Is periodontitis associated with an increased risk of coronary heart disease and preterm and/or low birth weight births?

The bidirectional association between diabetes and periodontitis, from basic to clinical

The prevalence and severity of periodontitis are increased and advanced in diabetes. Severe periodontitis elicits adverse effects on diabetes by impairing insulin actions due to systemic microinflammation. Recent studies unveil the emerging findings and molecular basis of the bidirectional relationship between periodontitis and diabetes. In addition to conventional mechanisms such as hyperglycemia, hyperlipidemia, and chronic inflammation, deficient insulin action may play a pathogenic role in the progression of periodontitis under diabetes. Epidemiologically, from the viewpoint of the adverse effect of periodontitis on diabetes, recent studies have suggested that Asians including Japanese and Asian Americans with diabetes and mild obesity (BMI <25 kg/m2) should pay more attention to their increased risk for cardiovascular diseases. In this review, we summarize recent findings on the effect of diabetes on periodontitis from the viewpoint of abnormalities in metabolism and insulin resistance with novel mechanisms, and the influence of periodontitis on diabetes mainly focused on micro-inflammation related to mature adipose tissue and discuss future perspectives about novel approaches to interrupt the adverse interrelationship.

Could the periodontal therapy improve the cardiologic patient health? A narrative review

BACKGROUND

Cardiovascular diseases (CVD) is the major cause of mortality globally, with increasing evidence suggesting a link between periodontitis, and CVD. This study aims to explore the association between periodontitis and CVD, and the impact of periodontal therapy on cardiovascular health.

METHODS

This review synthesized findings from preclinical and clinical studies, without publication year restrictions, examining periodontitis and CVD through various lenses. Scientific databases were inspected with keywords related to periodontitis and CVD.

RESULTS

The review identifies a substantial association between periodontitis and an increased risk of several CVD, supported by both epidemiological and interventional studies. Results suggest the complexity of the relationship, influenced by factors like the severity of periodontitis and the presence of other systemic conditions. Clinical data indicates that periodontal therapy, particularly non-surgical periodontal therapy, may reduce systemic inflammatory markers and thus may play a role in the primary and secondary prevention of CVD events, highlighting the potential of periodontal therapy to not only maintain oral health but also to modulate cardiovascular risk factors.

CONCLUSIONS

Current evidence supports a significant association between periodontitis and increased cardiovascular risk, promoting integrated healthcare approaches that consider oral health as a key-component of cardiovascular care and wellbeing.

Synthesis of novel metal silica nanoparticles exhibiting antimicrobial potential and applications to combat periodontitis

Periodontitis is a severe form of gum disease caused by bacterial plaque that affects millions of people and has substantial worldwide health and economic implications. However, current clinical antiseptic and antimicrobial drug therapies are insufficient because they frequently have numerous side effects and contribute to widespread bacterial resistance. Recently, nanotechnology has shown promise in the synthesis of novel periodontal therapeutic materials. Nanoparticles are quickly replacing antibiotics in the treatment of bacterial infections, and their potential application in dentistry is immense. The alarming increases in antimicrobial resistance further emphasize the importance of exploring and utilizing nanotechnology in the fight against tooth diseases particularly periodontitis. We developed 16 different combinations of mesoporous silica nanomaterials in this study by ageing, drying, and calcining them with 11 different metals including silver, zinc, copper, gold, palladium, ruthenium, platinum, nickel, cerium, aluminium, and zirconium. The antibacterial properties of metal-doped silica were evaluated using four distinct susceptibility tests. The agar well diffusion antibacterial activity test, which measured the susceptibility of the microbes being tested, as well as the antibacterial efficacy of mesoporous silica with different silica/metal ratios, were among these studies. The growth kinetics experiment was used to investigate the efficacy of various metal-doped silica nanoparticles on microbial growth. To detect growth inhibitory effects, the colony-forming unit assay was used. Finally, MIC and MBC tests were performed to observe the inhibition of microbial biofilm formation. Our findings show that silver- and zinc-doped silica nanoparticles synthesized using the sol-gel method can be effective antimicrobial agents against periodontitis-causing microbes. This study represents the pioneering work reporting the antimicrobial properties of metal-loaded TUD-1 mesoporous silica, which could be useful in the fight against other infectious diseases too.

Adverse Pregnancy Outcomes and Maternal Periodontal Disease: An Overview on Meta-Analytic and Methodological Quality

This umbrella review aims to appraise the methodological quality and strength of evidence on the association between maternal periodontitis and adverse pregnancy outcomes (APOs). PubMed, CENTRAL, Web-of-Science, LILACS, and Clinical Trials were searched until February 2023, without date or language restrictions. Two authors independently screened studies, extracted data, performed the risk-of-bias analysis, and estimated the meta-analytic strengths and validity and the fail-safe number (FSN). A total of 43 SRs were identified, of which 34 conducted meta-analyses. Of the 28 APOs, periodontitis had a strong association with preterm birth (PTB), low birth weight (LBW), and gestational diabetes mellitus (GDM), PTB and LBW showed all levels of strength, and pre-eclampsia showed only suggestive and weak strength. Regarding the consistency of the significant estimates, only 8.7% were likely to change in the future. The impact of periodontal treatment on APOs was examined in 15 SRs, 11 of which conducted meta-analyses. Forty-one meta-analyses were included and showed that periodontal treatment did not have a strong association with APOs, although PTB revealed all levels of strength and LBW showed only suggestive and weak evidence. Strong and highly suggestive evidence from observational studies supports an association of periodontitis with a higher risk of PTB, LBW, GDM, and pre-eclampsia. The effect of periodontal treatment on the prevention of APOs is still uncertain and requires future studies to draw definitive and robust conclusions.

