (J.M.S.)
| | - Georg Conrads
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, 52074 Aachen, Germany;
| | - Jamal M. Stein
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, 52074 Aachen, Germany; (F.S.); (A.B.); (J.M.S.)
- Private Practice, 52062 Aachen, Germany
| |
Collapse
|
20
|
Di Stefano M, Polizzi A, Santonocito S, Romano A, Lombardi T, Isola G. Impact of Oral Microbiome in Periodontal Health and Periodontitis: A Critical Review on Prevention and Treatment. Int J Mol Sci 2022; 23:ijms23095142. [PMID: 35563531 PMCID: PMC9103139 DOI: 10.3390/ijms23095142] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 02/07/2023] Open
Abstract
The skin, oral cavity, digestive and reproductive tracts of the human body harbor symbiotic and commensal microorganisms living harmoniously with the host. The oral cavity houses one of the most heterogeneous microbial communities found in the human organism, ranking second in terms of species diversity and complexity only to the gastrointestinal microbiota and including bacteria, archaea, fungi, and viruses. The accumulation of microbial plaque in the oral cavity may lead, in susceptible individuals, to a complex host-mediated inflammatory and immune response representing the primary etiological factor of periodontal damage that occurs in periodontitis. Periodontal disease is a chronic inflammatory condition affecting about 20-50% of people worldwide and manifesting clinically through the detection of gingival inflammation, clinical attachment loss (CAL), radiographic assessed resorption of alveolar bone, periodontal pockets, gingival bleeding upon probing, teeth mobility and their potential loss in advanced stages. This review will evaluate the changes characterizing the oral microbiota in healthy periodontal tissues and those affected by periodontal disease through the evidence present in the literature. An important focus will be placed on the immediate and future impact of these changes on the modulation of the dysbiotic oral microbiome and clinical management of periodontal disease.
Collapse
Affiliation(s)
- Mattia Di Stefano
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (M.D.S.); (G.I.)
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (M.D.S.); (G.I.)
- Correspondence: (A.P.); (S.S.); Tel.: +39-095-3782638 (A.P. & S.S.)
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (M.D.S.); (G.I.)
- Correspondence: (A.P.); (S.S.); Tel.: +39-095-3782638 (A.P. & S.S.)
| | - Alessandra Romano
- Department of General Surgery and Surgical-Medical Specialties, Unit of Hematology, University of Catania, 95124 Catania, Italy;
| | - Teresa Lombardi
- Department of Health Sciences, Magna Græcia University, 88100 Catanzaro, Italy;
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (M.D.S.); (G.I.)
| |
Collapse
|
21
|
de Sire A, Ferrillo M, Lippi L, Agostini F, de Sire R, Ferrara PE, Raguso G, Riso S, Roccuzzo A, Ronconi G, Invernizzi M, Migliario M. Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review. Nutrients 2022; 14:nu14050982. [PMID: 35267957 PMCID: PMC8912303 DOI: 10.3390/nu14050982] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.
Collapse
Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: (A.d.S.); (M.F.)
| | - Martina Ferrillo
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: (A.d.S.); (M.F.)
| | - Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy;
| | - Roberto de Sire
- Department of Clinical Medicine and Surgery, University Federico II of Naples, 80126 Naples, Italy;
| | - Paola Emilia Ferrara
- University Polyclinic Foundation Agostino Gemelli IRCSS, Catholic University of Sacred Heart, 00168 Rome, Italy; (P.E.F.); (G.R.)
| | - Giuseppe Raguso
- Department of Otolaryngology-Head and Neck Surgery, University of Verona, 37129 Verona, Italy;
| | - Sergio Riso
- Dietetic and Clinical Nutrition Unit, Maggiore della Carità Hospital, 28100 Novara, Italy;
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland;
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), 2100 Copenhagen, Denmark
| | - Gianpaolo Ronconi
- University Polyclinic Foundation Agostino Gemelli IRCSS, Catholic University of Sacred Heart, 00168 Rome, Italy; (P.E.F.); (G.R.)
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Mario Migliario
- Dental Clinic, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy;
| |
Collapse
|
22
|
Schulz S, Stein JM, Schumacher A, Kupietz D, Yekta-Michael SS, Schittenhelm F, Conrads G, Schaller HG, Reichert S. Nonsurgical Periodontal Treatment Options and Their Impact on Subgingival Microbiota. J Clin Med 2022; 11:1187. [PMID: 35268280 PMCID: PMC8911148 DOI: 10.3390/jcm11051187] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Different periodontal treatment methods (quadrant-wise debridement, scaling and root planing (Q-SRP), full-mouth scaling (FMS), full-mouth disinfection (FMD), and FMD with adjuvant erythritol air-polishing (FMDAP)) were applied in periodontitis patients (stage III/IV). The study objective (substudy of ClinicalTrials.gov Identifier: NCT03509233) was to compare the impact of treatments on subgingival colonization. METHODS Forty patients were randomized to the treatment groups. Periodontal parameters and subgingival colonization were evaluated at baseline and 3 and 6 months after treatment. RESULTS Positive changes in clinical parameters were recorded in every treatment group during the 3-month follow-up period, but did not always continue. In three groups, specific bacteria decreased after 3 months; however, this was associated with a renewed increase after 6 months (FMS: Porphyromonas gingivalis; FMD: Eubacterium nodatum, Prevotella dentalis; and FMDAP: uncultured Prevotella sp.). CONCLUSIONS The benefit of all clinical treatments measured after 3 months was associated with a decrease in pathogenic bacteria in the FMS, FMD, and FMDAP groups. However, after 6 months, we observed further improvement or some stagnation in clinical outcomes accompanied by deterioration of the microbiological profile. Investigating the subgingival microbiota might help appraise successful periodontal treatment and implement individualized therapy.
Collapse
Affiliation(s)
- Susanne Schulz
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06108 Halle, Germany; (A.S.); (D.K.); (H.-G.S.); (S.R.)
| | - Jamal M. Stein
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital (RWTH) Aachen, 52074 Aachen, Germany; (J.M.S.); (S.S.Y.-M.); (F.S.); (G.C.)
- Private Practice, 52062 Aachen, Germany
| | - Anne Schumacher
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06108 Halle, Germany; (A.S.); (D.K.); (H.-G.S.); (S.R.)
| | - David Kupietz
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06108 Halle, Germany; (A.S.); (D.K.); (H.-G.S.); (S.R.)
| | - Sareh S. Yekta-Michael
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital (RWTH) Aachen, 52074 Aachen, Germany; (J.M.S.); (S.S.Y.-M.); (F.S.); (G.C.)
| | - Florian Schittenhelm
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital (RWTH) Aachen, 52074 Aachen, Germany; (J.M.S.); (S.S.Y.-M.); (F.S.); (G.C.)
