Clinical course of chronic periodontitis

Salivary and serum inflammatory biomarkers during periodontitis progression and after treatment

AIM

To identify serum- and salivary-derived inflammatory biomarkers of periodontitis progression and determine their response to non-surgical treatment.

MATERIALS AND METHODS

Periodontally healthy (H; n = 113) and periodontitis patients (P; n = 302) were monitored bi-monthly for 1 year without therapy. Periodontitis patients were re-examined 6 months after non-surgical periodontal therapy (NSPT). Participants were classified according to disease progression: P0 (no sites progressed; P1: 1-2 sites progressed; P2: 3 or more sites progressed). Ten salivary and five serum biomarkers were measured using Luminex. Log-transformed levels were compared over time according to baseline diagnosis, progression trajectory and after NSPT. Significant differences were sought using linear mixed models.

RESULTS

P2 presented higher levels (p < .05) of salivary IFNγ, IL-6, VEGF, IL-1β, MMP-8, IL-10 and OPG over time. Serum analytes were not associated with progression. NSPT led to clinical improvement and significant reduction of IFNγ, IL-6, IL-8, IL-1β, MMP-8, IL-10, OPG and MMP-9 in saliva and of CRP, MMP-8, MMP-9 and MPO in serum.

CONCLUSIONS

Periodontitis progression results from a sustained pro-inflammatory milieu that is reflected in salivary biomarkers, but less so in serum, likely because of the limited amount of progression per patient. NSPT can significantly decrease the levels of several salivary analytes.

Snus Use in Adolescents: A Threat to Oral Health

Background: Snus consumption is increasingly popular, mainly among the youth, due to the promotion of the tobacco industry and the lack of knowledge regarding its adverse effects. Even though some of its systemic complications are common knowledge, the oral consequences are rarely known. Aim: Therefore, the objective of this study is to evaluate the oral health effects of snus consumption among a highly exposed group of adolescent athletes. Design: Participants received an interactive presentation, followed by interviews and dental screenings by young doctors to establish trust. They were categorized into groups based on the frequency of snus usage. The oral hygiene habits and status, snus consumption habits, and awareness about its adverse effects were evaluated. Results: Statistically significantly (p < 0.05), more regular snus users experience gum bleeding while tooth brushing than nonusers (60% and 37%, p = 0.004). Snus consumption and poor oral hygiene have a cumulative effect on oral health. Some young athletes experience ulcerous oral mucosal lesions coinciding with snus placement. Nonusers exhibit greater awareness of the adverse effects of snus than regular users (27% and 49%). Conclusions: Regular snus use negatively affects oral health, especially the gums. Early education is of the utmost importance in preventing snus usage by raising awareness.

Relationship between 1-, 3-, and 6-Month Gingival Bleeding Outcomes

INTRODUCTION

Results from systematic reviews and meta-analyses show generally consistent antigingivitis effects between 3- and 6-mo observation time points with twice-daily use of stannous fluoride (SnF2) dentifrice. However, the relationship between 1-, 3-, and 6-mo gingivitis responses has not been investigated.

METHODS

This pooled analysis was conducted to understand the relationship of 1-, 3-, and 6-mo gingival bleeding outcomes. Number of bleeding sites, derived from Löe-Silness Gingival Index (LSGI) or Gingival Bleeding Index, was identified as the primary end point of the analysis for the biological and clinical relevance. Randomized, double-blinded, controlled clinical studies meeting the following predefined selection criteria were identified: 1) published and unpublished gingivitis clinical trials conducted from 1995 to 2022 comparing efficacy of 0.454% SnF2 dentifrices to negative controls (sodium fluoride or sodium monofluorophosphate dentifrice) and 2) studies with a 3-mo assessment and at least a 1- or 6-mo assessment.

RESULTS

The search resulted in ten 6-mo and fourteen 3-mo studies meeting selection criteria. A mixed-effects model was performed on the pooled data to assess gingival bleeding outcomes across time. The bleeding efficacy significantly increased between months 1 and 3 (P < 0.0001) and plateaued between months 3 and 6 (P = 0.007), supporting the fact that bleeding reduction relative to control established by 1 mo will increase and be maintained through 3 and 6 mo (R2 = 0.857). In addition, gingival bleeding and gingivitis efficacy, as measured by LSGI, were found to be highly correlated (R2 = 0.874).

CONCLUSION

A clear relationship has been demonstrated between 1-, 3-, and 6-mo gingival bleeding outcomes in gingivitis clinical studies comparing SnF2 dentifrice to negative control dentifrice. These findings have important implications to the dental practice and scientific research as antigingivitis efficacy evaluations can be observed as early as 1 mo and are consistent with those seen at 3 or 6 mo.

KNOWLEDGE TRANSFER STATEMENT

Outcomes from this investigation indicate that the clinical evaluation of antigingivitis efficacy at 1 mo is predictive of that at 3 and 6 mo, supporting studies of 1-mo duration as a viable method of knowledge acquisition. This more efficient, expedited research design has positive implications for patient care, clinical practice guidelines, protocols, and policies.

Cost-effectiveness and cost-utility analyses of three different gargles in the treatment of chronic periodontitis

OBJECTIVE

This study aimed to investigate the economics of three different gargles in the treatment of chronic periodontitis.

METHODS

A total of 108 patients with periodontitis received one of the following three gargles: xipayi, compound chlorhexidine, or Kangfuxin gargle. The basic information of the patients, the costs of the gargles, the periodontal indexes before and after treatment, and the scores of the 3-level version of the EuroQol Five Dimensions Questionnaire were collected. The cost-effectiveness and cost-utility of the various gargles were determined.

RESULTS

The cost-effectiveness ratios (CER) of the three groups after treatment were 1828.75, 1573.34, and 1876.92 RMB, respectively. The utility values before treatment were 0.92, 0.90, and 0.91, respectively, and the utility values after treatment were 0.98, 0.98, and 0.97, respectively. The cost-utility ratios (CURs) were 213.43, 195.61, and 301.53 RMB, respectively.

CONCLUSIONS

For each increase in effective rate and quality-adjusted life years, the treatment cost of periodontitis patients was lower than the gross domestic product per capita of Jiangsu Province, indicating that the treatment cost is completely worth it. The CER and CUR results were the same, and the compound chlorhexidine group was the lowest, demonstrating that when the same therapeutic effect was achieved, it cost the least.

Recent advances in nanomaterial-based biosensor for periodontitis detection

Periodontitis, a chronic inflammatory condition caused by bacteria, often causes gradual destruction of the components that support teeth, such as the alveolar bone, cementum, periodontal ligament, and gingiva. This ultimately results in teeth becoming loose and eventually falling out. Timely identification has a crucial role in preventing and controlling its progression. Clinical measures are used to diagnose periodontitis. However, now, there is a hunt for alternative diagnostic and monitoring methods due to the progress of technology. Various biomarkers have been assessed using multiple bodily fluids as sample sources. Furthermore, conventional periodontal categorization factors do not provide significant insights into the present disease activity, severity and amount of tissue damage, future development, and responsiveness to treatment. In recent times, there has been a growing utilization of nanoparticle (NP)-based detection strategies to create quick and efficient detection assays. Every single one of these platforms leverages the distinct characteristics of NPs to identify periodontitis. Plasmonic NPs include metal NPs, quantum dots (QDs), carbon base NPs, and nanozymes, exceptionally potent light absorbers and scatterers. These find application in labeling, surface-enhanced spectroscopy, and color-changing sensors. Fluorescent NPs function as photostable and sensitive instruments capable of labeling various biological targets. This article presents a comprehensive summary of the latest developments in the effective utilization of various NPs to detect periodontitis.

