Influence of hormonal variation on the periodontium in women

Gender-based cytomorphometric analysis of buccal exfoliated cells in a South Indian population

OBJECTIVE

To assess differences based on gender in nuclear area (NA), cytoplasmic area (CA), and nuclear-cytoplasmic ratio (N:C ratio) values for clinically normal buccal smears in apparently healthy subjects of a South Indian population, thereby providing definitive baseline cytomorphometric measurements for the South Indian population.

METHODS

Buccal smears were collected from 60 healthy subjects (30 males and 30 females) of a South Indian population above 18 years in age. Values of the NA and CA were measured, and the N:C ratio calculated, using ImageJ software. Statistical analysis of the data with independent t tests and 95% confidence intervals was done using SPSS version 21 (significance set at P < 0.05).

RESULTS

The results showed that there were significant differences in the NA, CA, and N:C values between males and females irrespective of age (P = 0.01).

CONCLUSION

Definitive gender-specific baseline cytomorphometric data can be established using exfoliative cytology for the South Indian population, and this may be helpful in deciphering the occurrence of oral pre-malignant diseases and oral squamous cell carcinoma in this population, as the incidence of these conditions varies with gender and different ethnic groups.

Immunohistochemical expression of estrogen receptor alpha in the maxillary sinus, pulp, and periodontal ligament of adjacent teeth in late pregnancy in rats

This study aimed to assess the histological changes in the maxillary sinus and its adjacent dental tissues as pulp and periodontal ligament during pregnancy and investigate the role of estrogen hormone in these changes through the detection of estrogen receptors in these tissues. Sixteen adult female rats were used and were allocated into two groups: control non-pregnant (n = 8) and pregnant (n = 8). They were sacrificed and their heads were prepared for histological and immunohistochemical examination for estrogen receptor alpha. Our results revealed that pregnant rats revealed inflammatory changes in the sinus as thick epithelial lining, loss of cilia, swollen goblet cells, intraepithelial and interstitial edema. The lamina propria demonstrated considerable infiltration of inflammatory cells, glandular hyperplasia with vacuolar degeneration, and vascular congestion. Periodontal ligament and pulp revealed hyperemia and vascular congestion. Immunohistochemical examination of estrogen receptor alpha in the maxillary sinus and adjacent dental tissues (Periodontal ligament and pulp) in pregnant rats revealed a significant increase in its expression in all examined tissues. In conclusion, there was an increase in expression of ERα in the sinus mucosa and dental tissues during pregnancy together with slight inflammatory changes in these tissues. Hence, dentists should be aware of the effect of these changes on the pregnant women avoiding teeth extraction due to misdiagnosis of dental, periodontal or sinus pain after exclusion of true pathologies.

Parity, dental caries and implications for maternal depletion syndrome in northern Nigerian Hausa women

BACKGROUND

Female reproductive history, especially high parity, affects general health and may impact negatively on oral health. While parity has been positively linked to tooth loss, the specific association between parity and caries has not been adequately investigated.

AIM

To determine the association between parity and caries in a population of higher parity women. Influences of likely confounders (age, socio-economic status, reproductive parameters, oral health practices and sugar consumption between meals) were considered.

METHODS

This was a cross-sectional study involving 635 Hausa women of varying parity aged 13-80 years. Socio-demographic status, oral health practices and sugar consumption were obtained using a structured interviewer-administered questionnaire. All decayed, missing and filled teeth due to caries (excluding third molars) were noted, and tooth loss etiology was queried. Associations with caries were evaluated through correlation, ANOVA, post hoc analyses and Student's t tests. Effect sizes were considered for magnitude of differences. Multiple regression (binomial model) was used to investigate predictors of caries.

RESULTS

Hausa women had a high prevalence of caries (41.4%) despite low sugar consumption; nonetheless the overall mean DMFT score was very low (1.23 ± 2.42). Older, higher parity women experienced more caries, as did those with longer reproductive spans. Additionally, poor oral hygiene, use of fluoride toothpaste and frequency of sugar consumption were significantly associated with caries.

CONCLUSION

Higher parity (>6 children) was associated with higher DMFT scores. These results suggest that a form of maternal depletion, expressed as heightened caries susceptibility and subsequent tooth loss, occurs with higher parity.

Relationship between soluble neuropilin-1 in the gingival crevicular fluid of early pregnant women and different severities of periodontitis: A cross-sectional study

Background

Pregnancy exacerbates the periodontal inflammation; however, the biological mediators involved are not well characterized. Neuropilins (NRPs) are transmembrane glycoproteins involved in physiological and pathogenic processes such as angiogenesis and immunity but its relationship with periodontal disease in pregnant women has not been studied.

Objective

To explore the soluble Neuropilin-1 (sNRP-1) levels in gingival crevicular fluid (GCF) samples during early pregnancy and its association with the periodontitis severity and periodontal clinical parameters.

Methods

80 pregnant women were recruited, and GCF samples were collected. Clinical data and periodontal clinical parameters were recorded. sNRP-1 expression was determined by ELISA assay. The relationship between sNRP-1(+) pregnant women with the severity of periodontitis and periodontal clinical parameters was determined by Kruskal-Wallis and Mann-Whitney tests. Spearman's test estimated the correlation between sNRP-1 levels and periodontal clinical parameters.

Results

Periodontitis was classified as mild in 27.5% (n = 22) women, moderate in 42.5% (n = 34), and severe in 30% (n = 24). sNRP-1 expression was higher in the GCF of pregnant with severe (41.67%) and moderate (41.17%) periodontitis compared than in those with mild periodontitis (18.8%). The sNRP-1(+) pregnant had a higher BOP (76.5% v/s 57%; p = 0.0071) and PISA (1199.5 mm2 v/s 880.2 mm2; p = 0.0282) compared with sNRP-1(-). A positive correlation between sNRP-1 levels in GCF and BOP (p = 0.0081) and PISA (p = 0.0398) was observed.

Conclusions

The results suggest that sNRP-1 could be involved in periodontal inflammation during pregnancy.

Periodontal disease in pregnancy: A comparative prospective study

INTRODUCTION

Periodontal disease affects many pregnant women and may be associated with adverse pregnancy outcomes. The object of this study was to evaluate women's level of knowledge about this condition in pregnancy. We compared level of knowledge, participation in medical screening, and periodontal health status in pregnant women and nonpregnant controls.

MATERIAL AND METHODS

This study included 141 pregnant and 141 nonpregnant women, examined by one examiner at the Department of Gynecology and Obstetrics of the University Hospital Muenster, Germany. With reference to periodontal health status, the Periodontal Screening Index was used and a questionnaire was designed to represent the level of knowledge and predisposing factors.

RESULTS

Pregnant women showed a strong tendency towards higher Periodontal Screening Indices than the nonpregnant controls (P=0.058). A strong positive correlation between participation in screenings and a lower Periodontal Screening Index was measured, but no direct relation between knowledge and periodontal health was detected. However, a better level of knowledge correlated noticeably with participation in screening programs. Educational attainment was found to be a main factor correlated with periodontal health and further factors such as medical screening and smoking habits. A great number of women felt they were not sufficiently informed about oral health aspects in pregnancy.

CONCLUSIONS

As participation in screenings was a main item that positively correlated with healthier periodontal status, it had to be a focused element. The possible positive influence of knowledge regarding the participation in screening programs showed not only the need to spread awareness but also the need for proper education.