- Private Practice, 52062 Aachen, Germany
| | - Georg Conrads
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital (RWTH) Aachen, 52074 Aachen, Germany; (J.M.S.); (S.S.Y.-M.); (F.S.); (G.C.)
| | - Hans-Günter Schaller
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06108 Halle, Germany; (A.S.); (D.K.); (H.-G.S.); (S.R.)
| | - Stefan Reichert
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06108 Halle, Germany; (A.S.); (D.K.); (H.-G.S.); (S.R.)
| |
Collapse
|
23
|
Vinel A, Al Halabi A, Roumi S, Le Neindre H, Millavet P, Simon M, Cuny C, Barthet JS, Barthet P, Laurencin-Dalicieux S. Non-surgical Periodontal Treatment: SRP and Innovative Therapeutic Approaches. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1373:303-327. [DOI: 10.1007/978-3-030-96881-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
24
|
Diakoumopoulou D, Magana M, Karoussis IK, Nikolaou C, Chatzipanagiotou S, Ioannidis A. The ever-changing landscape in modern dentistry therapeutics - Enhancing the emptying quiver of the periodontist. Heliyon 2021; 7:e08342. [PMID: 34816039 PMCID: PMC8591475 DOI: 10.1016/j.heliyon.2021.e08342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/12/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction/Objectives Periodontitis comprises of a wide range of inflammatory conditions of the gums leading to soft tissue damage and attachment loss. The initiation of periodontitis constitutes a rather complex disease pathogenesis which is based on pathogenic shifts of the oral microbiota combined with the host-microbiome interactions. The severity of the periodontitis is multifactorial depending on genetic, environmental, as well as host immunity factors. Data and sources To make an inclusive analysis on the periodontitis therapeutics, reading of the recent relevant literature was carried out using the MEDLINE/PubMed database, Google Scholar and the NIH public online database for clinical trials (http://www.clinicaltrials.gov). Conclusions Tackling the inflammation associated periodontal defects can be succeeded with conventional therapy or resective and regenerative treatment. To date, the mechanical removal of the supragingival and subgingival biofilm is considered the “gold standard” of periodontal therapy in combination with the use of antibacterial compounds. The antimicrobial resistance phenomenon tends to turn all the currently applied antibacterials into “endangered species”. Ongoing efforts through the conduct of clinical trials should be focused on understanding the advantages of modern approaches in comparison to traditional therapies.
Collapse
Affiliation(s)
- Dimitra Diakoumopoulou
- Department of Clinical Microbiology, Athens Medical School, Aeginition Hospital, Athens, Greece
| | - Maria Magana
- Department of Clinical Microbiology, Athens Medical School, Aeginition Hospital, Athens, Greece
| | - Ioannis K Karoussis
- Department of Periodontology, School of Dental Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysoula Nikolaou
- Department of Clinical Microbiology, Athens Medical School, Aeginition Hospital, Athens, Greece
| | | | - Anastasios Ioannidis
- Department of Clinical Microbiology, Athens Medical School, Aeginition Hospital, Athens, Greece.,Department of Nursing, Faculty of Health Sciences, University of Peloponnese, Tripolis, Greece
| |
Collapse
|
25
|
Periodontal therapy on the oral health-related quality of life of obese and non-obese individuals. Odontology 2021; 109:956-964. [PMID: 34023952 DOI: 10.1007/s10266-021-00617-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
Oral diseases such as periodontitis can have a more negative influence on the quality of life of obese than in normal-weight patients. The objective of the present study was to assess the impact of one-stage full-mouth disinfection (OSFMD) therapy on the oral health-related quality of life (OHRQL) of obese and non-obese individuals with periodontitis. Fifty-five obese and thirty-nine non-obese patients were evaluated. The questionnaires oral impacts on daily performance (OIDP) and oral health and quality of life (OHQoL) were given to all patients at baseline and 6 months after periodontal treatment by the OSFMD protocol. For statistical analysis, Chi-square, the two-factor repeated-measures ANOVA, and correlation tests were used. At baseline, mean global OHQoL and OIDP scores were similar for both groups (p > 0.05). At 6 months, OSFMD resulted in OHQoL and OIDP global scores improvements in both groups (p < 0.05), with no significant difference between groups. The most impaired activity at baseline was eating and cleaning teeth for both groups. Periodontal parameters were associated with worse values in the OHQoL and OIDP questionnaires only in obese patients. In conclusion, OSFMD yielded similar improvements in overall OHRQL in both obese and non-obese individuals. Periodontal parameters were associated with a worse quality of life in obese patients. Periodontal treatment can be an important component to improve the OHRQL of obese individuals, and clinicians should expect similar results as those obtained with non-obese patients.
Collapse
|
26
|
The effect of drug dose and duration of adjuvant Amoxicillin-plus-Metronidazole to full-mouth scaling and root planing in periodontitis: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:5671-5685. [PMID: 33751238 DOI: 10.1007/s00784-021-03869-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/01/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim is to explore the optimal drug dose and duration of adjunctive Amoxicillin-plus-Metronidazole (AMX/MET) to full-mouth scaling and planing (FMSRP) in periodontitis. METHODS An electronic search in four databases and manual search in four journals were conducted for randomised clinical trials comparing AMX/MET adjunct to FMSRP with FMSRP alone for at least 3 months. RESULTS Eleven studies were eligible and included. The primary outcome was clinical attachment level (CAL) gain, the secondary outcomes were periodontal pocket depth (PPD) reduction and adverse events. Our results showed a beneficial effect of adjunctive AMX/MET with higher drug dose to FMSRP for CAL gain and PPD reduction at 3 months, and the benefit remained stable at 6 months. However, minimal difference among three-seven-and ten-day drug duration was observed. In addition, the risk difference of adverse events was minimal between two groups. CONCLUSION FMSRP adjunct to a high drug dose of 500/500 mg of AMX/MET showed a significant and stable improvement on 6-month follow-up period. No decision for drug duration could be made due to limited evidence. CLINICAL RELEVANCE On 6-month follow-up, higher dose of AMX/MET adjunct to FMSRP could provide a stable clinical effect. No recommendation for drug duration could be made.