Shotgun metagenomic analysis of the oral microbiome in gingivitis: a nested case-control study

Background

Gingivitis, i.e. inflammation of the gums, is often induced by dentalplaque. However, its exact link to the oral microbiota remains unclear.

Methods

In a case-control study involving 120 participants, comprising 60 cases and 60 controls (mean age (SD) 36.6 (7.6) years; 50% males), nested within a prospective multicentre cohort study, we examined theoral microbiome composition of gingivitis patients and their controlsusing shotgun metagenomic sequencing of saliva samples. Participants underwent clinical and radiographic oral health examinations, including bleeding on probing (BOP), at six tooth sites. BOP ≥33%was considered 'generalized gingivitis/initial periodontitis'(GG/IP), and BOP <33% as 'healthy and localized gingivitis'(H/LG). Functional potential was inferred using HUMANn3.

Results

GG/IP exhibited an increase in the abundance of Actinomyces, Porphyromonas, Aggregatibacter, Corynebacterium, Olsenella, and Treponema, whereas H/LG exhibited an increased abundance of Candidatus Nanosynbacter. Nineteen bacterial species and fourmicrobial functional profiles, including L-methionine, glycogen, andinosine-5'-phosphate biosynthesis, were associated with GG/IP. Constructing models with multiple markers resulted in a strong predictive value for GG/IP, with an area under the curve (ROC) of 0.907 (95% CI: 0.848-0.966).

Conclusion

We observed distinct differences in the oral microbiome between the GG/IP and H/LG groups, indicating similar yet unique microbial profiles and emphasizing their potential role in progression of periodontal diseases.

Natural history of periodontal disease: The original Sri Lanka and Oslo studies

Susceptibility to periodontal disease depends on individual factors within the host response to the bacterial challenge. The study of these factors requires longitudinal studies of an undisturbed development of the disease process. On the basis of the original longitudinal studies on the natural histology of periodontal disease staged in Sri Lanka and Oslo/Norway, several analyses of periodontal parameters and tooth status have been performed. The main findings were that in the first 20 years of complete absence of oral hygiene practices or preventive services attachment was lost at various rates. Three groups of subjects could be identified: rapidly progressing (RP) (8%), moderately progressing (MP) (81%), and subjects with no disease progression (NP) (11%). In the second two decades, the RP subjects have lost most of their teeth and no NP patients were identified anymore. The progression rate in these two decades was much slower, and the tooth mortality decreased. It could be predicted that subjects who had lost more than 2 mm at age 30 would not maintain a functional dentition at age 60. The corresponding control population in Oslo was used to study the influence of gingival inflammation on the initiation and progression of periodontal disease. The pattern and rates of attachment loss were identified in a population that was exposed to optimal and regular preventive services from age 3 onward. In the observation period of 26 years, it could be demonstrated that gingival inflammation varied little throughout adult life and always bleeding sites occurred consistently in 10% to 20%. The role of ongoing gingivitis in the pathogenesis of attachment loss was identified and also reflected stability whenever it was absent. Tooth mortality was only found in subjects with ongoing gingivitis. After 50 years of tooth age, 63% of the teeth were still maintained, while 99.8% were maintained after 50 years when gingival inflammation had been absent. Consequently, continuous gingivitis represented a risk factor for tooth loss.

Clinical parameters and inflammatory biomarkers among patients with multibracket appliances: a prospective clinical trial

BACKGROUND

Aim of the presented study was to investigate changes in clinical parameters and active matrix metalloproteinase-8 (aMMP-8) levels in gingival crevicular fluid of patients before and during treatment with multibrackets appliances.

METHODS

Fifty-five adolescents scheduled for the treatment were included. Clinical parameters and subgingival samples were obtained at six time points: 1 week before appliance insertion (T0), 3 (T1), 6 (T2) weeks, 3 (T3), 6 (T4) months, and 1 year (T5) after that. Gingival index and plaque index were assessed to evaluated changes on the clinical status. Subgingival samples were collected to analyze changes in aMMP-8.

RESULTS

Scores for gingival and plaque index increased after bracket insertion. The gingival index increased from T2 (p < 0.05) until T5 (p < 0.0001). Plaque index also increased, reaching its maximum peak at T3 (p < 0.05). Moreover, an increase of aMMP-8 levels (p < 0.05) was noted. There was no significant between upper and lower jaws.

CONCLUSIONS

Treatment with multibracket appliances in adolescents favors dental plaque accumulation and may transitionally increase gingival and plaque index and aMMP-8 levels leading to gingival inflammation, even 1 year after therapy began.

TRIAL REGISTRATION

This study was approved by the Ethics Committee of the dental medical association Rheiland-Pfalz, Germany (process no. 837.340.12 (8441-F)), and followed the guidelines of Good Clinical Practices.

The increasing importance of the oral microbiome in periodontal health and disease

Herein, the aim is to discuss the current knowledge of microbiome and periodontal diseases. Current treatment strategies include mechanical therapy such as root planing, scaling, deep pocket debridement and antimicrobial chemotherapy as an adjuvant therapy. Among promising therapeutic strategies, dental probiotics and oral microbiome transplantation have gained attention, and may be used to treat bacterial imbalances by competing with pathogenic bacteria for nutrients and adhesion surfaces, as well as probiotics targeting the gut microbiome. Development of strategies to prevent and treat periodontal diseases are warranted as both are highly prevalent and can affect human health. Further studies are necessary to better comprehend the microbiome in order to develop innovative preventative measures as well as efficacious therapies against periodontal diseases.

The Development and Evaluation of Melatonin-Loaded, Calcium Oxide Nanoparticle-Based Neem and Clove Extract: An In Vitro Study

Background Various local drug delivery systems have been tried so far to target microorganisms responsible for periodontitis. However, none of them were effective enough to destroy the periodontal pathogens. This study aimed to analyze the antimicrobial, antioxidant, and anti-inflammatory properties of melatonin-loaded, calcium oxide nanoparticles-based neem and clove extract against oral pathogens to be further used as a local delivery agent. Methodology Powdered fresh neem leaves and clove buds were weighed, added to double distilled water, and then boiled for half an hour. Boiling helps in activating the phytochemicals present in the extract. The solution was boiled further to obtain a concentrated solution. To this 0.241 g of melatonin powder dissolved in 10 mL of double distilled water was added to the previous mixture and left undisturbed in a stirrer overnight. Results The properties of the extract such as antioxidant, antibacterial, anti-inflammatory, cytotoxicity, and embryonic toxicology were studied. In the case of antimicrobial activity, at 100 μg/mL, the zone of inhibition (ZOI) was the highest at 18 ± 0.16 μg/mL and the lowest at 13 ± 0.3 at 25 μg/mL for Candida albicans. Similarly, at 100 μg/mL, the ZOI was the highest at 15 ± 0.25 μg/mL and the lowest was 13 ± 0.12 at 25 μg/mL for Streptococcus mutans and Staphylococcus aureus. Similarly, in the case of antioxidant and anti-inflammatory properties, they showed increased activity with increased concentrations of 10, 20, 30, 40, and 50 μg/mL. Conclusions This study proves that melatonin-added extracts have antimicrobial, antioxidant, anti-inflammatory, and cytotoxic properties which are almost equal to that of the standard. This indicates that they can be possibly further used as local delivery drugs. Further animal or cell line studies should be conducted before experimenting this is in clinical trials for periodontitis patients.