Comparing Gingival Inflammation And Salivary Acidity To Hormonal Variation During Menstruation

Introduction

Hormonal changes are associated with healthy female in different stages of her life, such as menarche, pregnancy, and menopause. The main female hormones (i.e., Estrogen and progesterone) act as modulators and effectors during different phases of menstrual cycle. Additionally, these hormones were shown to affect the body inflammatory status. Few studies addressed gingivitis and female hormones. Although gingivitis main cause is dental biofilm, female hormones might modulate this inflammation. If no treatment provided, gingivitis might proceed to periodontitis and alveolar bone destruction may appear.

The study aim

was to assess the changes in gingival inflammation, and salivary pH in relation to changes in hormonal levels during different menstrual phases in young females.

Method

25 healthy young females with regular menstrual cycles were included. The volunteers were invited to visit the clinic during their 2nd day of menstrual cycle (menses phase (MP)). During the visit, plaque index (PLI) and gingival index (GI) were scored. Additionally, salivary pH was calculated. Follow-up readings were taken on the 20th day of menstruation (pre-menstrual phase (PMP)). The difference in PLI, GI and salivary pH was analysed using t-test and chi-square test.

Results

The study showed that PLI and GI increased statistically significantly with increasing levels of female hormones during PMP and decreased during MP (P-value = 0.012 for PLI and 0.0003 for GI). Salivary pH decreases slightly during PMP and saliva becomes more alkaline during MP (P-value = 0.015).

Conclusion

The study showed increased gingival inflammation and plaque accumulation during the premenstrual period. It is recommended to raise awareness of gingival inflammation among adult females to prevent progressive changes of periodontitis. However, due to the limited sample size of this study, a comprehensive population-based study is needed to support the findings.

The Impact of Progesterone and Estrogen on the Tooth Mobility

Background and Objectives: Progesterone and estrogen modify the bone metabolism directly related to the periodontium, this study aimed at answering the question whether fluctuations in the levels of these hormones or the use of their synthetic equivalents in modern contraceptives have a significant impact on the natural tooth mobility (TM) in its alveolus. Materials and Methods: Sixty healthy women who had never been pregnant and when interviewed reported either (1) having regular menstruations every 28-30 days or (2) taking oral two-phase two-ingredient hormonal contraceptives formed, respectively, groups M and S in the study. TM evaluated as the Periotest value (PTV) was checked in the menstruation, ovulation, and luteal phases of the menstrual cycle (group M) and on the days corresponding to the moment of the menstrual cycle in group S. Results: Although the PTV-s were within the limits of norm, the canines and the molars were always more stable than the other teeth. In group M, the TM was statistically comparable (p > 0.05) in the menstrual and ovulation phases, thus significantly increased (p < 0.001) in the luteal phase. The TM remained constant (p = 0.758) in all studies in group S. The results demonstrated that the canines and the molars in the luteal phase were significantly more mobile in group M than in group S (p < 0.001), although increased mobility of the teeth in group M affected the canines and the first molars to a significantly lesser degree than the other teeth. Conclusions: However, since women between 20 and 30 years old constitute the majority of ortho-dontic patients, possible determination of the optimum moment of force application in relation to the sex hormones cycle, namely, to its luteal phase, is clinically very promising.

Knowledge of oral health during pregnancy and associated factors among pregnant mothers attending antenatal care at South Omo Zone public hospitals, Southern Ethiopia, 2021

Background

The awareness of women towards oral health during pregnancy is an important aspect of her general health. It can compromise pregnancy outcomes, as well as it may affect the newborn’s overall health. Every pregnant woman plays a critical role in shaping the oral hygiene habits adopted by her if she is aware of pregnancy-related oral health and result in good perinatal outcomes. This study aimed to assess knowledge of oral health during pregnancy and associated factors among pregnant mothers who attend antenatal care at South Omo Zone public hospitals, Southern Ethiopia, 2021.

Methods

An institution-based cross-sectional study was conducted among pregnant women attending routine antenatal care from October 01 to November 30. A systematic random sampling method was conducted to select study participants. Data had been collected through face-to-face interviews using semi-structured questionnaires. Data were entered using epi data version 3.1 and exported to Statistical Package for the Social Sciences version 25 for data analysis. Descriptive statistics had calculated for each variable, and binary logistic regression analysis with 95% confidence intervals was carried out to assess the factors associated with the outcome variables. Variables with P-value less than 0.05 were used to declare statistical significance.

Result

Overall good knowledge of pregnant mothers regarding oral health was 34.1% with 95% CI, (32.76, 35.44). Having access to health facility (AOR = 2.60, 95% CI, 1.44, 4.70), having the educational status of secondary and above (AOR 1.37, 95% CI, 1.44, 4.31), having the educational status of primary education (AOR = 0.43, 95% CI, 0.20, 0.92), having a median income of > = 1500 Ethiopian birr (AOR = 0.41, 95% CI, 0.23, 0.72), being governmental employee (AOR = 0.11, 95% CI, 0.03, 0.41), received oral health hygiene counseling during pregnancy (AOR = 1.33, 95% CI, 1.62, 2.84) were significantly associated with good knowledge of oral health of pregnant mothers.

Conclusion

This study showed that the knowledge of pregnant mothers about oral health was 34.1%. Educational status, monthly income, occupation, access to health services, and receiving counseling on oral hygiene at antenatal care were some factors associated with good knowledge of oral health during pregnancy. Therefore strengthening counseling during antenatal care, improving access to a health facility, improving educational status, monthly income, and being government employee are crucial to enhance knowledge of women towards oral health during pregnancy.

Prevalence and Risk Factors for Periodontal Disease Among Women Attending Antenatal Care in Public Hospitals, Southwest Ethiopia, 2022: A Multicenter Cross-Sectional Study

Background

Periodontal disease is characterized by the inflammation of all tissues that surround and support the teeth, and it is the most common public health problem worldwide. It has many different contributing factors, such as poor oral hygiene, smoking, anemia, bacterial plaque, poor economic status, and nutritional deficiency. It also causes different feto-maternal complications like preeclampsia, gestational diabetes, preterm labor, low birth weight, and early abortion. Thus, this study aimed to assess the prevalence and associated factors of periodontal disease among pregnant women.

Methods

A cross-sectional study was conducted among 618 women at public hospitals in the Southwest Ethiopia. Data were collected using a systematic random sampling method and a structured interviewer administered questionnaire. The data were entered into Epi-Data Manager 4.2 and then transferred to a statistical package for social science (SPSS) version 21 for analysis. The logistic regression analysis was done to see the significant association between each predictor with periodontal disease by considering a p-value of <0.05 and a CI of 95%.

Results

A total of 618 women attending ANC with a 100% response rate were enrolled in this study. The mean and standard deviation of the age of the study participants was 31.07 ± 7.8 years. The periodontal disease was observed among 240 (38.8%) of the total participants with 95% C.I of (35%, 43%). Predictors like rural residency, women who could not read and write, women with poor wealth index, nutritional status of underweight, had no information about periodontal disease, depression, history of diabetes mellitus, self-perceived halitosis, no history of ANC, and lower gestational age were found to be significantly associated with periodontal disease.

Conclusion

In this study, the prevalence of periodontal disease was found to be significantly higher. Therefore, in order to minimize the burden of periodontal disease among pregnant women, oral, medical, and mental health education should be promoted.

