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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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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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Eezammuddeen NN, Vaithilingam RD, Hassan NHM. Influence of periodontitis on levels of autoantibodies in rheumatoid arthritis patients: A systematic review. J Periodontal Res 2023; 58:29-42. [PMID: 36317493 DOI: 10.1111/jre.13065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/16/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Periodontitis (PD) is a dysbiotic disease of tooth-supporting structures that has been associated with various systemic diseases including rheumatoid arthritis (RA). To date, evidence demonstrated increased prevalence of RA among PD patients and postulated PD to have a role in the development of autoantibodies in RA patients. Therefore, a systematic review was conducted to assess the available evidence to ascertain the effect of PD on levels of autoantibodies in the serum, saliva and gingival crevicular fluid (GCF) of RA patients. MATERIAL AND METHODS The systematic review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Relevant literature was searched from PubMed, Web of Science, Scopus and Ebscohost databases from inception until 31 August 2020. The risk of bias in each study was determined based on the Newcastle-Ottawa Scale tool. Results from random-effect meta-analyses were presented as summary estimates of odds ratios (ORs) for seropositivity and standardised mean difference (SMD) of autoantibody levels with 95% confidence intervals. Sensitivity tests and meta-regression were performed to assess the robustness of the results and potential cause of heterogeneity. RESULTS The electronic and manual searches gathered 932 articles. Following screening and full-text assessment, a total of 29 studies were included in the analysis. Twenty-eight published observational studies were included in the quantitative analysis in the form of random-effect meta-analysis which revealed that PD was associated with anti-citrullinated proteins autoantibodies (ACPAs) and Rheumatoid Factor (RF) seropositive RA patients (OR for ACPA seropositivity: 1.82; 95% CI: 1.13-2.93) (OR for RF seropositivity: 1.53; 95% CI: 1.05-2.24). Also, RA patients with PD had increased serum levels of ACPA and RF. However, high heterogeneity among studies' results, partially ascribed to the unstandardised case definition of PD and laboratory testing of autoantibodies. Apart from ACPA and RF in serum, studies which reported on other RA-related autoantibodies, as well as autoantibody levels in saliva and GCF were scarce. CONCLUSION RA patients with PD tend to have greater ACPA and RF levels in their serum when compared with the RA patients without PD supporting the plausible role of PD in the development of systemic autoimmunity in RA patients.
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Affiliation(s)
- Nazurah Nik Eezammuddeen
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia.,Centre for Comprehensive Care, Faculty of Dentistry, Universiti Teknologi MARA, Selangor, Malaysia
| | - Rathna Devi Vaithilingam
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
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Treatment resistance of rheumatoid arthritis relates to infection of periodontal pathogenic bacteria: a case-control cross-sectional study. Sci Rep 2022; 12:12353. [PMID: 35854051 PMCID: PMC9296452 DOI: 10.1038/s41598-022-16279-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022] Open
Abstract
Recent studies have shown that periodontitis is associated with rheumatoid arthritis (RA) and periodontal bacteria, such as Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) are involved in the pathogenesis of RA via citrullinated proteins. Smoking has also been shown to be involved in the pathogenesis of RA; however, the extent of this involvement is still poorly understood. In addition, RA and polymyalgia rheumatica (PMR) are sometimes difficult to differentiate; however, the relationship between PMR and the factors from smoking and periodontal bacteria is unclear. The aim of this study was to clarify the relationship between periodontal pathogenic bacterial infections and smoking in patients with RA or PMR. This case–control study included 142 patients with untreated RA or PMR. This study evaluated the serum antibody titers against periodontal pathogenic bacterial antigens and an anti-citrullinated peptide antibody (ACPA). In patients with RA, the relationship between antibody titers and disease activity of RA and response after 3 months of treatment was also investigated. Additionally, the effects of smoking were evaluated. Although there was no significant difference in serum antibody titer against periodontal pathogenic bacteria between the ACPA-positive RA group and the ACPA-negative PMR group, we found an association between the elevated antibody titer against Pg and the degree of ACPA value, especially between negative group and high-value positive group (≥ 100 U/mL). The antibody titers against Aa and Pg did not differ depending on disease activity score 28 (DAS28) at baseline; however, patients with high antibody titers had poor RA therapeutic response as judged by DAS28 after 3 months. We could not find any association between smoking and any of these parameters. Periodontal pathogenic bacteria, especially Pg, are associated with elevated ACPA levels. Our findings suggest that Pg and Aa infections interfere with the therapeutic response of RA.