Dyslipidemia, diabetes and periodontal disease, a cross-sectional study in Rafsanjan, a region in southeast Iran

THE OBJECTIVES

The association between dyslipidemia, diabetes and alterations in periodontal health are inconsistent. The aim of this study was to determine the association between dyslipidemia, diabetes and periodontal disease in the Oral Health Branch of Rafsanjan Cohort Study (OHBRCS).

METHODS

Rafsanjan Cohort Study (RCS) was launched in 2015 in Rafsanjan City a region in the southeast of Iran. A total of 8682 participants aged 35-70 years of both gender were recruited into the OHBRCS as a part of RCS. Bleeding on probing (BOP), probing pocket depth (PPD) and Clinical attachment loss (CAL) were used to assess periodontal health status. When CAL progression was ≥ 1 mm and PPD was > 3 mm, it was defined as periodontitis.

RESULTS

The final sample consisted of 6751 individuals with mean age of 47.67 ± 8.79 years. Among this population, 73.32% (n = 4949), 13.75% (n = 928), 59.67% (n = 4028) and 11.76% (n = 794) had BOP, PPD > 3 mm, CAL ≥ 1 mm and periodontitis respectively. The odds of CAL ≥ 1 mm increased 14% in subjects with high LDL cholesterol (OR: 1.14; 95% CI: 1.01-1.30), 17% in subjects with diabetes (OR: 1.17; 95% CI: 1.01-1.36) and 23% in subjects with both dyslipidemia and diabetes (OR: 1.23; 95% CI: 1.05-1.44). Also, the odds of PPD > 3 mm in the group with high total cholesterol (TC) was 16% higher compared to those with normal TC (OR: 1.16; 95% CI: 1.01-1.34).

CONCLUSIONS

There was an increased odds in periodontal disease in association with high TC, high LDL cholesterol, diabetes and having both dyslipidemia and diabetes. This suggests that high TC, high LDL cholesterol, diabetes and having both dyslipidemia and diabetes might be potential indicators for the presence of periodontal disease.

Modifiable risk factors for the development and progression of periodontal tissue diseases

In this review, an analysis of modifiable risk factors for the development and progression of periodontal tissue diseases was carried out. The review highlights the data on the relationship of periodontal infection, tobacco smoking, diabetes mellitus, cardiovascular disease, drug-induced periodontal tissue damage, stress, and obesity with the risk of developing and progression of periodontal tissue diseases. A rather detailed analysis of the mechanisms of pathogenic influence of the microflora of the oral cavity, including in the subgingival plaque, was carried out. The mechanisms of the pathological effect of smoking on the state of periodontal tissues are described. Data on the effect of periodontal treatment on glycemic control in patients with diabetes mellitus are presented. The article emphasizes the importance of the presence of periodontal diseases as a risk factor for cardiovascular and cerebrovascular diseases, describes the mechanisms of the mutual influence of cardiovascular pathology and the inflammatory process in the periodontium. In addition, the article presents the possibilities of the iatrogenic effect of systemic drugs on the state of periodontal tissues. The data on the influence of stress loads on the development of dental diseases are presented. The review article describes in detail the mechanisms of influence of overweight and obesity on the risks of development and progression of periodontal tissue diseases. Based on the results of the scientific research publications presented in the article, it can be stated that not only the dentist, but also doctors of other specialties need to work to change the modifiable risk factors for the development and progression of periodontal diseases.

The Significance of Oral Inflammation in Elite Sports: A Narrative Review

Recently, there has been intense discussion about sports dentistry and potential interactions between oral health and athletes' performance. This narrative review aims to provide a comprehensive overview of the available literature about oral inflammation in sports. For this purpose, it presents the most common types of oral inflammation (gingivitis, periodontitis, pericoronitis, apical periodontitis), and their prevalence in athletes. Both the impact of oral inflammation on performance and causes for oral inflammation in athletes are discussed by presenting current literature. Finally, international recommendations for dental care in sports are presented. Several studies stated a high prevalence of oral inflammation in athletes, especially of gingivitis (58-97%) and periodontitis (41%). Also, many athletes report oral pain (17-30%) and a negative impact of oral health on training (3-9%). Besides this, a systemic impact of oral inflammation is discussed: In periodontitis patients, blood parameters and physical fitness are changed. In athletes, associations between muscle injuries and poor oral health are reported. There are deficits in oral health behavior. Furthermore, systemic changes due to physical stress could influence oral tissues. Overall, complex bidirectional interactions between competitive sports and oral inflammation are possible. Regular dental examinations and prevention strategies should be implemented in sports.

Clinical Effectiveness of Herbal Oral Care Products in Periodontitis Patients: A Systematic Review

BACKGROUND

The use of herbal products in oral cavity has shown an increased popularity and potential benefits due to their additional anti-inflammatory and antioxidant properties as well as the lack of side effects related to their use.

OBJECTIVE

To assess the clinical effectiveness of herbal dental products (mouthwash, dentifrice, gel) when compared to conventional products or placebo in periodontitis patients.

MATERIAL AND METHODS

A systematic review with 22 studies was carried out using MEDLINE/Pubmed, EMBASE and Web of Science databases in addition to hand searches. Randomized and non-randomized clinical trials that evaluated the effect of any herbal dental product and compared it with conventional products or placebo in periodontitis patients and published up to March 2022, were screened.

RESULTS

Herbal products used as adjuncts to scaling and root planing (SRP) or supragingival debridement (SPD) led to superior clinical outcomes than placebo or no adjuncts (8 studies). In conjunction with SRP, these products showed comparable outcomes with chlorhexidine (6 studies) or better (4 studies). When used as adjuncts to SPD, herbal oral care products demonstrated comparable outcomes with chlorhexidine and conventional products (4 studies).

CONCLUSIONS

Within the limitations of this systematic review, herbal oral care products may play a key role in the management of periodontal disease. Further well-designed studies are needed to establish their efficacy.

Oral Health, Antimicrobials and Care for Patients With Chronic Oral Diseases – A Review of Knowledge and Treatment Strategies

Periodontal and chronic oral mucosal diseases are significant life impacting conditions which may co-exist and synergistically act to cause more severe and widespread oral pathology with enhanced challenges in effective management. Clinicians regularly observe these effects and struggle to effectively manage both problems in many patients. There is limited understanding of many basic and applied scientific elements underpinning potentially shared aetiopathological features and management. Recent developments in translational science provide an opportunity to greater improve knowledge and subsequently care for patients with these problems.

Heterogeneity of Blood Vessels and Assessment of Microvessel Density-MVD in Gingivitis

Gingivitis is a very common oral disease highly prevalent in adults that, if left untreated, can progress to periodontitis. It involves a complex and slow interaction between the host response and the oral microbiome represented by the dental plaque. The inflammation of the gingiva is associated with the activation of pathological angiogenesis and the existence of a high number of newly formed blood vessels quantified as microvessel density (MVD). The present study includes a number of 51 gingival biopsies from patients with different gingival indexes (GI): GI = 0, n = 12; GI = 1, n = 15; GI = 2, n = 16; and GI = 3, n = 8, processed and stained with the routine hematoxylin-eosin method. The inflammatory infiltrate was scored, the blood vessels were detected with anti-CD34 antibody, and MVD was determined. Inflammatory changes were observed in 39 of the 51 cases included in our study. CD34 + vessels with normal morphological appearance were observed in all 12 cases of health gingiva. In cases of inflammatory lesions, the morphology of the blood vessels showed changes with the evolution of gingival lesions. In severe inflammation, a particular aspect was observed in the vessels, such as the presence of the phenomenon of intussusception. MVD increases with the severity of gingival lesions, with the highest density being observed in severe inflammation.

