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Pham TAV, Nguyen MD. Subgingival 0.75% boric acid vs 1% povidone-iodine adjunctive to subgingival instrumentation in stage II and III periodontitis-A double-blind randomized clinical trial. Int J Dent Hyg 2024. [PMID: 38764161 DOI: 10.1111/idh.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 04/21/2024] [Accepted: 04/28/2024] [Indexed: 05/21/2024]
Abstract
PURPOSE To compare the effects of subgingival irrigation with 0.75% boric acid (BA) and 1% povidone-iodine (PVP-I) as an adjunct to scaling and root planing (SRP) on clinical and microbiologic parameters in the management of patients with periodontitis after a 12-month follow-up. METHODS Sixty systemically healthy individuals diagnosed with periodontitis were included in this double-blind randomised clinical trial. The patients were randomly allocated to treatment groups: (1) SRP plus 0.75% BA and (2) SRP plus 1% PVP-I. Whole-mouth periodontals were clinically examined, and the counts of bacteria including Aggregatibacter actinomycetemcomitans (Aa), Fusobacterium nucleatum (Fn), Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythia (Tf), Solobacterium moorei (Sm) and Streptococcus salivarius (Ss) were tested by real-time polymerase chain reaction (PCR). RESULTS All periodontal parameters and the counts of Aa, Fn, Pg, Td, Tf, Sm and Ss in both groups showed statistically significant reductions at T3, T6 and T12 compared to T0. Whole-mouth or moderate or severe PD and CAL improvements were significantly found in the 0.75% BA group compared to the 1% PVP-I group at T3, T6 and T12. The reduction in Aa or Fn and the reduction in Ss were significantly higher in the 0.75% BA group at T6 and T12 than in the 1% PVP-I group. CONCLUSION This study shows that subgingival irrigation with 0.75% BA may be an alternative to 1% PVP-I because it promotes greater PD reductions and CAL gain, particularly up to 12 months after treatment.
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Affiliation(s)
- Thuy Anh Vu Pham
- School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam
- Vietnam National University, Ho Chi Minh City, Vietnam
| | - Minh Duc Nguyen
- School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam
- Vietnam National University, Ho Chi Minh City, Vietnam
- Hospital of Odonto-Stomatology, Ho Chi Minh City, Vietnam
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2
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Li Q, Wang D, Xiao C, Wang H, Dong S. Advances in Hydrogels for Periodontitis Treatment. ACS Biomater Sci Eng 2024; 10:2742-2761. [PMID: 38639082 DOI: 10.1021/acsbiomaterials.4c00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Periodontitis is a common condition characterized by a bacterial infection and the disruption of the body's immune-inflammatory response, which causes damage to the teeth and supporting tissues and eventually results in tooth loss. Current therapy involves the systemic and local administration of antibiotics. However, the existing treatments cannot exert effective, sustained release and maintain an effective therapeutic concentration of the drug at the lesion site. Hydrogels are used to treat periodontitis due to their low cytotoxicity, exceptional water retention capability, and controlled drug release profile. Hydrogels can imitate the extracellular matrix of periodontal cells while offering suitable sites to load antibiotics. This article reviews the utilization of hydrogels for periodontitis therapy based on the pathogenesis and clinical manifestations of the disease. Additionally, the latest therapeutic strategies for smart hydrogels and the main techniques for hydrogel preparation have been discussed. The information will aid in designing and preparing future hydrogels for periodontitis treatment.
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Affiliation(s)
- Qiqi Li
- The First Outpatient Department, Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, China
| | - Di Wang
- The First Outpatient Department, Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, China
| | - Chunsheng Xiao
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, China
| | - Hao Wang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, China
| | - Shujun Dong
- The First Outpatient Department, Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
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Lopez-Oliva I, Malcolm J, Culshaw S. Periodontitis and rheumatoid arthritis-Global efforts to untangle two complex diseases. Periodontol 2000 2024. [PMID: 38411247 DOI: 10.1111/prd.12530] [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: 03/12/2023] [Revised: 08/07/2023] [Accepted: 09/01/2023] [Indexed: 02/28/2024]
Abstract
Understanding the impact of oral health on rheumatoid arthritis (RA) will inform how best to manage patients with both periodontitis and RA. This review seeks to provide an update on interventional and mechanistic investigations, including a brief summary of European Research programs investigating the link between periodontitis and RA. Recent clinical studies are described that evaluate how the treatment of one disease impacts on the other, as are studies in both humans and animal models that have sought to identify the potential mechanisms linking the two diseases.
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Affiliation(s)
- Isabel Lopez-Oliva
- Department of Periodontology, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jennifer Malcolm
- Oral Sciences, University of Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Centre for Immunobiology, School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Shauna Culshaw
- Oral Sciences, University of Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Centre for Immunobiology, School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Clinic for Periodontology, Endodontology and Cariology, University Center of Dental Medicine, University of Basel, Basel, Switzerland
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Popoca-Hernández EA, Martínez-Martínez RE, González-Amaro RF, Niño-Moreno PDC, Ayala-Herrera JL, Jerezano-Domínguez AV, Espinosa-Cristóbal LF, Márquez-Corona MDL, Espinosa-de Santillana IA, Medina-Solís CE. Impact of Non-Surgical Periodontal Treatment on the Concentration and Level of MRP-8/14 (Calprotectin) as an Inflammatory Biomarker in Women with Periodontitis and Rheumatoid Arthritis: A Quasi-Experimental Study. Diseases 2024; 12:12. [PMID: 38248363 PMCID: PMC10814914 DOI: 10.3390/diseases12010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
The aim of this study was to evaluate the impact of non-surgical periodontal treatment (NS-PT) on periodontal parameters and inflammatory biomarkers in the concentration and level of calprotectin (CLP) in women with periodontitis and rheumatoid arthritis (RA). In this quasi-experimental study, we evaluated 30 women (mean age: 52.0 ± 5.8 years) with periodontitis and RA who had been diagnosed and treated for RA for more than 3 years and whose activity markers remained at similar values without significant reduction over three consecutive months. Patients underwent NS-PT, which included plaque control, scaling, and root planing. Serum and saliva samples, periodontal indices, RA activity markers, Disease Activity Score-28 (DAS28), the erythrocyte sedimentation rate (ESR), and the C-reactive protein (CRP) and CLP contents were measured at the beginning of the study and 6 and 12 weeks after NS-PT. Parametric and nonparametric tests were used in the analysis. The mean age was 52.0 ± 5.8 years. Compared to the baseline results, all periodontal indices were significantly reduced 6 and 12 weeks after NS-PT (p < 0.001). DAS28 was also significantly reduced after 12 weeks (p < 0.0001). Similarly, the serum CLP concentration decreased 6 and 12 weeks after NS-PT (p < 0.0001). Of the patients, 100% presented lower levels of CRP and ESR (p < 0.0001). Overall, NS-PT reduced inflammation and disease activity, highlighting the importance of oral health in the control and treatment of systemic diseases such as RA and confirming that NS-PT effectively reduces periodontitis activity and plays a key role in modulating RA activity. Therefore, NS-PT should be considered as an adjunct treatment for RA.
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Affiliation(s)
- Elena Aurora Popoca-Hernández
- Doctoral Program in Basic Biomedical Sciences, Faculty of Medicine, Autonomous University of San Luis Potosi, San Luis Potosi 78210, Mexico;
- Master Program in Advanced Dentistry, Faculty of Dentistry, Autonomous University of San Luis Potosi, San Luis Potosi 78290, Mexico
| | - Rita Elizabeth Martínez-Martínez
- Master Program in Advanced Dentistry, Faculty of Dentistry, Autonomous University of San Luis Potosi, San Luis Potosi 78290, Mexico
| | - Roberto Fidencio González-Amaro
- Department of Immunology, Faculty of Medicine, Autonomous University of San Luis Potosi, San Luis Potosi 78210, Mexico;
- Center of Research in Health Sciences and Biomedicine, Faculty of Medicine, Autonomous University of San Luis Potosi, San Luis Potosi 78210, Mexico;
| | - Perla del Carmen Niño-Moreno
- Center of Research in Health Sciences and Biomedicine, Faculty of Medicine, Autonomous University of San Luis Potosi, San Luis Potosi 78210, Mexico;
| | | | | | - Leon Francisco Espinosa-Cristóbal
- Master Program in Dental Sciences, Stomatology Department, Institute of Biomedical Sciences, Autonomous University of Juarez City, Ciudad Juárez 32310, Mexico;
| | - María de Lourdes Márquez-Corona
- Academic Area of Dentistry, Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (M.d.L.M.-C.); (C.E.M.-S.)
| | | | - Carlo Eduardo Medina-Solís
- Academic Area of Dentistry, Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (M.d.L.M.-C.); (C.E.M.-S.)
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Inchingolo F, Inchingolo AM, Avantario P, Settanni V, Fatone MC, Piras F, Di Venere D, Inchingolo AD, Palermo A, Dipalma G. The Effects of Periodontal Treatment on Rheumatoid Arthritis and of Anti-Rheumatic Drugs on Periodontitis: A Systematic Review. Int J Mol Sci 2023; 24:17228. [PMID: 38139057 PMCID: PMC10743440 DOI: 10.3390/ijms242417228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Rheumatoid arthritis (RA) and periodontitis are chronic inflammatory diseases that widely spread and share the same patterns of pro-inflammatory cytokines. This systematic review aims to evaluate the effects of non-surgical periodontal treatment (NSPT) on RA and, conversely, the impact of disease-modifying anti-rheumatic drugs (DMARDs) on periodontitis. PubMed, Embase, and Web of Science were searched using the MESH terms "periodontitis" and "rheumatoid arthritis" from January 2012 to September 2023. A total of 49 articles was included in the final analysis, 10 of which were randomized controlled trials. A total of 31 records concerns the effect of NSPT on parameters of RA disease activity, including a 28-joint disease activity score, anti-citrullinated protein antibodies, rheumatoid factor, C reactive protein, erythrocyte sedimentation rate, pro-inflammatory cytokines and acute phase proteins in serum, saliva, gingival crevicular fluid, and synovial fluid. A total of 18 articles investigated the effect of DMARDs on periodontal indexes and on specific cytokine levels. A quality assessment and risk-of-bias of the studies were also performed. Despite some conflicting results, there is evidence that RA patients and periodontitis patients benefit from NSPT and DMARDs, respectively. The limitations of the studies examined are the small samples and the short follow-up (usually 6 months). Further research is mandatory to evaluate if screening and treatment of periodontitis should be performed systematically in RA patients, and if the administration of DMARDs is useful in reducing the production of cytokines in the periodontium.
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Affiliation(s)
- Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (V.S.); (F.P.); (D.D.V.); (A.D.I.); (G.D.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (V.S.); (F.P.); (D.D.V.); (A.D.I.); (G.D.)
| | - Pasquale Avantario
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (V.S.); (F.P.); (D.D.V.); (A.D.I.); (G.D.)
| | - Vito Settanni
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (V.S.); (F.P.); (D.D.V.); (A.D.I.); (G.D.)
| | | | - Fabio Piras
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (V.S.); (F.P.); (D.D.V.); (A.D.I.); (G.D.)
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (V.S.); (F.P.); (D.D.V.); (A.D.I.); (G.D.)
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (V.S.); (F.P.); (D.D.V.); (A.D.I.); (G.D.)
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (V.S.); (F.P.); (D.D.V.); (A.D.I.); (G.D.)
