Cardiovascular disease and periodontitis: an update on the associations and risk

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

Objectives

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

Methods

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

Results

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

Conclusions

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

UCP2 polymorphisms, daily step count, and number of teeth associated with all-cause mortality risk in Sado City: A hospital-based cohort study

Objective

Uncoupling protein 2 (UCP2) is an ion/anion transporter in the mitochondrial inner membrane that plays a crucial role in immune response, regulation of oxidative stress, and cellular metabolism. UCP2 polymorphisms are linked to chronic inflammation, obesity, diabetes, heart disease, exercise efficiency, and longevity. Daily step count and number of teeth are modifiable factors that reduce mortality risk, although the role of UCP2 in this mechanism is unknown. This study aimed to assess the possible effects of UCP2 polymorphisms on the association between daily step count and number of teeth with all-cause mortality.

Methods

This study was conducted as a cohort project involving adult Japanese outpatients at Sado General Hospital (PROST). The final number of participants was 875 (mean age: 69 y). All-cause mortality during thirteen years (from June 2008 to August 2021) was recorded. The functional UCP2 genotypes rs659366 and rs660339 were identified using the Japonica Array®. Survival analyses were performed using multivariate Cox proportional hazard models.

Results

There were 161 deaths (mean observation period: 113 months). Age, sex, daily step count, and the number of teeth were significantly associated with mortality. In females, UCP2 polymorphisms were associated with mortality independent of other factors (rs659366 GA compared to GG + AA; HR = 2.033, p = 0.019, rs660339 C T compared to CC + TT; HR = 1.911, p = 0.029). Multivariate models, with and without UCP2 genotypes, yielded similar results. The interaction terms between UCP2 genotype and daily step count or number of teeth were not significantly associated with mortality.

Conclusion

The effects of UCP2 polymorphisms on the association between daily step count or the number of teeth and all-cause mortality were not statistically significant. In females, UCP2 polymorphisms were significantly associated with all-cause mortality. Our findings confirmed the importance of physical activity and oral health and suggested a role of UCP2 in mortality risk independently with those factors.

Impact of Periodontitis on Endothelial Risk Dysfunction and Oxidative Stress Improvement in Patients with Cardiovascular Disease

Periodontitis is a multifactorial chronic inflammatory disease that affects the periodontium and overall oral health and is primarily caused by a dysbiotic gingival biofilm, which includes, among others, Gram-negative bacteria such as Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, and Tannerella forsythensis that colonize gingival tissues and that can lead, if not properly treated, to periodontal tissue destruction and tooth loss. In the last few decades, several large-scale epidemiological studies have evidenced that mild and severe forms of periodontitis are strictly bilaterally associated with several cardiovascular diseases (CVDs), stroke, and endothelial dysfunction. Specifically, it is hypothesized that patients with severe periodontitis would have compromised endothelial function, a crucial step in the pathophysiology of atherosclerosis and several CVD forms. In this regard, it was postulated that periodontal treatment would ameliorate endothelial dysfunction, hence bolstering the notion that therapeutic approaches targeted at diminishing cardiovascular risk factors and different forms of periodontal treatment could improve several CVD biomarker outcomes in the short- and long-term in CVD patients. The aim of this review is to update and analyze the link between periodontitis and CVD, focusing on the inflammatory nature of periodontitis and its correlation with CVD, the effects of periodontal therapy on endothelial dysfunction and oxidative stress, and the impact of such therapy on CVD biomarkers and outcomes. The article also discusses future research directions in this field.

Association between carotenoid intake and periodontitis in diabetic patients

This study aimed to evaluate the association between dietary carotenoid intake and periodontitis in diabetic patients. Data on diabetic patients were collected from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 for this cross-sectional study. Dietary intake of carotenoids was assessed through the first 24-hour dietary recall interview. Full-mouth periodontal examinations were conducted by trained dental examiners. Subgroup analysis was conducted in terms of age, gender, the number of missing teeth, cardiovascular disease, smoking, and anti-diabetic drugs. Totally 1914 diabetic patients were included, with 1281 (66.93%) in the periodontitis group. After adjusting for age, gender, race, education, smoking, dental implants, hepatitis, and the number of missing teeth, α-carotene intake ≥55.82 mcg was associated with lower odds of periodontitis than α-carotene intake <55.82 mcg [OR = 0.70, 95% CI: 0.53-0.91, P = 0.010]; lutein and zeaxanthin intake ≥795.95 mcg was associated with decreased odds of periodontitis than lutein and zeaxanthin intake <795.95 mcg (OR = 0.75, 95%CI: 0.57-0.98, P = 0.039). The association between carotenoid intake and periodontitis varied across different subpopulations. In diabetes, dietary intake of α-carotene and lutein and zeaxanthin was inversely associated with the odds of periodontitis, which may facilitate clinical periodontitis management.

Association between toothbrushing and cardiovascular risk factors: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2015-2017

BACKGROUND

Previous studies have suggested that frequent toothbrushing is associated with a lower risk of future cardiovascular events. We sought to investigate further the relationship between toothbrushing, cardiovascular risk factors, and lifestyle behaviours.

METHODS

We analysed a cross-sectional survey including 13,761 adults aged 30 years or older without a history of cardiovascular diseases from the Korean National Health and Nutritional Examination Survey. Conventional cardiovascular risk factors (blood pressure, lipid profiles, and fasting glucose), and inflammatory markers (high-sensitivity C-reactive protein [hsCRP], and white blood cell counts [WBC]) were investigated in relation to the frequency of toothbrushing.

RESULTS

The estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk, calculated using the pooled cohort equations was 13.7%, 9.1%, and 7.3% for participants who reported toothbrushing 0-1, 2, and ≥ 3 times a day, respectively. Both conventional risk factors and inflammatory markers were significantly associated with frequent toothbrushing. However, after adjusting potential confounding factors such as age, sex, comorbidities, and lifestyle behaviours, only inflammatory markers were remained as significant factors.

CONCLUSIONS

Oral hygiene behaviours are closely linked to cardiovascular risk factors. This study suggests that reduced systemic inflammatory burden may explain the benefit of improved oral hygiene in terms of cardiovascular risk.

The gut-microbiota-brain axis in a Spanish population in the aftermath of the COVID-19 pandemic: microbiota composition linked to anxiety, trauma, and depression profiles

The prevalence of anxiety and depression soared following the COVID-19 pandemic. To effectively treat these conditions, a comprehensive understanding of all etiological factors is needed. This study investigated fecal microbial features associated with mental health outcomes (symptoms of anxiety, depression, or posttraumatic stress disorder (PTSD)) in a Spanish cohort in the aftermath of the COVID-19 pandemic. Microbial communities from stool samples were profiled in 198 individuals who completed validated, self-report questionnaires. 16S ribosomal RNA gene V3-4 amplicon sequencing was performed. Microbial diversity and community structure were analyzed, together with relative taxonomic abundance. In our cohort of N=198, 17.17% reported depressive symptoms, 37.37% state anxiety symptoms, 40.90% trait anxiety symptoms, and 8.08% PTSD symptoms, with high levels of comorbidity. Individuals with trait anxiety had lower Simpson's diversity. Fusicatenibacter saccharivorans was reduced in individuals with comorbid PTSD + depression + state and trait anxiety symptoms, whilst an expansion of Proteobacteria and depletion of Synergistetes phyla were noted in individuals with depressive symptoms. The relative abundance of Anaerostipes was positively correlated with childhood trauma, and higher levels of Turicibacter sanguinis and lower levels of Lentisphaerae were found in individuals who experienced life-threatening traumas. COVID-19 infection and vaccination influenced the overall microbial composition and were associated with distinct relative taxonomic abundance profiles. These findings will help lay the foundation for future studies to identify microbial role players in symptoms of anxiety, depression, and PTSD and provide future therapeutic targets to improve mental health outcomes.