Association between the Risk of Preterm Birth and Low Birth Weight with Periodontal Disease in Pregnant Women: An Umbrella Review

Background: The purpose of this review is to determine the association between the risk of preterm birth and low birth weight in newborns and periodontal disease in pregnant women. Methods: A bibliographic search was carried out until November 2021 in the following biomedical databases: PubMed/Medline, Cochrane Library, Scopus, EMBASE, Web of Science, Scielo, LILACS and Google Scholar. Studies reporting the association between the risk of preterm birth and low birth weight in newborns with periodontal disease in pregnant women, which were systematic reviews, in English and without time limits were included. AMSTAR-2 was used to assess the risk of the included studies, and the GRADEPro GDT tool was used to assess the quality of the evidence and the strength of the recommendation of the results. Results: The preliminary search yielded a total of 161 articles, discarding those that did not meet the selection criteria, leaving only 15 articles. Seven articles were entered into a meta-analysis, and it was found that there is an association between the risk of preterm birth and low birth weight in newborns with periodontal disease in pregnant women. Conclusions: There is an association between the risk of preterm birth and low birth weight in newborns with periodontal disease in pregnant women.

Periodontal disease as a non-traditional risk factor for acute coronary syndrome: a systematic review and meta-analysis

OBJECTIVES

Previous observational studies have suggested an association between periodontal disease (PD) and cardiovascular and cerebrovascular diseases. Nonetheless, evidence linking PD with coronary heart disease (CHD) and acute coronary syndrome (ACS) is still contradictory. We aim to systematically review the role of PD as a risk factor for ACS (myocardial infarction and unstable angina).

METHODS

The protocol was registered in PROSPERO (CRD42021286278) and we followed the recommendations of the PRISMA and AMSTAR 2 guidelines. We systematically searched for 7 databases and electronic thesis repositories from inception to February 2022. We included articles without language restriction following the PECO strategy (population: "adult participants"; exposure: "periodontal disease"; comparator: "no periodontal disease"; outcome: "acute coronary syndrome" OR "acute myocardial infarction" OR "unstable angina"). Odds ratios (OR) with 95% confidence intervals (95% CI) were pooled using random effects and heterogeneity was quantified by Cochran's Q and Higgins' I² statistics. Subgroup analyses were carried out according to the participants' sex, type of diagnosis of PD, type of study, and continent of origin of studies.

RESULTS

We included 46 papers (17 cohort, 25 case-control, and 4 cross-sectional studies) that met the inclusion criteria. This meta-analysis includes a total of 6,806,286 participants and at least 68,932 ACS events, mainly myocardial infarction (MI). In accordance with our results, PD is associated with a higher risk of ACS (OR 1.35; 95% CI 1.25-1.45). However, clinical and methodological heterogeneity was significant (I²=86%, p<0.05). In the sensitivity analysis, the exclusion of some studies with "extreme" results (outliers) did not significantly affect the overall estimate or heterogeneity. In subgroup analysis, we found no statistically significant differences between men and women according to subgroup difference tests (I²=0%, p=0.67). Conversely, there were differences according to the type of diagnosis of PD (clinical or self-reported diagnosis), type of study (cohort, case-control, or cross-sectional study), and the continent of origin (North America, South America, Asia, or Europe) of the studies (I²=79%-96%, p<0.10). Of the 46 studies, only 4 had a high risk of bias. Additionally, the funnel plot suggested publication bias.

CONCLUSION

PD may be an important non-traditional risk factor for ACS. Although, this meta-analysis brings together more studies, and therefore more evidence, than any other previous similar study, its results should be interpreted with caution due to the great heterogeneity and the potential presence of bias.

Periodontitis and Number of Teeth in the Risk of Coronary Heart Disease: An Updated Meta-Analysis

Background

A positive link between periodontitis and chronic systemic disease has been indicated. However, few studies focused on the loss of teeth. Our analysis aims to analyze the relationship of periodontitis and number of teeth with the risk of coronary heart disease (CHD).

Material/Methods

A meta-analysis was conducted on qualified data extracted from the PubMed, Embase, and Cochrane Library databases. Only cohort studies were included in this study. We screened articles that assessed the periodontal condition and teeth number as well as the incidence or mortality of CHD. Hazard ratio (HR) and relative risk (RR) were calculated by Stata SE software.

Results

A total of 11 prospective studies with over 200 000 total participants were analyzed. Ten studies reported on periodontitis and CHD, and 4 studies included data on number of teeth. After adjusting for multivariate factors, there was a significant association between periodontitis and the risk of CHD (RR, 1.18; 95% confidence interval [CI], 1.10–1.26); the RR of CHD in the edentulous population was 1.20 (95% CI, 1.08–1.34). Moreover, results on the RR values for number of teeth were as follows: 24–17 teeth (RR, 1.12; 95% CI, 1.05–1.19); 16–11 (RR, 1.28; 95% CI, 1.15–1.42); and ≤10 (RR, 1.55; 95% CI, 1.43–1.69).

Conclusions

Our study showed that periodontitis is a risk factor for CHD and that the number of removed teeth is positively correlated with the risk of CHD. During clinical assessment, both factors need to be considered as factors associated with cardiovascular risks.

Oral microflora and pregnancy: a systematic review and meta-analysis

Understanding changes in oral flora during pregnancy, its association to maternal health, and its implications to birth outcomes is essential. We searched PubMed, Embase, Web of Science, and Cochrane Library in May 2020 (updated search in April and June 2021), and conducted a systematic review and meta-analyses to assess the followings: (1) oral microflora changes throughout pregnancy, (2) association between oral microorganisms during pregnancy and maternal oral/systemic conditions, and (3) implications of oral microorganisms during pregnancy on birth outcomes. From 3983 records, 78 studies were included for qualitative assessment, and 13 studies were included in meta-analysis. The oral microflora remains relatively stable during pregnancy; however, pregnancy was associated with distinct composition/abundance of oral microorganisms when compared to postpartum/non-pregnant status. Oral microflora during pregnancy appears to be influenced by oral and systemic conditions (e.g. gestational diabetes mellitus, pre-eclampsia, etc.). Prenatal dental care reduced the carriage of oral pathogens (e.g. Streptococcus mutans). The Porphyromonas gingivalis in subgingival plaque was more abundant in women with preterm birth. Given the results from meta-analyses were inconclusive since limited studies reported outcomes on the same measuring scale, more future studies are needed to elucidate the association between pregnancy oral microbiota and maternal oral/systemic health and birth outcomes.

