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Tokede B, Yansane A, Brandon R, Lin GH, Lee CT, White J, Jiang X, Lee E, Alsaffar A, Walji M, Kalenderian E. The burden of diagnostic error in dentistry: A study on periodontal disease misclassification. J Dent 2024; 148:105221. [PMID: 38960000 DOI: 10.1016/j.jdent.2024.105221] [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: 05/10/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Periodontal disease constitutes a widely prevalent category of non-communicable diseases and ranks among the top 10 causes of disability worldwide. Little however is known about diagnostic errors in dentistry. In this work, by retrospectively deploying an electronic health record (EHR)-based trigger tool, followed by gold standard manual review, we provide epidemiological estimates on the rate of diagnostic misclassification in dentistry through a periodontal use case. METHODS An EHR-based trigger tool (a retrospective record review instrument that uses a list of triggers (or clues), i.e., data elements within the health record, to alert reviewers to the potential presence of a wrong diagnosis) was developed, tested and run against the EHR at the two participating sites to flag all cases having a potential misdiagnosis. All cases flagged as potentially misdiagnosed underwent extensive manual reviews by two calibrated domain experts. A subset of the non-flagged cases was also manually reviewed. RESULTS A total of 2,262 patient charts met the study's inclusion criteria. Of these, the algorithm flagged 1,124 cases as potentially misclassified and 1,138 cases as potentially correctly diagnosed. When the algorithm identified a case as potentially misclassified, compared to the diagnosis assigned by the gold standard, the kappa statistic was 0.01. However, for cases the algorithm marked as potentially correctly diagnosed, the review against the gold standard showed a kappa statistic of 0.9, indicating near perfect agreement. The observed proportion of diagnostic misclassification was 32 %. There was no significant difference by clinic or provider characteristics. CONCLUSION Our work revealed that about a third of periodontal cases are misclassified. Diagnostic errors have been reported to happen more frequently than other types of errors, and to be more preventable. Benchmarking diagnostic quality is a first step. Subsequent research endeavor will delve into comprehending the factors that contribute to diagnostic errors in dentistry and instituting measures to prevent them. CLINICAL SIGNIFICANCE This study sheds light on the significance of diagnostic excellence in the delivery of dental care, and highlights the potential role of technology in aiding diagnostic decision-making at the point of care.
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Affiliation(s)
- Bunmi Tokede
- Department of Diagnostic and Biomedical Sciences, Health Science Center, University of Texas at Houston, Houston, TX, USA.
| | - Alfa Yansane
- Preventive and Restorative Dental Sciences, University of California, San Francisco/ UCSF School of Dentistry, 3333 California Street, Ste. 495, San Francisco, CA, 94118, USA
| | - Ryan Brandon
- Willamette Dental Group and Skourtes Institute, Hillsboro, OR, USA
| | - Guo-Hao Lin
- Postgraduate Periodontics Program, School of Dentistry, University of California, 707 Parnassus Avenue, D-3015, San Francisco, CA 94143, USA
| | - Chun-Teh Lee
- Department of Periodontics & Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge Street, Suite 6470, USA
| | - Joel White
- Preventive and Restorative Dental Sciences, University of California, San Francisco/ UCSF School of Dentistry, 707 Parnassus Avenue, D-3248, Box 0758, San Francisco, CA 94143, USA
| | - Xiaoqian Jiang
- UTHealth School of Biomedical informatics, 7000 Fannin St Suite 600, Houston, TX 77030, USA
| | - Eric Lee
- Department of Orofacial Sciences, University of California San Francisco, USA
| | - Alaa Alsaffar
- Department of Periodontics & Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge Street, Suite 6470, USA
| | - Muhammad Walji
- Department of Diagnostic and Biomedical Sciences, Health Science Center, University of Texas at Houston, Houston, TX, USA; UTHealth School of Biomedical informatics, 7000 Fannin St Suite 600, Houston, TX 77030, USA
| | - Elsbeth Kalenderian
- Surgical Sciences, Marquette School of Dentistry, 1801 West Wisconsin Avenue, PO Box 1881, Milwaukee, WI, USA
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AlJaafary AA, Alahmari R, AlHumaid NA. Epidemiology of Periodontal Diseases in Individuals With Diabetes in Saudi Arabia: A Systematic Review. Cureus 2024; 16:e67721. [PMID: 39318963 PMCID: PMC11421309 DOI: 10.7759/cureus.67721] [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] [Accepted: 08/25/2024] [Indexed: 09/26/2024] Open
Abstract
Diabetes mellitus (DM) is one of the most common and prevalent metabolic disorders worldwide. It affects men, women, and children and can cause severe organ damage, including kidney damage. The two most common types of DM are Type 1 DM and Type 2 DM. Similarly, periodontal disease (PD) affects a significant portion of the population and involves the tissues supporting the teeth. The bidirectional relationship between diabetes and PD is a well-established phenomenon. However, no comprehensive study on the prevalence of PD among diabetic patients has been conducted on the Saudi population. This systematic review aims to examine the current literature on the impact of these conditions on the Saudi population. A literature search was conducted from January 2001 through June 2024 using Scopus, PubMed, and Google Scholar. An extensive search was performed, duplicates were removed, and inclusion and exclusion criteria were applied. Nine studies were selected for review, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The retrieved studies confirm the relationship between DM and PDs in regional studies. The review highlights the need for integrated healthcare approaches to manage both conditions effectively. Further research is recommended to understand the causal mechanisms and develop comprehensive treatment strategies.
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Affiliation(s)
- Abdulaziz A AlJaafary
- Family Medicine, King Fahad Medical City in Riyadh, Health Cluster 2, Ministry of Health, Riyadh, SAU
| | - Raed Alahmari
- Family Medicine, King Fahad Medical City, Riyadh, SAU
| | - Nora A AlHumaid
- Medicine, King Fahad Medical City, Health Cluster 2, Ministry of Health, Riyadh, SAU
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Han X, Wang F, Ma Y, Lv X, Zhang K, Wang Y, Yan K, Mei Y, Wang X. TPG-functionalized PLGA/PCL nanofiber membrane facilitates periodontal tissue regeneration by modulating macrophages polarization via suppressing PI3K/AKT and NF-κB signaling pathways. Mater Today Bio 2024; 26:101036. [PMID: 38600919 PMCID: PMC11004206 DOI: 10.1016/j.mtbio.2024.101036] [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: 01/12/2024] [Revised: 03/06/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024] Open
Abstract
Traditional fibrous membranes employed in guided tissue regeneration (GTR) in the treatment of periodontitis have limitations of bioactive and immunomodulatory properties. We fabricated a novel nTPG/PLGA/PCL fibrous membrane by electrospinning which exhibit excellent hydrophilicity, mechanical properties and biocompatibility. In addition, we investigated its regulatory effect on polarization of macrophages and facilitating the regeneration of periodontal tissue both in vivo and in vitro. These findings showed the 0.5%TPG/PLGA/PCL may inhibit the polarization of RAW 264.7 into M1 phenotype by suppressing the PI3K/AKT and NF-κB signaling pathways. Furthermore, it directly up-regulated the expression of cementoblastic differentiation markers (CEMP-1 and CAP) in periodontal ligament stem cells (hPDLSCs), and indirectly up-regulated the expression of cementoblastic (CEMP-1 and CAP) and osteoblastic (ALP, RUNX2, COL-1, and OCN) differentiation markers by inhibiting the polarization of M1 macrophage. Upon implantation into a periodontal bone defect rats model, histological assessment revealed that the 0.5%TPG/PLGA/PCL membrane could regenerate oriented collagen fibers and structurally intact epithelium. Micro-CT (BV/TV) and the expression of immunohistochemical markers (OCN, RUNX-2, COL-1, and BMP-2) ultimately exhibited satisfactory regeneration of alveolar bone, periodontal ligament. Overall, 0.5%TPG/PLGA/PCL did not only directly promote osteogenic effects on hPDLSCs, but also indirectly facilitated cementoblastic and osteogenic differentiation through its immunomodulatory effects on macrophages. These findings provide a novel perspective for the development of materials for periodontal tissue regeneration.
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Affiliation(s)
- Xiang Han
- Department of Periodontology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, 210029, People's Republic of China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, 210029, People's Republic of China
| | - Feiyang Wang
- Department of Periodontology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, 210029, People's Republic of China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, 210029, People's Republic of China
| | - Yuzhuo Ma
- Department of Periodontology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, 210029, People's Republic of China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, 210029, People's Republic of China
| | - Xuerong Lv
- Department of Periodontology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, 210029, People's Republic of China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, 210029, People's Republic of China
| | - Kewei Zhang
- Department of Periodontology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, 210029, People's Republic of China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, 210029, People's Republic of China
| | - Yue Wang
- Department of Periodontology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, 210029, People's Republic of China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, 210029, People's Republic of China
| | - Ke Yan
- Department of Periodontology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, 210029, People's Republic of China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, 210029, People's Republic of China
| | - Youmin Mei
- Department of Periodontology, Nantong Stomatological Hospital, Affiliated Nantong Stomatological Hospital of Nantong University, Nantong, 226000, People's Republic of China
| | - Xiaoqian Wang
- Department of Periodontology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, 210029, People's Republic of China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, 210029, People's Republic of China
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Adam HS, Molinsky R, Bohn B, Roy S, Rosenbaum M, Paster B, Yuzefpolskaya M, Colombo PC, Papapanou PN, Desvarieux M, Jacobs DR, Demmer RT. Clinical attachment loss is cross-sectionally associated with elevated glucose among adults without diabetes. J Clin Periodontol 2024; 51:522-535. [PMID: 38343130 PMCID: PMC11023769 DOI: 10.1111/jcpe.13945] [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: 06/23/2023] [Revised: 12/19/2023] [Accepted: 01/01/2024] [Indexed: 04/18/2024]
Abstract
AIM We investigated whether periodontal measures are cross-sectionally associated with prediabetes and cardiometabolic biomarkers among non-diabetic younger adults. MATERIALS AND METHODS One thousand seventy-one participants (mean age = 32.2 years [SE = 0.3]; 73% female) from the Oral Infections, Glucose Intolerance and Insulin Resistance Study were enrolled. Full-mouth clinical attachment loss (fm-CAL), probing depth (fm-PD) and bleeding on probing were ascertained. Interproximal CAL (i-CAL) and probing depths (i-PD) served as our primary exposures. Glucose, HbA1c, insulin and insulin resistance (HOMA-IR) outcomes were assessed from fasting blood. Prediabetes was defined per American Diabetes Association guidelines. Prediabetes prevalence ratios (PR [95% CI]) and mean [SE] cardiometabolic biomarkers were regressed on periodontal variables via multivariable robust variance Poisson regression or multivariable linear regression. RESULTS Prevalence of prediabetes was 12.5%. Fully adjusted prediabetes PR in Tertiles 3 versus 1 of mean i-CAL was 2.42 (1.77, 3.08). Fully adjusted fasting glucose estimates across i-CAL tertiles were 83.29 [0.43], 84.31 [0.37], 86.48 [0.46]; p for trend <.01. Greater percent of sites with i-PD ≥3 mm showed elevated natural-log-HOMA-IR after adjustment (0%-12% of sites = 0.33 [0.03], 13%-26% of sites = 0.39 [0.03], ≥27% of sites = 0.42 [0.03]; p for trend = .04). CONCLUSIONS i-CAL (vs. fm-CAL) was associated with elevated fasting glucose and prediabetes, whereas i-PD (vs. fm-PD) was associated with insulin resistance. Future studies are needed to examine periodontal disease and incident prediabetes.
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Affiliation(s)
- Hamdi S. Adam
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rebecca Molinsky
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Bruno Bohn
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Department of Epidemiology, School of Public Health, University of Colorado, Aurora, CO, USA
| | - Sumith Roy
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Michael Rosenbaum
- Division of Molecular Genetics, Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | | | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Paolo C. Colombo
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Panos N. Papapanou
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University, New York, NY, USA
| | - Moïse Desvarieux
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David R. Jacobs
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ryan T. Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Division of Epidemiology, Department of Quantitative Health Sciences, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
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Gül SNS, Birdal O, Laloğlu E. Serum asprosin levels are increased in patients with periodontitis and ST-segment elevation myocardial infarction and correlated with periodontal parameters: A case-control study. J Periodontal Res 2024; 59:259-266. [PMID: 37984462 DOI: 10.1111/jre.13210] [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: 07/25/2023] [Revised: 09/18/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE The study aims to investigate whether patients with ST-elevation myocardial infarction (STEMI)-related periodontitis will experience any changes in asprosin levels. BACKGROUND Periodontitis is a common, chronic infection of the periodontium that is epidemiologically associated with cardiovascular disease. Although asprosin, a hormone released from adipose tissue, is a protective role in cardiovascular diseases, its effectiveness in periodontitis is unknown. METHODS The study was conducted on a total of 120 patients, divided into four groups; the group of healthy control (n = 35), the group of periodontitis (n = 35), the group of periodontitis+STEMI (n = 25), and the group of STEMI (n = 25). In each patient, age, serum asprosin, CRP, troponin-I, and clinical periodontal parameters [plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL)] were evaluated. The results were analyzed statistically. RESULTS Serum asprosin, CRP, and troponin-I levels were statistically higher in the STEMI+periodontitis group compared to the other groups. In addition, as a result of the study, it was observed that there was a correlation between serum asprosin levels, clinical periodontal parameters, and CRP levels. CONCLUSIONS The results of this study show that STEMI and periodontitis are associated with high asprosin levels. Since the risk of periodontitis is high in STEMI patients, periodontitis should also be considered when evaluating asprosin levels in STEMI patients.
