Effects of different periodontal interventions on the risk of adverse pregnancy outcomes in pregnant women: a systematic review and network meta-analysis of randomized controlled trials

Background

Periodontal disease is widespread among pregnant women, and it is possible that taking action to improve oral health conditions can make improvements in adverse pregnancy outcomes. Herein, we summarize the recent evidence using a network meta-analysis to assess the effects of different periodontal treatment intervention strategies on the risk of adverse pregnancy outcomes in pregnant women.

Materials and methods

Randomized controlled trials were retrieved from PubMed, Web of Science, Embase, and Cochrane Library databases. After literature screening, data extraction, and quality evaluation of the included literature were performed, the R studio 4.2.2 "netmeta" package was used for the network meta-analysis.

Results

A total of 20 studies were included, and 5 adverse pregnancy outcomes (preterm birth, low birth weight, preterm birth and/or low birth weight infants, small for gestational age, and pre-eclampsia) were considered to examine the effects of different periodontal treatment interventions strategies on the risk of the abovementioned outcome indicators. The results of the network meta-analysis demonstrated that the three periodontal treatment intervention strategies of sub- and/or supra-gingival scaling and root planing + chlorhexidine rinsing (SRP + CR), sub- and/or supra-gingival scaling and root planing+chlorhexidine rinsing + tooth polishing and plaque control (SRP + CR + TP), and sub- and/or supra-gingival scaling and root planing +sonic toothbrush + tooth polishing and plaque control (SRP + ST + TP) reduced the risk of preterm birth [odds ratio (OR) = 0.29, 95% confidence interval (CI) (0.10-0.88), OR = 0.25, 95CI% (0.10-0.63), OR = 0.28, 95CI% (0.11-0.69), respectively]. In addition, two periodontal treatment intervention strategies, SRP + CR and SRP + CR + TP, were effective methods in terms of the risk of preterm birth and/or low birth weight [OR = 0.18, 95CI% (0.06-0.52), OR = 0.31, 95CI% (0.12-0.79)].

Conclusion

The available evidence suggests that the risk of preterm birth and preterm birth and/or low birth weight can be reduced with certain periodontal treatment intervention strategies. Future studies should focus on optimizing intervention strategies and the optimal timing for different periods of pregnancy, in order to provide a reference for pregnant women's healthcare.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=407901, CRD42023407901.

Evaluation of systemic antibiotic usage in the treatment of periodontal diseases among dental professionals in Turkey: Cross - sectional epidemiological study

Background/Aim: Systemic antibiotic use in periodontal diseases has increased in recent years. The purpose of this study was to investigate the antibiotic prescribing patterns for systemic antibiotics for the treatment of periodontal diseases. Material and Methods: A prepared questionnaire was sent to the e-mail addresses of dentists located in seven different regions of Turkey, who were requested to reply the questions online. In total, 512 emails were sent for the study, which was carried out with the participation of general dentists (GDs), periodontists (PDs), and specialist dentists (SDs). The participants were asked questions about their professional experiences, the institutions that they work for, and their antibiotic training and knowledge, their perspectives on clinical antibiotic use and antibiotic preferences invarious clinical situations. Results: 65.5% of GDs, 23.3% of PDs, 11.6% of SDs participated in this study. In reviewing the participants' systemic antibiotic use to treat periodontal diseases, most preferred systemic antibiotics to treat acute necrotizan ulcerative gingivitis, aggressive periodontitis, diabetes associated periodontitis. Regarding antibiotic prescriptions, 40.7% of the GDs and 34.8% of the SDs prescribed 1-3 antibiotics per day. Meanwhile, 31.3% of the PDs prescribed 1-3 antibiotics a day and 31.3% 1-4 antibiotics a week (p<0.005). Conclusions: Based on the results of this survey, shows that dentists do not have sufficient training for systemic antibiotic use and that their current approach is based on clinical experience alone. Clearer, more specific guidelines and increased post-graduate education can lead to a reduction in the negative consequences of this issue's resultant over-prescribed antibiotics.