The efficacy of powered toothbrushes: A systematic review and network meta-analysis

AIM

This systematic review and network meta-analysis synthesizes the available clinical evidence concerning efficacy with respect to plaque scores following a brushing action with oscillating-rotating (OR) or high-frequency sonic (HFS) powered toothbrushes (PTB) compared with a manual toothbrush (MTB) as control.

MATERIAL AND METHODS

Databases were searched up to 1 August 2021, for clinical trials that evaluated the efficacy of a PTB with OR or HFS technology compared with an MTB on plaque removal after a single-brushing action and conducted with healthy adult patients. Meta-analysis (MA) and a network meta-analysis (NMA) were performed.

RESULTS

Twenty-eight eligible publications, including 56 relevant comparisons, were retrieved. The overall NMA results for the mean post-brushing score showed a statistically significant difference for the comparison between an OR PTB and an MTB (SMD = -0.43; 95% CI [-0.696;-0.171]). The change in plaque score data showed a significant effect of a PTB over an MTB and OR over HFS. Based on ranking, the OR PTB was highest, followed by the HFS PTB and the MTB.

CONCLUSION

Within the limitations of the present study design, based on the outcome following a single-brushing action, it can be concluded that for dental plaque removal, there is a high certainty for a small effect of a PTB over an MTB. This supports the recommendation to use a powered toothbrush for daily plaque removal. There is moderate certainty for a very small benefit for the use of a powered toothbrush with an OR over an HFS mode of action.

Comparative evaluation of subgingival microbiome in healthy periodontium and gingivitis using next-generation sequencing technology: A case–control study

Background:

Human dental plaque is a complex microbial community containing millions of species. Gingivitis is a dysregulated immune-inflammatory response induced by dysbiotic plaque biofilm that interrupts symbiosis. The emergence of next-generation sequencing with 16S rRNA gene has greatly contributed in understanding the complexity of microbiota. However, studies focusing on microbiome in gingivitis are limited. The whole bacterial community is important in causing periodontal disease than a small number of periodontal pathogens. In this study, we attempted to profile the subgingival microbiome from individuals with healthy gingiva and in patients with gingivitis using next-generation sequencing technology.

Materials and Methods:

Subgingival plaque samples from 15 healthy periodontium (Group I) and 15 gingivitis (Group II) were collected and 16s rRNA sequencing was done in Illumina Solexa Sequencer. Data analysis using 16s metagenomics tool from BaseSpace onsite operational taxonomic units was assigned to each sequence using HOMD database. Individual variation in the microbiome of the subgingival samples between the two groups was also evaluated.

Results:

The comparison of top 20 species between Group I and Group II revealed no significant species group between them. Synergistetes was absent in Group I samples but found in Group II. At the genus level, HACEK group species were found in both the groups, while Dialister and Aneroglobus were found abundantly in the Group II.

Conclusion:

The presence of unique genera and species seen in Group II samples could point toward a dysbiotic shift that could be taking place in the subgingival environment leading to gingivitis.

Wnt Signaling in Periodontal Disease

Periodontitis is a multifactorial and chronic condition associated with the formation of a dysbiotic biofilm, leading to a pro-inflammatory environment that can modulate cell signaling. The Wnt pathway plays fundamental roles during homeostasis and disease, and emerging evidence suggests its involvement in the maintenance of the periodontium and the development of periodontitis. Here, we summarize the role of the Wnt/β-catenin and non-canonical Wnt signaling pathways in periodontitis. The accumulated data suggests specific roles for each branch of the Wnt pathway. Wnt5a emerges as a critical player promoting periodontal ligament remodeling and impairing regenerative responses modulated by the Wnt/β-catenin pathway, such as alveolar bone formation. Collectively, the evidence suggests that achieving a proper balance between the Wnt/β-catenin and non-canonical pathways, rather than their independent modulation, might contribute to controlling the progression and severity of the periodontal disease.

[The effectiveness of parodontax toothpaste in the complex treatment of chronic gingivitis]

THE AIM OF THE STUDY

Was to evaluate the clinical efficacy of parodontax Comprehensive Protection (GlaxoSmithKline, London, UK) toothpaste in the complex therapy of chronic gingivitis.

MATERIALS AND METHODS

The study involved 119 volunteers; group 1 (n=59, age range 18 to 32 years) and group 2 (n=60, age range 20 to 35 years) with a diagnosis of chronic gingivitis (K05.1). The criterion for inclusion in the study was sulcus bleeding index (SBI) more than 1 point. Dental examination included SBI, papillary-marginal-alveolar index (PMA), and Green-Vermillion oral hygiene index (OHI-S). After determining the indices, all patients underwent professional oral hygiene and controlled tooth cleaning. Patients in group 1 (parodontax) were prescribed parodontax Comprehensive Protection toothpaste (GlaxoSmithKline, London, UK), patients in group 2 - a toothpaste that did not contain sodium bicarbonate. Repeated clinical examinations with the determination of the SBI, PMA, OHI-S were carried out after week 2 and 4.

RESULTS

After 4 weeks, SBI scores in group 1 were 63% lower than at baseline, and in group 2 - by 30%. PMA values at 4 weeks in group 1 were 58% and in group 2 30% lower, compared to baseline levels. The results of the analysis of the OHI-S index showed a statistically significant decrease in group 1 by 75%, while in group 2 by only 8% from the initial values. The difference in all index values between groups at 4 weeks of the study was statistically significant (p<0.05).

CONCLUSION

The use of parodontax Comprehensive Protection Toothpaste (GlaxoSmithKline, London, UK) has been shown to reduce the clinical signs of biofilm-associated gingivitis and effectively maintain optimal oral hygiene in patients.

Microbiomes in supragingival biofilms and saliva of adolescents with gingivitis and gingival health

BACKGROUND

Important alterations exist in the microbiomes of supragingival biofilm and saliva samples from adolescent patients developing induced or spontaneous gingivitis relative to healthy controls. These and the relationships to dental health are not fully understood yet.

SUBJECTS AND METHODS

Supragingival biofilm samples (n = 36) were collected from the teeth of 9 adolescents with gingivitis induced by orthodontic appliances, as well as dental plaques (n = 40) from 10 adolescents with spontaneous gingivitis, in addition to similar samples (n = 36) from 9 healthy controls. The bacterial metagenomes were analyzed by 16S rRNA gene amplicon sequencing. Salivary microbiomes of the same persons were characterized by shotgun metagenome sequencing. The data sets were examined using advanced bioinformatics workflows and two reference databases.

RESULTS

The composition and diversity of bacterial communities did not differ extensively among the three study groups. Nevertheless, the relative abundances of the genera Fusobacterium, Akkermansia, Treponema, and Campylobacter were prominently higher in gingivitis patients versus controls. In contrast, the genera Lautropia, Kingella, Neisseria, Actinomyces, and Rothia were significantly more abundant in controls than in either of the two gingivitis groups.