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Affiliation(s)
- Sema Nur Sevinç Gül
- Department of Periodontology, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
| | - Oğuzhan Birdal
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Esra Laloğlu
- Department of Medical Biochemistry, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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Nasution DLI, Furuta M, Li H, Zakaria MN, Takeshita T, Peres MA, Yamashita Y. Longitudinal association between periodontal condition and glycaemic status in middle-aged adults: A cross-lagged panel analysis. J Clin Periodontol 2023; 50:1042-1050. [PMID: 36935202 DOI: 10.1111/jcpe.13809] [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: 09/11/2022] [Revised: 02/08/2023] [Accepted: 03/13/2023] [Indexed: 03/21/2023]
Abstract
AIM To investigate the existence of a bidirectional temporal relationship between periodontal condition and glycaemic status. MATERIALS AND METHODS This longitudinal study included 2198 participants with mean age 43.4 ± 7.7 years, who underwent dental examinations in Yokohama, Japan, at two time points, 2003-2004 and 2008-2009, at an interval of 5 years. Periodontal condition was assessed by the mean value of probing pocket depth (PPD) and clinical attachment level (CAL). Glycaemic status was assessed by fasting glucose and glycated haemoglobin (HbA1c). RESULTS The cross-lagged panel models showed the effect of HbA1c at baseline on mean PPD at follow-up (β = 0.044, p = .039). There was a marginal effect of fasting glucose on the mean PPD (β = 0.037, p = .059). It was similar to the effect of fasting glucose or HbAlc on mean CAL. However, in the opposite direction, no effect of mean PPD or CAL at baseline on fasting glucose or HbAlc at follow-up was identified. CONCLUSIONS This study demonstrated a unidirectional relationship between glycaemic status and periodontal condition. The study population, however, had mostly mild periodontitis. Future studies are needed to investigate the effect of periodontal condition on glycaemic status in patients with severe periodontitis.
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Affiliation(s)
- Dewi L I Nasution
- Faculty of Dentistry, Universitas Padjadjaran, West Java, Indonesia
- Department of Periodontology, Faculty of Dentistry, Universitas Jenderal Achmad Yani, Cimahi, Indonesia
| | - Michiko Furuta
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
| | - Huihua Li
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
- Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore
| | - Myrna Nurlatifah Zakaria
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Operative Dentistry and Endodontology, Faculty of Dentistry, Universitas Jenderal Achmad Yani, Cimahi, Indonesia
| | - Toru Takeshita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
- OBT Research Center, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Marco A Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
- Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore
| | - Yoshihisa Yamashita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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Kadatane SP, Satariano M, Massey M, Mongan K, Raina R. The Role of Inflammation in CKD. Cells 2023; 12:1581. [PMID: 37371050 DOI: 10.3390/cells12121581] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic kidney disease (CKD) affects many adults worldwide. Persistent low-grade inflammation is a substantial factor in its development and progression and has correlated with increased mortality and cardiovascular problems. This low-grade inflammation is a product of dysregulation of the normal balance between pro- and anti-inflammatory markers. Various factors such as increased innate immune system activation, reactive oxygen species production, periodontal disease, dysregulation of anti-inflammatory systems and intestinal dysbiosis result in the dysregulation of this balance. Furthermore, this low-grade inflammation has down-effects such as hypertension, renal fibrosis and acceleration of renal function decline. Moreover, low-grade inflammation over time has been linked to malignancy in CKD. As CKD progresses, many patients require dialysis, which has a negative bidirectional relationship with persistent inflammation. Treatment options for inflammation in CKD are vast, including cytokine inhibitors, statins and diets. However, more research is needed to create a standardized management plan. In this review, we will examine the normal physiology of the kidney and its relationship with the immune system. We will then delve into the pathology behind persistent inflammation, the various causes of inflammation, the downstream effects of inflammation, dialysis and potential treatments for inflammation in CKD.
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Affiliation(s)
| | - Matthew Satariano
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Michael Massey
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Kai Mongan
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH 44302, USA
- Department of Nephrology, Akron Children's Hospital, Akron, OH 44308, USA
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Sen S, Meyer J, Mascari R, Trivedi T, Suri F, Wasserman B, Rosamond W, Moss K, Beck J, Gottesman RF. Association of Dental Infections with Intracranial Atherosclerotic Stenosis. Cerebrovasc Dis 2023; 53:28-37. [PMID: 37121226 DOI: 10.1159/000530829] [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: 11/27/2022] [Accepted: 04/24/2023] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Periodontal disease (PD) and dental caries are oral infections leading to tooth loss that are associated with atherosclerosis and cerebrovascular disease. We assessed the hypothesis that PD and caries are associated with asymptomatic intracranial atherosclerosis (ICAS) in the Atherosclerosis Risk in Communities (ARIC) study. METHODS Full-mouth clinical periodontal measurements (7 indices) collected at 6 sites per tooth from 6,155 subjects from the Dental Atherosclerosis Risk in Communities Study (DARIC) without prior stroke were used to differentiate seven PD stages (Periodontal Profile Class [PPC]-I to -VII) and dental caries on coronal dental surface (DS) and dental root surface (DRS). A stratified subset underwent 3D time-of-flight MR angiogram and 3D high isotropic-resolution black blood MRI. ICAS was graded according to the criteria established by the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. We evaluated the relationship between PD stage and dental caries with asymptomatic ICAS, graded as no ICAS, <50% ICAS, and ≥50% ICAS. RESULTS Among dentate subjects who underwent vascular imaging, 801 (70%) had no ICAS, 232 (20%) had <50% ICAS, and 112 (10%) had ≥50% ICAS. Compared to participants without gum disease (PPC-I), participants with mild-moderate tooth loss (PPC-VI), severe tooth loss (PPC-VII), and severe PD (PPC-IV) had higher odds of having <50% ICAS. Participants with extensive gingivitis (PPC-V) had significantly higher odds of having ≥50% ICAS. This association remained significant after adjusting for confounding variables: age, gender, race, hypertension, diabetes, dyslipidemia, 3-level education, and smoking status. There was no association between dental caries (DS and DRS) and ICAS <50% and ≥50%. CONCLUSION We report significant associations between mild-moderate tooth loss, severe tooth loss, and severe PD with <50% ICAS as well as an association between extensive gingivitis and ≥50% ICAS. We did not find an association between dental caries and ICAS.
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Affiliation(s)
- Souvik Sen
- Department of Neurology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Jaclyn Meyer
- Department of Neurology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Rachel Mascari
- Department of Neurology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Tushar Trivedi
- Department of Neurology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Fareed Suri
- Department of Neurology, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Bruce Wasserman
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Wayne Rosamond
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin Moss
- Division of Oral and Craniofacial Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James Beck
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Comprehensive Oral Health/Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
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Pamuk F, Kantarci A. Inflammation as a link between periodontal disease and obesity. Periodontol 2000 2022; 90:186-196. [PMID: 35916870 DOI: 10.1111/prd.12457] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nutrition plays a critical role in the homeostatic balance, maintenance of health, and longevity. There is a close link between inflammatory diseases and nutritional health. Obesity is a severe pathological process with grave implications on several organ systems and disease processes, including type 2 diabetes, cardiovascular disease, osteoarthritis, and rheumatoid arthritis. The impact of obesity on periodontal inflammation has not been fully understood; the association between nutritional balance and periodontal inflammation is much less explored. This review is focused on the potential mechanistic links between periodontal diseases and obesity and common inflammatory activity pathways that can be pharmacologically targeted.
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Affiliation(s)
- Ferda Pamuk
- Forsyth Institute, Cambridge, Massachusetts, USA.,Department of Oral Health Sciences, University of Leuven (KU Leuven), Leuven, Belgium
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10
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Boese S, Gill HS. Drug-Coated Floss to Treat Gum Diseases: In Vitro and In Vivo Characterization. ACS APPLIED MATERIALS & INTERFACES 2022; 14:28663-28670. [PMID: 35708223 DOI: 10.1021/acsami.2c07976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Treatment of gum disease often requires antibiotic treatment. In this study, our objective was to advance the practicality of drug-coated floss as an intra gum pocket drug delivery system. The initial design of this delivery system has been previously reported by us. Here, we advance the concept further through in vitro and in vivo evaluation. A floss piece was dip coated in the middle section with model molecules leaving free ends for holding. Porcine gum tissues were used ex vivo and in vivo to evaluate the coated floss, including effect of coating thickness on delivery efficiency, ability to deliver more than one type of molecule (one hydrophilic and one hydrophobic), mechanical properties using a scratch test, and finally retention of delivered material in vivo in the porcine model. After reaching a certain coating thickness, the delivery efficiency of the coated floss decreased, indicating the presence of an optimal coating thickness. Hydrophobic and hydrophilic molecules were successfully coated and delivered with high efficiency into gum pockets. The scratch test indicated that the coatings were resilient. Lastly, the in vivo analysis showed that the drug coating was delivered into the porcine gum pocket with about 65% efficiency, and the coatings could maintain extended residency within the gum pocket despite the native adverse environment of the oral cavity. Overall, this data shows that drug-coated floss can act as a drug delivery vehicle and has potential to provide a minimally invasive and practical method for the delivery of drugs into the gum pockets.
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Affiliation(s)
- Seth Boese
- Department of Chemical Engineering, Texas Tech University, Lubbock, Texas 79409, United States
| | - Harvinder Singh Gill
- Department of Chemical Engineering, Texas Tech University, Lubbock, Texas 79409, United States
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11
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Qin R, Cui Z, Zhou H, Guo R, Yao X, Wang T, Qin X, He X. Effect of lentivirus-mediated BMP2 from autologous tooth on the proliferative and osteogenic capacity of human periodontal ligament cells. J Periodontal Res 2022; 57:869-879. [PMID: 35730345 DOI: 10.1111/jre.13025] [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: 12/01/2021] [Revised: 04/28/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Periodontitis is a chronic progressive inflammation that invades periodontal supporting tissues, in which periodontal tissue regeneration engineering offers new hope for prevention and treatment, including seed cells, scaffolds, and growth factors. In recent years, scholars have shown that autologous teeth can be used as new bone tissue repair materials for periodontal regeneration and bone tissue repair. The aim of this study was to establish a human periodontal ligament cell line that expresses the human bone morphogenetic protein 2 gene (BMP2) in a stable manner using lentiviral mediation in order to explore the effect of BMP2 from autologous tooth on the proliferative and osteogenic capacity of human periodontal ligament cells (hPDLCs). MATERIALS AND METHODS Human periodontal ligament cells were cultured, subcultured, and identified, and then homologous recombinant lentivirus plasmid plv-BMP2 was constructed and transfected into the third passage (P3 ) hPDLCs. After that, the effect of BMP2 on its proliferation was detected by CCK-8, at the same time, the osteogenic induction of hPDLCs was carried out at 7, 14, and 21 days, and then the effect of BMP2 on its osteogenic ability was detected by alizarin red staining, alkaline phosphatase activity determination, and the mRNA expression levels of osteogenic-related genes using real-time fluorescence quantitative PCR, including alkaline phosphatase, runt-related transcription factor 2, bone sialoprotein, osteocalcin, osteopontin, and collagen I. Finally, spss26.0 software was used for statistical processing. RESULTS The results showed that cells transfected with the homologous recombinant lentiviral plasmid pLV-BMP2 had a similar morphology to normal hPDLCs, showing a typical radial arrangement; the cell proliferative capacity of the pLV-BMP2 group as measured by CCK-8 was enhanced compared with the control group and the pLV-puro group (p < .05); alizarin red staining and alkaline phosphatase activity assay showed that the osteogenic ability of pLV-BMP2 was significantly enhanced compared with the control and pLV-puro groups (p < .01), and the findings of real-time fluorescence-based quantitative PCR showed high expression of osteogenic-related genes in pLV-BMP2 group (p < .01). CONCLUSION In conclusion, a stable periodontal ligament cell line overexpressing BMP2 was successfully established by a lentivirus-mediated method, which proved that BMP2 has a strong ability to promote the proliferation and osteogenesis of hPDLCs, thereby providing an opportunity for the study of periodontal tissue regeneration as well as providing an experimental basis for the application of autologous teeth as a new type of bone repair material for periodontal therapy and even for maxillofacial bone tissue repair.
