Causation and pathogenesis of periodontal disease

Injectable hypoxia-preconditioned human exfoliated deciduous teeth stem cells encapsulated within GelMA-AMP microspheres for bone regeneration in periodontitis

Periodontitis, an inflammatory and infectious disease resulting from dental plaque, affects tooth-supporting tissues and interconnects with various systemic conditions. Advancing periodontal tissue regeneration stands as pivotal in periodontitis treatment. Presently, odontogenic stem cells garner substantial interest for dental pulp functional tissue regeneration. Essential to stem cell delivery success is the design of suitable drug delivery vehicles. Hence, this research introduces novel injectable antimicrobial peptide-grafted methacryloyl gelatin (GelMA-AMP) microspheres, housing hypoxia-inducible factor (HIF-1α), ensuring sustained release to stimulate osteogenic differentiation of deciduous dental pulp stem cells (SHEDs). Through in vitro co-culturing and preparation of HIF-1α@GelMA-AMP@SHED cell spheres, they were injected and transplanted into periodontal pockets for periodontitis treatment. Results display microsphere sizes averaging 93.92 ± 6.00 μm, akin to human dental pulp, showcasing commendable cytocompatibility and in vitro antibacterial properties. Additionally, GelMA-AMP microspheres carrying HIF-1α enhance cell adhesion, proliferation, and extracellular matrix protein secretion. Notably, HIF-1α@GelMA-AMP@SHED microspheres were effective in reducing periodontal inflammation in vivo and promoting vascularization and tissue regeneration in the periodontal region. Consequently, the application potential of HIF-1α@GelMA-AMP@SHED hydrogel microspheres in periodontitis treatment appears promising.

Investigation of the preventive effect of methylsulfonylmethane on alveolar bone loss and oxidative stress in a rat model of periodontitis

BACKGROUND

To investigate the preventive efficacy of methylsulfonylmethane (MSM) on alveolar bone destruction in rats with periodontitis.

METHODS

Twenty-four male Sprague-Dawley rats were randomly divided into three groups: control, experimental periodontitis (Ep), and Ep-MSM. Periodontitis was induced by placing 4.0 silk sutures in the subparamarginal position on the necks of the mandibular first molars and applying the suture for 5 weeks. The Ep-MSM group was given 500 mg/body weight/day MSM intraperitoneally for 35 days. At the end of the study, bilateral mandibular samples were taken. Periodontal bone loss was measured through histologic sections. Histomorphometric and immunohistochemical (receptor activator of nuclear factor kappa B ligand (RANKL), osteoprotegerin (OPG)) evaluations were performed on right mandibular tissue samples, and biochemical (interleukin (IL)-1 beta (β)/IL-10, malondialdehyde (MDA), glutathione (GSH), oxidative stress index (OSI)) evaluations were performed on left mandibular tissue samples.

RESULTS

No significant difference was found between the groups in IL-1β and IL-1β/IL-10 values ​​(p > 0.05). A significant decrease in IL-10 levels was observed in the Ep-MSM and Ep groups compared with the control group (p < 0.05). MDA levels significantly increased in the Ep and Ep-MSM groups compared with the control group, and GSH levels significantly decreased in the Ep group compared with the other groups (p < 0.05). OSI values ​​were significantly higher only in the Ep group (p < 0.05). RANKL levels showed a significant increase in the Ep group compared with the other groups. OPG levels were significantly increased only in the Ep-MSM group (p < 0.05).

CONCLUSIONS

The results of this study may suggest that MSM has preventive effects on alveolar bone loss and oxidative stress.

Crosstalk between periodontitis and cardiovascular risk

Recent demographic developments resulted in an aged society with a rising disease burden of systemic and non-communicable diseases (NCDs). In cardiovascular disease (CVD), a NCD with high morbidity and mortality, recent preventive strategies include the investigation of comorbidities to reduce its significant economic burden. Periodontal disease, an oral bacterial-induced inflammatory disease of tooth-supporting tissue, is regulated in its prevalence and severity by the individual host response to a dysbiotic oral microbiota. Clinically, both NCDs are highly associated; however, shared risk factors such as smoking, obesity, type II diabetes mellitus and chronic stress represent only an insufficient explanation for the multifaceted interactions of both disease entities. Specifically, the crosstalk between both diseases is not yet fully understood. This review summarizes current knowledge on the clinical association of periodontitis and CVD, and elaborates on how periodontitis-induced pathophysiological mechanisms in patients may contribute to increased cardiovascular risk with focus on atherosclerosis. Clinical implications as well as current and future therapy considerations are discussed. Overall, this review supports novel scientific endeavors aiming at improving the quality of life with a comprehensive and integrated approach to improve well-being of the aging populations worldwide.

Preparation and Evaluation of Poloxamer/Carbopol In-Situ Gel Loaded with Quercetin: In-Vitro Drug Release and Cell Viability Study

BACKGROUND

Periodontitis is a severe chronic inflammatory disease, whose traditional systemic antimicrobial therapy faces great limitations. In-situ gels provide an effective solution as an emerging local drug delivery system.

METHODS

In this study, the novel thermosensitive poloxamer/carbopol in-situ gels loaded with 20 μmol/L quercetin for the treatment of periodontitis were prepared by cold method. Thirteen batches of in-situ gels based on two independent factors (X1: poloxamer 407 and X2: carbopol 934P) were designed and optimized by the statistical method of central composite design (CCD). The transparency, pH, injectability, viscosity, gelation temperature, gelation time, elasticity modulus, degradation rate and in-vitro drug release studies of the batches were evaluated, and the percentage of drug release in the first hour, the time required for 90% drug release, gelation temperature, and gelation time were selected as dependent variables.

RESULTS

These two independent factors significantly affected the four dependent variables (p < 0.05). The optimization result displayed that the optimized concentration of poloxamer 407 was 20.84% (w/v), and carbopol 934P was 0.5% (w/v). The optimized formulation showed a clear appearance (++), acceptable injectability (Pass), viscosity(151,798 mPa s), gelation temperature (36 °C), gelation time (213 s), preferable cell viability and cell proliferation, conformed to first-order release kinetics, and had a significant antibacterial effect.

CONCLUSIONS

The article demonstrates the great potential of the quercetin in-situ gel as an effective treatment for periodontitis.

Efficacy of Lycium barbarum (Goji berry) mouthwash for managing periodontitis: a randomized clinical trial

Background

Removal of the microbial deposits (plaque and calculus) by performing effective scaling and root planing (SRP) is the fundamental step for managing periodontal disease (gingivitis and periodontitis). Various adjuncts in the form of mouthwash, gels, and toothpaste are also being used as adjuncts to SRP for managing periodontitis. Recently, Lycium barbarum ( L. barbarum), commonly known as goji berry or wolfberry, has gained popularity for managing chronic inflammatory and infectious diseases. However, its efficacy in managing periodontitis has never been explored. Hence the present study aims to evaluate the efficacy of goji berry mouthwash compared to chlorhexidine mouthwash for managing periodontitis.

Methods

60 adult participants were divided randomly using computer-generated random sequences into two groups (case group: L. barbarum mouthwash (Males: 16; Female: 14); control group: 0.2% chlorhexidine gluconate mouthwash (Males: 14; Females: 16)). The changes in the gingival index (Gi), plaque index (Pi), bleeding on probing (BOP), clinical attachment loss (CAL), probing pocket depth (PPD), microbial load, and antioxidant levels (protein thiol) in saliva were noted at the baseline, at 15 days and one month.

Results

A significant reduction in the mean PPD, Pi, BOP, and Gi was seen from baseline to one month in both the control (P-value=0.006, 0.027, 0.000, and 0.036 respectively) and test groups (P-value=0.035, 0.000, 0.034, and 0.000 respectively). However, the antioxidant levels (protein thiol) in saliva were significantly increased only in the test group.

Conclusion

Goji berry mouthwash along with SRP reduced the Gi, Pi, BOP, and PPD in patients with periodontitis. However, no statistically significant difference was noted between the use of goji berry and chlorhexidine mouthwash. Goji berry mouthwash was more effective than chlorhexidine in increasing the antioxidant levels in saliva.

Effect of Er: YAG laser therapy in non-surgical periodontal treatment: an umbrella review

AIM

The current umbrella review aimed to summarize the effect of erbium-doped yttrium aluminum garnet (Er: YAG) laser adjunct with the conventional non-surgical periodontal treatment which was evidenced from available systematic reviews.

METHODS

An extensive literature search was piloted by two independent reviewers in the PubMed, Scopus, Science Direct, and Google Scholar databases. The search was limited to the English language from 2011 to 2023 years. The methodological quality of systematic reviews 2 (AMSTAR 2) guideline was followed to evaluate the risk of bias for the selected studies. Cohen's kappa statistic was implemented to evaluate the level of agreement to assess the risk of bias in the selected studies.

RESULTS

A total of 472 studies were initially identified. After removing the duplicates and screening, a total of four studies were selected for the current overview. Based on the quality assessment tool, each study scored as high, moderate, low, and critically low-quality study following AMSTAR 2 tool. Inter-rater reliability by Cohen's Kappa statistics showed near-perfect agreement (0.95) between the two reviewers.

CONCLUSION

Even though weak evidence of effectiveness was observed for Er: YAG laser application in non-surgical periodontal treatment, the clinical benefits are still lacking.

