1
|
Marruganti C, Gaeta C, Falciani C, Cinotti E, Rubegni P, Alovisi M, Scotti N, Baldi A, Bellan C, Defraia C, Fiorino F, Valensin S, Bellini E, De Rosa A, D'Aiuto F, Grandini S. Are periodontitis and psoriasis associated? A pre-clinical murine model. J Clin Periodontol 2024; 51:1044-1053. [PMID: 38699834 DOI: 10.1111/jcpe.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/26/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
AIM To investigate the bidirectional influence between periodontitis and psoriasis, using the respective experimental models of ligature- and imiquimod-induced diseases on murine models. MATERIALS AND METHODS Thirty-two C57/BL6J mice were randomly allocated to four experimental groups: control (P- Pso-), ligature-induced periodontitis (P+ Pso-), imiquimod-induced psoriasis (P- Pso+) and periodontitis and psoriasis (P+ Pso+). Samples (maxilla, dorsal skin and blood) were harvested immediately after death. Measures of periodontitis (distance between the cemento-enamel junction and alveolar bone crest [CEJ-ABC] and the number of osteoclasts) and psoriasis (epidermal thickness and infiltrate cell [/0.03mm2]) severity as well as systemic inflammation (IL-6, IL-17A, TNF-α) were collected. RESULTS The P+ Pso+ group exhibited the most severe experimental periodontitis and psoriasis, with the highest values of CEJ-ABC, number of osteoclasts, epidermal thickness and infiltrate cells in the dorsal skin, as well as the highest blood cytokine concentration. The P+ Pso- group presented with higher cell infiltrate (/0.03mm2) compared to the control group (p <.05), while the P- Pso+ group showed substantially higher alveolar bone loss (CEJ-ABC) than the control group (p <.05). CONCLUSIONS Experimental periodontitis may initiate and maintain psoriasiform skin inflammation and, vice versa, experimental psoriasis may contribute to the onset of periodontitis. In a combined model of the diseases, we propose a bidirectional association between periodontitis and psoriasis via systemic inflammation.
Collapse
Affiliation(s)
- Crystal Marruganti
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Carlo Gaeta
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Chiara Falciani
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Mario Alovisi
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Nicola Scotti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Andrea Baldi
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Cristiana Bellan
- Unit of Anatomical Pathology, Department of Human Pathology and Oncology, University of Siena, Siena, Italy
| | - Chiara Defraia
- Unit of Anatomical Pathology, Department of Human Pathology and Oncology, University of Siena, Siena, Italy
| | - Fabio Fiorino
- Laboratory of Molecular Microbiology and Biotechnology (LAMMB), Department of Medical Biotechnologies, University of Siena, Siena, Italy
- LUM University "Giuseppe Degennaro", Casamassima (Bari)
| | | | | | | | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Simone Grandini
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| |
Collapse
|
2
|
Chen X, Niu W, Hu G, Chen C. Cost-effectiveness and cost-utility analyses of three different gargles in the treatment of chronic periodontitis. PLoS One 2024; 19:e0302592. [PMID: 38717998 PMCID: PMC11078434 DOI: 10.1371/journal.pone.0302592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the economics of three different gargles in the treatment of chronic periodontitis. METHODS A total of 108 patients with periodontitis received one of the following three gargles: xipayi, compound chlorhexidine, or Kangfuxin gargle. The basic information of the patients, the costs of the gargles, the periodontal indexes before and after treatment, and the scores of the 3-level version of the EuroQol Five Dimensions Questionnaire were collected. The cost-effectiveness and cost-utility of the various gargles were determined. RESULTS The cost-effectiveness ratios (CER) of the three groups after treatment were 1828.75, 1573.34, and 1876.92 RMB, respectively. The utility values before treatment were 0.92, 0.90, and 0.91, respectively, and the utility values after treatment were 0.98, 0.98, and 0.97, respectively. The cost-utility ratios (CURs) were 213.43, 195.61, and 301.53 RMB, respectively. CONCLUSIONS For each increase in effective rate and quality-adjusted life years, the treatment cost of periodontitis patients was lower than the gross domestic product per capita of Jiangsu Province, indicating that the treatment cost is completely worth it. The CER and CUR results were the same, and the compound chlorhexidine group was the lowest, demonstrating that when the same therapeutic effect was achieved, it cost the least.
Collapse
Affiliation(s)
- Xin Chen
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
| | - Wenzhi Niu
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
| | - Guangyu Hu
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
| | - Changfeng Chen
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
| |
Collapse
|
3
|
Özer E, Yilmaz HE, Narin F, Sağlam M. The evaluation of salivary leucine-rich alpha-2 glycoprotein (LRG) and C-reactive protein (CRP) in humans with periodontal health or periodontal disease. J Periodontal Res 2024; 59:387-394. [PMID: 38126217 DOI: 10.1111/jre.13223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The purpose of the present research is to evaluate the salivary levels of leucine-rich alpha-2 glycoprotein (LRG) and C-reactive protein (CRP) in periodontal health and disease (gingivitis and stage III periodontitis) and also to compare the discriminative efficiencies of both biomarkers in periodontal disease. BACKGROUND LRG is a new acute-phase protein whose functions are still being investigated. LRG and CRP are both biomarkers that are increased by inflammation. No clinical study has yet investigated the comparison of the level of LRG and CRP in periodontal health, gingivitis and periodontitis in saliva samples. METHODS A total of 60 individuals, including 20 periodontally healthy (control group/group C), 20 with gingivitis (group G), and 20 with Stage III periodontitis (group P), who were systemically healthy and non-smokers, participated in this study. Periodontal charts were used for recording clinical periodontal parameters and saliva LRG and CRP levels were measured by ELISA. Analyzing the area under the curve (AUC) was performed by the receiver-operating characteristics curve. RESULTS Salivary levels of LRG and CRP were significantly higher in disease groups than in group C (p < .05). Positive statistically significant correlations were observed between both biomarkers and clinical parameters (p < .05). There was also a strong positive correlation between two biomarkers (p < .05). In distinguishing periodontal disease from periodontal health, LRG (AUC = 0.833) and CRP (AUC = 0.826) were found to have similar accuracy (p = .923). CONCLUSION LRG and CRP may be useful and similarly effective biomarkers in the diagnosis of periodontal diseases based on the findings of this study.
Collapse
Affiliation(s)
- Ece Özer
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - Huriye Erbak Yilmaz
- Department of Medical Biochemistry, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey
- Izmir Biomedicine Genome Center, Dokuz Eylul University, Izmir, Turkey
| | - Figen Narin
- Department of Medical Biochemistry, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Mehmet Sağlam
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| |
Collapse
|
4
|
Baker JL, Mark Welch JL, Kauffman KM, McLean JS, He X. The oral microbiome: diversity, biogeography and human health. Nat Rev Microbiol 2024; 22:89-104. [PMID: 37700024 PMCID: PMC11084736 DOI: 10.1038/s41579-023-00963-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/14/2023]
Abstract
The human oral microbiota is highly diverse and has a complex ecology, comprising bacteria, microeukaryotes, archaea and viruses. These communities have elaborate and highly structured biogeography that shapes metabolic exchange on a local scale and results from the diverse microenvironments present in the oral cavity. The oral microbiota also interfaces with the immune system of the human host and has an important role in not only the health of the oral cavity but also systemic health. In this Review, we highlight recent advances including novel insights into the biogeography of several oral niches at the species level, as well as the ecological role of candidate phyla radiation bacteria and non-bacterial members of the oral microbiome. In addition, we summarize the relationship between the oral microbiota and the pathology of oral diseases and systemic diseases. Together, these advances move the field towards a more holistic understanding of the oral microbiota and its role in health, which in turn opens the door to the study of novel preventive and therapeutic strategies.
Collapse
Affiliation(s)
- Jonathon L Baker
- Oregon Health & Science University, Portland, OR, USA
- J. Craig Venter Institute, La Jolla, CA, USA
- UC San Diego School of Medicine, La Jolla, CA, USA
| | - Jessica L Mark Welch
- The Forsyth Institute, Cambridge, MA, USA
- Marine Biological Laboratory, Woods Hole, MA, USA
| | | | | | - Xuesong He
- The Forsyth Institute, Cambridge, MA, USA.
- Harvard School of Dental Medicine, Boston, MA, USA.
| |
Collapse
|
5
|
Perić M, Marhl U, Gennai S, Marruganti C, Graziani F. Treatment of gingivitis is associated with reduction of systemic inflammation and improvement of oral health-related quality of life: A randomized clinical trial. J Clin Periodontol 2022; 49:899-910. [PMID: 35762095 DOI: 10.1111/jcpe.13690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
AIM To compare the level of inflammatory markers, oral health-related quality of life (OHRQoL) and gingival parameters 1 month after introduction of electric toothbrush and intensive oral hygiene maneuvers adaptation (OHI) versus routine habits (no-OHI) in patients affected by generalized gingivitis. METHODS 140 subjects with generalized gingivitis were randomized to receive either OHI or no-OHI. Full-mouth plaque/bleeding scores (FMPS/FMBS), serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6- (IL-6) and an Oral health impact profile-14 questionnaire (OHIP-14) were collected at baseline and at 1-month follow-up visit. RESULTS In the OHI, a significant FMPS and FMPBS reduction (p<0.01), a significant intragroup decrease in hs-CRP and IL-6 (p<0.01) and a significant improvement of OHRQoL (p<0.01) was noted at 1-month. In the no-OHI, lower-magnitude differences were noted only for oral parameters. Resolution of gingivitis varied between OHI and no-OHI (89% versus 7% respectively, p<0.01). A Logistic multivariate regression suggested that FMBS ≤8% was associated with odds ratio of 13 of having both CRP and IL-6 below the selected threshold for healthy young adults (p=0.04). CONCLUSIONS Gingivitis resolution determined important reductions of gingival inflammation and plaque levels, as well as systemic inflammatory markers and an improvement of quality of life (NCT03848351).
