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Yang M, Peng R, Li X, Peng J, Liu L, Chen L. Association between chronic obstructive pulmonary disease and periodontal disease: a systematic review and meta-analysis. BMJ Open 2023; 13:e067432. [PMID: 37369414 PMCID: PMC10410961 DOI: 10.1136/bmjopen-2022-067432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Objectives Studies have suggested contradictory results on the relationship between chronic obstructive pulmonary disease (COPD) and periodontal disease (PD). The aim of this study was to determine whether PD increased the risk of COPD and COPD-related clinical events. Design A systematic review and meta-analysis. Data sources PubMed, Ovid EMBASE and Ovid CENTRAL were searched from inception to 22 February 2023. Eligibility criteria for studies We included trials and observational studies evaluating association of PD with the risk of COPD or COPD-related events (exacerbation and mortality), with statistical adjustment for smoking. Data extraction and synthesis Two investigators independently extracted data from selected studies using a standardised Excel file. Quality of studies was evaluated using the Newcastle-Ottawa Scale. OR with 95% CI was pooled in a random-effect model with inverse variance method. Results 22 observational studies with 51 704 participants were included. Pooled analysis of 18 studies suggested that PD was weakly associated with the risk of COPD (OR: 1.20, 95% CI 1.09 to 1.32). However, in stratified and subgroup analyses, with strict adjustment for smoking, PD no longer related to the risk of COPD (adjusting for smoking intensity: OR: 1.14, 95% CI 0.86 to 1.51; smokers only: OR: 1.46, 95% CI 0.92 to 2.31; never smokers only: OR: 0.93, 95% CI 0.72 to 1.21). Moreover, PD did not increase the risk of COPD-related exacerbation or mortality (OR: 1.18, 95% CI 0.71 to 1.97) in the pooled result of four studies. Conclusions This study demonstrates PD confers no risk for COPD and COPD-related events when strictly adjusted by smoking. Large-scale prospective cohort studies with control of potential confounding factors are warranted to validate the present findings.
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Affiliation(s)
- Mei Yang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ran Peng
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, 363 Hospital, Chengdu, Sichuan, China
| | - Xiaoou Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junjie Peng
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Liu
- Department of Pulmonary and Critical Care Medicine, 363 Hospital, Chengdu, Sichuan, China
| | - Lei Chen
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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2
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Meng Z, Wu C, Lin L. THE EFFECT DIRECTION SHOULD BE TAKEN INTO ACCOUNT WHEN ASSESSING SMALL-STUDY EFFECTS. J Evid Based Dent Pract 2023; 23:101830. [PMID: 36914304 PMCID: PMC10014930 DOI: 10.1016/j.jebdp.2022.101830] [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] [Received: 09/03/2022] [Revised: 11/17/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Studies with statistically significant results are frequently more likely to be published than those with non-significant results. This phenomenon leads to publication bias or small-study effects and can seriously affect the validity of the conclusion from systematic reviews and meta-analyses. Small-study effects typically appear in a specific direction, depending on whether the outcome of interest is beneficial or harmful, but this direction is rarely taken into account in conventional methods. METHODS We propose to use directional tests to assess potential small-study effects. The tests are built on a one-sided testing framework based on the existing Egger's regression test. We performed simulation studies to compare the proposed one-sided regression tests, conventional two-sided regression tests, as well as two other competitive methods (Begg's rank test and the trim-and-fill method). Their performance was measured by type I error rates and statistical power. Three real-world meta-analyses on measurements of infrabony periodontal defects were also used to examine the various methods' performance. RESULTS Based on simulation studies, the one-sided tests could have considerably higher statistical power than competing methods, particularly their two-sided counterparts. Their type I error rates were generally controlled well. In the case study of the three real-world meta-analyses, by accounting for the favored direction of effects, the one-sided tests could rule out potential false-positive conclusions about small-study effects. They also are more powerful in assessing small-study effects than the conventional two-sided tests when true small-study effects likely exist. CONCLUSION We recommend researchers incorporate the potential favored direction of effects into the assessment of small-study effects.