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Affiliation(s)
- Ruoshan Qin
- Department of Prosthodontics, School of Dentistry, Lanzhou University, Lanzhou, Gansu, China
| | - Ziwei Cui
- Department of Prosthodontics, School of Dentistry, Lanzhou University, Lanzhou, Gansu, China
| | - Hongli Zhou
- Department of Prosthodontics, School of Dentistry, Lanzhou University, Lanzhou, Gansu, China
| | - Ru Guo
- Department of Prosthodontics, School of Dentistry, Lanzhou University, Lanzhou, Gansu, China
| | - Xuanxuan Yao
- Department of Prosthodontics, School of Dentistry, Lanzhou University, Lanzhou, Gansu, China
| | - Tao Wang
- Department of Prosthodontics, School of Dentistry, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaodong Qin
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu, China
| | - Xiangyi He
- Department of Prosthodontics, School of Dentistry, Lanzhou University, Lanzhou, Gansu, China
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12
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Almohamad M, Krall Kaye E, Mofleh D, Spartano NL. The association of sedentary behaviour and physical activity with periodontal disease in NHANES 2011-2012. J Clin Periodontol 2022; 49:758-767. [PMID: 35634657 DOI: 10.1111/jcpe.13669] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/20/2022] [Accepted: 05/18/2022] [Indexed: 12/30/2022]
Abstract
AIM Periodontal disease is one of the most prevalent oral pathologies and a major chronic disease worldwide. Lifestyle habits such as poor nutrition and smoking have been established to contribute to the development of periodontal disease, but limited research has investigated whether physical activity and sedentary lifestyle play a role. The purpose of this study is to evaluate the association between physical activity, sedentary behaviour, and periodontal disease. MATERIALS AND METHODS We used a nationally representative data set from the National Health and Nutrition Examination Survey (NHANES) 2011-2012. We examined the association between physical activity and sedentary behaviour and periodontal disease using multivariable logistic regression models and reported odds ratios (ORs). RESULTS Individuals with higher total physical activity, higher leisure time physical activity, and lower amount of total sedentary behaviour had lower periodontal disease prevalence. Adjusted multivariable regression models showed that higher sedentary behaviour (more than 7.5 h/day) was associated with higher odds of periodontal disease (OR = 1.17; 95% confidence interval = 1.00-1.36; p = .045). CONCLUSIONS The findings showed that higher sedentary behaviour is associated with higher odds of periodontal disease. Future prospective longitudinal studies and strategies are needed to investigate implications further and define the magnitude of the association between physical activity and periodontal disease.
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Affiliation(s)
- Maha Almohamad
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center School of Public Health, Houston, Texas, USA
| | - Elizabeth Krall Kaye
- Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - Dania Mofleh
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center School of Public Health, Houston, Texas, USA
| | - Nicole L Spartano
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University School of Medicine, Boston, Massachusetts, USA
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13
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Adam HS, Lakshminarayan K, Wang W, Norby FL, Mosley T, Walker KA, Gottesman RF, Meyer K, Hughes TM, Pankow JS, Wong DF, Jack CR, Sen S, Lutsey PL, Beck J, Demmer RT. The prospective association between periodontal disease and brain imaging outcomes: The Atherosclerosis Risk in Communities study. J Clin Periodontol 2022; 49:322-334. [PMID: 34905804 PMCID: PMC8934294 DOI: 10.1111/jcpe.13586] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/10/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
AIM We investigate if periodontal disease is prospectively associated with cerebrovascular and neurodegenerative markers of dementia and Alzheimer's pathology. MATERIALS AND METHODS N = 1306 participants (Visit 5 mean age = 76.5 [standard deviation = 5.4] years) in the Atherosclerosis Risk in Communities study with completed dental exams at Visit 4 underwent brain magnetic resonance imaging scans at Visit 5 while N = 248 underwent positron emission tomography scans. Participants were classified as edentulous or, among the dentate, by the modified Periodontal Profile Class. Brain volumes were regressed on periodontal status in linear regressions. Cerebrovascular measures and β-amyloid positivity were regressed on periodontal status in logistic regressions. RESULTS Periodontal disease was not associated with brain volumes, microhaemorrhages, or elevated β-amyloid. Compared with periodontally healthy individuals, odds ratios [95% confidence interval] for all-type infarcts were 0.37 [0.20, 0.65] for severe tooth loss and 0.56 [0.31, 0.99] for edentulous participants. CONCLUSIONS Within the limitations of this study, periodontal disease was not associated with altered brain volumes, microhaemorrhages, or β-amyloid positivity. Tooth loss was associated with lower odds of cerebral infarcts.
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Affiliation(s)
- Hamdi S. Adam
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
| | - Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
| | - Faye L. Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
| | - Thomas Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216
| | - Keenan A. Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21218
| | - Rebecca F. Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21218
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21218
| | - Katie Meyer
- Department of Nutrition, University of North Carolina, Chapel Hill, Chapel Hill, NC, 27599
| | - Timothy M. Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27101
| | - James S. Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
| | - Dean F. Wong
- Mallinckrodt Institute of Radiology, Washington University in St. Louis Missouri, St. Louis, MO, 63110
| | | | - Souvik Sen
- Department of Neurology, University of South Carolina, School of Medicine, Columbia, SC, 29203
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
| | - Jim Beck
- Division of Comprehensive Oral Health - Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Ryan T. Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032
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14
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Ras AB, Ghalwash D, Khalil E, Ahmed E. Assessment of serum and gingival crevicular fluid level of fibroblast growth factor 23 in patients having diseased periodontium with and without end-stage renal disease: A cross-sectional analytical study. J Int Oral Health 2022. [DOI: 10.4103/jioh.jioh_175_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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15
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Shah PD, Badner VM, Moss KL. Association between asthma and periodontitis in the US adult population: A population-based observational epidemiological study. J Clin Periodontol 2021; 49:230-239. [PMID: 34866232 DOI: 10.1111/jcpe.13579] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
AIM To examine the association between asthma and periodontitis in a nationally representative sample of adults in the United States. MATERIALS AND METHODS Data obtained from 10,710 adult men and women who participated in National Health and Nutritional Examination Survey from 2009 to 2014 were analysed. Asthma was measured based on self-reported physician diagnosis. Periodontitis was the outcome of interest. It was classified into mild, moderate, and severe periodontitis according to the updated CDC/AAP case definitions. Multivariable models were developed to examine the association of asthma with periodontitis while controlling for age, race/ethnicity, gender, education, income, body mass index, diabetes, and smoking. Odds ratio (OR) and respective 95% confidence interval (CI) were calculated. Replication was performed by differently classifying the outcome using another system called periodontal profile class (PPC). RESULTS Current asthmatics, in reference to never asthmatics, had lower odds of severe periodontitis [(adjusted OR = 0.51, 95% CI = 0.30-0.87) and (adjusted OR = 0.58, 95% CI = 0.35-0.97) as classified using CDC/AAP case definitions and PPC system, respectively]. However, there was no statistically significant association between asthma and any other forms of periodontitis (p value >.05). CONCLUSIONS In the United States, current-asthmatic adults were less likely to have severe periodontitis as compared with never-asthmatic adults. Further research is required to fully understand this association.
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Affiliation(s)
- Parth D Shah
- Division of Population Health & Community Dentistry, Department of Dentistry and Oral & Maxillofacial Surgery, Jacobi Medical Center in affiliation with the Albert Einstein College of Medicine, Bronx, New York, USA
| | - Victor M Badner
- Department of Dentistry and Oral & Maxillofacial Surgery, Jacobi Medical Center in affiliation with the Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kevin L Moss
- Department of Dental Ecology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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16
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Marchesan J, Moss K, Morelli T, Teles F, Divaris K, Styner M, Ribeiro A, Webster-Cyriaque J, Beck J. Distinct Microbial Signatures between Periodontal Profile Classes. J Dent Res 2021; 100:1405-1413. [PMID: 33906500 PMCID: PMC8529299 DOI: 10.1177/00220345211009767] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Precise classification of periodontal disease has been the objective of concerted efforts and has led to the introduction of new consensus-based and data-driven classifications. The purpose of this study was to characterize the microbiological signatures of a latent class analysis (LCA)-derived periodontal stratification system, the Periodontal Profile Class (PPC) taxonomy. We used demographic, microbial (subgingival biofilm composition), and immunological data (serum IgG antibody levels, obtained with checkerboard immunoblotting technique) for 1,450 adult participants of the Dental Atherosclerosis Risk in Communities (ARIC) study, with already generated PPC classifications. Analyses relied on t tests and generalized linear models with Bonferroni correction. Men and African Americans had higher systemic antibody levels against most microorganisms compared to women and Caucasians (P < 0.05). Healthy individuals (PPC-I) had low levels of biofilm bacteria and serum IgG levels against most periodontal pathogens (P < 0.05). Subjects with mild to moderate disease (PPC-II to PPC-III) showed mild/moderate colonization of multiple biofilm pathogens. Individuals with severe disease (PPC-IV) had moderate/high levels of biofilm pathogens and antibody levels for orange/red complexes. High gingival index individuals (PPC-V) showed moderate/high levels of biofilm Campylobacter rectus and Aggregatibacter actinomycetemcomitans. Biofilm composition in individuals with reduced periodontium (PPC-VI) was similar to health but showed moderate to high antibody responses. Those with severe tooth loss (PPC-VII) had significantly high levels of multiple biofilm pathogens, while the systemic antibody response to these microorganisms was comparable to health. The results support a biologic basis for elevated risk for periodontal disease in men and African Americans. Periodontally healthy individuals showed a low biofilm pathogen and low systemic antibody burden. In the presence of PPC disease, a microbial-host imbalance characterized by higher microbial biofilm colonization and/or systemic IgG responses was identified. These results support the notion that subgroups identified by the PPC system present distinct microbial profiles and may be useful in designing future precise biological treatment interventions.
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Affiliation(s)
- J.T. Marchesan
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K. Moss
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T. Morelli
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - F.R. Teles
- Department of Basic and Translational Sciences, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA
| | - K. Divaris
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M. Styner
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A.A. Ribeiro
- Division of Diagnostic Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J. Webster-Cyriaque
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J. Beck
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Wernicke K, Grischke J, Stiesch M, Zeissler S, Krüger K, Bauer P, Hillebrecht A, Eberhard J. Influence of physical activity on periodontal health in patients with type 2 diabetes mellitus. A blinded, randomized, controlled trial. Clin Oral Investig 2021; 25:6101-6107. [PMID: 33796948 PMCID: PMC8531088 DOI: 10.1007/s00784-021-03908-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim was to investigate the effect of physical activity on periodontal health and HbA1c levels in patients with type 2 diabetes mellitus (T2DM) over a period of 6 months. MATERIALS AND METHODS Thirty-seven patients with non-insulin-dependent T2DM were included in the study. The intervention group (n=20) performed physical activity over a period of 6 months. The control group (n=17) did not receive any intervention. Baseline and final examinations included dental parameters and concentrations of glycosylated hemoglobin (HbA1c) and high-sensitivity C-reactive protein (hsCRP). RESULTS Physical activity showed a positive effect on periodontal health. Both the BOP (p= 0.005) and the severity of periodontitis (p= 0.001) were significantly reduced in the intervention group compared to the control group. Furthermore, HbA1c levels were reduced (p= 0.010) significantly in the intervention group while hsCRP levels significantly increased in the control group (p= 0.04). CONCLUSIONS Within the limitations of this randomized, controlled trial, physical activity over a period of 6 months is a health-promoting measure for patients with T2DM and improves both periodontal health and HbA1c concentrations.
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Affiliation(s)
- K Wernicke
- Hannover Medical School, Hanover, Germany
| | - J Grischke
- Hannover Medical School, Hanover, Germany.
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
| | - M Stiesch
- Hannover Medical School, Hanover, Germany
| | | | - K Krüger
- Justus-Liebig-Universität Gießen, Gießen, Germany
| | - P Bauer
- Justus-Liebig-Universität Gießen, Gießen, Germany
| | | | - J Eberhard
- The University of Sydney School of Dentistry and the Charles Perkins Centre, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia
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18
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Laniado N, Cloidt M, Altonen B, Badner V. Interprofessional Oral Health Collaboration: A Survey of Knowledge and Practice Behaviors of Hospital-Based Primary Care Medical Providers in New York City. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1211-1218. [PMID: 34675748 PMCID: PMC8523314 DOI: 10.2147/amep.s332797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The siloed delivery of oral and medical health care in the United States has contributed to a lack of awareness of the consequences of poor oral health and has hampered effective interprofessional education and collaboration. The aim of this study was to assess the knowledge and practice behaviors of primary care medical providers in an urban safety-net hospital regarding collaboration with dentists and integration of oral health into overall health-care delivery. METHODS A 36-item survey was designed in a web-based platform (Survey Monkey®) and electronically distributed in September 2020 to 181 primary care medical providers (physicians, nurses, physician assistants) within a municipal hospital in the Bronx, New York. The questionnaire included sections on demographics, current practices, oral health knowledge, and opinions regarding interprofessional collaboration. Descriptive statistics and bivariate analyses using the chi-square and Fisher's exact test were performed with a significance level of 0.05. RESULTS The response rate was 66% (119 respondents). The vast majority (80%) reported little or no training in oral health and 85% reported no team experience with oral health professionals. Medical providers' confidence in examining the oral cavity was positively associated with previous additional training (p = 0.001) and with team experience (p = 0.005). The two most commonly reported barriers to willingness to collaborate were lack of formal relationships with dental providers (74%) and competing priorities (69%). CONCLUSION Overall, there is very limited awareness and integration of oral health into the clinical practice of medical providers at this safety-net hospital. However, those providers with previous training and team experience had greater oral health confidence. Given the critical importance of oral health to overall health, increased efforts should be directed to further educate and train medical providers and address barriers to interprofessional care.