Effect of polycaprolactone nanofibers loaded with oxytetracycline hydrochloride and zinc oxide as an adjunct to SRP on GCF lipocalin-2 levels in periodontitis patients: A clinical and laboratory study

Background. The aim of this study was the clinical and laboratory evaluation of using polycaprolactone (PCL) nanofibers loaded with oxytetracycline hydrochloride (OTC) and zinc oxide (ZnO) as an adjunct to mechanical therapy in managing stage II grade A periodontitis patients concerning GCF lipocalin2- levels. Methods. Fifty stage II grade A periodontitis patients (27 women and 23 men, with an age range of 30‒60) were enrolled in the study. The patients were randomly assigned to five equal groups and treated with scaling and root planing (SRP), followed by local application of PCL nanofibers: group I: SRP + PCL loaded with OTC and ZnO, group II: SRP + PCL loaded with OTC, group III: SRP + PCL loaded with ZnO, group IV: SRP + unloaded PCL, and group V: SRP alone. Additionally, 10 healthy subjects with healthy periodontium (group VI) (age- and gender-matched) served as the negative control. Nanofibers were applied in the selected pockets of periodontitis patients in groups I to IV once weekly for two months. All the participants were examined clinically by assessing periodontal indices (gingival index, plaque index, pocket depth, and clinical attachment level), and biochemically by assessing GCF lipocalin-2 levels. Results. Compared to controls, periodontitis groups (I, II, III, IV, and V) showed significant elevation of both clinical parameters and GCF lipocalin2- levels at baseline. In addition, these parameters improved significantly after treatment, which was more pronounced in groups I, II-, and III) compared to groups IV and V. However, it did not reach normal values. Conclusion. In association with SRP, PCL nanofibers loaded with OTC and ZnO had beneficial therapeutic effects at both clinical and laboratory levels.

Alterations of HDL's to piHDL's Proteome in Patients with Chronic Inflammatory Diseases, and HDL-Targeted Therapies

Chronic inflammatory diseases, such as rheumatoid arthritis, steatohepatitis, periodontitis, chronic kidney disease, and others are associated with an increased risk of atherosclerotic cardiovascular disease, which persists even after accounting for traditional cardiac risk factors. The common factor linking these diseases to accelerated atherosclerosis is chronic systemic low-grade inflammation triggering changes in lipoprotein structure and metabolism. HDL, an independent marker of cardiovascular risk, is a lipoprotein particle with numerous important anti-atherogenic properties. Besides the essential role in reverse cholesterol transport, HDL possesses antioxidative, anti-inflammatory, antiapoptotic, and antithrombotic properties. Inflammation and inflammation-associated pathologies can cause modifications in HDL's proteome and lipidome, transforming HDL from atheroprotective into a pro-atherosclerotic lipoprotein. Therefore, a simple increase in HDL concentration in patients with inflammatory diseases has not led to the desired anti-atherogenic outcome. In this review, the functions of individual protein components of HDL, rendering them either anti-inflammatory or pro-inflammatory are described in detail. Alterations of HDL proteome (such as replacing atheroprotective proteins by pro-inflammatory proteins, or posttranslational modifications) in patients with chronic inflammatory diseases and their impact on cardiovascular health are discussed. Finally, molecular, and clinical aspects of HDL-targeted therapies, including those used in therapeutical practice, drugs in clinical trials, and experimental drugs are comprehensively summarised.

Periodontal status and the incidence of selected bacterial pathogens in periodontal pockets and vascular walls in patients with atherosclerosis and abdominal aortic aneurysms

The aim of the study was to examine the periodontal status of patients with atherosclerosis and abdominal aortic aneurysms. The occurrence of 5 periodontopathogens was evaluated in periodontal pockets and atheromatous plaques together with specimens from pathologically changed vascular walls of aortic aneurysms. The study comprised 39 patients who qualified for vascular surgeries. Patients with periodontitis and concomitant atherosclerosis or aneurysms were enrolled in the study. Periodontal indices were evaluated, and subgingival plaque samples were examined together with atheromatous plaques or specimens from vascular walls to identify, by polymerase chain reaction (PCR), the following periodontopathogens: Porphyromonas gingivalis, Tanarella forsythia, Aggregatibacter actinomycetemcomitans, Prevotella intermedia and Treponema denticola. The majority of patients had chronic severe generalized periodontitis in stages III and IV. Laboratory investigations showed the occurrence of one or more of the five targeted periodontopathogens in 94.6% of the periodontal pockets examined. Of the examined periodontopathogens, only Porphyromonas gingivalis was confirmed in 1 atheromatous plaque sample collected from the wall of an aortic aneurysm. Therefore, the occurrence of this bacterium in these vessels was considered to be occasional in patients with chronic periodontitis.

Association of periodontitis, missing teeth, and oral hygiene behaviors with the incidence of hypertension in middle-aged and older adults in Korea: A 10-year follow-up study

BACKGROUND

The relationship between periodontitis and hypertension remains controversial. This study aimed to investigate the association of periodontitis, missing teeth, and oral hygiene behaviors with the incidence of hypertension.

METHODS

A total of 104,349 participants were selected from the National Health Insurance System-Health Screening cohort. Incident hypertension and periodontitis were diagnosed based on the patients' clinical records and health examinations. A multivariable Cox proportional hazards regression analysis was performed after adjusting for socioeconomic factors, coexisting disease, and health behaviors.

RESULTS

The mean age of the participants was 51.1 years (range, 40-79 years) at baseline, and 55.1% were men. A total of 52,855 incident hypertension cases were identified during the median follow-up period of 9.6 years. Among the participants, periodontitis (hazard ratio [HR]: 1.02, 95% confidence interval [95% CI]: 1.00-1.04), number of missing teeth (for ≥15 group, HR: 1.40, 95% CI: 1.29-1.52), dental scaling (HR: 0.93, 95% CI: 0.91-0.95), and tooth brushing frequency (for ≥3 group, HR: 0.85, 95% CI: 0.83-0.88) were significantly associated with incident hypertension after full adjustments for covariates. While periodontitis was significantly associated with incident hypertension (HR: 1.04, 95% CI: 1.02-1.06) in the middle-aged group (40-64 years), the effect was insignificant in the older group (≥65 years).

CONCLUSION

Oral inflammation could contribute to the incidence of hypertension; thus, efforts to reduce oral inflammation should be encouraged. Future intervention studies are warranted to determine whether oral health care could be beneficial in the management of hypertension. This article is protected by copyright. All rights reserved.

The association of dental pulp stones to cardiovascular and renal diseases: A systematic review and meta-analysis

BACKGROUND

Pulp stone (PS) is a dystrophic calcification in the tooth's pulp chamber and was suggested in the literature to be associated with other calcifications in the body. This study aimed to investigate the association of PS to cardiovascular diseases (CVD) and renal stones (RS).

METHODS

Three databases were searched until June 2021 in addition to manual searching of Google Scholar and grey literature. Original studies were only included and critically appraised using an adapted version of the Newcastle-Ottawa scale. The odds ratio (OR) effect measure was calculated using the Mantel-Haenszel statistical test (95% confidence interval [CI]) to investigate the association of PS with CVD and or RS (p-value ˂ 0.05).

RESULTS

The database search identified 4933 studies, and 19 studies were finally included. The risk of bias was low in thirteen studies, moderate in four studies, and high in two studies. The meta-analysis of the moderate-and-low risk of bias studies revealed a significant association between PS and CVD (OR 3.35, 95% CI 1.91-5.89, P < 0.001, I² = 65%), but no association was found between PS and RS. The results also revealed an association between PS and CVD in patients older than 40 (OR 8.78, 95% CI 3.64-21.17, P < 0.001, I² = 0%).

CONCLUSIONS

The current study results showed an association between PS and CVD, but no association was found between PS and RS. PS in patients younger than 40 years, compared to older patients (> 40 years), was associated with CVD.