Collapse
Affiliation(s)
- Marina Perić
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Urska Marhl
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Crystal Marruganti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy.,Unit of Periodontology, Endodontology and Restorative dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| |
Collapse
|
6
|
Ide M, Karimova M, Setterfield J. Oral Health, Antimicrobials and Care for Patients With Chronic Oral Diseases – A Review of Knowledge and Treatment Strategies. FRONTIERS IN ORAL HEALTH 2022; 3:866695. [PMID: 35747534 PMCID: PMC9210540 DOI: 10.3389/froh.2022.866695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/04/2022] [Indexed: 11/19/2022] Open
Abstract
Periodontal and chronic oral mucosal diseases are significant life impacting conditions which may co-exist and synergistically act to cause more severe and widespread oral pathology with enhanced challenges in effective management. Clinicians regularly observe these effects and struggle to effectively manage both problems in many patients. There is limited understanding of many basic and applied scientific elements underpinning potentially shared aetiopathological features and management. Recent developments in translational science provide an opportunity to greater improve knowledge and subsequently care for patients with these problems.
Collapse
|
7
|
Shaikh MS, Shahzad Z, Tash EA, Janjua OS, Khan MI, Zafar MS. Human Umbilical Cord Mesenchymal Stem Cells: Current Literature and Role in Periodontal Regeneration. Cells 2022; 11:cells11071168. [PMID: 35406732 PMCID: PMC8997495 DOI: 10.3390/cells11071168] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/21/2022] Open
Abstract
Periodontal disease can cause irreversible damage to tooth-supporting tissues such as the root cementum, periodontal ligament, and alveolar bone, eventually leading to tooth loss. While standard periodontal treatments are usually helpful in reducing disease progression, they cannot repair or replace lost periodontal tissue. Periodontal regeneration has been demonstrated to be beneficial in treating intraosseous and furcation defects to varied degrees. Cell-based treatment for periodontal regeneration will become more efficient and predictable as tissue engineering and progenitor cell biology advance, surpassing the limitations of present therapeutic techniques. Stem cells are undifferentiated cells with the ability to self-renew and differentiate into several cell types when stimulated. Mesenchymal stem cells (MSCs) have been tested for periodontal regeneration in vitro and in humans, with promising results. Human umbilical cord mesenchymal stem cells (UC-MSCs) possess a great regenerative and therapeutic potential. Their added benefits comprise ease of collection, endless source of stem cells, less immunorejection, and affordability. Further, their collection does not include the concerns associated with human embryonic stem cells. The purpose of this review is to address the most recent findings about periodontal regenerative mechanisms, different stem cells accessible for periodontal regeneration, and UC-MSCs and their involvement in periodontal regeneration.
Collapse
Affiliation(s)
- Muhammad Saad Shaikh
- Department of Oral Biology, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi 75510, Pakistan;
| | - Zara Shahzad
- Lahore Medical and Dental College, University of Health Sciences, Lahore 53400, Pakistan;
| | - Esraa Abdulgader Tash
- Department of Oral and Clinical Basic Science, College of Dentistry, Taibah University, Al Madinah Al Munawarah 41311, Saudi Arabia;
| | - Omer Sefvan Janjua
- Department of Maxillofacial Surgery, PMC Dental Institute, Faisalabad Medical University, Faisalabad 38000, Pakistan;
| | | | - Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah Al Munawarah 41311, Saudi Arabia
- Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan
- Correspondence: ; Tel.: +966-507544691
| |
Collapse
|
8
|
Effects of Essential Oils and Selected Compounds from Lamiaceae Family as Adjutants on the Treatment of Subjects with Periodontitis and Cardiovascular Risk. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11209563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Essential oils from different plant species were found to contain different compounds exhibiting anti-inflammatory effects with the potential to be a valid alternative to conventional chemotherapy that is limited in long-term use due to its serious side effects. Generally, the first mechanism by which an organism counteracts injurious stimuli is inflammation, which is considered a part of the innate immune system. Periodontitis is an infectious and inflammatory disease caused by a dysbiosis in the subgingival microbiome that triggers an exacerbated immune response of the host. The immune–inflammatory component leads to the destruction of gingival and alveolar bone tissue. The main anti-inflammation strategies negatively modulate the inflammatory pathways and the involvement of inflammatory mediators by interfering with the gene’s expression or on the activity of some enzymes and so affecting the release of proinflammatory cytokines. These effects are a possible target from an effective and safe approach, suing plant-derived anti-inflammatory agents. The aim of the present review is to summarize the current evidence about the effects of essentials oils from derived from plants of the Lamiaceae family as complementary agents for the treatment of subjects with periodontitis and their possible effect on the cardiovascular risk of these patients.
Collapse
|
9
|
Abstract
Oral commensal bacteria actively participate with gingival tissue to maintain healthy neutrophil surveillance and normal tissue and bone turnover processes. Disruption of this homeostatic host-bacteria relationship occurs during experimental gingivitis studies where it has been clearly established that increases in the bacterial burden increase gingival inflammation. Here, we show that experimental gingivitis resulted in three unique clinical inflammatory phenotypes (high, low, and slow) and reveal that interleukin-1β, a reported major gingivitis-associated inflammatory mediator, was not associated with clinical gingival inflammation in the slow response group. In addition, significantly higher levels of Streptococcus spp. were also unique to this group. The low clinical response group was characterized by low concentrations of host mediators, despite similar bacterial accumulation and compositional characteristics as the high clinical response group. Neutrophil and bone activation modulators were down-regulated in all response groups, revealing novel tissue and bone protective responses during gingival inflammation. These alterations in chemokine and microbial composition responses during experimental gingivitis reveal a previously uncharacterized variation in the human host response to a disruption in gingival homeostasis. Understanding this human variation in gingival inflammation may facilitate the identification of periodontitis-susceptible individuals. Overall, this study underscores the variability in host responses in the human population arising from variations in host immune profiles (low responders) and microbial community maturation (slow responders) that may impact clinical outcomes in terms of destructive inflammation.
Collapse
|
10
|
Weekly and Daily Tooth Brushing by Care Staff Reduces Gingivitis and Calculus in Racing Greyhounds. Animals (Basel) 2021; 11:ani11071869. [PMID: 34201689 PMCID: PMC8300175 DOI: 10.3390/ani11071869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/05/2022] Open
Abstract
Simple Summary Dental disease affects many dogs worldwide and is believed to be particularly problematic for racing greyhounds. It costs the industry and rehoming charities financially and likely causes unnecessary suffering to a large number of dogs. The risk factors for dental disease in this population are debated, and the best methods to overcome it are relatively unresearched. We carried out a trial in which 160 racing greyhounds were divided into three groups. The staff looking after them either brushed their teeth daily, weekly or never, for a period of two months. An experimenter measured the dog’s level of calculus (hardened dental plaque) and gingivitis (gum inflammation) at the start, and again after two months. We found that both weekly and daily brushing resulted in significant reductions in calculus, but for gingivitis only daily brushing resulted in a significant reduction. The effects, however, were not noticeable on the front incisor teeth. Since the staff implementing the routine reported a minimal time commitment and positive experiences, we suggest that daily brushing is recommended for racing greyhounds, and that emphasis is placed on brushing all teeth groups. Similar trials need to be conducted with retired greyhounds since these have been shown to present particularly high levels of periodontal disease. Abstract Periodontal disease is one of the most common conditions affecting dogs worldwide and is reported to be particularly prevalent in racing greyhounds. A range of potential risk factors have been hypothesised. Previous research has suggested that regular tooth brushing can reduce both calculus and gingivitis, but the frequency required is unclear. Here, we report a controlled blinded in situ trial, in which kennel staff brushed 160 racing greyhounds’ teeth (living at six kennel establishments), either weekly, daily or never over a two-month period. All of the visible teeth were scored for calculus and gingivitis, using previously validated scales. We calculated average scores for each of the three teeth groups and overall whole mouth scores, averaging the teeth groups. Changes were compared to the baseline. After two months, the total calculus scores (controlling for baseline) were significantly different in the three treatment groups, (F(2,129) = 10.76, p < 0.001) with both weekly and daily brushing resulting in significant reductions. Gingivitis was also significantly different between groups (F(2,128) = 4.57, p = 0.012), but in this case, only daily brushing resulted in a significant reduction. Although the dogs in different kennels varied significantly in their levels of both calculus (F(5,129) = 8.64, p < 0.001) and gingivitis (F(5,128) = 3.51 p = 0.005), the intervention was similarly effective in all of the establishments. The teeth groups varied, and the incisors were not significantly affected by the treatment. Since the trainers implementing the routine, reported a minimal time commitment and positive experiences, we suggest that daily brushing is recommended for racing greyhounds, and that any instructions or demonstrations should include attention to all teeth groups including the incisors. Similar trials need to be conducted with retired greyhounds since these have been shown to present particularly high levels of periodontal disease.