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Elsadek MF, Farahat MF. Impact of photodynamic therapy as an adjunct to non-surgical periodontal treatment on clinical and biochemical parameters among patients having mild rheumatoid arthritis with periodontitis. Photodiagnosis Photodyn Ther 2021; 37:102698. [PMID: 34921986 DOI: 10.1016/j.pdpdt.2021.102698] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the efficacy of photodynamic therapy (PDT) as an adjunct to non-surgical periodontal therapy on the clinical periodontal and biochemical parameters among patients with rheumatoid arthritis (RA) having periodontitis. METHODS A total of 50 RA patients with periodontitis were included. The subjects were equally divided into two groups: Group A - scaling and root planning (SRP) + PDT; Group B - SRP only, respectively. Plaque score (PS), bleeding on probing (BOP), and pocket depth (PD) were estimated. The biochemical parameters included the assessment of interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α) and rheumatoid factors (RFs). RESULTS Plaque scores and BOP significantly reduced in both the groups at both 6 and 12 weeks with significant difference between both the groups at 6 weeks follow up (p<0.05). On inter-group comparison, there was a statistically significant reduction seen for BOP in Group A at 12 weeks (p<0.001). PD significantly reduced in both the groups at both time points; however, significant reduction was noted for Group A compared to Group B (p<0.01). IL-6 and TNF-α significantly reduced in both the groups at 6 and 12 weeks follow up. However, the proinflammatory cytokine levels significantly reduced in group A as compared to group B at both 6 and 12 weeks (p<0.05). GCF levels of RF did not show any change in either of the groups at either time point or between the groups (p>0.05). CONCLUSION PDT significantly reduced the proinflammatory burden in terms of periodontal attachment level and bleeding on probing within the periodontal inflammatory pockets in patients having RA.
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Affiliation(s)
- Mohamed Farouk Elsadek
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, P.O.Box 10219, Riyadh 11433, Saudi Arabia.
| | - Mohamed Fawzi Farahat
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, P.O.Box 10219, Riyadh 11433, Saudi Arabia.
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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: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 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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Botero JE, Posada-López A, Mejía-Vallejo J, Pineda-Tamayo RA, Bedoya-Giraldo E. Effects of nonsurgical periodontal therapy in patients with rheumatoid arthritis: a prospective before and after study. Colomb Med (Cali) 2021; 52:e2095051. [PMID: 35431355 PMCID: PMC8973312 DOI: 10.25100/cm.v52i3.5051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/09/2021] [Accepted: 09/14/2021] [Indexed: 11/11/2022] Open
Abstract
Background periodontal therapy has been suggested to have systemic effects. However, studies of periodontal therapy in rheumatoid arthritis patients have produced controversial results. Aim To compare the effects of nonsurgical periodontal therapy on biochemical markers of rheumatoid arthritis and periodontal parameters in patients with and without rheumatoid arthritis. Methods a prospective before-and-after study was conducted that included 21 participants without and 29 participants with rheumatoid arthritis. Periodontal parameters, Porphyromonas gingivalis detection, C-reactive protein, rheumatoid factor and anti-citrullinated protein antibodies were measured at baseline and three months after nonsurgical periodontal therapy and the changes were statistically assessed. Results In general, both groups presented statistically significant improvement in periodontal parameters (p<0.05). There was an increase in the counts of P. gingivalis in both groups at three months. In addition, there was a reduction in levels of anti-citrullinated protein antibodies and rheumatoid factor in participants with rheumatoid arthritis. In contrast, C-reactive protein levels increased in both groups but were higher in the rheumatoid arthritis group. Periodontal parameters in rheumatoid arthritis participants under disease-modifying antirheumatic drugs presented a slightly higher improvement (p <0.05). Conclusions Nonsurgical periodontal therapy has similar improvements in periodontal parameters in patients with and without rheumatoid arthritis. In addition, nonsurgical periodontal therapy may benefit serum levels of anti-citrullinated protein antibodies and rheumatoid factors in patients with rheumatoid arthritis. NCT04658615.