Oral microbiota in human systematic diseases

Oral bacteria directly affect the disease status of dental caries and periodontal diseases. The dynamic oral microbiota cooperates with the host to reflect the information and status of immunity and metabolism through two-way communication along the oral cavity and the systemic organs. The oral cavity is one of the most important interaction windows between the human body and the environment. The microenvironment at different sites in the oral cavity has different microbial compositions and is regulated by complex signaling, hosts, and external environmental factors. These processes may affect or reflect human health because certain health states seem to be related to the composition of oral bacteria, and the destruction of the microbial community is related to systemic diseases. In this review, we discussed emerging and exciting evidence of complex and important connections between the oral microbes and multiple human systemic diseases, and the possible contribution of the oral microorganisms to systemic diseases. This review aims to enhance the interest to oral microbes on the whole human body, and also improve clinician’s understanding of the role of oral microbes in systemic diseases. Microbial research in dentistry potentially enhances our knowledge of the pathogenic mechanisms of oral diseases, and at the same time, continuous advances in this frontier field may lead to a tangible impact on human health.

Higher dental care is positively associated with key prognosis factors in peritoneal dialysis patients: findings from a retrospective study

Background

Oral disease may be increased in people with end-stage renal disease and associated with inflammation, cardiovascular disease, and mortality. Moreover, oral disease may be essential to decide the prognosis of peritoneal dialysis (PD) patients. However, only a few reports have explored the effects of dental care (DC) on cardiovascular diseases and mortality in PD patients. Thus, we aimed to investigate the association of DC with the prognosis of PD patients.

Methods

In this single-center, retrospective study, we enrolled 165 incident PD patients aged ≥ 20 years. We classified patients based on their dental care score, assessed using a self-reported questionnaire into the better dental care group (Group A, score ≥ 7) or the worse dental care group (Group B, score < 7). Demographic, clinical, hospitalization, hospital admission, comorbidities (including congestive heart failure, acute coronary syndrome, stroke, peripheral artery disease, and pneumonia), and mortality (including specific causes) data were extracted from the patient’s medical records. Data were analyzed using one-way ANOVA, Wilcoxon t-test, Kruskal–Wallis, Mann–Whitney U-test, chi-square test, Fisher’s exact test and multiple regression when appropriate. We compared the survival distributions among groups using the long-rank test.

Results

Of the 165 patients, 75 were allocated to group A and 90 to group B. PD patients with better dental care (group A) had significantly lower levels of C-reactive protein (CRP) and higher levels of serum albumin compared to PD patients with worse dental care (group B). Hospital admissions due to congestive heart failure, acute coronary syndrome, pneumonia, and peritonitis were also lower in group A than group B. Mortality rates due to congestive heart failure, acute coronary syndrome, pneumonia, and sepsis were lower in group A than in group B.

Conclusions

The study highlights the importance of good dental care, particularly for PD patients. Nephrologists and dental professions should design and implement oral health education strategies to improve PD patients’ dental care.

Effect of Dental Screening on Cardiovascular Risk: A Nationwide Cohort Study

AIM

To evaluate the effect of dental screening on the risk of cardiovascular disease (CVD) using data from a nationwide population-based cohort.

MATERIALS AND METHODS

This retrospective cohort study extracted data of 478,245 individuals aged 40-79 years who participated in a health screening programme in 2002-2003 from the National Health Insurance Service-National Health Screening Cohort. Based on screening experience, participants were classified into the non-screening, general screening only, and dental screening groups. Using Cox proportional hazard models, hazard ratios (HRs) were determined for major adverse cardiovascular events (MACE) during each group's 11-year follow-up period.

RESULTS

The risk of MACE in the dental screening group was 10% lower than that in the non-screening group (adjusted HR, 0.90; 95% confidence interval [CI], 0.87-0.93; P<0.001) and 9% lower than that in the general screening only group (adjusted HR, 0.91; 95% CI, 0.89-0.94; P<0.001).

CONCLUSIONS

Dental screening was associated with a lower MACE risk; however, decreases in CVD-related healthcare utilisation and costs were not clinically significant. The association could be attributed to healthy habits of participants in the dental screening group; nevertheless, it is conceivable that the improvement of oral health through dental screening influenced CVD prevention.

Association between the frequency of toothbrushing and lifestyle in people with type 2 diabetes mellitus: at the baseline date of the Kamogawa-DM cohort study

It has been reported that oral health is associated with some co-morbid conditions, including cardiovascular disease, in people with type 2 diabetes mellitus. The present study investigated the association between the frequency of toothbrushing and lifestyle in people with type 2 diabetes mellitus. This cross-sectional study included 624 outpatients at the Kyoto Prefectural University of Medicine in Kyoto, Japan from January 2014 to January 2016. Lifestyle was evaluated using a self-administered questionnaire. The average age and hemoglobin A1c level were 67.6 ± 10.9 years and 7.2 ± 1.1%, respectively. The number of patients who brushed their teeth twice or more a day was 189 (50.3%) in men and 198 (79.8%) in women. Among men, the proportion of patients living alone was lower in those who brushed their teeth twice or more a day than those who brushed their teeth never/rarely or once a day. The logistic regression analysis, after adjusting for confounding factors, revealed that living alone (odds ratio 2.88; 95% confidence interval 1.53–5.66) was associated with the increased odds of the low frequency of toothbrushing (never/rarely or once a day) in men, but not in women. In conclusion, the results of our study suggest that living alone was associated with the low frequency of toothbrushing in people with type 2 diabetes mellitus, particularly in men.

Associations of toothbrushing behaviour with risks of vascular and nonvascular diseases in Chinese adults

Accumulating evidence has shown that poor oral hygiene is associated with increased risk of cardiometabolic diseases in Western populations. However, its relevance about the relationships in Chinese adults remains unclear. The China Kadoorie Biobank enrolled 512 715 adults aged 30-79 years in China during 2004-2008. Cox regression was used to estimate adjusted hazard ratios (HRs) for each disease associated with measures of oral hygiene. Overall 9.3% of the participants reported rarely or never brushing teeth at baseline. Participants who rarely or never brushed teeth had adjusted HR of 1.12 (95% CI: 1.09, 1.15) for MVE, with similar HRs for stroke (1.08, 1.05-1.12), intracerebral haemorrhage (1.18, 1.11-1.26) and pulmonary heart disease (1.22, 1.13-1.32) compared with those who brushed teeth regularly. Those who did not brush teeth also had increased risk of cancer (1.09, 1.04-1.14), chronic obstructive pulmonary disease (COPD) (1.12, 1.05-1.20), liver cirrhosis (1.25, 1.09-1.44) and all-cause death (1.25, 1.21-1.28) but not type 2 diabetes (0.94, 0.86-1.03) and chronic kidney disease (0.98, 0.81-1.18). Among Chinese adults, we found that poor oral hygiene is associated with higher risks of major vascular disease, cancer, COPD, liver cirrhosis and all-cause deaths, but not type 2 diabetes and chronic kidney disease.

Relationship of coronary heart disease and comorbide dental background

Cardiovascular disease has serious economic and social consequences that affect people, health systems and societies around the world. Ischemic heart disease is one of the main global causes of death of the population, and its growth is predicted in the coming years. This fact continues to be of serious concern to health, social and economic services. Cardiovascular disease remains the most common cause of death, and age-standardized rates are higher for men than for women. Cardiovascular comorbidity increases significantly with age.The combination of ischemic heart disease and comorbid pathology is noted in cancer incidence, bronchial asthma, non-alcoholic fatty liver disease, type 2 diabetes mellitus, chronic obstructive pulmonary disease, periodontal disease, etc. It is necessary to analyze the existing disease with past diseases, risk factors and predictors available in the patient. The presence of concomitant diseases quite often requires additional diagnostic methods and changes in the tactics of treating coronary heart disease due to the fact that some of them are a contraindication to the use of certain groups of drugs. Periodontal disease includes a wide range of inflammatory conditions that affect the supporting structures of the teeth, which can lead to tooth loss and contribute to systemic inflammation. Periodontal disease is associated with several systemic diseases, one of which is coronary artery disease. It is imperative that clinicians understand the link between periodontal disease and cardiovascular disease. Comprehensive treatment of periodontitis and restoration of a healthy periodontium can help reduce overall inflammation in the body and reduce the risks of coronary heart disease.