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Affiliation(s)
- Nadia Laniado
- Department of Dentistry, Health+Hospitals/Jacobi Medical Center Bronx, New York, NY, 10461, USA
| | - Megan Cloidt
- Department of Dentistry, Health+Hospitals/Jacobi Medical Center Bronx, New York, NY, 10461, USA
| | - Brian Altonen
- Department of Research Administration, Health+Hospitals/Central Office, New York, NY, 10013, USA
| | - Victor Badner
- Department of Dentistry, Health+Hospitals/Jacobi Medical Center Bronx, New York, NY, 10461, USA
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Järvisalo MJ, Jokihaka V, Hakamäki M, Lankinen R, Helin H, Koivuviita NS, Hellman T, Metsärinne K. Dental health assessed using panoramic radiograph and adverse events in chronic kidney disease stage 4-5 patients transitioning to dialysis and transplantation-A prospective cohort study. PLoS One 2021; 16:e0258055. [PMID: 34591943 PMCID: PMC8483312 DOI: 10.1371/journal.pone.0258055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background and aims Oral health could potentially be a modifiable risk factor for adverse outcomes in chronic kidney disease (CKD) patients transitioning from predialysis treatment to maintenance dialysis and transplantation. We aimed to study the association between an index of radiographically assessed oral health, Panoramic Tomographic Index (PTI), and cardiovascular and all-cause mortality, major adverse cardiovascular events (MACEs) and episodes of bacteremia and laboratory measurements during a three-year prospective follow-up in CKD stage 4–5 patients not on maintenance dialysis at baseline. Methods Altogether 190 CKD stage 4–5 patients without maintenance dialysis attended panoramic dental radiographs in the beginning of the study. The patients were followed up for three years or until death. MACEs and episodes of bacteremia were recorded during follow-up. Laboratory sampling for C-reactive protein and leukocytes was repeated tri-monthly. Results PTI was not associated with baseline laboratory parameters or C-reactive protein or leukocytes examined as repeated measures through the 3-year follow-up. During follow-up, 22 patients had at least one episode of bacteremia, but only 2 of the bacteremias were considered to be of oral origin. PTI was not associated with incident bacteremia during follow-up. Thirty-six patients died during follow-up including 17 patients due to cardiovascular causes. During follow-up 42 patients were observed with a MACE. PTI was independently associated with all-cause (HR 1.074 95% CI 1.029–1.122, p = 0.001) and cardiovascular (HR 1.105, 95% CI 1.057–1.157, p<0.0001) mortality, as well as, incident MACEs (HR 1.071 95% CI 1.031–1.113, p = 0.0004) in the multivariable Cox models adjusted for age and kidney transplantation or CKD treatment modality during follow-up. Conclusions Radiographically assessed dental health is independently associated with all-cause and cardiovascular mortality and MACEs but not with the incidence of bacteremia in CKD stage 4–5 patients transitioning to maintenance dialysis and renal transplantation during follow-up.
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Affiliation(s)
- Mikko J. Järvisalo
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
- Department of Anaesthesiology and Intensive Care, Turku University Hospital and University of Turku, Turku, Finland
- Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, Turku, Finland
- * E-mail:
| | - Viljami Jokihaka
- Department of Radiology, Dental Radiology, Turku University Hospital, Turku, Finland
| | - Markus Hakamäki
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Roosa Lankinen
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Heidi Helin
- Department of Radiology, Dental Radiology, Turku University Hospital, Turku, Finland
| | - Niina S. Koivuviita
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Tapio Hellman
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaj Metsärinne
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
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20
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Alhadainy HA, Keefe T, Abdel‐Karim AH, Abdulrab S, Halboub E. Association between dental diseases and history of stroke in the United States. Clin Exp Dent Res 2021; 7:845-851. [PMID: 33797859 PMCID: PMC8543477 DOI: 10.1002/cre2.416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/23/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aimed to determine the potential association between the dental diseases and self-reported history of stroke in the United States based on data from the Third National Health and Nutrition Examination Survey (NHANES III). METHODS Data were extracted from NHANES III. Dental variables were carious tooth surfaces, number of missing teeth, gingival bleeding, and periodontal pockets. Multiple logistic regression modeling was used to estimate the effect of these dental diseases on the self-reported history of stroke with intent to adjust for the other potential determinants: age, sex, race, marital status, health insurance, education, exercise, body mass index, smoking, alcohol, hypertension, high serum cholesterol, and diabetes. RESULTS Number of missing teeth was found to be significantly associated with the self-reported history of stroke. Associations between the self-reported history of stroke and caries, gingival bleeding, or periodontal pockets were not statistically significant. CONCLUSIONS Number of missing teeth was an independent determinant of the self-reported history of stroke.
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Affiliation(s)
- Hatem A. Alhadainy
- Department of Endodontics, College of DentistryTanta UniversityTantaEgypt
- Department of Environmental and Radiological Health SciencesColorado State UniversityFort CollinsColoradoUSA
| | - Thomas Keefe
- Department of Environmental and Radiological Health SciencesColorado State UniversityFort CollinsColoradoUSA
| | - Amany H. Abdel‐Karim
- Department of Statistics, Mathematics and Insurance, Faculty of CommerceTanta UniversityTantaEgypt
| | - Saleem Abdulrab
- Madinat Khalifa Health CentrePrimary Health Care CorporationDohaQatar
| | - Esam Halboub
- Department of Maxillofacial Surgery and Diagnostic SciencesCollege of Dentistry, Jazan UniversityJazanSaudi Arabia
- Department of Oral Medicine, Oral Pathology and Oral RadiologyFaculty of Dentistry, Sana'a UniversitySana'aYemen
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21
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Zhang S, Philips KH, Moss K, Wu D, Adam HS, Selvin E, Demmer RT, Norby FL, Mustapha IZ, Beck JD. Periodontitis and Risk of Diabetes in the Atherosclerosis Risk In Communities (ARIC) Study: A BMI-Modified Association. J Clin Endocrinol Metab 2021; 106:e3546-e3558. [PMID: 33982107 PMCID: PMC8372648 DOI: 10.1210/clinem/dgab337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine whether periodontal disease is positively associated with incident diabetes across the continuum of body mass levels (BMI) and test the hypothesis that the periodontal risk for incident diabetes is modified by BMI. METHODS We included 5569 diabetes-free participants from Visit 4 (1996-1998) of the Atherosclerosis Risk in Communities study and followed them until 2018. Periodontal disease status was classified by periodontal profile class (PPC)-Stages , and incident diabetes was based on participant report of physician diagnosis. We estimated the hazard ratios (HR) for diabetes using a competing risk model for each PPC-Stage. We assessed multiplicative interactions between periodontal disease and BMI (as a continuous variable) on risk of diabetes. RESULTS During a median time of 19.4 years of follow-up, 1348 incident diabetes cases and 1529 deaths occurred. Compared to the "Health/Incidental Disease" stage, participants with PPC "Severe Periodontal Disease" or "Severe Tooth Loss" stage and lower BMI had elevated risk for diabetes adjusting for demographic, smoking, education, and biological variables when accounting for death as a competing risk with HRs of 1.76 (95% CI 1.10-2.80) and 2.11 (95% CI 1.46-3.04), respectively. The interaction between PPC-Stages and BMI was significant (P = 0.01). No significant associations of PPC-Stages with incident diabetes were present when BMI was above 31 kg/m2. CONCLUSION Periodontal disease was associated with incident diabetes, especially in nonobese participants. Dentists should be aware that periodontal disease is associated with incident diabetes but the association may be modified for patient's at higher BMI levels.
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Affiliation(s)
- Shaoping Zhang
- Periodontics Department, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Kamaira H Philips
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kevin Moss
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Di Wu
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hamdi S Adam
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology, Mailman School of Public Health, Columbia University, NY, NY, USA
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Indra Z Mustapha
- Department of Periodontics, School of Dentistry, Howard University, Washington, DC, USA
| | - James D Beck
- Division of Comprehensive Oral Health/Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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22
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Bahar B, Kanagasingam S, Tambuwala MM, Aljabali AAA, Dillon SA, Doaei S, Welbury R, Chukkapalli SS, Singhrao SK. Porphyromonas gingivalis (W83) Infection Induces Alzheimer's Disease-Like Pathophysiology in Obese and Diabetic Mice. J Alzheimers Dis 2021; 82:1259-1275. [PMID: 34151813 DOI: 10.3233/jad-210465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Periodontal disease(s) and metabolic illnesses negatively impact the quality of life and, eventually mental health. OBJECTIVE This study investigated the effect of Porphyromonas gingivalis (W83) oral infection on the development of Alzheimer's disease (AD) pathophysiology in a wild-type obese, diabetic (db/db) mouse model. METHODS The db/db mice were either orally infected with P. gingivalis and Fusobacterium nucleatum or sham infected for 16 weeks. The presence of amyloid-β (Aβ) and neurofibrillary tangles (NFTs) were assessed using a silver impregnation technique and subsequently by immunohistochemistry for tau and neuroinflammation. The mRNA abundance of a panel of 184 genes was performed using quantitative real-time PCR, and the differentially expressed genes were analyzed by Ingenuity Pathway Analysis. RESULTS While no Aβ plaques and NFTs were evident by silver impregnation, immunohistochemistry (glial cell markers) of the P. gingivalis-infected mice tissue sections exhibited neuroinflammation in the form of reactive microglia and astrocytes. Anti-tau immunopositivity, in addition to cells, was prominent in thickened axons of hippocampal CA neurons. The mRNA abundance of crucial genes in the insulin signaling pathway (INSR, IGF1, IRS, IDE, PIK3R, SGK1, GYS, GSK3B, AKT1) were upregulated, potentially exacerbating insulin resistance in the brain by P. gingivalis oral infection. Increased mRNA abundance of several kinases, membrane receptors, transcription factors, and pro-inflammatory mediators indicated hyperactivation of intracellular cascades with potential for tau phosphorylation and Aβ release in the same infection group. CONCLUSION P. gingivalis W83 infection of db/db mice provides a disease co-morbidity model with the potential to reproduce AD pathophysiology with induced periodontal disease.
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Affiliation(s)
- Bojlul Bahar
- Nutrition Sciences and Applied Food Safety Studies, Research Centre for Global Development, School of Sport & Health Sciences, University of Central Lancashire, Preston, UK
| | - Shalini Kanagasingam
- Brain and Behavior Centre, Faculty of Clinical and Biomedical Sciences, School of Dentistry, University of Central Lancashire, Preston, UK
| | - Murtaza M Tambuwala
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, County Londonderry, Northern Ireland, UK
| | - Alaa A A Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Stephanie A Dillon
- Nutrition Sciences and Applied Food Safety Studies, Research Centre for Global Development, School of Sport & Health Sciences, University of Central Lancashire, Preston, UK
| | - Saeid Doaei
- Research Center of Health and Environment, Shool of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Richard Welbury
- Brain and Behavior Centre, Faculty of Clinical and Biomedical Sciences, School of Dentistry, University of Central Lancashire, Preston, UK
| | - Sasanka S Chukkapalli
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Sim K Singhrao
- Brain and Behavior Centre, Faculty of Clinical and Biomedical Sciences, School of Dentistry, University of Central Lancashire, Preston, UK
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23
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Lăzureanu PC, Popescu F, Tudor A, Stef L, Negru AG, Mihăilă R. Saliva pH and Flow Rate in Patients with Periodontal Disease and Associated Cardiovascular Disease. Med Sci Monit 2021; 27:e931362. [PMID: 34305133 PMCID: PMC8323473 DOI: 10.12659/msm.931362] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/15/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Periodontal disease, a frequent oral health problem, is connected with cardiovascular morbidity and mortality. This study aimed to assess the unstimulated saliva flow rate and saliva pH as markers of the severity of periodontal disease in patients with cardiovascular disease. MATERIAL AND METHODS A cohort of 155 patients (78 men and 77 women, aged 30-92 years) was included, and a structured questionnaire obtained information about their health status, oral healthcare behaviors, and eating habits. An oral examination was performed to assess periodontal status and presence of dental calculus. The unstimulated whole salivary flow rate and salivary pH were measured. An oral hygienization was performed, and 3 months later, salivary flow rate and pH were reevaluated. RESULTS A severe form of periodontal disease was found in 22.4% of patients. Disease severity was strongly correlated with low pH values (6.25 in stage IV periodontal disease), lower salivary flow rate (0.28 mL/min), smoking, poor oral hygiene habits and obesity, with no significant differences by sex. We observed a significant increase of pH (up to 6.30±0.17) in patients with severe periodontal disease (P=0.001) and salivary flow rate values (0.29±0.07 mL/min; P=0.014) 3 months after oral hygienization. There was a strong association between the severity of periodontal disease and presence of cardiovascular disease (P=0.001). CONCLUSIONS Our study suggests that the decrease of salivary flow rate and pH level might be associated with the severity of periodontal disease.