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Exploring the Role of Interleukin-6 Receptor Inhibitor Tocilizumab in Patients with Active Rheumatoid Arthritis and Periodontal Disease. J Clin Med 2021; 10:jcm10040878. [PMID: 33672771 PMCID: PMC7924637 DOI: 10.3390/jcm10040878] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of our study was to explore the influence of weekly subcutaneous administration of interleukin-6 (IL-6) receptor inhibitor tocilizumab (TCZ) on periodontal status in a local longitudinal study of patients with rheumatoid arthritis (RA) and periodontal disease (PD). METHODS We performed a 6-month prospective study in 51 patients with chronic periodontitis and moderate-to-severe RA starting TCZ in accordance with local recommendations. Extensive rheumatologic (clinical activity, inflammatory, serological biomarkers) and periodontal (visible plaque index, gingival index, bleeding on probing, probing pocket depth, clinical attachment loss) assessments were done. Changes in RA activity and periodontal status were reassessed after 3 and 6 months. RESULTS We demonstrated significant correlations between periodontal status, disease activity, and serologic biomarkers (p < 0.05). Tocilizumab significantly improved the gingival index scores and decreased the number of sites with bleeding on probing after only 3 months (p < 0.05), while the probing pocket depth significantly decreased after 6 months; overall, clinical attachment loss presented only slight changes without any statistical significance as well as teeth count and plaque levels (p > 0.05). CONCLUSION IL-6 inhibition is able to improve periodontal outcomes in patients with RA and concomitant PD, which is essentially related to a dramatic decrease in serum inflammatory mediators.
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Davison E, Johnston W, Piela K, Rosier BT, Paterson M, Mira A, Culshaw S. The Subgingival Plaque Microbiome, Systemic Antibodies Against Bacteria and Citrullinated Proteins Following Periodontal Therapy. Pathogens 2021; 10:193. [PMID: 33578802 PMCID: PMC7916579 DOI: 10.3390/pathogens10020193] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 12/11/2022] Open
Abstract
Periodontitis (PD) shows an association with rheumatoid arthritis (RA) and systemic inflammation. Periodontal pathogens, namely Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, are proposed to be capable of inducing citrullination of peptides in the gingiva, inducing the formation of anti-citrullinated protein antibodies (ACPAs) within susceptible hosts. Here, we sought to investigate whether periodontal treatment influenced systemic inflammation and antibody titres to P. gingivalis, A. actinomycetemcomitans, Prevotella intermedia and ACPA in 42 systemically health patients with periodontal disease. Subgingival plaque and serum samples were collected from study participants before (baseline) and 90 days after treatment to analyse the abundance of specific bacteria and evaluate anti-bacterial antibodies, C-reactive protein (CRP), tumour necrosis factor α (TNF-α), interleukin 6 (IL-6) and ACPA in serum. Following treatment, all patients showed reduced periodontal inflammation. Despite observing a weak positive correlation between CRP and IL-6 with periodontal inflammation at baseline, we observed no significant reductions in any indicators of systemic inflammation 90 days after treatment. In contrast, anti-P. gingivalis IgG significantly reduced post-treatment (p < 0.001, Wilcoxon signed rank test), although no changes were observed for other antibody titres. Patients who had detectable P. gingivalis in subgingival plaques had significantly higher anti-P. gingivalis IgG and ACPA titres, suggesting a potential association between P. gingivalis colonisation and systemic antibody titres.
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Affiliation(s)
- Emily Davison
- Oral Sciences, College of Medical, Veterinary and Life Sciences, Dental School, University of Glasgow, Glasgow G12 8QQ, UK; (E.D.); (W.J.); (K.P.); (M.P.)
| | - William Johnston
- Oral Sciences, College of Medical, Veterinary and Life Sciences, Dental School, University of Glasgow, Glasgow G12 8QQ, UK; (E.D.); (W.J.); (K.P.); (M.P.)
| | - Krystyna Piela
- Oral Sciences, College of Medical, Veterinary and Life Sciences, Dental School, University of Glasgow, Glasgow G12 8QQ, UK; (E.D.); (W.J.); (K.P.); (M.P.)
- Division of Dentistry, Medical University of Lodz, 92-213 Lodz, Poland
| | - Bob T. Rosier
- The Foundation for the Promotion of Health and Biomedical Research (FISABIO), 46020 Valencia, Spain; (B.T.R.); (A.M.)
| | - Michael Paterson
- Oral Sciences, College of Medical, Veterinary and Life Sciences, Dental School, University of Glasgow, Glasgow G12 8QQ, UK; (E.D.); (W.J.); (K.P.); (M.P.)
| | - Alex Mira
- The Foundation for the Promotion of Health and Biomedical Research (FISABIO), 46020 Valencia, Spain; (B.T.R.); (A.M.)
| | - Shauna Culshaw
- Oral Sciences, College of Medical, Veterinary and Life Sciences, Dental School, University of Glasgow, Glasgow G12 8QQ, UK; (E.D.); (W.J.); (K.P.); (M.P.)