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Affiliation(s)
- Zhuo Meng
- Department of Statistics, Florida State University, Tallahassee, United States of America
| | - Chong Wu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Lifeng Lin
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, United States of America.
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3
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Sparbrod M, Gager Y, Koehler AK, Jentsch H, Stingu CS. Relationship between Phenotypic and Genotypic Resistance of Subgingival Biofilm Samples in Patients with Periodontitis. Antibiotics (Basel) 2022; 12:antibiotics12010068. [PMID: 36671269 PMCID: PMC9854985 DOI: 10.3390/antibiotics12010068] [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: 11/28/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023] Open
Abstract
The phenotypic expression of antibiotic resistance genes (ARGs) can hamper the use of antibiotics as adjuncts to subgingival instrumentation in the treatment of periodontitis patients. The aim of the study was to analyze the relationship between the phenotypic and genotypic resistance against ampicillin-sulbactam, clindamycin, doxycycline and metronidazole of subgingival biofilm samples from 19 periodontitis patients. Samples were analyzed with shotgun sequencing and cultivated anaerobically for 7 days on microbiological culture media incorporating antibiotics. All growing isolates were identified to the species level using MALDI-TOF-MS and sequence analysis of the 16S ribosomal RNA (rRNA) gene. Phenotypic resistance was determined using EUCAST-breakpoints. The genetic profile of eight patients matched completely with phenotypical resistance to the tested antibiotics. The positive predictive values varied from 1.00 for clindamycin to 0.57 for doxycycline and 0.25 for ampicillin-sulbactam. No sample contained the nimI gene. It can be concluded that antibiotic resistance may be polygenetic and genes may be silent. Every biofilm sample harboring erm genes was phenotypic resistant. The absence of cfx and tet genes correlated to 100%, respectively, to 75%, with the absence of phenotypic resistance. The absence of nimI genes leads to the assumption that constitutive resistance among several species could explain the resistance to metronidazole.
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Affiliation(s)
- Moritz Sparbrod
- Institute for Medical Microbiology and Virology, University Hospital Leipzig, 04103 Leipzig, Germany
- Correspondence: (M.S.); (C.-S.S.)
| | | | | | - Holger Jentsch
- Center of Periodontology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Catalina-Suzana Stingu
- Institute for Medical Microbiology and Virology, University Hospital Leipzig, 04103 Leipzig, Germany
- Correspondence: (M.S.); (C.-S.S.)
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4
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Vollmer A, Vollmer M, Lang G, Straub A, Shavlokhova V, Kübler A, Gubik S, Brands R, Hartmann S, Saravi B. Associations between Periodontitis and COPD: An Artificial Intelligence-Based Analysis of NHANES III. J Clin Med 2022; 11:jcm11237210. [PMID: 36498784 PMCID: PMC9737076 DOI: 10.3390/jcm11237210] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
A number of cross-sectional epidemiological studies suggest that poor oral health is associated with respiratory diseases. However, the number of cases within the studies was limited, and the studies had different measurement conditions. By analyzing data from the National Health and Nutrition Examination Survey III (NHANES III), this study aimed to investigate possible associations between chronic obstructive pulmonary disease (COPD) and periodontitis in the general population. COPD was diagnosed in cases where FEV (1)/FVC ratio was below 70% (non-COPD versus COPD; binary classification task). We used unsupervised learning utilizing k-means clustering to identify clusters in the data. COPD classes were predicted with logistic regression, a random forest classifier, a stochastic gradient descent (SGD) classifier, k-nearest neighbors, a decision tree classifier, Gaussian naive Bayes (GaussianNB), support vector machines (SVM), a custom-made convolutional neural network (CNN), a multilayer perceptron artificial neural network (MLP), and a radial basis function neural network (RBNN) in Python. We calculated the accuracy of the prediction and the area under the curve (AUC). The most important predictors were determined using feature importance analysis. Results: Overall, 15,868 participants and 19 feature variables were included. Based on k-means clustering, the data were separated into two clusters that identified two risk characteristic groups of patients. The algorithms reached AUCs between 0.608 (DTC) and 0.953% (CNN) for the classification of COPD classes. Feature importance analysis of deep learning algorithms indicated that age and mean attachment loss were the most important features in predicting COPD. Conclusions: Data analysis of a large population showed that machine learning and deep learning algorithms could predict COPD cases based on demographics and oral health feature variables. This study indicates that periodontitis might be an important predictor of COPD. Further prospective studies examining the association between periodontitis and COPD are warranted to validate the present results.