Collapse
|
11
|
Krikheli NI, Pustovoit EV, Zhuravleva EG. [The effectiveness of parodontax toothpaste in the complex treatment of chronic gingivitis]. STOMATOLOGII︠A︡ 2021; 100:50-54. [PMID: 33874661 DOI: 10.17116/stomat202110002150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
THE AIM OF THE STUDY Was to evaluate the clinical efficacy of parodontax Comprehensive Protection (GlaxoSmithKline, London, UK) toothpaste in the complex therapy of chronic gingivitis. MATERIALS AND METHODS The study involved 119 volunteers; group 1 (n=59, age range 18 to 32 years) and group 2 (n=60, age range 20 to 35 years) with a diagnosis of chronic gingivitis (K05.1). The criterion for inclusion in the study was sulcus bleeding index (SBI) more than 1 point. Dental examination included SBI, papillary-marginal-alveolar index (PMA), and Green-Vermillion oral hygiene index (OHI-S). After determining the indices, all patients underwent professional oral hygiene and controlled tooth cleaning. Patients in group 1 (parodontax) were prescribed parodontax Comprehensive Protection toothpaste (GlaxoSmithKline, London, UK), patients in group 2 - a toothpaste that did not contain sodium bicarbonate. Repeated clinical examinations with the determination of the SBI, PMA, OHI-S were carried out after week 2 and 4. RESULTS After 4 weeks, SBI scores in group 1 were 63% lower than at baseline, and in group 2 - by 30%. PMA values at 4 weeks in group 1 were 58% and in group 2 30% lower, compared to baseline levels. The results of the analysis of the OHI-S index showed a statistically significant decrease in group 1 by 75%, while in group 2 by only 8% from the initial values. The difference in all index values between groups at 4 weeks of the study was statistically significant (p<0.05). CONCLUSION The use of parodontax Comprehensive Protection Toothpaste (GlaxoSmithKline, London, UK) has been shown to reduce the clinical signs of biofilm-associated gingivitis and effectively maintain optimal oral hygiene in patients.
Collapse
Affiliation(s)
- N I Krikheli
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov Russian Ministry of Health, Moscow, Russia
| | - E V Pustovoit
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov Russian Ministry of Health, Moscow, Russia
| | - E G Zhuravleva
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov Russian Ministry of Health, Moscow, Russia
| |
Collapse
|
12
|
Wirth R, Maróti G, Lipták L, Mester M, Al Ayoubi A, Pap B, Madléna M, Minárovits J, Kovács KL. Microbiomes in supragingival biofilms and saliva of adolescents with gingivitis and gingival health. Oral Dis 2021; 28:2000-2014. [PMID: 33876475 DOI: 10.1111/odi.13883] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Important alterations exist in the microbiomes of supragingival biofilm and saliva samples from adolescent patients developing induced or spontaneous gingivitis relative to healthy controls. These and the relationships to dental health are not fully understood yet. SUBJECTS AND METHODS Supragingival biofilm samples (n = 36) were collected from the teeth of 9 adolescents with gingivitis induced by orthodontic appliances, as well as dental plaques (n = 40) from 10 adolescents with spontaneous gingivitis, in addition to similar samples (n = 36) from 9 healthy controls. The bacterial metagenomes were analyzed by 16S rRNA gene amplicon sequencing. Salivary microbiomes of the same persons were characterized by shotgun metagenome sequencing. The data sets were examined using advanced bioinformatics workflows and two reference databases. RESULTS The composition and diversity of bacterial communities did not differ extensively among the three study groups. Nevertheless, the relative abundances of the genera Fusobacterium, Akkermansia, Treponema, and Campylobacter were prominently higher in gingivitis patients versus controls. In contrast, the genera Lautropia, Kingella, Neisseria, Actinomyces, and Rothia were significantly more abundant in controls than in either of the two gingivitis groups. CONCLUSIONS The abundance pattern of certain taxa rather than individual strains shows characteristic features of potential diagnostic value. Stringent bioinformatics treatment of the sequencing data is mandatory to avoid unintentional misinterpretations.
Collapse
Affiliation(s)
- Roland Wirth
- Department of Biotechnology, University of Szeged, Szeged, Hungary.,Institute of Plant Biology, Biological Research Centre, Szeged, Hungary
| | - Gergely Maróti
- Institute of Plant Biology, Biological Research Centre, Szeged, Hungary
| | - Lídia Lipták
- Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | - Mónika Mester
- Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | - Alaa Al Ayoubi
- Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | - Bernadett Pap
- Institute of Plant Biology, Biological Research Centre, Szeged, Hungary
| | - Melinda Madléna
- Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | - János Minárovits
- Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | - Kornél L Kovács
- Department of Biotechnology, University of Szeged, Szeged, Hungary.,Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| |
Collapse
|
13
|
Velickovic M, Arsenijevic A, Acovic A, Arsenijevic D, Milovanovic J, Dimitrijevic J, Todorovic Z, Milovanovic M, Kanjevac T, Arsenijevic N. Galectin-3, Possible Role in Pathogenesis of Periodontal Diseases and Potential Therapeutic Target. Front Pharmacol 2021; 12:638258. [PMID: 33815121 PMCID: PMC8017193 DOI: 10.3389/fphar.2021.638258] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/11/2021] [Indexed: 12/11/2022] Open
Abstract
Periodontal diseases are chronic inflammatory diseases that occur due to the imbalance between microbial communities in the oral cavity and the immune response of the host that lead to destruction of tooth supporting structures and finally to alveolar bone loss. Galectin-3 is a β-galactoside-binding lectin with important roles in numerous biological processes. By direct binding to microbes and modulation of their clearence, Galectin-3 can affect the composition of microbial community in the oral cavity. Galectin-3 also modulates the function of many immune cells in the gingiva and gingival sulcus and thus can affect immune homeostasis. Few clinical studies demonstrated increased expression of Galectin-3 in different forms of periodontal diseases. Therefore, the objective of this mini review is to discuss the possible effects of Galectin-3 on the process of immune homeostasis and the balance between oral microbial community and host response and to provide insights into the potential therapeutic targeting of Gal-3 in periodontal disease.
Collapse
Affiliation(s)
- Milica Velickovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandar Arsenijevic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandar Acovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Dragana Arsenijevic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Jelena Milovanovic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Department of Histology and Embriology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Jelena Dimitrijevic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Zeljko Todorovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marija Milovanovic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Tatjana Kanjevac
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Nebojsa Arsenijevic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| |
Collapse
|
14
|
Martínez M, Martín-Hernández D, Virto L, MacDowell KS, Montero E, González-Bris Á, Marín MJ, Ambrosio N, Herrera D, Leza JC, Sanz M, García-Bueno B, Figuero E. Periodontal diseases and depression: A pre-clinical in vivo study. J Clin Periodontol 2021; 48:503-527. [PMID: 33432590 DOI: 10.1111/jcpe.13420] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/10/2020] [Accepted: 01/07/2021] [Indexed: 12/17/2022]
Abstract
AIM To analyse, through a pre-clinical in vivo model, the possible mechanisms linking depression and periodontitis at behavioural, microbiological and molecular levels. MATERIALS AND METHODS Periodontitis (P) was induced in Wistar:Han rats (oral gavages with Porphyromonas gingivalis and Fusobacterium nucleatum) during 12 weeks, followed by a 3-week period of Chronic Mild Stress (CMS) induction. Four groups (n = 12 rats/group) were obtained: periodontitis and CMS (P+CMS+); periodontitis without CMS; CMS without periodontitis; and control. Periodontal clinical variables, alveolar bone levels (ABL), depressive-like behaviour, microbial counts and expression of inflammatory mediators in plasma and brain frontal cortex (FC), were measured. ANOVA tests were applied. RESULTS The highest values for ABL occurred in the P+CMS+ group, which also presented the highest expression of pro-inflammatory mediators (TNF-α, IL-1β and NF-kB) in frontal cortex, related to the lipoprotein APOA1-mediated transport of bacterial lipopolysaccharide to the brain and the detection of F. nucleatum in the brain parenchyma. A dysregulation of the hypothalamic-pituitary-adrenal stress axis, reflected by the increase in plasma corticosterone and glucocorticoid receptor levels in FC, was also found in this group. CONCLUSIONS Neuroinflammation induced by F. nucleatum (through a leaky mouth) might act as the linking mechanism between periodontal diseases and depression.
Collapse
Affiliation(s)
- María Martínez
- Postgraduate program in Periodontology, Faculty of Dentistry, Complutense University, Madrid (UCM), Madrid, Spain
| | - David Martín-Hernández
- Department of Child and Adolescent Psychiatry, Hospital Gregorio Marañón Research Institute (IiSGM), Madrid, Spain.,Department of Pharmacology and Toxicology, Faculty of Medicine UCM, Hospital 12 de Octubre Research Institute (Imas12), Neurochemistry Research Institute UCM, IUIN, Madrid, Spain.,Biomedical Network Research Center of Mental Health (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
| | - Leire Virto
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group (UCM), Madrid, Spain
| | - Karina S MacDowell
- Department of Pharmacology and Toxicology, Faculty of Medicine UCM, Hospital 12 de Octubre Research Institute (Imas12), Neurochemistry Research Institute UCM, IUIN, Madrid, Spain.,Biomedical Network Research Center of Mental Health (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
| | - Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group (UCM), Madrid, Spain
| | - Álvaro González-Bris
- Department of Pharmacology and Toxicology, Faculty of Medicine UCM, Hospital 12 de Octubre Research Institute (Imas12), Neurochemistry Research Institute UCM, IUIN, Madrid, Spain.,Biomedical Network Research Center of Mental Health (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
| | - María José Marín
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group (UCM), Madrid, Spain
| | - Nagore Ambrosio
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group (UCM), Madrid, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group (UCM), Madrid, Spain
| | - Juan Carlos Leza
- Department of Pharmacology and Toxicology, Faculty of Medicine UCM, Hospital 12 de Octubre Research Institute (Imas12), Neurochemistry Research Institute UCM, IUIN, Madrid, Spain.,Biomedical Network Research Center of Mental Health (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group (UCM), Madrid, Spain
| | - Borja García-Bueno
- Department of Pharmacology and Toxicology, Faculty of Medicine UCM, Hospital 12 de Octubre Research Institute (Imas12), Neurochemistry Research Institute UCM, IUIN, Madrid, Spain.,Biomedical Network Research Center of Mental Health (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
| | - Elena Figuero
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group (UCM), Madrid, Spain
| |
Collapse
|
15
|
Incidence of Periodontal Disease among Adolescents. JOURNAL OF INTERDISCIPLINARY MEDICINE 2020. [DOI: 10.2478/jim-2020-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Despite the scarcity of studies regarding periodontal disease in young patients (teenagers and young adults), it seems that this disorder is also affecting the young population. Risk factors for periodontal disease include older age, chronic tobacco use, male gender, habits regarding oral hygiene, educational status, ethnicity, and financial status.