Hormonal Fluctuations and Periodontal Status in Postmenopausal Women

Introduction. While the short-term effects of hormonal events on gingival inflammation have been well described, their long-term effects on the periodontium have received less attention. Our investigation was aimed at evaluating the correlation between hormonal fluctuations and periodontal status in postmenopausal women from the profile of the Rafsanjan Cohort Study. Material and Methods. We used the data obtained from the profile of the Rafsanjan Cohort Study (RCS) as a part of the prospective epidemiological research studies in Iran (PERSIAN). The RCS includes 10,000 participants aged 35–70 years old. Among this population, the periodontal status data of 4143 women were available. Of these 4,143, the postmenopausal women were included in the study, and those who had a history of gingival treatment during the past 6 months were excluded from the study. Finally, 928 postmenopausal women were included in the present study. Periodontal status was assessed by measuring the clinical attachment loss, pocket depth, and bleeding on probing (BOP). Univariate and multivariate regression analyses were applied using three different models. Results. The results showed that 53.2% of postmenopausal women had periodontitis. There were significant differences between the participants with and without periodontitis in brushing frequency and educational status $\left(P<0.05\right)$ . After adjusting for all potential confounders, no correlation was found between hormonal fluctuations and periodontal status. Conclusion. There was no correlation between hormonal fluctuations and periodontal status.

Profile of the oral microbiota from preconception to the third trimester of pregnancy and its association with oral hygiene practices

Background

The oral microbiota plays vital roles in both oral and systemic health, but limited studies have explored the transition of the female oral microbiota from preconception to pregnancy along with pronounced hormonal fluctuations.

Aim

To characterize the oral microbiota among women in preconception and pregnancy through a prospective study and to explore the associations between the oral microbiota and oral hygiene practices.

Methods

A total of 202 unstimulated saliva samples were collected from 101 women in both preconception and late pregnancy. The oral microbiota was analyzed using 16S rRNA gene sequencing.

Results

The Ace and phylogenetic diversity (PD) index were significantly lower in the third trimester than preconception. The pathogenic taxa Prevotella and Atopobium parvulum were significantly higher during late pregnancy than preconception. Women with overall better oral hygiene practice showed lower richness     and diversity     in preconception compared to women with poorer oral hygiene practice. The abundance of pathogens such as Dialister during both preconception and pregnancy decreased among women with better oral hygiene practice.

Conclusions

The composition of the oral microbiota changed slightly from preconception to late pregnancy, with more pathogens in saliva samples during pregnancy. Improving oral hygiene practices has the potential to maintain oral micro-ecological balance.

Oral health knowledge, attitude, and practice of pregnant women in Deccan, South India: a cross-sectional prenatal survey

Pregnancy is a unique condition for women, associated with physiological and emotional changes in the body. Various research showed an association between periodontal disease and adverse pregnancy outcomes. Importance to hygiene maintenance should be given during pregnancy and improve the wellbeing of the mother and child. This study assessed oral health knowledge, attitude, and practices among pregnant women in Hyderabad. The study design was cross-sectional and included 445 women who responded and completed the survey. Subjects were selected using a random sampling technique in gynecology clinics. The questionnaire form consisted of four sections: demographic data, knowledge, attitude, and oral hygiene practice. Out of the 482 pregnant females invited to participate in the study, 445 women completed the survey, giving a response rate of 92%. The majority of women showed good knowledge and attitude regarding oral hygiene and its relation to pregnancy. However, the participants showed poor compliance with the recommended protocol. There are certain myths and barriers to dental treatment that need to be considered in the prenatal education of women. If explained by the gynecologist, the importance of oral health and its correlation with systemic health will play a crucial role in improving oral hygiene practice and regular dental visits.

Clinical study showing a lower abundance of Neisseria in the oral microbiome aligns with low birth weight pregnancy outcomes

OBJECTIVES

The objective of this study was to examine the association between the oral microbiome and pregnancy outcomes, specifically healthy or preterm low birth weight (PLBW) in individuals with and without periodontal disease (PD).

MATERIAL AND METHODS

In this prospective clinical trial, we recruited 186 pregnant women, 17 of whom exhibited PD and delivered PLBW infants (PD-PLBW group). Of the remaining women, 155 presented PD and delivered healthy infants; 18 of these subjects with similar periodontal condition and age matched to the PD-PLBW group, and they became the PD-HD group. From the total group, 11 women exhibited healthy gingiva and had a healthy delivery (HD) and healthy infants (H-HD group), and 3 exhibited healthy gingiva and delivered PLBW infants (H-PLBW group). Periodontal parameters were recorded, and subgingival plaque and serum were collected during 26-28 gestational weeks. For the plaque samples, microbial abundance and diversity were accessed by 16S rRNA sequencing.

RESULTS

Women with PD showed an enrichment in the genus Porphyromonas, Treponema, and Filifactor, whereas women with healthy gingiva showed an enrichment in Streptococcus, Actinomyces, and Corynebacterium, independently of the birth status. Although no significant difference was found in the beta diversity between the 4 groups, women that had PLBW infants presented a significantly lower abundance of the genus Neisseria, independently of PD status.

CONCLUSION

Lower levels of Neisseria align with preterm low birth weight in pregnant women, whereas a higher abundance of Treponema, Porphyromonas, Fretibacterium, and Filifactor and a lower abundance of Streptococcus may contribute to periodontal disease during pregnancy.

CLINICAL RELEVANCE

The oral commensal Neisseria have potential in the prediction of PLBW.

Oral health and emotional well-being in premenopausal and postmenopausal women: a cross-sectional cohort study

Background

Menopause, the absence of ovarian sex steroids, is frequently accompanied by emotional and physiological changes in a woman´s body, as well as oral health changes. The present study aimed to evaluate the association between the periodontal health status and emotional and physical well-being among postmenopausal women (PMW) in comparison with regularly menstruating premenopausal women (RMPW).

Methods

A total of 115 women (PMW, n = 56, mean age ± SD: 54 ± 5; RMPW, n = 59, mean age ± SD: 41 ± 4) received a comprehensive medical assessment and a full-mouth oral examination. All completed the Women’s Health Questionnaire (WHQ) to measure emotional and physical well-being. The corresponding bone mineral density (BMD) scores were obtained from participants´ medical records.

Results

Tooth loss was significantly higher in PMW than RMPW after adjusting for age (3.88 ± 2.41 vs 2.14 ± 2.43, p < 0.05). No significant difference was found in the prevalence of periodontitis between the two groups (PMW: 39.2%, RMPW: 32.2%, p > 0.05). The prevalence of periodontitis was associated with fewer daily brushing sessions in PMW (p = 0.021). Based on the WHQ, both PMW and RMPW with periodontitis had higher ‘’depressed mood’’ scores compared to periodontally healthy women (p = 0.06 and p = 0.038, respectively). The women who reported fewer daily toothbrushing sessions found to have higher depressive mood scores (p = 0.043).

Conclusions

Presence of periodontitis is associated with the emotional and physical well-being of women and reinforcement of oral healtcare is recommended at different stages of a woman’s life including menopause to reduce the risk for early tooth loss in women.

Severe Odontogenic Infections during Pregnancy and Related Adverse Outcomes. Case Report and Systematic Literature Review

Odontogenic infections have the potential to develop into deep-space infections and may cause severe diseases with possible life-threatening complications. Dental infections during pregnancy require special attention in terms of possible complications and treatments due to the potential to affect the lives of two individuals. A case of a 36-year-old pregnant patient with a submandibular abscess caused by an odontogenic infection is reported, followed by a comprehensive systematic review of the literature in order to retrieve information regarding severe odontogenic infections and adverse pregnancy outcomes. The review was conducted according to the PRISMA guidelines using PubMed, Scopus, and Google Scholar databases. A total of 69 cases were included in the qualitative analysis. The mean age was 27.72 years. Patients were managed with surgery in combination with antibiotics. Nine infectious-related cesarean sections were detected, and preterm birth was associated in 3 cases, low birth weight in 2 cases, death of the fetus in 9 cases (13%), and maternal death in 4 cases (5.8%). The possible compromise of oral health during pregnancy is well known; however, severe odontogenic infections are rarely considered in the literature, and they may be associated with severe and life-threatening complications for both mother and the fetus.