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Affiliation(s)
- Andreas Vollmer
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, 97070 Würzburg, Germany
- Correspondence:
| | - Michael Vollmer
- Department of Oral and Maxillofacial Surgery, Tuebingen University Hospital, Osianderstrasse 2-8, 72076 Tuebingen, Germany
| | - Gernot Lang
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany
| | - Anton Straub
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, 97070 Würzburg, Germany
| | - Veronika Shavlokhova
- Division of Medicine, Department of Oral and Maxillofacial Surgery, University Hospital Ruppin-Brandenburg, Brandenburg Medical School, Fehrbelliner Straße 38, 16816 Neuruppin, Germany
| | - Alexander Kübler
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, 97070 Würzburg, Germany
| | - Sebastian Gubik
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, 97070 Würzburg, Germany
| | - Roman Brands
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, 97070 Würzburg, Germany
| | - Stefan Hartmann
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, 97070 Würzburg, Germany
| | - Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany
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5
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Fu L, Khazaeinezhad R, Hariri A, Qi B, Chen C, Jokerst JV. Posterior photoacoustic/ultrasound imaging of the periodontal pocket with a compact intraoral transducer. PHOTOACOUSTICS 2022; 28:100408. [PMID: 36204181 PMCID: PMC9530592 DOI: 10.1016/j.pacs.2022.100408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/15/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
Periodontitis is a public issue and imaging periodontal pocket is important to evaluate periodontitis. Regular linear transducers have limitations in imaging the posterior teeth due to their geometry restrictions. Here we characterized a transducer that can image the posterior teeth including assessment of periodontal pockets via a combination of photoacoustic and ultrasound imaging. Unlike conventional transducer design, this device has a toothbrush-shaped form factor with a side-view transducer to image molars (total size: 1 ×1.9 cm). A laser diode was integrated as the light source to reduce the cost and size and facilitates clinical transition. The in vivo imaging of a molar of a periodontal patient demonstrated that the transducer could image in the posterior area of gum in vivo; the value determined by imaging was within 7 % of the value measured clinically.