Periodontal diseases in Africa

Periodontal diseases, a group of complex conditions marked by an excessive immune response and periodontal tissue destruction, are a global health concern. Since 1990, the incidence of these diseases has doubled, with Western sub-Saharan Africa experiencing the highest burden. Accurate diagnosis and case identification are crucial for understanding the etiology, features of disease, research, treatment and prevention. Modern perspectives on periodontal disease classification are based on commonality among those affected. However, current literature is often plagued by methodological inconsistencies and focused on disease mechanisms in European populations. Health inequalities in low- and middle-income countries (LMICs) are exacerbated by these challenges, with sub-Saharan Africa, and Nigeria specifically, facing unique difficulties such as clinical personnel shortages and limited research infrastructure. This review explored disparities in periodontal disease research, care and outcomes in African populations. We highlighted these disparities and identified the factors contributing to inequities in periodontal health outcomes. We further demonstrated the critical need for inclusive and equitable healthcare and research practices tailored to the unique challenges faced by diverse populations and regions with limited resources. Addressing these disparities is essential for ensuring that advancements in healthcare are accessible to all, thereby improving global oral health and general health.

Analysis of immunogenic cell death in periodontitis based on scRNA-seq and bulk RNA-seq data

Background

Recent studies have suggested that cell death may be involved in bone loss or the resolution of inflammation in periodontitis. Immunogenic cell death (ICD), a recently identified cell death pathway, may be involved in the development of this disease.

Methods

By analyzing single-cell RNA sequencing (scRNA-seq) for periodontitis and scoring gene set activity, we identified cell populations associated with ICD, which were further verified by qPCR, enzyme linked immunosorbent assay (ELISA) and immunofluorescence (IF) staining. By combining the bulk transcriptome and applying machine learning methods, we identified several potential ICD-related hub genes, which were then used to build diagnostic models. Subsequently, consensus clustering analysis was performed to identify ICD-associated subtypes, and multiple bioinformatics algorithms were used to investigate differences in immune cells and pathways between subtypes. Finally, qPCR and immunohistochemical staining were performed to validate the accuracy of the models.

Results

Single-cell gene set activity analysis found that in non-immune cells, fibroblasts had a higher ICD activity score, and KEGG results showed that fibroblasts were enriched in a variety of ICD-related pathways. qPCR, Elisa and IF further verified the accuracy of the results. From the bulk transcriptome, we identified 11 differentially expressed genes (DEGs) associated with ICD, and machine learning methods further identified 5 hub genes associated with ICD. Consensus cluster analysis based on these 5 genes showed that there were differences in immune cells and immune functions among subtypes associated with ICD. Finally, qPCR and immunohistochemistry confirmed the ability of these five genes as biomarkers for the diagnosis of periodontitis.

Conclusion

Fibroblasts may be the main cell source of ICD in periodontitis. Adaptive immune responses driven by ICD may be one of the pathogenesis of periodontitis. Five key genes associated with ICD (ENTPD1, TLR4, LY96, PRF1 and P2RX7) may be diagnostic biomarkers of periodontitis and future therapeutic targets.

Association of ABO phenotype, rhesus factor, platelet count and hemoglobin level with oral hygiene status and severity of chronic periodontitis

Background

The development of periodontal diseases has multifactorial causes including genetic factors. Limited investigations have been conducted to explore the association between ABO blood groups and the development and progression of periodontal diseases.

Aim

To evaluate and assess the association of ABO Phenotype and Rhesus factor with oral hygiene status, severity of chronic periodontitis and blood parameters like hemoglobin level and Platelet count in localized and generalized chronic periodontitis.

Material and methods

Study was carried out on 100 patients, out of which 80 patients of Generalized Chronic Periodontitis and 20 patients of Localized Chronic Periodontitis. Patients were categorized into Mild, Moderate and Severe Periodontitis.

Result

A highly significant association was found between severity of periodontitis and blood groups with blood group B and O were found to be at a greater risk to develop moderate to severe form of chronic periodontitis. Also subjects with blood group B and O showed worst oral hygiene among all the blood groups. Also patients suffering from chronic periodontitis showed a general trend towards lower limit of both hemoglobin level and platelet.

Conclusion

Genetic factors such as ABO blood group antigens may act as a risk influencer that plays a role in progression and severity of the chronic periodontitis, with blood group B and O being worst affected. Another observation was that a long standing case of chronic periodontitis can lead to anemia thus having systemic implications.

Periodontal pathogens and cancer development

Increasing evidence suggests a significant association between periodontal disease and the occurrence of various cancers. The carcinogenic potential of several periodontal pathogens has been substantiated in vitro and in vivo. This review provides a comprehensive overview of the diverse mechanisms employed by different periodontal pathogens in the development of cancer. These mechanisms induce chronic inflammation, inhibit the host's immune system, activate cell invasion and proliferation, possess anti-apoptotic activity, and produce carcinogenic substances. Elucidating these mechanisms might provide new insights for developing novel approaches for tumor prevention, therapeutic purposes, and survival improvement.

Association between the number of existing teeth and maintenance dialysis therapy: A cross-sectional study of adult male dentists

Dental caries and periodontal disease are typical oral diseases frequently observed in patients with renal diseases. Tooth loss is an outcome of dental caries and periodontal disease, and the number of existing teeth is an indicator of oral health status. However, the association between the number of existing teeth and end-stage kidney disease (ESKD) has not been investigated in detail. This study aimed to investigate the association between oral health status, expressed by the number of existing teeth, and ESKD. We analyzed data from the second survey of the Longitudinal Evaluation of Multi-phasic, Odontological, and Nutritional Associations in Dentists, a cohort study conducted among members of the Japan Dental Association. From August 2016 to July 2017, self-administered questionnaires were mailed to 16,128 male dentists and 8,722 responded. Among them, 7,479 men with complete data on age, number of existing teeth, and ESKD were included in the analysis. Multivariate logistic regression analysis was conducted, with ESKD as the dependent variable and the number of existing teeth (≥23 teeth and <23 teeth) as the independent variable. Subgroup analysis by age (<65 years and ≥65 years) was also conducted. The <23 teeth group had a significantly higher rate of ESKD than did the ≥23 teeth group. After adjusting for age, body mass index, smoking habits, hypertension, and diabetes mellitus, there was no significant association between having <23 teeth and ESKD in all participants. However, the subgroup analysis revealed a significant association after adjustment for covariates in participants aged <65 years but not in those aged ≥65 years. In conclusion, having <23 teeth was associated with the risk of requiring maintenance dialysis therapy among Japanese men aged <65 years. Therefore, tooth loss may be associated with renal function decline.

Clinical efficacy of green tea, aloe vera and chlorhexidine mouthwashes in the treatment of dental biofilm induced gingivitis: A multi-arm, double-blinded, randomized controlled clinical trial

OBJECTIVE

This multi-arm, randomized, double-blinded, controlled clinical trial was designed to evaluate the clinical efficacy of 0.5% green tea (GT), 0.2% chlorhexidine (CHX) and aloe vera (AV) mouthwash as compared to the control (CNT) group (scaling and polishing alone with no mouthwash) in the management of dental biofilm induced gingivitis among 18-40-year-old patients.

MATERIAL AND METHODS

Sixty patients with generalized dental biofilm-induced gingivitis were randomly allocated to four study groups (n = 15 each) for treatment, namely Group GT, Group CHX, Group AV and Group CNT after scaling and polishing were administered to all the patients. Plaque index (PI), gingival index (GI) and sulcular bleeding index (SBI) were recorded at baseline, 14th and 21st day.

RESULTS

PI, GI and SBI at various time intervals (baseline, 14th and 21st day) showed high statistically significant differences within the group (p < 0.01). Among these, the maximum percentage change was found in the CHX group followed by GT when evaluated from baseline to 21st day. The least percentage change was found in the AV group for PI and GI while the CNT group showed the least percentage change for sulcular index when evaluated from 14th to 21st day. Inter-group results showed high statistically significant differences (p < 0.01) for PI and GI when evaluated between baseline to 14th day and baseline to 21st day. SBI also showed statistically significant differences (p < 0.05) when evaluated between baselines to 14th day and baseline to 21st day.

CONCLUSION

Green tea mouthwash displayed a significant reduction in plaque index, gingival index and sulcular bleeding index. 0.5% green tea catechin has equivalent anti-plaque efficacy as 0.2% chlorhexidine gluconate and can be considered a potent alternative to prevent and treat gingival diseases.

Treatment of Intrabony Defects with Non-Surgical Subgingival Debridement: A Radiographic Evaluation of Bone Gain Using an Experimental Digital Software "Bone Defect Analysis (BDA)"

Background: The aim of this study was to retrospectively evaluate the 3-year radiographic outcomes of periodontal intrabony defects treated with non-surgical subgingival therapy (NST), assessing radiographic bone gain (RBG) through experimental digital software, named "Bone Defect Analysis (BDA)". Methods: The study included 17 intrabony defects in 14 patients. BDA software (version 1) was used on radiographs to calculate RBG (in %) and variations in defect angle (in °) between baseline (T0) and 3-year follow-up (T1). Soft tissue conditions were registered, reporting bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL). Defects were analyzed according to angles less (group A) or greater (group B) than 30°. Results: Nine and eight defects were, respectively, analyzed in groups A and B. Three years after treatment, an average RBG of 12.28% was found overall, with 13.25% and 10.11% for groups A and B, respectively (p = 0.28). Clinically, a mean CAL of 6.05 mm at T1 (from 10.94 mm at T0) was found, with 6.88 mm and 5.12 mm in groups A and B, respectively (p = 0.07). Conclusions: BDA software demonstrated predictability in the evaluation of bone variations after NST, revealing better clinical findings for intrabony defects with an initial smaller angle.

Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients

Objectives

This narrative review aims to update the current evidence and offer insight into the new non-invasive ultrasound techniques used to early identify degenerative vascular changes in subjects with periodontitis and to investigate if these methodologies could be useful to identify subclinical cardiovascular disease (CVD) dysfunction in periodontitis patients and to monitor changes in CVD risk after periodontal treatment.

Methods

Studies examining the assessment of vascular endothelial function through the latest methodologies were analyzed. Systematic reviews, observational studies, and clinical trials in the English language were identified using PubMed, Web of Science, and Google Scholar databases with key search terms such as "periodontitis," "endothelial dysfunction (ED)," "arterial stiffness," and "periodontal therapy."

Results

Several mechanisms are involved in the association between periodontitis and CVD. The key players are periodontal bacteria and their toxins, which can enter the circulation and infiltrate blood vessel walls. The increase in proinflammatory molecules such as interleukins and chemokines, c-reactive protein, fibrinogen, and oxidative stress also plays a decisive role. In addition, an increase in parameters of ED, arterial stiffness, and atherosclerosis, such as carotid intima-media thickness, pulse wave velocity, and flow-mediated dilatation, has been shown in periodontal patients.

Conclusions

The literature today agrees on the association of periodontitis and CVD and the positive role of periodontal therapy on systemic inflammatory indices and cardiovascular outcomes. Hopefully, these non-invasive methodologies could be extended to periodontal patients to provide a comprehensive understanding of the CVD-periodontitis link from the perspective of a personalized medicine approach in periodontology.

Effect of non-surgical periodontal therapy on salivary and gingival crevicular fluid concentration of visfatin in periodontal health and disease

Background and objective

Visfatin, a pleotropic mediator mostly produced by visceral fat, is crucial in controlling the immunological and defensive systems. It serves the roles of a cytokine, an enzyme involved in energy metabolism, and a growth factor. The objective of the present study was to assess the impact of non-surgical periodontal therapy (scaling and root planing) on visfatin concentrations in saliva and gingival crevicular fluid in individuals with Periodontitis (stage-II grade-A).

Materials and methods

54 individuals were divided into Group A (Periodontally Healthy) and Group B1(Periodontitis baseline) based on periodontal parameters including plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), and radiographic parameters. After NSPT (SRP), Group B1 patients were recalled after 4 weeks, constituting Group B2 (post NSPT group B1). At baseline and 4 weeks after non-surgical periodontal therapy (SRP), all clinical parameters, salivary and GCF samples were recorded. An ELISA kit was used to measure the levels of visfatin. Using the paired t-test, unpaired t-test, and Pearson's correlation coefficient, data were analysed using SPSS 15.

Results

After non-surgical periodontal treatment (SRP), the mean salivary and gingival crevicular fluid concentration of visfatin considerably decreased to a level comparable to periodontal health. In all groups, GCF visfatin concentration was higher than salivary concentration of visfatin. In periodontitis patients, visfatin concentration in GCF was 1.5 times higher than in saliva.

Conclusion

The results of this investigation suggest a direct correlation between salivary and gingival crevicular fluid visfatin concentration and periodontal tissue inflammation and disease activity.

Herbal Formulation of High Phenols and Flavonoids with the Extract of Phyllanthus emblica, Punica granatum, and Illicium verum and Assessment of Hematotoxicity Assay: An In vitro Study

BACKGROUND

A growing number of consumers are embracing the philosophy that natural products are better for their health and the environment. As such, they are seeking products they perceive to be safer, healthier, and without toxic chemical or synthetic ingredients. Natural products are gentle enough for daily use and provide a less abrasive alternative to more potent prescription formulations meant for short-term use. Herbal antimicrobial and antioxidant mouth rinses are considered effective adjuncts to toothbrushing and flossing for patients having gingivitis who have undergone implant treatment, providing a clinically significant benefit in the reduction of dental plaque, and also being antioxidant in nature.

MATERIALS AND METHODS

Three types of plant species were taken into consideration. Phyllanthus emblica fruit, Punica granatum flower, and Illicium verum fruit and seed were collected from the native trees of Chennai, Tamil Nadu.

RESULTS AND CONCLUSION

We conclude that P. emblica fruit, P. granatum flower, and I. verum fruit and seed exhibit large amounts of flavonoids, phenolics, and tannins. This study also shows that these samples can be used in clinical practice as it has less hematotoxixity percentage. P. granatum that is a pomegranate flower shows a high positive percentage in the presence of flavonoids and phenols. These plant extracts can be used in further studies and in clinical use as mouthwash or topical gel by adding preservatives and flavoring agents.

Bidirectional Association between Periodontitis and Thyroid Disease: A Scoping Review

Periodontitis is a chronic inflammatory disease of the tissues surrounding and supporting the teeth. Due to the development of chronic inflammation, periodontitis can contribute to the development of several systemic diseases, including thyroid disease. Thyroid pathology includes benign, malignant, and autoimmune conditions leading to hypothyroidism, hyperthyroidism, or euthyroidism. Alterations in thyroid hormones, especially hypothyroidism, can reveal significant oral manifestations, including periodontitis. This scoping review aims to explore the probable causal relationship between periodontitis and thyroid disease, in terms of epidemiology, pathogenesis, and treatment. The search strategy follows the PRISMA-ScR guidelines. PubMed, Scopus, Web of Science, and Cochrane were searched from January 2014 to January 2024, entering the MESH terms "periodontitis" and "thyroid". Of 153 initial records, 20 articles were selected and discussed. There is a high prevalence of periodontitis among patients with thyroid disease, including thyroid cancer. The causes at the basis of this association are genetic factors, the oral microbiome, and proinflammatory cytokines. Periodontal treatment, specifically scaling and root planning, can ameliorate thyroid parameters. Although there are a few randomized controlled studies in the literature, this review lays the foundation for a bidirectional relationship between periodontitis and thyroid disease, the link to which is, once again, systemic inflammation.

Impaired oral health: a required companion of bacterial aspiration pneumonia

Laryngotracheal aspiration has a widely-held reputation as a primary cause of lower respiratory infections, such as pneumonia, and is a major concern of care providers of the seriously ill orelderly frail patient. Laryngeal mechanical inefficiency resulting in aspiration into the lower respiratory tract, by itself, is not the cause of pneumonia. It is but one of several factors that must be present simultaneously for pneumonia to develop. Aspiration of oral and gastric contentsoccurs often in healthy people of all ages and without significant pulmonary consequences. Inthe seriously ill or elderly frail patient, higher concentrations of pathogens in the contents of theaspirate are the primary catalyst for pulmonary infection development if in an immunocompromised lower respiratory system. The oral cavity is a complex and ever changing eco-environment striving to maintain homogeneity among the numerous microbial communities inhabiting its surfaces. Poor maintenance of these surfaces to prevent infection can result inpathogenic changes to these microbial communities and, with subsequent proliferation, can altermicrobial communities in the tracheal and bronchial passages. Higher bacterial pathogen concentrations mixing with oral secretions, or with foods, when aspirated into an immunecompromised lower respiratory complex, may result in bacterial aspiration pneumonia development, or other respiratory or systemic diseases. A large volume of clinical evidence makes it clear that oral cleaning regimens, when used in caring for ill or frail patients in hospitals and long-term care facilities, drastically reduce the incidence of respiratory infection and death. The purpose of this narrative review is to examine oral health as a required causative companionin bacterial aspiration pneumonia development, and the effectiveness of oral infection control inthe prevention of this disease.

The impact of different states of type 2 diabetes when stratified by baseline HbA1c on the periodontal outcomes of non-surgical periodontal treatment: A systematic review and network meta-analysis

BACKGROUND

Type 2 diabetes mellitus (T2DM) has been considered by many studies to have a bidirectional relationship with periodontitis. This systematic review and network meta-analysis aimed to investigate the impact of different states of T2DM when stratified by baseline HbA1c on the clinical outcomes of non-surgical periodontal treatment (NSPT).

METHODS

This study followed the Preferred Reporting Items for Meta-Analyses (PRISMA) guidelines and involved an electronic literature search (from inception to the 2nd of January 2023). The study included at least two groups of patients: chronic periodontitis only (No-DM) or periodontitis and well-controlled/poorly controlled type 2 diabetes mellitus (WC/PC-T2DM). Clinical outcomes included probing depth (PD) reduction, bleeding on probing reduction, and clinical attachment level (CAL) gain. Direct and indirect comparisons between groups were assessed by network meta-analysis, thus allowing us to establish a treatment ranking.

RESULTS

Ten prospective cohort studies (11 data sets) were included for qualitative analysis and network meta-analysis. The data included in this study had high consistency; in addition, a funnel plot and Egger's test showed that the articles had low publication bias. Network meta-analysis showed that the effect of NSPT in the No-DM group was significantly better than the WC-T2DM group [weighted mean difference (WMD) = 0.09, 95% confidence interval (CI) (0.01, 0.18)] and the PC-T2DM group [WMD = 0.09, 95% CI (0.01, 0.18)] in terms of CAL gain and better than the PC-T2DM group [WMD = 0.15, 95% CI (0.02, 0.28)] in terms of PD reduction. According to the surface under the cumulative ranking value, the No-DM group had the highest probability of achieving the best outcome following NSPT.

CONCLUSIONS

Collectively, our analyses show that T2DM exerts significant effects on the outcomes of NSPT.