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6
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Isola G, Tartaglia GM, Santonocito S, Polizzi A, Williams RC, Iorio-Siciliano V. Impact of N-terminal pro-B-type natriuretic peptide and related inflammatory biomarkers on periodontal treatment outcomes in patients with periodontitis: An explorative human randomized-controlled clinical trial. J Periodontol 2023; 94:1414-1424. [PMID: 37433155 DOI: 10.1002/jper.23-0063] [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: 01/28/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND N-terminal portion of the B-type natriuretic propeptide (NT-proBNP) has potentially been shown to play an important role in the development of periodontitis and cardiovascular disease (CVD). This study evaluated the efficacy of periodontal treatment on NT-proBNP and related CVD biomarkers and explored whether subjects harboring high NT-proBNP at baseline showed increased clinical benefits with the non-surgical periodontal treatment performed with full-mouth scaling and root planing (FM-SRP) at 6-month follow-up. METHODS Forty-eight patients with stage III periodontitis were randomized to receive minimal standard oral care (SOC) (n = 24) or FM-SRP (n = 24) protocol. Clinical periodontal parameters (probing depth, clinical attachment loss, bleeding on probing), serum NT-proBNP, α1-antitrypsin, C-reactive protein (hs-CRP), endothelial cell-specific molecule-1 (ECM-1), and neutrophil gelatinase-associated lipocalin (NGAL) concentrations were assessed at baseline and at 1-, 3-, and 6- month follow-up. RESULTS At 6 months, FM-SRP was more effective than SOC in reducing periodontal parameters and mean proportions of NT-proBNP (p = 0.004), hs-CRP (p = 0.003), α1-antitrypsin (p = 0.012), ECM-1 (p = 0.014), and NGAL (p = 0.045). At 6-month follow-up, the reduced NT-proBNP, α1-antitrypsin, hs-CRP, ECM-1, and NGAL levels were significantly correlated with the extent of periodontitis (p < 0.05). Furthermore, the analysis of variance analysis evidenced that, at 6-month follow-up, FM-SRP significantly impacted the reduction of NT-proBNP, hs-CRP, ECM-1, and NGAL. Moreover, high levels of NT-proBNP, hs-CRP, ECM-1, and NGAL at baseline significantly influenced the efficacy of periodontal treatment positively. CONCLUSION In this study, FM-SRP was more effective than SOC in reducing clinical variables and NT-proBNP levels, although subjects who harbored high NT-proBNP concentrations at baseline showed greater clinical benefits of periodontal treatment at 6-month follow-up.
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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
| | - Gianluca Martino Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Santonocito
- 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
| | - Ray C Williams
- Department of Periodontology, UNC-Chapel Hill School of Dentistry, Chapel Hill, North Carolina, USA
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Kobayashi T, Bartold PM. Periodontitis and periodontopathic bacteria as risk factors for rheumatoid arthritis: A review of the last 10 years. JAPANESE DENTAL SCIENCE REVIEW 2023; 59:263-272. [PMID: 37674898 PMCID: PMC10477376 DOI: 10.1016/j.jdsr.2023.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
Rheumatoid arthritis (RA) is characterized by chronic inflammatory destruction of joint tissue and is caused by an abnormal autoimmune response triggered by interactions between genetics, environmental factors, and epigenetic and posttranslational modifications. RA has been suggested to be interrelated with periodontitis, a serious form or stage of chronic inflammatory periodontal disease associated with periodontopathic bacterial infections, genetic predisposition, environmental factors, and epigenetic influences. Over the last decade, a number of animal and clinical studies have been conducted to assess whether or not periodontitis and associated periodontopathic bacteria constitute risk factors for RA. The present review introduces recent accumulating evidence to support the associations of periodontitis and periodontopathic bacteria with the risk of RA or the outcome of RA pharmacological treatment with disease-modifying antirheumatic drugs. In addition, the results from intervention studies have suggested an improvement in RA clinical parameters after nonsurgical periodontal treatment. Furthermore, the potential causal mechanisms underlying the link between periodontitis and periodontopathic bacteria and RA are summarized.
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Affiliation(s)
- Tetsuo Kobayashi
- General Dentistry and Clinical Education Unit, Faculty of Dentistry & Medical and Dental Hospital, Niigata University, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
- Division of Periodontology, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Peter Mark Bartold
- Adelaide Dental School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia 5005, Australia
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Batool A, Vaithilingam RD, Mohamad Hassan NH, Safii SH, Saub R. Evaluating the potential of matrix metalloproteinase as a diagnostic biomarker in rheumatoid arthritis and periodontitis: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e35340. [PMID: 37832126 PMCID: PMC10578754 DOI: 10.1097/md.0000000000035340] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/31/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Matrix metalloproteinases (MMPs) play a crucial role in the pathogenesis of several chronic diseases including rheumatoid arthritis (RA) and periodontitis (PD). RA patients with periodontitis (RA-PD) are associated with elevated inflammatory burden due to increased production of proinflammatory cytokines. Controlling upregulated MMPs activity in these patients may have potential therapeutic effects. Therefore, aim of this study is to address the focused question: "Do RA subjects with concurrent PD have different levels of MMPs in comparison to RA alone, PD alone and HC subjects?" METHODS The systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search from 4 electronic databases (EMBASE, Medline, Web of Science, and Cochrane library) and manual search was performed from inception to July 2023. Quality assessment of each article was done using Newcastle-Ottawa Scale. Meta-analyses derived results were summarized as standardized mean difference (SMD) with 95% confidence intervals. RESULTS A total of 879 articles were extracted. Following screening and full text assessment, 9 studies were included. MMP-1, MMP-3, MMP-8, MMP-9, and MMP-13 were consistently elevated in RA-PD subjects. MMP-8 levels were found to be higher in RA-PD subjects compared with RA alone, PD alone, and HC in 3 studies reporting GCF levels (SMD = 1.2; Z = 2.07; P = .04) and 2 studies reporting serum levels (SMD = 0.87; Z = 4.53; P < .00001). CONCLUSION RA-PD group showed significantly higher MMP levels in their serum and GCF compared with HC, RA, and PD alone individuals. MMP-8 may serve as a reliable biomarker in the diagnosis and management of RA-PD subjects.
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Affiliation(s)
- Aimen Batool
- Department of Community Oral Health & Clinical Prevention, University Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Roslan Saub
- Department of Community Oral Health & Clinical Prevention, University Malaya, Kuala Lumpur, Malaysia
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Isola G, Tartaglia GM, Santonocito S, Chaurasia A, Marya A, Lo Giudice A. Growth differentiation factor-15 and circulating biomarkers as predictors of periodontal treatment effects in patients with periodontitis: a randomized-controlled clinical trial. BMC Oral Health 2023; 23:582. [PMID: 37605193 PMCID: PMC10440880 DOI: 10.1186/s12903-023-03237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND During the last decades, in patients with periodontitis, periodontal treatment has been shown to reduce the potential release of local and systemic biomarkers linked to an early risk of systemic inflammatory disorders. This study evaluated the efficacy of non-surgical-periodontal treatment (NSPT) on growth differentiation factor 15 (GDF-15) and related circulating biomarkers such as glutathione peroxidase 1 (GPx-1), c-reactive protein (hs-CRP), and surfactant protein D (SP-D) in periodontal patients and explored whether subjects who had high GDF-15 levels at baseline showed increased clinical benefits following NSPT at 6-months follow-up. METHODS For this two-arm, parallel randomized clinical trial, patients with periodontitis were randomly allocated to receive quadrant scaling and root-planing (Q-SRP, n = 23, median age 51 years old) or full-mouth disinfection (FMD, n = 23, median age 50 years old) treatment. Clinical and periodontal parameters were recorded in all enrolled patients. The primary outcome was to analyse serum concentrations changes of GDF-15 and of GPx-1, hs-CRP, and SP-D at baseline and at 30, 90, and 180-days follow-up after NSPT through enzyme-linked immunosorbent assay (ELISA) and nephelometric assay techniques. RESULTS In comparison with FMD, patients of the Q-SRP group showed a significant improvement in clinical periodontal parameters (p < 0.05) and a reduction in the mean levels of GDF-15 (p = 0.005), hs-CRP (p < 0.001), and SP-D (p = 0.042) and an increase of GPx-1 (p = 0.025) concentrations after 6 months of treatment. At 6 months of treatment, there was a significant association between several periodontal parameters and the mean concentrations of GDF-15, GPx-1, hs-CRP, and SP-D (p < 0.05 for all parameters). Finally, the ANOVA analysis revealed that, at 6 months after treatment, the Q-SRP treatment significantly impacted the reduction of GDF-15 (p = 0.015), SP-D (p = 0.026) and the upregulation of GPx-1 (p = 0.045). CONCLUSION The results evidenced that, after 6 months of treatment, both NSPT protocols improved the periodontal parameters and analyzed biomarkers, but Q-SRP was more efficacious than the FMD approach. Moreover, patients who presented high baseline GDF-15 and SP-D levels benefited more from NSPT at 6-month follow-up. TRIAL REGISTRATION NCT05720481.
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Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, Catania, 95123, Italy
| | - Gianluca Martino Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, Milan, 20100, Italy
- Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, 20100, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, Catania, 95123, Italy.
| | - Akhilanand Chaurasia
- Department of Oral Medicine, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anand Marya
- Department of Orthodontics, University of Puthisastra Phnom Penh Combodia, Phnom Penh, 55180, Cambodia.
- Center for Transdisciplinary Research, Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai, 600077, India.
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, Catania, 95123, Italy
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Zheng H, Zhou Y, Zheng Y, Liu G. Advances in hydrogels for the treatment of periodontitis. J Mater Chem B 2023; 11:7321-7333. [PMID: 37431231 DOI: 10.1039/d3tb00835e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Periodontitis is the second most prevalent oral disease and can cause serious harm to human health. Hydrogels are excellent biomaterials that can be used for periodontitis as drug delivery platforms to achieve inflammation control through high drug delivery efficiency and sustained drug release and as tissue scaffolds to achieve tissue remodelling through encapsulated cell wrapping and effective mass transfer. In this review, we summarize the latest advances in the treatment of periodontitis with hydrogels. The pathogenic mechanisms of periodontitis are introduced first, followed by the recent progress of hydrogels in controlling inflammation and tissue reconstruction, in which the specific performance of hydrogels is discussed in detail. Finally, the challenges and limitations of hydrogels for clinical applications in periodontitis are discussed and possible directions for development are proposed. This review aims to provide a reference for the design and fabrication of hydrogels for the treatment of periodontitis.
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Affiliation(s)
- Huiyu Zheng
- The State Key Laboratory of Polymer Materials Engineering, Polymer Research Institute of Sichuan University, Chengdu 610065, China.
| | - Yuan Zhou
- The State Key Laboratory of Polymer Materials Engineering, Polymer Research Institute of Sichuan University, Chengdu 610065, China.
| | - Yu Zheng
- The State Key Laboratory of Polymer Materials Engineering, Polymer Research Institute of Sichuan University, Chengdu 610065, China.
| | - Guiting Liu
- The State Key Laboratory of Polymer Materials Engineering, Polymer Research Institute of Sichuan University, Chengdu 610065, China.