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Affiliation(s)
- Lei Fu
- Department of NanoEngineering, University of California San Diego, La Jolla, CA 92093, USA
| | | | - Ali Hariri
- StyloSonic LLC, Lake Forest, CA 92630, USA
| | - Baiyan Qi
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA 92093, USA
| | - Casey Chen
- Herman Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA
| | - Jesse V. Jokerst
- Department of NanoEngineering, University of California San Diego, La Jolla, CA 92093, USA
- StyloSonic LLC, Lake Forest, CA 92630, USA
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA 92093, USA
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
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6
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Gardelis P, Zekeridou A, Suh N, Le Terrier C, Stavropoulos A, Giannopoulou C. A pilot clinical and radiographic study on the association between periodontitis and serious COVID‐19 infection. Clin Exp Dent Res 2022; 8:1021-1027. [PMID: 35932180 PMCID: PMC9562574 DOI: 10.1002/cre2.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 11/19/2022] Open
Abstract
Background During the pandemic of COVID‐19, the scientific community tried to identify the risk factors that aggravate the viral infection. Oral health and specifically periodontitis have been shown to have a significant impact on overall health. Current, yet limited, evidence suggests a link between periodontal status and severity of COVID‐19 infection. Objectives The present pilot study aimed to assess whether younger patients (≤60 years) that have been hospitalized in the intensive care unit (ICU) for severe COVID‐19 infection were susceptible to severe periodontitis. Material and Methods All dentate patients ≤60 years of age diagnosed with COVID‐19 and surviving hospitalization in the ICU were considered for inclusion. Susceptibility to periodontitis was determined by assessing radiographic bone loss (RBL) in recent dental radiographs (posterior bitewings, periapical, and panoramic X‐rays). RBL in % was obtained from the most affected tooth and patients were classified into: Stage I, RBL ≤ 15%; Stage II, RBL = 15%−33% and Stage III/IV, RBL ≥ 33%. The grade was defined using the RBL to age ratio on the most severely affected tooth. Patients were attributed to: Grade A, ratio <0.25; Grade B, ratio 0.25−1 and Grade C, ratio >1. Patients classified into Stage III/IV and Grade C were considered highly susceptible to periodontitis. Results Of 87 eligible patients, 30 patients were finally assessed radiographically and/or clinically; from the remaining 57 patients, 16 refused participation for various reasons and 41 could not be reached. Based on the radiographic assessment, all patients were periodontally compromised. Half of them were classified with Stage III/IV and Grade B or C; 26.7% were classified with Stage III/IV and Grade C. Conclusions The present pilot study showed that about half of the patients suffering from severe forms of COVID‐19 infection in need of ICU admission suffered also from severe periodontitis, and about one‐fourth of them were highly susceptible to it.
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Affiliation(s)
- Panagiotis Gardelis
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine University of Geneva Geneva Switzerland
| | - Alkisti Zekeridou
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine University of Geneva Geneva Switzerland
| | - Noemie Suh
- Intensive Care Unit, Department of Acute Medicine University Hospitals of Geneva Geneva Switzerland
| | - Christophe Le Terrier
- Intensive Care Unit, Department of Acute Medicine University Hospitals of Geneva Geneva Switzerland
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology Malmo University Malmo Sweden
- Division of Conservative Dentistry and Periodontology University Clinic of Dentistry, Medical University of Vienna Vienna Austria
| | - Catherine Giannopoulou
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine University of Geneva Geneva Switzerland
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7
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The Use of Probiotics as Adjuvant Therapy of Periodontal Treatment: A Systematic Review and Meta-Analysis of Clinical Trials. Pharmaceutics 2022; 14:pharmaceutics14051017. [PMID: 35631603 PMCID: PMC9143599 DOI: 10.3390/pharmaceutics14051017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
For many years, the use of probiotics in periodontitis treatment was reflected in their abilities to control the immune response of the host to the presence of pathogenic microorganisms and to upset periodontopathogens. Accordingly, the aim of the present study was to assess the use of probiotics as adjuvant therapy on clinical periodontal parameters throughout a systematic review and meta-analysis. The literature was screened, up to 4 June 2021, by two independent reviewers (L.H. and R.B.) in four electronic databases: PubMed (MedLine), ISI Web of Science, Scielo, and Scopus. Only clinical trials that report the effect of the use of probiotics as adjuvants in the treatment of periodontal disease were included. Comparisons were carried out using Review Manager Software version 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). A total of 21 studies were considered for the meta-analysis. For the index plaque, the use of probiotics did not improve this clinical parameter (p = 0.16). On the other hand, for the periodontal pocket depth, the clinical attachment loss, the bleeding on probing, and the use of probiotics as adjuvant therapy resulted in an improvement of these parameters, since the control group achieved statistically higher values of this parameter (p < 0.001; p < 0.001; and p = 0.005, respectively). This study suggests that the use of probiotics led to an improvement in periodontal pocket depth, clinical attachment loss, and bleeding on probing parameters. On the other hand, this protocol seems to not be beneficial for the index plaque parameter.