Effects of omega-3 fatty acids and aspirin on Porphyromonas gingivalis-induced periodontitis in rats

BACKGROUND

Periodontitis is a common chronic inflammatory disease caused by bacteria which can result in periodontal tissue inflammation, as well as alveolar bone resorption. The purpose of this study was to evaluate the effects of omega-3 fatty acids plus aspirin (ASA) on ligature-induced periodontitis in rats.

METHODS

Ninety-six male Sprague-Dawley (SD) rats (age 6 weeks) were randomly divided into eight groups (n = 12 each) and had ligatures placed for 7 days, followed by daily treatment with specific drug regimens for 14 days. The rats were sacrificed 20 days after drug treatment, and their maxillary were subjected to histomorphometric analysis. RAW264.7 cells were cultured with lipopolysaccharide (LPS) or receptor activator (NF)-κB ligand (RANKL), and treated with various concentrations of omega-3 and ASA. Then, cyclooxygenase (COX-2), inducible nitric oxide synthase (iNOS) protein expression and receptor activator of nuclear factor κ B (RANK), tartrate-resistant acid phosphatase (TRAP), matrix metalloproteinase-9 (MMP-9), MMP-2, and Cathepsin-K gene expression were detected.

RESULTS

The administration of omega-3 fatty acids and aspirin significantly inhibited tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in serum of rats. Histomorphometric analysis showed omega-3 fatty acids plus aspirin promoted alveolar bone increase. Omega-3 fatty acids only, aspirin only, or omega-3 fatty acids plus aspirin also inhibited the protein expressions of COX-2 and iNOS in LPS-stimulated RAW264.7 cells. In addition, omega-3 combined with ASA also inhibited the RANKL-induced gene expressions of MMPs in dose-dependent manners.

CONCLUSION

These results demonstrate that omega-3 fatty acids plus aspirin could decrease alveolar bone loss, while simultaneously increasing the protection against periodontal inflammation.

Effect of zein on biodegradable inserts for the delivery of tetracycline within periodontal pockets

Treatment with antibiotics within the periodontal pocket against bacterial infections represents a useful and adjunctive tool to conventional therapy for healing and teeth preservation. With this function in view, an implantable, tetracycline delivery device for the treatment of periodontal disease was developed. The aim of this study was to develop biodegradable, tetracycline-loaded microparticles made of two polymers: PLGA and zein which were compressed into monolithic devices. In this polymer delivery system, the encapsulation efficiency, release characteristics, drug–polymer interaction, and antibacterial activity of loaded drug were investigated. The interaction of tetracycline with the corn protein zein was studied by nuclear magnetic resonance (NMR), Fourier transform infrared, and X-ray diffraction. The hydrophobic interaction of tetracycline with zein in the formulations was deduced from the NMR studies, whereas X-ray diffraction studies showed a new crystalline state of the drug in the presence of the protein. Zein was not denatured by preparation of inserts. Sustained release of tetracycline was obtained, and the proportion of zein in the inserts had a great impact on the drug release. Finally, an effective tetracycline release from inserts against Staphylococcus aureus was achieved over 30 days. In conclusion, the PLGA:zein delivery system described in this study was found to be effective in controlled delivery of tetracycline, and hence may be suitable for intra-pocket delivery of antimicrobial agents in the treatment of periodontitis.

Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm

OBJECTIVES

The aim was to answer three relevant questions: can systemic antimicrobials be efficacious if the biofilm is not disrupted? Can the type of debridement of the subgingival biofilm impact upon the clinical outcomes of the adjunctive antimicrobial therapy? Is the efficacy of the adjunctive systemic antimicrobial therapy dependent on the quality of the debridement of the subgingival biofilm and the sequence debridement-antibiotic usage?