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El-Wakeel NM, Shalaby ZF, Abdulmaguid RF, Elhamed SSA, Shaker O. Local gingival crevicular fluid, synovial fluid, and circulating levels of prolactin hormone in patients with moderately active rheumatoid arthritis and stage III and IV periodontitis before and after non-surgical periodontal treatment-a controlled trial. Clin Oral Investig 2023; 27:2813-2821. [PMID: 36717425 PMCID: PMC10264271 DOI: 10.1007/s00784-023-04867-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/14/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVES We aimed to investigate prolactin (PRL) levels in gingival crevicular fluid (GCF), synovial fluid, and serum in patients suffering from moderately active rheumatoid arthritis (RA) with and without periodontitis (P). Further, to evaluate the effect of non-surgical periodontal treatment on these levels compared to controls. MATERIALS AND METHODS Eighty subjects were divided into 4 groups: group 1: 20 patients with RA + P, group 2: 20 periodontitis patients (systemically healthy), group 3: RA patients (periodontally healthy), and group 4: healthy controls. Patients with periodontitis received scaling and root planning (SRP). PRL was measured using enzyme-linked immunosorbent assay. RESULTS At baseline, in GCF of RA + P group showed the highest mean PRL levels, followed by P group whereas groups 3 and 4 showed a statistically less values than the first 2 groups. Serum values showed non-significant difference between the first three groups, although higher than healthy controls. SRP reduced GCF and serum levels of PRL in both P groups as well as synovial fluid PRL in group 1. SRP caused no change in DAS scores while reduced ESR values were observed in group 1 after treatment. CONCLUSIONS Local GCF and synovial levels of PRL seem to be linked to the disease process of both periodontitis and rheumatoid arthritis than serum levels. SRP reduced these local levels. CLINICAL RELEVANCE In patients with RA and CP, local PRL seems to play a role in the association between the two conditions; further, periodontal treatment is essential to improve periodontal condition in RA patients. TRIAL REGISTRATION Clinicaltrials.gov. Identifier: NCT04279691.
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Affiliation(s)
- Naglaa Mohamed El-Wakeel
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Al-Azhar University (Girls Branch), Al-Mokhayam El Dayem St., Nasr City, 1178, Cairo, Egypt.
| | - Zienab Farid Shalaby
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Al-Azhar University (Girls Branch), Al-Mokhayam El Dayem St., Nasr City, 1178, Cairo, Egypt
| | - Rania Farouk Abdulmaguid
- Oral Medicine and Periodontology Department, Faculty of Dentistry, October University for Modern Sciences and Arts, Giza, Egypt
| | - Sally Said Abd Elhamed
- Internal Medicine Department, Faculty of Medicine, Al-Azhar University (Girls Branch), Cairo, Egypt
| | - Olfat Shaker
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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12
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Koziel J, Potempa J. Pros and cons of causative association between periodontitis and rheumatoid arthritis. Periodontol 2000 2022; 89:83-98. [PMID: 35262966 PMCID: PMC9935644 DOI: 10.1111/prd.12432] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 06/28/2021] [Accepted: 07/03/2021] [Indexed: 02/05/2023]
Abstract
Research in recent decades has brought significant advancements in understanding of the molecular basis of the etiology of autoimmune diseases, including rheumatoid arthritis, a common systemic disease in which an inappropriate or inadequate immune response to environmental challenges leads to joint destruction. Recent studies have indicated that the classical viewpoint of the immunological processes underpinning the pathobiology of rheumatoid arthritis is restricted and needs to be expanded to include a more holistic and interdisciplinary approach incorporating bacteria-induced inflammatory reactions as an important pathway in rheumatoid arthritis etiology. Here, we discuss in detail data showing the clinical and molecular association of rheumatoid arthritis development with periodontal diseases. We also describe the unique role of periopathogens, which have been proposed to be crucial in the initiation and progression of this autoimmune pathological disorder.
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Affiliation(s)
- Joanna Koziel
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Jan Potempa
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland.,Department of Oral Immunity and Infectious Diseases, University of Louisville School of Dentistry, Louisville, Kentucky, USA
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13
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de Oliveira RCG, Gardev E, Shaddox LM. Dysbiotic relationship between arthritis and the oral-gut microbiome. A critical review. J Periodontal Res 2022; 57:711-723. [PMID: 35583216 DOI: 10.1111/jre.13002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/18/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
Arthritis and prosthetic joint infections (PJIs) overall are associated with reduced quality of life and limited work capacity. Multiple, overlapping factors contribute to these conditions. Some investigations have suggested a dysbiotic association between the oral-gut microbiome and pathogenesis of arthritis and PJIs. A better understanding of the role of the oral-gut microbiota in arthritis and PJI pathophysiology can shed light into how its disequilibrium can discharge a pro-inflammatory response, and impact the health of patients susceptible to arthritis or with established joint disease. A review of published in vivo and clinical data suggested that alterations in oral and gut microbiota can lead to a disturbance of immunoregulatory properties, and may be associated with joint infections and arthritis. This review brings new insights into the current status of the evidence on the potential molecules and inflammatory biomarkers disrupted by an oral-gut microbial dysbiosis. Normal commensals and pathogenic oral and gut microflora homeostasis are important not only to prevent infections per se but also its potential progression. Further experiments, especially controlled clinical trials, are needed to ascertain how microbiome manipulation and other microbiota-directed approaches can help control inflammation and effectively prevent and treat arthritic diseases. Additionally, studies on the effects of the long-term oral diseases, such as chronic periodontitis, on arthritis and PJIs need to be conducted.
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Affiliation(s)
- Rubelisa Candido Gomes de Oliveira
- Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA.,College of Dentistry, Federal University of Goias, Goiania, Goias, Brazil
| | - Elly Gardev
- Arizona State University, Tempe, Arizona, USA
| | - Luciana Macchion Shaddox
- Division of Periodontology and Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA
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14
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Mustufvi Z, Twigg J, Kerry J, Chesterman J, Pavitt S, Tugnait A, Mankia K. Does periodontal treatment improve rheumatoid arthritis disease activity? A systematic review. Rheumatol Adv Pract 2022; 6:rkac061. [PMID: 35993013 PMCID: PMC9390064 DOI: 10.1093/rap/rkac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/10/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
The association of periodontal disease in people diagnosed with RA is emerging as an important driver of the RA autoimmune response. Screening for and treating periodontal disease might benefit people with RA. We performed a systematic literature review to investigate the effect of periodontal treatment on RA disease activity.
Methods
Medline/PubMed, Embase and Cochrane databases were searched. Studies investigating the effect of periodontal treatment on various RA disease activity measures were included. The quality of included studies was assessed. Data were grouped and analysed according to RA disease outcome measures, and a narrative synthesis was performed.
Results
We identified a total of 21 studies, of which 11 were of non-randomized experimental design trials and 10 were randomized controlled trials. The quality of the studies ranged from low to serious/critical levels of bias. RA DAS-28 was the primary outcome for most studies. A total of 9 out of 17 studies reported a significant intra-group change in DAS-28. Three studies demonstrated a significant intra-group improvement in ACPA level after non-surgical periodontal treatment. Other RA biomarkers showed high levels of variability at baseline and after periodontal treatment.
Conclusion
There is some evidence to suggest that periodontal treatment improves RA disease activity in the short term, as measured by DAS-28. Further high-quality studies with longer durations of follow-up are needed. The selection of the study population, periodontal interventions, biomarkers and outcome measures should all be considered when designing future studies. There is a need for well-balanced subject groups with prespecified disease characteristics.
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Affiliation(s)
| | | | - Joel Kerry
- Library and Information Service, Leeds Teaching Hospitals NHS Trust
| | | | - Sue Pavitt
- School of Dentistry, University of Leeds
| | | | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds , Leeds, UK
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15
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Looh SC, Soo ZMP, Wong JJ, Yam HC, Chow SK, Hwang JS. Aggregatibacter actinomycetemcomitans as the Aetiological Cause of Rheumatoid Arthritis: What Are the Unsolved Puzzles? Toxins (Basel) 2022; 14:toxins14010050. [PMID: 35051027 PMCID: PMC8777676 DOI: 10.3390/toxins14010050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 01/23/2023] Open
Abstract
Leukotoxin A (LtxA) is the major virulence factor of an oral bacterium known as Aggregatibacter actinomycetemcomitans (Aa). LtxA is associated with elevated levels of anti-citrullinated protein antibodies (ACPA) in rheumatoid arthritis (RA) patients. LtxA targets leukocytes and triggers an influx of extracellular calcium into cytosol. The current proposed model of LtxA-mediated hypercitrullination involves the dysregulated activation of peptidylarginine deiminase (PAD) enzymes to citrullinate proteins, the release of hypercitrullinated proteins through cell death, and the production of autoantigens recognized by ACPA. Although model-based evidence is yet to be established, its interaction with the host’s immune system sparked interest in the role of LtxA in RA. The first part of this review summarizes the current knowledge of Aa and LtxA. The next part highlights the findings of previous studies on the association of Aa or LtxA with RA aetiology. Finally, we discuss the unresolved aspects of the proposed link between LtxA of Aa and RA.
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Affiliation(s)
- Sung Cheng Looh
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Kuala Lumpur 56000, Malaysia; (S.C.L.); (H.C.Y.)
| | - Zoey May Pheng Soo
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway 47500, Malaysia; (Z.M.P.S.); (J.J.W.)
| | - Jia Jia Wong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway 47500, Malaysia; (Z.M.P.S.); (J.J.W.)
| | - Hok Chai Yam
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Kuala Lumpur 56000, Malaysia; (S.C.L.); (H.C.Y.)
| | | | - Jung Shan Hwang
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway 47500, Malaysia
- Correspondence:
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16
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Ding N, Luo M, Wen YH, Li RY, Bao QY. The Effects of Non-Surgical Periodontitis Therapy on the Clinical Features and Serological Parameters of Patients Suffering from Rheumatoid Arthritis as Well as Chronic Periodontitis. J Inflamm Res 2022; 15:177-185. [PMID: 35046692 PMCID: PMC8760992 DOI: 10.2147/jir.s326896] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/09/2021] [Indexed: 01/22/2023] Open
Affiliation(s)
- Nan Ding
- Department of Stomatology, Beijing LuHe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Correspondence: Nan Ding Department of Stomatology, Beijing LuHe Hospital, Capital Medical University, No. 82 of Xinhua South Road, Tongzhou District, Beijing, 101149, People’s Republic of ChinaTel/Fax +86 10 69543901 Email
| | - Mei Luo
- Department of Central Laboratory, Beijing LuHe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
| | - Ya-Hui Wen
- Department of Internal Medicine, Beijing LuHe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
| | - Rong-Yin Li
- Department of Stomatology, Beijing LuHe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
| | - Qi-Yan Bao
- Department of Stomatology, Beijing LuHe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
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17
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Del Rei Daltro Rosa CD, de Luna Gomes JM, Dantas de Moraes SL, Araujo Lemos CA, Minatel L, Justino de Oliveira Limirio JP, Pellizzer EP. Does non-surgical periodontal treatment influence on rheumatoid arthritis? A systematic review and meta-analysis. Saudi Dent J 2021; 33:795-804. [PMID: 34916763 PMCID: PMC8670789 DOI: 10.1016/j.sdentj.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 04/29/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The objective of this systematic review was to evaluate
the efficacy of non-surgical periodontal therapy on rheumatoid arthritis
activity. Material and methods Articles published until April 2019 were electronically
searched and screened using PubMed / MEDLINE, Scopus, and Cochrane databases
according to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines (PRISMA). This study was recorded in the international
PROSPERO database (CRD42019132205). The PICO question (population, intervention,
comparison, results) was: in adult patients with rheumatoid arthritis and
periodontitis (P), does non-surgical periodontal treatment (I), as compared to
no treatment (C), provides better outcomes in rheumatoid arthritis activity
(O). Results After searching the databases, seven articles were
selected for qualitative and five for quantitative analysis. The total number of
participants included was 292, with an average age of 50.5 years. All patients
had rheumatoid arthritis and periodontal disease. Non-surgical periodontal
treatment significantly reduced Disease Activity Score 28 (P = 0.004;
I2 = 92%) and erythrocyte sedimentation rate (P = 0.01;
I2 = 78%), but with no significant effect on C-reactive
protein (P = 0.34; I2 = 92%). Conclusions It can be concluded that non-surgical periodontal
treatment can benefit patients with rheumatoid arthritis.