Do the clinical criteria used to diagnose periodontitis affect the association with prematurity?

In recent years, several studies have examined the possible relationship between periodontal disease in pregnant women and preterm birth. One of the difficulties facing these studies is the heterogeneity of the clinical criteria used to define periodontitis. The aim of this cross-sectional study was to determine the degree of association between maternal periodontitis and preterm birth according to different consensus definitions of periodontal disease. In a study of 146 mothers (60 with preterm births and 86 with term deliveries) at the Sant Joan de Déu Maternal and Children's Hospital in Barcelona, a periodontal examination was carried out within 2 days of birth and the presence of periodontal disease was evaluated using the main clinical classifications published in the literature. The prevalence of periodontitis ranged from 25.4 to 52.1%, depending on the criteria used for its definition. Using the most restrictive criteria, pregnant women with periodontitis had a higher risk of preterm birth (OR: 7.49; p < 0.001) and premature rupture of membranes (OR: 2.49; p = 0.017). Premature infants born to mothers with periodontitis presented a tendency toward low weight, adjusted for gestational age (OR: 3.32; p = 0.065). Our findings suggest that the association between periodontitis and preterm birth is influenced by the definitions of periodontitis used.

Efficacy of toothbrushing procedures performed in intensive care units in reducing the risk of ventilator-associated pneumonia: A systematic review

The aim of this systematic review (SR) was to assess whether toothbrushing-based oral heath measure (OHM), performed in intensive care units, can reduce the risk of ventilator-associated pneumonia (VAP). Dental biofilm removal has been considered important to prevent VAP. PUBMED, SCOPUS, WEB OF SCIENCE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to and including December 2018 to identify randomized clinical trials (RCT) on the use of toothbrushing procedures in the prevention of VAP. Search was conducted by two independent reviewers. The risk of bias of each included study was assessed using the Cochrane Collaboration's domain-based, two-part tool. Random effects meta-analyses were conducted thoroughly. Search strategy identified 215 potentially eligible articles, of which 12 RCT were included. All studies evidenced the importance of OHM in mechanically ventilated patients in order to prevent VAP. Seven RCT (58.3%) found some degree of positive association between toothbrushing, alone or associated to oral topical chlorhexidine (CHX), and a potential reduction of mechanical ventilation-related outcomes and dental biofilm/oral bacteria. However, pooled estimates did not identify an additional decrease of VAP incidence for any of the tested procedures (ie, toothbrushing + CHX versus swab/gauze cleaning + CHX or toothbrushing + CHX versus toothbrushing alone or + placebo). Toothbrushing does not seem to promote a reduction of VAP-outcomes compared to swab/gauze cleaning, when topic CHX is applied for oral hygiene of patients submitted to mechanical ventilation.

Characterization of periodontitis in people with type 1 diabetes of 50 years or longer duration

BACKGROUND

Periodontitis is more common and severe in people with diabetes than the general population. We have reported in the Joslin Medalist Study that people with type 1 diabetes of ≥50 years (Medalists) may have endogenous protective factors against diabetic nephropathy and retinopathy.

METHODS

In this cross-sectional study, the prevalence of periodontitis according to the Centers for Disease Control/American Academy of Periodontology classification in a subset (n = 170, mean age = 64.6 ± 6.9 years) of the Medalist cohort, and its associations to various criteria of periodontitis and diabetic complications were assessed.

RESULTS

The prevalence of severe periodontitis in Medalists was only 13.5% which was lower than reported levels in diabetic patients of similar ages. Periodontal parameters, including bleeding on probing, plaque index, gingival index, and demographic traits, including male sex, chronological age, and age at diagnosis were significantly associated with severity of periodontitis, which did not associate with diabetes duration, hemoglobin A1c (HbA1c), body mass index, and lipid profiles. Random serum C-peptide levels inversely associated with severity of periodontitis (P = 0.03), lower probing depth (P = 0.0002), and clinical attachment loss (P = 0.03). Prevalence of cardiovascular diseases (CVD) and systemic inflammatory markers, plasma interleukin-6 (IL-6), and serum immunoglobulin G titer against Porphyromonas gingivalis positively associated with severity of periodontitis (P = 0.002 and 0.02, respectively). Antibody titer to P. gingivalis correlated positively and significantly with CVD, serum IL-6, and high-sensitivity C-reactive protein.

CONCLUSIONS

Some Medalists could be protected from severe periodontitis even with hyperglycemia. Endogenous protective factors for periodontitis could possibly be related to residual insulin production and lower levels of chronic inflammation.

Oral care in pregnancy

Pregnant women are susceptible to a wide range of oral health conditions that could be harmful to their own health and the future of their baby. There are many myths about the safety of dental care during pregnancy. As a result, pregnant women receive less dental care than when they are not pregnant. In our review, we tried to emphasize the importance and safety of routine dental care for pregnant women.

Periodontal, metabolic, and cardiovascular disease: Exploring the role of inflammation and mental health

Previous evidence connects periodontal disease, a modifiable condition affecting a majority of Americans, with metabolic and cardiovascular morbidity and mortality. This review focuses on the likely mediation of these associations by immune activation and their potential interactions with mental illness. Future longitudinal, and ideally interventional studies, should focus on reciprocal interactions and cascading effects, as well as points for effective preventative and therapeutic interventions across diagnostic domains to reduce morbidity, mortality and improve quality of life.

Assessment of Knowledge and Attitude of Medical Practitioners Towards Pediatric Dental Care in Raichur District, Karnataka, India-A Survey

AIM

To determine the knowledge and attitude of medical practitioners towards dental care of children in Raichur district.