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Fu L, Ling C, Jin Z, Luo J, Palma-Chavez J, Wu Z, Zhou J, Zhou J, Donovan B, Qi B, Mishra A, He T, Jokerst JV. Photoacoustic imaging of posterior periodontal pocket using a commercial hockey-stick transducer. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-210363GR. [PMID: 35610752 PMCID: PMC9128833 DOI: 10.1117/1.jbo.27.5.056005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/02/2022] [Indexed: 06/02/2023]
Abstract
SIGNIFICANCE Photoacoustic imaging has shown advantages over the periodontal probing method in measuring the periodontal probing depth, but the large size of conventional photoacoustic transducers prevents imaging of the more posterior teeth. AIM Our aim is to develop a photoacoustic imaging system to image the more posterior periodontal pocket. APPROACH We report a clinical "hockey-stick"-style transducer integrated with fibers for periodontal photoacoustic imaging. Cuttlefish ink labeled the periodontal pocket as the photoacoustic contrast agent. RESULTS We characterized the imaging system and then measured the pocket depth of 35 swine teeth. Three raters evaluated the performance of the hockey-stick transducer. The measurements between the Williams probing (gold standard) and the photoacoustic methods were blinded but highly correlated. We showed a bias of ∼0.3 mm for the imaging-based technique versus Williams probing. The minimum inter-reliability was over 0.60 for three different raters of varying experience, suggesting that this approach to measure the periodontal pocket is reproducible. Finally, we imaged three pre-molars of a human subject. We could access more upper and posterior teeth than conventional linear transducers. CONCLUSIONS The unique angle shape of the hockey-stick transducer allows it to image more posterior teeth than regular linear transducers. This study demonstrated the ability of a hockey-stick transducer to measure the periodontal pocket via photoacoustic imaging.
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Affiliation(s)
- Lei Fu
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Chen Ling
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Zhicheng Jin
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Jessica Luo
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Jorge Palma-Chavez
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Zhuohong Wu
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Jingcheng Zhou
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Jiajing Zhou
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Brian Donovan
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Baiyan Qi
- University of California San Diego, Materials Science and Engineering Program, La Jolla, California, United States
| | - Aditya Mishra
- University of California San Diego, Materials Science and Engineering Program, La Jolla, California, United States
| | - Tengyu He
- University of California San Diego, Materials Science and Engineering Program, La Jolla, California, United States
| | - Jesse V. Jokerst
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
- University of California San Diego, Materials Science and Engineering Program, La Jolla, California, United States
- University of California San Diego, Department of Radiology, La Jolla, California, United States
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9
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Majeed MM, Ahmed I, Roome T, Alali Y, Al-Aali KA, Ahmed N, Saleem Z, Alhumaidan AA, Farooqui WA, Ahmed S, Vohra F, Abduljabbar T. Association of the Unstimulated Whole Salivary Cytokine IL-1β Levels with Initial, Moderate and Severe Periodontitis. A Case Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052889. [PMID: 35270581 PMCID: PMC8910701 DOI: 10.3390/ijerph19052889] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 01/03/2023]
Abstract
Periodontitis (P) is a highly prevalent inflammatory disease of the oral cavity. The objective of the study was to evaluate the stages of pro-inflammatory cytokine IL-1β in initial, moderate and severe periodontitis. One hundred and twenty two patients were included in the study. Periodontitis subjects had at least 20 natural teeth and ≥8 sites with pocket depths of >4 mm and clinical attachment loss (CAL). A questionnaire was used with respect to the socio demographic parameters which included age, gender, ethnicity, education, marital, residence and occupation. To categorize the severity of the disease, teeth were assessed for, Plaque index (PI), Bleeding on probing (BOP), CAL, missing tooth, tooth mobility and