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Affiliation(s)
| | - Florina Popescu
- Department of Occupational Health, Victor Babeş University of Medicine and Pharmacy, Timișoara, Romania
| | - Anca Tudor
- Department of Functional Science, Discipline of Medical Informatics and Biostatistics Victor Babeş University of Medicine and Pharmacy, Timișoara, Romania
| | - Laura Stef
- Department of Oral Health and Nursing, Faculty of Medicine, Research Center for Complex Physical Systems, Lucian Blaga University, Sibiu, Romania
| | - Alina Gabriela Negru
- Department of Cardiology, Victor Babeş University of Medicine and Pharmacy, Timișoara, Romania
| | - Romeo Mihăilă
- Department of Internal Medicine, County Emergency Hospital Sibiu, Faculty of Medicine, Lucian Blaga University, Sibiu, Romania
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24
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Codella R, Della Guardia L, Terruzzi I, Solini A, Folli F, Varoni EM, Carrassi A, Luzi L. Physical activity as a proxy to ameliorate inflammation in patients with type 2 diabetes and periodontal disease at high cardiovascular risk. Nutr Metab Cardiovasc Dis 2021; 31:2199-2209. [PMID: 34099361 DOI: 10.1016/j.numecd.2021.04.022] [Citation(s) in RCA: 3] [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] [Received: 02/04/2021] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 12/17/2022]
Abstract
While the beneficial impact of physical activity has been ascertained in a variety of pathological scenarios, including diabetes and low-grade systemic inflammation, its potential remains still putative for periodontal health. Periodontal disease has been associated with inflammatory systemic alterations, which share a common denominator with type 2 diabetes mellitus and cardiovascular disease. Physical exercise, along with nutritional counseling, is a cornerstone in the treatment and prevention of type 2 diabetes, also able to reduce the prevalence of periodontal disease and cardiovascular risk. In addition, considering the higher incidence of periodontitis in patients with type 2 diabetes compared to healthy controls, the fascinating research question would be whether physical activity could relieve the inflammatory pressure exerted by the combination of these two diseases. This multi-disciplinary viewpoint discusses available literature in order to argument the hypothesis of a "three-way relationship" linking diabetes, periodontitis, and physical activity.
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Affiliation(s)
- Roberto Codella
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milano, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Lucio Della Guardia
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milano, Italy
| | - Ileana Terruzzi
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milano, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, Università di Pisa, Pisa, Italy
| | - Franco Folli
- Endocrinology and Metabolism, Department of Health Science, Università Degli Studi di Milano, Milano, Italy
| | - Elena Maria Varoni
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milano, Italy
| | - Antonio Carrassi
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milano, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milano, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy.
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25
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Mosen DM, Banegas MP, Dickerson JF, Fellows JL, Pihlstrom DJ, Kershah HM, Scott JL, Keast EM. Evaluating the Effectiveness of Medical-Dental Integration to Close Preventive and Disease Management Care Gaps. FRONTIERS IN DENTAL MEDICINE 2021; 2:670012. [PMID: 36213339 PMCID: PMC9536421 DOI: 10.3389/fdmed.2021.670012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The integration of medical care into the dental setting has been shown to facilitate the closure of care gaps among patients with unmet needs. However, little is known about whether program effectiveness varies depending on whether the care gap is related to preventive care or disease management. Materials and Methods We used a matched cohort study design to compare closure of care gaps between patients aged 65+ who received care at a Kaiser Permanente Northwest (KPNW) Medical-Dental Integration (MDI) clinic or a non-MDI dental clinic between June 1, 2018, and December 31, 2019. The KPNW MDI program focuses on closing 12 preventive (e.g., flu vaccines) and 11 disease management care gaps (e.g., HbA1c testing) within the dental setting. Using the multivariable logistic regression, we separately analyzed care gap closure rates (yes vs. no) for patients who were overdue for: (1) preventive services only (n = 1,611), (2) disease management services only (n = 538), or (3) both types of services (n = 429), analyzing closure of each care gap type separately. All data were obtained through the electronic health record of KPNW. Results The MDI patients had significantly higher odds of closing preventive care gaps (OR = 1.51, 95% CI = 1.30-1.75) and disease management care gaps (OR = 1.65, 95% CI = 1.27-2.15) than the non-MDI patients when they only had care gaps of one type or the other. However, no significant association was found between MDI and care gap closure when patients were overdue for both care gap types. Conclusions Patients with care gaps related to either preventive care or disease management who received dental care in an MDI clinic had higher odds of closing these care gaps, but we found no evidence that MDI was helpful for those with both types of care gaps. Practical Implications MDI may be an effective model for facilitating the delivery of preventive and disease management services, mainly when patients are overdue for one type of these services. Future research should examine the impact of MDI on long-term health outcomes.
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Affiliation(s)
- David M. Mosen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Matthew P. Banegas
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - John F. Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Jeffrey L. Fellows
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | | | - Hala M. Kershah
- Dental Administration, Kaiser Permanente Northwest, Portland, OR, United States
| | - Jason L. Scott
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Erin M. Keast
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
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26
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Li L, Zhang YL, Liu XY, Meng X, Zhao RQ, Ou LL, Li BZ, Xing T. Periodontitis Exacerbates and Promotes the Progression of Chronic Kidney Disease Through Oral Flora, Cytokines, and Oxidative Stress. Front Microbiol 2021; 12:656372. [PMID: 34211440 PMCID: PMC8238692 DOI: 10.3389/fmicb.2021.656372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/01/2021] [Indexed: 12/25/2022] Open
Abstract
Periodontitis is a type of systemic immune inflammation that is caused by the complex infection of a variety of microorganisms in the subgingival plaque and the imbalance of the microbial ecological environment in the mouth. Periodontitis and chronic kidney disease (CKD) share many risk factors, such as obesity, smoking, and age. A growing body of data supports a strong correlation between periodontitis and kidney disease. Evidence supports the role of periodontal inflammation and elevated serum inflammatory mediators in renal atherosclerosis, renal deterioration, and end-stage renal disease (ESRD) development. Periodontitis is a risk factor for kidney disease. However, to our knowledge, there are few studies detailing the possible link between periodontitis and CKD. This review summarizes the possible mechanisms underlying periodontitis and CKD. More importantly, it highlights novel and potential pathogenic factors for CKD, including bacteria, pro-inflammatory mediators and oxidative stress. However, most research on the relationship between periodontitis and systemic disease has not determined causality, and these diseases are largely linked by bidirectional associations. Future research will focus on exploring these links to contribute to new treatments for CKD.
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Affiliation(s)
- Ling Li
- School of Stomatology, Anhui Medical University, Hefei, China
| | - Ya-Li Zhang
- School of Stomatology, Anhui Medical University, Hefei, China
| | - Xing-Yu Liu
- School of Stomatology, Anhui Medical University, Hefei, China
| | - Xiang Meng
- Key Laboratory of Oral Diseases Research of Anhui Province, College and Hospital of Stomatology, Anhui Medical University, Hefei, China
| | - Rong-Quan Zhao
- School of Stomatology, Anhui Medical University, Hefei, China
| | - Lin-Lin Ou
- School of Stomatology, Anhui Medical University, Hefei, China
| | - Bao-Zhu Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Tian Xing
- School of Stomatology, Anhui Medical University, Hefei, China
- Key Laboratory of Oral Diseases Research of Anhui Province, College and Hospital of Stomatology, Anhui Medical University, Hefei, China
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27
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Isola G, Polizzi A, Alibrandi A, Williams RC, Leonardi R. Independent impact of periodontitis and cardiovascular disease on elevated soluble urokinase-type plasminogen activator receptor (suPAR) levels. J Periodontol 2021; 92:896-906. [PMID: 33091149 DOI: 10.1002/jper.20-0242] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous studies have demonstrated that a soluble urokinase-type plasminogen activator receptor (suPAR) plays an essential function in leukocytes and endothelial homeostasis and, therefore, in the development of coronary heart disease (CHD) and periodontitis. The aim of this study was to analyze the impact of gingival health, periodontitis, and CHD on suPAR levels in plasma and saliva and to evaluate suPAR as a biomarker of periodontitis and CHD. METHODS Healthy controls (n = 33), patients with periodontitis (n = 31), CHD (n = 29), and a combination of periodontitis + CHD (n = 29) were enrolled in the present study. All patients were clinically and periodontally evaluated and regularly assessed for socioeconomic status, serum lipids, high-sensitivity C-reactive protein (hs-CRP), and for plasma and salivary suPAR levels. RESULTS Patients with periodontitis (P <.001) and with periodontitis + CHD (P <.001) presented higher median plasma and salivary suPAR levels compared with CHD and healthy controls. Moreover, univariate regression analysis demonstrated that hs-CRP (P <.001) and periodontitis (P <.001) had a significant negative direct effect on both plasma and salivary suPAR levels. The multivariate regression analysis showed that periodontitis was the only significant predictor of plasma suPAR (P = .035) while hs-CRP was the only significant predictor of salivary suPAR (P <.001). CONCLUSIONS The results of the present study demonstrated that patients with periodontitis and periodontitis + CHD presented higher suPAR levels in both plasma and saliva in comparison with healthy controls and CHD. Moreover, periodontitis and hs-CRP were the only significant predictors of the augmented suPAR levels in plasma and saliva, respectively.
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Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, Unit of Periodontology, School of Dentistry, University of Catania, Catania, Italy
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, Unit of Periodontology, School of Dentistry, University of Catania, Catania, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical Sciences, University of Messina, Messina, Italy
| | - Ray C Williams
- Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Rosalia Leonardi
- Department of General Surgery and Surgical-Medical Specialties, Unit of Periodontology, School of Dentistry, University of Catania, Catania, Italy
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28
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Lyra P, Machado V, Proença L, Mendes JJ, Botelho J. Tooth Loss and Blood Pressure in Parkinson's Disease Patients: An Exploratory Study on NHANES Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095032. [PMID: 34068631 PMCID: PMC8126086 DOI: 10.3390/ijerph18095032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 12/15/2022]
Abstract
Objectives: To evaluate tooth loss severity in PD patients and the impact of missing teeth on blood pressure (BP) and glycated hemoglobin (Hba1c) levels. Methods: All adults reporting specific PD medication regimens with complete dental examinations were included from the NHANES 2001 to 2018 databases. Sociodemographic, systolic BP (SBP), diastolic BP (DBP) and Hba1c data were compared according to tooth loss severity, and linear regression analyses on the impact of tooth loss on SBP, DBP and Hba1c levels were conducted. Results: The 214 included participants presented 9.7 missing teeth, 23.8% severe tooth loss and 18.2% total edentulousness. Severe tooth loss cases were significantly older (p < 0.001), had higher smoking prevalence (p = 0.008), chronic medical conditions (p = 0.012) and higher Hba1c (p = 0.001), SBP (p = 0.015) and DBP (p < 0.001) levels. Crude and adjusted linear models revealed a relationship between SBP, DBP and missing teeth; however, age confounded these links (SBP: B = 0.10, SE = 0.16, p < 0.05; DBP: B = 0.16, SE = 0.10, p < 0.05). Tooth loss presented no significant relationship with Hba1c levels. Conclusions: Severe tooth loss is prevalent among PD patients. Blood pressure levels showed a positive linear relationship with the number of missing teeth, although age was a confounding factor. Furthermore, tooth loss and Hba1c levels revealed no significant linear relationship.
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Affiliation(s)
- Patrícia Lyra
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Clinical Research Unit (CRU), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (P.L.); (V.M.); (J.J.M.)
| | - Vanessa Machado
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Clinical Research Unit (CRU), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (P.L.); (V.M.); (J.J.M.)
- Evidence-Based Hub, CRU, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal;
| | - Luís Proença
- Evidence-Based Hub, CRU, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal;
- Quantitative Methods for Health Research (MQIS), CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal
| | - José João Mendes
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Clinical Research Unit (CRU), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (P.L.); (V.M.); (J.J.M.)
- Evidence-Based Hub, CRU, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal;
| | - João Botelho
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Clinical Research Unit (CRU), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (P.L.); (V.M.); (J.J.M.)
- Evidence-Based Hub, CRU, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal;
- Correspondence: ; Tel.: +351-969-848-394
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29
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Sen S, Redd K, Trivedi T, Moss K, Alonso A, Soliman EZ, Magnani JW, Chen LY, Gottesman RF, Rosamond W, Beck J, Offenbacher S. Periodontal Disease, Atrial Fibrillation and Stroke. Am Heart J 2021; 235:36-43. [PMID: 33503409 PMCID: PMC8084947 DOI: 10.1016/j.ahj.2021.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND We recently described the association between periodontal disease (PD) and stroke risk. PURPOSE The purpose of this study was to test the association between PD, dental care utilization and incident atrial fibrillation (AF), as well as AF as a mediator to PD- stroke association. METHODS In dental cohort of the Atherosclerosis Risk in Communities Study (ARIC), participants without prior AF underwent full-mouth periodontal measurements. PD was defined on an ordinal scale as healthy (referent), mild, moderate and severe. In ARIC main cohort, participants were classified as regular or episodic dental care users. These patients were followed for AF, over 17 years. Cox proportional hazards models adjusted for AF risk factors were used to study relationships between PD severity, dental care utilization and AF. Mediation analysis was used to test if AF mediated the PD- stroke association. RESULTS In dental ARIC cohort, 5,958 were assessed without prior AF, 754 were found to have AF. Severe PD was associated with AF on both univariable (crude HR, 1.54; 95% CI, 1.26-1.87) and multivariable (adjusted HR, 1.31, 95% CI, 1.06-1.62) analyses. Mediation analysis suggested AF mediates the association between PD and stroke. In the main ARIC cohort, 9,666 participants without prior AF were assessed for dental care use, 1558 were found to have AF. Compared with episodic users, regular users had a lower risk for AF on univariable (crude HR, 0.82, 95% CI, 0.74-0.90) and multivariable (adjusted HR, 0.88, 95% CI, 0.78-0.99) analyses. CONCLUSIONS PD is associated with AF. The association may explain the PD-stroke risk. Regular users had a lower risk of incident AF compared with episodic users.