Collapse
|
27
|
Salhi L, Albert A, Seidel L, Lambert F. Respective Effects of Oral Hygiene Instructions and Periodontal Nonsurgical Treatment (Debridement) on Clinical Parameters and Patient-Reported Outcome Measures with Respect to Smoking. J Clin Med 2020; 9:E2491. [PMID: 32756385 PMCID: PMC7464916 DOI: 10.3390/jcm9082491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Oral hygiene instructions (OHI) and periodontal nonsurgical treatment (PNST) play pivotal roles in the management of periodontitis. The study aims to discern their respective effects on periodontal clinical parameters and patient-reported outcome measures (PROMs). METHODS Ninety-one patients were included, 34 non-smokers (NS), 25 former smokers (FS) and 32 current smoker (CS). Clinical parameters such as probing depth (PD) and bleeding on probing (BOP) were collected, and the periodontal inflamed tissue area (PISA) was calculated. Clinical parameters and PROMs were recorded before and after receiving OHI, with electronic tooth brush and interdental brushes, as well as 3 months after debridement. RESULTS Smokers presented a significantly higher proportion of severe periodontitis (64.7%) with generalized extension (76.5%) and with a rapid rate of progression (97.1%) compared to NS and FS. OHI led to a significant decrease of PD, BOP, and PISA (p < 0.0001) only in NS and FS. Debridement reduced PD and the percentage of PD >6 mm in all groups (p < 0.0001). OHI induced significant improvement of oral hygiene, frequency of interdental cleaning, and PROMs (p < 0.0001). Further debridement induced significant additional improvement PROMs in FS and NS (p < 0.0001). CONCLUSION OHI and debridement improved periodontal clinical parameters and PROMs in both NS and FS. Former smokers had comparable outcomes to non-smokers, suggesting that smoking cessation should be encouraged.
Collapse
Affiliation(s)
- Leila Salhi
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, 4000 Liège, Belgium
| | - Adelin Albert
- Department of Public Health Sciences, University of Liège, 4000 Liège, Belgium;
| | - Laurence Seidel
- Department of Biostatistics and Medico-economic information, University of Liège, 4000 Liège, Belgium;
| | - France Lambert
- Dental Biomaterials Research Unit, Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, 4000 Liège, Belgium;
| |
Collapse
|
28
|
Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Berglundh T, Sculean A, Tonetti MS. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol 2020; 47 Suppl 22:4-60. [PMID: 32383274 PMCID: PMC7891343 DOI: 10.1111/jcpe.13290] [Citation(s) in RCA: 667] [Impact Index Per Article: 166.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The recently introduced 2017 World Workshop on the classification of periodontitis, incorporating stages and grades of disease, aims to link disease classification with approaches to prevention and treatment, as it describes not only disease severity and extent but also the degree of complexity and an individual's risk. There is, therefore, a need for evidence-based clinical guidelines providing recommendations to treat periodontitis. AIM The objective of the current project was to develop a S3 Level Clinical Practice Guideline (CPG) for the treatment of Stage I-III periodontitis. MATERIAL AND METHODS This S3 CPG was developed under the auspices of the European Federation of Periodontology (EFP), following the methodological guidance of the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The rigorous and transparent process included synthesis of relevant research in 15 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and consensus, on those recommendations, by leading experts and a broad base of stakeholders. RESULTS The S3 CPG approaches the treatment of periodontitis (stages I, II and III) using a pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions. Consensus was achieved on recommendations covering different interventions, aimed at (a) behavioural changes, supragingival biofilm, gingival inflammation and risk factor control; (b) supra- and sub-gingival instrumentation, with and without adjunctive therapies; (c) different types of periodontal surgical interventions; and (d) the necessary supportive periodontal care to extend benefits over time. CONCLUSION This S3 guideline informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat periodontitis and to maintain a healthy dentition for a lifetime, according to the available evidence at the time of publication.
Collapse
Affiliation(s)
- Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity Complutense of MadridMadridSpain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity Complutense of MadridMadridSpain
| | - Moritz Kebschull
- Periodontal Research GroupInstitute of Clinical SciencesCollege of Medical and Dental SciencesThe University of BirminghamBirminghamUK
- Birmingham Community Healthcare NHS TrustBirminghamUK
- Division of PeriodonticsSection of Oral, Diagnostic and Rehabilitation SciencesCollege of Dental MedicineColumbia UniversityNew YorkNYUSA
| | - Iain Chapple
- Periodontal Research GroupInstitute of Clinical SciencesCollege of Medical and Dental SciencesThe University of BirminghamBirminghamUK
- Birmingham Community Healthcare NHS TrustBirminghamUK
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive DentistryUniversity Hospital BonnBonnGermany
| | - Tord Berglundh
- Department of PeriodontologyInstitute of OdontologyThe Sahlgrenska AcademyUniversity of GothenburgGöteborgSweden
| | - Anton Sculean
- Department of PeriodontologySchool of Dental MedicineUniversity of BernBernSwitzerland
| | - Maurizio S. Tonetti
- Division of Periodontology and Implant DentistryFaculty of DentistryThe University of Hong KongHong KongHong Kong
- Department of Oral and Maxillo‐facial ImplantologyShanghai Key Laboratory of StomatologyNational Clinical Research Centre for StomatologyShanghai Ninth People HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
| |
Collapse
|
29
|
Castro Dos Santos NC, Andere NMRB, Araujo CF, de Marco AC, Kantarci A, Van Dyke TE, Santamaria MP. Omega-3 PUFA and aspirin as adjuncts to periodontal debridement in patients with periodontitis and type 2 diabetes mellitus: Randomized clinical trial. J Periodontol 2020; 91:1318-1327. [PMID: 32103495 DOI: 10.1002/jper.19-0613] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/29/2019] [Accepted: 02/05/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Supplementation with omega-3 polyunsaturated fatty acids (ω-3 PUFA) and low-dose aspirin (ASA) have been proposed as a host modulation regimen to control chronic inflammatory diseases. The aim of this study was to investigate the clinical and immunological impact of orally administered ω-3 PUFA and ASA as adjuncts to periodontal debridement for the treatment of periodontitis in patients type 2 diabetes. METHODS Seventy-five patients (n = 25/group) were randomly assigned to receive placebo and periodontal debridement (CG), ω-3 PUFA + ASA (3 g of fish oil/d + 100 mg ASA/d for 2 months) after periodontal debridement (test group [TG]1), or ω-3 PUFA + ASA (3 g of fish oil/d + 100 mg ASA/d for 2 months) before periodontal debridement (TG2). Periodontal parameters and GCF were collected at baseline (t0), 3 months after periodontal debridement and ω-3 PUFA + ASA or placebo for TG1 and CG (t1), after ω-3 PUFA + ASA (before periodontal debridement) for TG2 (t1), and 6 months after periodontal debridement (all groups) (t2). GCF was analyzed for cytokine levels by multiplex ELISA. RESULTS Ten patients (40%) in TG1 and nine patients (36%) in TG2 achieved the clinical endpoint for treatment (less than or equal to four sites with probing depth ≥ 5 mm), as opposed to four (16%) in CG. There was clinical attachment gain in moderate and deep pockets for TG1. IFN-γ and interleukin (IL)-8 levels decreased over time for both test groups. IL-6 levels were lower for TG1. HbA1c levels reduced for TG1. CONCLUSION Adjunctive ω-3 and ASA after periodontal debridement provides clinical and immunological benefits to the treatment of periodontitis in patients with type 2 diabetes.