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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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Yadav AR, Deshmukh J, Devarathnamma MV, Kardal A, Bhagchandani M, Srivastava R. An assessment of anti-citrullinated protein antibody in systemically healthy individuals with or without chronic periodontitis: A case-control study. J Indian Soc Periodontol 2021; 24:525-529. [PMID: 33424168 PMCID: PMC7781259 DOI: 10.4103/jisp.jisp_141_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Periodontitis has been implicated as a risk factor for rheumatoid arthritis (RA). Aim: This study aimed to assess the relationship between RA and chronic periodontitis (CP) by evaluating the serum levels of the anti citrullinated protein antibody (ACPA) which is a marker of RA in systemically healthy individuals with and without CP. Materials and Methods: This case–control study enrolled 40 systemically healthy individuals. Participants were divided into two groups, i.e., CP group Systemically healthy chronic periodontitis (CPSH) (n = 20) and control group Systemically healthy (SH) (n = 20), matched for age and gender. The CP patients were evaluated for periodontal parameters, namely probing pocket depth, clinical attachment loss, percentage of the site involved with attachment loss, and number of teeth present. A volume of 5 ml of venous blood was collected from both the groups and centrifuged; the separated serum was stored at − 70°C before being analyzed. Later, serum samples were tested for levels of ACPA in both the groups and compared. Results: The mean serum ACPA levels were higher in CPSH patients compared to SH (131.38 RU/ml vs. 34.54 RU/ml, P = 0.001), which was statistically highly significant. In addition, we found a significant elevation of serum ACPA levels in severe generalized CP patients compared to moderate generalized CP patients (175.47 RU/ml vs. 95.31 RU/ml, P = 0.001), and the difference was statistically highly significant. Conclusion: The results of the study confirmed that CP can be a risk factor for RA. Moreover, the severity of periodontitis appeared to be related to elevated serum levels of ACPA.
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Affiliation(s)
- Ankita Rajaram Yadav
- Department of Periodontics, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Jeevanand Deshmukh
- Department of Periodontics, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | | | - Asif Kardal
- Department of Periodontics, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Mitali Bhagchandani
- Department of Periodontics, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Ratika Srivastava
- Department of Periodontics, Rishiraj College of Dental Sciences and Research Center, Bhopal, Madhya Pradesh, India
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Medara N, Lenzo JC, Walsh KA, Reynolds EC, Darby IB, O'Brien-Simpson NM. A review of T helper 17 cell-related cytokines in serum and saliva in periodontitis. Cytokine 2020; 138:155340. [PMID: 33144024 DOI: 10.1016/j.cyto.2020.155340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/21/2020] [Accepted: 10/06/2020] [Indexed: 12/24/2022]
Abstract
Periodontitis is a chronic inflammatory disease with a complex underlying immunopathology. Cytokines, as molecular mediators of inflammation, play a role in all stages of disease progression. T helper 17 (Th17) cells are thought to play a role in periodontitis. Th17 cell development and maintenance requires a pro-inflammatory cytokine milieu, with many of the cytokines implicated in the pathogenesis of periodontitis. Serum and saliva are easily accessible biofluids which can represent the systemic and local environment to promote the development of Th17 cells. Here we review human clinical studies that investigate IL-1β, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, IFN-γ, sCD40L and TNF-α in serum and saliva in periodontitis. We highlight their putative role in the pathogenesis of periodontitis and place them within a wider context of animal and other clinical studies.
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Affiliation(s)
- Nidhi Medara
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia.
| | - Jason C Lenzo
- Centre for Oral Health Research, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia.
| | - Katrina A Walsh
- Department of Surgery, The University of Melbourne, Austin Health, Lance Townsend Building, Level 8, 145 Studley Road, Heidelberg, VIC 3084, Australia.
| | - Eric C Reynolds
- Centre for Oral Health Research, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia.
| | - Ivan B Darby
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia.
| | - Neil M O'Brien-Simpson
- Centre for Oral Health Research, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia.