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Affiliation(s)
- Cleber Davi Del Rei Daltro Rosa
- Department of Dental Materials and Prosthodontics, Dentistry School, UNESP - São Paulo State University, R: José Bonifácio, 1193, Vila Mendonça, Araçatuba, São Paulo, Brazil
| | - Jéssica Marcela de Luna Gomes
- Department of Dental Materials and Prosthodontics, Dentistry School, UNESP - São Paulo State University, R: José Bonifácio, 1193, Vila Mendonça, Araçatuba, São Paulo, Brazil
| | - Sandra Lúcia Dantas de Moraes
- Dentistry School, UPE - University of Pernambuco, Av. General Newton Cavalcanti, 1650, Camaragibe, Pernambuco, Brazil
| | - Cleidiel Aparecido Araujo Lemos
- Department of Dental Materials and Prosthodontics, Dentistry School, UNESP - São Paulo State University, R: José Bonifácio, 1193, Vila Mendonça, Araçatuba, São Paulo, Brazil
| | - Lurian Minatel
- Department of Dental Materials and Prosthodontics, Dentistry School, UNESP - São Paulo State University, R: José Bonifácio, 1193, Vila Mendonça, Araçatuba, São Paulo, Brazil
| | - João Pedro Justino de Oliveira Limirio
- Department of Dental Materials and Prosthodontics, Dentistry School, UNESP - São Paulo State University, R: José Bonifácio, 1193, Vila Mendonça, Araçatuba, São Paulo, Brazil
| | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, Dentistry School, UNESP - São Paulo State University, R: José Bonifácio, 1193, Vila Mendonça, Araçatuba, São Paulo, Brazil
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18
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Mustufvi Z, Serban S, Chesterman J, Mankia K. Should We Be Screening for and Treating Periodontal Disease in Individuals Who Are at Risk of Rheumatoid Arthritis? Healthcare (Basel) 2021; 9:1326. [PMID: 34683006 PMCID: PMC8544588 DOI: 10.3390/healthcare9101326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/24/2021] [Accepted: 09/30/2021] [Indexed: 12/21/2022] Open
Abstract
There is increasing evidence supporting an association between periodontal disease (PD) and rheumatoid arthritis (RA), both mechanistically and clinically. Trials have shown that treating PD in people with RA may improve RA disease activity. Patients with musculoskeletal symptoms without arthritis, who test positive for cyclic-citrullinated protein antibodies, are at risk of RA (CCP+ at-risk), with seropositivity preceding arthritis onset by months or years. Importantly, there is evidence to suggest that periodontal inflammation may precede joint inflammation in CCP+ at-risk and, therefore, this could be a trigger for RA. There has been increased research interest in RA prevention and the phenotyping of the pre-RA disease phase. This review will examine the merits of identifying individuals who are CCP+ at-risk and performing screening for PD. In addition, we discuss how PD should be treated once identified. Finally, the review will consider future research needed to advance our understanding of this disease association.
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Affiliation(s)
- Zhain Mustufvi
- Leeds Teaching Hospitals NHS Trust, National Institute for Health Research, School of Dentistry, University of Leeds, Leeds LS2 9LU, UK
| | - Stefan Serban
- School of Dentistry, University of Leeds, Leeds LS2 9LU, UK;
| | - James Chesterman
- Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Worsley Building, Clarendon Way, Leeds LS2 9LU, UK;
| | - Kulveer Mankia
- National Institute for Health Research Biomedical Research Centre, Chapel Allerton Hospital, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapeltown Road, Leeds LS7 4SA, UK;
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19
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Albrecht K, de Pablo P, Eidner T, Hoese G, Wassenberg S, Zink A, Callhoff J. Association Between Rheumatoid Arthritis Disease Activity and Periodontitis Defined by Tooth Loss: Longitudinal and Cross-Sectional Data From Two Observational Studies. Arthritis Care Res (Hoboken) 2021. [PMID: 34590439 DOI: 10.1002/acr.24799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To analyze the effect of tooth loss/periodontitis on disease activity in early and established rheumatoid arthritis (RA). METHODS Participants of the Course And Prognosis of Early Arthritis (CAPEA) early arthritis cohort reported their number of teeth at baseline. The number of teeth had been validated as a predictor of periodontitis. Clinical end points, including disease activity score (Disease Activity Score in 28 joints using the erythrocyte sedimentation rate [ESR]), swollen joint count (SJC), ESR, and C-reactive protein level were collected at baseline, 3, 6, 12, 18, and 24 months. We used linear mixed regression models to estimate the association between tooth loss and clinical end points over time in early arthritis. For established RA, we analyzed cross-sectional data from the German National Database (NDB). All models accounted for age, sex, smoking, seropositivity, education level, and disease duration (only NDB). RESULTS Among 1,124 CAPEA participants with early arthritis, those with higher tooth loss were older, more often male, smokers, and seropositive, and they had higher disease activity and inflammation markers at baseline. Tooth loss was associated with higher disease activity and ESR values over time. Inflammatory markers decreased comparably across tooth loss categories. Glucocorticoid use was higher among those with more tooth loss, whereas dose reduction was similar across tooth loss categories. Among 7,179 NDB participants with longstanding RA, disease activity and inflammation markers but not SJC were significantly higher in patients with more tooth loss. CONCLUSION Although we observed an association between tooth loss and disease activity scores and inflammation markers in early and established RA, longitudinal results suggest that tooth loss does not hamper treatment response.
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Affiliation(s)
- Katinka Albrecht
- German Rheumatism Research Centre, Programme Area of Epidemiology and Health Care Research, Berlin, Germany
| | - Paola de Pablo
- University of Birmingham, Institute of Inflammation and Ageing, Research into Inflammatory Arthritis Center Versus Arthritis and MRC-Versus Arthritis Centre für Muskuloskeletal Ageing Research, Birmingham, West Midlands, UK
| | | | | | | | - Angela Zink
- German Rheumatism Research Centre, Programme Area of Epidemiology and Health Care Research, Berlin, Germany
| | - Johanna Callhoff
- German Rheumatism Research Centre, Charité-Universitätsmedizin Berlin, Institute for Social Medicine, Berlin, Germany
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20
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González-Febles J, Sanz M. Periodontitis and rheumatoid arthritis: What have we learned about their connection and their treatment? Periodontol 2000 2021; 87:181-203. [PMID: 34463976 DOI: 10.1111/prd.12385] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Rheumatoid arthritis and periodontitis are chronic inflammatory diseases defined respectively by the destruction of the articular cartilage and tooth-supporting periodontal tissues. Although the epidemiologic evidence for an association between these two diseases is still scarce, there is emerging scientific information linking specific bacterial periodontal pathogens, such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, in the citrullination process, leading to autoantibody formation and compromised immunotolerance of the susceptible patient to rheumatoid arthritis. In this review, we update the existing information on the evidence, not only regarding the epidemiologic association, but also the biologic mechanisms linking these two diseases. Finally, we review information emerging from intervention studies evaluating whether periodontal treatment could influence the initiation and progression of rheumatoid arthritis.
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Affiliation(s)
- Jerián González-Febles
- Departament of Dental Clinical Specialties, Faculty of Odontology, University Complutense, Madrid, Spain.,Research Group on the Aetiology and Treatment of Periodontal and Periimplant Diseases (ETEP), Faculty of Odontology, University Complutense, Madrid, Spain
| | - Mariano Sanz
- Departament of Dental Clinical Specialties, Faculty of Odontology, University Complutense, Madrid, Spain.,Research Group on the Aetiology and Treatment of Periodontal and Periimplant Diseases (ETEP), Faculty of Odontology, University Complutense, Madrid, Spain
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21
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Huang Y, Zhang Z, Zheng Y, Zhao Z, Zhong Y, Zhang Q, Xia D, Ma N, Zhang L. Effects of non-surgical periodontal therapy on periodontal clinical data in periodontitis patients with rheumatoid arthritis: a meta-analysis. BMC Oral Health 2021; 21:340. [PMID: 34246253 PMCID: PMC8272313 DOI: 10.1186/s12903-021-01695-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/28/2021] [Indexed: 12/18/2022] Open
Abstract
Backgrounds To date, there is still no consensus about the clinical efficacy of non-surgical periodontal therapy in rheumatoid arthritis (RA) patients with periodontitis. Therefore, the aim of this study was to summarize clinical data regarding the efficacy of scaling and root planing (SRP) in patients with RA and periodontitis compared to non-RA periodontitis patients. Methods We selected randomized controlled trials (RCTs) that compared periodontal clinical data in RA as compared to non-RA periodontitis patients by searching Embase, PubMed and Cochrane Central Register of Controlled Trials and by manually retrieving from the earliest records to March 8, 2021. The overall effect size of plaque index (PI), gingival index (GI), attachment loss (AL), probing depth (PD) and bleeding on probing (BOP) were calculated by either a fixed or random-effect model, and subgroup analyses were conducted according to the different time points of follow-up. Two investigators extracted the data and assess the accuracy of the obtained results with 95% of Confidence Intervals (CI). Cochrane Collaboration's tool was responsible for the evaluation of the literature quality and the inter-study heterogeneity was evaluated by Q test and I2 statistic. Sensitivity analyses were applied for results with heterogeneity. Publication bias was determined by Begg's test, Egger's test and the trim-and-fill method. Results Seven RCTs including 212 patients eventually met the inclusion criteria for the study. As the primary results, the change of PD was not statistically significant and in the secondary results changes of PI, GI, AL and BOP were also not statistically significant in RA patients with periodontitis compared to non-RA periodontitis patients. In subgroup analysis, a larger BOP reduction at 3 months, PI and AL reduction at 6 months were observed in patients with RA and periodontitis group. The results of sensitivity analyses had no significant effect. No evidence of potential publication bias was tested. There were some limitations due to the small number of eligible RCTs. Conclusions SRP is equally effective in RA as compared to non-RA periodontitis patients. It suggests RA does not affect the clinical efficacy of non-surgical periodontal therapy. These results could serve evidence-based practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01695-w.
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Affiliation(s)
- Yu Huang
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Zheng Zhang
- School of Medicine, Tianjin Stomatological Hospital, Nankai University, Tianjin, 300041, China.,Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin, 300041, China
| | - Youli Zheng
- Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China
| | - Zhulan Zhao
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Yang Zhong
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Qingyu Zhang
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Degeng Xia
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Ning Ma
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China.
| | - Li Zhang
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China.
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22
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Efficacy of Curcumin Gel on Zinc, Magnesium, Copper, IL-1 β, and TNF- α in Chronic Periodontitis Patients. BIOMED RESEARCH INTERNATIONAL 2021; 2020:8850926. [PMID: 33083489 PMCID: PMC7559506 DOI: 10.1155/2020/8850926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022]
Abstract
Curcumin exhibits antibacterial, antioxidant, and anti-inflammatory effects and has been suggested as a treatment for inflammatory diseases. The study is aimed at evaluating the effect of curcumin gel on serum levels of micronutrients (zinc, copper, and magnesium) and proinflammatory cytokines (IL-1β and TNF-α) in chronic periodontitis patients. Ninety subjects with an age of 25-54 were included in this study. From the total number, 30 subjects with healthy periodontium (control group) (mean age = 37.30 ± 7.08) were employed for the sole purpose of obtaining the normal mean values of clinical, chemical, and immunological parameters, and 60 with chronic periodontitis (mean age = 36.73 ± 6.22) were divided randomly into 2 groups, of which each group included 30 subjects. Group A received scaling and root planing SRP and curcumin gel injection covered by Coe pack for 7 days, and group B received SRP alone covered by Coe pack. Clinical parameters (plaque index, gingival index, bleeding on probing, pocket depth, and clinical attachment loss measurements) and blood samples were collected before and after 1 month of treatment to measure serum levels of zinc, copper, magnesium, IL-1β, and TNF-α. The results showed significant micronutrient alteration and increase of proinflammatory cytokines in the chronic periodontitis group as compared to healthy control (P ≤ 0.05), and curcumin gel had a significant effect on the reduction of IL-1β, TNF-α, copper, and clinical parameters (P ≤ 0.05) and increase of zinc and magnesium levels after 1 month as compared to baseline (P ≤ 0.05), nearly the same pattern for group B but with nonsignificant differences for Zn (P > 0.05). In conclusion, curcumin gel resulted in a more significant reduction in clinical parameters, inflammatory mediators, and copper and increase of zinc and magnesium levels as compared to SRP alone.