CONCLUSIONS

The abundance pattern of certain taxa rather than individual strains shows characteristic features of potential diagnostic value. Stringent bioinformatics treatment of the sequencing data is mandatory to avoid unintentional misinterpretations.

Correlation between dental plaque accumulation and gingival health in periodontal maintenance patients using short or extended personal oral hygiene intervals

AIMS

To evaluate the correlation between bacterial dental plaque accumulation and gingival health in subjects with history of periodontitis attending a maintenance programme including personal oral hygiene measures (pOH) at short and extended intervals. This study is a secondary analysis of a randomized clinical trial.

MATERIALS AND METHODS

Forty-two subjects were randomized into groups performing pOH at 12-, 24- or 48-h intervals. The Plaque Index (PlI), Gingival Index (GI) and bleeding on probing (BoP) were recorded at baseline, 30 and 90 days. For the analysis, pOH groups were collapsed into subjects performing pOH at daily (G12/24) or extended (G48) intervals. Summary statistics and Spearman correlations between plaque accumulation and gingival inflammation are presented.

RESULTS

G12/24 and G48 subjects showed significant increases in plaque scores and percentage sites with gingival inflammation over the course of study. At 90 days, G48 subjects showed significantly greater GI and BoP scores than G12/24 subjects. While PlI/GI correlations were not affected by pOH interval, PlI/BoP correlations remained unchanged with short to increase with extended pOH intervals.

CONCLUSION

pOH interval influences the correlation between bacterial dental plaque accumulation and gingival inflammation. Subjects using extended pOH intervals exhibit an increased correlation allowing accumulation of bacterial dental plaque to the detriment of gingival health. (ClinicalTrials.gov: 50208115.9.0000.5346). Clinical Trials: ClinicalTrials.gov: NCT02684682.

Microbial signatures of health, gingivitis, and periodontitis

The subgingival crevice harbors diverse microbial communities. Shifts in the composition of these communities occur with the development of gingivitis and periodontitis, which are considered as successive stages of periodontal health deterioration. It is not clear, however, to what extent health- and gingivitis-associated microbiota are protective, or whether these communities facilitate the successive growth of periodontitis-associated taxa. To further our understanding of the dynamics of the microbial stimuli that trigger disruptions in periodontal homeostasis, we reviewed the available literature with the aim of defining specific microbial signatures associated with different stages of periodontal dysbiosis. Although several studies have evaluated the subgingival communities present in different periodontal conditions, we found limited evidence for the direct comparison of communities in health, gingivitis, and periodontitis. Therefore, we aimed to better define subgingival microbiome shifts by merging and reanalyzing, using unified bioinformatic processing strategies, publicly available 16S ribosomal RNA gene amplicon datasets of periodontal health, gingivitis, and periodontitis. Despite inherent methodological differences across studies, distinct community structures were found for health, gingivitis, and periodontitis, demonstrating the specific associations between gingival tissue status and the subgingival microbiome. Consistent with the concept that periodontal dysbiosis is the result of a process of microbial succession without replacement, more species were detected in disease than in health. However, gingivitis-associated communities were more diverse than those from subjects with periodontitis, suggesting that certain species ultimately become dominant as dysbiosis progresses. We identified the bacterial species associated with each periodontal condition and prevalent species that do not change in abundance from one state to another (core species), and we also outlined species co-occurrence patterns via network analysis. Most periodontitis-associated species were rarely detected in health but were frequently detected, albeit in low abundance, in gingivitis, which suggests that gingivitis and periodontitis are a continuum. Overall, we provide a framework of subgingival microbiome shifts, which can be used to generate hypotheses with respect to community assembly processes and the emergence of periodontal dysbiosis.

Effectiveness of a 30-year periodontist's primary care for 1946 patients during five-year follow-up

OBJECTIVE

To evaluate the effect of the periodontal primary care (PPC) on the improvement of periodontal probing depth based on a periodontist's 30-year practice.

MATERIALS AND METHODS

We enrolled a total of 2,894 patients who underwent periodontal basic treatment between 1987 and 2017 with 84.5% retention rate. The study population was composed of 80% (n = 1,946) of retained patients with complete re-evaluation up to five-year follow-up. The outcome was measured by the improvement of probing depths (graded as 1:1-3 mm; 2:4-6 mm; 3: ≥7 mm) before and after PPC on both sextant and patient levels. Whether a better improvement was seen in the surgical group and the non-smoker group opposed to their comparators was assessed with various multi-variable regression models.

RESULTS

On patient (sextant) level, 82% (38%) improved, 13% (59%) unchanged, and 5% (3%) deteriorated. Adjusted better improvement of probing depth was noted for the surgical group by 63% and non-smoker by 31% compared with their counterparts. The similar findings were found for the outcomes based on continuous probing depth scores.

CONCLUSIONS

We demonstrate the improvement of probing depth scores with a periodontal primary care offered for the retained patients and larger effect for the surgical group and non-smoker patients.

Salivary Metalloproteinase-8 and Metalloproteinase-9 Evaluation in Patients Undergoing Fixed Orthodontic Treatment before and after Periodontal Therapy

(1) Background: Metalloproteinase-8 (MMP-8) and metalloproteinase-9 (MMP-9) are members of a family of proteases of major importance during orthodontic tooth movement. Their levels increase during orthodontic therapy and in periodontally affected tissues. Orthodontic fixed appliances retain dental plaque and can cause gingival inflammation. When gingival inflammation is present, the forces produced during orthodontic tooth movement can aggravate tissue reaction and cause the destruction of supportive periodontal tissue. This study aimed to identify biomarkers that facilitate the assessment of periodontal status during orthodontic treatment. (2) Methods: Our study was conducted on 111 patients who were about to receive fixed orthodontic treatment. We determined the salivary levels of MMP-8 and MMP-9 and bleeding on probing (BOP) before applying the orthodontic fixed appliance (T1), one week after appliance placement (T2), and during orthodontic treatment, one month after non-surgical periodontal treatment (T3). (3) Results: Patients undergoing orthodontic treatment show a significant increase in BOP, MMP-8, and MMP-9 levels one week after orthodontic appliance placement (T2) and a decrease in these parameters one month after periodontal treatment (T3). Statistically significant correlations were found between MMP-8 levels and BOP values at T1, T2, and T3. (4) Conclusion: In our study patients undergoing orthodontic treatment show a significant increase in BOP, MMP-8, and MMP-9 levels one week after orthodontic appliance placement and a decrease in these parameters one month after periodontal treatment. Strong positive statistically significant correlations were found between MMP-8 levels and BOP and medium positive statistically significant correlations between MMP-9 and BOP values before and after orthodontic treatment and periodontal treatment. MMP-8, MMP-9, and BOP could be used to assess the periodontal status of orthodontic patients.

Effect of Aging on Homeostasis in the Soft Tissue of the Periodontium: A Narrative Review

Aging is characterized by a progressive decline or loss of physiological functions, leading to increased susceptibility to disease or death. Several aging hallmarks, including genomic instability, cellular senescence, and mitochondrial dysfunction, have been suggested, which often lead to the numerous aging disorders. The periodontium, a complex structure surrounding and supporting the teeth, is composed of the gingiva, periodontal ligament, cementum, and alveolar bone. Supportive and protective roles of the periodontium are very critical to sustain life, but the periodontium undergoes morphological and physiological changes with age. In this review, we summarize the current knowledge of molecular and cellular physiological changes in the periodontium, by focusing on soft tissues including gingiva and periodontal ligament.