Effect of ovariectomy-induced osteoporosis on the amount of orthodontic tooth movement: a systematic review of animal studies

BACKGROUND

Understanding the impact of osteopenia and osteoporosis on orthodontic tooth movement could be of benefit to the orthodontist, but research in humans presents practical and ethical problems. The ovariectomized animal model could provide useful information on osteoporosis.

OBJECTIVE

To compare the amount of tooth movement during or after the application of orthodontic forces between ovariectomized animals and control or sham-operated subjects.

SEARCH METHODS

Unrestricted searches in seven databases and manual searching of the reference lists in relevant studies were performed up to February 2021 (PubMed, Central, Cochrane Database of Systematic Reviews, Scopus, Web of Science, Arab World Research Source, ProQuest Dissertations, and Theses Global).

SELECTION CRITERIA

We searched for studies quantitatively comparing the amount of tooth movement during or after the application of orthodontic forces between ovariectomized animals and control or sham-operated subjects.

DATA COLLECTION AND ANALYSIS

Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. Exploratory synthesis and meta-regression were carried out using the random effects model.

RESULTS

Thirteen studies were finally selected and no specific concerns regarding bias were identified. During the active period, ovariectomy was associated with a statistically significant acceleratory effect on the rate of orthodontic tooth movement compared to non-treated rats (3 weeks; 4 studies, 0.15 mm more movement in the ovariectomized rats; 95 per cent confidence interval: 0.10-0.19; P = 0.000). Exploratory meta-regression showed that this difference could increase over time. Following force discontinuation, no statistically significant differences were observed [3 weeks; 1 study (median ± SE), Ovariectomy group: 0.30 ± 0.04 mm; Sham operation group: 0.18 ± 0.03; P = 0.1558].

CONCLUSIONS

Ovariectomy-induced osteoporosis may affect the rate of orthodontic tooth movement. Although animal studies should be approached with caution regarding their translational potential, the safe practice would suggest that one should consider potential implications.

REGISTRATION

PROSPERO (CRD42018118003).

Periodontal Disease in Type 1 Diabetes Mellitus: Influence of Pubertal Stage and Glycemic Control

OBJECTIVE

Though gingivitis is common in children with type 1 diabetes mellitus (T1DM), the overall periodontal health in T1DM during the pubertal stage is less well-characterized. The study was undertaken to explore the possible influence of puberty and metabolic derangement on periodontal health in T1DM.

METHODS

In this cross-sectional study, 110 subjects between 10-18 years with T1DM and 52 healthy siblings of similar age were evaluated for pubertal stage, glycosylated hemoglobin (HbA1c), and periodontal health. Simplified oral hygiene index (OHIS), gingival index (GI), plaque index (PI), bleeding on probing (BOP), and probing depth (PPD) were evaluated at 4 sites per tooth as per 6 Ramfjord index teeth used to assess periodontal disease (PD).

RESULTS

PD not merely gingivitis was significantly higher in T1DM (84/110, 76.36%) than the control group (28/52, 53.8%) (P = .004). Irrespective of pubertal status, children with T1DM had worse GI, PI, BOP, and PPD than nondiabetic subjects, although OHIS was better in diabetes. In both T1DM and nondiabetic subjects, pubertal subjects showed significantly worse OHIS, PPD, BOP, and GI than prepubertal subjects. PD was correlated with pubertal stage, age, and HbA1c, although less strongly with the duration of diabetes. In logistic regression, pubertal stage was a stronger predictor of PD (OR = 14.26) than age (OR = 2.22), and HbA1c (OR = 1.5) rather than the presence of diabetes and its duration.

CONCLUSIONS

Though pubertal status, age, and poor glycemic control rather than the presence of diabetes and its duration are associated with gingivitis and other forms of PD, puberty had a more profound effect in the pathogenesis of PD in T1DM.

Association between parity and tooth loss among northern Nigerian Hausa women

BACKGROUND

Female reproduction is associated with physiological, metabolic, and nutritional demands that can negatively affect health and are possibly cumulative when parity is high. While it is probable that maternal oral health is similarly affected, available evidence is based on fairly low parity populations and likely confounders affecting oral health status were not considered.

AIM

To determine the relationship between parity and tooth loss in a population with many high parity women. Contributions of age, reproductive and socioeconomic parameters, and oral health practices were considered.

MATERIALS AND METHODS

This was a cross-sectional study involving 612 Hausa women of all parity levels aged 13-65 years. Women with ≥5 children were considered high parity. Sociodemographic status and oral health practices were collected using a structured interviewer-administered questionnaire. All teeth present, (excluding third molars) and missing teeth were noted, with inquiries regarding tooth loss etiology. Associations with tooth loss were evaluated through correlations, ANOVA, post hoc analyses and Student's t tests. Effect sizes were used to interpret the magnitude of differences. Multiple regression (negative binomial model) was used to investigate predictors of tooth loss.

RESULTS

Hausa women had a low prevalence of tooth loss, despite poor oral hygiene, and limited dental care. Older, middle SES, and higher parity women experienced significantly more tooth loss. Additionally, increased duration of reproductively active years was significantly related to fewer remaining teeth.

CONCLUSION

Higher parity was related to greater tooth loss in Hausa women. Women with ≥5 children experienced more loss than lower parity age mates.

Periodontal disease and adverse pregnancy outcomes

Periodontal diseases are considered not only to affect tooth-supporting tissues but also to have a cause-and-effect relationship with various systemic diseases and conditions, such as adverse pregnancy outcomes. Mechanistic studies provide strong evidence that periodontal pathogens can translocate from infected periodontium to the feto-placental unit and initiate a metastatic infection. However, the extent and mechanisms by which metastatic inflammation and injury contribute to adverse pregnancy outcomes still remain unclear. The presence of oral bacteria in the placenta of women with term gestation further complicates our understanding of the biology behind the role of periodontal pathogens in pregnancy outcomes. Epidemiological studies demonstrate many methodological inconsistencies and flaws that render comparisons difficult and conclusions insecure. Therefore, despite the fact that a number of prospective studies show a positive association between periodontal diseases and various adverse pregnancy outcomes, the evidence behind it is still weak. Future well-designed explanatory studies are necessary to verify this relationship and, if present, determine its magnitude. The majority of high-quality randomized controlled trials reveal that nonsurgical periodontal therapy during the second trimester of gestation does not improve pregnancy outcomes. From a biological standpoint, this can be partially explained by the fact that therapy rendered at the fourth to sixth months of pregnancy is too late to prevent placental colonization by periodontal pathogens and consequently incapable of affecting pathogen-induced injury at the feto-placental unit. Thus, interventions during the preconception period may be more meaningful. With the increase in our understanding on the potential association between periodontal disease and adverse pregnancy outcomes, it is clear that dental practitioners should provide periodontal treatment to pregnant women that is safe for both the mother and the unborn child. Although there is not enough evidence that the anti-infective therapy alters pregnancy outcomes, it improves health-promoting behavior and periodontal condition, which in turn advance general health and risk factor control.

Oral manifestation and its management in postmenopausal women: an integrated review

Postmenopause is a phase of life which leads physical and emotional instability from multiple health related issues. Oral health in this stage of life is also compromised. Oral health has an impact on general wellbeing of the individual as oral cavity is commonly act as a mirror to general health. Menopause is phase in a woman’s life when menstrual cycles cease by reduced secretion of the ovarian hormones, such as estrogen and progesterone. This review article has emphasized on the diverse oral presentations of peri- and postmenopausal phase of women’s life. Practicing dental surgeons and general physician should be aware of the possible association of postmenopause and its various oral signs and symptoms in this midlife phase of women. It also focuses on its symptomatic management of various oral health issues. This article explains diverse oral conditions in detailed and their management. Stress causing anxiety and depression among this midlife phase of women can lead to alteration in immunity which can again lead to various oral conditions, like lichen planus, apthous ulcer that can cause burning sensation in oral mucosa and alter the food habit. By dealing with all this diverse condition, practicing oral physician can help to reduce and manage oral manifestation of postmenopausal phase of life.