Collapse
Affiliation(s)
- Nidia C Castro Dos Santos
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil.,Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA.,Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Naira M R B Andere
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Cássia F Araujo
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Andrea C de Marco
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Alpdogan Kantarci
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
| | - Thomas E Van Dyke
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
| | - Mauro P Santamaria
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| |
Collapse
|
30
|
Zhang Y, Qi Y, Lo ECM, McGrath C, Mei ML, Dai R. Using next-generation sequencing to detect oral microbiome change following periodontal interventions: A systematic review. Oral Dis 2020; 27:1073-1089. [PMID: 32390250 PMCID: PMC8247266 DOI: 10.1111/odi.13405] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 01/22/2023]
Abstract
Objectives This systematic review was to evaluate the change of oral microbiome based on next‐generation sequencing (NGS)‐metagenomic analysis following periodontal interventions among systematically healthy subjects. Materials and Methods A structured search strategy consisting of “metagenomics” and “oral diseases” was applied to PubMed, EMBASE, and Web of Science to identify effective papers. The included studies were original studies published in English, using metagenomic approach to analyze the effectiveness of periodontal intervention on oral microbiome among systematically healthy human subjects with periodontitis. Results A total of 12 papers were included in this review. Due to the heterogeneity of selected study, quantitative analysis was not performed. The findings as to how alpha diversity changed after interventions were not consistent across studies. Six studies illustrated clear separation of microbial composition between dental plaque samples collected before and after intervention using principal coordinates/component analysis. The most commonly detected genera before intervention were Porphyromonas, Treponema, Tannerella, and Prevotella, while Streptococcus and Actinomyces usually increased and became the dominant genera after intervention. Correlation network analysis revealed that after intervention, the topology of network was different compared to the corresponding pre‐interventional samples. Conclusion Existing evidence of metagenomic studies depicts a complex change in oral microbiome after periodontal intervention.
Collapse
Affiliation(s)
- Ya Zhang
- The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China.,Key Laboratory of Oral Diseases Research of Anhui Province, Stomatological Hospital & College, Anhui Medical University, Hefei, China
| | - Yinliang Qi
- The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Edward C M Lo
- Department of Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Colman McGrath
- Department of Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - May Lei Mei
- The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China.,Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Ruoxi Dai
- The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China
| |
Collapse
|
31
|
Liu W, Cao Y, Dong L, Zhu Y, Wu Y, Lv Z, Iheozor‐Ejiofor Z, Li C. Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis. Cochrane Database Syst Rev 2019; 12:CD009197. [PMID: 31887786 PMCID: PMC6953391 DOI: 10.1002/14651858.cd009197.pub4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There may be an association between periodontitis and cardiovascular disease (CVD); however, the evidence so far has been uncertain about whether periodontal therapy can help prevent CVD in people diagnosed with chronic periodontitis. This is the second update of a review originally published in 2014, and first updated in 2017. Although there is a new multidimensional staging and grading system for periodontitis, we have retained the label 'chronic periodontitis' in this version of the review since available studies are based on the previous classification system. OBJECTIVES To investigate the effects of periodontal therapy for primary or secondary prevention of CVD in people with chronic periodontitis. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health's Trials Register, CENTRAL, MEDLINE, Embase, and CINAHL, two trials registries, and the grey literature to September 2019. We placed no restrictions on the language or date of publication. We also searched the Chinese BioMedical Literature Database, the China National Knowledge Infrastructure, the VIP database, and Sciencepaper Online to August 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared active periodontal therapy to no periodontal treatment or a different periodontal treatment. We included studies of participants with a diagnosis of chronic periodontitis, either with CVD (secondary prevention studies) or without CVD (primary prevention studies). DATA COLLECTION AND ANALYSIS Two review authors carried out the study identification, data extraction, and 'Risk of bias' assessment independently and in duplicate. They resolved any discrepancies by discussion, or with a third review author. We adopted a formal pilot-tested data extraction form, and used the Cochrane tool to assess the risk of bias in the studies. We used GRADE criteria to assess the certainty of the evidence. MAIN RESULTS We included two RCTs in the review. One study focused on the primary prevention of CVD, and the other addressed secondary prevention. We evaluated both as being at high risk of bias. Our primary outcomes of interest were death (all-cause and CVD-related) and all cardiovascular events, measured at one-year follow-up or longer. For primary prevention of CVD in participants with periodontitis and metabolic syndrome, one study (165 participants) provided very low-certainty evidence. There was only one death in the study; we were unable to determine whether scaling and root planning plus amoxicillin and metronidazole could reduce incidence of all-cause death (Peto odds ratio (OR) 7.48, 95% confidence interval (CI) 0.15 to 376.98), or all CVD-related death (Peto OR 7.48, 95% CI 0.15 to 376.98). We could not exclude the possibility that scaling and root planning plus amoxicillin and metronidazole could increase cardiovascular events (Peto OR 7.77, 95% CI 1.07 to 56.1) compared with supragingival scaling measured at 12-month follow-up. For secondary prevention of CVD, one pilot study randomised 303 participants to receive scaling and root planning plus oral hygiene instruction (periodontal treatment) or oral hygiene instruction plus a copy of radiographs and recommendation to follow-up with a dentist (community care). As cardiovascular events had been measured for different time periods of between 6 and 25 months, and only 37 participants were available with at least one-year follow-up, we did not consider the data to be sufficiently robust for inclusion in this review. The study did not evaluate all-cause death and all CVD-related death. We are unable to draw any conclusions about the effects of periodontal therapy on secondary prevention of CVD. AUTHORS' CONCLUSIONS For primary prevention of cardiovascular disease (CVD) in people diagnosed with periodontitis and metabolic syndrome, very low-certainty evidence was inconclusive about the effects of scaling and root planning plus antibiotics compared to supragingival scaling. There is no reliable evidence available regarding secondary prevention of CVD in people diagnosed with chronic periodontitis and CVD. Further trials are needed to reach conclusions about whether treatment for periodontal disease can help prevent occurrence or recurrence of CVD.