bone loss. Unstimulated whole saliva (UWS) was collected and Interleukin-1β (IL-1β) cytokine levels were analyzed using enzyme linked immunosorbent assay with microplate reader at 450 nm. Clinical parameters and salivary cytokine concentrations were assessed using one-way analysis of variance, whereas a correlation of cases with gender and severity of periodontitis was evaluated using chi-square test. Fifty-nine patients were healthy controls and 63 were periodontitis patients Thirty two percent (n = 20) had initial periodontitis, 40% (n = 25) suffered from moderate and 29% (n = 18) had severe periodontitis. Periodontitis subgroups were significantly different with regards to age and gender (p < 0.001). The mean PPD and CAL among the periodontitis patients (PPD, 3.52 ± 1.25 mm; CAL, 4.04 ± 1.64 mm) were significantly compromised (p < 0.05) compared to healthy controls (PPD, 1.52 ± 0.73 mm; CAL, 0.08 ± 0.28 mm). Increased levels of IL-1β were associated with high CAL and PPD findings. UWS IL-1β levels were higher in periodontitis patients compared to healthy individuals. In addition, cases of severe periodontitis showed significantly higher UWS IL-1β levels compared to initial and moderate periodontitis patients. Comparative levels of salivary IL-1β can be potentially used as a diagnostic tool for periodontitis identification and disease progression along with clinical parameters.
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Affiliation(s)
- Muhammad M. Majeed
- Department of Oral Biology, Altamash Institute of Dental Medicine, Karachi 75500, Pakistan;
| | - Imtiaz Ahmed
- Department of Orthodontics, Dow University of Health Sciences, Karachi 74200, Pakistan;
| | - Talat Roome
- Section of Molecular Pathology, Dow University of Health Sciences, Karachi 74200, Pakistan;
| | - Yasser Alali
- Department of Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Khulud A. Al-Aali
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia;
| | - Naseer Ahmed
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi 75500, Pakistan;
| | - Zohra Saleem
- Deprtment of Oral and Maxillofacial Surgery, Dow University of Health Sciences, Karachi 74200, Pakistan;
| | - Abdulkareem A. Alhumaidan
- Preventive Dental Sciences Department, College of Dentistry, Imam Abdulrahman bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Waqas A. Farooqui
- School of Public Health, Dow University of Health Sciences, Karachi 74200, Pakistan;
| | - Saeeda Ahmed
- Department of Public Health, Baqai Mecial University, Karachi 75340, Pakistan;
| | - Fahim Vohra
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh 12372, Saudi Arabia;
| | - Tariq Abduljabbar
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh 12372, Saudi Arabia;
- Correspondence: ; Tel.: +966-1434555
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10
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Lee CT, Kabir T, Nelson J, Sheng S, Meng HW, Van Dyke TE, Walji MF, Jiang X, Shams S. Use of the deep learning approach to measure alveolar bone level. J Clin Periodontol 2022; 49:260-269. [PMID: 34879437 PMCID: PMC9026777 DOI: 10.1111/jcpe.13574] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/21/2021] [Accepted: 11/12/2021] [Indexed: 12/24/2022]
Abstract
AIM The goal was to use a deep convolutional neural network to measure the radiographic alveolar bone level to aid periodontal diagnosis. MATERIALS AND METHODS A deep learning (DL) model was developed by integrating three segmentation networks (bone area, tooth, cemento-enamel junction) and image analysis to measure the radiographic bone level and assign radiographic bone loss (RBL) stages. The percentage of RBL was calculated to determine the stage of RBL for each tooth. A provisional periodontal diagnosis was assigned using the 2018 periodontitis classification. RBL percentage, staging, and presumptive diagnosis were compared with the measurements and diagnoses made by the independent examiners. RESULTS The average Dice Similarity Coefficient (DSC) for segmentation was over 0.91. There was no significant difference in the RBL percentage measurements determined by DL and examiners ( p = .65 ). The area under the receiver operating characteristics curve of RBL stage assignment for stages I, II, and III was 0.89, 0.90, and 0.90, respectively. The accuracy of the case diagnosis was 0.85. CONCLUSIONS The proposed DL model provides reliable RBL measurements and image-based periodontal diagnosis using periapical radiographic images. However, this model has to be further optimized and validated by a larger number of images to facilitate its application.