MATERIALS AND METHODS

The present study is a cross-sectional survey conducted among the medical practitioners of Raichur district. The study was conducted on 300 practitioners, randomly selected. The data pertaining to their knowledge and attitude about oral health was gathered using a self-administered questionnaire. Data were analyzed using descriptive studies.

RESULTS

Among the study subjects, 32.7% of the respondents could recognize the precancerous and cancerous lesions in the oral cavity. A total of 65.3% considered that dental caries is not infectious. About 52.7% of the physicians thought that scaling causes tooth sensitivity and only 22.7% knew that tooth brushing should be initiated after the eruption of the first milk tooth.

CONCLUSION

Medical practitioners had a moderate knowledge and attitude towards pediatric dental care.How to cite this article: Rao DG, Sheereen S, Havale R, Prakasha SS, Zulfikar MM. Assessment of Knowledge and Attitude of Medical Practitioners Towards Pediatric Dental Care in Raichur District, Karnataka, India-A Survey. Int J Clin Pediatr Dent, 2018;11(5):375-381.

Periodontal pathogens in the placenta and membranes in term and preterm birth

INTRODUCTION

Preterm birth is a common cause of adverse neonatal and childhood outcomes. It is commonly associated with infection of the maternal-fetal interface. The relationship between periodontitis and preterm labour is controversial.

METHODS

Control placental tissues from uncomplicated term births were compared with those from spontaneous preterm births for incidence of common periodontal bacteria. A chi-square analysis was used to compare the populations, with significance determined at p=<0.05.

RESULTS

The study group comprised 29 control women who had an uncomplicated term birth, 25 delivered by caesarean section and 4 vaginal deliveries, and 36 women with a spontaneous preterm labour and subsequent delivery at less than 34 weeks gestation. There were significant (p=<0.05) differences between the preterm and term groups maternal age with 28.7 compared to 32.0 years old respectively. There was no significant (p=>0.05) differences between the groups fetal risk factors or co-morbidities, except the preterm group had a significantly higher (p=<0.05) rate of premature rupture of membrane (PROM). There were significantly (p=<0.01) more Fusobacterium spp. in the placentas from term births than preterm births.

DISCUSSION

This study found that the common periodontal pathogen, Fusobacterium spp., is not detected more in placentas from preterm birth and may potentially be lower, possibly resulting from bacterial ecological factors in term placentas.

Periodontal Disease, Systemic Inflammation and the Risk of Cardiovascular Disease

Periodontal and cardiovascular disease are both major health issues. Poor oral health has long been associated with the development of systemic diseases, with the typical example being the risk of endocarditis posterior to dental procedures. Through the years, the association of periodontal disease with other non-infectious systemic diseases has been brought to attention. One of the most interesting associations is the one that exists with the development of cardiovascular disease. Many studies, including systematic reviews and meta-analyses, suggest an important association between periodontal disease and ischaemic heart disease, cerebrovascular disease, heart failure, atrial fibrillation and peripheral artery disease. Among the proposed mechanisms of this relationship, systemic inflammation appears to play a major role. Evidence suggests that periodontal inflammation triggers a systemic inflammatory state that, added to the damage mediated by antibodies that cross react between periodontal pathogens and components of the intimal wall, and the direct lesion of the intima by bacteria entering the circulation, promotes atheroma plaque development and progression. There are other studies that show a clear relationship between periodontal disease severity, elevations of inflammatory markers, and the presence of atherosclerosis. Here, we give a review of the available evidence supporting this association, and the possible mechanisms involved.

Evaluation of the relationship between periodontal risk and carotid artery calcifications on panoramic radiographs

Objective:

To evaluate if there is a relationship between findings of carotid artery calcification (CAC) and periodontal risk in nonsmoker subjects by using panoramic radiographs (DPR).

Materials and Methods:

A total of 1146 DPRs were investigated. Gender, age, severity of bone loss, tooth loss, periodontal risk, and findings of carotid calcification were recorded. The periodontal risk was evaluated and classified according to the degree of alveolar bone loss.

Results:

CAC was diagnosed in %13.6 (n: 156) of DPRs. Of 1146 patients, 338 (29.5%) had low, 668 (60%) had moderate, and 120 (10.5%) had high periodontal risk. A statistically significant relation was observed between carotid calcification and periodontal risk.

Conclusion:

Positive findings of carotid calcification may be related with periodontal problems. Clinicians must be careful about diagnosing CACs on DPRs during routine examinations. In the case of positive findings of CAC and periodontitis together, the patient may be consulted to a specialist for further investigation.

Association between maternal periodontitis and preterm and/or low birth weight infants in normal pregnancies

OBJECTIVE

To relate the periodontal condition with the presence of periodontal bacteria in pregnant that had babies with preterm delivery or/and low weight at birth (PTLBW).

METHODS

We recruited 134 pregnant women without systemic diseases attending at the Gynaecology and Obstetrics Room, from Maternal Provincial Hospital, Córdoba, Argentine. Pregnant were grouped according to the International Classification for a System of Periodontal Disease. A sample from periodontal pocket was extracted to identify Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythia (Tf) Prevotella intermedia (Pi) and Agreggatibacter actinomycemcomitans (Aa).

RESULTS

We identified 7 (5%) cases of children born underweight or preterm of mothers diagnosed with Gingivitis, 6 (4%) in Mild Periodontitis and 4 (3%) in Moderate Periodontitis. We estimated that when Pi and/or Aa were not detected in the periodontal pockets of mothers, the infants had more than 129% chance of having normal birth weights (OR 3.47 for Pi and OR and 2.29 for Aa). The average age of the mothers who has PTLBW was 21 ± 3.5. The age showed an association with PTLBW (p < 0.0008).

CONCLUSIONS

The presences of periodontal pathogens in periodontal pockets from pregnant with different periodontal status would associate with PTLBW infants when the mothers are young, and the normal term and normal birth weight infant are associated with the absence of periodonto bacteria like Pi and Aa.

Periodontal bacteria in the genital tract: are they related to adverse pregnancy outcome?