Aim: This study aimed to evaluate the periodontal health among adolescents in two high schools in Târgu Mureș that had dental practices.
Material and Methods: An online questionnaire consisting of 16 questions was distributed among high schoolers of Târgu Mureș. Data about personal characteristics, oral hygiene habits, family history of periodontal disease, risk factors for periodontal disease, and symptoms of periodontal disease observed by the respondents were collected and analyzed.
Results: Out of the 501 teenagers who responded to the online questionnaire, 114 (22.8%) were 18 years old and were mostly females (88.2%). Regarding oral hygiene habits, 75.8% prefer a manual toothbrush over an electric toothbrush, 66.7% brush their teeth twice a day, and 54.1% practice a horizontal method of toothbrushing. Mouthwash was the most used oral hygiene aid (58.3%). Family history of periodontal disease was observed in 21.9% of respondents. As favoring factors, nicotine addiction (23.8%), bruxism (24.4%), interposition of various objects between teeth (48.3%), past or present orthodontic treatments (38.7%) were recorded. Symptoms of gingivitis and periodontitis, such as gingival bleeding (81.4%), redness of gingiva (39.3%), increased gingival volume (44.5%), gingival retraction (22.8%), and halitosis (81%), were present in the responding teenagers.
Conclusions: In this study, periodontal disease was affecting mostly adolescent females who are practicing inappropriate methods of toothbrushing with inadequate frequency.
Collapse
|
16
|
|
17
|
Holde GE, Jönsson B, Oscarson N, Müller H. To what extent does smoking affect gingival bleeding response to supragingival plaque? Site‐specific analyses in a population‐based study. J Periodontal Res 2020; 55:277-286. [DOI: 10.1111/jre.12713] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/10/2019] [Accepted: 11/12/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Gro Eirin Holde
- Department of Clinical Dentistry Faculty of Health Sciences UiT the Arctic University of Norway Tromsø Norway
- The Public Dental Health Service Competence Centre of Northern Norway Tromsø Norway
| | - Birgitta Jönsson
- The Public Dental Health Service Competence Centre of Northern Norway Tromsø Norway
- Department of Periodontology Institute of Odontology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Nils Oscarson
- Department of Clinical Dentistry Faculty of Health Sciences UiT the Arctic University of Norway Tromsø Norway
- The Public Dental Health Service Competence Centre of Northern Norway Tromsø Norway
| | - Hans‐Peter Müller
- Department of Clinical Dentistry Faculty of Health Sciences UiT the Arctic University of Norway Tromsø Norway
| |
Collapse
|
18
|
Ripari F, Cera A, Freda M, Zumbo G, Zara F, Vozza I. Tea Tree Oil versus Chlorhexidine Mouthwash in Treatment of Gingivitis: A Pilot Randomized, Double Blinded Clinical Trial. Eur J Dent 2020; 14:55-62. [PMID: 32168532 PMCID: PMC7069753 DOI: 10.1055/s-0040-1703999] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective
The study evaluated the efficacy of tea tree oil for the treatment of gingivitis.
Materials and Methods
The tea tree oil was administered in the form of mouthwash and then compared with a mouthwash with chlorhexidine 0.12%. Both treatments were domestic and lasted for 14 days. Patients were chosen according to random criteria, aged between 18 and 60 years, and who showed a clinically evident gingivitis. In clinical evaluation, the following clinical criteria were taken into consideration: gingival index (GI), plaque index (PI), bleeding index (BI), probing depth (PD), the presence of dental dyschromia, and the presence of taste alteration. The subjects were evaluated before (T0) and after the treatment (T1), and the data collected for each patient were recorded on a periodontal chart.
Results
The comparison showed that tea tree oil offered a better improvement in the evaluation of PI, BOP, and PD; furthermore, it did not cause dental dyschromia and taste alteration. In group A, treated with tea tree oil, PI decreased from 53.25 to 5.50% and BI from 38.41 to 4.22%. In group B, treated with chlorhexidine PI decreased from 47.69 to 2.37% and BI from 32.93 to 6.28%. Instead, the subjects using chlorhexidine 0.12% blamed a distaste for the product that caused a slight taste alteration; 20% of them showed iatrogenic dental dyschromia.
Conclusions
The collected data showed the efficacy of both treatments. Although further research works will be necessary, this study showed that tea tree oil could be an effective nontoxic substitute for the therapy of gingivitis.
Collapse
Affiliation(s)
- Francesca Ripari
- Department of Oral and Maxillo facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessia Cera
- Department of Oral and Maxillo facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Monica Freda
- Department of Oral and Maxillo facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Zumbo
- Department of Oral and Maxillo facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesca Zara
- Department of Oral and Maxillo facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Iole Vozza
- Department of Oral and Maxillo facial Sciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
19
|
Wang Y, Anderson EP, Tatakis DN. Whole transcriptome analysis of smoker palatal mucosa identifies multiple downregulated innate immunity genes. J Periodontol 2020; 91:756-766. [DOI: 10.1002/jper.19-0467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/23/2019] [Accepted: 10/01/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Yun Wang
- Division of PeriodontologyCollege of DentistryThe Ohio State University Columbus OH
| | - Eric P. Anderson
- Division of PeriodontologyCollege of DentistryThe Ohio State University Columbus OH
- Private practice Aurora CO
| | - Dimitris N. Tatakis
- Division of PeriodontologyCollege of DentistryThe Ohio State University Columbus OH
| |
Collapse
|
20
|
Murakami S, Mealey BL, Mariotti A, Chapple ILC. Dental plaque-induced gingival conditions. J Periodontol 2019; 89 Suppl 1:S17-S27. [PMID: 29926958 DOI: 10.1002/jper.17-0095] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/08/2017] [Accepted: 08/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This review proposes revisions to the current classification system for gingival diseases and provides a rationale for how it differs from the 1999 classification system. IMPORTANCE Gingival inflammation in response to bacterial plaque accumulation (microbial biofilms) is considered the key risk factor for the onset of periodontitis. Thus, control of gingival inflammation is essential for the primary prevention of periodontitis. FINDINGS The clinical characteristics common to dental plaque-induced inflammatory gingival conditions include: a) clinical signs and symptoms of inflammation that are confined to the gingiva: b) reversibility of the inflammation by removing or disrupting the biofilm; c) the presence of a high bacterial plaque burden to initiate the inflammation; d) systemic modifying factors (e.g., hormones, systemic disorders, drugs) which can alter the severity of the plaque-induced inflammation and; e) stable (i.e., non-changing) attachment levels on a periodontium which may or may not have experienced a loss of attachment or alveolar bone. The simplified taxonomy of gingival conditions includes: 1) introduction of the term "incipient gingivitis;" 2) a description of the extent and severity of gingival inflammation; 3) a description of the extent and severity of gingival enlargement and; 4) a reduction of categories in the dental plaque-induced gingival disease taxonomy. CONCLUSIONS Dental plaque-induced gingival inflammation is modified by various systemic and oral factors. The appropriate intervention is crucial for the prevention of periodontitis.
Collapse
Affiliation(s)
- Shinya Murakami
- Osaka University, Graduate School of Dentistry-Department of Periodontology, Osaka, Japan
| | - Brian L Mealey
- Department of Periodontics, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Angelo Mariotti
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Iain L C Chapple
- Department of Periodontology, University of Birmingham School of Dentistry, Birmingham, UK
| |
Collapse
|
21
|
Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque-induced gingivitis: Case definition and diagnostic considerations. J Periodontol 2019; 89 Suppl 1:S46-S73. [PMID: 29926936 DOI: 10.1002/jper.17-0576] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/15/2017] [Accepted: 10/21/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Clinical gingival inflammation is a well-defined site-specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a "gingivitis site") is completely different from defining and grading a "gingivitis case" (GC) (i.e. a patient affected by gingivitis), and that a "gingivitis site" does not necessarily mean a "GC". The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque-induced gingivitis and to propose a set of criteria to define GC. IMPORTANCE A universally accepted case definition for gingivitis would provide the necessary information to enable oral health professionals to assess the effectiveness of their prevention strategies and treatment regimens; help set priorities for therapeutic actions/programs by health care providers; and undertake surveillance. FINDINGS Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%) CONCLUSIONS: A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.