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23
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Moura MF, Silva TA, Cota LOM, Oliveira SR, Cunha FQ, Ferreira GA, Cortelli JR, Cortelli SC, Costa FO. Nonsurgical periodontal therapy decreases the severity of rheumatoid arthritis and the plasmatic and salivary levels of RANKL and Survivin: a short-term clinical study. Clin Oral Investig 2021; 25:6643-6652. [PMID: 33954850 DOI: 10.1007/s00784-021-03950-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/16/2021] [Indexed: 01/02/2023]
Abstract
AIM To investigate the influence of nonsurgical periodontal treatment (NSPT) on clinical periodontal status, rheumatoid arthritis (RA) activity, and plasmatic and salivary levels of biomarkers through a controlled clinical trial on individuals with RA and periodontitis (PE). METHODS Sixty-six individuals from a convenience sample were considered eligible and consecutively allocated in 3 groups: (1) individuals without PE and RA (-PE-RA, n = 19); (2) individuals without PE and with RA (-PE+RA, n = 23), and (3) individuals with PE and RA (+PE+RA, n = 24). Full-mouth periodontal clinical examinations, Disease Activity Score (DAS-28) evaluations, and analysis in plasma and saliva of RANKL, OPG, RANKL/OPG, and Survivin were performed at baseline (T1) and 45 days after NSPT (T2). RESULTS NSPT in the +PE+RA group was very effective to improve periodontal condition. At T2, significant reductions in DAS-28 were observed in +PE+RA (p = 0.011). Significantly higher levels of Survivin and RANKL were observed in saliva and plasma from RA individuals (with and without PE) compared to controls. Additionally, Survivin e RANKL demonstrated positive correlations with DAS-28 and an expressively significant reduction in +PE+RA at T2 (p < 0.001). CONCLUSIONS NSPT was effective on improving both the periodontal and the RA clinical status and reducing the concentration of Survivin and RANKL in saliva and plasma. PRACTICAL IMPLICATIONS Nonsurgical periodontal treatment was effective on reducing the concentration of Survivin and RANKL and on improving both the periodontal and the RA clinical status of affected individuals. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC) protocol #RBR-8g2bc8 ( http://www.ensaiosclinicos.gov.br/rg/RBR-8g2bc8/ ).
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Affiliation(s)
- Marcela Faria Moura
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Tarcília Aparecida Silva
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Luís Otávio Miranda Cota
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Sicilia Rezende Oliveira
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | - Gilda Aparecida Ferreira
- School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - José Roberto Cortelli
- Departament of Dentistry, Periodontics Research Division, University of Taubaté, São Paulo, Brazil
| | - Sheila Cavalca Cortelli
- Departament of Dentistry, Periodontics Research Division, University of Taubaté, São Paulo, Brazil
| | - Fernando Oliveira Costa
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil. .,Faculty of Dentistry, Department of Periodontology, Federal University of Minas Gerais, Antônio Carlos Avenue, 6627, Pampulha, PO Box 359, Belo Horizonte, Minas Gerais, Zip Code 31270-901, Brazil.
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24
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Interface between Periodontal Tissues and Dental Materials: Dynamic Changes and Challenges. COATINGS 2021. [DOI: 10.3390/coatings11050485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Periodontal tissues play an important role in the correct aesthetics, function and comfort of the dentition [...]
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25
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Isola G. New Advances On Biomaterials for Regenerative and Reparative Treatment Following Periodontal and Peri-implant Diseases. Open Dent J 2021. [DOI: 10.2174/1874210602115010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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26
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Isola G, Polizzi A, Iorio-Siciliano V, Alibrandi A, Ramaglia L, Leonardi R. Effectiveness of a nutraceutical agent in the non-surgical periodontal therapy: a randomized, controlled clinical trial. Clin Oral Investig 2021; 25:1035-1045. [PMID: 32556659 DOI: 10.1007/s00784-020-03397-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Nutraceutical agents have been demonstrated as adjuncts for the treatment of several inflammatory diseases. The present study analyzed and compared new nutraceutical agent as an adjunct to Scaling and root planing (SRP) versus SRP alone for the treatment of periodontitis. MATERIALS AND METHODS Sixty-six patients with moderate periodontitis were enrolled. Through a randomized design, the patients were randomly assigned to SRP + nutraceutical agent (test group) or SRP alone (control group). Patients were regularly examined the clinical, inflammatory mediators and visual analogue scale (VAS) changes over a 6-month period. Clinical attachment level (CAL) was the primary outcome variable chosen. Gingival crevicular fluid (GCF) inflammatory mediator change and the impact of treatment on VAS were evaluated through a linear regression model. RESULTS Both treatments demonstrated an improvement in periodontal parameters compared with baseline. After 6 months of treatment, compared with the control group, the test group determined a significant probing depth (PD) (p = 0.003) and bleeding on probing (BOP) reduction (p < 0.001), while CAL gain was significantly obtained at 30 and 60 days after treatment (p < 0.05). In the test group, the level of inflammatory mediators was significantly reduced compared with the control group (p < 0.05). The linear regression analysis demonstrated that the nutraceutical agent exerted, in the test group, a significant influence on VAS at 6, 12, 24, and 48 h after treatment (p < 0.05). CONCLUSIONS Nutraceutical agent resulted in a more significant reduction in clinical, inflammatory mediators and short-term pain compared with SRP alone. CLINICAL RELEVANCE Nutraceutical agent, when combined with SRP, was demonstrated to be effective in reducing periodontal parameters and controlling the levels of inflammatory mediators and pain in patients with periodontitis.
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Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Vincenzo Iorio-Siciliano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine, University of Naples "Federico II", Via G. Pansini 5, 80131, Naples, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Piazza Pugliatti 1, Messina, 98123, Italy
| | - Luca Ramaglia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine, University of Naples "Federico II", Via G. Pansini 5, 80131, Naples, Italy
| | - Rosalia Leonardi
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
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27
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Non-surgical periodontal treatment improves rheumatoid arthritis disease activity: a meta-analysis. Clin Oral Investig 2021; 25:4975-4985. [PMID: 33515120 DOI: 10.1007/s00784-021-03807-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/21/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aim of the meta-analysis was to clarify the efficacy of non-surgical periodontal treatment (NSPT) in improving rheumatoid arthritis (RA) disease activity. METHODS A systematic literature search was conducted using the PubMed, Embase, and Cochrane databases up to October 2020. A total of nine studies were included for the comparison of RA-related indicator changes between the NSPT group and no treatment (NT) group. Mean differences (MD) and 95% confidence intervals (CI) were calculated for disease activity score (DAS28), erythrocyte sedimentation rate (ESR), tender joint counts (TJC), swollen joint counts (SJC), visual analogical scale (VAS), morning stiffness (MS), rheumatoid factor (RF), C-reactive protein (CRP), tumor necrosis factor α (TNF-α), and interleukin-6 (IL-6). RESULTS NSPT induced significant reductions of DAS28 (MD: 0.61, 95% CI: 0.37, 0.85, P < 0.001), TJC (MD: 0.65, 95% CI: 0.37, 0.93, P < 0.001), SJC (MD: 0.67, 95% CI: 0.18, 1.17, P = 0.008), VAS (MD: 0.48, 95% CI: 0.08, 0.88, P = 0.02), and CRP (MD: 0.34, 95% CI: 0.07, 0.64, P = 0.01) in RA patients with periodontitis. Other parameters showed a trend toward reduction, but results were not statistically significant. CONCLUSIONS This meta-analysis indicates that NSPT could improve RA activity as assessed by DAS28, TJC, SJC, VAS, and CRP. CLINICAL RELEVANCE The results emphasize the effectiveness and need for periodontal diagnosis and periodontal therapy in rheumatoid arthritis patients to reduce disease activity.
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28
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Rovas A, Puriene A, Punceviciene E, Butrimiene I, Stuopelyte K, Jarmalaite S. Associations of periodontal status in periodontitis and rheumatoid arthritis patients. J Periodontal Implant Sci 2021; 51:124-134. [PMID: 33913635 PMCID: PMC8090795 DOI: 10.5051/jpis.2006060303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/15/2020] [Accepted: 12/30/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose The aim of this study was to assess the association between the clinical status of rheumatoid arthritis (RA) and periodontitis (PD) in patients diagnosed with PD and to evaluate the impact of RA treatment on the severity of PD. Methods The study included 148 participants with PD, of whom 64 were also diagnosed with RA (PD+RA group), while 84 age-matched participants were rheumatologically healthy (PD-only group). PD severity was assessed by the following periodontal parameters: clinical attachment loss, probing pocket depth (PPD), bleeding on probing (BOP), alveolar bone loss, and number of missing teeth. RA disease characteristics and impact of disease were evaluated by the Disease Activity Score 28 using C-reactive protein, disease duration, RA treatment, the RA Impact of Disease tool, and the Health Assessment Questionnaire. Outcome variables were compared using parametric and non-parametric tests and associations were evaluated using regression analysis with the calculation of odds ratios (ORs). Results Participants in the PD+RA group had higher mean PPD values (2.81 ± 0.59 mm vs. 2.58 ± 0.49 mm, P=0.009) and number of missing teeth (6.27±4.79 vs. 3.93±4.08, P=0.001) than those in the PD-only group. A significant association was found between mean PPD and RA (OR, 2.22; 95% CI, 1.16–4.31; P=0.016). Within the PD+RA group, moderate to severe periodontal disease was significantly more prevalent among participants with higher RA disease activity (P=0.042). The use of biologic disease-modifying antirheumatic drugs (bDMARDs) was associated with a lower BOP percentage (P=0.016). Conclusions In patients with PD, RA was associated with a higher mean PPD and number of missing teeth. The severity of PD was affected by the RA disease clinical activity and by treatment with bDMARDs, which were associated with a significantly lower mean BOP percentage.