Collapse
Affiliation(s)
- Wei Liu
- West China Hospital of Stomatology, Sichuan UniversityState Key Laboratory of Oral DiseasesNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Yubin Cao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan UniversityDepartment of Head and Neck OncologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Li Dong
- Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical UniversityDepartment of Cardiovascular MedicineNo 11, South Jiangyang RoadLuzhouSichuanChina646000
| | - Ye Zhu
- West China Hospital, Sichuan UniversityDepartment of Cardiovascular DiseaseNo 37, Guo Xue XiangChengduSichuanChina610041
| | - Yafei Wu
- West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral DiseasesDepartment of PeriodontologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Zongkai Lv
- Nan Chong Central Hospital, Second Clinical Medical College of Chuan Bei Medical CollegeDepartment of StomatologyNo. 66 , Da Bei Jie RoadNanchongSichuanChina637000
| | | | - Chunjie Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan UniversityDepartment of Head and Neck OncologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | | |
Collapse
|
32
|
Almeida ML, Duarte PM, Figueira EA, Lemos JC, Nobre CMG, Miranda TS, de Vasconcelos Gurgel BC. Effects of a full-mouth disinfection protocol on the treatment of type-2 diabetic and non-diabetic subjects with mild-to-moderate periodontitis: one-year clinical outcomes. Clin Oral Investig 2019; 24:333-341. [PMID: 31102044 DOI: 10.1007/s00784-019-02927-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 04/30/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study compared the clinical effects of a full-mouth disinfection (FMD) protocol for the treatment of mild-to-moderate periodontitis in type 2 diabetic and non-diabetic subjects for up to 1 year. Secondary aim was to evaluate the effects of this therapy on the salivary levels of periodontal pathogens between diabetics and non-diabetics. MATERIAL AND METHODS Twenty-six type 2 diabetic subjects and 28 non-diabetic subjects with mild-to-moderate periodontitis received full-mouth scaling and root planing within 24 h, application of chlorhexidine digluconate (CHX) gel in pockets and tongue plus CHX rinses for 14 days. Clinical monitoring was performed at baseline, 3, 6, and 12 months post-therapy. Salivary levels of red complex bacterial species were evaluated at baseline, 6, and 12 months post-therapy by qPCR. RESULTS Intention-to-treat analyses were performed for seven diabetics and three non-diabetics that did not return for the 12-month evaluation. Most clinical parameters improved significantly at 3, 6, and 12 months post-therapies for both groups (p < 0.05). Overall, there were no significant differences in clinical parameters between groups after therapy (p > 0.05). At 1 year, 39.3% and 50.0% of the non-diabetic and diabetic subjects, respectively, achieved the desired clinical endpoint for treatment (≤ 4 sites with probing depth ≥ 5 mm) (primary outcome variable) (p > 0.05). FMD did not promote changes in the salivary levels of pathogens in either of the groups (p > 0.05). Levels of T. forsythia were lower in diabetic than in non-diabetic subjects at 6 months post-therapy (p < 0.05). CONCLUSIONS Type 2 diabetic subjects and systemically healthy subjects with mild-to-moderate periodontitis responded similarly to the proposed FMD protocol for up to 1 year. CLINICAL RELEVANCE There is a general thought that diabetics do not answer as well as non-diabetics to periodontal treatments. However, this study showed that diabetics and non-diabetics respond equally to the FMD protocol. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02643771.
Collapse
Affiliation(s)
- Mariana Linhares Almeida
- Department of Dentistry, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 Lagoa Nova, Natal, Rio Grade do Norte, 59056-000, Brazil.,Department of Periodontology, Dental Research Division, Guarulhos University, São Paulo, Brazil
| | - Poliana Mendes Duarte
- Department of Periodontology, Dental Research Division, Guarulhos University, São Paulo, Brazil
| | - Eduardo Aleixo Figueira
- Department of Dentistry, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 Lagoa Nova, Natal, Rio Grade do Norte, 59056-000, Brazil
| | - Janaína Cavalcante Lemos
- Department of Dentistry, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 Lagoa Nova, Natal, Rio Grade do Norte, 59056-000, Brazil
| | - Cintia Mirela Guimarães Nobre
- Department of Dentistry, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 Lagoa Nova, Natal, Rio Grade do Norte, 59056-000, Brazil
| | | | - Bruno César de Vasconcelos Gurgel
- Department of Dentistry, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 Lagoa Nova, Natal, Rio Grade do Norte, 59056-000, Brazil.