Minimizing risk of customized titanium mesh exposures - a retrospective analysis

BACKGROUND

Recommendations for soft tissue management associated with customized bone regeneration should be developed. The aim of this study was to evaluate a new protocol for customized bone augmentation in a digital workflow.

METHODS

The investigators implemented a treatment of three-dimensional bone defects based on a customized titanium mesh (Yxoss CBR®, ReOSS, Filderstadt, Germany). Patients and augmentation sites were retrospectively analysed focussing on defect regions, demographic factors, healing difficulties and potential risk factors. An exposure rate was investigated concerning surgical splint application, A®- PRF and flap design.

RESULTS

In total, 98 implants could be placed. Yxoss CBR® was removed after mean time of 6.53 ± 2.7 months. Flap design was performed as full flap preparation (27.9%), full flap and periosteal incision (39.7%), periosteal incision (1.5%), poncho/split flap (27.9%) and rotation flap (2.9%). In 25% of the cases, exposures of the meshes were documented. Within this exposure rate, most of them were slight and only punctual (A = 16.2%), like one tooth width (B = 1.5%) and complete (C = 7.4%). A®- PRF provided significantly less exposures of the titanium meshes (76.5% no exposure vs. 23.5% yes, p = 0.029). Other parameters like tobacco abuse (p = 0.669), diabetes (p = 0.568) or surgical parameters (mesh size, defect region, flap design) did not influence the exposure rate. Surgical splints were not evaluated to reduce the exposure rate (p = 0.239). Gender (female) was significantly associated with less exposure rate (78,4% female vs. 21.6% male, p = 0.043).

CONCLUSIONS

The results of this study suggest that the new digital protocol including patient-specific titanium meshes, resorbable membranes and bone grafting materials was proven to be a promising technique. To improve soft tissue healing, especially A®-PRF should be recommended.

Role of Epithelial Mesenchymal Transition in Phenytoin Influenced Gingival Overgrowth in Children and Young Adults. A Preliminary Clinical and Immunohistochemical Study

Objectives: To prove the role of epithelial mesenchymal transition (EMT) in the pathogenesis of phenytoin influenced gingival overgrowth (PIGO) in children and young adults. Study design: Thirty male individuals who are to start with oral phenytoin therapy were recruited for the study. All the 30 individuals underwent full mouth scaling and root planning and were then followed up for a period of one year at intervals of 3 months each. Based on the clinical gingival status they were divided into group1 (responders) individuals who showed gingival overgrowth (GO) and group 2 (non responders) individuals who do not show any GO. Gingival tissue samples were obtained from both the groups at the end of 1 year and subjected to immuno histochemical analysis for E-cadherin expression and histo-pathological for alteration in the basement membrane and confirmation of the fibrosis. Results: Decrease in expression of E cadherin, loss of basement membrane integrity and fibrosis were noted on responder group when compared to non responder group at p<0.001. Fibrosis was seen in the epithelial connective tissue junction. Conclusion: Decrease in cell adhesion, degradation of basement membrane and presence of fibrosis could suggest the role of EMT in the pathogenesis of PIGO.

Influence of Pregnancy on the Inflammatory Process Following Direct Pulp Capping: a Preliminary Study in Rats

The purpose of this study was to evaluate the inflammatory process following direct pulp capping during pregnancy. This experimental study involved 48 maxillary first molars of female Wistar rats. The procedures were performed in pregnant and non-pregnant animals (n =20 each). Direct pulp capping with mineral trioxide aggregate (MTA) and restoration with a light-cured resin composite was performed in half of exposed pulp specimens. In the other half of specimens, light-cured composite was placed directly on the exposed pulp. In the control groups (n=4 each), no intervention was performed. Animals were euthanized at 3 and 7 days. All sections (three per slide) were viewed under an optical microscope. One previously calibrated pathologist performed descriptive analysis and assigned scores for inflammatory response and tissue organization adjacent to the pulp exposure. The Kappa value for intra-examiner variability was 0.91. At 3 days, in animals treated with MTA, inflammatory infiltrate was absent in non-pregnant animals while mild inflammatory infiltrate was observed in some pregnant animals. The inflammatory response ranged from mild to severe in both groups treated with composite alone. At 7 days, the inflammatory response was more intense in pregnant than in non-pregnant animals treated with MTA; while this difference were not evident in animals treated with composite alone. In conclusion, pregnancy may not influence the inflammatory process following direct pulp capping with light-cured resin composite, which was always harmful to the pulp; while the tissue response after the direct pulp with MTA were more favorable in non-pregnant animals.

Difference in the expression of inflammatory mediators in gingival crevicular fluid in postmenopausal patients with chronic periodontitis with and without menopausal hormone therapy

OBJECTIVE

Hormonal changes experience by women produce significant changes in the periodontium. The aim of this study is to assess whether menopausal hormone therapy, in patients diagnosed with moderate chronic periodontitis and menopause presents a beneficial effect, in terms of clinical and immunological outcomes.

STUDY DESIGN

Thirty subjects with moderate chronic periodontitis and menopause were selected and assigned to two groups in accordance to the presence of menopausal hormone therapy. Periodontal clinical parameters, microbiological samples and immunological variables were assessed in both groups. Inter-group differences were evaluated using non-paired Student t-tests and chi square tests. Also, Pearson coefficient correlation was performed to determine the correlation between variables.

RESULTS

There were statistically significant differences between groups for clinical attachment level, probing pocket depth, interleukin 1β and interleukin 6. Smoking habit, deeper PPD and higher Il-6 levels in non-menopausal hormone therapy users group, tend to increase the interleukin 1ß GCF levels. These findings were supported by serum estrogen levels. The variables levels were higher in the menopausal hormone therapy users group.

CONCLUSION

Within the limitations of the present study, the hypothesis that menopausal hormone therapy user's women will show better periodontal status and differences in immunological variables respect to those being non-menopausal hormone therapy users was supported.

Impact of oral contraceptives on periodontal health

Background

Oral contraceptives pills (OCPs) are common and a convenient form of contraception. The use of hormonal contraceptives by women has been considered to influence gingival and periodontal disease progression.

Aim

This study was conducted to assess the effect of oral contraceptive pills on the periodontal health.

Materials and method

A cross-sectional comparative study was conducted among 200 females aged 18 years and above of Jaipur city. The study subjects were divided into two groups i.e. contraceptive users and non-contraceptive users, each group consisted 100 females. Data was collected using Modified WHO Performa (1997). Periodontal status was examined using Community Periodontal Index (CPI) and Loss of Attachment (LOA). Chi-square test and one sample t-test was used for statistical analysis and P value was set (p< 0.05) as significant.

Results

Mean CPI score in subjects and non-contraceptive users was 2.34+ 0.81 and 1.16+ 0.89 respectively. Mean LOA score in each group was 0.28+ 0.45 and 0.19+ 0.50 respectively.

Conclusion

Oral Contraceptive pills had adverse effects on periodontal health.

Prevalence of oral mucosal disorders during pregnancy: A systematic review and meta‐analysis

OBJECTIVE

To assess the prevalence of oral mucosal disorders during pregnancy.