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Affiliation(s)
- Adomas Rovas
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Zalgiris Clinic, Vilnius, Lithuania.
| | - Alina Puriene
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Zalgiris Clinic, Vilnius, Lithuania
| | - Egle Punceviciene
- Clinic of Rheumatology, Orthopedics Traumatology and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Rheumatology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Irena Butrimiene
- Clinic of Rheumatology, Orthopedics Traumatology and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Rheumatology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Kristina Stuopelyte
- Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania.,National Cancer Institute, Vilnius, Lithuania
| | - Sonata Jarmalaite
- Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania.,National Cancer Institute, Vilnius, Lithuania
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29
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Wang B, Booij-Vrieling HE, Bronkhorst EM, Shao J, Kouwer PHJ, Jansen JA, Walboomers XF, Yang F. Antimicrobial and anti-inflammatory thermo-reversible hydrogel for periodontal delivery. Acta Biomater 2020; 116:259-267. [PMID: 32937208 DOI: 10.1016/j.actbio.2020.09.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 01/06/2023]
Abstract
In periodontal treatment, topical adjunctive therapy with antimicrobials or anti-inflammatory agents is frequently applied. However, currently available drug carrier biomaterials often exhibit poor perfusion into small crevices, such as the deep and irregular periodontal pockets, due to relatively high viscosity. Moreover, high polymer concentrations of the polymer can potentially be cytotoxic upon confined local administration. This study aimed to formulate an antimicrobial and anti-inflammatory treatment option, by incorporating doxycycline (DOX) and/or lipoxin A4 (LXA4) into 0.5 wt% thermo-reversible polyisocyanopeptide (PIC). PIC can form hydrogels upon low polymer concentration, and we hypothesized that the thermo-reversible nature of the material would allow for application into the periodontal pocket. The formulations were characterized in vitro and finally tested in dogs with naturally occurring periodontitis, which were not euthanized afterward. Results showed that PIC/DOX/LXA4 hydrogel could be easily prepared and injected into periodontal pockets. The PIC hydrogel facilitated the release of DOX or LXA4 for around 4 days in vitro. When applied in dogs, the hydrogel exerted no local or systemic adverse effects. Gels loaded with LXA4 and/or DOX reduced the subgingival bacterial load and pro-inflammatory interleukin-8 level. In addition, PIC-DOX and PIC-DOX+LXA4 improved gingival clinical attachment by 0.6 mm compared with conventional periodontal treatment alone (i.e. mechanical debridement). In conclusion, the thermo-reversible PIC hydrogel is a safe and effective vehicle for periodontal drug delivery.
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Affiliation(s)
- Bing Wang
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Biomaterials, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands; School of Stomatology, Shandong University, Jinan, Shandong, China
| | - Henriëtte E Booij-Vrieling
- Department of Clinical Sciences of Companion Animals, General Surgery, Faculty of Veterinary Medicine, Utrecht University, the Netherlands
| | - Ewald M Bronkhorst
- Radboud University Medical Center, Department of Dentistry, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands
| | - Jinlong Shao
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Biomaterials, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands; School of Stomatology, Shandong University, Jinan, Shandong, China
| | - Paul H J Kouwer
- Institute for Molecules and Materials, Radboud University, Nijmegen, the Netherlands
| | - John A Jansen
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Biomaterials, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands
| | - X Frank Walboomers
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Biomaterials, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands
| | - Fang Yang
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Biomaterials, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands.
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30
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Cosgarea R, Eick S, Jepsen S, Arweiler NB, Juncar R, Tristiu R, Salvi GE, Heumann C, Sculean A. Microbiological and host-derived biomarker evaluation following non-surgical periodontal therapy with short-term administration of systemic antimicrobials: secondary outcomes of an RCT. Sci Rep 2020; 10:16322. [PMID: 33004857 PMCID: PMC7530673 DOI: 10.1038/s41598-020-73054-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022] Open
Abstract
Nonsurgical periodontal therapy with adjunctive use of systemic antimicrobials (for 7–14 days) showed improved clinical, microbiological and immunological results over the mechanical protocol alone. Considering the increasing risk for antimicrobial resistance with longer antibiotic regimes, it is important to establish the optimal antibiotic protocol with a maximum antimicrobial benefit and minimum risk for adverse effects. The aim of the study was to evaluate the microbiological and inflammatory outcomes 12-months after a 3-/7-day systemic antibiotic protocol [amoxicillin (AMX) + metronidazole (MET)] adjunctive to subgingival debridement in severe periodontitis compared to mechanical treatment alone. From the initially treated 102 patients, 75 subjects (Placebo group: n = 26; 3-day AMX + MET group: n = 24; 7-day AMX + MET group: n = 25) completed the 12-month examination. Clinical parameters, eight periodontal pathogens and inflammatory markers were determined at baseline and 3-, 6-, 12-months after therapy using real-time PCR and ELISA respectively. After 6 months, several periodontopathogens were significantly more reduced in the two antibiotic groups compared to placebo (p < 0.05). After 1 year, both antibiotic protocols showed significant reductions and detection of the keystone pathogen P. gingivalis compared to placebo. Antibiotic protocols, smoking, disease severity, baseline-BOP, -CAL and -IL-1β, as well as detection of T. denticola at 12-months significantly influenced the residual number of deep sites. The present data indicate that the systemic use of both short and longer antibiotic protocols (AMX + MET) adjunctive to nonsurgical periodontal therapy lead to higher microbiological improvements compared to subgingival debridement alone. The two investigated antibiotic protocols led to comparable microbiological and inflammatory results.
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Affiliation(s)
- Raluca Cosgarea
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnen str 17, 53111, Bonn, Germany. .,Clinic for Prosthetic Dentistry, University Iuliu-Hatieganu, Cluj-Napoca, Romania. .,Department of Periodontology and Peri-implant Diseases, Philipps University Marburg, Marburg, Germany.
| | - S Eick
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - S Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnen str 17, 53111, Bonn, Germany
| | - N B Arweiler
- Department of Periodontology and Peri-implant Diseases, Philipps University Marburg, Marburg, Germany
| | - R Juncar
- Department of Dental Medicine, University of Oradea, Oradea, Romania
| | - R Tristiu
- Clinic for Prosthetic Dentistry, University Iuliu-Hatieganu, Cluj-Napoca, Romania
| | - G E Salvi
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - C Heumann
- Department for Statistics, Ludwig-Maximilians University, Munich, Germany
| | - A Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
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31
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Isola G. The Impact of Diet, Nutrition and Nutraceuticals on Oral and Periodontal Health. Nutrients 2020; 12:nu12092724. [PMID: 32899964 PMCID: PMC7551041 DOI: 10.3390/nu12092724] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023] Open
Abstract
Oral and periodontal diseases can determine severe functional, phonatory and aesthetic impairments and are the main cause of adult tooth loss. They are caused by some specific bacteria that provoke an intense local inflammatory response and affect-with particular gravity-susceptible subjects, because of reasons related to genetics and lifestyles (e.g., smoking and home oral hygiene habits). They are more frequent in the disadvantaged segments of society and, in particular, in subjects who have difficulty accessing preventive services and dental care. Some systemic diseases, such as uncontrolled diabetes, can increase their risk of development and progression. Recently, in addition to the obvious considerations of severe alterations and impairments for oral health and well-being, it has been noted that periodontitis can cause changes in the whole organism. Numerous clinical and experimental studies have highlighted the presence of a strong association between periodontitis and some systemic diseases, in particular, cardiovascular diseases, diabetes, lung diseases and complications of pregnancy. The purpose of this editorial is to provide a current and thoughtful perspective on the relationship of diet and natural agents on oral, periodontal diseases, and chewing disorder preventions which may reflect good systemic conditions and related quality of life or to analyze indirect effects through the contribution of diet and nutrition to systemic health in order to obtain a modern diagnostic-therapeutic approach.
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Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy
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32
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Cheah CW, Al‐Maleki AR, Vadivelu J, Danaee M, Sockalingam S, Baharuddin NA, Vaithilingam RD. Salivary and serum cathelicidin LL‐37 levels in subjects with rheumatoid arthritis and chronic periodontitis. Int J Rheum Dis 2020; 23:1344-1352. [DOI: 10.1111/1756-185x.13919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/17/2020] [Accepted: 06/29/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Chia Wei Cheah
- Department of Restorative Dentistry Faculty of Dentistry University of Malaya Kuala Lumpur Malaysia
| | - Anis Rageh Al‐Maleki
- Department of Medical Microbiology Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Jamuna Vadivelu
- Department of Medical Microbiology Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Mahmoud Danaee
- Department of Social Preventive Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Sargunan Sockalingam
- Department of Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Nor Adinar Baharuddin
- Department of Restorative Dentistry Faculty of Dentistry University of Malaya Kuala Lumpur Malaysia
| | - Rathna Devi Vaithilingam
- Department of Restorative Dentistry Faculty of Dentistry University of Malaya Kuala Lumpur Malaysia
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Isola G, Matarese G, Ramaglia L, Pedullà E, Rapisarda E, Iorio-Siciliano V. Association between periodontitis and glycosylated haemoglobin before diabetes onset: a cross-sectional study. Clin Oral Investig 2020; 24:2799-2808. [PMID: 31776665 DOI: 10.1007/s00784-019-03143-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of the present cross-sectional study was to investigate the association between serum glycosylated haemoglobin (HbA1c) levels and periodontal status in patients with periodontitis (CP) and periodontally healthy controls. Furthermore, the objectives were to determine if the periodontitis influenced the serum HbA1c levels. MATERIALS AND METHODS A total of 93 patients with CP and 95 periodontally healthy subjects were enrolled in the present study using a cross-sectional design. At baseline, patients were examined and characterized on a regular basis for blood serum parameters and non-fasting blood samples levels. In all patients, a full periodontal examination was performed and clinical attachment loss (CAL) was the primary outcome variable chosen. The spearman correlation, a stepwise multivariable linear regression, and Jonckheere-Terpstra tests were applied in order to assess the relationship between HbA1c levels and periodontitis. RESULTS Patients in the CP group presented a significantly higher median serum level of HbA1c [40.9 (31.2; 45.6) mmol/mol)] compared to patients in the healthy control group [35.3 (29.6; 38.6) mmol/mol)] (p < 0.001). HbA1c levels were negatively correlated with the number of teeth and positively correlated with C-reactive protein levels and all periodontal parameters (p < 0.001). Moreover, there was a significant decrease in the number of teeth when HbA1c levels increased (P-trend < 0.001), while there was a significant increase in periodontal parameters (CAL, p = 0.002); PD, p = 0.008; BOP, p < 0.001) when levels of HbA1c increased. CONCLUSIONS Patients with CP and undiagnosed diabetes presented significantly higher serum levels of HbA1c compared to periodontally healthy controls. Moreover, the presence of periodontitis was positively correlated with serum HbA1c levels before diabetes onset. CLINICAL RELEVANCE HbA1c levels were positively correlated with the severity of periodontitis before diabetes onset.
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Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia n° 78, 95125, Catania, Italy.
| | - Giovanni Matarese
- Department of Biomedical, Odontostomatological, Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Luca Ramaglia
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Eugenio Pedullà
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia n° 78, 95125, Catania, Italy
| | - Ernesto Rapisarda
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia n° 78, 95125, Catania, Italy
| | - Vincenzo Iorio-Siciliano
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
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Wang B, Wang J, Shao J, Kouwer PH, Bronkhorst EM, Jansen JA, Walboomers XF, Yang F. A tunable and injectable local drug delivery system for personalized periodontal application. J Control Release 2020; 324:134-145. [DOI: 10.1016/j.jconrel.2020.05.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 01/10/2023]
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35
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Tachibana M, Yonemoto Y, Okamura K, Suto T, Sakane H, Kaneko T, Dam TT, Okura C, Tajika T, Tsushima Y, Chikuda H. Does periodontitis affect the treatment response of biologics in the treatment of rheumatoid arthritis? Arthritis Res Ther 2020; 22:178. [PMID: 32711580 PMCID: PMC7382136 DOI: 10.1186/s13075-020-02269-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/13/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) and periodontitis (PD) have been suggested to share many clinical and pathological features. However, few reports have investigated the relationship between the degree of PD and the treatment response to RA. This study aimed to examine the relationship between the extent of PD and the treatment response to biologics in RA patients using FDG-PET/CT. METHODS Sixty RA patients (male, n = 14; female, n = 46; average age, 58.3 years) treated with biologic agents were included in this study. FDG-PET/CT was performed at baseline and 6 months after the initiation of biological therapy. The maximum standardized uptake value (SUVmax) was used as a representative value for the assessment of the FDG uptake in periodontal tissue and joints including the bilateral shoulders, elbows, wrists, hip, knees, and ankle joints. The Disease Activity Score (DAS) 28-CRP and the following clinical parameters were assessed: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), anti-cyclic citrullinated peptide antibody (ACPA), rheumatoid factor (RF), and matrix metalloproteinase 3 (MMP-3). The relationship between the treatment response of RA and the baseline SUVmax of the periodontal tissue was evaluated. RESULTS The baseline periodontal SUVmax was related to patient age (r = 0.302, p = 0.009) and the ACPA level (r = 0.265, p = 0.025). The DAS28-CRP, CRP, ESR, MMP-3, and joint SUVmax values were significantly decreased after 6 months of biological therapy. However, the mean periodontal SUVmax, ACPA, and RF showed no significant changes after treatment. There was a significantly negative correlation between the baseline periodontal SUVmax and the treatment response of DAS28-CRP (r = - 0.369, p = 0.004). CONCLUSION There was a negative correlation between the extent of PD at baseline and the treatment response of RA patients who received biological therapy. The evaluation of the periodontal condition is considered to be an essential part for the management of RA.
