1
|
Sedghi LM, Bacino M, Kapila YL. Periodontal Disease: The Good, The Bad, and The Unknown. Front Cell Infect Microbiol 2021; 11:766944. [PMID: 34950607 PMCID: PMC8688827 DOI: 10.3389/fcimb.2021.766944] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/11/2021] [Indexed: 01/08/2023] Open
Abstract
Periodontal disease is classically characterized by progressive destruction of the soft and hard tissues of the periodontal complex, mediated by an interplay between dysbiotic microbial communities and aberrant immune responses within gingival and periodontal tissues. Putative periodontal pathogens are enriched as the resident oral microbiota becomes dysbiotic and inflammatory responses evoke tissue destruction, thus inducing an unremitting positive feedback loop of proteolysis, inflammation, and enrichment for periodontal pathogens. Keystone microbial pathogens and sustained gingival inflammation are critical to periodontal disease progression. However, recent studies have revealed the importance of previously unidentified microbes involved in disease progression, including various viruses, phages and bacterial species. Moreover, newly identified immunological and genetic mechanisms, as well as environmental host factors, including diet and lifestyle, have been discerned in recent years as further contributory factors in periodontitis. These factors have collectively expanded the established narrative of periodontal disease progression. In line with this, new ideologies related to maintaining periodontal health and treating existing disease have been explored, such as the application of oral probiotics, to limit and attenuate disease progression. The role of systemic host pathologies, such as autoimmune disorders and diabetes, in periodontal disease pathogenesis has been well noted. Recent studies have additionally identified the reciprocated importance of periodontal disease in potentiating systemic disease states at distal sites, such as in Alzheimer's disease, inflammatory bowel diseases, and oral cancer, further highlighting the importance of the oral cavity in systemic health. Here we review long-standing knowledge of periodontal disease progression while integrating novel research concepts that have broadened our understanding of periodontal health and disease. Further, we delve into innovative hypotheses that may evolve to address significant gaps in the foundational knowledge of periodontal disease.
Collapse
Affiliation(s)
- Lea M. Sedghi
- School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Margot Bacino
- School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Yvonne Lorraine Kapila
- School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
- Department of Periodontology, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
2
|
Sojod B, Pidorodeski Nagano C, Garcia Lopez GM, Zalcberg A, Dridi SM, Anagnostou F. Systemic Lupus Erythematosus and Periodontal Disease: A Complex Clinical and Biological Interplay. J Clin Med 2021; 10:jcm10091957. [PMID: 34063235 PMCID: PMC8125164 DOI: 10.3390/jcm10091957] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/12/2022] Open
Abstract
Reports on the association of periodontal disease (PD) with systemic lupus erythematosus (SLE) have regularly been published. PD is a set of chronic inflammatory conditions linked to a dysbiotic microbial biofilm, which affects the periodontal tissues, resulting eventually in their destruction and contributing to systemic inflammation. SLE is a multi-system chronic inflammatory autoimmune disease that has a wide range of clinical presentations, touching multiple organ systems. Many epidemiological studies have investigated the two-way relationship between PD and SLE, though their results are heterogeneous. SLE and PD are multifactorial conditions and many biological-based hypotheses suggest common physiopathological pathways between the two diseases, including genetics, microbiology, immunity, and environmental common risk factors. By focusing on recent clinical and translational research, this review aimed to discuss and give an overview of the relationship of SLE with PD, as well as looking at the similarities in the immune-pathological aspects and the possible mechanisms connecting the development and progression of both diseases.
Collapse
Affiliation(s)
- Bouchra Sojod
- Service d’Odontologie, Hôpital Universitaire Pitié Salpêtrière (AP-HP), 75013 Paris, France; (B.S.); (G.M.G.L.); (A.Z.)
- Faculté de Chirurgie Dentaire-Garancière, Université de Paris, 75006 Paris, France
| | | | - Glenda Melissa Garcia Lopez
- Service d’Odontologie, Hôpital Universitaire Pitié Salpêtrière (AP-HP), 75013 Paris, France; (B.S.); (G.M.G.L.); (A.Z.)
- Faculté de Chirurgie Dentaire-Garancière, Université de Paris, 75006 Paris, France
| | - Antoine Zalcberg
- Service d’Odontologie, Hôpital Universitaire Pitié Salpêtrière (AP-HP), 75013 Paris, France; (B.S.); (G.M.G.L.); (A.Z.)
- Faculté de Chirurgie Dentaire-Garancière, Université de Paris, 75006 Paris, France
| | | | - Fani Anagnostou
- Service d’Odontologie, Hôpital Universitaire Pitié Salpêtrière (AP-HP), 75013 Paris, France; (B.S.); (G.M.G.L.); (A.Z.)