MATERIAL AND METHODS

Relevant papers were searched, critically analysed and their data were extracted.

RESULTS

For the first question, studies assessing susceptibility of bacteria in biofilms, and clinical studies evaluating systemic antimicrobials as monotherapy, were reviewed. For the second question, clinical studies comparing systemic antimicrobials as adjuncts to non-surgical debridement or to periodontal surgery and clinical trials using systemic antibiotics with periodontal surgery were evaluated. For the third question, a previous systematic review was updated.

CONCLUSION

If systemic antimicrobials are indicated in periodontal therapy, they should be adjunctive to mechanical debridement. There is not enough evidence to support their use with periodontal surgery. Indirect evidence suggests that antibiotic intake should start on the day of debridement completion, debridement should be completed within a short time (preferably <1 week) and with an adequate quality, to optimize the results.

The effect of dexamethasone in the pathogenesis of ligature-induced periodontal disease in Wistar rats

The aim of this study was to evaluate, in rats, the role of the systemic use of dexamethasone in the pathogenesis of induced alveolar bone loss. In 26 female Wistar rats, ligatures were placed around the second upper molars, and the contralateral ones served as intra-group controls. Two groups were formed. The test group received 0.5 mg/kg of dexamethasone subcutaneously every third day during thirty days. The control group received the same amount of saline solution. After thirty days, the animals were sacrificed and their maxillae were removed. Sodium hypochlorite was used to prepare the specimens, and the cementum-enamel junction was stained with 1% methylene blue. Morphometric analysis of the alveolar bone loss was performed with standardized digital photographs, and the distance between the cementum-enamel junction and the alveolar bone crest was measured with the software ImageTool 3.0. Intra-examiner calibration revealed a Pearson correlation coefficient of 0.99. Statistical analysis was performed by paired or independent samplet tests, as appropriate (alpha = 0.05). Dexamethasone increased the mean alveolar bone loss in ligature-induced periodontitis in relation to the control group (0.77 and 0.61 buccally, and 0.65 and 0.56 palatally, respectively). No significant differences were observed intergroups in the teeth without ligatures. In the animal model used here, the use of dexamethasone increased the progression of ligature-induced alveolar bone loss.

Use of Anti-Inflammatory Medications in Managing Atypical Gingivitis Associated With Hypermobile Ehlers-Danlos Syndrome: A Case Report

BACKGROUND

Ehlers-Danlos syndrome (EDS) is a group of collagen disorders primarily affecting the skin and joints. This case report describes the periodontal management of a case of hypermobile EDS (type III) associated with atypical gingivitis.

METHODS

A 17-year-old Caucasian female with a history of EDS type III presented with erythematous mucogingival lesions. An incisional biopsy was taken. The treatment objective was to control the mucogingival inflammatory lesions. Plaque control measures were followed with anti-inflammatory medications. Prednisone was administered systemically for 3 weeks (first week: 30 mg/day, second week: 15 mg/day, and third week: 5 mg/day), and was followed with topical applications of clobetasol (0.05%) twice daily for 2 weeks. Persistent marginal gingival inflammation was managed with a 3-month course of doxycycline (20 mg) twice/day. The patient was placed on a 3-month maintenance program and monitored for over a year

RESULTS

Histopathology showed multiple granulomas enclosing fragments of crystalline foreign material. Steriodal anti-inflammatory medications partially reduced the size and intensity of the mucogingival lesions. Doxycycline controlled the residual marginal inflammation. A 3-month maintenance interval helped in maintaining the results obtained.

CONCLUSIONS

The collagen disorder may have facilitated the introduction and lodging of foreign material within the gingival tissues, initiating a foreign body reaction. Poor healing associated with EDS excluded surgical excision and necessitated the use of anti-inflammatory medications. A combined approach of plaque control measures along with anti-inflammatory medications was helpful in controlling the mucogingival inflammatory lesions associated with this condition.