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Affiliation(s)
- Masahiro Tachibana
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Showa-machi 3-39-15, Maebashi, Gunma, 371-8511, Japan
| | - Yukio Yonemoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Showa-machi 3-39-15, Maebashi, Gunma, 371-8511, Japan
| | - Koichi Okamura
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Showa-machi 3-39-15, Maebashi, Gunma, 371-8511, Japan.
| | - Takahito Suto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Showa-machi 3-39-15, Maebashi, Gunma, 371-8511, Japan
| | - Hideo Sakane
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Showa-machi 3-39-15, Maebashi, Gunma, 371-8511, Japan
| | - Tetsuya Kaneko
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Showa-machi 3-39-15, Maebashi, Gunma, 371-8511, Japan
| | - Trang Thuy Dam
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Showa-machi 3-39-15, Maebashi, Gunma, 371-8511, Japan.,Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Showa-machi 3-39-15, Maebashi, Gunma, 371-8511, Japan.,Radiology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Chisa Okura
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Showa-machi 3-39-15, Maebashi, Gunma, 371-8511, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Showa-machi 3-39-15, Maebashi, Gunma, 371-8511, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Showa-machi 3-39-15, Maebashi, Gunma, 371-8511, Japan.,Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Showa-machi 3-39-15, Maebashi, Gunma, 371-8511, Japan
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Wang J, Toebes BJ, Plachokova AS, Liu Q, Deng D, Jansen JA, Yang F, Wilson DA. Self-Propelled PLGA Micromotor with Chemotactic Response to Inflammation. Adv Healthc Mater 2020; 9:e1901710. [PMID: 32142216 DOI: 10.1002/adhm.201901710] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/13/2020] [Indexed: 02/01/2023]
Abstract
Local drug delivery systems have recently been developed for multiple diseases that have the requirements of site-specific actions, prolonged delivery periods, and decreased drug dosage to reduce undesirable side effects. The challenge for such systems is to achieve directional and precise delivery in inaccessible narrow lesions, such as periodontal pockets or root canals in deeper portions of the dentinal tubules. The primary strategy to tackle this challenge is fabricating a smart tracking delivery system. Here, drug-loaded biodegradable micromotors showing self-propelled directional movement along a hydrogen peroxide concentration gradient produced by phorbol esters-stimulated macrophages are reported. The drug-loaded poly(lactic-co-glycolic acid) micromotors with asymmetric coverage of enzyme (patch-like enzyme distribution) are prepared by electrospraying and postfunctionalized with catalase via 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide coupling. Doxycycline, a common drug for the treatment of periodontal disease, is selected as a model drug, and the release study by high-performance liquid chromatography is shown that both the postfunctionalization step and the presence of hydrogen peroxide have no negative influence on drug release profiles. The movement behavior in the presence of hydrogen peroxide is confirmed by nanoparticle tracking analysis. An in vitro model is designed and confirmed the response efficiency and directional control of the micromotors toward phorbol esters-stimulated macrophages.
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Affiliation(s)
- Jiamian Wang
- Department of Dentistry – BiomaterialsRadboud University Medical Center 6525 EX Nijmegen The Netherlands
| | - B. Jelle Toebes
- Institute for Molecules and Materials Radboud University 6525 AJ Nijmegen The Netherlands
| | - Adelina S. Plachokova
- Department of Dentistry – Implantology and PeriodontologyRadboud University Medical Center 6525 EX Nijmegen The Netherlands
| | - Qian Liu
- Department of Dentistry – BiomaterialsRadboud University Medical Center 6525 EX Nijmegen The Netherlands
| | - Dongmei Deng
- Department of Preventive DentistryAcademic Center for Dentistry Amsterdam (ACTA)University of Amsterdam and VUUniversity Amsterdam 1081 LA Amsterdam The Netherlands
| | - John A. Jansen
- Department of Dentistry – BiomaterialsRadboud University Medical Center 6525 EX Nijmegen The Netherlands
| | - Fang Yang
- Department of Dentistry – BiomaterialsRadboud University Medical Center 6525 EX Nijmegen The Netherlands
| | - Daniela A. Wilson
- Institute for Molecules and Materials Radboud University 6525 AJ Nijmegen The Netherlands
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Keceli HG, Ercan N, Karsiyaka Hendek M, Kisa U, Mesut B, Olgun E. The effect of the systemic folic acid intake as an adjunct to scaling and root planing on clinical parameters and homocysteine and C-reactive protein levels in gingival crevicular fluid of periodontitis patients: A randomized placebo-controlled clinical trial. J Clin Periodontol 2020; 47:602-613. [PMID: 32109317 DOI: 10.1111/jcpe.13276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 02/14/2020] [Accepted: 02/24/2020] [Indexed: 01/09/2023]
Abstract
AIM To evaluate clinical and biochemical effects of adjunctive systemic folic acid (FA) intake with scaling and root planing (SRP) in periodontitis treatment. MATERIALS AND METHODS Sixty periodontitis subjects (30 per group) were randomly assigned into study groups and treated with either SRP + placebo (SRP + P) or SRP + folic acid (SRP + F). In addition to clinical parameters (plaque index [PI], gingival index [GI], probing pocket depth [PPD], clinical attachment level [CAL] and gingival recession [GR]), gingival crevicular fluid (GCF) samples were obtained at baseline and post-treatment (PT) periods (one (PT-1), three (PT-3) and six (PT-6) months) for C-reactive protein (CRP) and homocysteine (Hcy) evaluation. RESULTS Significant time-dependent reduction was detected at all clinical parameters for both groups (p < .001). Compared to SRP + P, CAL was lower in SRP + F at PT-1 (p = .004) and PT-3 (p = .035), whereas GR was lower at only PT-1 (p = .015). GCF volume and CRP did not show inter-group differences, whereas Hcy was higher in SRP + F at PT-3 (p = .044) and PT-6 (p = .041). GCF volume and Hcy showed reduction after treatment in both groups (p < .001). CONCLUSION Both modalities exhibited clinical improvement and change in biochemical parameters. Adjunctive systemic FA intake may be recommended adjunctive to periodontitis treatment to reveal better outcomes. However, its impact mechanisms should be further enlightened.
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Affiliation(s)
- H Gencay Keceli
- Periodontology Department, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Nuray Ercan
- Oral Health and Dental Care Centre, Duzce, Turkey
| | | | - Ucler Kisa
- Biochemistry Department, Faculty of Medicine, Kirikkale University, Kırıkkale, Turkey
| | - Burcu Mesut
- Pharmaceutical Technology Department, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Ebru Olgun
- Periodontology Department, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkey
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Hussain SB, Botelho J, Machado V, Zehra SA, Mendes JJ, Ciurtin C, Orlandi M, D'Aiuto F. Is there a bidirectional association between rheumatoid arthritis and periodontitis? A systematic review and meta-analysis. Semin Arthritis Rheum 2020; 50:414-422. [PMID: 32113837 DOI: 10.1016/j.semarthrit.2020.01.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several lines of evidence suggest a bi-directional association between Rheumatoid Arthritis (RA) and Periodontitis (PD). Our aim was to systematically appraise the evidence on the association between RA and PD in terms of clinical and laboratory outcomes. METHODS An electronic search of several databases (PubMed, EMBASE, MEDLINE, LILACS, CINHL, Scopus, Web of Science, The Cochrane Library, OpenGrey and Google Scholar) was conducted up to March 2019 (PROSPERO CRD42018107817) by two independent reviewers. Observational studies included in the review were quality-appraised using the Newcastle-Ottawa Scale (NOS) tool. Random effects models were used for quantitative analyses. RESULTS A total of 8 case-control studies were identified after the final search of 1491 titles. Following quality assessment, 2 studies were excluded due to the high risk of bias, while the remaining 6 were further analysed. Meta-analyses revealed no substantial effect of RA on the Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL) of patients with PD when compared to controls but high degree of study heterogeneity was found. To the contrary, PD was associated with substantially worse RA disease activity as assessed by an increase in the DAS28 score of 0.74 (0.25-1.24, 95%CI, p < 0.001). CONCLUSION There is consistent evidence suggesting that PD is associated with worse RA clinical activity as assessed by DAS28 scores whereas, RA patients do not have worsen PD clinical outcomes.
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Affiliation(s)
- Syed Basit Hussain
- Periodontology Unit, UCL Eastman Dental Institute 256 Gray's Inn Road, London WC1X 8LD, UK.
| | - João Botelho
- Periodontology Department, Clinical Research Unit (CRU), Egas Moniz Interdisciplinary Research Centre, Egas Moniz, Almada, Portugal
| | - Vanessa Machado
- Periodontology Department, Clinical Research Unit (CRU), Egas Moniz Interdisciplinary Research Centre, Egas Moniz, Almada, Portugal
| | - Syeda Ambreen Zehra
- Department of Dental Physical Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - José João Mendes
- Periodontology Department, Clinical Research Unit (CRU), Egas Moniz Interdisciplinary Research Centre, Egas Moniz, Almada, Portugal
| | - Coziana Ciurtin
- Department of Rheumatology, University College London Hospital, London, UK
| | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute 256 Gray's Inn Road, London WC1X 8LD, UK
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute 256 Gray's Inn Road, London WC1X 8LD, UK
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Buwembo W, Munabi IG, Kaddumukasa M, Kiryowa H, Mbabali M, Nankya E, Johnson WE, Okello E, Sewankambo NK. Non-surgical oral hygiene interventions on disease activity of Rheumatoid arthritis patients with periodontitis: A randomized controlled trial. J Dent Res Dent Clin Dent Prospects 2020; 14:26-36. [PMID: 32454955 PMCID: PMC7235694 DOI: 10.34172/joddd.2020.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/20/2019] [Indexed: 12/15/2022] Open
Abstract
Background. Periodontitis and rheumatoid arthritis have similar epidemiology and pathophysiology. Understanding the interaction between these two diseases is vital in our settings. We set out to assess the effect of oral hygiene interventions on disease activity of rheumatoid arthritis patients with periodontitis in Kampala, Uganda. Methods. Fifty-eight patients attending an arthritis clinic with rheumatoid arthritis and periodontitis were randomly assigned to either an intervention group or a control group. Patients diagnosed with rheumatoid arthritis at least two years before, who were on the same medication, dose, or formulation for RA treatment during the preceding three months, were included. The patients were >18 years of age, would be available for all the study visits in the next six months, had at least six natural teeth, had periodontal disease classified as Dutch Periodontal Index (DPSI) >3 and provided written informed consent. Those who had a chronic disorder requiring chronic or intermittent use of antibiotics, were pregnant, were lactating, or had intent to become pregnant were excluded. The primary outcome measure was a change in Disease Activity Score of 28 Joints (DAS28 score) in two 3-month follow-up periods after the intervention. The secondary outcome measure was a change in periodontal status. Results. There was a statistically significant improvement in the DAS-28 score in both the intervention and control arms during the follow-up period (P<0.01). The participants carrying more than one bacterial species had worse DAS-28 scores. Conclusion. Oral hygiene interventions given to RA patients could drastically improve their RA treatment outcomes, especially in resource-limited settings.