Association Between the Extent of Periodontal Inflammation and the Severity of Rheumatoid Arthritis in Japanese Patients With Rheumatoid Arthritis

OBJECTIVE

Periodontal inflammation can affect the progression of rheumatoid arthritis (RA), and RA drugs may influence the periodontal condition of patients with RA. We examined whether the association between periodontal inflammation and the severity of RA is influenced by RA medication.

METHODS

This cross-sectional study recruited 98 Japanese patients with RA from an orthopaedic clinic. We assessed the severity of RA using the Steinbrocker class and stage. The periodontal inflamed surface area (PISA) was used as an indicator of periodontal status. We obtained data on RA medications from medical records. We examined the associations among periodontal tissue inflammation, RA medications, and RA severity using multinomial logistic regression analyses.

RESULTS

In univariate multinomial logistic regression analyses, no significant association between PISA score and RA severity was observed. There was no significant association between PISA score and RA severity in multivariate analyses not including variables about RA drugs as independent variables. However, in multivariate analyses adjusted for RA drugs and other confounding variables, patients with a PISA >550 mm2 had significantly higher odds ratios (ORs) for Steinbrocker class III-IV and stage III-IV (OR, 20.24; 95% confidence interval [CI], 1.78-229.85 and OR, 12.42; 95% CI, 1.79-86.49, respectively) compared to patients with PISA score ≤550 mm2.

CONCLUSION

The extent of periodontal inflammation is associated with the severity of RA independent of RA medications.

Impact of the Diet on the Formation of Oxidative Stress and Inflammation Induced by Bacterial Biofilm in the Oral Cavity

The diet is related to the diversity of bacteria in the oral cavity, and the less diverse microbiota of the oral cavity may favor the growth of pathogenic bacteria of all bacterial complexes. Literature data indicate that disturbances in the balance of the bacterial flora of the oral cavity seem to contribute to both oral diseases, including periodontitis, and systemic diseases. If left untreated, periodontitis can damage the gums and alveolar bones. Improper modern eating habits have an impact on the oral microbiome and the gut microbiome, which increase the risk of several chronic diseases, including inflammatory bowel disease, obesity, type 2 diabetes, cardiovascular disease and cancer. The subject of our consideration is the influence of the traditional diet on the formation of oxidative stress and inflammation caused by bacterial biofilm in the oral cavity. Through dental, biomedical and laboratory studies, we wanted to investigate the effect of individual nutrients contained in specific diets on the induction of oxidative stress inducing inflammation of the soft tissues in the oral cavity in the presence of residual supra- and subgingival biofilm. In our research we used different types of diets marked as W, T, B, F and noninvasively collected biological material in the form of bacterial inoculum from volunteers. The analyzed material was grown on complete and selective media against specific strains of all bacterial complexes. Additionally, the zones of growth inhibition were analyzed based on the disc diffusion method. The research was supplemented with dental and periodontological indicators. The research was supplemented by the application of molecular biology methods related to bacterial DNA isolation, PCR reactions and sequencing. Such selected methods constitute an ideal screening test for the analysis of oral bacterial microbiota. The obtained results suggest that certain types of diet can be an effective prophylaxis in the treatment of civilization diseases such as inflammation of the oral cavity along with periodontal tissues and gingival pockets.

Challenges in ischaemic heart disease: not sleeping enough, not brushing your teeth, and skipping breakfast-three ways of increasing your risk of myocardial infarction?

Despite optimal medical therapies, there is currently a persistent residual cardiovascular risk. The most likely pathway responsible for this residual risk has been identified in the inflammatory state. Recent studies have confirmed that inflammation increases cardiovascular risk independently from LDL cholesterol levels. Addressing traditional risk factors, such as obesity, cigarette smoking, diabetes, arterial hypertension, and dyslipidaemia, also provides an important reduction of the levels of inflammation. Nonetheless, inflammation is also a target for specific and focused therapeutic interventions. Recent studies have outlined an association between oral hygiene, sleep deprivation, and nutritional patterns on the one hand, with the development of multi-districts atherosclerosis and/or adverse cardiovascular events on the other. These lifestyle patterns appear to be involved in fostering inflammation associated with atherosclerosis. There is, however, a persistent need for further studies to clarify whether such associations with cardiovascular disease are direct and causal, and if they are all channelled through vascular inflammation.

PorZ, an Essential Component of the Type IX Secretion System of Porphyromonas gingivalis, Delivers Anionic Lipopolysaccharide to the PorU Sortase for Transpeptidase Processing of T9SS Cargo Proteins

Cargo proteins of the type IX secretion system (T9SS) in human pathogens from the Bacteroidetes phylum invariably possess a conserved C-terminal domain (CTD) that functions as a signal for outer membrane (OM) translocation. In Porphyromonas gingivalis, the CTD of cargos is cleaved off after translocation, and anionic lipopolysaccharide (A-LPS) is attached. This transpeptidase reaction anchors secreted proteins to the OM. PorZ, a cell surface-associated protein, is an essential component of the T9SS whose function was previously unknown. We recently solved the crystal structure of PorZ and found that it consists of two β-propeller moieties, followed by a CTD. In this study, we performed structure-based modeling, suggesting that PorZ is a carbohydrate-binding protein. Indeed, we found that recombinant PorZ specifically binds A-LPS in vitro Binding was blocked by monoclonal antibodies that specifically react with a phosphorylated branched mannan in the anionic polysaccharide (A-PS) component of A-LPS, but not with the core oligosaccharide or the lipid A endotoxin. Examination of A-LPS derived from a cohort of mutants producing various truncations of A-PS confirmed that the phosphorylated branched mannan is indeed the PorZ ligand. Moreover, purified recombinant PorZ interacted with the PorU sortase in an A-LPS-dependent manner. This interaction on the cell surface is crucial for the function of the "attachment complex" composed of PorU, PorZ, and the integral OM β-barrel proteins PorV and PorQ, which is involved in posttranslational modification and retention of T9SS cargos on the bacterial surface.IMPORTANCE Bacteria have evolved multiple systems to transport effector proteins to their surface or into the surrounding milieu. These proteins have a wide range of functions, including attachment, motility, nutrient acquisition, and toxicity in the host. Porphyromonas gingivalis, the human pathogen responsible for severe gum diseases (periodontitis), uses a recently characterized type IX secretion system (T9SS) to translocate and anchor secreted virulence effectors to the cell surface. Anchorage is facilitated by sortase, an enzyme that covalently attaches T9SS cargo proteins to a unique anionic lipopolysaccharide (A-LPS) moiety of P. gingivalis Here, we show that the T9SS component PorZ interacts with sortase and specifically binds A-LPS. Binding is mediated by a phosphorylated branched mannan repeat in A-LPS polysaccharide. A-LPS-bound PorZ interacts with sortase with significantly higher affinity, facilitating modification of cargo proteins by the cell surface attachment complex of the T9SS.