One of the most important factors implicated in preterm birth (PTB) is acute genitourinary tract infection. The bacteria causing chronic periodontal inflammation include Gram-negative rods and anaerobes similar to those found in women with bacterial vaginosis. The aim of this prospective study is to investigate the relationship between oral and vaginal microflora and preterm low birth weight. Real-time polymerase chain reaction was used to detect both the presence and level of six periodontitis-related species: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), Fusobacterium nucleatum ssp(Fn), and Prevotella intermedia (Pi) for both oral samples of subgingival plaque and cervical samples, obtained from 80 patients, during gynaecological examinations. The more representative oral pathogen (less than 60 percent) species in oral samples of preterm and term group were Tf, Td, and Fn. 24.4 percent of pregnant women presented periodontal pathogens in vaginal swab; the most representative species with a percentage over 0.1 percent of total bacteria in genital tract of preterm group were Tf, Td, and Piwith a positive correlation (less than 0.5). The presence of the bacterium T. denticolain the vagina, regardless of the amount, adversely affects preterm delivery.

Association between periodontitis and acute myocardial infarction: a case-control study of a nondiabetic population

BACKGROUND AND OBJECTIVE

Periodontitis and acute myocardial infarction (AMI) are two diseases that share common risk factors. The role of periodontitis as an independent risk factor for cardiovascular disease has been under debate. The aim of this study was to investigate whether an association exists between periodontitis and AMI in a nondiabetic population, using multiple periodontal case definitions.

MATERIAL AND METHODS

Periodontal examination was performed in 204 patients with AMI. The control group comprised 102 healthy subjects, without significant coronary disease, confirmed angiographically. Periodontitis was assessed using measurements of clinical attachment loss (CAL), probing depth and number of missing teeth. From these measurements, five different case definitions of periodontitis were generated.

RESULTS

Using the continuous forms of periodontal measurements, the odds ratio (95% confidence interval) of the association with incident AMI was 1.74 (1.26-2.50), 1.83 (1.10-3.17) and 1.08 (1.06-1.13) for mean CAL, probing depth and number of missing teeth, respectively. A consistent positive association was observed regardless of the case definition of periodontitis.

CONCLUSION

In this nondiabetic population, the association between periodontitis and AMI was consistent across different measurements and/or definitions of periodontitis. The strength of the association increased concomitantly with the robustness of the criteria used to define periodontitis.

Periodontitis and systemic diseases: A literature review

Studies have revealed possible link between periodontitis and different systemic diseases. There is need to review this interesting subject. The aims are: to provide a comprehensive literature that can easily be consulted, on the subject; to draw the attention of health practitioners to the impact of oral health on the general well-being; and to emphasize the need for a deeper interaction between medical and dental training. The Medline database was searched for relevant literature by combining each of the following terms, “oral health,” “oral infection,” “periodontitis,” with “systemic diseases.” Manual library search and review of bibliographies of published literature were also conducted. Periodontitis is a constant potential source of infection and has been considered as a separate risk factor for some cardiovascular, respiratory, endocrine, musculoskeletal, and reproductive system related abnormalities. Oral health impacts on the general well-being, and if comprehensive health care is ever to be achieved, oral health should not be seen as a separate, distant, and less important area of health, which is totally unrelated to lifespan and its quality.

Periodontitis and chronic kidney disease: a systematic review of the association of diseases and the effect of periodontal treatment on estimated glomerular filtration rate

AIM

The aim of this systematic review (SR) was to evaluate the association between periodontitis and chronic kidney disease (CKD) and the effect of periodontal treatment (PT) on the estimated glomerular filtration rate (eGFR).

METHODS

MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to and including September 30, 2012 to observational (S1) and interventional (S2) studies on the association of periodontitis with CKD. Studies were considered eligible for inclusion if they reported the eGFR. Search was conducted by two independent reviewers. The methodological quality of the observational studies was assessed using the Newcastle-Ottawa Scale (NOS) adapted for this review, and the Cochrane's Collaboration risk of bias assessment tool. A random-effects odds-ratio meta-analysis was conducted to estimate the degree of association between periodontitis and CKD.

RESULTS

Search strategy identified 2456 potentially eligible articles, of which four cross-sectional, one retrospective, and three interventional studies were included. Four S1, 80.0% reported some degree of association between periodontitis and CKD. Similarly, such an outcome was supported by pooled estimates (OR: 1.65, 95% Confidence Interval: 1.35, 2.01, p < 0.00001, χ(2)  = 1.70, I(2 ) = 0%). All interventional studies found positive outcomes related to treatment.

CONCLUSION

There is quite consistent evidence to support the positive association between periodontitis and CKD, as well as the positive effect of PT on eGFR.

Periodontitis as risk factor for acute myocardial infarction: A case control study

OBJECTIVES

To assess the periodontal status among the patients suffering from acute myocardial infarction (AMI) and to investigate whether periodontitis is a risk factor for AMI or not.

MATERIALS AND METHODS

A cross-sectional study of 60 subjects, 30 subjects in each AMI group and control group was conducted. Details of risk factors like age, sex, smoking, and alcohol consumption were obtained through a personal interview. Medical history was retrieved from the medical file. The oral hygiene status was assessed by using a simplified oral hygiene index (OHI-S) and the periodontal status was assessed by community periodontal index (CPI) and loss of attachment (LOA) as per World Health Organization (WHO) methodology 1997. Chi-square test was used to analyze qualitative data whereas t-test and one way analysis of variance (ANOVA) test was used for quantitative data. Multiple regression model was applied to check the risk factors for AMI.

RESULTS

The mean OHI-S score for case and control group was 3.98 ± 0.70 and 3.11 ± 0.68, respectively, which was statistically highly significant ( P < 0.001). There was high severity of periodontitis (for both in terms of CPI and LOA) in the case group as compared with control group, that was found to be statistically highly significant ( P < 0.001). There was a significant result for OHI-S and LOA score with odds ratio of 0.13 and 0.79, respectively, when the multiple logistic regression model was applied.