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Chang YQ, Fang FF, Qin SS, Dong YC, Chen B. [Effect of scaling and root planing on serum C-reactive protein levels in patients with moderate to severe chronic periodontitis: a systematic review and Meta-analysis]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:385-392. [PMID: 32865356 PMCID: PMC7426693 DOI: 10.7518/hxkq.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/18/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effect of scaling and root planing (SRP) on serum C-reactive protein (CRP) levels in patients with moderate to severe chronic periodontitis. METHODS We searched the PubMed, Web of Science, EMBASE, Cochrane, CNKI, Wanfang, and VIP databases from the inception to July 8th, 2019. Two reviewers independently screened literature, extracted data, and evaluated the bias risk of included studies. Then, a meta-analysis was performed using RevMan 5.3 software. RESULTS A total of 13 randomized controlled clinical trials and 12 prospective clinical trials were included. Meta-analysis showed that serum CRP levels decreased at 2 and 3 months after SRP (P<0.05), and no significant difference in serum CRP levels was found at 6 months (P=0.49). CONCLUSIONS SRP can reduce serum CRP levels in systematically healthy patients with moderate to severe chronic periodontitis at 2 and 3 months after SRP.
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Affiliation(s)
- Ya-Qin Chang
- Dept. of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Fang-Fang Fang
- Dept. of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Sha-Sha Qin
- Dept. of Non-Communicable Diseases Prevention and Control, Xi'an Center for Disease Control and Prevention, Xi'an 710054, China
| | - Ying-Chun Dong
- Dept. of Anesthesiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Bin Chen
- Dept. of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
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Ancuța C, Pomîrleanu C, Mihailov C, Chirieac R, Ancuța E, Iordache C, Bran C, Țănculescu O. Efficacy of baricitinib on periodontal inflammation in patients with rheumatoid arthritis. Joint Bone Spine 2020; 87:235-239. [PMID: 31962162 DOI: 10.1016/j.jbspin.2019.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/12/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Despite a widely recognized bidirectional pathobiologic relationship between rheumatoid arthritis (RA) and periodontal disease, the impact of innovative anti-rheumatic drugs in modulating not only inflammatory and immune articular damage, but also periodontal microenvironment remains debatable. We aimed to evaluate the periodontal status in RA with and without baricitinib, a Janus kinase (JAK) inhibitor, and to better describe association between these entities. METHODS We performed a prospective longitudinal 24-weeks study in 21 active RA initiating baricitinib. Standard assessments included a dual rheumatologic (RA activity, disability, serological, inflammatory profile) and dental evaluation comprising plaque index, gingival index, bleeding on probing, probing depth, clinical attachment level. RESULTS More than half of RA presented at baseline with chronic periodontitis, as suggested by high prevalence of sites with dental plaque, abnormal bleeding on probing, probing depth and clinical attachment level. Aggressive periodontal disease was reported particularly in disease subsets with excessive inflammatory (serumC reactive protein level) and serologic biomarkers (anti-citrullinated peptide antibodies). Furthermore, significant correlations between dental pathology, disease activity and ACPA levels were also reported (P<0.05). Consistent improvement was noticed in both rheumatoid arthritis characteristics and periodontal status after 24 weeks of baricitinib (P<0.05). CONCLUSION RA, particularly severe active ACPA-positive disease, is basically associated with altered periodontal health. JAK blockade through oral baricitinib may be efficient in patients with active RA and potentially able to modulate the inflammatory process in the periodontal tissue.
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Affiliation(s)
- Codrina Ancuța
- Rheumatology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania; 2(nd) Rheumatology Department, Clinical Rehabilitation, 700661 Iași, Romania
| | - Cristina Pomîrleanu
- Rheumatology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania; 2(nd) Rheumatology Department, Clinical Rehabilitation, 700661 Iași, Romania
| | - Claudia Mihailov
- Internal Medicine and Rheumatology Department, "Ovidius" University, 900470 Constanța, Romania
| | | | - Eugen Ancuța
- Research Department, "Elena Doamna" Clinical Hospital, 700398 Iasi, Romania
| | - Cristina Iordache
- Implantology, Removable Dentures, Dental Technology Department, Faculty of Dentistry, "Grigore T. Popa" University of Medicine and Pharmacy, 700115, Romania.