Relationship between Apical Periodontitis and Metabolic Syndrome and Cardiovascular Events: A Cross-Sectional Study

Aim: Both apical periodontitis (AP) and metabolic syndrome (MetS) are associated with atherosclerotic cardiovascular disease (ACVD), the main cause of cardiovascular events. The aim of this study was to investigate the prevalence of AP and the oral inflammatory burden in control subjects and patients suffering cardiovascular events, analyzing the possible association between AP and the oral inflammatory burden with MetS. Materials and Methods: Using a cross-sectional design, 83 patients suffering a cardiovascular event were recruited in the study group (SG), and 48 patients without cardiovascular events were included in the control group (CG). Periapical index (PAI) was used to diagnose AP, and total dental index (TDI) was used to assess the total oral inflammatory burden. Diagnosis of MetS was made by meeting three or more American Heart Association Scientific Statement components. Results: In the multivariate logistic regression analysis, the number of teeth with AP (OR = 2.3; 95% C.I. = 1.3–4.3; p = 0.006) and TDI scores (OR = 1.5; 95% C.I. = 1.2–1.9; p = 0.001), significantly correlated with cardiovascular events. MetS was strongly associated (OR = 18.0; 95% C.I. = 6.5–49.7; p = 0000) with cardiovascular events. Higher TDI scores were significantly associated with MetS (OR = 1.3; 95% C.I. = 1.1–1.6; p = 0.003. Neither the number of root-filled teeth (RFT) (OR = 0.9; 95% C.I. = 0.6–1.3; p = 0.61) nor the number of teeth with apical periodontitis (OR = 1.1; 95% C.I. = 0.8–1.7; p = 0.49) were associated with MetS. Conclusions: Apical periodontitis is significantly associated with cardiovascular events. Total oral inflammatory burden assessed by TDI, but not AP alone, is associated with MetS.

Systemic Manifestations of the Periodontal Disease: A Bibliometric Review

This bibliometric review aimed to identify and analyze the top 100 most-cited publications on the systemic manifestations of periodontal disease (PD). A literature search was performed using the Web of Science (WoS) 'All Databases', without any restriction of language, publication year, or study design. Of 4418 articles, the top 100 were included based on their citation count. After downloading the full texts, their bibliometric information was extracted and analyzed. The citation counts for the top 100 articles ranged from 156 to 4191 (median 217). The most productive years were 2003 and 2005, with 20 articles on the list. Majority of the articles were published in the Journal of Periodontology (n = 25). The top 100 articles were generated primarily from the USA (n = 61). Most of the publications were clinical trials (n = 27) and focused on the cardiovascular manifestations of PD (n = 31). Most of the articles were within the evidence level V (n = 41). A total of 58 studies received funding and the most frequently used keyword in the top articles was "periodontal disease" (n = 39). The current citation analysis presents insights into the current trends in the systemic manifestations of periodontal disease.

Spatiotemporal signal detection using continuous shrinkage priors

Periodontal disease (PD) is a chronic inflammatory disease that affects the gum tissue and bone supporting the teeth. Although tooth-site level PD progression is believed to be spatio-temporally referenced, the whole-mouth average periodontal pocket depth (PPD) has been commonly used as an indicator of the current/active status of PD. This leads to imminent loss of information, and imprecise parameter estimates. Despite availability of statistical methods that accommodates spatiotemporal information for responses collected at the tooth-site level, the enormity of longitudinal databases derived from oral health practice-based settings render them unscalable for application. To mitigate this, we introduce a Bayesian spatiotemporal model to detect problematic/diseased tooth-sites dynamically inside the mouth for any subject obtained from large databases. This is achieved via a spatial continuous sparsity-inducing shrinkage prior on spatially varying linear-trend regression coefficients. A low-rank representation captures the nonstationary covariance structure of the PPD outcomes, and facilitates the relevant Markov chain Monte Carlo computing steps applicable to thousands of study subjects. Application of our method to both simulated data and to a rich database of electronic dental records from the HealthPartners® Institute reveal improved prediction performances, compared with alternative models with usual Gaussian priors for regression parameters and conditionally autoregressive specification of the covariance structure.

Porphyromonas gingivalis lipopolysaccharide activates platelet Cdc42 and promotes platelet spreading and thrombosis

BACKGROUND

Periodontitis confers an increased risk for cardiovascular diseases, including thrombosis. However, the molecular mechanisms that potentially link periodontitis with thrombosis are undefined. Here we test the hypothesis that Gram-negative periodontal infection promotes pathological platelet activation and amplifies shape change. We focus specifically on lipopolysaccharide (LPS) signaling to platelets.

METHODS

Platelets were isolated from blood samples and allowed to spread on coverslips in the presence or absence of LPS purified from the periodontal pathogen Porphyromonas gingivalis. Platelets were fixed and stained with Alexa-488-phalloidin to label the actin cytoskeleton. The degree of platelet spreading and shape change was quantified by confocal microscopy. In a translational pilot study, blood samples were obtained from human subjects exhibiting generalized severe periodontitis (SP) or healthy periodontium (HP). Rotational thromboelastometry was used to quantify the rate of clot formation via the intrinsic coagulation pathway.

RESULTS

LPS-treated platelets exhibited significantly (P < 0.05) greater spreading and higher numbers of actin-rich filopodia (cell extensions) than controls. We also found that LPS stimulation of platelets promoted the activation of Cdc42, the small GTPase responsible for filopodia formation. Exposure of whole blood samples to LPS significantly (P < 0.05) reduced clotting times. Blood from SP patients clotted significantly (P < 0.05) more rapidly and exhibited shorter partial thromboplastin times compared with HP controls.

CONCLUSIONS

This is the first study to suggest a mechanism by which LPS stimulation drives Cdc42 activation and platelet spreading. These data are consistent with the notion that periodontitis promotes accelerated clot formation and an increased risk of thrombosis.

Periodontal treatment needs in the Medicaid patient population: a retrospective study in a US dental school

OBJECTIVES

The aim of this study was to use electronic health records (EHRs) from a US dental school clinic to retrospectively investigate associations between periodontal treatment needs and insurance type in a newly insured adult Medicaid population. We hypothesized that newly insured Medicaid patients, covered by the Iowa Dental Wellness Plan (DWP), would display greater need for treatment than patients with other sources of financing.

METHODS

A retrospective chart review of EHRs of patients at the University of Iowa College of Dentistry and Dental Clinics (UI COD) from 2014 to 2016 was completed. The outcome of interest whether or not a new patient was indicated for scaling and root planing (SRP) based on clinical examination. Logistic regression models analyzed associations between treatment need and source of financing, adjusting for known periodontal disease risk indicators.

RESULTS

A total of 1,259 patient charts were evaluated. SRP was indicated for 56 percent of all patients. Patients with DWP coverage had significantly greater unadjusted odds of being indicated for SRP than privately insured individuals (OR = 1.47, P = 0.009). However, this association did not remain significant after adjusting for known risk indicators.

CONCLUSIONS

Although individuals enrolled in DWP were not significantly more likely to need treatment than individuals with other sources of financing when adjusting for risk indicators, their demonstrated clinical need was higher than privately insured adults. Public benefit programs could anticipate greater burden of periodontal need in low-income populations due to increased prevalence of risk factors in this population.

Association of Periodontitis with the Concentration Levels of Germanium and Tin in Hair

The purpose of this study was to investigate whether or not the concentration levels of certain kinds of trace elements in hair are associated with periodontitis. We studied a total of 109 participants, which are composed of 25 participants with periodontitis and 84 participants without periodontitis. Periodontal conditions were assessed by measuring the periodontal clinical attachment loss and pocket depth, which were determined at six sites of all teeth. Periodontitis was defined according to the criteria of periodontitis proposed by CDC-AAP. The hair samples were washed with acetone, water, and extran (1%v/v), and then aliquots of hair samples were wet-ashed. This sample solution was analyzed by Perkin-Elmer Mass Spectrometer. The odds ratios and 95% confidence intervals of the concentration levels of trace elements for periodontitis were calculated by multivariate logistic regression analysis. After adjusting all confounders, it was found that the higher concentration level of germanium in hair was significantly and positively associated with periodontitis (odds ratio [OR] 7.12; 95% confidential interval [CI] 2.03-25.00). The higher concentration level of tin in hair was significantly and negatively associated with periodontitis (OR 0.27; 95% CI 0.08-0.94). It was concluded that there was a significant relationship between periodontitis and the concentration level of germanium and tin in hair.