CONCLUSION

The results of the present study show evidence that those patients who have experienced myocardial infarction exhibit poor periodontal conditions in comparison to healthy subjects and suggest an association between chronic oral infections and myocardial infarction.

Dental neglect and adverse birth outcomes: a validation and observational study

OBJECTIVES

The objectives of this study were to validate the Indian translation of the Dental Neglect Scale (DNS) among a sample of parturient Indian women and to investigate dental neglect as a possible risk indicator in adverse birth outcomes.

SUBJECTS AND METHODS

Three hundred and sixteen parturient women were administered the DNS and the Modified Dental Beliefs Scale (MDBS) and were also clinically examined for oral health status. Information regarding socio-economic status, weeks of gestation and birth weight was also collected. A gestation period of less than 37 weeks was considered as preterm and a birth weight of less than 2500 gm as 'low birth weight'.

RESULTS

The Indian version of the DNS was found to be reliable (Cronbach's Alpha = 0.72) and valid for assessing dental neglect among the women. Factor analysis of the DNS revealed a two-factor structure accounting for 56% variance. Dental neglect was higher among those with poorer oral health status, lower socio-economic and educational status. Multinomial logistic regression showed high dental neglect and negative dental beliefs and not poor oral health, as significant risk indicators for occurrence of adverse birth outcomes.

CONCLUSION

The finding of an association of adverse birth outcomes with dental neglect and beliefs, but not with poor oral health could be due to the influence of other more important general factors which had a direct bearing on birth outcomes. There is a need for further research to assess the role of behavioural factors like dental neglect as risk indicators for adverse birth outcomes.

Causes of adverse pregnancy outcomes and the role of maternal periodontal status - a review of the literature

Preterm (PT) and Low birth weight (LBW) are considered to be the most relevant biological determinants of newborn infants survival, both in developed and in developing countries. Numerous risk factors for PT and LBW have been defined in the literature. Infections of the genitourinary tract infections along with various biological and genetic factors are considered to be the most common etiological factors for PT/LBW deliveries. However, evidence suggests that sub-clinical infection sites that are also distant from the genitor-urinary tract may be an important cause for PT/LBW deliveries. Maternal periodontal status has also been reported by many authors as a possible risk factor for PT and LBW, though not all of the actual data support such hypothesis. The aim of this paper is to review the evidence from various published literature on the association between the maternal periodontal status and adverse pregnancy outcomes. Although this review found a consistent association between periodontitis and PT/LBW, this finding should be treated with great caution until the sources of heterogeneity can be explained.

Association between carotid area calcifications and periodontal risk: a cross sectional study of panoramic radiographic findings

Background

The aim was to investigate the extent to which it is possible to diagnose suspected carotid calcification from dental panoramic radiography (PR) and to establish an association to periodontal risk.

Methods

824 PRs from one dental practice were investigated. Parameters considered were gender, age, bone loss - age index, tooth loss, periodontal risk and suspected carotid calcification (left, right, both sides). Periodontal risk was classified: low risk (under 4 missing teeth, bone loss - age index under 0.5), moderate risk (5 to 8 missing teeth and/or bone loss - age index 0.5 to 1.0) and high risk (more than 9 missing teeth and or bone loss - age index greater than 1.0).

Results

Of 824 patients, 349 were male (42.4%) and 475 female (57.6%); the mean age was 48.32 ± 16.52 years. In 9.0% (n = 74) of PRs, suspected carotid calcification was diagnosed (right: 5.5%, left: 2.3%, both sides: 1.2%). The mean tooth loss was 4.16 ± 5.39 teeth. In the case of 282 patients (34.2%), there was a low, in 335 patients (40.7%) a moderate, and in 207 patients (25.1%) a high periodontal risk. There was a significant correlation found between number of cases of suspected carotid calcification and periodontal risk, tooth loss and age (p = 0.0001). However, only age showed a significant association (OR: 4.9; CI: 2.4-9.8; p < 0.0001) in contrast to periodontal risk (OR 1.4; CI: 0.9-2.4).

Conclusion

PR can provides indication of carotid calcification as a secondary (chance) finding. In addition, periodontal risk may be correlated with positive findings of carotid calcification.

Evidence grade associating periodontitis with preterm birth and/or low birth weight: II: a systematic review of randomized trials evaluating the effects of periodontal treatment

AIM

The aim of this systematic review was to evaluate whether maternal periodontal disease treatment (MPDT) can reduce the incidence of preterm birth (PB) and/or low birth weight (LBW).

METHODS

The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were searched for entries up to October 2010 without restrictions regarding the language of publication. Only randomized-controlled clinical trials (RCTs) that evaluated the effect of MPDT on birth term and birth weight were included. The search was conducted by two independent reviewers and random-effects meta-analyses were conducted methodically.

RESULTS

Thirteen RCTs provided data, but only five trials were considered to be at a low risk of bias. The results of eight studies (61.5%) showed that MPDT may reduce the incidence of PB and/or LBW. However, the results of all meta-analyses showed contrasting results for PB [RR: 0.88 (95% CI: 0.72, 1.09)], LBW [RR: 0.78 (95% CI: 0.53, 1.17)] and PB/LBW [RR: 0.52 (95% CI: 0.08, 3.31)].

CONCLUSION

The results of this review show that MPDT did not decrease the risk of PB and/or LBW; however, the influence of specific aspects that were not investigated (disease diagnosis, extension and severity and the success of MPDT) should be evaluated by future RCTs.

Metabolic syndrome, insulin resistance, and periodontitis: a cross-sectional study in a middle-aged French population

AIM

Metabolic syndrome consists of a cluster of clinical and biological abnormalities, influenced by insulin resistance and promoting cardiovascular diseases. We examined the relationships between metabolic syndrome, its various components, insulin resistance, and periodontitis.

MATERIALS AND METHODS

The study included 276 subjects (35-74 years) recruited within a cross-sectional survey on cardiovascular risk factors. Twenty-one were excluded because of infectious risk or total tooth loss. Clinical attachment loss (CAL), probing pocket depth (PD), gingival and plaque indexes were recorded. Periodontitis was classified into moderate and severe forms.