| |
Collapse
|
33
|
Jagannathan N, Acharya A, Yi Farn O, Li KY, Nibali L, Pelekos G. Disease severity, debridement approach and timing of drug modify outcomes of adjunctive azithromycin in non-surgical management of chronic periodontitis: a multivariate meta-analysis. BMC Oral Health 2019; 19:65. [PMID: 31029129 PMCID: PMC6486979 DOI: 10.1186/s12903-019-0754-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/03/2019] [Indexed: 12/17/2022] Open
Abstract
Background Past meta-analyses have shown adjunctive systemic Azithromycin (AZI) to provide minor clinical benefits in scaling and root surface debridement (S/RSD). However, these have not considered the covariance of key outcome parameters; probing pocket depth (PPD) and Clinical Attachment Level (CAL) or systematically examined some potential sources of heterogeneity. Aim To jointly synthesize 6-month outcomes of systemic AZI as adjunctive to S/RSD in chronic periodontitis and investigate 3 potential sources of heterogeneity. Methods Four databases were searched for suitable randomized controlled clinical trials (RCTs). Standardized mean differences (SMD) in PPD and CAL between AZI + S/RSD and S/RSD alone, at 6-month follow-up were computed. Within-study covariances of PPD and CAL were derived from reported multiple time-point data. A multivariate meta-analysis with random effects jointly modelled PPD and CAL, factoring in their covariance. This model included 3 moderators with interaction effects; timing of AZI initiation (pre-therapy/post-therapy), type of S/RSD [full-mouth debridement (FMD)/partial-mouth debridement (PMD)], and baseline study-level mean values of PPD/CAL. Results Among 276 abstracts, 11 observations from 9 RCTs qualified for meta-analysis. Within-study correlation-coefficients of PPD with CAL significantly increased with increasing study-level baseline mean values (Spearman’s r = 0.79, p < 0.01). The full multivariate meta-analysis model showed significant effects for the 3 moderators (Q statistic = 150.03, p < 0.01), retained significant residual heterogeneity (Q statistic = 88.50, p < 0.01) but outperformed (Likelihood- ratio statistic = 102.95, p < 0.01,) a null-model with no moderators (Q statistic = 201.5, p < 0.01). A significant effect was seen only on the SMD for PPD (estimate = 1.16 mm, 95% CI: 0.27 mm–2.07 mm mm, p = 0.01) but not CAL (estimate = 0.17 mm, 95% CI: -0.92 mm-1.26 mm, p = 0.76). SMD in PPD positively interacted with study baseline value (estimate = 0.11, 95% CI: 0.08–0.15, p < 0.01). Significant negative interactions of SMD in PPD with PMD (estimate = − 1.25 mm, 95% CI: -1.73 mm- -0.78 mm, p < 0.01) and pre-therapy drug initiation (estimate = − 1.18 mm, 95% CI: -1.48 mm--0.87 mm, p < 0.01) were evident. Conclusion Joint synthesis of PPD and CAL showed, at 6-months, AZI + S/RSD provided a benefit over S/RSD alone for PPD alone when correlation with CAL was accounted for. Deeper study-level baseline PPD, FMD type of S/RSD, and post-therapy drug initiation associated with greater PPD reduction. Electronic supplementary material The online version of this article (10.1186/s12903-019-0754-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nithya Jagannathan
- Periodontology, Faculty of Dentistry, The University of Hong Kong, 3F, The Prince Philip Dental Hospital, 34 Hospital Road, Sai Yin Pun, Hong Kong
| | - Aneesha Acharya
- Periodontology, Faculty of Dentistry, The University of Hong Kong, 3F, The Prince Philip Dental Hospital, 34 Hospital Road, Sai Yin Pun, Hong Kong.,Dr D Y Patil Dental College and Hospital, Pimpri, Pune, India
| | - Ong Yi Farn
- Periodontology, Faculty of Dentistry, The University of Hong Kong, 3F, The Prince Philip Dental Hospital, 34 Hospital Road, Sai Yin Pun, Hong Kong
| | - Kar Yan Li
- Periodontology, Faculty of Dentistry, The University of Hong Kong, 3F, The Prince Philip Dental Hospital, 34 Hospital Road, Sai Yin Pun, Hong Kong
| | - Luigi Nibali
- Centre for Oral Immunobiology & Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, England
| | - George Pelekos
- Periodontology, Faculty of Dentistry, The University of Hong Kong, 3F, The Prince Philip Dental Hospital, 34 Hospital Road, Sai Yin Pun, Hong Kong.
| |
Collapse
|
34
|
Teufer B, Sommer I, Nussbaumer-Streit B, Titscher V, Bruckmann C, Klerings I, Gartlehner G. Screening for periodontal diseases by non-dental health professionals: a protocol for a systematic review and overview of reviews. Syst Rev 2019; 8:61. [PMID: 30803450 PMCID: PMC6388477 DOI: 10.1186/s13643-019-0977-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/14/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Periodontal diseases are responsible for a vast burden of disease globally and are associated with other severe illnesses such as cardiovascular diseases or diabetes. Tests for early diagnosis of periodontal diseases and effective treatments are available. The effectiveness of screening for periodontal diseases to detect periodontal diseases at an early stage during periodic health examinations at primary care facilities, however, is unclear. The objective of this systematic review is to assess the benefits and risks of screening for periodontal diseases in adults during the periodic health examinations. METHODS We will use two methodological approaches: (1) a systematic review to assess the effectiveness and risk of harms of screening for periodontal diseases during periodic health examinations and (2) an overview of systematic reviews to determine the effectiveness of treatment approaches for early periodontal disease. We will search electronic databases (Ovid MEDLINE, Embase.com , the Cochrane Library, Epistemonikos, Centre for Reviews and Dissemination databases, PubMed (non-MEDLINE content)) for published studies as well as sources for grey literature to detect unpublished studies. Two authors will independently screen abstracts and full texts using pre-defined eligibility criteria, select studies, extract data, and assess the risk of bias of included studies or reviews. In general, we will conduct a systematic narrative synthesis. Criteria for conducting meta-analyses were defined a priori. Our primary outcomes of interest are tooth loss, loosening of teeth, and depletion of bone tissue. Secondary outcomes are gingivitis/gum inflammation, pocket depths, dental hygiene, lifestyle modifications (e.g., smoking, alcohol, nutrition), and toothache. We consulted a panel of experts and patient representatives to prioritize these outcomes. Two investigators will assess independently the certainty of the evidence for each outcome using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. DISCUSSION We anticipate that our review will highlight the gaps in the available evidence about the effectiveness of screening for periodontal diseases during periodic health examinations. Implications for screening programs may be based on linked evidence about the validity of available screening tools and the effectiveness of early treatment. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017081150.
Collapse
Affiliation(s)
- Birgit Teufer
- Department for Evidence-based Medicine and Clinical Epidemiology, University for Continuing Education Krems (Danube University Krems), Dr. Karl Dorrek Str. 30, 3500, Krems, Austria.