Vitamin D Deficiency as It Relates to Oral Immunity and Chronic Periodontitis

The biologically active form of vitamin D, 1,25 dihydroxyvitamin D (1,25(OH)2D) and its receptor, the vitamin D receptor (VDR), play roles in maintaining oral immunity and the integrity of the periodontium. Results of observational cross-sectional clinical studies investigating the association between vitamin D serum level and the incidence and severity of chronic periodontitis indicate that, perhaps owing to the immunomodulatory, anti-inflammatory, and antibacterial properties of 1,25(OH)2 D/VDR signalling, a sufficient serum level of vitamin D is necessary for the maintenance of periodontal health. In cases of established chronic periodontitis, vitamin D supplementation is associated with reduction in the severity of periodontitis. As cross-sectional studies provide only weak evidence for any causal association and therefore are of questionable value, either longitudinal cohort studies, case controlled studies, or randomized control trials are needed to determine whether or not deficiency of vitamin D is a risk factor for chronic periodontitis, and whether or not vitamin D supplementation adjunctive to standard periodontal treatment is in any way beneficial. In this article, we discuss the relationship between vitamin D, oral immunity and periodontal disease and review the rationale for using vitamin D supplementation to help maintain periodontal health and as an adjunct to standard periodontal treatment.

Influence of plaque control on the relationship between rheumatoid arthritis and periodontal health status among Japanese rheumatoid arthritis patients

BACKGROUND

Functional disability of the finger joints in rheumatoid arthritis (RA) patients could affect their oral hygiene and periodontal status because of poor plaque control. We examined the influence of plaque control on the relationship between the severity of RA and periodontal status in RA patients.

METHODS

This study recruited 89 Japanese RA patients who reported no difficulty in performing oral hygiene. We assessed RA severity using four indices: the Steinbrocker stage and class, the Health Assessment Questionnaire (HAQ) and the Disease Activity Score (DAS). Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were taken as parameters of periodontal status. Oral hygiene status was assessed using the plaque index (PlI). We examined the association between the severity of RA and periodontal parameters using multivariable linear regression analyses.

RESULTS

In multivariable linear regression analyses not including PlI, Steinbrocker stage III-IV patients had significantly higher PlI scores and greater PD compared with those of stage I. The class III-IV patients had significantly higher PlI scores and greater PD. Patients with an HAQ score ≥0.5 had a significantly higher PlI score than those with an HAQ score of 0. However, when PlI was added to each multivariable model as an independent variable, no significant relationship between RA severity and periodontal status was observed.

CONCLUSIONS

This study suggests that it is important to consider the influence of plaque control when assessing the relationship between RA severity and periodontal health status in RA patients.

Effects of Kangfuxin solution on IL-1β, IL-6, IL-17 and TNF-α in gingival crevicular fluid in patients with fixed orthodontic gingivitis

Changes of interleukin (IL)-1β, IL-6, IL-17 and tumor necrosis factor-α (TNF-α) in gingival crevicular fluid in patients with fixed orthodontic gingivitis after treatment with Kangfuxin solution were analyzed to explore the clinical effect of Kangfuxin solution in patients with orthodontic gingivitis. A total of 78 patients diagnosed with fixed orthodontic gingivitis in Weifang People's Hospital from January 2015 to March 2017 were selected. Thirty-nine patients were treated with gingival cleansing as control group, and the other 39 patients were treated with gingival cleansing plus spraying and sublingual administration with Kangfuxin solution as treatment group. The general data of patients were collected, and the changes of IL-1β, IL-6, IL-17 and TNF-α in gingival crevicular fluid were measured, the bleeding index (BI), probing depth (PD), swelling and pain grades were recorded, and the clinical curative effects were compared between the two groups. The curative effect in treatment group was better than that in control group (p<0.05). After treatment, gingival BI and PD in both groups were lower than those before treatment. The curative effect in treatment group was better than that in control group (p<0.05). The levels of gingival pain and swelling after treatment in treatment group were mainly in grade I. The levels of gingival pain and swelling after treatment in control group were mainly in grade II and III (p<0.05). After treatment, the effective rate of control group was 76.92% and that of treatment group was 97.44% (p<0.05). It was found that the levels of IL-6 and TNF-α in gingival crevicular fluid were positively correlated with PD. The use of Kangfuxin solution in the treatment of patients with orthodontic gingivitis can effectively reduce the levels of IL-1β, IL-6, IL-17 and TNF-α in gingival crevicular fluid, and improve the periodontal conditions and the effective rate of treatment.

Reported gum disease as a cardiovascular risk factor in adults with intellectual disabilities

BACKGROUND

Several risk factors for cardiovascular disease (CVD) have been identified among adults with intellectual disabilities (ID). Periodontitis has been reported to increase the risk of developing a CVD in the general population. Given that individuals with ID have been reported to have a higher prevalence of poor oral health than the general population, the purpose of this study was to determine whether adults with ID with informant reported gum disease present greater reported CVD than those who do not have reported gum disease and whether gum disease can be considered a risk factor for CVD.

METHODS

Using baseline data from the Longitudinal Health and Intellectual Disability Study from which informant survey data were collected, 128 participants with reported gum disease and 1252 subjects without reported gum disease were identified. A series of univariate logistic regressions was conducted to identify potential confounding factors for a multiple logistic regression.

RESULTS

The series of univariate logistic regressions identified age, Down syndrome, hypercholesterolemia, hypertension, reported gum disease, daily consumption of fruits and vegetables and the addition of table salt as significant risk factors for reported CVD. When the significant factors from the univariate logistic regression were included in the multiple logistic analysis, reported gum disease remained as an independent risk factor for reported CVD after adjusting for the remaining risk factors. Compared with the adults with ID without reported gum disease, adults in the gum disease group demonstrated a significantly higher prevalence of reported CVD (19.5% vs. 9.7%; P = .001).

CONCLUSION

After controlling for other risk factors, reported gum disease among adults with ID may be associated with a higher risk of CVD. However, further research that also includes clinical indices of periodontal disease and CVD for this population is needed to determine if there is a causal relationship between gum disease and CVD.

Socioeconomic Inequalities in Oral Health among Middle-Aged and Elderly Japanese: NIPPON DATA2010

BACKGROUND

Most studies on socioeconomic inequalities in oral health have not considered the effects of behavioral and biological factors and age differences. Furthermore, the nationwide status of inequalities remains unclear in Japan.

METHODS

We analyzed data from 2,089 residents aged ≥40 years throughout Japan. The lowest quartile of the number of remaining teeth for each 10-year age category was defined as poor oral health. Behavioral and biological factors included smoking status, obesity, diabetes mellitus, high-sensitivity C-reactive protein, and the use of dental devices. Multiple logistic regression analyses were conducted to examine the associations of educational attainment and equivalent household expenditure (EHE) with oral health, and stratified analyses by age category were also conducted (40-64 years and ≥65 years).

RESULTS

Lower education and lower EHE were significantly associated with an increased risk of poor oral health after adjusting for age, sex, employment status, marital and living statuses, and EHE/education; the odds ratio for junior high school education compared with ≥college education was 1.84 (95% confidence interval [CI], 1.36-2.49), and the odds ratio of the lowest compared with the highest EHE quartile was 1.91 (95% CI, 1.43-2.56). Further adjustments for behavioral and biological factors attenuated but did not eliminate these associations. EHE was significantly associated with oral health among elderly adults only, with a significant interaction by age category.

CONCLUSIONS

Those with a lower education and those with lower EHE had a significantly higher risk of poor oral health, even after adjustments for behavioral and biological factors.