Clinical Use of Paraprobiotics for Pregnant Women with Periodontitis: Randomized Clinical Trial

Periodontal disease is very common in pregnant women. Paraprobiotics are a subset of probiotics. They can be defined as inactivated microbial cells providing health benefits to the host and are considered particularly safe. The aim of this study was to compare the periodontal health of pregnant women and puerperae after 6 months of home use of paraprobiotics. A total of 30 pregnant women were enrolled and divided into two groups: the test group, who had to use a paraprobiotic-based toothpaste (Biorepair Peribioma Pro, Coswell S.p.A., Funo di Argelato, BO, Italy) and mousse (Mousse Mouthwash Biorepair Peribioma, Coswell S.p.A.) twice a day, and the control group, who had to use only the paraprobiotic-based toothpaste. The time frames of the study were: 1 month (T1), 3 months (T2) and 6 months (T3), and data were collected during pregnancy and in the period immediately following delivery. The following indices were evaluated at T0, T1, T2 and T3: clinical attachment loss (CAL), probing pocket depth (PPD), bleeding on probing (BOP), plaque control record (PCR), modified marginal gingival index (mMGI), papillary marginal gingival index (PMGI) and recessions (R). All data were subjected to statistical analysis. PCR decreased significantly from T0 to T1 in the control group and from T0 to T2 and from T0 to T3 in the test group. BOP tended to decrease in both groups, but a significant reduction was observed only in the test group. CAL, PPD, PMGI and mMGI tended to decrease gradually in both groups without significant differences between or within groups. The combination of the paraprobiotic-based toothpaste and the paraprobiotic-based mousse significantly reduced BoP and plaque control over time, although there were no significant differences with the use of the paraprobiotic-based toothpaste alone. In addition, the combination of the two products promoted a trend towards the better stabilization of recessions.

Genetic evidence strengthens the bidirectional connection between oral health status and psychiatric disorders: A two-sample Mendelian randomization study

BACKGROUND

Observational studies cannot accurately infer the causal associations between oral health status and psychiatric disorders.

METHODS

We conducted univariate and multivariate Mendelian randomization (MR) analyses using single nucleotide polymorphisms (SNPs) associated with eight oral health statuses (periodontitis, DMFS, Nteeth, toothache, loose teeth, painful gums, bleeding gums, and mouth ulcers) and four psychiatric disorders (Schizophrenia, Major Depressive Disorder (MDD), anxiety and stress-related disorder (ASRD), and Bipolar Disorder (BIP)) as instrumental variables. Genetic data were sourced from the Gene-lifestyle interactions in dental endpoints (GLIDE), UK Biobank, Psychiatric Genomics Consortium (PGC), and Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH). The inverse variance-weighted (IVW) approach, supported by a comprehensive sensitivity analysis, was employed.

RESULTS

Genetically predicted mouth ulcers were significantly linked to higher MDD (OR = 2.17, 95 % CI: 1.33--3.54, P< 0.01) and BIP risks (OR = 2.25, 95 % CI: 1.22-4.15, P = 0.01). BIP heightened bleeding gums risk (OR = 1.01, 95 % CI: 1.00-1.01, P < 0.01). These associations were adjusted for smoking status and alcohol consumption. Painful gums were significantly associated with MDD risk (OR = 96.48, 95 % CI: 2.66-3495.28, P = 0.01), while MDD raised periodontitis risk (OR = 2.15, 95 % CI: 1.24-3.75, P = 0.01), both confounded by smoking and alcohol. Relatively small effects between several variables, while others could not withstand correction for multiple tests.

LIMITATIONS

The sample size and limitation to European populations limits the study generalizability.

CONCLUSIONS

This study provide evidence of possible causal relationships between several oral health conditions and mental illness. Focusing on oral health and valuing mental health are important for each other and overall health.

Triptolide mitigates the inhibition of osteogenesis induced by TNF-α in human periodontal ligament stem cells via the p-IκBα/NF-κB signaling pathway: an in-vitro study

BACKGROUND

Triptolide is a widely utilized natural anti-inflammatory drug in clinical practice. Aim of this study was to evaluate effects of triptolide on hPDLSCs osteogenesis in an inflammatory setting and to investigate underlying mechanisms.

METHODS

Using the tissue block method to obtain hPDLSCs from extracted premolar or third molar. Flow cytometry, osteogenic and adipogenic induction were carried out in order to characterise the features of the cells acquired. hPDLSC proliferative activity was assessed by CCK-8 assay to determine the effect of TNF-α and/or triptolide. The impact of triptolide on the osteogenic differentiation of hPDLSCs was investigated by ALP staining and quantification. Osteogenesis-associated genes and proteins expression level were assessed through PCR and Western blotting assay. Finally, BAY-117,082 was used to study the NF-κB pathway.

RESULTS

In the group treated with TNF-α, there was an elevation in inflammation levels while osteogenic ability and the expression of both osteogenesis-associated genes and proteins decreased. In the group co-treated with TNF-α and triptolide, inflammation levels were reduced and osteogenic ability as well as the expression of both osteogenesis-associated genes and proteins were enhanced. At the end of the experiment, both triptolide and BAY-117,082 exerted similar inhibitory effects on the NF-κB pathway.

CONCLUSION

The osteogenic inhibition of hPDLSCs by TNF-α can be alleviated through triptolide, with the involvement of the p-IκBα/NF-κB pathway in this mechanism.

Animal disease evidenced in the bone assemblage of a Late Neolithic settlement in Greece: Implications for animal management

OBJECTIVES

The objective of the paper is to interpret pathologies on faunal remains in an effort to evaluate the presence of husbandry practices.

MATERIALS

Bones and bone fragments from the Neolithic site of Dispilio, Greece. Those of domestic species were further studied.

METHODS

The pathological cases were examined macroscopically, the lesions were described, images were taken, and differential diagnoses were undertaken using published literature.

RESULTS

77 out of the 13,026 bones and bone fragments recovered displayed pathological conditions including oral disease, joint disease, trauma and congenital conditions. Most pathologies were found in the axial skeleton of caprines.

CONCLUSIONS

Pathological conditions in caprines are possibly related to the use of overgrazed pastures and fattening of females and castrates. These cases indicate specific husbandry practices used at the site.

SIGNIFICANCE

Reconstructing husbandry practices is complex, especially in extremely old sites with fragmentary remains. This study provides one of the very few studies of a large Neolithic animal bone assemblage providing insight into early human-animal interactions in Greece.

LIMITATIONS

The research is based on the bone material of the two later occupation phases of the site. It includes material from one site.

SUGGESTIONS FOR FURTHER RESEARCH

The bone assemblage of the earlier occupation phase should be studied for a diachronic investigation of husbandry practices at the site. Investigation of pathological cases in more settlements would provide a larger database for the evaluation of husbandry practices in Neolithic Greece.

Characterization of Chitosan-Gallic Acid Graft Copolymer for Periodontal Dressing Hydrogel Application

The postoperative periodontal wound is in a complex physiological environment; the bacteria accumulation, the saliva stimulation, and the food residues retention will aggravate the wound deterioration. Commercial periodontal dressings have been widely used for postoperative periodontal treatment, and there still exists some problems, such as poor biocompatibility, weak adhesion, insufficient antibacterial, and anti-inflammatory properties. In this study, a chitosan-gallic acid graft copolymer (CS-GA) is synthesized as a potential periodontal dressing hydrogel. CS-GA possesses high swelling rate, adjustable degradability, self-healing ability, biocompatibility, strong adhesion ability, high mechanical properties and toughness. Furthermore, CS-GA has good scavenging ability for ·OH, O2 - , and 1 O2. And CS-GA has good inhibition effect on different bacterial through bacterial membranes damage. CS-GA can stop bleeding in a short time and adsorb erythrocytes to form physical blood clots to enhance the hemostatic performance. In addition, CS-GA can reduce inflammatory factors expressions, increase collagen fibers deposition, and neovascularization to promote wounds healing, which makes it as a potential periodontal dressing for postoperative tissue restoration.

Salivary and serum nitric oxide synthase, macrophage inflammatory protein 1 alpha and macrophage migration inhibitory factor levels in periodontal disease

Objective

Periodontal disease is multifactorial inflammatory disease involving both gingivitis and periodontitis. Inducible nitric oxide synthase (iNOS), macrophage inflammatory protein 1 alpha (MIP-1α) and macrophage migration inhibitory factor (MIF) are mediators contributing to the progression of periodontal diseases with distinct functions. The aim of this study is to evaluate the local and systemic iNOS, MIP-1α and MIF concentrations in patients having periodontal disease with different severities.

Design

The study was conducted on 88 individuals equally divided into four groups; 1) Periodontally Healthy 2) Gingivitis 3) Stage I-II Periodontitis 4) Stage III-IV Periodontitis. Saliva and serum samples were obtained from each individual and then periodontal examinations were performed. Plaque and bleeding on probing indexes, probing depths and clinical attachment levels were measured on each tooth to determine the periodontal status. Concentrations of iNOS, MIP-1α and MIF were measured with enzyme-linked immunosorbent assay.

Results

Patients with stage I-II and stage III-IV periodontitis had more iNOS levels than periodontally healthy people in serum and saliva (p ≤ 0,001 for serum; p < 0,05 for saliva). Stage III-IV periodontitis group had significantly more serum-iNOS levels than that in gingivitis group (p = 0,005). When compared with periodontally healthy individuals, MIP-1α levels in stage III-IV periodontitis patients were measured significantly more in saliva; (p = 0,016) but less in serum (p = 0,006) samples. More serum-MIF concentrations were observed in stage I-II periodontitis groups than that in periodontally healthy individuals (p < 0,05).

Conclusion

Increased salivary and serum iNOS and serum-MIF levels in different stages of periodontitis suggest that these molecules might be involved in periodontal disease pathogenesis. Also, oral microenvironment may stimulate the enhanced MIP-1α concentration in advanced periodontitis cases.