| | - Isolde Sommer
- Department for Evidence-based Medicine and Clinical Epidemiology, University for Continuing Education Krems (Danube University Krems), Dr. Karl Dorrek Str. 30, 3500, Krems, Austria
| | - Barbara Nussbaumer-Streit
- Department for Evidence-based Medicine and Clinical Epidemiology, University for Continuing Education Krems (Danube University Krems), Dr. Karl Dorrek Str. 30, 3500, Krems, Austria
| | - Viktoria Titscher
- Department for Evidence-based Medicine and Clinical Epidemiology, University for Continuing Education Krems (Danube University Krems), Dr. Karl Dorrek Str. 30, 3500, Krems, Austria
| | - Corinna Bruckmann
- Universitätszahnklinik Wien GmbH (School of Dentistry Vienna), Sensengasse 2a, 1090, Vienna, Austria
| | - Irma Klerings
- Department for Evidence-based Medicine and Clinical Epidemiology, University for Continuing Education Krems (Danube University Krems), Dr. Karl Dorrek Str. 30, 3500, Krems, Austria
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Clinical Epidemiology, University for Continuing Education Krems (Danube University Krems), Dr. Karl Dorrek Str. 30, 3500, Krems, Austria.,RTI International, 3400 East Cornwallis Rd, Durham, NC, 27740, USA
| |
Collapse
|
35
|
Reinhardt B, Klocke A, Neering SH, Selbach S, Peters U, Flemmig TF, Beikler T. Microbiological dynamics of red complex bacteria following full-mouth air polishing in periodontally healthy subjects-a randomized clinical pilot study. Clin Oral Investig 2019; 23:3905-3914. [PMID: 30729346 DOI: 10.1007/s00784-019-02821-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 01/16/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Suppression of periodontal pathogens in the oral cavity of periodontally healthy individuals may lower the risk for periodontal or periimplant diseases. Therefore, the present study aimed to analyze the effect of supragingival debridement (SD) with adjunctive full mouth glycine powder air polishing (FM-GPAP) on the prevalence of periodontal pathogens in periodontally healthy individuals. MATERIALS AND METHODS Eighty-seven systemically and periodontally healthy intraoral carriers of red complex bacteria, i.e., Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola or other periodontal pathogens including Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Eikenella corrodens were enrolled into the study and randomly assigned to receive SD with adjunctive FM-GPAP (test, n = 42) or SD alone (control, n = 45). In the first observation period, microbiological samples were obtained prior to, and 2, 5, and 9 days following intervention. If one of these periodontal pathogens could still not be identified, additional microbial sampling was performed after 6 and 12 weeks. RESULTS The prevalence of red complex bacteria was significantly reduced in the test compared to the control group following treatment (p = 0.004) and at day 9 (p = 0.031). Intragroup comparison showed a significant (test, p < 0.001; control, p ≤ 0.01) reduction in the mean prevalence in both groups from BL through day 9 with an additional significant intergroup difference (p = 0.048) at day 9. However, the initial strong reduction returned to baseline values after 6 and 12 weeks. CONCLUSION In periodontally healthy carriers of periodontal pathogens, FM-GPAP as an adjunct to SD transiently enhances the suppression of red complex bacteria. CLINICAL RELEVANCE Whether the enhanced suppression of red complex bacteria by adjunctive FM-GPAP prevents the development of periodontitis in periodontally healthy carriers requires further investigations.
Collapse
Affiliation(s)
| | | | | | | | - Ulrike Peters
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center of Hamburg-Eppendorf (UKE), 20246, Hamburg, Germany
| | | | - Thomas Beikler
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center of Hamburg-Eppendorf (UKE), 20246, Hamburg, Germany.
| |
Collapse
|
36
|
Bertl K, Parllaku A, Pandis N, Buhlin K, Klinge B, Stavropoulos A. The effect of local and systemic statin use as an adjunct to non-surgical and surgical periodontal therapy-A systematic review and meta-analysis. J Dent 2018; 67:18-28. [PMID: 28855141 DOI: 10.1016/j.jdent.2017.08.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/19/2017] [Accepted: 08/23/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To evaluate the effect of local and/or systemic statin use as an adjunct to non-surgical and/or surgical periodontal therapy. DATA Literature search according to PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) interventional studies; (c) statins as monotherapy or as an adjunct to non-surgical and/or surgical treatment of periodontitis; (d) clinical and/or radiographic treatment effect size of statin intake reported. SOURCES Medline (PubMed), Embase (Ovid), CENTRAL (Ovid). STUDY SELECTION Thirteen clinical studies regarding local application and 2 with systemic administration of statins as an adjunct to non-surgical treatment (SRP) and 4 studies regarding intrasurgical statin application with a maximum follow-up of 9 months could be included; simvastatin, atorvastatin, and rosuvastatin were used. Local but not systemic statin application as an adjunct to SRP yielded significantly larger probing pocket depth (PD), radiographic defect depth (RDD), and bleeding index reduction, and larger clinical attachment level gain, and less residual PD and RDD (p≤0.016); rosuvastatin appeared as the most efficacious. Three of 4 studies reported a significant positive effect of intrasurgical statin application. No adverse events were reported after statin use. The vast majority of the included studies were from the same research group. CONCLUSIONS Significant additional clinical and radiographic improvements are obtained after local, but not systemic, statin use as an adjunct to SRP in deep pockets associated with intrabony defects and seemingly with furcation defects; intrasurgical statin application seems similarly beneficial. Confirmation of these results, and especially of the effect size, from other research groups is warranted.
Collapse
Affiliation(s)
- Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Sweden; Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Austria
| | - Arlinda Parllaku
- Private Practice, Tirana, Albania; Postgraduate Course Periodontology, Medical University of Vienna
| | - Nikolaos Pandis
- School of Dental Medicine, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Switzerland
| | - Kåre Buhlin
- Department of Dental Medicine, Division of Periodontology, Karolinska Institute, Huddinge, Sweden
| | - Björn Klinge
- Department of Periodontology, Faculty of Odontology, University of Malmö, Sweden
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Sweden.
| |
Collapse
|
37
|
Robles Raya P, Javierre Miranda AP, Moreno Millán N, Mas Casals A, de Frutos Echániz E, Morató Agustí ML. [Management of odontogenic infections in Primary Care: Antibiotic?]. Aten Primaria 2017; 49:611-618. [PMID: 28754576 PMCID: PMC6876037 DOI: 10.1016/j.aprim.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 11/12/2022] Open
Abstract
Our aim is to contribute to the rational use of antibiotics prescribed by family doctors when a patient consults for a dental problem. Nowadays we should not ask which antibiotic to give. The question has to be if we need to prescribe antibiotics in front of the most common odontogenic infections seen in our practice. We review the main dental infections, which should be their appropriate management and the role of prevention. We need to know the complexity of the oral microbiome because it?ll depend on the appropriateness of the antibiotherapy, the evolution towards cure or progression of some odontogenic infections. The bacterial plaque, formed by the biofilm, behaves as a barrier to the action of antimicrobials. It?s in the prevention of its development as well as in it mechanical elimination once shaped, in what the family doctor should insist. We must transmit antibiotics don?t heal dental pain.