Periodontal and caries status in unexplained female infertility: A case-control study

BACKGROUND

The aim of this study was to investigate the possible association between maternal periodontal disease and dental caries that affect oral health and unexplained infertility.

METHODS

This cross-sectional case-control study included 50 fertile women and 50 women with unexplained infertility aged 21 to 39 years. Dental and periodontal parameters were examined to evaluate the oral health of the participants. According to the new periodontal disease classification, periodontitis severity was determined.

RESULTS

In infertile women, the number of advanced caries lesions, the percentage of bleeding on probing (BOP), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were higher (P < 0.05). The DMFT and mean plaque index (PI) were not statistically different between the two groups. The PISA and PESA values were higher in women with unexplained infertility than in fertile women (P = 0.005 and P = 0.002, respectively). In multivariate analysis showed that association of DMFT and BOP variables with periodontitis was found to be significant for all women included in the study and for infertile women only (P = 0.000 and P = 0.012 for DMFT, respectively; P = 0.000 and P = 0.016 for BOP, respectively).

CONCLUSION

The chronic inflammatory environment caused by periodontitis and advanced carious lesions in women with unexplained infertility should be of great concern as it may have a role in the etiology of infertility.

Newer post-COVID perspective: Teledental encryption by de-multiplexed perceptrons

This paper presents an efficient mechanism for secured encryption of intraoral information in the emerging field of Teledental. Due to global rapid surge in the (Coronavirus Disease) COVID patients, the services of Teledental are best suited in the newer post-COVID era. A devised perceptron has been intelligently embedded with de-multiplexing ability to transmit data to the dentists has been proposed. Exact session key has been developed through learning rules applied on the perceptrons by both the patient and dentist. For simplicity, gingivitis data is highly recommended to transmit in a highly secured manner with patients' data integrity. Gingivitis is an important dental disease which is primarily caused by the bacterial colonization. It shows gum bleeding and inflammations in the gingiva. Encrypted transmission is required to the Dentist for early diagnosis and treatment in Teledental system in this pandemic context. Gingivitis data are then broken into parts by the demultiplexer followed by individual proposed header generation. It is predominantly done to confuse the intruders about the originality of the intraoral data. Chi-square, Avalanche, Strict Avalanche, etc. were carried on the proposed partial shares to generate good outcomes when compared to classical algorithms. To confuse the intruders, character frequency, floating frequency, and autocorrelation were tested extensively. It is a newer approach to avail the secured Teledental features in post-COVID time.

Do periodontal defects affect periodontal inflammation and destruction? Histological/microbiological changes and gene expression profiles of a pilot study in beagle dogs

BACKGROUND

The present study focused on the inflammatory disease progress after periodontal defect induction and aimed to specifically determine periodontal tissue responses following dental plaque accumulation by ligatures on a site with/without standardized periodontal defect induction.

METHODS

After 1 month from extraction of the adjacent teeth, semi-circumferential defects were surgically created in the unilateral second and fourth premolars (test group), whereas no defects were being induced at the contralateral sites (control group). One week later, silk was used to ligate the tooth cervix at both sites to encourage the accumulation of dental plaque. Four weeks later, the tissue samples were collected for histological/histomorphometric and microarray analysis. Microbiological analysis was performed before defect induction and at ligatures, and after 4 weeks of dental plaque accumulation.

RESULTS

Remarkable inflammation was clinically and histologically observed in both groups after plaque accumulation, and the intrabony type of periodontal defect exaggerated inflammatory cell infiltration into the connective tissue layer. Expression of genes related to inflammation such as IL-1 was highly up-regulated in test sites. However, these inflammatory infiltrations did not invade to a boundary of periodontal ligament and connective tissue attachment in both groups, and histomorphometric results corresponds to these observational results. Bacterial findings also showed no significant differences in detected microbiome compositions between control and test groups at three-time points.

CONCLUSION

Intrabony defect might exaggerate the plaque-induced inflammation in the aspect of inflammatory cell infiltration and the related gene expression, but both dental plaque and the pre-existing periodontal defect negligibly disrupt periodontal attachment and the underlying alveolar bone.

Risk-based, 6-monthly and 24-monthly dental check-ups for adults: the INTERVAL three-arm RCT

BACKGROUND

Traditionally, patients are encouraged to attend dental recall appointments at regular 6-month intervals, irrespective of their risk of developing dental disease. Stakeholders lack evidence of the relative effectiveness and cost-effectiveness of different recall strategies and the optimal recall interval for maintenance of oral health.

OBJECTIVES

To test effectiveness and assess the cost-benefit of different dental recall intervals over a 4-year period.

DESIGN

Multicentre, parallel-group, randomised controlled trial with blinded clinical outcome assessment at 4 years and a within-trial cost-benefit analysis. NHS and participant perspective costs were combined with benefits estimated from a general population discrete choice experiment. A two-stratum trial design was used, with participants randomised to the 24-month interval if the recruiting dentist considered them clinically suitable. Participants ineligible for 24-month recall were randomised to a risk-based or 6-month recall interval.

SETTING

UK primary care dental practices.

PARTICIPANTS

Adult, dentate, NHS patients who had visited their dentist in the previous 2 years.

INTERVENTIONS

Participants were randomised to attend for a dental check-up at one of three dental recall intervals: 6-month, risk-based or 24-month recall.

MAIN OUTCOMES

Clinical - gingival bleeding on probing; patient - oral health-related quality of life; economic - three analysis frameworks: (1) incremental cost per quality-adjusted life-year gained, (2) incremental net (societal) benefit and (3) incremental net (dental health) benefit.

RESULTS

A total of 2372 participants were recruited from 51 dental practices; 648 participants were eligible for the 24-month recall stratum and 1724 participants were ineligible. There was no evidence of a significant difference in the mean percentage of sites with gingival bleeding between intervention arms in any comparison. For the eligible for 24-month recall stratum: the 24-month (n = 138) versus 6-month group (n = 135) had an adjusted mean difference of -0.91 (95% confidence interval -5.02 to 3.20); the risk-based (n = 143) versus 6-month group had an adjusted mean difference of -0.98 (95% confidence interval -5.05 to 3.09); the 24-month versus risk-based group had an adjusted mean difference of 0.07 (95% confidence interval -3.99 to 4.12). For the overall sample, the risk-based (n = 749) versus 6-month (n = 737) adjusted mean difference was 0.78 (95% confidence interval -1.17 to 2.72). There was no evidence of a difference in oral health-related quality of life between intervention arms in any comparison. For the economic evaluation, under framework 1 (cost per quality-adjusted life-year) the results were highly uncertain, and it was not possible to identify the optimal recall strategy. Under framework 2 (net societal benefit), 6-month recalls were the most efficient strategy with a probability of positive net benefit ranging from 78% to 100% across the eligible and combined strata, with findings driven by the high value placed on more frequent recall services in the discrete choice experiment. Under framework 3 (net dental health benefit), 24-month recalls were the most likely strategy to deliver positive net (dental health) benefit among those eligible for 24-month recall, with a probability of positive net benefit ranging from 65% to 99%. For the combined group, the optimal strategy was less clear. Risk-based recalls were more likely to be the most efficient recall strategy in scenarios where the costing perspective was widened to include participant-incurred costs, and in the Scottish subgroup.

LIMITATIONS

Information regarding factors considered by dentists to inform the risk-based interval and the interaction with patients to determine risk and agree the interval were not collected.