Scanning electron microscopic analysis of 5% glycolic acid as a novel alternative to 17% ethylenediaminetetraacetic acid in root biomodification: An in vitro study

Background

Nonsurgical periodontal therapy results in the formation of a smear layer which inhibits tissue regeneration. Root biomodification (RB) using various agents has been tried for the enhancement of new attachment formation. However, no substantial therapeutic advantages of currently available root conditioning agents have been reported emphasizing the need for additional biologically acceptable agents. Glycolic acid (GA) due to its antimicrobial nature and ability of initiation and proliferation of fibroblasts may potentially modify root surface enabling regeneration.

Materials and Methods

Eighty specimens from 40 single-rooted teeth were treated with 17% ethylenediaminetetraacetic acid (EDTA) and 5% GA and scanning electron microscopy analysis was done. The micrographs were examined for the evaluation of smear layer removal, total number of dentinal tubules, total number of patent dentinal tubules, mean diameter and surface area of dentinal tubules, and dentin erosion. Statistical analysis was done using unpaired t-test for intergroup comparison.

Results

The efficacy of smear layer removal (P = 0.01) and dentin erosion (P = 0.042) was significantly better in the GA group. Both the groups showed no difference in dentinal tubule-related parameters.

Conclusion

GA showed improved RB with greater smear layer removal and lesser dentin erosion, indicating its use as a potent alternative to the conventional EDTA root conditioning.

Immunoaffinity-enriched salivary small extracellular vesicles in periodontitis

Aim

aliva extracellular vesicles (EVs) serve as a significant reservoir of biomarkers that may be of clinical use in disease diagnosis. Saliva, however, contains EVs of both host- and bacterial- origin. Identifying suitable EVs for disease diagnosis involves enriching host EVs and limiting non-host contamination with effective isolation methods. The objectives of this research were: (1) to evaluate the salivary EVs enrichment in 12 periodontally healthy patients by two different methods: size exclusion chromatography (SEC) and bead-based immunoaffinity capture (EXO-NET®); (2) to analyze the variance expression of inflammatory cytokines in EXO-NET-enriched EVs, comparing individuals with periodontitis (n = 20) to non-periodontitis (n = 12).

Methods

Whole unstimulated saliva samples were collected from 12 periodontally healthy and 20 periodontitis patients. EVs were isolated from the 12 non-periodontitis patients using SEC (referred to as SEC-EVs) and EXO-NET (referred to as EXO-NET EVs), after which their total protein content, 37 EV surface markers, and bacterial pathogens expression were compared. Subsequently, the inflammatory cytokines expression levels (interleukin-IL-6, IL-1β, IL-8, and IL-10) in EXO-NET EVs were measured for non-periodontitis and periodontitis.

Results

EXO-NET EVs contained more EV-specific protein and substantially higher expression of EV surface markers (CD9, CD81, CD63), but less pathogenic DNA was detected compared to that in SEC-EVs. Additionally, EXO-NET EVs from periodontitis patients contained higher amounts of IL-6 and IL-8, and decreased IL-10, compared to those from non-periodontitis patients.

Conclusion

The findings suggest that immunoaffinity capture (EXO-NET) is a dependable method for salivary EVs enrichment, resulting in a higher yield of host EVs with reduced bacterial DNA detection compared to SEC. Furthermore, the research proposes that immunoaffinity capture enriched EVs can function as biomarkers for periodontitis, demonstrated by an increased expression of proinflammatory cytokines from periodontitis patients.

Mesenchymal stem cell-derived apoptotic bodies alleviate alveolar bone destruction by regulating osteoclast differentiation and function

Periodontitis is caused by overactive osteoclast activity that results in the loss of periodontal supporting tissue and mesenchymal stem cells (MSCs) are essential for periodontal regeneration. However, the hypoxic periodontal microenvironment during periodontitis induces the apoptosis of MSCs. Apoptotic bodies (ABs) are the major product of apoptotic cells and have been attracting increased attention as potential mediators for periodontitis treatment, thus we investigated the effects of ABs derived from MSCs on periodontitis. MSCs were derived from bone marrows of mice and were cultured under hypoxic conditions for 72 h, after which ABs were isolated from the culture supernatant using a multi-filtration system. The results demonstrate that ABs derived from MSCs inhibited osteoclast differentiation and alveolar bone resorption. miRNA array analysis showed that miR-223-3p is highly enriched in those ABs and is critical for their therapeutic effects. Targetscan and luciferase activity results confirmed that Itgb1 is targeted by miR-223-3p, which interferes with the function of osteoclasts. Additionally, DC-STAMP is a key regulator that mediates membrane infusion. ABs and pre-osteoclasts expressed high levels of DC-STAMP on their membranes, which mediates the engulfment of ABs by pre-osteoclasts. ABs with knock-down of DC-STAMP failed to be engulfed by pre-osteoclasts. Collectively, MSC-derived ABs are targeted to be engulfed by pre-osteoclasts via DC-STAMP, which rescued alveolar bone loss by transferring miR-223-3p to osteoclasts, which in turn led to the attenuation of their differentiation and bone resorption. These results suggest that MSC-derived ABs are promising therapeutic agents for the treatment of periodontitis.

A Bacterial Nanomedicine Combines Photodynamic-Immunotherapy and Chemotherapy for Enhanced Treatment of Oral Squamous Cell Carcinoma

Bacterial therapy is an emerging hotspot in tumor immunotherapy, which can initiate antitumor immune activation through multiple mechanisms. Porphyromonas gingivalis (Pg), a pathogenic bacterium inhabiting the oral cavity, contains a great deal of pathogen associated molecular patterns that can activate various innate immune cells to promote antitumor immunity. Owing to the presence of protoporphyrin IX (PpIX), Pg is also an excellent photosensitizer for photodynamic therapy (PDT) via the in situ generation of reactive oxygen species. This study reports a bacterial nanomedicine (nmPg) fabricated from Pg through lysozyme degradation, ammonium chloride lysis, and nanoextrusion, which has potent PDT and immune activation performances for oral squamous cell carcinoma (OSCC) treatment. To further promote the tumoricidal efficacy, a commonly used chemotherapeutic drug doxorubicin (DOX) is efficiently encapsulated into nmPg through a simple incubation method. nmPg/DOX thus prepared exhibits significant synergistic effects on inhibiting the growth and metastasis of OSCC both in vitro and in vivo via photodynamic-immunotherapy and chemotherapy. In summary, this work develops a promising bacterial nanomedicine for enhanced treatment of OSCC.

Oral and general health conditions involved in periodontal status during pregnancy: a prospective cohort study

PURPOSE

Pregnancy is a period in a woman's life that has important consequences on oral health, particularly for gingival health. Present study aims to identify women at higher risk of developing periodontal disease (gingivitis and periodontitis) during late pregnancy and evaluate how this condition evolves during this period.

METHODS

Prospective cohort study was designed with pregnant women who were assessed during the first and third trimesters of gestation in a southern Spanish public hospital. Data regarding gingival and periodontal health, oral hygiene, and overall health status (obesity and diabetes mellitus) were collected. Reporting followed STROBE checklist.

RESULTS

Significantly higher number of women had the periodontal and gingival disease in the third trimester of gestation compared with in early pregnancy. In the third trimester of gestation, 42 (28.6%) and 63 (42.9%) of women presented symptoms of periodontal disease and gingival disease, respectively. Obesity (OR 2.834; 95%CI 0.919-8.741), worse oral hygiene during the first trimester of gestation (OR: 4.031; 95%CI 2.12-7.65), and periodontal disease during early pregnancy (OR: 15.104; 95%CI 3.60-63.36) most effectively predicted periodontal disease during late pregnancy.

CONCLUSIONS

Pregnancy is associated with exacerbated periodontal and gingival disease symptoms throughout the different trimesters of gestation. Obesity and oral hygiene during early pregnancy were the risk factors that most contributed to the aforementioned changes in periodontal disease.

The Bacterial Oral Microbiome in Children with Congenital Heart Disease: An Extensive Review

Children with congenital heart disease have poorer oral health compared with healthy children. Oral diseases, such as dental caries and gingivitis, are associated with the oral microbiome. The objective of this review was to find evidence of differences in the bacterial colonization of the oral cavity of children with congenital heart disease (CHD) versus healthy children. A literature review was conducted according to predetermined criteria, including the need for controlled clinical trials. Half of the 14 studies that met the inclusion criteria reported significant differences in bacterial colonization in children with congenital heart disease. A variety of influencing factors were discussed. There is some evidence for alterations in the oral microflora as a result of physiopathological and treatment-related factors in children with CHD, but additional research is required to validate these findings.

Correlation of Serum and Gingival Crevicular Fluid Levels of Caspase-3 and Milk Fat Globule-Epidermal Growth Factor 8 on Gingival Health

AIM

This study aimed to estimate and correlate the serum and gingival crevicular fluid (GCF) levels of caspase-3 and milk fat globule-epidermal growth factor 8 (MFG-E8) in healthy, gingivitis and generalised chronic periodontitis subjects.

MATERIALS AND METHODS

A total of 24 subjects were selected and divided into three groups. After recording the periodontal parameters (plaque index (PI), modified gingival index (MGI), probing depth (PD) and clinical attachment level (CAL)), the serum and GCF samples were collected and the levels of caspase-3 and MFG-E8 were estimated using enzyme-linked immunoassay (ELISA).

RESULTS

The mean values of PI, MGI, PD and CALs were significantly higher in group III when compared to group II and group I. The mean value of serum and GCF caspase-3 increased with increasing disease severity, whereas the mean serum and GCF values of MFG-E8 decreased with increasing severity of disease. Spearman's correlation showed a strong positive correlation between the serum and GCF levels of caspase-3 and periodontal parameters, whereas serum and GCF levels of MFG-E8 showed a strong negative correlation with the periodontal parameters.