METHODS

Observational studies were selected by two reviewers in a two-phase process. Search strategies were applied at CINAHL, LILACS, LIVIVO, PubMed, Scopus, Web of Science, Google Scholar, OpenGrey, and ProQuest. The risk of bias was assessed using the Joanna Briggs Institute's Critical Appraisal Checklist for Studies Reporting Prevalence Data. Synthesis of results was calculated by the software R Statistics version 3.5.1 (The R Foundation, Vienna, Austria). Confidence in cumulative evidence was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

RESULTS

Fifteen studies met the eligibility criteria and were selected for qualitative synthesis and meta-analysis, of which 5935 participants were enrolled. The overall prevalence of oral mucosal disorders was 11.8%. Gingival hyperplasia (17.1%), morsicatio buccarum (10%), oral candidiasis (4.4%), pyogenic granuloma (3%), and benign migratory glossitis (2.8%) were the most prevalent lesions. The overall risk of bias was considered moderate, and the quality of evidence was very low.

CONCLUSION

Disorders of the oral mucosa were present in approximately 1 out of 10 pregnant women. Gingival hyperplasia was the most prevalent lesion. Further studies should apply homogeneous methodology to improve the quality of evidence.

Influence of Lifestyle Factors on Oral Health-Related Quality of Life in Pregnant Women in Indore City

Background

Lifestyle factors affect the periodontal and oral hygiene status and, thus, may affect the Oral Health-Related Quality of Life (OHRQoL) in pregnant women. Thus, the aim of the study was to assess the OHRQoL and determine its relationship with lifestyle and other factors in pregnant women in Indore city.

Methods

This cross-sectional study was carried out on 400 pregnant women who were selected using stratified random sampling technique from eight private maternity centers located in Indore city. A questionnaire collected information on socio-demographic characteristics, oral hygiene practices, previous dental visit and past medical history. OHRQ_OL was assessed using Oral Health Impact Profile-14 questionnaire. Lifestyle factors were assessed using the Health practice Index.

Results

The lifestyle factors were the strongest predictor for poor OHRQ_OL. The pregnant women (OR = 3.22, P-value < 0.0001*) with poor lifestyle had significantly poor OHRQ_OL. Logistic regression analysis showed that poor socio-economic status (OR = 2.63, P-value = 0.025*), brushing frequency of less than or equal to once daily (OR = 2.02, P-value = 0.025*), and suffering from systemic diseases (OR = 2.11, P-value = 0.017*) were other important predictors for poor OHRQ_OL in pregnant women.

Conclusions

Our findings showed that lifestyle factors significantly impact OHRQ_OL in pregnant women. Thus, it is recommended that effective policies should be drafted to improve lifestyle factors and OHRQ_OL in pregnant women.

Gingival enlargement in orthodontic patients: Effect of treatment duration

INTRODUCTION

In this study, we aimed to assess the effect of the duration of fixed orthodontic treatment on gingival enlargement (GE) in adolescents and young adults.

METHODS

The sample consisted of 260 subjects (ages, 10-30 years) divided into 4 groups: patients with no fixed orthodontic appliances (G0) and patients undergoing orthodontic treatment for 1 year (G1), 2 years (G2), or 3 years (G3). Participants completed a structured questionnaire on sociodemographic characteristics and oral hygiene habits. Clinical examinations were conducted by a calibrated examiner and included the plaque index, the gingival index, and the Seymour index. Poisson regression models were used to assess the association between group and GE.

RESULTS

We observed increasing means of plaque, gingivitis, and GE in G0, G1, and G2. No significant differences were observed between G2 and G3. Adjusted Poisson regression analysis showed that patients undergoing orthodontic treatment had a 20 to 28-fold increased risk for GE than did those without orthodontic appliances (G1, rate ratio [RR] = 20.2, 95% CI = 9.0-45.3; G2, RR = 27.0, 95% CI = 12.1-60.3; G3 = 28.1; 95% CI = 12.6-62.5).

CONCLUSIONS

The duration of orthodontic treatment significantly influenced the occurrence of GE. Oral hygiene instructions and motivational activities should target adolescents and young adults undergoing orthodontic treatment.

Periodontal status during pregnancy and postpartum

Objectives

Different studies have documented an association between periodontal disease and low birth-weight delivery. Hence, knowledge of periodontal status during pregnancy and postpartum is important in order to reduce the risks of both diseases. This study aimed to analyze periodontal status at successive stages of pregnancy and 3–6 weeks postpartum in women with initial periodontal alterations.

Materials and methods

Ninety-six pregnant women were examined at 8–10 weeks (pregnancy diagnosis, baseline), 21–23 weeks and 34–36 weeks of gestation and at 40 days postpartum to record plaque scores, clinically assessed gingival inflammation and probing depth (mean depth and % sites with depth >3 mm). Bivariate and multivariate analyses were performed. Type 1 (α) error was established at 0.05

Results

Plaque Index increased (p = 0.043) throughout pregnancy (baseline, 42%±0.18); 21–23 weeks, 42.6%±0.14; 34–36 weeks, 45.6%±0.13 and decreased postpartum (44.8%±0–13). Gingival Index increased (p<0.001) throughout pregnancy (baseline, 56.7%±0.20; 21–23 weeks, 66.36%±0.17; 34–36 weeks, 74.5%±0.18) and decreased postpartum (59.3%±0.21). Probing Depth increased (p<0.001) throughout pregnancy (baseline, 2.51±0.05; 21–23 weeks, 2.63±0.053; 34–36 weeks 2.81±0.055) and decreased postpartum (2.54±0.049). Percentage of sites with Probing Depth >3 mm increased (p<0.001) throughout pregnancy (baseline, 17.6%±0.16; 21–23 weeks, 23.9%±0.17; 34–36 weeks, 31.1%±0.17) and decreased postpartum (21.2%±0.17) but remained significantly (p<0.02) higher than at baseline.

Conclusion

Periodontal status deteriorates during gestation but improves postpartum.

Influence of female sex hormones on periodontium: A case series

Dental plaque is the primary etiologic factor for the periodontal diseases. Although pathogenic bacteria in dental plaque are necessary for the incidence of periodontal disease, but a susceptible host is as important. The susceptibility of the host can be modified by various systemic factors with hormones level being one. The periodontium shows an exaggerated inflammatory response to plaque modified by female sex hormone during puberty, pregnancy, in women taking oral contraceptives and at the postmenopausal stage. This paper presents such few cases where periodontium is influenced by variation in sex steroid hormones of female during different phases of their life time and to discuss how much a same hormone at different age and stage shows an exaggerated gingival response to plaque.

Effects of Scaling and Root Planing on Gingival Status during Menstrual Cycle- A Cross-Sectional Analytical Study

INTRODUCTION

Variations in sex steroid hormones, noticeable through the menstrual cycle of women, may impact periodontal health. A relationship between female sex hormone levels and periodontal changes during puberty, pregnancy, and menopause has been reported. Little research on gingival status at different periods of menstrual cycle, but very less work has been done to observe the effect of scaling on gingival status during different periods of menstrual cycle.

MATERIALS AND METHODS

Thirty female subjects, aged 18-25 years were selected for a three month study. In Stage 1, clinical parameters {Plaque Index (PI), Gingival Index (GI), Modified Sulcular Bleeding Index (mSBI) and Probing depth (PD)} were recorded at three different time intervals {OV (Ovulation), PM (Premenstruation), M (Menstruation)} of their menstrual cycle, without scaling and polishing. In Stage 2, all clinical parameters were recorded at their subsequent menstrual cycle after scaling and polishing.

RESULTS

In interstage analysis, OV 1 > OV 2, PM 1 > PM 2 and M 1> M 2. In intrastage analysis, for PI, mean difference between all values was not statistically significant. For mSBI, PM 1 > OV 1 > M 1, also PM 2 > OV 2 > M 2. For GI, PM 1 > OV 1 > M 1, also PM 2 > OV 2 > M 2. For PD, mean difference was not statistically significant.