Collapse
Affiliation(s)
- Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy
| | - Cléverson O Silva
- Department of Dentistry, State University of Maringá, Maringá, Brazil
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
22
|
Effectiveness of Different Commercial Chlorhexidine-Based Mouthwashes After Periodontal and Implant Surgery: A Systematic Review. IMPLANT DENT 2019; 28:74-85. [PMID: 30648980 DOI: 10.1097/id.0000000000000854] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the present study was to review the effectiveness, side effects, and patient acceptance of different concentrations and formulation of chlorhexidine-based mouthwashes used after periodontal and implant surgery. MATERIALS AND METHODS The PRISMA guideline was adopted in the search strategy using electronic databases PubMed and MEDLINE to identify randomized and case-control prospective studies on humans written in English language and published up to September 2017. RESULTS A total of 10 articles were selected for a total of 344 patients. Because of the significant heterogeneity of the outcome measures, meta-analysis was not performed, and the data were summarized in a table. A positive relationship between the use of chlorhexidine and reduction of plaque was found, demonstrating the effectiveness of the substance in terms of antisepsis and decrease of inflammation after periodontal and implant surgery. CONCLUSION Chlorhexidine is recognized as the primary agent for plaque control and the gold standard in preventing infection, although the presence of largely known side effects would affect patient compliance. Future research should be directed at finding chlorhexidine formulation with negligible adverse effects, without compromising or even increasing its effectiveness as the antiseptics and antiplaque agent.
Collapse
|
23
|
Murakami S, Mealey BL, Mariotti A, Chapple IL. Dental plaque-induced gingival conditions. J Clin Periodontol 2018; 45 Suppl 20:S17-S27. [DOI: 10.1111/jcpe.12937] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/08/2017] [Accepted: 08/19/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Shinya Murakami
- Osaka University; Graduate School of Dentistry-Department of Periodontology; Osaka Japan
| | - Brian L. Mealey
- Department of Periodontics; The University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - Angelo Mariotti
- Division of Periodontology, College of Dentistry; The Ohio State University; Columbus OH USA
| | - Iain L.C. Chapple
- Department of Periodontology; University of Birmingham School of Dentistry; Birmingham UK
| |
Collapse
|
24
|
Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque-induced gingivitis: Case definition and diagnostic considerations. J Clin Periodontol 2018; 45 Suppl 20:S44-S67. [DOI: 10.1111/jcpe.12939] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/15/2017] [Accepted: 10/21/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases; University of Ferrara; Ferrara Italy
- Operative Unit of Dentistry; University-Hospital of Ferrara; Ferrara Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases; University of Ferrara; Ferrara Italy
- Operative Unit of Dentistry; University-Hospital of Ferrara; Ferrara Italy
| | | | - Dimitris N. Tatakis
- Division of Periodontology; College of Dentistry; The Ohio State University; Columbus OH USA
| |
Collapse
|
25
|
Tarnowski M, Duda-Sobczak A, Lipski J, Zozulinska-Ziolkiewicz D, Wyganowska-Swiatkowska M. Tobacco smoking decreases clinical symptoms of gingivitis in patients with type 1 diabetes-a cross-sectional study. Oral Dis 2018; 24:1336-1342. [PMID: 29757485 DOI: 10.1111/odi.12889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/23/2018] [Accepted: 04/27/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Periodontal disease may develop on the background of microvascular complications of diabetes. However, some modifying factors, such as tobacco smoking, should be taken into consideration when assessing risk of development of chronic complications. The aim of the study was the clinical assessment of the periodontal status in patients with type 1 diabetes according to tobacco smoking. SUBJECTS AND METHODS A total of 362 subjects aged 29 (IQR 22-35) years, type 1 diabetes duration 12 (8-18) years, hemoglobin A1c, HbA1c 8.0 (7.2-9.1)% were included. We used Gingival Index, Approximal Plaque Index, and Sulcus Bleeding Index to assess periodontal health. Patients were divided into two subgroups according to current cigarette smoking. RESULTS No differences in age, diabetes duration, and chronic complications were found between subgroups. A better metabolic control of diabetes expressed by lower HbA1c (p = 0.00001) and triglyceride levels (p = 0.004) was shown in nonsmokers. Smokers presented significantly lower gingival bleeding, p = 0.009. HbA1c correlated with API in study group (Rs = 0.16; p = 0.002) and in nonsmokers subgroup (Rs = 0.2;p = 0.004), however, not in smoker's subgroup. In multivariable regression analysis, smoking cigarettes (β = -0.26; p = 0.0002), hs-CRP (β = 0.15; p = 0.03) and age (β = -0.19; p = 0.007) occurred to be independent predictors of SBI after adjustment for confounding variables (R2 = 0.13; p = 0.001). CONCLUSIONS Patients with type 1 diabetes smoking cigarettes presented lower gingival sulcus bleeding and worse metabolic control of diabetes than nonsmoking patients.
Collapse
Affiliation(s)
- Mateusz Tarnowski
- Department of Dental Surgery and Periodontology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Duda-Sobczak
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jakub Lipski
- Department of Dental Surgery and Periodontology, Poznan University of Medical Sciences, Poznan, Poland
| | | | | |
Collapse
|
26
|
Montero E, Iniesta M, Rodrigo M, Marín MJ, Figuero E, Herrera D, Sanz M. Clinical and microbiological effects of the adjunctive use of probiotics in the treatment of gingivitis: A randomized controlled clinical trial. J Clin Periodontol 2017; 44:708-716. [DOI: 10.1111/jcpe.12752] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Eduardo Montero
- Periodontology - Faculty of Odontology; University Complutense; Madrid Spain
| | - Margarita Iniesta
- Periodontology - Faculty of Odontology; University Complutense; Madrid Spain
| | - Marta Rodrigo
- Periodontology - Faculty of Odontology; University Complutense; Madrid Spain
| | - María José Marín
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - Elena Figuero
- Periodontology - Faculty of Odontology; University Complutense; Madrid Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - David Herrera
- Periodontology - Faculty of Odontology; University Complutense; Madrid Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - Mariano Sanz
- Periodontology - Faculty of Odontology; University Complutense; Madrid Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| |
Collapse
|
27
|
Abstract
Periodontal diseases comprise a wide range of inflammatory conditions that affect the supporting structures of the teeth (the gingiva, bone and periodontal ligament), which could lead to tooth loss and contribute to systemic inflammation. Chronic periodontitis predominantly affects adults, but aggressive periodontitis may occasionally occur in children. Periodontal disease initiation and propagation is through a dysbiosis of the commensal oral microbiota (dental plaque), which then interacts with the immune defences of the host, leading to inflammation and disease. This pathophysiological situation persists through bouts of activity and quiescence, until the affected tooth is extracted or the microbial biofilm is therapeutically removed and the inflammation subsides. The severity of the periodontal disease depends on environmental and host risk factors, both modifiable (for example, smoking) and non-modifiable (for example, genetic susceptibility). Prevention is achieved with daily self-performed oral hygiene and professional removal of the microbial biofilm on a quarterly or bi-annual basis. New treatment modalities that are actively explored include antimicrobial therapy, host modulation therapy, laser therapy and tissue engineering for tissue repair and regeneration.
Collapse
Affiliation(s)
- Denis F Kinane
- University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, Pennsylvania 19104, USA
| | - Panagiota G Stathopoulou
- University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, Pennsylvania 19104, USA
| | - Panos N Papapanou
- Columbia University College of Dental Medicine, New York, New York, USA
| |
Collapse
|
28
|
Silva de Araujo Figueiredo C, Gonçalves Carvalho Rosalem C, Costa Cantanhede AL, Abreu Fonseca Thomaz ÉB, Fontoura Nogueira da Cruz MC. Systemic alterations and their oral manifestations in pregnant women. J Obstet Gynaecol Res 2017; 43:16-22. [DOI: 10.1111/jog.13150] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/24/2016] [Accepted: 08/07/2016] [Indexed: 12/23/2022]
|
29
|
Trombelli L, Farina R, Manfrini R, Tatakis DN. Modulation of Clinical Expression of Plaque-induced Gingivitis: Effect of Incisor Crown Form. J Dent Res 2016; 83:728-31. [PMID: 15329381 DOI: 10.1177/154405910408300914] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Evidence indicates that incisor crown form correlates with clinical periodontal features. It was hypothesized that incisor crown form may explain subject differences in gingivitis expression. The present experimental gingivitis study aimed to assess the effect of incisor crown form on plaque accumulation and gingival inflammation, and on individual susceptibility to plaque-induced gingivitis. Eighty-five periodontally healthy subjects were evaluated. A negative correlation was found between incisor crown width/crown length ratio and bleeding score (p = 0.045). From the 85 subjects, two groups of subjects with either ‘long-narrow’ or ‘short-wide’ incisor form were identified. The ‘long-narrow’ group had a significantly higher bleeding score than the ‘short-wide’ group (p = 0.014). No significant differences were found in the incisor crown width/crown length ratio between previously identified ‘high responder’ and ‘low responder’ subjects ( Trombelli et al., 2004a ). In conclusion, incisor crown form appears to affect the bleeding response of inflamed gingival tissues, while it exerts no influence on explaining differences in individuals’ susceptibility to plaque-induced gingivitis.