CONCLUSION

The findings of this study are suggestive that the serum and GCF levels of caspase-3 and MFG-E8 could serve as a potential biomarker for the role of apoptosis in periodontal disease. However, further studies are required to explore the mechanism and understand the relationship between these apoptotic markers and periodontitis.

Accuracy of Artificial Intelligence-Based Photographic Detection of Gingivitis

OBJECTIVES

Gingivitis is one of the most prevalent plaque-initiated dental diseases globally. It is challenging to maintain satisfactory plaque control without continuous professional advice. Artificial intelligence may be used to provide automated visual plaque control advice based on intraoral photographs.

METHODS

Frontal view intraoral photographs fulfilling selection criteria were collected. Along the gingival margin, the gingival conditions of individual sites were labelled as healthy, diseased, or questionable. Photographs were randomly assigned as training or validation datasets. Training datasets were input into a novel artificial intelligence system and its accuracy in detection of gingivitis including sensitivity, specificity, and mean intersection-over-union were analysed using validation dataset. The accuracy was reported according to STARD-2015 statement.

RESULTS

A total of 567 intraoral photographs were collected and labelled, of which 80% were used for training and 20% for validation. Regarding training datasets, there were total 113,745,208 pixels with 9,270,413; 5,711,027; and 4,596,612 pixels were labelled as healthy, diseased, and questionable respectively. Regarding validation datasets, there were 28,319,607 pixels with 1,732,031; 1,866,104; and 1,116,493 pixels were labelled as healthy, diseased, and questionable, respectively. AI correctly predicted 1,114,623 healthy and 1,183,718 diseased pixels with sensitivity of 0.92 and specificity of 0.94. The mean intersection-over-union of the system was 0.60 and above the commonly accepted threshold of 0.50.

CONCLUSIONS

Artificial intelligence could identify specific sites with and without gingival inflammation, with high sensitivity and high specificity that are on par with visual examination by human dentist. This system may be used for monitoring of the effectiveness of patients' plaque control.

Phyllanthus emblica fruits: a polyphenol-rich fruit with potential benefits for oral management

The fruit of Phyllanthus emblica Linn., which mainly grows in tropical and subtropical regions, is well-known for its medicine and food homology properties. It has a distinctive flavor, great nutritional content, and potent antioxidant, anti-inflammatory, anti-cancer and immunoregulatory effects. According to an increasing amount of scientific and clinical evidence, this fruit shows significant potential for application and development in the field of oral health management. Through the supplementation of vitamins, superoxide dismutase (SOD) and other nutrients reduce virulence expression of various oral pathogens, prevent tissue and mucosal damage caused by oxidative stress, etc. Phyllanthus emblica fruit can promote saliva secretion, regulate the balance of the oral microecology, prevent and treat oral cancer early, promote alveolar bone remodeling and aid mucosal wound healing. Thus, it plays a specific role in the prevention and treatment of common oral disorders, producing surprising results. For instance, enhancing the effectiveness of scaling and root planing in the treatment of periodontitis, relieving mucosal inflammation caused by radiotherapy for oral cancer, and regulating the blood glucose metabolism to alleviate oral discomfort. Herein, we systematically review the latest research on the use of Phyllanthus emblica fruit in the management of oral health and examine the challenges and future research directions based on its chemical composition and characteristics.

NADPH-dependent ROS accumulation contributes to the impaired osteogenic differentiation of periodontal ligament stem cells under high glucose conditions

Diabetes mellitus is an established risk factor for periodontal disease that can aggravate the severity of periodontal inflammation and accelerate periodontal destruction. The chronic high glucose condition is a hallmark of diabetes-related pathogenesis, and has been demonstrated to impair the osteogenic differentiation of periodontal ligament stem cells (PDLSCs), leading to delayed recovery of periodontal defects in diabetic patients. Reactive oxygen species (ROS) are small molecules that can influence cell fate determination and the direction of cell differentiation. Although excessive accumulation of ROS has been found to be associated with high glucose-induced cell damage, the underlying mechanisms remain unclear. Nicotinamide adenine dinucleotide phosphate (NADPH) is an important electron donor and functions as a critical ROS scavenger in antioxidant systems. It has been identified as a key mediator of various biological processes, including energy metabolism and cell differentiation. However, whether NADPH is involved in the dysregulation of ROS and further compromise of PDLSC osteogenic differentiation under high glucose conditions is still not known. In the present study, we found that PDLSCs incubated under high glucose conditions showed impaired osteogenic differentiation, excessive ROS accumulation and increased NADPH production. Furthermore, after inhibiting the synthesis of NADPH, the osteogenic differentiation of PDLSCs was significantly enhanced, accompanied by reduced cellular ROS accumulation. Our findings demonstrated the crucial role of NADPH in regulating cellular osteogenic differentiation under high glucose conditions and suggested a new target for rescuing high glucose-induced cell dysfunction and promoting tissue regeneration in the future.

The Association Between Periodontal Disease and Chronic Migraine: A Systematic Review

Migraine is a neurologic illness that produces intense throbbing pain on one side of the head and affects roughly 1 billion people worldwide. Recent research indicates a relationship between periodontitis and chronic migraines. This study aimed to review the association between chronic migraines and periodontitis through a systematic literature review. Four research databases (Google Scholar, PubMed, ProQuest, and SpringerLink) were searched according to PRISMA guidelines to retrieve the studies included in this review. A search strategy was developed to answer the study question with appropriate inclusion and exclusion criteria. Out of 34 published studies, 8 studies were included in this review. Three of the studies were cross-sectional, 3 were case-control, and 2 were clinical report and medical hypothesis papers. Seven of the 8 included studies showed that there is an association between periodontal disease and chronic migraine. The elevated blood levels of some biomarkers such as leptins, ProCalcitonin (proCT), calcitonin gene-related peptides (CGRPs), Pentraxin 3 (PTX3), and Soluble Tumor Necrosis Factor-like Weak Inducer Of Apoptosis (sTWEAK) play a significant role in this association. The limitations include a small sample size, the influence of anti-inflammatory drugs, and a self-reported headache measure that is subject to misclassification bias. This systematic review reveals a supposed correlation between periodontal disease and chronic migraine, as evidenced by various biomarkers and inflammatory mediators. This suggests that periodontal disease could potentially contribute to the development of chronic migraine. However, to further assess the potential benefits of periodontal treatment in patients with chronic migraine, additional longitudinal studies with larger sample sizes and interventional studies are needed.

Effects of metformin on human gingival fibroblasts: an in vitro study

OBJECTIVE

To investigate the effects of metformin (MF) treatment on the matrix metalloproteinases (MMPs) and proinflammatory cytokines production from lipopolysaccharide (LPS) - stimulated human gingival fibroblasts (HGFs).

METHODS

HGFs were obtained from subcultures of biopsies from clinically healthy gingival tissues of patients undergoing oral surgeries. Cell cytotoxicity assay was used to determine the effect of different concentrations of MF on viability of HGFs. HGFs were then incubated and treated with different concentrations of MF and Porphyromonas gingivais (Pg) LPS. MMP-1, MMP-2, MMP-8, MMP-9, IL-1β, and IL-8 expression analysis was performed using xMAP technology (Luminex 200, Luminex, Austin, TX, USA). Student's t-test for a single sample was used to compare the mean values of the study groups with the control value. A p-value of <0.05 and 95% confidence intervals were used to report the statistical significance and precision of mean values.

RESULTS

Concentrations of 0.5, 1- and 2-mM MF had a minimal non-significant cytotoxic effect on the HGFs and caused statistically significant reduction of MMP-1, MMP-2, MMP-8 and IL-8 expressed by the LPS-stimulated HGFs.

CONCLUSION

The results of the present study confirm that MF suppresses MMP-1, MMP-2, MMP-8 and IL-8 in LPS-stimulated HGFs suggesting an anti-inflammatory effect of MF and potential adjunct therapeutic role in the treatment of periodontal diseases.

Relationship between gastroesophageal reflux disease and periodontitis

Gastroesophageal reflux disease (GERD) is a condition related to the reflux of gastroduodenal contents into the esophagus, mouth, throat, or lungs. Recent studies have shown that there may be a correlation between GERD and periodontitis, a common oral disease. This review discusses the oral manifestations of GERD and the progress in the understanding of the relationship between GERD and periodontitis.

In Vitro Preventive Effect and Mechanism of Action of Weissella cibaria CMU against Streptococcus mutans Biofilm Formation and Periodontal Pathogens

In this study, we evaluated the in vitro anti-biofilm, antibacterial, and anti-inflammatory activity of Weissella cibaria CMU (CMU), an oral probiotic, against periodontopathogens. Compared to other oral probiotics, CMU showed a superior inhibitory effect on the biofilm formation and growth of Streptococcus mutans on orthodontic wires and artificial teeth (p < 0.05). CMU exerted potent antibacterial effects against S. mutans and Porphyromonas gingivalis according to a line test. In human gingival fibroblasts (HGFs) stimulated by P. gingivalis, Fusobacterium nucleatum, or Prevotella intermedia, CMU suppressed the gene expression of pro-inflammatory cytokines [interleukin (IL)-6, IL-1β, IL-8, and tumor necrosis factor-α] in a dose-dependent manner (p < 0.05). CMU restored the production of the tissue inhibitor of metalloproteinase-1 following its inhibition by P. gingivalis, and it suppressed the expression of matrix metalloproteinase (MMP)-1 and -3 induced by periodontopathogens (p < 0.05). Moreover, CMU needed direct contact with HGFs to exert their anti-inflammatory function, indicating that they act directly on gingival cells to modulate local inflammation. Our preclinical study provides evidence for the potential benefits of topical CMU treatments in preventing the development of caries and periodontitis caused by the dysbiosis of the dental plaque microbiome.