| | - Codruța Bran
- Rheumatology Department, "Sfantu Ioan" Clinical Emergency Hospital, 789007 Suceava, Romania
| | - Oana Țănculescu
- Odontology-Periodontology and Fixed Proshodontics Department, Faculty of Dentistry, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
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Buwembo W, Munabi IG, Kaddumukasa M, Kiryowa H, Nankya E, Johnson WE, Okello E, Sewankambo N. Periodontitis and Rheumatoid Arthritis in sub-Saharan Africa, gaps and way forward: a systematic review and meta-analysis. OPEN JOURNAL OF STOMATOLOGY 2019; 9:215-226. [PMID: 31695961 PMCID: PMC6834353 DOI: 10.4236/ojst.2019.910023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND This review identified papers that described periodontitis and rheumatoid arthritis in sub-Saharan Africa. Only English language publications from January 2010 to December 2017 describing original research in sub-Saharan Africa on the association between periodontitis and rheumatoid arthritis were considered for this study. METHODS Published databases: PubMed, Science direct and Google scholar, were searched using terms "periodontitis", "rheumatoid arthritis" and "Sub-Saharan Africa" to generate a set of putative studies. Articles with data on both rheumatoid arthritis and periodontitis compared to controls were selected. Studies on the association of periodontitis with cardiovascular disease, arthritis or rheumatoid arthritis alone were excluded. Data were extracted, critically appraised, and analyzed using a random-effect Mantel-Haenszel meta-analysis on plaque index, gingival index, pocket depth and clinical attachment loss. RESULTS Three publications were selected for the systematic review and 2 for the meta-analysis. Two studies were from Sudan, and one was from Burina Faso. There was a significant increase in pocket depth (mean difference: 0.31; 95% CI: 0.21, 0.41; N= 274; (p ≤ 0.001) and clinical attachment loss (mean difference: 0.47; 95% CI: 0.22, 0.75; N= 274; (p ≤ 0.001) in participants with rheumatoid arthritis compared to normal controls. CONCLUSION Findings from these combined studies show a significant relationship between periodontal disease and rheumatoid arthritis with increased periodontal pocket depth and clinical attachment loss. They also highlight the need for additional work especially in the area of associating rheumatoid arthritis with P. gingivalis, the oral microbiome and treating periodontal diseases to help in the management of rheumatoid arthritis.
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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
| | - 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 Sewankambo
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala Uganda
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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: 110] [Impact Index Per Article: 22.0] [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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Wang H, Feng C, Wang M, Yang S, Wei F. Circular RNAs: Diversity of Functions and a Regulatory Nova in Oral Medicine: A Pilot Review. Cell Transplant 2019; 28:819-830. [PMID: 30945569 PMCID: PMC6719493 DOI: 10.1177/0963689719837917] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Oral diseases, such as cancers, inflammation, loss of bone/tooth/soft tissues, are serious threats to human health since some can cause systemic disease and effective treatments are limited. Thus, discovering promising biomarkers for physiological and pathological processes in oral medicine, and identifying novel targets for therapy have become a most critical issue. Recently, circular RNAs (circRNAs), which were once thought to be a class of non-coding RNAs (ncRNAs), are found to be of coding potential. CircRNAs are highly present in the cytoplasm of eukaryotic cells and are key elements in the physiological and biological processes of various pathological conditions, and are also reflected in oral development and progress. Previous studies have indicated that circRNAs are involved in the initiation and development of different types of diseases and tissues (e.g., cancers, cardiovascular diseases, neural development, growth and development, wood healing, liver regeneration). Moreover, growing evidence demonstrates that circRNAs play vital roles in oral cancers and osteogenic differentiation of periodontal ligament stem cells (PDLSCs). Here, we focus on the biological characteristics of circRNAs, beginning with an overview of previous studies on the functional roles of circRNAs as diagnostic biomarkers and therapeutic targets in oral medicine. We hope this will give us a promising new comprehension of the underlying mechanisms occurring during related biological and pathological progress, and contribute to the development of effective diagnostic biomarkers and therapeutic targets for oral diseases.
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Affiliation(s)
- Hong Wang
- 1 Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, People's Republic of China.,2 Department of Orthodontics, School of Stomatology, Shandong University, Jinan, People's Republic of China.,* Both authors contributed equally
| | - Cheng Feng
- 3 Jinan Hospital of Traditional Chinese Medicine, Jinan, People's Republic of China.,* Both authors contributed equally
| | - Meng Wang
- 1 Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, People's Republic of China.,2 Department of Orthodontics, School of Stomatology, Shandong University, Jinan, People's Republic of China
| | - Shuangyan Yang
- 1 Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, People's Republic of China.,2 Department of Orthodontics, School of Stomatology, Shandong University, Jinan, People's Republic of China
| | - Fulan Wei
- 1 Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, People's Republic of China.,2 Department of Orthodontics, School of Stomatology, Shandong University, Jinan, People's Republic of China
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Kao JH. Highlights. J Formos Med Assoc 2018. [DOI: 10.1016/j.jfma.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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