RESULTS

The mean age was 58, 41% of the subjects had moderate and 39% had severe periodontitis. In univariate comparisons, periodontitis was associated with metabolic syndrome (p=0.050), most of its components, and HOMA index (homoeostasis model assessment of insulin resistance). After adjustment for confounders, only HOMA index remained associated with severe periodontitis (odds ratio [OR]=3.97 [95% confidence interval: 1.22-12.9], OR=3.78 [1.14-12.5] for third and fourth versus the first quartile of the HOMA index, respectively). The HOMA index was also associated with the number of periodontal sites with CAL>or=4 mm, CAL>or=5 mm, or PD>or=4 mm (greater number for higher HOMA-index values). This relationship disappeared in never-smokers.

CONCLUSIONS

Our data support the relationships between metabolic disturbances and periodontitis, with a central role of insulin resistance.

Prevalence of periodontal pathogens in subgingival lesions, atherosclerotic plaques and healthy blood vessels: a preliminary study

BACKGROUND AND OBJECTIVE

Previous studies have reported different periodontal bacteria in atherosclerotic lesions, but their involvement in plaque formation remains unclear. The aim of the present study was to investigate the presence of 20 periodontal bacteria in atherosclerotic samples and healthy blood vessels (used as controls) and to clarify their relationship in regard to clinical and bacteriological periodontal status.

MATERIAL AND METHODS

The day before vascular surgery the patients had a thorough periodontal examination and bacteriological samples were taken from periodontally diseased sites. Atheromatous plaques, internal mammary arteries and saphenous veins were harvested during surgery. A DNA-DNA hybridization procedure was used to screen periodontal and vascular samples for the 20 selected bacterial species.

RESULTS

Periodontal samples from the severe periodontitis group were found to have a higher prevalence and biomass of bacterial species than the moderate periodontitis group. In vessel samples, the prevalence of the same 20 bacterial species analyzed together was similar in the two groups, except for saphenous veins.

CONCLUSION

The presence of periodontal pathogens in atherosclerotic plaques and in apparently healthy vessels appeared to reflect a higher level of bacteremia rather than infection of endothelial cells.

The relationship between periodontitis and preterm low birthweight

There is no consensus about the influence of periodontal disease on preterm low birthweight. The objective was to investigate the relationship between periodontal disease and preterm low birthweight. A case-control study with 542 post partum women aged over 30 yrs was conducted. Three groups of cases were compared with non-preterm and non-low-birthweight control individuals (n = 393): low birthweight (n = 96), preterm (n = 110), and preterm and low birthweight (n = 63). Periodontal clinical parameters and covariates were recorded. Periodontal disease levels were higher in control individuals than in cases. The extent of periodontal disease did not increase risk of preterm low birthweight according to 15 measures of periodontal disease. Mean periodontal pocket depth and frequency of periodontal sites with clinical attachment level > or = 3 mm in preterm low birthweight cases were lower than in control individuals. Periodontal disease was not more severe in women with preterm low birthweight babies.

The Association Between Postmenopausal Osteoporosis and Periodontal Disease

BACKGROUND

The clinical importance of systemic bone loss as a contributory factor to alveolar bone loss and the subsequent loss of teeth merits further study, given that osteoporosis and periodontal disease lead to significantly increased morbidity and mortality and higher public expenditure of funds. This case-control study evaluated the association between osteoporosis and periodontal disease.

METHODS

The sample consisted of 139 postmenopausal women: 48 in the case group (with periodontal disease) and 91 in the control group (without periodontal disease). The diagnosis of periodontal disease was established following a complete clinical examination using measurements of probing depth, gingival recession and hyperplasia, clinical attachment loss, and bleeding index, and confirmed by panoramic radiography. The diagnosis of osteoporosis was made by reviewing densitometry reports obtained previously. Descriptive, stratified, and logistic regression analyses were applied to the data collected. Comparison of proportions was performed using the chi(2) and Fisher tests. Association measurements (odds ratios [ORs]) with and without adjustment for confounding factors and control for effect modifiers were obtained at a significance level of 5%.

RESULTS

The OR(unadjusted) for the principal association was 2.58 (95% confidence interval [CI]: 1.01 to 6.82). In subgroup analyses of the stratified model, the OR(unadjusted) for low education was 6.40 (95% CI: 1.77 to 23.18). When adjusted for smoking habit and age, the OR(adjusted) was 7.05 (95% CI: 1.90 to 26.19), which also was statistically significant.

CONCLUSION

Postmenopausal women with osteoporosis and low educational levels have a greater chance of having periodontal disease than do those without osteoporosis.

Pre-term delivery and periodontal disease: a case?control study from Croatia

AIM

The aim of this report was to assess the strength and influence of periodontitis as a possible risk factor for pre-term birth (PTB) in a cohort of 81 primiparous Croatian mothers aged 18-39 years.

METHODS

PTB cases (n = 17; mean age 25 +/- 2.9 years; age range 20-33 years) were defined as spontaneous delivery after less than 37 completed weeks of gestation that were followed by spontaneous labour or spontaneous rupture of membranes. Controls (full-time births) were normal births at or after 37 weeks of gestation (n = 64; mean age 25 +/- 2.9 years; age range 19-39 years). Information on known risk factors and obstetric factors included the current pregnancy history, maternal age at delivery, pre-natal care, nutritional status, tobacco use, alcohol use, genitourinary infections, vaginosis, gestational age, and birth weight. Full-mouth periodontal examination was performed on all mothers within 2 days of delivery.

RESULTS

PTB cases had significantly worse periodontal status than controls (p = 0.008). Multivariate logistic regression model, after controlling for other risk factors, demonstrated that periodontal disease is a significant independent risk factor for PTB, with an adjusted odds ratio of 8.13 for the PTB group (95% confidence interval 2.73-45.9).