Influence of periodontal surgery on the subgingival microbiome-A systematic review and meta-analysis

OBJECTIVE

The objective of this systematic review and meta-analysis was to evaluate the effect of periodontal surgery on the subgingival microbiome.

BACKGROUND

Periodontitis is a chronic inflammation of the tooth supporting tissues caused by the dysbiosis of the subgingival biofilm. It is managed through different non-surgical and surgical treatment modalities. Recent EFP S3 guidelines recommended performing periodontal surgery as part of Step 3 periodontitis treatment after Step 1 and Step 2 periodontal therapy, with the aim to achieve pocket closure of persisting sites. Changes in the sub-gingival microbiome may explain the treatment outcomes observed at different time points. Various microbiological detection techniques for disease-associated pathogens have been evolved over time and have been described in the literature. However, the impact of different types of periodontal surgery on the subgingival microbiome remains unclear.

METHODS

A systematic literature search was conducted in Medline, Embase, LILACS and Cochrane Library supplemented by manual search (23DEC2019, updated 21APR2022).

RESULTS

From an initial search of 3046 studies, 28 were included according to our specific inclusion criteria. Seven microbiological detection techniques were used to analyse disease-associated species in subgingival plaque samples: optical microscope, culture, polymerase chain reaction (PCR), checkerboard, enzymatic reactions, immunofluorescence and 16S gene sequencing. The included studies exhibited differences in various aspects of their methodologies such as subgingival plaque sample collection or treatment modalities. Clinical data showed a significant decrease in probing pocket depths (PPD) and clinical attachment loss (CAL) after periodontal surgery. Microbiological findings were overall heterogeneous. Meta-analysis was performed on a sub-cohort of studies all using checkerboard as a microbiological detection technique. Random effect models for Treponema denticola (T. denticola), Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia (T. forsythia) did not show a significant effect on mean counts 3 months after periodontal surgery. Notably, Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) showed a significant increase 3 months after periodontal surgery. 16S gene sequencing was used in one included study and reported a decrease in disease-associated species with an increase in health-associated species after periodontal surgery at 3 and 6 months.

CONCLUSION

This systematic review has shown that the effect of periodontal surgery on the changes in subgingival microbiome is heterogeneous and may not always be associated with a decrease in disease-associated species. The variability could be attributed to the microbiological techniques employed for the analysis. Therefore, there is a need for well-designed and adequately powered studies to understand how periodontal surgery influences the subgingival microbiome and how the individual's microbiome affects treatment outcomes after periodontal surgery.

Zoledronic acid affects the process of Porphyromonas gingivalis infecting oral mucosal epithelial barrier: An in-vivo and in-vitro study

Zoledronic acid (ZA), one of the commonly used bisphosphonates, is mainly used for bone-metabolic diseases. Studies proved that ZA has adverse effects on oral soft tissues. As the first line of innate immunity, the gingival epithelium could be infected by periodontal pathogens, which is a key process of the initiation of periodontal diseases. Yet, how ZA affects the periodontal pathogens infecting the epithelial barrier remains unclear. This study aimed to investigate the influences of ZA on the process of Porphyromonas gingivalis (P. gingivalis) infecting the gingival epithelial barrier via in-vitro and in-vivo experiments. In the in-vitro experiments, under the condition of different concentrations of ZA (0, 1, 10, and 100 μM), P. gingivalis was used to infect human gingival epithelial cells (HGECs). The infections were detected by transmission electron microscope and confocal laser scanning microscope. Besides, the internalization assay was applied to quantify the P. gingivalis, which infected the HGECs, in the different groups. To evaluate the expression levels of pro-inflammatory cytokines, including interleukin (IL)-1β, IL-6, and IL-8, by infected HGECs, real-time quantitative reverse transcription-polymerase chain reactions were applied. In the in-vivo experiments, rats were given ZA solution (ZA group) or saline (control group) by tail intravenous injection for 8 weeks. Subsequently, we put ligatures around the maxillary second molars of all the rats and inoculated P. gingivalis to the gingiva every other day from day 1 to day 13. The rats were sacrificed on days 3, 7, and 14 for micro-CT and histological analyses. The in-vitro results manifested that the quantity of P. gingivalis that had infected HGECs increased with the ZA concentrations. Pro-inflammatory cytokines expression by HGECs were significantly increased by 100 μM ZA. In the in-vivo study, compared to the control group, more P. gingivalis was detected in the superficial layer of gingival epithelium in the ZA group. Besides, ZA significantly increased the expression level of IL-1β on day 14 and IL-6 on days 7 and 14 in gingival tissues. These findings suggest that the oral epithelial tissues of patients who receive high-dose ZA treatment may be more susceptible to periodontal infections, resulting in severe inflammatory conditions.

Porphyromonas gingivalis Outer Membrane Vesicles Promote Apoptosis via msRNA-Regulated DNA Methylation in Periodontitis

The outer membrane vesicles (OMVs) produced by Porphyromonas gingivalis contain a variety of bioactive molecules that may be involved in the progression of periodontitis. However, the participation of P. gingivalis OMVs in the development of periodontitis has not been elucidated. Here, we isolated P. gingivalis OMVs and confirmed their participation in periodontitis both in vivo and in vitro. Microcomputed tomography (micro-CT) and histological analysis showed that under stimulation with P. gingivalis OMVs, the alveolar bone of rats was significantly resorbed in vivo. We found that P. gingivalis OMVs were taken up by human periodontal ligament cells ([hPDLCs]) in vitro, which subsequently resulted in apoptosis and inflammatory cytokine release, which was accomplished by the microRNA-size small RNA (msRNA) sRNA45033 in the P. gingivalis OMVs. Through bioinformatics analysis and screening of target genes, chromobox 5 (CBX5) was identified as the downstream target of screened-out sRNA45033. Using a dual-luciferase reporter assay, overexpression, and knockdown methods, sRNA45033 was confirmed to target CBX5 to regulate hPDLC apoptosis. In addition, CUT&Tag (cleavage under targets and tagmentation) analysis confirmed the mechanism that CBX5 regulates apoptosis through the methylation of p53 DNA. Collectively, these findings indicate that the role of P. gingivalis OMVs is immunologically relevant and related to bacterial virulence during the development of periodontitis. IMPORTANCE P. gingivalis is a bacterium often associated with periodontitis. This study demonstrates that (i) sRNA45033 in P. gingivalis OMVs targets CBX5, (ii) CBX5 regulates the methylation of p53 DNA and its expression, which is associated with apoptosis, and (iii) a novel mechanism of interaction between hosts and pathogens is mediated by OMVs in the occurrence of periodontitis.

Applications of Hydrogels in Drug Delivery for Oral and Maxillofacial Diseases

Oral and maxillofacial diseases have an important impact on local function, facial appearance, and general health. As a multifunctional platform, hydrogels are widely used in the biomedical field due to their excellent physicochemical properties. In recent years, a large number of studies have been conducted to adapt hydrogels to the complex oral and maxillofacial environment by modulating their pore size, swelling, degradability, stimulus-response properties, etc. Meanwhile, many studies have attempted to use hydrogels as drug delivery carriers to load drugs, cytokines, and stem cells for antibacterial, anticancer, and tissue regeneration applications in oral and maxillofacial regions. This paper reviews the application and research progress of hydrogel-based drug delivery systems in the treatment of oral and maxillofacial diseases such as caries, endodontic diseases, periodontal diseases, maxillofacial bone diseases, mucosal diseases, oral cancer, etc. The characteristics and applications of hydrogels and drug-delivery systems employed for the treatment of different diseases are discussed in order to provide a reference for further research on hydrogel drug-delivery systems in the future.

Anti-Periodontitis Effects of Dendropanax morbiferus H.Lév Leaf Extract on Ligature-Induced Periodontitis in Rats

Periodontitis is caused by pathogens in the oral cavity. It is a chronic infectious disease that causes symptoms including gingival bleeding and tooth loss resulting from the destruction of periodontal tissues coupled with inflammation. Dendropanax morbiferus H.Lév (DM) is a natural product that exhibits various biological activities with few side effects. In this study, the potential of DM leaf hot-water extracts (DMWE) as a treatment for periodontitis was determined and its anti-oxidant and anti-inflammatory effects were evaluated. Compounds in DMWE were identified by high-performance liquid chromatography (HPLC) and nitric oxide (NO) and prostaglandin E₂ (PGE₂) production was measured in RAW 264.7 cells. We measured the gingival index and gingival sulcus depth, and micro-CT was performed in vivo using a ligature-induced periodontitis rat model, which is similar to human periodontitis. The DMWE-treated group exhibited a decrease in cytokine concentration and relieved the gingival index and gingival sulcus depth compared with the periodontitis-induced control group. In addition, micro-CT and histological analysis revealed that DMWE exhibited anti-inflammatory effects and improved alveolar bone loss in periodontitis-induced rats. These findings suggest that DMWE has excellent anti-oxidant and anti-inflammatory effects that protect and prevent periodontal tissue damage and tooth loss caused by the inflammatory response.