Collapse
Affiliation(s)
- L Trombelli
- Research Center for the Study of Periodontal Diseases, University of Ferrara, Corso Giovecca 203, 44100, Italy.
| | | | | | | |
Collapse
|
30
|
Carrouel F, Viennot S, Santamaria J, Veber P, Bourgeois D. Quantitative Molecular Detection of 19 Major Pathogens in the Interdental Biofilm of Periodontally Healthy Young Adults. Front Microbiol 2016; 7:840. [PMID: 27313576 PMCID: PMC4889612 DOI: 10.3389/fmicb.2016.00840] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/19/2016] [Indexed: 12/12/2022] Open
Abstract
In oral health, the interdental spaces are a real ecological niche for which the body has few or no alternative defenses and where the traditional daily methods for control by disrupting biofilm are not adequate. The interdental spaces are the source of many hypotheses regarding their potential associations with and/or causes of cardiovascular disease, diabetes, chronic kidney disease, degenerative disease, and depression. This PCR study is the first to describe the interdental microbiota in healthy adults aged 18–35 years-old with reference to the Socransky complexes. The complexes tended to reflect microbial succession events in developing dental biofilms. Early colonizers included members of the yellow, green, and purple complexes. The orange complex bacteria generally appear after the early colonizers and include many putative periodontal pathogens, such as Fusobacterium nucleatum. The red complex (Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) was considered the climax community and is on the list of putative periodontal pathogens. The 19 major periodontal pathogens tested were expressed at various levels. F. nucleatum was the most abundant species, and the least abundant were Actinomyces viscosus, P. gingivalis, and Aggregatibacter actinomycetemcomitans. The genome counts for Eikenella corrodens, Campylobacter concisus, Campylobacter rectus, T. denticola, and Tannerella forsythensis increased significantly with subject age. The study highlights the observation that bacteria from the yellow complex (Streptococcus spp., S. mitis), the green complex (E. corrodens, Campylobacter gracilis, Capnocytophaga ochracea, Capnocytophaga sputigena, A. actinomycetemcomitans), the purple complex (Veillonella parvula, Actinomyces odontolyticus) and the blue complex (A. viscosus) are correlated. Concerning the orange complex, F. nucleatum is the most abundant species in interdental biofilm. The red complex, which is recognized as the most important pathogen in adult periodontal disease, represents 8.08% of the 19 bacteria analyzed. P. gingivalis was detected in 19% of healthy subjects and represents 0.02% of the interdental biofilm. T. forsythensis and T. denticola (0.02 and 0.04% of the interdental biofilm) were detected in 93 and 49% of healthy subjects, respectively. The effective presence of periodontal pathogens is a strong indicator of the need to develop new methods for disrupting interdental biofilm in daily oral hygiene.
Collapse
Affiliation(s)
- Florence Carrouel
- Institute of Functional Genomics of Lyon, UMR CNRS 5242, Ecole Normale Supérieure de Lyon, University Lyon 1, Lyon France
| | - Stéphane Viennot
- Laboratory "Health, Individual, Society" EA4129, University Lyon 1, Lyon France
| | - Julie Santamaria
- Department of Prevention and Public Health, Faculty of Dentistry, University Lyon 1, Lyon France
| | - Philippe Veber
- Laboratory "Biométrie et Biologie Évolutive", UMR CNRS 5558 - LBBE, University Lyon 1, Villeurbanne France
| | - Denis Bourgeois
- Laboratory "Health, Individual, Society" EA4129, University Lyon 1, Lyon France
| |
Collapse
|
31
|
Zaveri PK. Orthodontic management of a periodontally compromised dentition. APOS TRENDS IN ORTHODONTICS 2016. [DOI: 10.4103/2321-1407.173717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Malocclusion superimposed with severe periodontitis may present a great challenge to clinicians while providing orthodontic treatment due the episodic and site-specific nature of the disease with risk of rapid tissue breakdown. However, orthodontic treatment in such situation may contribute significantly to the overall rehabilitation both functionally and esthetically. In this article, a case report outlines a combined periodontic-orthodontic management of compromised dentition. A 37-year-old female patient with significant medical history was treated for Class II Division 1 type of malocclusion associated with spaced upper and lower anterior teeth, deep overbite, and increased overjet, superimposed with chronic generalized periodontitis and bone loss. Treatment was completed using temporary anchorage devices assisted strategically applied force and modified tandem retraction biomechanics amidst management of acute inflammatory episodes during and mucogingival complication after treatment. Affected areas healed very well after post-orthodontic periodontal treatment with minimal pocket depth, and bleeding on probing, and a healthy zone of attached gingiva at the follow up visits. The orthodontic results lead to improvement in patient’s facial profile, lip posture, and correction of protrusion which addressed her main concern. One year follow-up shows good orthodontic and periodontic stability. The report highlights the importance of identifying “at risk” individuals and continuous monitoring of disease status during treatment. Despite all precautionary measures, a flare-up during the treatment can be anticipated.
Collapse
|
32
|
Paes Batista da Silva A, Barros SP, Moss K, Preisser J, Marchesan JT, Ward M, Offenbacher S. Microbial Profiling in Experimentally Induced Biofilm Overgrowth Among Patients With Various Periodontal States. J Periodontol 2016; 87:27-35. [DOI: 10.1902/jop.2015.150328] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
33
|
Oliveira SC, Slot DE, Celeste RK, Abegg C, Keijser BJF, Van der Weijden FA. Correlations between two different methods to score bleeding and the relationship with plaque in systemically healthy young adults. J Clin Periodontol 2015. [PMID: 26212602 DOI: 10.1111/jcpe.12435] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the correlation between bleeding on marginal probing (BOMP) and bleeding on pocket probing (BOPP), and the correlation of both bleeding indices with plaque. MATERIALS AND METHODS This cross-sectional study screened 336 participants, from which 268 were eligible for examination and analysis. Bleeding and plaque indices were assessed by single examiners, at six sites per tooth. RESULTS The mean percentage of sites per individual with bleeding on marginal probing, bleeding on pocket probing and dental plaque were 19.9%, 51.2% and 32.2% respectively. In the quadrants where the margin was probed before the pocket, a 4.6 percentage points higher bleeding tendency with BOPP was observed (p < 0.05). At a site level, the correlation coefficients of plaque and bleeding on marginal probing and bleeding on pocket probing were 0.19 and 0.20 respectively. Both bleeding indices were also shown to be correlated (r = 0.89, fixed effect model). CONCLUSION The prevalence of bleeding upon probing is influenced by the scoring method that is used for the diagnosis. Probing the bottom of the pocket results in significantly more bleeding than running a probe along the margin.
Collapse
Affiliation(s)
- Sara Cioccari Oliveira
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije University Amsterdam, Amsterdam, The Netherlands.,Department of Social and Preventive Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Dagmar E Slot
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije University Amsterdam, Amsterdam, The Netherlands
| | - Roger Keller Celeste
- Department of Social and Preventive Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Claides Abegg
- Department of Social and Preventive Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bart J F Keijser
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije University Amsterdam, Amsterdam, The Netherlands.,Microbial Genomics Group, TNO Quality of Life, Business Unit Food and Biotechnology Innovations, Zeist, The Netherlands
| | - Fridus A Van der Weijden
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije University Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
34
|
Dosseva-Panova V, Mlachkova A, Popova C. Gene polymorphisms in periodontitis. Overview. BIOTECHNOL BIOTEC EQ 2015. [DOI: 10.1080/13102818.2015.1056230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
35
|
A combination of cis-2-decenoic acid and chlorhexidine removes dental plaque. Arch Oral Biol 2015; 60:1655-61. [PMID: 26351749 DOI: 10.1016/j.archoralbio.2015.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 08/08/2015] [Accepted: 08/10/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate the ability of cis-2-decenoic acid (C2DA) to induce dispersion in single-species biofilms formed by Streptococcus mutans and Candida albicans, as well as to remove their bacterial-fungal dual-species biofilms when combined with low concentrations of chlorhexidine (CHX). METHODS For biofilm dispersal bioassays, single-species biofilms of S. mutans and C. albicans were grown on the inside surface of petri dishes, using a semi-batch culture method in which the medium was replaced every 24h for 5 days. Biofilms were then treated with very low concentrations of C2DA (100 and 310 nM) for 1h to release cells into the bulk liquid and to evaluate dispersed cell number by measuring the optical density (OD). To assess the ability of C2DA combined CHX treatments to remove tested microorganisms' dual-species biofilms, they were grown on saliva-coated hydroxyapatite (sHA) discs for 48 h and then were treated with three different concentrations of CHX (0.08%, 0.06% and 0.04%) alone or in combination with indicated concentrations of C2DA for 1 min twice daily for 3 subsequent days. Biofilms were then either subjected to the field emission scanning electron microscopy (FESEM) analysis or harvested and colony forming units (CFUs) were counted after plating on agar. RESULTS Treatment of pre-established biofilms with 310 nM C2DA caused an approximately two-fold increase in the number of planktonic cells in both cultures. A combination of 310 nM C2DA and 0.04% CHX resulted in significant removal (p-value <0.05) of dual-species biofilms from sHA discs surface. CONCLUSIONS Anti-biofilm characteristic of C2DA boosts the action of CHX even at low concentrations.