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Affiliation(s)
- Chun-Teh Lee
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas, USA
| | - Tanjida Kabir
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jiman Nelson
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas, USA
| | - Sally Sheng
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas, USA
| | - Hsiu-Wan Meng
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas, USA
| | - Thomas E. Van Dyke
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, Massachusetts, USA
- Department of Oral Medicine, Infection, and Immunity, Faculty of Medicine, Harvard University, Boston, Massachusetts, USA
| | - Muhammad F. Walji
- Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas, USA
| | - Xiaoqian Jiang
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Shayan Shams
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Applied Data Science, San Jose State University, San Jose, California, USA
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Thim T, Scholz KJ, Hiller KA, Buchalla W, Kirschneck C, Fleiner J, Woelber JP, Cieplik F. Radiographic Bone Loss and Its Relation to Patient-Specific Risk Factors, LDL Cholesterol, and Vitamin D: A Cross-Sectional Study. Nutrients 2022; 14:nu14040864. [PMID: 35215516 PMCID: PMC8877125 DOI: 10.3390/nu14040864] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/01/2022] [Accepted: 02/16/2022] [Indexed: 02/01/2023] Open
Abstract
The influence of patient-specific factors such as medical conditions, low-density lipoprotein cholesterol (LDL-C) or levels of 25-hydroxyvitamin D (25OHD) on periodontal diseases is frequently discussed in the literature. Therefore, the aim of this retrospective cross-sectional study was to evaluate potential associations between radiographic bone loss (RBL) and patient-specific risk factors, particularly LDL-C and 25OHD levels. Patients from a dental practice, who received full-mouth cone beam CTs (CBCTs) and blood-sampling in the course of implant treatment planning, were included in this study. RBL was determined at six sites per tooth from CBCT data. LDL-C and 25OHD levels were measured from venous blood samples. Other patient-specific risk factors were assessed based on anamnesis and dental charts. Statistical analysis was performed applying non-parametric procedures (Mann–Whitney U tests, error rates method). Data from 163 patients could be included in the analysis. RBL was significantly higher in male patients, older age groups, smokers, patients with high DMFT (decayed/missing/filled teeth) score, lower number of teeth, and high LDL-C levels (≥160 mg/dL). Furthermore, patients with high 25OHD levels (≥40 ng/mL) exhibited significantly less RBL. In summary, RBL was found to be associated with known patient-specific markers, particularly with age and high LDL-C levels.
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Affiliation(s)
- Teresa Thim
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany; (T.T.); (K.J.S.); (K.-A.H.); (W.B.)
- Private Practice, 63110 Rodgau, Germany
| | - Konstantin Johannes Scholz
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany; (T.T.); (K.J.S.); (K.-A.H.); (W.B.)
| | - Karl-Anton Hiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany; (T.T.); (K.J.S.); (K.-A.H.); (W.B.)
| | - Wolfgang Buchalla
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany; (T.T.); (K.J.S.); (K.-A.H.); (W.B.)
| | - Christian Kirschneck
- Department of Orthodontics, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Jonathan Fleiner
- Center of Dental Implantology, Periodontology and 3D-Imaging, 78462 Konstanz, Germany;
| | - Johan Peter Woelber
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany;
| | - Fabian Cieplik
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany; (T.T.); (K.J.S.); (K.-A.H.); (W.B.)