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Affiliation(s)
- Souvik Sen
- Department of Neurology, University of South Carolina, School of Medicine, Columbia, SC.
| | - Kolby Redd
- Department of Neurology, University of South Carolina, School of Medicine, Columbia, SC
| | - Tushar Trivedi
- Department of Neurology, University of South Carolina, School of Medicine, Columbia, SC
| | - Kevin Moss
- Department of Periodontology, University of North Carolina, Chapel Hill, NC
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Elsayed Z Soliman
- Department of Epidemiology and Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Lin Y Chen
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wayne Rosamond
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC
| | - James Beck
- Department of Periodontology, University of North Carolina, Chapel Hill, NC
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Alanazi AF, Alenezy A, Alotiby A, Bukhari T, Alturaiki W, BinShaya AS, Waggiallah HA, W H, Y K, K M, Alanazi AF, Q B Alenzi F. Relationship between high CRP and cytokines in Saudi old people with dental caries in alkharj Region, Saudi Arabia. Saudi J Biol Sci 2021; 28:3523-3525. [PMID: 34121894 PMCID: PMC8176057 DOI: 10.1016/j.sjbs.2021.03.022] [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: 12/11/2020] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 10/25/2022] Open
Abstract
Objective Dental caries is one of the most common problems of the oral cavity which is frequently observed in older people. The aim of this study is to evaluate serum C-reactive proteins (CRP) levels and to identify the correlation between dental caries and CRP levels. Methodology The study included 12 aged patients with an average age of 65-years; the patients were diagnosed with dental caries and did not have clinical history of heart diseases, rheumatoid arthritis or any other infection. The control group consisted of 10 healthy donors with an average age of 60-years. The CRP level of positive samples was measured by using CRP Enzyme-linked immunosorbent assay-ELISA Kit. Results The currents study showed that only 5 out of 12 patients were CRP positive. Conclusions Because of study limitations, it is early to conclude of close relationship between serum CRP and dental caries from the findings of this study; however, this study will give a clearer picture to understand the relationship between serum CRP, inflammatory cytokines and dental caries.
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Affiliation(s)
- Arwa F Alanazi
- Dept of Dentistry, Riyadh Alm University, Riyadh, Saudi Arabia
| | - Awwad Alenezy
- Dept of Family and Community Medicine, College of Medicine, NBU, Arar, Saudi Arabia
| | - Amna Alotiby
- Dept of Immunology, College of Medicine, Um Qura University, Makka, Saudi Arabia
| | - Talat Bukhari
- Dept of Immunology, College of Medicine, Um Qura University, Makka, Saudi Arabia
| | - Wael Alturaiki
- Dept of Med Lab Sci, College of Appl Med Sci, Majmma University, Saudi Arabia
| | - Abdulkarim S BinShaya
- Dept of Med Lab Sci, College of Appl Med Sci, Prince Sattam University, Alkharj, Saudi Arabia
| | - Hisham Ali Waggiallah
- Dept of Med Lab Sci, College of Appl Med Sci, Prince Sattam University, Alkharj, Saudi Arabia
| | - Harbi W
- Dept of Med Lab Sci, College of Appl Med Sci, Prince Sattam University, Alkharj, Saudi Arabia
| | - Kahtani Y
- Dept of Med Lab Sci, College of Appl Med Sci, Prince Sattam University, Alkharj, Saudi Arabia
| | - Majli K
- Dept of Med Lab Sci, College of Appl Med Sci, Prince Sattam University, Alkharj, Saudi Arabia
| | | | - Faris Q B Alenzi
- Dept of Med Lab Sci, College of Appl Med Sci, Prince Sattam University, Alkharj, Saudi Arabia
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Botelho J, Leira Y, Viana J, Machado V, Lyra P, Aldrey JM, Pías-Peleteiro JM, Blanco J, Sobrino T, Mendes JJ. The Role of Inflammatory Diet and Vitamin D on the Link between Periodontitis and Cognitive Function: A Mediation Analysis in Older Adults. Nutrients 2021; 13:924. [PMID: 33809193 PMCID: PMC8001166 DOI: 10.3390/nu13030924] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 12/13/2022] Open
Abstract
Patients suffering from periodontitis are at a higher risk of developing cognitive dysfunction. However, the mediation effect of an inflammatory diet and serum vitamin D levels in this link is unclear. In total, 2062 participants aged 60 years or older with complete periodontal diagnosis and cognitive tests from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 and 2013-2014 were enrolled. The Consortium to Establish a Registry for Alzheimer's disease (CERAD) word learning subtest (WLT) and CERAD delayed recall test (DRT), the animal fluency test (AFT) and the digit symbol substitution test (DSST) was used. Dietary inflammatory index (DII) was computed via nutrition datasets. Mediation analysis tested the effects of DII and vitamin D levels in the association of mean probing depth (PD) and attachment loss (AL) in all four cognitive tests. Periodontitis patients obtained worse cognitive test scores than periodontally healthy individuals. DII was negatively associated with CERAD-WLT, CERAD-DRT, AFT and DSST, and was estimated to mediate between 9.2% and 36.4% of the total association between periodontitis with cognitive dysfunction (p < 0.05). Vitamin D showed a weak association between CERAD-DRT, AFT and DSST and was estimated to between 8.1% and 73.2% of the association between periodontitis and cognitive dysfunction (p < 0.05). The association between periodontitis and impaired cognitive function seems to be mediated both by a proinflammatory dietary load and vitamin D deficiency. Future studies should further explore these mediators in the periodontitis-cognitive decline link.
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Affiliation(s)
- João Botelho
- Periodontology Department, Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal;
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal; (J.V.); (P.L.); (J.J.M.)
| | - Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute and NIHR UCLH Biomedical Research Centre, University College London, London WC1E 6DE, UK;
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain;
- Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
| | - João Viana
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal; (J.V.); (P.L.); (J.J.M.)
| | - Vanessa Machado
- Periodontology Department, Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal;
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal; (J.V.); (P.L.); (J.J.M.)
| | - Patrícia Lyra
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal; (J.V.); (P.L.); (J.J.M.)
| | - José Manuel Aldrey
- Dementia Unit, Department of Neurology, Clinical University Hospital, 15706 Santiago de Compostela, Spain; (J.M.A.); (J.M.P.-P.)
| | - Juan Manuel Pías-Peleteiro
- Dementia Unit, Department of Neurology, Clinical University Hospital, 15706 Santiago de Compostela, Spain; (J.M.A.); (J.M.P.-P.)
| | - Juan Blanco
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain;
- Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
| | - José João Mendes
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal; (J.V.); (P.L.); (J.J.M.)
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Tiensripojamarn N, Lertpimonchai A, Tavedhikul K, Udomsak A, Vathesatogkit P, Sritara P, Charatkulangkun O. Periodontitis is associated with cardiovascular diseases: A 13-year study. J Clin Periodontol 2021; 48:348-356. [PMID: 33386631 DOI: 10.1111/jcpe.13418] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 09/25/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
AIM To prospectively evaluate the association between periodontitis and the incidence of cardiovascular diseases (CVDs) in Thai adults. MATERIALS AND METHODS Medical data from the questionnaires and physical examinations of 1850 participants aged 47-73 years from EGAT study were gathered. Random half-mouth periodontal examination of each participant was performed by calibrated periodontists, and periodontal status was defined. The incidence of new CVD events, including coronary heart disease (CHD) and stroke, was verified by cardiologists. The Cox proportional hazard regression model was used to estimate hazard ratios (HRs). RESULTS The prevalence of no/mild, moderate and severe periodontitis in the study participants was 11.7%, 52.7% and 35.6%, respectively. During the 13-year follow-up, CVD events occurred in 110 (5.9%) participants, with 82 (4.4%) from CHD and 28 (1.5%) from stroke. After adjusting for cardiovascular risk factors, a significant association between severe periodontitis and the incidence of CHD was found compared with the no/mild periodontitis group with an HR of 4.53 (95% confidence intervals: 1.08-19.02). However, no significant association was seen when considering total CVD events and stroke outcome. CONCLUSIONS This study demonstrates that severe periodontitis is associated with an increased incidence of CHD, independent of established cardiovascular risk factors.
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Affiliation(s)
| | - Attawood Lertpimonchai
- Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Kanoknadda Tavedhikul
- Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Artit Udomsak
- Electricity Generating Authority of Thailand, Nonthaburi, Thailand
| | | | | | - Orawan Charatkulangkun
- Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
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Philips KH, Zhang S, Moss K, Ciarrocca K, Beck JD. Periodontal disease, undiagnosed diabetes, and body mass index: Implications for diabetes screening by dentists. J Am Dent Assoc 2021; 152:25-35. [PMID: 33256949 PMCID: PMC8078479 DOI: 10.1016/j.adaj.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Periodontal disease and diabetes are widespread comorbid conditions that are detrimental to oral and overall health. Dentists' performing chairside screenings for undiagnosed diabetes mellitus (UDM) can be beneficial to both patients and providers. The authors determined UDM rates in a population-based study and whether UDM and periodontal disease were independently associated. METHODS Data from 7,343 participants in the Atherosclerosis Risk in Communities study visit 4 were used to determine rates of UDM by periodontal status, edentulism, and body mass index. The authors used a χ2 test or analysis of variance, along with a 2-stage logistic regression model, to determine relationships with UDM. UDM was defined as no self-reported diabetes and blood glucose levels (fasting glucose ≥ 126 milligrams/deciliter or nonfasting glucose > 200 mg/dL). Periodontal disease was defined using the Periodontal Profile Classes system adapted to stages and the Centers for Disease Control and Prevention and American Academy of Periodontology index. RESULTS UDM rates overall were 5.6%. The highest rates occurred in patients who were obese and edentulous (12.6%) and obese and had severe periodontal disease (12.2%). Significant associations were found for UDM and severe periodontal disease (Periodontal Profile Classes system stage IV) (odds ratio, 1.78; 95% confidence interval, 1.10 to 2.88). Edentulism was significantly associated with UDM in the Periodontal Profile Classes system model (odds ratio, 1.87; 95% confidence interval, 1.27 to 2.75) and Centers for Disease Control and Prevention and American Academy of Periodontology index (odds ratio, 1.70; 95% confidence interval, 1.08 to 2.67). Hyperglycemia was found in participants of all body mass index categories. CONCLUSIONS UDM is significantly associated with obesity, edentulism, and periodontitis. These characteristics could help dentists identify patients at higher risk of developing DM. Patients without these characteristics still have UDM, so dentists performing chairside diabetes screening for all patients would yield additional benefit. PRACTICAL IMPLICATIONS Dental offices are a major point of contact within the US health care system. Diabetes screening in this setting can provide important health information with direct relevance to patient care.
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Boynes S, Nelson J, Diep V, Kanan C, Pedersen DN, Brown C, Mathews R, Tranby E, Apostolon D, Bayham M, Minter-Jordan M. Understanding value in oral health: the oral health value-based care symposium. J Public Health Dent 2020; 80 Suppl 2:S27-S34. [PMID: 33058156 DOI: 10.1111/jphd.12402] [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: 06/16/2020] [Revised: 08/17/2020] [Accepted: 09/08/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE There are both opportunities and challenges with the implementation of oral health value-based care (OHVBC). To tackle concerns and advance conversation, a symposium was convened with subject matter experts to develop a gap analysis and capture insights into professional readiness for value-based care design. METHODS The symposium was convened as a private event for 46 participants over the course of one and a half days in December 2019. Thematic analyses utilized the OHVBC Readiness Framework (DentaQuest Partnership, 2019) to further codify conversations as part of the gap-analysis process. Poll Everywhere, a text messaging application that allows participants to answer questions in real time, was also employed to solicit responses. RESULTS Attendees of the symposium felt that OHVBC would have a large portion of market share within the next 10 years. A qualitative assessment of multiple table discussions determined that the participants developed more consensus around themes for the current state and the future-desired state than the action-planning needed to close the gap between the two. This may relate to individual ideology, and the siloed environment is still prevalent in the oral health realm. In a postsymposium survey, respondent attendees did not perceive that COVID-19 would delay or negatively impact the adoption of OHVBC and may result in accelerating its utilization. CONCLUSION The oral health community is experiencing multiple drivers to adopt more OHVBC within business and care models. However, there is still a lack of uniformity on how to execute this delivery model.