Collapse
|
36
|
Porphyromonas gingivalis Periodontal Infection and Its Putative Links with Alzheimer's Disease. Mediators Inflamm 2015; 2015:137357. [PMID: 26063967 PMCID: PMC4430664 DOI: 10.1155/2015/137357] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/01/2015] [Indexed: 12/18/2022] Open
Abstract
Periodontal disease (PD) and Alzheimer's disease (AD) are inflammatory conditions affecting the global adult population. In the pathogenesis of PD, subgingival complex bacterial biofilm induces inflammation that leads to connective tissue degradation and alveolar bone resorption around the teeth. In health, junctional epithelium seals the gingiva to the tooth enamel, thus preventing bacteria from entering the gingivae. Chronic PD involves major pathogens (Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia) which have an immune armoury that can circumvent host's immune surveillance to create and maintain an inflammatory mediator rich and toxic environment to grow and survive. The neurodegenerative condition, AD, is characterised by poor memory and specific hallmark proteins; periodontal pathogens are increasingly being linked with this dementing condition. It is therefore becoming important to understand associations of periodontitis with relevance to late-onset AD. The aim of this review is to discuss the relevance of finding the keystone periodontal pathogen P. gingivalis in AD brains and its plausible contribution to the aetiological hypothesis of this dementing condition.
Collapse
|
37
|
Quintas V, Prada-López I, Donos N, Suárez-Quintanilla D, Tomás I. Antiplaque effect of essential oils and 0.2% chlorhexidine on an in situ model of oral biofilm growth: a randomised clinical trial. PLoS One 2015; 10:e0117177. [PMID: 25689859 PMCID: PMC4331278 DOI: 10.1371/journal.pone.0117177] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the in situ antiplaque effect after 4 days of using of 2 commercial antimicrobial agents in short term on undisturbed plaque-like biofilm. TRIAL DESIGN AND PARTICIPANTS An observer-masked, crossover randomised clinical trial on 15 oral and systemically healthy volunteers between 20-30 years who were randomly and sequentially allocated in the same group which performed 3 interventions in different randomised sequences. INTERVENTION The participants wore an appliance in 3 different rinsing periods doing mouthwashes twice a day (1/0/1) with essential oils, 0.2% chlorhexidine or sterile water (negative control). At the end of each 4-day mouthwash period, samples were removed from the appliance. Posteriorly, after bacterial vital staining, samples were analysed using a Confocal Laser Scanning Microscope. MAIN OUTCOME MEASURES Bacterial vitality, thickness and covering grade by the biofilm after 4 days of applying each of the mouthwashes. RESULTS The essential oils and the 0.2% chlorhexidine were significantly more effective than the sterile water at reducing bacterial vitality, thickness and covering grade by the biofilm. No significant differences were found between the 0.2% chlorhexidine and the essential oils at reducing the bacterial vitality (13.2% vs. 14.7%). However, the 0.2% chlorhexidine showed more reduction than the essential oils in thickness (6.5 μm vs. 10.0 μm; p<0.05) and covering grade by the biofilm (20.0% vs. 54.3%; p<0.001). CONCLUSION The essential oils and 0.2% chlorhexidine showed a high antiplaque effect. Although the 0.2% chlorhexidine showed better results with regard to reducing the thickness and covering grade by the biofilm, both antiseptics showed a high and similar antibacterial activity. CLINICAL RELEVANCE Daily essential oils or 0.2% chlorhexidine mouthwashes are effective when reducing dental plaque formation in the short term. Although 0.2% chlorhexidine continues to be the "gold standard" in terms of antiplaque effect, essential oils could be considered a reliable alternative. TRIAL REGISTRATION ClinicalTrials.gov NCT02124655.
Collapse
Affiliation(s)
- Víctor Quintas
- Oral Sciences Research Group, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Isabel Prada-López
- Oral Sciences Research Group, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Nikolaos Donos
- Periodontology Unit, UCL Eastman Dental Institute, London, United Kingdom
| | - David Suárez-Quintanilla
- Oral Sciences Research Group, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Inmaculada Tomás
- Oral Sciences Research Group, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
38
|
Rahman B, Alkawas S, Al Zubaidi EA, Adel OI, Hawas N. Comparative antiplaque and antigingivitis effectiveness of tea tree oil mouthwash and a cetylpyridinium chloride mouthwash: A randomized controlled crossover study. Contemp Clin Dent 2014; 5:466-70. [PMID: 25395761 PMCID: PMC4229754 DOI: 10.4103/0976-237x.142813] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the antiplaque and antigingivitis effects of a mouthwash containing tea tree oil (TTO) with a cetylpyridinium chloride (CPC) mouthwash. MATERIALS AND METHODS This was a randomized 4 × 4, controlled, cross-over, involving 20 healthy volunteers in a 5-day plaque re-growth model. Test mouthwashes were TTO (Tebodont(®)) and a mouthwash containing CPC 0.05% (Aquafresh(®)). A 0.12% chlorhexidine (CHX) mouthwash (Oro-Clense(®)) was used as positive and colored water (placebo [PLB]) as negative controls. Gingival bleeding index (GBI) and plaque index (PI) scores were recorded before and after each test period. Test periods were separated with 2 weeks washout period. RESULTS All four mouthwashes significantly (P < 0.001) reduced the GBI scores when compared to the baseline GBI scores. There was no significant difference between PLB and active mouthwashes in the GBI scores. CHX and CPC mouthwashes were found more effective in reducing the PI scores than TTO and PLB mouthwashes. There was no significant difference in PI scores of CHX and CPC mouthwashes. CONCLUSION 0.05% CPC mouthwash can be an alternative to CHX mouthwash since it is alcohol free and found as efficient as CHX in dental plaque reduction with lesser side effects. More studies are needed to test antigingivitis effects of the mouthwashes used in this study, preferably without initial scaling and polishing.
Collapse
Affiliation(s)
- Betul Rahman
- Department of General and Specialist Dental Practice, College of Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Sausan Alkawas
- Department of Oral and Craniofacial Health Sciences, College of Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Elaf A Al Zubaidi
- Department of General and Specialist Dental Practice, College of Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Omar I Adel
- Department of General and Specialist Dental Practice, College of Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Nuha Hawas
- Department of Oral Health, McGill University, Canada
| |
Collapse
|
39
|
Predictive modeling of gingivitis severity and susceptibility via oral microbiota. ISME JOURNAL 2014; 8:1768-80. [PMID: 24646694 DOI: 10.1038/ismej.2014.32] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/17/2013] [Accepted: 01/29/2014] [Indexed: 01/17/2023]
Abstract
Predictive modeling of human disease based on the microbiota holds great potential yet remains challenging. Here, 50 adults underwent controlled transitions from naturally occurring gingivitis, to healthy gingivae (baseline), and to experimental gingivitis (EG). In diseased plaque microbiota, 27 bacterial genera changed in relative abundance and functional genes including 33 flagellar biosynthesis-related groups were enriched. Plaque microbiota structure exhibited a continuous gradient along the first principal component, reflecting transition from healthy to diseased states, which correlated with Mazza Gingival Index. We identified two host types with distinct gingivitis sensitivity. Our proposed microbial indices of gingivitis classified host types with 74% reliability, and, when tested on another 41-member cohort, distinguished healthy from diseased individuals with 95% accuracy. Furthermore, the state of the microbiota in naturally occurring gingivitis predicted the microbiota state and severity of subsequent EG (but not the state of the microbiota during the healthy baseline period). Because the effect of disease is greater than interpersonal variation in plaque, in contrast to the gut, plaque microbiota may provide advantages in predictive modeling of oral diseases.
Collapse
|
40
|
Khosravisamani M, Maliji G, Seyfi S, Azadmehr A, Abd Nikfarjam B, Madadi S, Jafari S. Effect of the menstrual cycle on inflammatory cytokines in the periodontium. J Periodontal Res 2014; 49:770-6. [PMID: 24673464 DOI: 10.1111/jre.12161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVE The effects of different levels of steroid hormones, as experienced during puberty, pregnancy and menopause, on the periodontium have been demonstrated, but changes in sex hormone levels during the menstrual cycle, and the influence of these changes on the periodontium, remain unresolved. The aim of this study was to investigate the effect of the menstrual cycle on the levels of interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) in gingival crevicular fluid and on periodontal clinical parameters, including the gingival bleeding index (GBI) and the modified gingival index (MGI), in periodontally healthy women. MATERIAL AND METHODS Twenty-seven periodontally healthy women with a regular menstrual cycle were included in the study. Clinical parameters, including the GBI, the MGI and the simplified oral health index, were recorded during menstruation, ovulation and premenstruation phases (e.g. on days 1-2, 12-14 and 22-24, respectively) of the menstrual cycle. Gingival crevicular fluid and unstimulated saliva were collected, at each study phase, for assessment of IL-1β, TNF-α, estrogen and progesterone. RESULTS Both the GBI and the MGI increased significantly during the menstrual cycle, and were significantly higher during ovulation than during menstruation or premenstruation (p < 0.001). No significant change in the simplified oral health index was observed during the menstrual cycle ( p = 0.18). The levels of IL-1β and TNF-α increased during the different phases of the menstrual cycle, but only the change in the TNF-α concentration was significant ( p < 0.05). CONCLUSION This study indicated that changes occurring during the menstrual cycle influence the periodontium and induce inflammatory conditions.
Collapse
Affiliation(s)
- M Khosravisamani
- Department of Periodontology and Implantology, Dental Materials Research Center, Dental Faculty, Babol University of Medical Sciences and Health Services, Babol, Iran
| | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
During pregnancy profound perturbations in innate and adaptive immunity impact the clinical course of a number of infectious diseases, including those affecting periodontal tissues. Conversely, it has been suggested that periodontal infections may increase the risk of adverse pregnancy outcomes. In this review, a summary of the literature associated with the bidirectional relationship between pregnancy and periodontal disease as well as the possible mechanisms behind this interaction were examined.