[Periodontal microbiota and microorganisms isolated from heart valves in patients undergoing valve replacement surgery in a clinic in Cali, Colombia]

INTRODUCTION

Periodontitis is an infectious disease that affects the support tissue of the teeth and it is associated with different systemic diseases, including cardiovascular disease. Microbiological studies facilitate the detection of microorganisms from subgingival and cardiovascular samples.

OBJECTIVE

To describe the cultivable periodontal microbiota and the presence of microorganisms in heart valves from patients undergoing valve replacement surgery in a clinic in Cali.

MATERIALS AND METHODS

We analyzed 30 subgingival and valvular tissue samples by means of two-phase culture medium, supplemented blood agar and trypticase soy agar with antibiotics. Conventional PCR was performed on samples of valve tissue.

RESULTS

The periodontal pathogens isolated from periodontal pockets were: Fusobacterium nucleatum (50%), Prevotella intermedia/ nigrescens (40%), Campylobacter rectus (40%), Eikenella corrodens (36.7%), Gram negative enteric bacilli (36.7%), Porphyromonas gingivalis (33.3%), and Eubacterium spp. (33.3%). The pathogens isolated from the aortic valve were Propionibacterium acnes (12%), Gram negative enteric bacilli (8%), Bacteroides merdae (4%), and Clostridium bifermentans (4%), and from the mitral valve we isolated P. acnes and Clostridium beijerinckii. Conventional PCR did not return positive results for oral pathogens and bacterial DNA was detected only in two samples.

CONCLUSIONS

Periodontal microbiota of patients undergoing surgery for heart valve replacement consisted of species of Gram-negative bacteria that have been associated with infections in extraoral tissues. However, there is no evidence of the presence of periodontal pathogens in valve tissue, because even though there were valve and subgingival samples positive for Gram-negative enteric bacilli, it is not possible to maintain they corresponded to the same phylogenetic origin.

Potential relationship between periodontal diseases and eye diseases

Periodontal diseases are inflammatory lesions initiated by oral bacteria and lead to the destruction of the supporting structures of the teeth (gingiva, periodontal ligament and alveolar bone) in susceptible patient. Via several biological mechanisms, periodontal diseases have been associated with multiple systemic diseases, such as rheumatoid arthritis, diabetes, cardiovascular diseases, Alzheimer's disease and adverse pregnancy outcomes. Similarly certain eye diseases have been associated with systemic diseases of the inflammatory pathway. We hypothesized that periodontal diseases are associated with eye diseases. Thus using literature data we find that several studies have reported that eye disorders are associated with the presence of periodontal diseases. But the mechanisms of this relationship are not clear. However the innate immune response involvement, the sharing of similar risk factors in pathogenesis and the changes of eye choroid thickness may be suggested as several hypotheses to explain this potential association.

Oral health and coronary heart disease

BACKGROUND

It is well documented that there is some correlation between poor oral health in the form of periodontal disease and coronary heart disease (CHD). It is unclear whether this correlation is due to a causal relationship or shared underlying disorder such as inflammation. A suitable integrated model of the CHD pathogenetic pathways relevant to periodontal disease may help to elucidate the association. Such a model is currently not available in literature.

METHODS

A previously developed integrated model of CHD was used to investigate potential pathogenetic pathways linking periodontal disease to CHD biomarkers.

RESULTS

The integrated model was created to provide insight into possible higher-order biological interactions underlying CHD and periodontal disease. In order to simplify these interactions a novel 'connection graph' was developed. It quantitatively illustrates the relationship between periodontal disease and various serological biomarkers of CHD. The pathogenesis of periodontitis shows various possible pathways which could link periodontitis to CHD pathogenesis.

CONCLUSION

An integrated model of CHD was developed which provides a summary of the potential CHD effects of periodontal disease. Further research must refine and validate the model.

Low frequency of toothbrushing practices is an independent risk factor for diabetes mellitus in male and dyslipidemia in female: A large-scale, 5-year cohort study in Japan

BACKGROUND

We previously reported the association between toothbrushing practices and diabetes mellitus (DM) and dyslipidemia (DL) in a cross-sectional study. This study was conducted to clarify whether low frequency of toothbrushing practices is an independent risk factor for DM and DL using a follow-up design.

METHODS

This study was a 5-year retrospective cohort study at St. Luke's International Hospital, Tokyo, Japan. We analyzed study subjects between 30 and 85 years old in 2004, who underwent annual medical examination both in 2004 and 2009. We compared the cumulative incidences of developing DM, DL, hypertension (HT), and hyperuricemia (HUA) between 2004 and 2009 among 3 groups: toothbrushing practices 'after every meal,' 'at least once a day,' and 'less than once a day'. Furthermore, we analyzed odds ratios (ORs) of risk for developing DM and DL by sex after making adjustments for age, obesity, DM, DL, HT, and HUA between two groups: 'after every meal' and 'not after every meal.'

RESULTS

The number of study subjects was 13,070. Of 13,070 study subjects, 575 had DM, 5118 had DL, 2599 had HT, and 1908 had HUA in 2004. We excluded the subjects with each disease in 2004. The cumulative incidences (rates) of DM, DL, HT, and HUA between 2004 and 2009 were 318 (2.5%), 1454 (18.3%), 1108 (10.6%), and 489 (4.4%), respectively. Toothbrushing practices 'not after every meal' was a significant risk factor for developing DM in male [OR: 1.43; 95% confidence interval (CI), 1.040-1.970] and developing DL in female (OR: 1.18; 95% CI, 1.004-1.383) compared with toothbrushing practices 'after every meal.'

CONCLUSION

Toothbrushing practices 'after every meal' prevented developing DM in males and DL in females significantly. Toothbrushing practices may be beneficial to reduce developing risk factors for cardiovascular disease.

[Effects of Porphyromonas gingivalis on interleukin-33 expression in rabbit vascular endothelium tissues]

OBJECTIVE

To investigate interleukin-33 (IL-33) in the arterial vascular endothelium of rabbits infected with Porphyromonas gingivalis (P. gingivalis), and to explore the relationship between P. gingivalis and atherosclerosis.

METHODS

A total of 24 rabbits were randomly divided into control and experimental groups. The experimental group received intravenous injection of P. gingivalis once a week for 12 weeks to establish a coronary atherosclerosis model. The rabbits in the control group were injected with equal volume of physiological saline. All the rabbits were killed after 13 weeks. The IL-33 expression levels in the arterial vascular endothelium of the rabbits were detected through immunohistochemistry, reverse transcription polymerase chain reaction, and Western blot analysis. The effects of P. gingivalis on the IL-33 expression in the arterial vascular endothelium of the rabbits were analyzed.

RESULTS

The relative expression levels of IL-33 mRNA in the vascular endothelium cells were 58.244±2.407, and the relative expression levels of IL-33 protein were 1.863±0.171 in the experimental group. The relative expression levels of IL-33 mRNA were 3.143±0.805, and the relative expression levels of IL-33 protein were 0.537±
0.028 in the control group. The expression levels of IL-33 mRNA and protein of vascular endothelium cells in the experimental group were significantly higher than those of the control group (P<0.01).

CONCLUSIONS

P. gingivalis infection promotes IL-33 expression levels in vascular endothelial cells and may regulate the occurrence and development of atherosclerosis.
.

Evaluation of inflammation during fixed orthodontic treatment

OBJECTIVE

The aim of this study was to assess effects of fixed orthodontic therapy on high-sensitivity C-reactive protein (hs-CRP) level, CBC parameters and levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), urea, creatinine, sodium (Na), potassium (K), calcium (Ca), total protein (TP), and albumin (Alb).

DESIGN

Blood samples (7ml) were drawn at baseline, on days 1 and 7, and three months after placement of braces in the study group, while only one blood sample was drawn at baseline in the control group. Serum hs-CRP levels were measured by nephelometric method. Friedman two-way variance analysis was used to assess values with skewed distribution obtained at baseline, on days 1 and 7, in the third month. Wilcoxon rank sign test was performed if median values were unequal.