CONCLUSION

Ovarian hormones influence gingival status of females, with an increase observed primarily during PM and OV phases of menstrual cycle. Scaling leads to a subsequent decrease in gingival inflammation.

Qualitative assessment of red blood cell parameters for signs of anemia in patients with chronic periodontitis

AIM

Anemia of chronic disease is defined as anemia occurring in chronic infections and inflammatory conditions that is not caused by marrow deficiencies or other diseases and in the presence of adequate iron stores and vitamins. The present case control study was aimed to assess the red blood cell parameters for signs of anemia in patients with mild, moderate, and severe chronic periodontitis.

MATERIALS AND METHODS

A simple random sampling method was used to select 80 healthy male patients, who were divided into four groups based on full mouth periodontal examination as follows: group I patients comprised the control group (n = 20), which included patients with a clinically healthy periodontium, group II patients (n = 20) were diagnosed with mild chronic periodontitis, group III (n = 20) included moderate chronic periodontitis patients, and patients with severe chronic periodontitis formed group IV (n = 20). Laboratory blood investigations included total number of erythrocytes, hemoglobin concentration, packed cell volume, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration.

RESULTS

Data analysis showed a statistically significant decrease in red blood cell parameters with increase in different grades of periodontitis.

CONCLUSION

Results of the present study show a substantial decrease in red blood cell parameters with increase in the severity of periodontal destruction.

Periodontal treatment outcomes in post menopausal women receiving hormone replacement therapy

Purpose:

To evaluate the effect of hormone replacement therapy(HRT) on periodontal treatment outcomes in a group of postmenopausal women with periodontitis.

Materials and Methods:

23 post-menopausal chronic periodontitis patients were included in this study. The test group(n=11) consisted of women who started HRT with this study and received conjugated estrogen and medroxyprogesteron. The control group(n=12) was women not taking any HRT or supplement therapy. Study groups received the same periodontal treatment. All subjects examiend by recording the following: plaque index (PI), sulcus bleeding index (SBI), periodontal pocket depth (PD) and relative attachment level (RAL) from 6 sites in each tooth. Measurements were recorded at the baseline, 1 month, 3 months, and 6 months following periodontal treatment. Serum estrogene level and bone mineral density was recorded at baseline and 6 months following periodontal treatment.

Results:

The GI change was greater in the control group. There wasn’t significant difference by means of PD, the attachment gain was significantly greater in the HRT receiving group.

Conclusion:

HRT seems to have a positive effect on periodontal treatment outcomes.

Change of periodontal inflammatory indicators through a 4-week weight control intervention including caloric restriction and exercise training in young Koreans: a pilot study

BACKGROUND

Recent cross-sectional studies indicate that obesity is a risk factor for periodontal disease. Exercise training in high fat mice or rats can inhibit gingival inflammation effectively. The objective of this human intervention study was to investigate whether short-term weight control could affect periodontal indexes and serum and gingival crevicular fluid (GCF) biomarkers in young Koreans.

METHODS

Forty-one obese volunteers (body mass index (BMI) > 25.0) and 12 normal weight subjects (18.5 ≤ BMI ≤ 23.0) participated in a four-week weight control program to analyze the changes in anthropometric criteria, the concentrations of C-reactive protein (CRP), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides in serum, gingival index, bleeding on probing, periodontal biomarkers in GCF, and dental plaque index at the first and the 27th days.

RESULTS

The means of obesity measures decreased significantly more in the obese group (BMI 2.53 ± 0.96, waist-to-hip ratio (WHR) 4.88 ± 1.58 %, LDL 35.85 ± 21.74 mgdL(-1)) than in the normal weight group (BMI 0.78 ± 0.72, WHR 2.00 ± 0.95 %, LDL 15.58 ± 18.07 mgdL(-1)). While the obese group showed significant decreases in the biomarkers in GCF (IL-1β 58.38 ± 65.55 pgmL(-1), MMP-8 4.19 ± 5.61 ngmL(-1), MMP-9 3.36 ± 6.30 ngmL(-1)), the mean changes for the normal weight group (IL-1β 10.07 ± 21.08 pgmL(-1), MMP-8 1.49 ± 4.61 ngmL(-1), MMP-9 -1.52 ± 9.71 ngmL(-1)) were not statistically significant. Anthropometric measures and the amounts of GCF biomarkers had weak positive correlations (0.242 ≤ r ≤ 0.340), and LDL in serum correlated with MMP-8 (r = 0.332) and IL-1β (r = 0.342) in the obese group. Stepwise multiple linear regression analysis in the obese group showed that the relationship between the amount of IL-1β in GCF and predictor variables including LDL and BMI was highly significant and accounted for 19.1 % of the variance in IL-1β in GCF.

CONCLUSIONS

In periodontally healthy subjects, weight control could reduce the amounts of MMP-8, MMP-9, and IL-1β in GCF of the obese subjects. Further studies with periodontally unhealthy and obese people are needed to identify the mechanism of decreases in inflammation biomarkers in GCF through weight control.

TRIAL REGISTRATION

ISRCTN86753073 (2015.08.14).

Periodontal Condition and Treatment Needs of Some Pregnant Women in Ibadan, Nigeria

Background:

Periodontal diseases had been reported to be worse in the presence of hormonal imbalance as seen during pregnancy, which if that is the case, should resolve following childbirth when the hormonal level of the women should have reverted to normal.

Subjects and methods

Periodontal health of 345 pregnant women was assessed once during pregnancy and at 14^th week following their childbirth. The clinical variant of community periodontal index of treatment needs probe was used in the assessment.

Results:

During pregnancy, 167/345 (48.4%) of the women had deep pockets, 178/345 (51.6%) had shallow pockets. After childbirth, 5/345 (1.5%) had healthy periodontium, 25/345 (7.2%) had calculus and 7/345 (2.0%) had deep pockets. All of the respondents required oral hygiene instructions (OHI) and prophylaxis and 167/345 (48.4%) required complex treatment during pregnancy. After childbirth, 340/345 (98.5%) of the women required OHI and prophylaxis. Despite the great need for dental treatment among the respondents, majority never sought any treatment as 308/345 (89.3%) of the respondents had never visited a dentist before the study.

Conclusion:

The fact that the deep pocket reduced drastically following childbirth shows that it was not a true pocket. The high unmet treatment needs among the respondents require a concerted effort from dentists and policy makers in order to enlighten the women, especially those of child bearing age concerning the need for preventive dental visitation.

Gingival crevicular fluid proteomes in health, gingivitis and chronic periodontitis

OBJECTIVE

The aim of this study was to compare the proteome composition of gingival crevicular fluid obtained from healthy periodontium, gingivitis and chronic periodontitis affected sites.

BACKGROUND

Owing to its site-specific nature, gingival crevicular fluid is ideal for studying biological processes that occur during periodontal health and disease progression. However, few studies have been conducted into the gingival crevicular fluid proteome due to the small volumes obtained.

METHODS

Fifteen males were chosen for each of three different groups, healthy periodontium, gingivitis and chronic periodontitis. They were categorized based on clinical measurements including probing depth, bleeding on probing, plaque index, radiographic bone level, modified gingival index and smoking status. Gingival crevicular fluid was collected from each patient, pooled into healthy, gingivitis and chronic periodontitis groups and their proteome analyzed by gel electrophoresis and liquid chromatography electrospray ionization ion trap tandem mass spectrometry.