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Affiliation(s)
- Sean Boynes
- DentaQuest Partnership for Oral Health Advancement, Boston, MA, USA
| | - Joni Nelson
- Medical University of South Carolina, James B. Edwards College of Dental Medicine, Charleston, SC, USA
| | - Vuong Diep
- DentaQuest Partnership for Oral Health Advancement, Boston, MA, USA
| | - Christine Kanan
- DentaQuest Partnership for Oral Health Advancement, Boston, MA, USA
| | | | - Carolyn Brown
- DentaQuest Partnership for Oral Health Advancement, Boston, MA, USA
| | - Rebekah Mathews
- DentaQuest Partnership for Oral Health Advancement, Boston, MA, USA
| | - Eric Tranby
- DentaQuest Partnership for Oral Health Advancement, Boston, MA, USA
| | | | - Mary Bayham
- DentaQuest Partnership for Oral Health Advancement, Boston, MA, USA
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Demmer RT, Norby FL, Lakshminarayan K, Walker KA, Pankow JS, Folsom AR, Mosley T, Beck J, Lutsey PL. Periodontal disease and incident dementia: The Atherosclerosis Risk in Communities Study (ARIC). Neurology 2020; 95:e1660-e1671. [PMID: 32727837 PMCID: PMC7713724 DOI: 10.1212/wnl.0000000000010312] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that periodontal disease would be associated with increased risk for dementia and mild cognitive impairment (MCI) by assessing dementia/MCI outcomes after a baseline periodontal examination. METHODS Participants enrolled in the Atherosclerosis Risk in Communities study with a clinical periodontal examination (or edentulous participants) at visit 4 (1996-1998; mean ± SD age 63 ± 6 years, 55% female, 21% black) and adjudicated dementia outcomes through 2016 were included (n = 8,275). A subgroup of 4,559 participants had adjudicated dementia and MCI assessments at visit 5 (2011-2013). Participants received a full-mouth periodontal examination and were classified into periodontal profile classes (PPCs) based on the severity and extent of gingival inflammation and attachment loss. MCI and dementia were determined via neurocognitive testing, neurological examination and history, informant interviews, and brain MRI in a subset. Cox proportional hazards models regressed incident dementia on PPCs. Relative risk regression models were used for the composite of MCI/dementia. RESULTS The cumulative incidence and incidence density of dementia during follow-up (average 18.4 years) were 19% (n = 1,569) and 11.8 cases per 1,000 person-years. Multivariable adjusted hazard ratios for incident dementia among participants with severe PPC or edentulism (vs periodontal healthy) were 1.22 (95% confidence interval [CI] 1.01-1.47) and 1.21 (95% CI 0.99-1.48), respectively. For the combined dementia/MCI outcome, adjusted risk ratios among participants with mild/intermediate PPC, severe PPC, or edentulism (vs periodontal healthy) were 1.22 (95% CI 1.00-1.48), 1.15 (95% CI 0.88-1.51), and 1.90 (95% CI 1.40-2.58). Results were stronger among younger (≤62 years) participants (p for interaction = 0.02). CONCLUSION Periodontal disease was modestly associated with incident MCI and dementia in a community-based cohort of black and white participants.
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Affiliation(s)
- Ryan T Demmer
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill.
| | - Faye L Norby
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Kamakshi Lakshminarayan
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Keenan A Walker
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - James S Pankow
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Aaron R Folsom
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Thomas Mosley
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Jim Beck
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Pamela L Lutsey
- From the Division of Epidemiology and Community Health (R.T.D., F.L.N., K.L., J.S.P., A.R.F., P.L.L.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (R.T.D.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (K.A.W.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Division of Comprehensive Oral Health-Periodontology (J.B.), Adams School of Dentistry, University of North Carolina at Chapel Hill
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Seki K, Hasuike A, Iwano Y, Hagiwara Y. Influence of antihypertensive medications on the clinical parameters of anodized dental implants: a retrospective cohort study. Int J Implant Dent 2020; 6:32. [PMID: 32696295 PMCID: PMC7374550 DOI: 10.1186/s40729-020-00231-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background Hypertension is a chronic medical condition in which blood pressure in the arteries is elevated. Given the large proportion of dental implant patients using antihypertensive medications, it is crucial to evaluate the effects of these drugs on the clinical parameters of osseointegrated implants. The aim of the present retrospective cohort study was to evaluate the influence of antihypertensive medications on clinical peri-implant tissue parameters. Methods Thirty-five patients received a total of 77 anodized dental implants. Based on the history of the use of antihypertensive medications, the patients were divided into two groups: the group taking antihypertensive medications (AH group) and the group of healthy patients (H group). Implants were followed up clinically and radiologically, with a focus on the peri-implant soft tissue parameters probing pocket depth, bleeding on probing, modified plaque index, and marginal peri-implant bone level stability. Results None of the implants were lost, and no technical failures occurred. The mean follow-up duration was 7 years and 1 month. A significant difference was observed in the probing pocket depth 3.8 ± 1.3 mm in the AH group and 3.0 ± 0.7 mm in the H group. In the AH and H groups, 26.5% (9/34) and 4.7% (2/43) of the patients were diagnosed with peri-implantitis at the implant level, respectively. Conclusions Our findings suggest some correlations between antihypertensive medication use and clinical parameters in anodized peri-implant tissue.
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Affiliation(s)
- Keisuke Seki
- Implant Dentistry, Nihon University School of Dentistry Dental Hospital, Tokyo, Japan. .,Department of Comprehensive Dentistry and Clinical Education, Nihon University School of Dentistry, Tokyo, Japan.
| | - Akira Hasuike
- Implant Dentistry, Nihon University School of Dentistry Dental Hospital, Tokyo, Japan.,Department of Periodontology, Nihon University School of Dentistry, Tokyo, Japan
| | | | - Yoshiyuki Hagiwara
- Implant Dentistry, Nihon University School of Dentistry Dental Hospital, Tokyo, Japan
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Barros SP, Hefni E, Fahimipour F, Kim S, Arora P. Maintaining barrier function of infected gingival epithelial cells by inhibition of DNA methylation. J Periodontol 2020; 91 Suppl 1:S68-S78. [PMID: 32633810 DOI: 10.1002/jper.20-0262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Infection and inflammation induce epigenetic changes that alter gene expression. In periodontal disease, inflammation, and microbial dysbiosis occur, which can lead to compromised barrier function of the gingival epithelia. Here, we tested the hypotheses that infection of cultured human gingival epithelial (HGEp) cells with Porphyromonas gingivalis disrupts barrier function by inducing epigenetic alterations and that these effects can be blocked by inhibitors of DNA methylation. METHODS Primary HGEp cells were infected with P. gingivalis either in the presence or absence of the non-nucleoside DNA methyltransferase (DNMT) inhibitors RG108, (-) epigallocatechin-3-gallate (EGCG), or curcumin. Barrier function was assessed as transepithelial electrical resistance (TEER). DNA methylation and mRNA abundance were quantified for genes encoding components of three cell-cell junction complexes, CDH1, PKP2, and TJP1. Cell morphology and the abundance of cell-cell junction proteins were evaluated by confocal microscopy. RESULTS Compared to non-infected cells, P. gingivalis infection decreased TEER (P < 0.0001) of HGEp cells; increased methylation of the CDH1, PKP2, and TJP1 (P < 0.0001); and reduced their expression (mRNA abundance) (P < 0.005). Pretreatment with DNMT inhibitors prevented these infection-induced changes in HGEp cells, as well as the altered morphology associated with infection. CONCLUSION Pathogenic infection induced changes in DNA methylation and impaired the barrier function of cultured primary gingival epithelial cells, which suggests a mechanism for systemic consequences of periodontal disease. Inhibition of these events by non-nucleoside DNMT inhibitors represents a potential strategy to treat periodontal disease.
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Affiliation(s)
- Silvana P Barros
- Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Eman Hefni
- Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Farahnaz Fahimipour
- Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Steven Kim
- Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Divaris K, Moss K, Beck JD. Biologically informed stratification of periodontal disease holds the key to achieving precision oral health. J Periodontol 2020; 91 Suppl 1:S50-S55. [PMID: 32432812 DOI: 10.1002/jper.20-0096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 12/24/2022]
Abstract
Medicine and dentistry need to treat the individual not the "average patient." This personalized or precision approach to health care involves correctly diagnosing and properly classifying people to effectively customize prevention, diagnosis, and treatment. This is not a trivial undertaking. Achieving precision health requires making sense of big data, both at the population level and at the molecular level. The latter can include genetic, epigenetic, transcriptomic, proteomic, metabolomic data, and microbiome data. This biological information can augment established clinical measurements and supplement data on socioeconomic status, lifestyle, behaviors, and environmental conditions. Here, the central thesis is that, with sufficient data and appropriate methods, it is possible to segregate symptom-based and phenotypically based categories of patients into clinically and biologically similar groups. These groups are likely to have different clinical trajectories and benefit from different treatments. Additionally, such groups are optimal for investigations seeking to unveil the genomic basis of periodontal disease susceptibility. Analysis of these complex data to produce actionable and replicable health and disease categories requires appropriately sophisticated bioinformatics approaches and thorough validation in diverse patient samples and populations. Successful research programs will need to consider both population-level and well-controlled deep phenotyping approaches. Biologically informed stratification of periodontal disease is both feasible and desirable. Ultimately, this approach can accelerate the development of precision health through improvements in research and clinical applications.
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Affiliation(s)
- Kimon Divaris
- Pediatric and Public Health, Adams School of Dentistry and Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Kevin Moss
- Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - James D Beck
- Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC
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Beck JD, Philips K, Moss K, Sen S, Morelli T, Preisser J, Pankow J. Periodontal disease classifications and incident coronary heart disease in the Atherosclerosis Risk in Communities study. J Periodontol 2020; 91:1409-1418. [PMID: 32449797 DOI: 10.1002/jper.19-0723] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Periodontal disease has been linked to coronary heart disease (CHD), but studies have been inconclusive. This study investigates the link between periodontal disease and incident CHD. METHODS Baseline periodontal data from a full-mouth periodontal exam (N = 6,300) and CHD outcomes through 2017 were obtained from the Atherosclerosis Risk in Communities Study. Periodontitis was defined by the Periodontal Profile Class System adapted to Stages (PPC stages) and the Centers for Disease Control/American Academy of Periodontology (CDC/AAP) index. Competing risk models were used to determine hazard ratios (HR) for incident CHD, congestive heart failure (CHF), and other causes of death. Secondary analysis included myocardial infarction (MI) and fatal CHD. RESULTS Females comprised 56% of participants and males 44% with a combined mean age of 62.3 years (range: 52 to 74). Participants were followed for an average of 16.7 (SD: 5.5) years. In a fully adjusted model, PPC stage VII (Severe Tooth Loss) was moderately significantly related to incident CHD, (HR 1.51 [1.11 to 2.09]). PPC stage V (Mild Tooth Loss/High Gingival Inflammation) was significant for fatal CHD (HR, 5.27 [1.80 to 15.4]) and PPC stage VII was significant for incident MI (HR, 1.59 [1.13 to 2.23]). The CDC/AAP definition was not significantly associated with incident CHD. CONCLUSIONS Incident CHD was moderately significantly associated with a specific stage of periodontal disease characterized by severe tooth loss, while none of the categories of the CDC/AAP were significantly associated. Thus, while periodontal therapy may improve oral health, it may be effective at impacting CHD incidence in only certain groups of people.
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Affiliation(s)
- James D Beck
- Division of Comprehensive Oral Health - Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kamaira Philips
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kevin Moss
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Souvik Sen
- Department of Neurology, University of South Carolina, School of Medicine, Columbia, SC
| | - Thiago Morelli
- Division of Comprehensive Oral Health - Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - James Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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Hickey NA, Shalamanova L, Whitehead KA, Dempsey-Hibbert N, van der Gast C, Taylor RL. Exploring the putative interactions between chronic kidney disease and chronic periodontitis. Crit Rev Microbiol 2020; 46:61-77. [PMID: 32046541 DOI: 10.1080/1040841x.2020.1724872] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) and chronic periodontitis (CP) are both common diseases, which are found disproportionately comorbid with each other and have been reported to have a detrimental effect on the progression of each respective disease. They have an overlap in risk factors and both are a source of systemic inflammation along with a wide selection of immunological and non-specific effects that can affect the body over the lifespan of the conditions. Previous studies have investigated the directionality of the relationship between these two diseases; however, there is a lack of literature that has examined how these diseases may be interacting at the localized and systemic level. This review discusses how oral microorganisms have the ability to translocate and have distal effects and provides evidence for microbial involvement in a systemic disease. Furthermore, it summarizes the reported local and systemic effects of CKD and CP and discusses how the interaction of these effects may be responsible for directionality associations reported.
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Affiliation(s)
- Niall A Hickey
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Liliana Shalamanova
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Kathryn A Whitehead
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Nina Dempsey-Hibbert
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Christopher van der Gast
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Rebecca L Taylor
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
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Zhao S, Jiang H, Liang ZH, Ju H. Integrating Multi-Omics Data to Identify Novel Disease Genes and Single-Neucleotide Polymorphisms. Front Genet 2020; 10:1336. [PMID: 32038707 PMCID: PMC6993083 DOI: 10.3389/fgene.2019.01336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/06/2019] [Indexed: 12/15/2022] Open
Abstract
Stroke ranks the second leading cause of death among people over the age of 60 in the world. Stroke is widely regarded as a complex disease that is affected by genetic and environmental factors. Evidence from twin and family studies suggests that genetic factors may play an important role in its pathogenesis. Therefore, research on the genetic association of susceptibility genes can help understand the mechanism of stroke. Genome-wide association study (GWAS) has found a large number of stroke-related loci, but their mechanism is unknown. In order to explore the function of single-nucleotide polymorphisms (SNPs) at the molecular level, in this paper, we integrated 8 GWAS datasets with brain expression quantitative trait loci (eQTL) dataset to identify SNPs and genes which are related to four types of stroke (ischemic stroke, large artery stroke, cardioembolic stroke, small vessel stroke). Thirty-eight SNPs which can affect 14 genes expression are found to be associated with stroke. Among these 14 genes, 10 genes expression are associated with ischemic stroke, one gene for large artery stroke, six genes for cardioembolic stroke and eight genes for small vessel stroke. To explore the effects of environmental factors on stroke, we identified methylation susceptibility loci associated with stroke using methylation quantitative trait loci (MQTL). Thirty-one of these 38 SNPs are at greater risk of methylation and can significantly change gene expression level. Overall, the genetic pathogenesis of stroke is explored from locus to gene, gene to gene expression and gene expression to phenotype.