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Affiliation(s)
- William Buwembo
- Department of Human Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala Uganda
| | - Ian Guyton Munabi
- Department of Human Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala Uganda
| | - Mark Kaddumukasa
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala Uganda
| | - Haruna Kiryowa
- Department of Human Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala Uganda
| | - Muhammad Mbabali
- Department of Dentistry, School of Health Sciences, Makerere University College of Health Sciences, Kampala Uganda
| | - Ethel Nankya
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, MA, Boston University, USA
| | - William Evan Johnson
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, MA, Boston University, USA
| | - Emmy Okello
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala Uganda
| | - Nelson K. Sewankambo
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala Uganda
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40
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Non-surgical periodontal disease: A new treatment for rheumatoid arthritis? Joint Bone Spine 2020; 87:1-3. [DOI: 10.1016/j.jbspin.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/20/2019] [Indexed: 12/17/2022]
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Linkage of Periodontitis and Rheumatoid Arthritis: Current Evidence and Potential Biological Interactions. Int J Mol Sci 2019; 20:ijms20184541. [PMID: 31540277 PMCID: PMC6769683 DOI: 10.3390/ijms20184541] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/07/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023] Open
Abstract
The association between rheumatoid arthritis (RA) and periodontal disease (PD) has been the focus of numerous investigations driven by their common pathological features. RA is an autoimmune disease characterized by chronic inflammation, the production of anti-citrullinated proteins antibodies (ACPA) leading to synovial joint inflammation and destruction. PD is a chronic inflammatory condition associated with a dysbiotic microbial biofilm affecting the supporting tissues around the teeth leading to the destruction of mineralized and non-mineralized connective tissues. Chronic inflammation associated with both RA and PD is similar in the predominant adaptive immune phenotype, in the imbalance between pro- and anti-inflammatory cytokines and in the role of smoking and genetic background as risk factors. Structural damage that occurs in consequence of chronic inflammation is the ultimate cause of loss of function and disability observed with the progression of RA and PD. Interestingly, the periodontal pathogen Porphyromonas gingivalis has been implicated in the generation of ACPA in RA patients, suggesting a direct biological intersection between PD and RA. However, more studies are warranted to confirm this link, elucidate potential mechanisms involved, and ascertain temporal associations between RA and PD. This review is mainly focused on recent clinical and translational research intends to discuss and provide an overview of the relationship between RA and PD, exploring the similarities in the immune-pathological aspects and the possible mechanisms linking the development and progression of both diseases. In addition, the current available treatments targeting both RA and PD were revised.
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Mariette X, Perrodeau E, Verner C, Struillou X, Picard N, Schaeverbeke T, Constantin A, Ravaud P, Bouchard P. Role of good oral hygiene on clinical evolution of rheumatoid arthritis: a randomized study nested in the ESPOIR cohort. Rheumatology (Oxford) 2019; 59:988-996. [DOI: 10.1093/rheumatology/kez368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/02/2019] [Indexed: 12/11/2022] Open
Abstract
Abstract
Objective
There is a relationship between RA and periodontal disease. We aimed to investigate if a good oral hygiene could improve activity of RA.
Methods
The patients with RA according to ACR/EULAR 2010 criteria and included in the French early arthritis ESPOIR cohort were included in a randomized nested study into: (i) intervention group: general recommendations of good oral hygiene including teeth brushing, daily antiseptic mouthwash and twice a year scaling; and (ii) control group: no intervention. The primary end point was the delta DAS28-ESR.
Results
Four hundred and seventy-two patients were randomized (238 in intervention and 234 in control). 92/238 from the intervention group accepted the procedure and 81 had a first visit to the dentist. 56% of patients had periodontal disease at baseline. Duration of RA was 9.0±0.7 years. Baseline DAS28-ESR was 2.7±1.3. After a median duration of 24 months, delta DAS28-ESR was −0.17±1.29 and −0.09±1.28 in intervention and control groups, respectively (mean difference (complier average causal effect): −0.37 (95% CI −1.12, 0.37), P = 0.33). In the intervention group, there was a significant decrease of the bacteria involved in the red complex: Porphyromonas gingivalis (P = 0.002), Tannerella forsythia (P = 0.002) and Treponema denticola (P = 0.019). The patients with baseline periodontal disease and those who became negative for one red complex bacterium had a slightly more important decrease of DAS28-ESR.
Conclusion
Oral hygiene instruction together with regular scaling and polishing of the teeth significantly decreased the load of periodontal pathogens but did not decrease RA activity. This intervention should be tested in patients with earlier RA and more active disease.
Trial registration
ClinicalTrials.gov, http://clinicaltrials.gov, NCT01831648.
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Affiliation(s)
- Xavier Mariette
- Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Assistance Publique–Hôpitaux de Paris (AP-HP), Université Paris-Sud, INSERM UMR1184, Le Kremlin Bicêtre
| | | | | | - Xavier Struillou
- Department of Periodontology, University of Nantes, Nantes
- INSERM, UMR-S 1229, RMeS, Faculty of Dental Surgery, University of Nantes, Nantes
| | | | | | - Arnaud Constantin
- Department of Rheumatology, Hôpital Pierre-Paul Riquet and Université Toulouse III - Paul Sabatier, Toulouse
| | - Philippe Ravaud
- Department of Epidemiology, Université Paris-Descartes, Paris
| | - Philippe Bouchard
- Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Denis Diderot University
- EA 2496, Paris 5-Descartes University, U.F.R. of Odontology, Paris, France
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Rahajoe PS, Smit MJ, Kertia N, Westra J, Vissink A. Cytokines in gingivocrevicular fluid of rheumatoid arthritis patients: A review of the literature. Oral Dis 2019; 25:1423-1434. [PMID: 31206910 PMCID: PMC6853197 DOI: 10.1111/odi.13145] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 12/12/2022]
Abstract
Objective Rheumatoid arthritis (RA) and periodontitis share several pathological features including bone and soft tissue destruction and high levels of circulating inflammatory proteins. Studies related to cytokines in the periodontal inflammatory exudate (gingivocrevicular fluid, GCF) of RA patients might provide insight into the association between periodontitis and RA. The aim of our study was to review the literature on cytokines in GCF of RA patients including the effect of anti‐rheumatic treatment with biological disease‐modifying anti‐rheumatic drugs (DMARDs) and periodontal treatment on these cytokines. Materials and methods MedLine/PubMed searches with different combinations of keywords “rheumatoid arthritis or RA” and “crevicular fluid or GCF” until June 2019 revealed 64 articles. Ten cross‐sectional observational studies and nine treatment studies fulfilled the inclusion criteria. Results Rheumatoid arthritis patients have increased circulating and GCF levels of pro‐inflammatory cytokines and proteins, despite anti‐rheumatic treatment with biological DMARDs. Presence of periodontitis was accompanied by higher cytokine and protein levels. Treatment of periodontitis resulted in a decrease of these levels. Conclusion Analysis of GCF of RA patients reveals that the relationship between periodontitis and RA is bidirectional, probably caused by a non‐specific inflammatory burden. Data for a specific relationship are barely present in GCF.
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Affiliation(s)
- Poerwati S Rahajoe
- Department of Oral and Maxillofacial Surgery, Dr. Sardjito General Hospital, Gadjah Mada University, Yogyakarta, Indonesia
| | - Menke J Smit
- Department of Oral and Maxillofacial Surgery, Department of Rheumatology and Clinical Immunology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Nyoman Kertia
- Department of Rheumatology, Dr. Sardjito General Hospital, Gadjah Mada University, Yogyakarta, Indonesia
| | - Johanna Westra
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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Are There Any Common Genetic Risk Markers for Rheumatoid Arthritis and Periodontal Diseases? A Case-Control Study. Mediators Inflamm 2019; 2019:2907062. [PMID: 30890897 PMCID: PMC6390239 DOI: 10.1155/2019/2907062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/14/2019] [Accepted: 01/29/2019] [Indexed: 12/15/2022] Open
Abstract
Background Several studies suggest that there is a biologically plausible connection between rheumatoid arthritis (RA) and periodontal diseases (PD). Both disorders are characterized as multifactorial diseases potentially sharing common risk factors. Based on the inflammatory nature of RA and PD, the impact of genetic variations of genes of the immune system on both diseases was studied in this study. Materials and Methods We conducted a case-control study (n = 201) comparing 101 RA patients suffering from periodontal disease of different severities (no/mild PD vs. severe PD) with 100 systemically healthy controls without RA and severe PD. The genotype, allele, and haplotype distributions of 22 SNPs of 13 pro- and anti-inflammatory cytokines were assessed applying sequence-specific PCR. Results Evaluating the impact of cytokine SNPs in RA, we identified the G allele of rs1801275 in IL4Rα (p = 0.043) and the G allele of rs361525 in TNFα (p = 0.005) as disease-associated risk factors in bivariate analyses. In multivariate analyses, these significant associations could not be proven. The A allele of rs2430561 in IFNγ was indicative for severe periodontitis among the patients with rheumatoid arthritis (p = 0.039). Investigating the impact of rs2430561 in IFNγ on comorbidity using binary logistic regression analyses, the A allele was confirmed as an independent risk factor for severe periodontal disease and RA (p = 0.024). Conclusions These results emphasize the association of genetic variations in proinflammatory cytokines (TNFα and IFNγ) and cytokine receptor (IL4Rα) and RA and periodontal diseases. In multivariate analyses, the A allele of IFNγ was proven to be a significant marker of RA and PD comorbidities. The study broadens the knowledge about disease-specific differences in genetic composition and provides an improved understanding of a possible association of both diseases.
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Cordero OJ, Varela-Calviño R. Oral hygiene might prevent cancer. Heliyon 2018; 4:e00879. [PMID: 30417145 PMCID: PMC6218413 DOI: 10.1016/j.heliyon.2018.e00879] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/26/2018] [Accepted: 10/19/2018] [Indexed: 12/21/2022] Open
Abstract
Many evidences support that species from the Human Oral Microbiome Database such as Fusobacterium nucleatum or Bacteroides, linked previously to periodontitis and appendicitis, play a role in colorectal cancer (CRC), including metastasis. These typically oral species are invasive anaerobes that form biofilms in their virulent state. Aspirin (a NSAID) has been recently included into routine CRC prevention rationale. NSAIDs can prevent the growth of neoplastic lesions by inhibiting COX enzymes and another set of recently identified COX-independent targets, which include the WNT, AMPK and MTOR signaling pathways, the crosstalk between nucleoli and NF-κB transcriptional activity in apoptosis, and the biochemistry of platelets. These are signaling pathways related to tumor-promoting inflammation. In this process, pathogens or simple deregulation of the microbiota play an important role in CRC. Aspirin and other NSAIDs are efficient inhibitors of biofilm formation and able to control periodontitis development preventing inflammation related to the microbiota of the gingival tissue, so its seems plausible to include this pathway in the mechanisms that aspirin uses to prevent CRC. We propose arguments suggesting that current oral hygiene methods and other future developments against periodontitis might prevent CRC and probably other cancers, alone or in combination with other options; and that the multidisciplinary studies needed to prove this hypothesis might be relevant for cancer prevention.
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Affiliation(s)
- Oscar J. Cordero
- University of Santiago de Compostela, Department of Biochemistry and Molecular Biology, Campus Vida, 15782 Santiago de Compostela, Spain
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