RESULTS

One hundred and twenty-one proteins in total were identified, and two-thirds of these were identified in all three conditions. Forty-two proteins were considered to have changed in abundance. Of note, cystatin B and cystatin S decreased in abundance from health to gingivitis and further in chronic periodontitis. Complement proteins demonstrated an increase from health to gingivitis followed by a decrease in chronic periodontitis. Immunoglobulins, keratin proteins, fibronectin, lactotransferrin precursor, 14-3-3 protein zeta/delta, neutrophil defensin 3 and alpha-actinin exhibited fluctuations in levels.

CONCLUSION

The gingival crevicular fluid proteome in each clinical condition was different and its analysis may assist us in understanding periodontal pathogenesis.

Menopause and oral health

Different phases of a woman's life: Puberty, menses, pregnancy, and menopause have varied influence on her oral health. During the menopause, women go through biological and endocrine changes, particularly in their sex steroid hormone production, affecting their health. Because the oral mucosa contains estrogen receptors, variations in hormone levels directly affect the oral cavity. A few oral conditions and or diseases are seen more frequently during post menopausal years. Role of hormones affecting the health of oro-dental tissues, as well as treatment by HRT in ameliorating these conditions is not clear. There is paucity of randomized controlled trials in this field and more data is needed, before the recommendations for oral health care in post menopausal women can be made. A gynecologist sitting in menopausal clinic should be aware of oral changes happening during this period, and dental needs of these women and should refer them to the dental specialists accordingly. On the other hand, a dentist should also be sensitized about the menopausal status of the woman, her HRT status and special preventive and treatment needs.

Interrelationship between chronic periodontitis and anemia: A 6-month follow-up study

Background:

In India, anemia is a common and serious health disorder among both sexes and all age groups, with anemia of chronic disease (ACD) being the second most prevalent anemia. Periodontitis is an inflammatory disease of the supporting tissues of the tooth caused by specific microorganisms. An immune response to bacteria and their products induces a major vascular response, offering explanatory mechanisms for the interactions between periodontal infection and a variety of systemic disorders. Therefore, periodontitis results in low-grade systemic inflammation, which may cause lower number of erythrocytes and, consequently, lower hemoglobin concentration.

Materials and Methods:

A total of 100 systemically healthy male patients visiting the outpatient department participated in the study. Of these, 50 patients had healthy periodontium and 50 patients had chronic periodontitis. Clinical parameters and red blood cell parameters of all the patients were assessed at baseline and 6 months after non-surgical periodontal therapy. Statistical analysis using Student's t-test was performed.

Results:

Data analysis revealed that patients with chronic periodontitis showed an improvement in both clinical and red blood cell parameters from baseline to 6 months after non-surgical periodontal therapy.

Conclusion:

From the present study, it can be concluded that like any other chronic condition, chronic periodontitis can lead to ACD. It also provides evidence that non-surgical periodontal therapy can improve the anemic status of patients with chronic periodontitis.

Oral contraceptives and the periodontium

Oral contraceptives are a safe and effective means of contraception for millions of women worldwide. The first formulations of these drugs contained much higher doses of estrogens and progestins than those available today, and these were associated with an unacceptably high rate of unwanted effects including serious cardiovascular events. In addition, a number of case reports and clinical studies suggested that use of the first generation oral contraceptives was also associated with an increased risk for gingival and/or periodontal disease. Unfortunately, many of these early studies suffered from significant methodological flaws which throw their findings into question. Nonetheless, these studies provided the basis for a perception among the dental profession that oral contraceptives increase the risk for gingivitis and/or periodontitis. Realisation that the adverse events profile of oral contraceptives was dose dependant led to the development of the modern low dose formulations that are in use today. There have been far fewer studies to investigate whether modern oral contraceptives have any impact on the periodontium compared to studies of the early contraceptive formulations, but the quality of the more recent research is undoubtedly better. Following extensive review of the relevant literature and consideration of the historical perspective, the best available evidence strongly supports that oral contraceptives no longer place users at any increased risk for gingivitis or periodontitis. Oral contraceptives should not be viewed as a risk factor for gingival or periodontal disease.

Periodontal disease awareness among pregnant women in the central and eastern regions of Saudi Arabia

AIM

The purpose of this study was to assess the knowledge and awareness regarding periodontal disease and its effects on pregnancy among pregnant women in the central and eastern regions of Saudi Arabia.

METHODS

In this cross-sectional survey, self-administered, structured questionnaires were distributed to 300 pregnant women who were chosen randomly from attendees of maternity health care centers in the central and eastern regions of Saudi Arabia. The questions were developed from literature reviews of articles. The questionnaire addressed personal and sociodemographic variables, periodontal health awareness, and knowledge of pregnant women. The questionnaire was translated into Arabic and was pretested during the pilot study on a random sample of 50 pregnant women. Data were analyzed by χ(2) -tests, with the level of significance set at P < 0.05.

RESULTS

An overall response rate of 81% was obtained. Approximately 53% had a higher level of education, but only 21% knew how to define dental plaque and 30% knew its harmful effects. Almost 73% stated that gum disease could be prevented through toothbrushing and flossing. Approximately 97% of the respondents knew the negative effect of smoking, while only 12% knew there was a possible relationship between periodontal disease and adverse pregnancy outcomes.

CONCLUSION

The results of this cross-sectional study found that there is limited knowledge and awareness about periodontal disease and its possible effects on pregnancy among pregnant women attending maternal health care centers in the central and eastern regions of Saudi Arabia.

A study to evaluate mobility of teeth during menstrual cycle using Periotest

BACKGROUND AND OBJECTIVE

Over a century, an increased prevalence of gingival disease associated with increasing plasma sex steroid hormone levels has been reported. These situations present unique challenges to the oral health care professional. It is believed that hormonal fluctuations such as those associated with pregnancy, menstruation, and use of hormonal contraceptives lead to an increase in tooth mobility. However, this effect of female sex hormones on periodontal ligament and tooth supporting alveolar bone has rarely been investigated. So this study was undertaken to understand the effect on tooth mobility because of hormonal changes during the menstrual cycle.

MATERIALS AND METHODS

The mobility of index teeth 16, 13, 21, 23, 24, 36, 33, 41, 43, and 44 was measured with Periotest in 50 females at menstruation, ovulation, and premenstruation time points. Simplified oral hygiene index, plaque index, gingival index, and probing depth were also evaluated during the different phases of menstrual cycle for each subject participating in the study.

STATISTICAL ANALYSIS

The results of the study were subjected to statistical analysis. Data analysis was done by applying Z test for comparing difference between two sample means.

RESULT

The stages of menstrual cycle had no significant influence on the Periotest value. Despite no significant change in plaque levels, GI was significantly higher during ovulation and premenstruation time points.

CONCLUSION

No change in tooth mobility was seen during the phases of the menstrual cycle. However, an exaggerated gingival response was seen during ovulation and premenstruation time when the entire menstrual cycle was observed.

Gingival enlargement as an early diagnostic indicator in therapy-related acute myeloid leukemia: A rare case report and review of literature

Treatment for Hodgkin's lymphoma (HL) has resulted in excellent survival rates but is associated with increased risks of secondary therapy-related acute myeloid leukemia (t-AML). Gingival enlargement associated with bleeding and ulceration is the most common rapidly appearing oral manifestations of leukemic involvement. An 8 months pregnant patient reported with generalized gingival enlargement, with localized cyanotic and necrotic papillary areas. Co-relating the hematological report with the oral lesions and her past medical history of HL, a diagnosis of t-AML secondary to treatment for HL was made by the oncologist. As oral lesions are one of the initial manifestations of acute leukemia, they may serve as a significant diagnostic indicator for the dental surgeons and their important role in diagnosing and treating such cases. Furthermore, this case report highlights the serious complication of t-AML subsequent to HL treatment and the important role that a general and oral health care professional may play in diagnosing and treating such cases.