CONCLUSIONS

Over a 4-year period, we found no evidence of a difference in oral health for participants allocated to a 6-month or a risk-based recall interval, nor between a 24-month, 6-month or risk-based recall interval for participants eligible for a 24-month recall. However, people greatly value and are willing to pay for frequent dental check-ups; therefore, the most efficient recall strategy depends on the scope of the cost and benefit valuation that decision-makers wish to consider.

FUTURE WORK

Assessment of the impact of risk assessment tools in informing risk-based interval decision-making and techniques for communicating a variable recall interval to patients.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN95933794.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme [project numbers 06/35/05 (Phase I) and 06/35/99 (Phase II)] and will be published in full in Health Technology Assessment; Vol. 24, No. 60. See the NIHR Journals Library website for further project information.

Efficacy of Behaviour Change Techniques to improve oral hygiene control of individuals undergoing orthodontic therapy. A systematic review

AIM

This study aims to review the available evidence on the efficacy of behaviour change techniques to improve compliance in young orthodontic patients and to compare these with conventional oral hygiene instructions.

METHODS

The review was conducted according to the PRISMA statement. PICO method was used to define eligibility criteria. Two independent reviewers performed the research, examined electronic databases (MEDLINE, Scopus and CENTRAL) and manually checked relevant journals. Only RCTs with more than 10 participants and 3 months follow-up were included. Data extraction and their qualitative analysis were performed for included studies.

RESULTS

Search strategy identified 320 articles. After screening for titles, abstracts and full texts, 10 articles were then selected for qualitative analysis. High methodological heterogeneity was present among studies and therefore no meta-analysis was performed. Low risk of bias was detected for one study only. The most common intervention was "mobile phone communication," which was investigated in five studies. Motivational interviewing, repeated reinforcements and visual-aided approach were also examined.

CONCLUSION

The interest in remote control of patients compliance appears to be fruitful, nonetheless there is no consensus as to a unique treatment protocol. Every other treatment looks beneficial but higher methodological homogeneity should be sought for in future investigations.

Gingival inflammation influences oral health-related quality of life in individuals living in a rural area of southern Brazil

AIM

The aim of the present cross-sectional study was to evaluate whether the extent levels of gingival inflammation (GI) in whole mouth or restricted to the anterior region are independently associated with oral health-related quality of life (OHRQoL) in individuals living in a rural area of southern Brazil.

MATERIALS AND METHODS

A probability sample of 688 individuals was submitted to a full-mouth periodontal examination at six sites on each tooth. Extent levels of GI in whole mouth and restricted to anterior region were dichotomously considered when bleeding on probing (BoP) occurred at 20% or more of whole-mouth sites and at 10% or more of anterior region sites, respectively, in individuals with probing depths ≤3 mm, totalling 121 individuals analysed, aged 15-82 years. OHRQoL was assessed using the simplified version of the Oral Health Impact Profile (OHIP₁₄ ) questionnaire. Adjusted multilevel Poisson regression analysis was used with a conceptual hierarchical approach to calculate the rate ratio (RR) of OHIP₁₄ scores.

RESULTS

In the adjusted model, higher extent levels of full-mouth GI (RR = 1.23; 95% confidence interval [CI]: 1.06-1.44; p = .004) and GI restricted to the anterior region (RR = 1.29; 95% CI: 1.11-1.51; p ≤ .001) were significantly associated with poorer OHRQoL.

CONCLUSIONS

The extent of GI in whole mouth (≥20% of sites with BoP) and in the anterior region (≥10% of sites with BoP) was independently associated with OHRQoL in individuals living in a rural area.

An 8-week randomized controlled trial comparing the effect of a novel oscillating-rotating toothbrush versus a manual toothbrush on plaque and gingivitis

PURPOSE

To compare a novel oscillating-rotating (O-R) electric rechargeable toothbrush with micro-vibrations (Oral-B iO) to a manual brush for gingivitis and plaque reduction.

METHODS

Adult subjects with gingivitis and plaque were randomized to use either the O-R or the manual toothbrush with standard fluoride dentifrice twice daily. Efficacy was assessed at baseline, week 1, and week 8 using the Rustogi Modification of the Navy Plaque Index (RMNPI), Modified Gingival Index (MGI), and Gingival Bleeding Index (GBI). Gingivitis status ('healthy'/'not healthy') was also assessed, per the American Academy of Periodontology/European Federation of Periodontology criteria.

RESULTS

One hundred and ten subjects were enrolled and completed the randomized controlled trial. The baseline mean number (SD) of bleeding sites for all subjects was 32.11 (16.703). At week 8, 82% of subjects using the O-R toothbrush were categorized as 'healthy' (<10% bleeding sites), versus 24% of subjects using the manual brush (P < 0.001). Subjects using the O-R toothbrush showed statistically significantly greater reductions (P < 0.001) in the number of bleeding sites, GBI scores and MGI scores versus those using a manual toothbrush as early as 1 week and throughout the 8-week study. The O-R toothbrush also provided statistically significantly greater reductions (P < 0.001) in all plaque measures, including sub-regions, versus the manual toothbrush after a single brushing and at weeks 1 and 8.

CONCLUSIONS

The novel O-R electric toothbrush with micro-vibrations provided statistically significantly greater plaque and gingivitis reductions versus a manual toothbrush, with performance benefits demonstrated after a single brushing and continuing throughout the 8-week study.

Effect of synbiotics in the treatment of smokers and non-smokers with gingivitis: randomized controlled trial

BACKGROUND

To evaluate the efficacy of synbiotic tablets on the clinical and biochemical parameters of smokers and non-smokers with gingivitis.

METHODS

Eighty patients with gingivitis [40 smokers (+), 40 non-smokers (-)] were randomly assigned to test (T) or control (C) groups. Four groups were defined: T(+), T(-), C(+) and C(-). The subjects daily chewed a synbiotic or placebo tablet for 30 days. The gingival crevicular fluid levels of interleukin (IL)-6, IL-8 and IL-10 were determined as the primary outcome variables.

RESULTS

The clinical and biochemical parameters for all groups significantly reduced compared with the baseline (P < 0.05). While there were no significant differences between the groups for gingival index, the plaque index was significantly higher in both smoker groups than that in the T(-) group during the second month (P < 0.05). IL-8 levels in C(-) and IL-6 levels in both control groups were significantly higher than those in the T(+) group. The IL-10 levels in both control groups were significantly higher than those in the T(-) group during the second month (P < 0.05).

CONCLUSIONS

Adjunctive synbiotic tablets significantly reduce subclinical therapeutic outcomes for both smokers and non-smokers compared with placebo according to the biochemical parameters.

The effects of bioavailable gluconate chelated stannous fluoride dentifrice on gingival bleeding: Meta-analysis of eighteen randomized controlled trials

AIM

To estimate gingivitis effects of a bioavailable gluconate chelated 0.454% stannous fluoride (SnF2 ) family of dentifrices in adult subjects versus positive (triclosan) and negative (NaF or MFP) controls when used ≤3 months.

MATERIALS AND METHODS

A meta-analysis evaluated bioavailable gluconate chelated SnF2 dentifrices versus a negative or positive control for gingival bleeding.