- Faculté de Chirurgie Dentaire-Garancière, Université de Paris, 75006 Paris, France
- B3OA, CNRS UMR 7052-INSERM U1271, Université de Paris, 75010 Paris, France;
- Correspondence:
| |
Collapse
|
3
|
Oral Manifestations of Systemic Lupus Erythematosus Patients in Qatar: A Pilot Study. Int J Rheumatol 2018; 2018:6052326. [PMID: 29849650 PMCID: PMC5914093 DOI: 10.1155/2018/6052326] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/11/2018] [Accepted: 03/11/2018] [Indexed: 12/16/2022] Open
Abstract
Objective The purpose of this pilot study was to assess the prevalence of oral manifestations among systemic lupus erythematosus (SLE) patients in Qatar, in order to warrant future studies that would investigate each one of these manifestations with detail and further scrutiny. Methods Study procedures took place between November 2014 and April 2016. All patients visiting the outpatient rheumatology clinics at Hamad General Hospital, Doha, Qatar, were asked to join. The American College of Rheumatology (ACR) 1997 criteria of SLE were used. The patients were examined initially by a rheumatologist and were later scheduled for an appointment with a dentist at the same institution. A total of 77 patients were recruited for the study. Results Prevalence rates for the different oral manifestations ranged from 2.4% for soft palate ulcers, cheilitis, and oral candida to 88.1% for the presence of cavitation. Gingivitis, periodontal disease, cavities, and missing teeth were observed in more than 50% of the sample. The prevalence of periodontal disease and missing teeth was higher among those with an SLE duration > 8 years. On the contrary, the prevalence of gingivitis and cavities was higher among those with an SLE duration ≤ 8 years. Conclusion This study found high rates of gingivitis, periodontal disease, cavities, and missing teeth among SLE patients in Qatar. It is recommended that healthcare providers of such patients monitor the presence of any oral manifestations in order to arrange for early treatment and prevention efforts. Future prospective longitudinal studies with adequate sample size and power are needed in order to ascertain any causation factors or common etiology pathways.
Collapse
|
4
|
Zhang Q, Zhang X, Feng G, Fu T, Yin R, Zhang L, Feng X, Li L, Gu Z. Periodontal disease in Chinese patients with systemic lupus erythematosus. Rheumatol Int 2017. [PMID: 28631047 DOI: 10.1007/s00296-017-3759-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Disease of systemic lupus erythematosus (SLE) and periodontal disease (PD) shares the common multiple characteristics. The aims of the present study were to evaluate the prevalence and severity of periodontal disease in Chinese SLE patients and to determine the association between SLE features and periodontal parameters. A cross-sectional study of 108 SLE patients together with 108 age- and sex-matched healthy controls was made. Periodontal status was conducted by two dentists independently. Sociodemographic characteristics, lifestyle factors, medication use, and clinical parameters were also assessed. The periodontal status was significantly worse in SLE patients compared to controls. In univariate logistic regression, SLE had a significant 2.78-fold [95% confidence interval (CI) 1.60-4.82] increase in odds of periodontitis compared to healthy controls. Adjusted for potential risk factors, patients with SLE had 13.98-fold (95% CI 5.10-38.33) increased odds against controls. In multiple linear regression model, the independent variable negatively and significantly associated with gingival index was education (P = 0.005); conversely, disease activity (P < 0.001) and plaque index (P = 0.002) were positively associated; Age was the only variable independently associated with periodontitis of SLE in multivariate logistic regression (OR 1.348; 95% CI: 1.183-1.536, P < 0.001). Chinese SLE patients were likely to suffer from higher odds of PD. These findings confirmed the importance of early interventions in combination with medical therapy. It is necessary for a close collaboration between dentists and clinicians when treating those patients.
Collapse
Affiliation(s)
- Qiuxiang Zhang
- School of Nursing, Nantong University, Nantong, China.,Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China
| | - Xiaoli Zhang
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China
| | - Guijaun Feng
- Department of Stomatology, Affiliated Hospital of Nantong University, Nantong, China
| | - Ting Fu
- School of Nursing, Nantong University, Nantong, China.,Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China
| | - Rulan Yin
- School of Nursing, Nantong University, Nantong, China.,Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China
| | - Lijuan Zhang
- School of Nursing, Nantong University, Nantong, China.,Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China
| | - Xingmei Feng
- Department of Stomatology, Affiliated Hospital of Nantong University, Nantong, China
| | - Liren Li
- School of Nursing, Nantong University, Nantong, China
| | - Zhifeng Gu
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.
| |
Collapse
|
5
|
Calderaro DC, Ferreira GA, Corrêa JD, Mendonça SMS, Silva TA, Costa FO, Lúcio Teixeira A. Is chronic periodontitis premature in systemic lupus erythematosus patients? Clin Rheumatol 2016; 36:713-718. [PMID: 27557901 DOI: 10.1007/s10067-016-3385-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/12/2016] [Accepted: 08/14/2016] [Indexed: 12/15/2022]
Abstract
The aim of this study was to compare the frequency and severity of chronic periodontitis (CP) in systemic lupus erythematosus (SLE) patients with individuals without rheumatic diseases. Seventy-five patients with SLE were compared to 75 individuals without rheumatic diseases (control group) matched for age, educational level, and income. The activity of SLE was assessed with the Systemic Lupus Erythematosus Disease Activity Index 2000. Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for Systemic Lupus Erythematosus evaluated SLE-related damage. Dental evaluation included measuring plaque index and parameters of periodontal disease (probing depth, clinical attachment level, and bleeding on probing). Fifty-one (68 %) SLE patients and 42 (56 %) control individuals had CP (p = 0.13). Periodontal status was similar in both groups. Considering only individuals with CP, SLE patients were younger than controls (40.7 ± 9.8 versus 46.14 ± 12.5 years of age, p = 0.02). CP was not associated with activity or therapeutics in SLE patients. Severity of periodontal parameters was similar in SLE patients and control subjects; however, CP occurred earlier in SLE patients.
Collapse
Affiliation(s)
- Débora Cerqueira Calderaro
- Rheumatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Rua Dona Nancy de Vasconcelos Gomes, 125/401, Sagrada Família, Belo Horizonte, Minas Gerais, CEP: 31030-071, Brazil.
| | - Gilda Aparecida Ferreira
- Department of Locomotor System, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jôice Dias Corrêa
- Cellular Biology Post-graduation Program, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Antônio Lúcio Teixeira
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|