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Affiliation(s)
- Sheng Zhao
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huijie Jiang
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zong-Hui Liang
- Department of Radiology, Jian'an District Centre Hospital of Fudan University, Shanghai, China
| | - Hong Ju
- Department of Information Engineering, Heilongjiang Biological Science and Technology Career Academy, Harbin, China
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Perry MA, Lieurance AJ. The Nabataean Urban Experiment and Dental Disease and Childhood Stress. BIOARCHAEOLOGY AND SOCIAL THEORY 2020. [DOI: 10.1007/978-3-030-53417-2_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Ercan Şahin N, Jablonski RA. Ağız Sağlığı Değerlendirme Aracı Türkçe versiyonunun psikometrik özellikleri. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.567995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Beck JD, Philips K, Moss K, Divaris K, Morelli T, Offenbacher S. Advances in precision oral health. Periodontol 2000 2019; 82:268-285. [DOI: 10.1111/prd.12314] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- James D. Beck
- Division of Comprehensive Oral Health Adams School of Dentistry University of North Carolina at Chapel Hill Chapel Hill North Carolina, USA
| | - Kamaira Philips
- Division of Oral and Craniofacial Health Sciences Adams School of Dentistry University of North Carolina at Chapel Hill Chapel Hill North Carolina, USA
| | - Kevin Moss
- Division of Oral and Craniofacial Health Sciences Adams School of Dentistry University of North Carolina at Chapel Hill Chapel Hill North Carolina, USA
| | - Kimon Divaris
- Division of Pediatric and Public Health Adams School of Dentistry University of North Carolina at Chapel Hill Chapel Hill North Carolina, USA
| | - Thiago Morelli
- Division of Comprehensive Oral Health Adams School of Dentistry University of North Carolina at Chapel Hill Chapel Hill North Carolina, USA
| | - Steven Offenbacher
- Division of Comprehensive Oral Health Adams School of Dentistry University of North Carolina at Chapel Hill Chapel Hill North Carolina, USA
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45
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Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol 2019; 89 Suppl 1:S159-S172. [PMID: 29926952 DOI: 10.1002/jper.18-0006] [Citation(s) in RCA: 1137] [Impact Index Per Article: 227.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/11/2018] [Accepted: 02/11/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Authors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state-of-the-art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance. METHODS Evidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis. RESULTS The manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis-associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A-C). Risk factor analysis is used as grade modifier. CONCLUSIONS The paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis.
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Affiliation(s)
- Maurizio S Tonetti
- Periodontology, Faculty of Dentistry, University of Hong Kong, Hong Kong, SAR China
| | - Henry Greenwell
- Graduate Periodontics, School of Dentistry, University of Louisville, Louisville, KY, USA
| | - Kenneth S Kornman
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Fagundes NCF, Almeida APCPSC, Vilhena KFB, Magno MB, Maia LC, Lima RR. Periodontitis As A Risk Factor For Stroke: A Systematic Review And Meta-Analysis. Vasc Health Risk Manag 2019; 15:519-532. [PMID: 31806984 PMCID: PMC6847992 DOI: 10.2147/vhrm.s204097] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/01/2019] [Indexed: 12/20/2022] Open
Abstract
This systematic review and meta-analysis investigate the association between periodontitis and stroke. This review followed the methods established by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searches were conducted in five databases and two sources of grey literature. After the selection of the articles, a risk of bias evaluation was performed. Three meta-analyzes were performed: Assessing the overall association between stroke and periodontitis in case–control studies; Ischemic stroke and periodontitis in case–control studies; The association between stroke and periodontitis in cohort studies. Heterogeneity was assessed using the I2 index and the odds ratio was also calculated (p < 0.05). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to evaluate the level of evidence. 2193 potentially relevant studies were identified, with 10 studies included in qualitative and quantitative analysis. All the articles were considered with low risk of bias and a low level of certainty. The results demonstrated a positive association between both disorders and increased risk for stroke among cohort studies (RR 1.88 [1.55, 2.29], p<0.00001, I2=0%) and for ischemic stroke events in case–control studies (RR 2.72 [2.00, 3.71], p<0.00001, I2= 4%). Periodontitis may represent a risk factor for stroke, especially in ischemic events. However, new studies with a robust design are necessary for a reliable conclusion.
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Affiliation(s)
- Nathalia Carolina Fernandes Fagundes
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém-Pará, Brazil.,School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | | | - Kelly Fernanda Barbosa Vilhena
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém-Pará, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Rodrigues Lima
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém-Pará, Brazil
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Yang L, Jing L, Jiao Y, Wang L, Marchesan JT, Offenbacher S, Schoenfisch MH. In Vivo Antibacterial Efficacy of Nitric Oxide-Releasing Hyperbranched Polymers against Porphyromonas gingivalis. Mol Pharm 2019; 16:4017-4023. [PMID: 31361146 PMCID: PMC6752707 DOI: 10.1021/acs.molpharmaceut.9b00671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The in vivo antibacterial activity of NO-releasing hyperbranched polymers was evaluated against Porphyromonas gingivalis, a key oral pathogen associated with periodontitis, using a murine subcutaneous chamber model. Escalating doses of NO-releasing polymers (1.5, 7.5, and 37.5 mg/kg) were administered into a P. gingivalis-infected chamber once a day for 3 days. Chamber fluids were collected on day 4, with microbiological evaluation indicating a dose-dependent bactericidal action. In particular, NO-releasing polymers at 37.5 mg/kg (1170 μg of NO/kg) achieved complete bacterial eradication (>6-log reduction in bacterial viability), demonstrating greater efficacy than amoxicillin (∼4-log reduction in bacterial viability), a commonly used antibiotic. Time-kill assays further revealed that largest dose (37.5 mg/kg; 1170 μg of NO/kg) resulted in ∼3-log killing of P. gingivalis after only a single dose. Based on these results, the potential clinical utility of NO-releasing hyperbranched polymers appears promising, particularly for oral health applications.
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Affiliation(s)
| | | | | | - Lufei Wang
- Oral and Craniofacial Biomedicine Program, School of Dentistry , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina 27599 , United States
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Khouja T, Miller RG, Moore PA, Orchard TJ, Costacou T. Periodontal disease, smoking, cardiovascular complications and mortality in type 1 diabetes. J Diabetes Complications 2019; 33:603-609. [PMID: 31235433 PMCID: PMC6690769 DOI: 10.1016/j.jdiacomp.2019.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 12/16/2022]
Abstract
AIM To assess the role of periodontal disease (PD) as a predictor of coronary artery disease (CAD) and mortality in a prospective type 1 diabetes (T1D) cohort and to evaluate the role of smoking in this relationship. METHODS Data were based on 320 participants of the Pittsburgh Epidemiology of Diabetes Complications study of T1D who, during 1992-94, received a partial mouth periodontal exam, and who were followed for up to 19 years to ascertain complication incidence. PD was defined as clinical attachment loss of ≥4 mm for at least 10% of the examined sites. Predictors of all-cause mortality; Hard CAD (CAD death, myocardial infarction or revascularization), and Total CAD (Hard CAD, angina, ischemic ECG) were assessed using Cox models. RESULTS During 19 years of follow-up, 33.7% (97/288) developed CAD, 27.3% (83/304) developed Hard CAD, and 16.9% (54/320) died. Among current smokers, 46.4% (26/56) developed CAD, 42.7% (24/56) developed Hard CAD and 29.5% (18/61) died. PD was not associated with all-cause mortality, although it was a significant predictor of both CAD (HR = 1.12, CI = 1.01-1.23) and Hard CAD (HR = 1.30, CI = 1.11-1.51). As smoking modified the PD-CAD and PD-Hard CAD associations, analyses were stratified by smoking status. PD was associated with an increased risk of CAD (HR = 1.25, CI = 1.03-1.50) and Hard CAD (HR = 1.85, CI = 1.17-2.93) only among smokers. CONCLUSION PD was a significant predictor of CAD and Hard CAD among current smokers with T1D.
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Affiliation(s)
- Tumader Khouja
- University of Pittsburgh, Graduate School of Public Health, Department of Health Policy and Management, Pittsburgh, PA, United States
| | - Rachel G Miller
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, United States
| | - Paul A Moore
- University of Pittsburgh, School of Dental Medicine, Department of Dental Public Health, Pittsburgh, PA, United States
| | - Trevor J Orchard
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, United States
| | - Tina Costacou
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, United States.
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Márquez-Corona MDL, Tellez-Girón-Valdez A, Pontigo-Loyola AP, Islas-Zarazúa R, Robles-Bermeo NL, Gonzalez-López BS, Medina-Solís CE. Preterm birth associated with periodontal and dental indicators: a pilot case-control study in a developing country. J Matern Fetal Neonatal Med 2019; 34:690-695. [PMID: 31035800 DOI: 10.1080/14767058.2019.1613363] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: Preterm delivery is a multifactorial health problem that represents a serious public health problem around the world. In recent years, there has been an increase in scientific evidence suggesting associations between oral health status (mainly periodontal disease and tooth loss) and an increased risk of systemic diseases and various adverse pregnancy outcomes. This study explores the association between indicators of oral health and preterm delivery in a sample of Mexican pregnant women.Materials and methods: A case-control study was carried out with 111 pregnant (36 cases, 75 controls) who received prenatal care and delivered in an obstetric hospital in Pachuca, Mexico. Clinical files were reviewed to obtain the necessary information for the variables studied. The dependent variable was preterm delivery and the independent variables were gingivitis, periodontitis, DMFT index and its components, the number of decayed teeth with pulpal exposure or endodontic lesions, age of the mother, education, alcohol use, smoking status, number of gestations, and sex of the newborn.Results: The average ages were similar between the cases and the controls (24.29 ± 5.42 versus 24.89 ± 5.67, p = .5781). Significant differences were observed with gingivitis (p < .01) and periodontitis (p < .001). In addition, when the severity of gingivitis or periodontitis increased, the percentage of cases of preterm delivery increased (p < .01). The average number of teeth lost was higher among the cases than among the controls (1.33 ± 1.89 versus 0.81 ± 1.82, p < .05).Conclusions: It was found that gingivitis, periodontitis, and tooth loss were associated with preterm delivery. It is necessary to carry out actions aimed at the preservation of oral health in pregnant patients to avoid adverse results. These findings indicate a likely association, but it needs to be confirmed by large and well-designed studies.
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Affiliation(s)
| | - Aldo Tellez-Girón-Valdez
- Academic Area of Dentistry of Health Sciences Institute at Autonomous University of Hidalgo State, Pachuca, Mexico
| | | | - Rosalina Islas-Zarazúa
- Academic Area of Dentistry of Health Sciences Institute at Autonomous University of Hidalgo State, Pachuca, Mexico
| | - Norma Leticia Robles-Bermeo
- Advanced Studies and Research Center in Dentistry, "Dr. Keisaburo Miyata" of Faculty of Dentistry, Autonomous University State of Mexico, Toluca, Mexico
| | - Blanca Silvia Gonzalez-López
- Advanced Studies and Research Center in Dentistry, "Dr. Keisaburo Miyata" of Faculty of Dentistry, Autonomous University State of Mexico, Toluca, Mexico
| | - Carlo Eduardo Medina-Solís
- Academic Area of Dentistry of Health Sciences Institute at Autonomous University of Hidalgo State, Pachuca, Mexico.,Advanced Studies and Research Center in Dentistry, "Dr. Keisaburo Miyata" of Faculty of Dentistry, Autonomous University State of Mexico, Toluca, Mexico
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Ferreira RDO, Corrêa MG, Magno MB, Almeida APCPSC, Fagundes NCF, Rosing CK, Maia LC, Lima RR. Physical Activity Reduces the Prevalence of Periodontal Disease: Systematic Review and Meta-Analysis. Front Physiol 2019; 10:234. [PMID: 30949062 PMCID: PMC6438044 DOI: 10.3389/fphys.2019.00234] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/22/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Regular physical activity boosts several physical capacities and reduces many inflammatory markers of several diseases. In this sense, periodontal disease is a multifactorial inflammatory disease of tooth supporting tissues that has been claimed to trigger processes of systemic alterations. The aim of this systematic review and meta-analysis was to assess the effects of physical activity on periodontal disease. Methods: Observational studies published until August 2018 were searched in online databases (PubMed, Scopus, Web of Science, The Cochrane Library, LILACS, OpenGrey, and Google Scholar) after developing a PECO statement that focused on the comparison between adults that followed a routine of exercises or presented a sedentary lifestyle and its effects on periodontal disease. Searching and data extraction were conducted by following PRISMA guidelines. Registration protocol: CRD42016049661. Quality assessment and risk of bias were analyzed by following Fowkes and Fulton protocol. Results: A total of 512 references were retrieved, while only seven were considered eligible. Two meta-analysis involving the prevalence of periodontal disease and unadjusted/adjusted Odds ratio were performed. One of studies did not find association between clinical periodontal parameters and physical activity. Six articles suggested an association between periodontal disease and regular practice of physical activity since a reduction of periodontal prevalence was observed. Moderate level of evidence was demonstrated on GRADE analysis. Conclusion: Physical activity was associated as a potential tool for reduction of periodontal disease prevalence. The frequency of physical activity is directly related to a low occurrence of periodontitis. However, it is important that further investigations evaluate the effects of other exercise variables, such as volume and intensity, on the periodontal disease prevalence.
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Affiliation(s)
- Railson de Oliveira Ferreira
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém-Pará, Brazil
| | - Marcio Gonçalves Corrêa
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém-Pará, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Rodrigues Lima
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém-Pará, Brazil
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