Collapse
|
42
|
Farina R, Tomasi C, Trombelli L. The bleeding site: a multi-level analysis of associated factors. J Clin Periodontol 2013; 40:735-42. [DOI: 10.1111/jcpe.12118] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases; University of Ferrara; Ferrara Italy
| | - Cristiano Tomasi
- Department of Periodontology; Institute of Odontology; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
| | - Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases; University of Ferrara; Ferrara Italy
| |
Collapse
|
43
|
|
44
|
Lushnikova EL, Nepomnyashchikh LM, Oskolsky GI, Jurkevich NV. Ultrastructure of gingival epithelium in chronic gingivitis. Bull Exp Biol Med 2012; 152:637-41. [PMID: 22803154 DOI: 10.1007/s10517-012-1596-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We studied ultrastructural reorganization of the gingival mucosa in chronic gingivitis. It was found that chronic inflammation leads to significant intracellular reorganization of epitheliocytes in the basal and prickle cell layers of gingival epithelium and their pronounced structural and functional heterogeneity. The main ultrastructural alterations of epitheliocytes in the basal and prickle cell layers include pronounced vacuolization of the perinuclear zone (partial necrosis), formation of thick tonofilament bundles, focal lysis and sequestration of glycogen, and destruction and reduction of intracellular junctions in some cases accompanied by acantholytic alterations. Chronic inflammation in the gingival mucosa induced extensive remodeling of the lamina propria manifested in multiplication of the basement membrane and obturation of blood vessels with collagen fibrils.
Collapse
Affiliation(s)
- E L Lushnikova
- Research Institute of Regional Pathology and Pathomorphology, Siberian Division of the Russian Academy of Medical Sciences, Novosibirsk, Russia.
| | | | | | | |
Collapse
|
45
|
Microbiological profile and calprotectin expression in naturally occurring and experimentally induced gingivitis. Clin Oral Investig 2011; 16:1475-84. [DOI: 10.1007/s00784-011-0643-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 11/16/2011] [Indexed: 10/15/2022]
|
46
|
Jönsson D, Ramberg P, Demmer RT, Kebschull M, Dahlén G, Papapanou PN. Gingival tissue transcriptomes in experimental gingivitis. J Clin Periodontol 2011; 38:599-611. [PMID: 21501207 DOI: 10.1111/j.1600-051x.2011.01719.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS We investigated the sequential gene expression in the gingiva during the induction and resolution of experimental gingivitis. MATERIAL AND METHODS Twenty periodontally and systemically healthy non-smoking volunteers participated in a 3-week experimental gingivitis protocol, followed by debridement and 2-week regular plaque control. We recorded clinical indices and harvested gingival tissue samples from four interproximal palatal sites in half of the participants at baseline, Day 7, Day 14 and Day 21 (the "induction phase"), and at Day 21, Day 25, Day 30 and Day 35 in the other half (the "resolution phase"). RNA was extracted, amplified, reversed transcribed, amplified, labelled and hybridized using Affymetrix Human Genome U133Plus2.0 microarrays. Paired t-tests compared gene expression changes between consecutive time points. Gene ontology analyses summarized the expression patterns into biologically relevant categories. RESULTS The median gingival index was 0 at baseline, 2 at Day 21 and 1 at Day 35. Differential gene regulation peaked during the third week of induction and the first 4 days of resolution. Leucocyte transmigration, cell adhesion and antigen processing/presentation were the top differentially regulated pathways. CONCLUSIONS Transcriptomic studies enhance our understanding of the pathobiology of the reversible inflammatory gingival lesion and provide a detailed account of the dynamic tissue responses during the induction and resolution of experimental gingivitis.
Collapse
Affiliation(s)
- Daniel Jönsson
- Division of Periodontics, Section of Oral and Diagnostic Sciences, College of Dental Medicine, Columbia University, New York, NY 10032, USA
| | | | | | | | | | | |
Collapse
|
47
|
Rintakoski K, Kaprio J, Murtomaa H. Genetic and Environmental Factors in Oral Health among Twins. J Dent Res 2010; 89:700-4. [DOI: 10.1177/0022034510366795] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To date, studies on the contributions of genetic factors to oral health have been inconclusive. We hypothesized that major dental diseases show a significant genetic component. The study was based on self-reported oral health among young adult twins. The data were derived from the fourth wave of the longitudinal FinnTwin16 study, in which participants completed a questionnaire in 2000-2002 enquiring about the number of filled teeth and the prevalence of gingival bleeding. We used quantitative genetic modeling, based on the genetic similarity of identical and non-identical twins, to calculate the most probable model for both filled teeth and gingival bleeding. The models revealed a strong genetic component behind the number of filled teeth, differing between males (49%) and females (68%), and a weaker genetic component affecting gingival bleeding, being similar for males and females (32%). Genetic factors contribute to inter-individual differences in oral health among young adults.
Collapse
Affiliation(s)
- K. Rintakoski
- Department of Oral Public Health, PL 41, 00014 University of Helsinki, Finland
| | - J. Kaprio
- Department of Public Health, University of Helsinki & Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
| | - H. Murtomaa
- Department of Oral Public Health, PL 41, 00014 University of Helsinki, Finland
| |
Collapse
|
48
|
Trombelli L, Scapoli C, Carrieri A, Giovannini G, Calura G, Farina R. Interleukin-1 beta levels in gingival crevicular fluid and serum under naturally occurring and experimentally induced gingivitis. J Clin Periodontol 2010; 37:697-704. [PMID: 20528961 DOI: 10.1111/j.1600-051x.2010.01573.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS To evaluate the interleukin-1 beta (IL-1 beta) levels in gingival crevicular fluid (GCF) and serum in either naturally occurring (N-O) or experimentally induced (E-I) plaque-associated gingivitis. MATERIAL AND METHODS Thirty-seven periodontally healthy subjects were evaluated in real life conditions (N-O gingivitis) as well as after 21 days of experimental gingivitis trial (E-I gingivitis). During the experimental gingivitis trial, in one maxillary quadrant (test quadrant), gingival inflammation was induced by oral hygiene abstention, while in the contralateral (control) quadrant, oral hygiene was routinely continued. IL-1 beta concentrations in N-O and E-I gingivitis were investigated for IL-1B(+3954) and IL-1B(-511) gene polymorphisms. RESULTS (i) GCF IL-1 beta concentrations in E-I gingivitis were significantly higher compared with N-O gingivitis; (ii) an intra-individual correlation between GCF concentrations of IL-1 beta detected in N-O and E-I gingivitis was observed in control quadrants, but not in test quadrants; (iii) IL-1 beta concentration in GCF was associated with IL-1B(+3954) genotype only at test quadrants; (iv) IL-1 beta was detectable in serum only at low levels in a limited number of subjects, without difference between gingivitis conditions. CONCLUSIONS Aspects of the bacterial challenge to the gingival tissues, such as the amount of plaque deposits and plaque accumulation rate, appear to affect the IL-1 beta levels in GCF in subjects with a specific IL-1B genotype.
Collapse
|
49
|
Tsalikis L. The effect of age on the gingival crevicular fluid composition during experimental gingivitis. A pilot study. Open Dent J 2010; 4:13-26. [PMID: 20502645 PMCID: PMC2874215 DOI: 10.2174/1874210601004010013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 06/17/2009] [Accepted: 10/21/2009] [Indexed: 11/22/2022] Open
Abstract
Background: Cytokines have been proposed as potentially useful diagnostic or prognostic markers of periodontal inflammation related alterations during the experimental gingivitis model. The role of ageing in periodontal disease needs further elucidation; therefore investigations of its influence on host response are needed. Objective: To study the effect of age on interleukins IL -6, IL-8 and TNF-a levels in gingival crevicular fluid (GCF) and their correlations to clinical parameters during experimental gingivitis. Materials and Methods: Five young subjects (20-22 years old) and five old subjects (61-65 years old), all periodontal healthy, participated in this clinical trial. A professional plaque control programme was undertaken to establish healthy gingival conditions at baseline. Plaque index (PI), gingival index (GI) were recorded at 60 sites at baseline, after 21 days of no oral hygiene and one week later after professional cleaning and reestablishment of oral hygiene procedures. A total of 180 samples were analyzed with ELISA for levels of IL -6, IL-8 and TNF-a in gingival crevicular fluid. The examination included the mesiobuccal sites of the Ramfjord teeth. Comparisons between and within groups were performed by non-parametric tests (Mann- Withney) and correlations were sought for with Wilcoxon test. Significance was set at p=0.05. Results: Results showed significant diferences between the two groups with regard to the plaque and bleeding scores and GCF volume, all of which proved to be more pronounced in old group. With respect to laboratory data, mean cytokine concentrations were in general lower in young group. TNF-a had a steady increase for the adults, which was found to be statistically significant between Days 0 and 21, IL-8 showed a statistically significant decrease at Day 28 in the young group and finally IL-6 showed a fluctuation, which was totally adverse for the two groups at each time point. Conclusion: Within the limitations of the present study, age cannot be identified as a factor that strongly affects the cytokine expression and fluctuations even in a well-controlled environment of inflammation, such as experimental gingivitis.
Collapse
Affiliation(s)
- Lazaros Tsalikis
- Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School Aristotle, University of Thessaloniki, Greece
| |
Collapse
|
50
|
Müller HP, Barrieshi-Nusair KM. Site-Specific Gingival Bleeding on Probing in a Steady-State Plaque Environment: Influence of Polymorphisms in the Interleukin-1 Gene Cluster. J Periodontol 2010; 81:52-61. [DOI: 10.1902/jop.2009.090315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|