Collapse
Affiliation(s)
- Purificación Robles Raya
- Grupo de Prevención en Enfermedades Infecciosas de la Sociedad Catalana de Medicina Familiar y Comunitaria (CAMFiC)
| | - Ana Pilar Javierre Miranda
- Grupo de Prevención en Enfermedades Infecciosas de la Sociedad Española de Medicina Familiar y Comunitaria (PAPPS-semFyC)
| | - Nemesio Moreno Millán
- Grupo de Prevención en Enfermedades Infecciosas de la Sociedad Catalana de Medicina Familiar y Comunitaria (CAMFiC)
| | - Ariadna Mas Casals
- Grupo de Prevención en Enfermedades Infecciosas de la Sociedad Catalana de Medicina Familiar y Comunitaria (CAMFiC)
| | - Elena de Frutos Echániz
- Grupo de Prevención en Enfermedades Infecciosas de la Sociedad Catalana de Medicina Familiar y Comunitaria (CAMFiC)
| | - M Luisa Morató Agustí
- Grupo de Prevención en Enfermedades Infecciosas de la Sociedad Catalana de Medicina Familiar y Comunitaria (CAMFiC); Grupo de Prevención en Enfermedades Infecciosas de la Sociedad Española de Medicina Familiar y Comunitaria (PAPPS-semFyC).
| |
Collapse
|
38
|
Lamont TJ, Clarkson JE, Ricketts DNJ, Heasman PA, Ramsay CR. Core outcomes in periodontal trials: study protocol for core outcome set development. Trials 2017; 18:436. [PMID: 28931440 PMCID: PMC5607503 DOI: 10.1186/s13063-017-2169-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 09/01/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There are a large number of clinical outcome measures used to assess the effectiveness of prevention and management strategies of periodontal diseases. This heterogeneity causes difficulties when trying to synthesise data for systematic reviews or clinical guidelines, reducing their impact. Core outcome sets are an agreed, standardised list of outcomes that should be measured and reported in all trials in specific clinical areas. We aim to develop a core outcome set for effectiveness trials investigating the prevention and management of periodontal disease in primary or secondary care. METHODS To identify existing outcomes we screened the Cochrane systematic reviews and their included studies on the prevention and management of periodontal diseases. The core outcome set will be defined by consensus of key stakeholders using an online e-Delphi process and face-to-face meeting. Key stakeholders involved in the development will include: patients, dentists, hygienists/therapists, specialists, clinical researchers and policy-makers. Stakeholders will be asked to prioritise outcomes and feedback will be provided in the next round(s). Stakeholders will have an opportunity to add outcomes found in the Cochrane review screening process at the end of the first round. If consensus is not reached after the second round we will provide feedback prior to a third round. Remaining outcomes will be discussed at a face-to-face meeting and agreement will be measured via defined consensus rules of outcome inclusion. DISCUSSION The inclusive consensus process should provide a core outcome set that is relevant to all key stakeholders. We will actively disseminate our findings to help improve clinical trials, systematic reviews and clinical guidelines with the ultimate aim of improving the prevention and management of periodontal diseases. TRIAL REGISTRATION COMET ( http://www.comet-initiative.org/studies/details/265?result=true ). Registered on August 2012.
Collapse
Affiliation(s)
- Thomas J Lamont
- Dundee Dental School, Park Place, University of Dundee, Dundee, UK.
| | - Jan E Clarkson
- Dundee Dental School, Park Place, University of Dundee, Dundee, UK
| | | | - Peter A Heasman
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
39
|
Beresescu GF, Ormenisan A, Szekely M, Monea M, Monea A. Clinical Outcomes after Regenerative Periodontal Therapy with Emdogain. ACTA MEDICA MARISIENSIS 2017. [DOI: 10.1515/amma-2017-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective: Regeneration is defined as a reconstruction of a lost part of the body in such a way that the structure and function of the lost tissue are completely restored. The aim of this study is to compare the clinical outcomes of intrabony defects treatment using regenerative periodontal therapy with enamel matrix proteins (Emdogain, EMD) with a control group.
Methods: Ten patients with chronic periodontitis were included in this randomized, controlled clinical study. Two groups received conservative periodontal therapy. In the test group, different teeth received regenerative treatment with EMD. In the control group teeth received solely conservative periodontal therapy. Pocket depth probing (PD) and bone reduction (based on X rays) were registered at baseline and after eight months in both groups. In the control group
Results: Both groups showed a significant reduction of PD. The teeth treated with EMD showed a significant attachment gain. Within the test group, the radiographic examination of the teeth treated with EMD showed no significant change, whereas the teeth in the control group showed significant bone reduction.
Conclusions: Intrabony defects in teeth treaded with EMD exhibit a substantially higher gain in clinical attachment and defect filling. The use of EMD in dental practice can prevent further bone loss.
Collapse
Affiliation(s)
| | - Alina Ormenisan
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine , University of Medicine and Pharmacy Tirgu Mures , Romania
| | - Melinda Szekely
- Department of Tooth and Dental Arch Morphology, Faculty of Dental Medicine , University of Medicine and Pharmacy Tirgu Mures , Romania
| | - Monica Monea
- Department of Odontology and Oral Pathology, Faculty of Dental Medicine , University of Medicine and Pharmacy Tirgu Mures , Romania
| | - Adriana Monea
- Department of Odontology and Oral Pathology, Faculty of Dental Medicine , University of Medicine and Pharmacy Tirgu Mures , Romania
| |
Collapse
|
40
|
Canabarro A, Marcantonio É, De-Deus G. Use of the Strength of Recommendation Taxonomy (SORT) to assess full-mouth treatments of chronic periodontitis. J Oral Sci 2015; 57:345-53. [PMID: 26666858 DOI: 10.2334/josnusd.57.345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Previous studies have not resolved whether scaling and root planing with a full-mouth (with or without antiseptics) or quadrant approach is better for treatment of chronic periodontitis. We identified relevant studies and used Strength of Recommendation Taxonomy (SORT) criteria to critically interpret the results of all relevant studies. A literature search was performed using the PubMed, EMBASE, and Cochrane databases up to July 2015. Selected studies were stratified according to their quality, quantity, and consistency. In total, 377 studies were identified, and 36 articles selected for retrieval were stratified according SORT criteria, as follows: no level 1 studies, 15 level 2 studies, and 21 level 3 studies (which were excluded from subsequent analysis). Among the selected level 2 studies, including seven randomized clinical trials and three systematic reviews, 67% showed no significant difference between scaling and root planing with a full-mouth or quadrant approach. In conclusion, on the basis of the best available data, the strength of evidence is grade B (consistent, low-quality evidence) for full-mouth (with or without antiseptics) and quadrant scaling and root planing for treatment of chronic periodontitis.
Collapse
Affiliation(s)
- Antonio Canabarro
- Department of Periodontology, School of Dentistry, Veiga de Almeida University
| | | | | |
Collapse
|