The role of extracellular vesicles in periodontitis: pathogenesis, diagnosis, and therapy

Periodontitis is a prevalent disease and one of the leading causes of tooth loss. Biofilms are initiating factor of periodontitis, which can destroy periodontal tissue by producing virulence factors. The overactivated host immune response is the primary cause of periodontitis. The clinical examination of periodontal tissues and the patient's medical history are the mainstays of periodontitis diagnosis. However, there is a lack of molecular biomarkers that can be used to identify and predict periodontitis activity precisely. Non-surgical and surgical treatments are currently available for periodontitis, although both have drawbacks. In clinical practice, achieving the ideal therapeutic effect remains a challenge. Studies have revealed that bacteria produce extracellular vesicles (EVs) to export virulence proteins to host cells. Meanwhile, periodontal tissue cells and immune cells produce EVs that have pro- or anti-inflammatory effects. Accordingly, EVs play a critical role in the pathogenesis of periodontitis. Recent studies have also presented that the content and composition of EVs in saliva and gingival crevicular fluid (GCF) can serve as possible periodontitis diagnostic indicators. In addition, studies have indicated that stem cell EVs may encourage periodontal regeneration. In this article, we mainly review the role of EVs in the pathogenesis of periodontitis and discuss their diagnostic and therapeutic potential.

Effect of supragingival plaque control on recurrent periodontitis and clinical stability among individuals under periodontal maintenance therapy: 10-year follow-up

BACKGROUND

The aim of this study was to evaluate the effect of supragingival plaque control on the recurrence of periodontitis (RP) and the achievement of a stable periodontal clinical endpoint after 10 years of periodontal maintenance therapy (PMT).

METHODS

The present retrospective cohort study included 225 individuals in continuous PMT. The plaque index (PI) determining the oral hygiene (OH) status, periodontal clinical parameters, and other variables of interest were collected at three time points: T1 (prior to active periodontal therapy [APT]), T2 (after APT), and T3 (10 years after T2). According to PI records at T3, participants were categorized into: (1) good OH (GOH; PI ≤ 30%, n = 63); (2) fair OH (FOH; PI > 30% and ≤40%, n = 73); and (3) poor OH (POH; PI > 40%, n = 88). Data were analyzed using the chi-square and Student t tests, analysis of variance (ANOVA), and mediation and regression analyses.

RESULTS

Significant differences in all periodontal clinical parameters between the GOH, FOH, and POH groups were observed at T3. The POH group exhibited higher mean bleeding on probing (BOP), periodontal probing depth (PD), and clinical attachment level (CAL), as well as higher tooth loss (POH > FOH > GOH; P < .001). There was an increased risk for RP in the FOH (odds ratio [OR] 2.02; CI, 1.10-4.38) and POH (OR 4.33; CI, 2.17-8.65) groups. Moreover, the FOH and POH groups had an approximately 2.5 and 6.0 times greater chance of not achieving a stable periodontal clinical endpoint, respectively.

CONCLUSIONS

After 10 years of monitoring in PMT, individuals with higher PI scores (>30%) presented an unhealthier periodontal status, a higher risk for RP, and a lower chance of achieving ≤4 sites with PD ≥ 5 mm.

The In Vitro Effect of Laser Irradiation (Er:YAG and CO2) and Chemical Reagents (Hydrogen Peroxide, Sodium Hypochlorite, Chlorhexidine, or Sodium Fluoride) Alone or in Combination on Reducing Root Caries Bacteria

(1) Lasers have been used for the treatment of dentinal hypersensitivity and bacterial reductions in periodontology. The purpose of this in vitro study was to evaluate the effect of Carbon Dioxide (CO₂) and Erbium-doped Yttrium Aluminum Garnet (Er:YAG) lasers with chlorhexidine (CHX), hydrogen peroxide (H₂O₂), sodium hypochlorite (NaOCl), or sodium fluoride (NaF) on the viability of oral bacteria associated with root caries. (2) Streptococcus mutans, Streptococcus sanguinis, and Enterococcus faecalis were grown in Brain Heart Infusion (BHI) broth, diluted to an OD660 of 0.5, and treated with antiseptics with or without simultaneous irradiation with the Er:YAG and CO₂ lasers for 30 s repeated three times. The treatment groups consisted of 1: no treatment, 2: 0.5% H₂O₂ alone, 3: 0.5% NaOCl alone, 4: 0.12% CHX alone, 5: 2% NaF alone, 6: laser alone, 7: laser with 0.5% H₂O₂, 8: laser with 0.5% NaOCl, 9: laser with 0.12% CHX, and 10: laser with 2% NaF for both lasers. The microbial viability was determined through plating and viable colonies were counted, converted into CFU/mL, and transformed into log form. The statistical analysis was performed using a two-tailed paired t-test. (3) The use of CO₂ and Er:YAG lasers alone failed to show statistically significant antibacterial activity against any of the bacteria. The only effective monotreatment was CHX for S. mutans. The combined treatment of 0.5% NaOCl with Er:YAG produced the greatest reduction in overall viability. (4) The combination of the Er:YAG laser with 0.5% NaOCl resulted in the largest reduction in bacterial survival when compared to monotherapies with antimicrobial solutions or lasers.

Periodontitis is a potential risk factor for transient ischemic attack and minor ischemic stroke in young adults: A nationwide population-based cohort study

BACKGROUND

This study aims to determine whether periodontitis is a risk factor for transient ischemic attack (TIA) in young adults.

METHODS

The National Health Insurance (NHI) Research Database in Taiwan was the source of the data used in this retrospective cohort study. Individuals aged 20 to 53 years with periodontitis in 2001 and 2002 (n = 792,426) and an age- and sex-matched control group (n = 792,426) were selected. All participants were followed up until TIA diagnosis, 55 years of age, removal from the NHI program, death, or December 31, 2016. The incidence density and hazard ratio (HR) of new-onset TIA were compared between individuals with periodontitis and controls. Periodontitis was defined by dentists according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 523.3-5 with concurrent antibiotic prescription or periodontal treatment excluding scaling performed by certified dentists. TIA was defined according to the ICD-9-CM code 435.x at hospital discharge.

RESULTS

After adjustment for confounding factors, the risk of developing TIA/minor ischemic stroke was calculated to be higher in participants with periodontitis (HR, 1.24; 95% confidence interval, 1.15-1.32; P <0.001) than in those without. The HR was slightly higher among people aged 20 to 40 years than among those aged 40 to 53 years.

CONCLUSION

Periodontitis is associated with an increased risk of developing TIA/minor ischemic stroke. Periodontitis might be a modifiable risk factor for stroke in young adults. Clinicians must devote greater attention to this potential association to develop new preventive and therapeutic strategies for stroke in young adults.

Validity of Simple Self-Reported Periodontal Status Questions

OBJECTIVE

The aim of this research was to evaluate the validity of the questions developed by Thai periodontists on self-reported periodontal status and symptoms in identifying severe periodontitis amongst adults in Thailand.

METHODS

Registered Electricity Generating Authority of Thailand (EGAT) employees completed medical examinations and full-mouth periodontal examinations. They also were interviewed using a self-reported questionnaire that was developed by Thai periodontists. The questions pertained to their periodontal status and symptoms comprising swollen gums, bad breath, loose teeth, bleeding on brushing, painful gums, and pus or abscesses. The participants were categorised as having nonsevere and severe periodontitis according to the Centers for Disease Control and Prevention in partnership with the American Academy of Periodontology (CDC/AAP) case definitions. Self-reported periodontal status and symptom results were compared with actual periodontal status. The area under the receiver operating characteristic curve (AUROCC), sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated.

RESULTS

A total of 1393 EGAT employees participated in this study. The questions on self-reported periodontal status and all symptoms poorly identified patients with severe periodontitis, with an AUROCC of 0.52 to 0.60. The sensitivity was 5.0% to 40.2%; however, the specificity was good, at 73.2% to 99.1%. The validity of the self-reported questions was comparable amongst the sex, education, and income subgroups.

CONCLUSIONS

This study demonstrated that self-reported periodontal status and symptoms were inadequate in identifying patients with severe periodontal disease.

Neutrophil N1 and N2 Subsets and Their Possible Association with Periodontitis: A Scoping Review

Periodontitis is a chronic non-communicable disease caused by dysbiotic changes that affect the subgingival microbiota. During periodontitis, neutrophils play a central role in the initial recognition of bacteria, and their number increases with the appearance of the first signs of periodontal inflammation. Recent evidence has led to the proposition that neutrophils can also functionally polarize, determining selective activity patterns related to different diseases. Two well-defined neutrophil phenotypes have been described, the pro-inflammatory N1 subset and the suppressor N2 subset. To date, it has not been established whether these different neutrophil subtypes play a role in the pathogenesis of periodontitis. Thus, this scoping review aimed to determine whether there was evidence to suggest that the neutrophils present in periodontal tissues can be associated with certain phenotypes. The research question, population, concept, and context sought to identify original articles, in humans, that detected the presence of neutrophils in the periodontal tissues of people affected by periodontitis. Based on the search strategy, we found 3658 studies. After removing the papers with abstracts not related to the outcome measures and eligibility criteria, 16 articles were included for qualitative analysis. Several studies identified the presence of different neutrophil subsets, specifically, the naive, pro- and para-inflammatory, hyper-reactive and hyper-active, and high- and low-responder phenotypes. The existing evidence demonstrates the presence of pro-inflammatory, hyper-reactive and high-responder neutrophils in periodontal tissues affected with periodontitis. There is no evidence demonstrating the presence of the N1 or N2 phenotypes in periodontal tissues during periodontitis. However, the existence of pro-inflammatory phenotypes, which increase NETosis and degranulation, and increase the production of pro-inflammatory cytokines, could be suggestive of the N1 phenotypes.