RESULTS

During measurement periods, there were significant increases in hs-CRP level, WBC count and neutrophil count while a significant decrease in Na level (p<0.05). K level was significantly decreased on the day 1. No significant differences were detected in other biochemical parameters evaluated.

CONCLUSION

Elevation in serum hs-CRP levels and neutrophil: lymphocyte ratio within first 3 months indicates that a systemic immune response develops against therapy in patients undergoing fixed orthodontic therapy.

Evaluation of various hematological parameters in patients with periodontitis after nonsurgical therapy at different intervals

Background and Objective:

Chronic low-level bacteremia and a systemic inflammatory response have been suggested as a pathogenetic link between periodontal disease and atherosclerosis. The objective of this study is to evaluate the effect of nonsurgical periodontal therapy on various hematological parameters in patients with periodontitis.

Materials and Methods:

A total of 30 periodontitis patients were selected for the study. Clinical parameters such as plaque index, gingival index, and probing pocket depth were assessed. For each patient, venous blood sample were collected, and the estimation of total leukocyte count (TLC), differential leukocyte count, platelet count, and erythrocyte sedimentation rate (ESR) was carried out. All the clinical and hematological parameters were measured at baseline, 1 week and 2 weeks after nonsurgical periodontal therapy.

Results:

The study results showed that there was a statistically significant decrease in TLC, ESR, and platelet count at 1 week and 2 weeks following nonsurgical periodontal therapy.

Conclusion:

In this study, it has been concluded that there is a decrease in the hematological parameters after nonsurgical periodontal therapy, which may also reduce the risk of atherosclerosis formation in the blood vessel and possibly prevent cardiovascular diseases.

Factors affecting peri-implant bone resorption in four Implant supported mandibular full-arch restorations: a 3-year prospective study

BACKGROUND

Peri-implant marginal bone-level (MBL) alteration represents one of the parameters included in the criteria for determining implant health.

OBJECTIVE

Factors affecting peri-implant MBL alteration for 4-implant-supported fixed mandibular prostheses (4-ISFMP) were assessed.

MATERIAL & METHODS

A 3-year prospective, cohort study was conducted on 44 mandibularly edentulous patients treated with 4-ISFMP. Peri-implant MBL alteration was evaluated radiographically at the 12-, 24- and 36-month follow-ups considering to patient-related risk factors [age, gender, diabetes mellitus, smoking, cardiovascular disease (CVD), rheumatic disorders (RD)] and implant/prosthesis-related features (implant location, keratinized gingiva, denture cantilever length, prosthesis supporting zone, opposing dentition) as well as to peri-implant biological parameters (plaque-, bleeding-, calculus index).

RESULTS

148/176 implants (37 patients, drop-out: 15%) were followed for 3 years showing significant (p < 0.001) annual differences of MBL alterations over time. The univariate analysis demonstrated differences of MBL alterations for smokers (p = 0.014), for patients with CVD (p = 0.001) and RD (p = 0.011). In the 3-year multivariate analysis, MBL alteration was influenced by time (p < 0.001) and showed relationship with risk factors as smoking (p < 0.002; OR = 18.965), CVD (p < 0.021; OR = 5.172), RD (p < 0.006; OR = 50.171) and plaque-index (p = 0.034; OR = 3.252).

CONCLUSIONS

Although peri-implant MBL alteration increased annually, significant odds ratios, were found for patients-related risk factors identifying them potentiating the alterations.

Association between toothbrushing and risk factors for cardiovascular disease: a large-scale, cross-sectional Japanese study

OBJECTIVES

To clarify the association between toothbrushing and risk factors for cardiovascular disease--namely, hypertension (HT), diabetes mellitus (DM), dyslipidaemia (DL), hyperuricaemia (HUA) and chronic kidney disease (CKD).

DESIGN

A large-scale, single-centre, cross-sectional study.

SETTING

St Luke's International Hospital, Center for Preventive Medicine, Tokyo, Japan, between January 2004 and June 2010.

PARTICIPANTS

This study examined the toothbrushing practices of 85,866 individuals according to the 3-category frequency criterion: 'after every meal', 'at least once a day' and 'less than once a day'. The ORs by frequency were calculated for the prevalences of HT, DM, DL, HUA and CKD according to binominal logistic regression analyses adjusted for age, gender, body mass index and lifestyle habits--smoking, drinking, walk time and sleep time.

RESULTS

The prevalences of the risk factors were as follows: HT ('after every meal': 13.3%, 'at least once a day': 17.9% and 'less than once a day': 31.0%), DM (3.1%, 5.3% and 17.4%, respectively), DL (29.0%, 42.1% and 60.3%, respectively), HUA (8.6%, 17.5% and 27.2%, respectively) and CKD (3.8%, 3.1% and 8.3%, respectively). The prevalences were significantly higher in the 'less than once a day' group than in the 'after every meal' group for DM (OR=2.03; 95% CI 1.29 to 3.21) and DL (OR=1.50; 95% CI 1.06 to 2.14), but not for HT, HUA and CKD.

CONCLUSIONS

Even taking into account lifestyle habits, a lower frequency of toothbrushing was associated with high prevalences of DM and DL. Toothbrushing practices may be beneficial for oral health improvement and also for prevention of certain systemic diseases.

The mechanism by which moderate alcohol consumption influences coronary heart disease

Background

Moderate alcohol consumption is associated with a lower risk for coronary heart disease (CHD). A suitably integrated view of the CHD pathogenesis pathway will help to elucidate how moderate alcohol consumption could reduce CHD risk.

Methods

A comprehensive literature review was conducted focusing on the pathogenesis of CHD. Biomarker data were further systematically analysed from 294 cohort studies, comprising 1 161 560 subjects. From the above a suitably integrated CHD pathogenetic system for the purpose of this study was developed.

Results

The resulting integrated system now provides insight into the integrated higher-order interactions underlying CHD and moderate alcohol consumption. A novel ‘connection graph’ further simplifies these interactions by illustrating the relationship between moderate alcohol consumption and the relative risks (RR) attributed to various measureable CHD serological biomarkers. Thus, the possible reasons for the reduced RR for CHD with moderate alcohol consumption become clear at a glance.

Conclusions

An integrated high-level model of CHD, its pathogenesis, biomarkers, and moderate alcohol consumption provides a summary of the evidence that a causal relationship between CHD risk and moderate alcohol consumption may exist. It also shows the importance of each CHD pathway that moderate alcohol consumption influences.

Vaspin: a new adipokine correlating the levels of crevicular fluid and tear fluid in periodontitis and obesity

AIM

In the present study, we investigated the levels of vaspin in gingival crevicular fluid (GCF) and tear fluid in obese patients with chronic periodontitis (CP), and sought to find an association, if any.

METHODS

Forty patients (20 males and 20 females) with moderate-severe CP were selected based on their clinical parameters of gingival index, probing depth (PD), clinical attachment level (CAL), bleeding on probing, body mass index (BMI), and waist circumference, and divided into four groups (n = 10/group): group 1 (healthy non-obese), group 2 (healthy obese), group 3 (non-obese with CP), and group 4 (obese with CP). GCF and tear fluid vaspin levels were estimated by enzyme-linked immunosorbent assay.

RESULTS

The mean vaspin concentration both in GCF and tear fluid was greater for group 4 (1.84 ± 0.03) and (1.98 ± 0.08), followed by groups 3 (1.35 ± 0.03 and 1.50 ± 0.06), 2 (0.95 ± 0.26 and 1.27 ± 0.51), and then 1 (0.65 ± 0.02 and 0.75 ± 0.02), respectively. Mean vaspin levels correlated with BMI, CAL, and PD. The association between GCF and tear fluid vaspin concentration was also statistically significant (P < 0.001).

CONCLUSION

Vaspin can be a novel biomarker connecting inflammatory marker for the systemic inflammatory response in obesity and CP.