RESULTS

In 18 randomized controlled trials (RCTs) with 2,890 subjects assessing SnF2 paste versus a negative or positive control, the average number of bleeding sites was reduced by 51% and 31%, respectively. The average change (95% CI) in number of bleeding sites was -16.3 (-27.8, -4.9) versus the negative control and -3.6 (-5.4, -1.8) versus the positive control. Subjects with localized or generalized gingivitis had 3.7 times better odds (95% CI [2.8, 5.0]) of shifting to generally healthy using SnF2 versus a negative control and 2.8 times better odds (95% CI [2.1, 3.9]) of shifting to generally healthy using SnF2 versus a positive control. The individual study risk of bias was deemed to be low in all categories of bias.

CONCLUSION

This meta-analysis demonstrates significant gingivitis benefits of bioavailable SnF2 dentifrices when used ≤3 months versus positive (triclosan) and negative (NaF or MFP) controls.

Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non-dental plaque biofilm-induced gingival diseases and dental plaque-induced gingivitis. Non-dental plaque biofilm-induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque-induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque-induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non-periodontitis patient or in a currently stable "periodontitis patient" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient-centered approach to care, and therefore, creates differences in the way in which a "case" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations.

Dental plaque-induced gingival conditions

OBJECTIVE

This review proposes revisions to the current classification system for gingival diseases and provides a rationale for how it differs from the 1999 classification system.

IMPORTANCE

Gingival inflammation in response to bacterial plaque accumulation (microbial biofilms) is considered the key risk factor for the onset of periodontitis. Thus, control of gingival inflammation is essential for the primary prevention of periodontitis.

FINDINGS

The clinical characteristics common to dental plaque-induced inflammatory gingival conditions include: a) clinical signs and symptoms of inflammation that are confined to the gingiva: b) reversibility of the inflammation by removing or disrupting the biofilm; c) the presence of a high bacterial plaque burden to initiate the inflammation; d) systemic modifying factors (e.g., hormones, systemic disorders, drugs) which can alter the severity of the plaque-induced inflammation and; e) stable (i.e., non-changing) attachment levels on a periodontium which may or may not have experienced a loss of attachment or alveolar bone. The simplified taxonomy of gingival conditions includes: 1) introduction of the term "incipient gingivitis;" 2) a description of the extent and severity of gingival inflammation; 3) a description of the extent and severity of gingival enlargement and; 4) a reduction of categories in the dental plaque-induced gingival disease taxonomy.

CONCLUSIONS

Dental plaque-induced gingival inflammation is modified by various systemic and oral factors. The appropriate intervention is crucial for the prevention of periodontitis.

Plaque-induced gingivitis: Case definition and diagnostic considerations

OBJECTIVE

Clinical gingival inflammation is a well-defined site-specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a "gingivitis site") is completely different from defining and grading a "gingivitis case" (GC) (i.e. a patient affected by gingivitis), and that a "gingivitis site" does not necessarily mean a "GC". The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque-induced gingivitis and to propose a set of criteria to define GC.

IMPORTANCE

A universally accepted case definition for gingivitis would provide the necessary information to enable oral health professionals to assess the effectiveness of their prevention strategies and treatment regimens; help set priorities for therapeutic actions/programs by health care providers; and undertake surveillance.

FINDINGS

Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%) CONCLUSIONS: A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.

Periodontal health in a cohort of subjects with type 1 diabetes mellitus

To evaluate periodontal health and oral health behaviors in a cohort of subjects with type 1 diabetes (T1D), 50 persons with T1D (30 males and 20 females; mean age: 35.2 years) were recruited from the Diabetology Unit of the Geneva University Hospitals; 50 nondiabetic persons matched for gender, age, and smoking status comprised the control group. We assessed periodontal health using the gingival index (GI), plaque index, probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL) and recorded self-reported attitudes and behaviors regarding dental care. The two groups were compared using conditional logistic regression. With respect to the mean PD, CAL, and the mean number of sites with PD >4 mm that bled upon probing, there were no significant differences between the groups. However, subjects with diabetes had significantly more plaque and gingival inflammation and presented more sites with BOP compared with control subjects. Further analysis of the subjects in younger (<40 years) and older (>40 years) cohorts revealed a marked difference in GI between younger healthy and controls, which was also present in older patients and controls but much reduced in magnitude and significance. This marked difference in the gingival health of young versus old diabetic patients to matched controls may provide diagnostic advantages and screening and prevention opportunities to exploit. In spite of similar self-reported oral hygiene habits and frequency of dental visits, patients with T1D presented more plaque and more inflammation than healthy controls, particularly in the younger subjects. Gingivitis in young T1D patients may be an early indicator for more complicated diabetes and periodontitis in the future. Thus, patients with T1D mellitus should be screened for signs of periodontal disease early and should be motivated and instructed in good oral hygiene practices.

Body fat rather than body mass index is associated with gingivitis - A southern Brazilian cross-sectional study

BACKGROUND

This cross-sectional study aimed to evaluate the association between body mass index (BMI) and body fat with gingivitis in 613 adults of Porto Alegre, Brazil.

METHODS

Individuals with at least four teeth were included in this study. They were identified through a multi-stage probability sampling, considering the city distribution of sex and age. Structured interviews were conducted by trained researchers in order to collect sociodemographic characteristics, behavioral habits, and systemic impaired conditions. Visible plaque and modified gingival index were assessed by a trained and calibrated examiner. Additionally, weight, height, and body fat percentage were measured. Body fat percentage was determined by bioelectrical-impedance analysis using a portable electrical micro-current monitor. The median sites with marginal bleeding was 20%, and used as a cutoff point for gingivitis. Crude and adjusted prevalence ratio by mean Poisson regression with robust variance were calculated. Two multivariable models were performed in order to associate both independent and dependent variables.

RESULTS

In the multivariable analysis that included BMI, no significant association with gingivitis was detected. On the other hand, the multivariable model that included body fat showed that very high body fat category (PR 1.22; 95% CI: 1.01 to 1.49) was significantly associated with higher marginal gingival bleeding.

CONCLUSION

Very high body fat category rather than BMI was significantly associated with higher positive marginal gingival bleeding in adults.

Interleukin-6 and interleukin-10 gene polymorphisms and the risk of further periodontal disease progression

Susceptible genotypes to periodontal disease are associated with disease onset and progression. The aim of this study was to examine the effect of gene polymorphisms on the risk of further disease progression and the need for further treatment among adults with chronic periodontal disease. Sixty-seven patients diagnosed with chronic periodontitis were grouped according to genotype status and risk of further progression of disease and tooth loss. All individuals were clinically evaluated for probing pocket depth, clinical attachment loss and bleeding on probing at baseline and 45 days after treatment. Blood samples were collected at baseline and genotyping of the polymorphisms in IL-6 (rs1800796) and IL-10 (rs1800872) genes were performed by PCR. Following DNA separation and genotyping, 65.7% of the patients were homozygous carriers of the IL-6 -572G and 49.3% were carriers of the IL-10 -592A allele. Individuals at risk of disease progression ranged from 7.5% to 62.7% based on the criteria used. Carriers of the IL-10 -592A allele were significantly associated with BOP ≥ 30% and therefore exhibited a higher risk of further periodontal breakdown (p = 0.018) with an odds ratio of 1.18. None of the other definitions of disease progression were significantly associated with the examined IL-6 and IL-10 genotypes (p > 0.05). IL-10 polymorphism was associated with an increased risk of further disease progression and the potential need for further treatment following non-surgical periodontal treatment. Susceptible IL-6 genotypes were not associated with the risk of persisting or recurrent disease activity.