CONCLUSION

Periodontal disease represents a strong, independent, and clinically significant risk factor for PTB in the studied cohort. There are strong indicators that periodontal therapy should form a part of preventive prenatal care in Croatia.

Periodontology as a recognized dental speciality in Europe

The impetus of the Bologna Process under the auspices of European Union governments has raised enormous expectations. It is the major educational change in Europe within the last 50 years and all the focus from university institutions, learned societies and thematic networks has shifted to this process, with the aim of developing consensus schemes in order to arrive at the expected European Convergence in Higher Education (to be completed by 2010). Dentistry as one of the health professions with clear Educational Standards, as defined by the European Dental Directives, is also reviewing its educational processes within this Bachelor-Master-Doctorate scheme and evaluating how the current and future dental specialities should be accommodated within this framework. Among these specialities, Periodontology is currently considered a formal dental speciality in 11 countries belonging to the EU however it lacks this legal status in the rest of the 14 EU countries. The purpose of this position paper is to provide evidence for the need for a recognized specialty in Periodontology at European level focusing on both the educational and professional perspective, with the hope of providing discussions that may contribute to facilitate its legal establishment as a new dental speciality in Europe.

Periodontal infections cause changes in traditional and novel cardiovascular risk factors: results from a randomized controlled clinical trial

BACKGROUND

Chronic infections, such as periodontitis, are associated with increased risk of systemic diseases driven by a persistent low-grade systemic inflammation and metabolic changes. Severity of periodontitis has also been associated with increased systolic blood pressure (BP). However, the issue remains poorly investigated. We aimed to estimate the effect of periodontal therapy on traditional and novel cardiovascular risk factors in systemically healthy individuals who have periodontitis.

METHODS

We enrolled 40 otherwise healthy patients with severe chronic generalized periodontitis in a 6-month pilot intervention trial. Individuals were randomized either to a standard course of periodontal therapy (subgingival scaling and root planing) or an intensive one (including the adjunctive use of a locally delivered antimicrobial, IPT).

RESULTS

Compared to control, IPT produced significant reductions in a cluster of inflammatory markers at 1 (P = .0406) and 2 (P = .0060) months together with an improvement in lipid markers at 2 (P = .0320) and 6 (P = .0432) months after therapy. Intensive periodontal therapy produced greater reductions in IL-6 at 1 (0.4 +/- 0.2 ng/L difference, 95% CI 0.03-0.9, P = .0284) and 2 months (0.3 +/- 0.2 ng/L difference, 95% CI 0.1-0.8, P = .0284), together with decreases in C-reactive protein (0.4 +/- 0.2 mg/L difference, 95% CI 0.01-0.8, P = .0438) and total cholesterol (0.3 +/- 0.1 mmol/L difference, 95% CI 0.04-0.6, P = .0254). Moreover, a 7 +/- 3-mm Hg decrease in systolic BP was observed at 2 months in the IPT group (95% CI 1-12, P = .0211), and this difference was greater in current smokers (14 +/- 5 mm Hg 95% CI 3-25, P = 0.0124). Intensive periodontal therapy subjects exhibited a 1.53% +/- 1.20% (95% CI 1.05-2.24, P = .0290) and 2.00% +/- 1.42% (95% CI 0.98-4.09, P = .0568) decreases in cardiovascular risk scores (Framingham) at 2 and 6 months, respectively, when compared to those in the standard group.

CONCLUSIONS

Our findings suggest that intensive periodontal treatment reduces systemic inflammatory markers and systolic BP, and improves lipid profiles with subsequent changes in cardiovascular risk when compared to standard therapy.

Oral health in women with pregnancy and delivery complications

Oral health was retrospectively studied in 207 women (mean age 30 years) in the Helsinki Womens' Hospital with the hypothesis that women with pregnancy complications and/or delivery complications would present poorer dental status than women without complications. Computerized dental records of the City of Helsinki Health Department were used with decayed, missing, filled index (DMF) and community periodontal index (CPI) scoring systems and a summary dental health index (DHI) was constructed for statistics. In 72%, the delivery was uncomplicated, while 18% had Caesarean section. Of the women, 8% had gestational diabetes, 7.1% had gestational hypertension, and 1.8% had preeclampsia. Fifteen (6.6%) preterm babies were born; eight (3.5%) babies weighed <2.500 g, seven (3.2%) received a 1-min Apgar point <7 indicating less than satisfactory state of the newborn. DMF was 12.9+/-6.6 in women without complications compared to 15.3+/-6.7 in women with complications (n.s.). CPI values did not differ between the groups. The mean DHI values were 2.07 in women with normal pregnancy complications and no delivery complications, 2.23 in those with pregnancy complications, and 2.13 in those with delivery complications, respectively. In logistic regression analysis, no oral health parameters associated with any complications. Thus, this study failed to show an association between poor dental health and pregnancy or delivery complications.

Associations Between Periodontal Disease and Systemic Disease: Evaluating the Strength of the Evidence

Much work has been published on the association between periodontal disease and systemic disease, including original reports, narrative reviews, systematic reviews, and meta-analyses. Based on the existent work, one can assign an evidence level and grade, using standard evidence-based criteria, to the data available in the four major categories of medical outcomes studied: cardiovascular/cerebrovascular, pregnancy, pulmonary, and diabetes. We discuss methodologic and conceptual problems in the study of oral-systemic associations, focusing as an example on the association between periodontal disease and cardiovascular/cerebrovascular disease. We argue that the hierarchical ranking of studies by levels of evidence may be misleading. In particular, while randomized controlled trials (RCTs) are needed to determine the efficacy of periodontal treatment to reduce the risk of cardiovascular events, they may be of limited value in determining the etiologic role of periodontal disease on coronary heart disease and stroke. We discuss limitations of RCTs as well as the limitations of currently available data from epidemiologic studies, including study design and confounding and misclassification errors. We conclude that well-designed observational studies into the associations between periodontal disease and systemic disease need to remain an integral component of future research efforts in order to fully understand such associations.