- Correspondence:
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12
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Development of a Radiographic Index for Periodontitis. Dent J (Basel) 2021; 9:dj9020019. [PMID: 33562404 PMCID: PMC7915110 DOI: 10.3390/dj9020019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/25/2022] Open
Abstract
The use of radiographic indices is noticeably diminished due to the lack of simplicity and standardisation among the existing ones. The aim of this study was to introduce a radiographic index to aid clinicians in determining the extent and severity of interproximal alveolar bone loss (iABL), in relation to individual root lengths, among patients suffering from periodontitis. A retrospective analysis of 50 anonymised dental panoramic tomograms (DPTs) of patients with periodontitis was conducted. Visual interpretation of iABL was recorded by a single investigator and by 20 volunteering clinicians for the ‘worst site’ in each quintet. Results were compared to a gold standard quantification method. Intra-examiner and inter-examiner agreement were measured using the Kappa coefficient and the intra-class correlation coefficient, respectively. Validity was assessed using Cramér’s V test. The mean intra-examiner agreement on the severity and pattern of iABL was 0.808 (K) and 0.802 (K), respectively. A stronger overall inter-examiner agreement was noted when the severity in contrast to the pattern of iABL and presence/absence of furcation involvement were analysed. The statistically significant total mean agreement values from this correlation coefficient were 0.892 and 0.739, respectively. A very strong association between all the visual interpretations carried out by all participants and the gold standard measurements was evident. Within the limitations of this study, the proposed radiographic index may serve as a simple, yet valid and reliable, adjunctive screening tool to further assist clinicians in determining the extent and severity of iABL in patients with periodontitis.
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13
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Farook FF, Alodwene H, Alharbi R, Alyami M, Alshahrani A, Almohammadi D, Alnasyan B, Aboelmaaty W. Reliability assessment between clinical attachment loss and alveolar bone level in dental radiographs. Clin Exp Dent Res 2020; 6:596-601. [PMID: 32918518 PMCID: PMC7745069 DOI: 10.1002/cre2.324] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 12/24/2022] Open
Abstract
Background The clinical attachment level (CAL) and radiographically assessed bone levels are used to assess the loss of periodontal tissue support in periodontitis, a chronic, multifactorial inflammatory disease of the periodontium. However, few studies have been done to study the relationship between these two parameters. According to our knowledge, this is the first study investigating the relationship between the two measurements using intraclass correlation analysis. Aim The aim of the study is to investigate the relationship between CAL and radiographically assessed bone level in teeth affected with periodontitis. Methods A retrospective cross‐sectional study was conducted by selecting a sample of 880 periodontal sites in 104 periodontitis patients, aged 25–60 years. CAL and peri‐apical radiographs of the selected sites were obtained from the computerized patient records. The distance from the cemento‐enamel junction (CEJ) to the base of the alveolar bone level (ABL) was measured. The data was analyzed using SPSS. Results Intraclass correlation analysis (ICC) revealed a moderate degree of reliability between CAL and CEJ to ABL measurements. The average ICC was 0.68 with a 95% confidence interval of 0.53–0.77 (p < .001) indicating moderate to good reliability. Comparing the types of teeth, the central incisors, particularly the lower central incisors showed the highest ICC values (ICC: 0.822, CI: 0.77–0.86) indicating good reliability while the premolar and molars showed poor to moderate agreement (Maxillary premolars ICC: 0.464, CI: −0.18–0.74; maxillary first molar ICC: 0.516, CI: −0.154–0.772; mandibular first premolar ICC: 0.662, CI: 0.269–0.782; mandibular first molar ICC: 0.625, CI: 0.31–0.82). A moderate correlation existed between the radiographic and the clinical assessments (r = 0.5, p < .001). Conclusion Despite the fact that significant varying levels of reliability has been found between CAL and radiographic bone level, both the clinical and radiographic examinations should be performed for the accuracy of diagnosis.
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Affiliation(s)
- Fathima Fazrina Farook
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hussah Alodwene
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Rasha Alharbi
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Meral Alyami
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Amjad Alshahrani
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Duaa Almohammadi
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Bothinah Alnasyan
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Wael Aboelmaaty
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oral Radiology and Diagnostic Sciences, Faculty of Dentistry, Mansoura University, Egypt
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