Influence of periodontal infections on systemic health

Immunologic burden links periodontitis to acute coronary syndrome: levels of CD4 + and CD8 + T cells in gingival granulation tissue

OBJECTIVE

To investigate the proportional variation of macrophage and T-lymphocytes subpopulations in acute coronary syndrome (ACS) patients, its association with periodontitis (P), and to compare with control individuals.

SUBJECTS AND METHODS

Three groups of subjects participated: one group consisted of 17 ACS patients with P (ACS + P), another group consisted of 22 no ACS + P patients, and a control group consisted of 23 participants with gingivitis (no ACS + G). Macrophage, CD4 + , and CD8 + T-lymphocytes and CD4 + /CD8 + ratio values in gingival tissue were determined histometrically.

RESULTS

Significant differences were found among three groups regarding the mean number of macrophage (no ACS + P > ACS + P > no ACS + G; p < 0.05) and CD8 + T-lymphocytes (no ACS + P > ACS + P > no ACS + G; p < 0.05). Significant variations were observed between the groups both CD4 + T-lymphocytes densities (ACS + P > no ACS + P and ACS + P > no ACS + G; p < 0.05) and CD4 + / CD8 + ratio (no ACS + P < no ACS + G and ACS + P < no ACS + G; p < 0.05).

CONCLUSIONS

The increased number of CD8 + T-lymphocytes in both group ACS + P and group no ACS + P resulted in a reduction of the CD4 + /CD8 + ratio in gingival tissue when compared with no ACS + G group.

CLINICAL RELEVANCE

The decrease of CD4 + /CD8 + ratio in gingival tissue reflects periodontitis and may be associated with severe adverse outcomes in people with ACS.

Risk factors for the development of oral precancerous lesions in a cohort of 293 oral lichen planus patients with or without chronic periodontitis in southern Taiwan

Background/purpose

Oral lichen planus (OLP) may contribute to the risk of chronic periodontitis, and no reports have shown whether OLP patients with periodontitis have a greater risk of oral precancerous lesions, Candida infection or other clinicopathological diseases. This study aimed to assess the risk factors for the development of oral precancerous lesions in a cohort of 293 OLP patients with or without chronic periodontitis in southern Taiwan.

Materials and methods

The current study recruited 293 OLP patients without preexisting periodontitis at a tertiary institution from 1995 to 2018. The patients were divided into two groups based on the presence or absence of periodontitis. The study compared various clinical and pathological characteristics between the two groups, and also estimated the odds ratio (OR) and the 10-year cumulative risk of chronic periodontitis in OLP patients using logistic regression models and Kaplan‒Meier analysis methods, respectively.

Results

After adjusting for age and gender, the significant contributors to oral precancerous lesions in OLP patients (P < 0.05) were periodontal disease (OR = 2.24) and the male gender (OR = 7.52). Betel nut consumption (OR = 2.61), smoking (OR = 2.46), and candidiasis infection (OR = 3.02) also showed significant associations. Older OLP patients had a lower lesion risk, while a longer OLP duration heightened the periodontal disease likelihood.

Conclusion

The present study demonstrated that coexisting periodontal disease increases the likelihood of developing precancerous lesions in patients with OLP. Periodontal management with oral hygiene care and quitting betel nut consumption and smoking can reduce the risk.

Assessment of Dental Patients' Awareness of the Correlation Between Systemic and Periodontal Diseases: A Questionnaire-Based Study

AIM

The correlation between periodontal diseases and systemic diseases has been proven. Considering the high prevalence of periodontitis, as well as the high prevalence of systemic diseases such as hypertension, diabetes, and anemia, in Saudi Arabia, patients visiting dental clinics need to be educated about this correlation. This study aimed to evaluate the knowledge and awareness levels of dental patients on the correlation between periodontal and systemic diseases and compare the awareness levels of the population based on their gender, educational level, and age group specifications.

METHODOLOGY

 The awareness level of patients was assessed using a questionnaire consisting of 18 questions about the correlation between periodontal and systemic health, along with demographic data (gender, age, and educational level). The questionnaire was distributed to randomly chosen patients who were attending Qassim University dental clinics. Patients could select their responses from three options: "yes," "no," and "no idea." The awareness level of patients was categorized based on their educational qualifications, age, and gender.

RESULTS

 A total of 252 patients participated in the study. Out of the 252 patients, 116 (46%) were male, and the remaining 136 (54%) were female. Females were found to be more aware of the correlation between pregnancy and anemia, independently, and periodontal diseases. Additionally, younger age groups were found to be more aware of the interaction between periodontal diseases and hyperparathyroidism. However, the awareness level based on educational qualification was almost equivalent between high school and college graduates.

CONCLUSION

 The general public of the Qassim region of Saudi Arabia needs to be educated further on the correlation between systemic and periodontal disease. Being part of the community, we wish to contribute to improving the level of awareness about the relationship between periodontal and systemic diseases, as our study has concluded that more efforts are required to achieve higher health standards.

Effect of oral gargle containing Lespedeza cuneata extract on periodontal health improvement and disease prevention: a randomized, controlled clinical trial

BACKGROUND

This study aimed to evaluate the antiplaque and antibacterial effects of a mouthwash containing Lespedeza cuneata (LC) extract through clinical periodontal disease (PD) indicators and changes in PD-causing bacteria.

METHODS

A total of 63 subjects participated in this double-blind clinical trial. Subjects were divided into two groups: 32 participants gargled with LC extract, and 31 used saline. Scaling was performed 1 week before the experiment to secure the homogeneity of the subjects' oral conditions. After gargling with 15 ml of each solution for 1 min, participants spit out the solution to remove any residual mouthwash solution. Then, PD-related bacteria were measured via the O'Leary index, plaque index (PI), and gingival index (GI). The clinical data were collected three times: before gargling, immediately after gargling, and 5 d after gargling.

RESULTS

After 5 d, the O'Leary index, PI, and GI scores were significantly reduced in the LC extract gargle group (p < 0.05). PD-inducing Gram-positive and -negative bacteria were also reduced, confirming the LC extract's effect on periodontal health improvement and disease prevention.

CONCLUSION

Mouthwash containing LC extract, a new alternative natural substance that is safe and effective, may be used to treat PD because of its ability to inhibit and prevent PD.

Behavioral strategies for periodontal health

The impact of lifestyle factors has been increasingly studied and discussed in oral healthcare. Positive lifestyle factors are important in maintaining oral health or controlling disease, but they are not easy to adopt over the long term. Along with public health initiatives within communities and groups, there is a role for behavior change interventions delivered in dental practice settings to improve the periodontal health of individuals. Behavior management is now seen as a part of both prevention and therapy of periodontal diseases. This article summarizes the evidence on behavioral strategies for periodontal health to inform and assist oral healthcare professionals in implementing behavior change in their practice. In addition, strategies for education and training in communication and behavior change techniques are considered.

Cultivation of Lactic Acid Bacteria and Evaluation of the Antimicrobial Potential of Partially Purified Bacteriocin-like Inhibitory Substances against Cariogenic and Food Pathogens

One of the major challenges in the pharmaceutical industry is the search for new antimicrobial compounds that can replace antibiotics. Lactic acid bacteria (LAB) can produce bacteriocin-like inhibitory substances (BLIS) that have a bacteriostatic or bactericidal effect against different bacterial genera, including those responsible for dental caries. Among the pathological processes of microbial etiology, the dental caries stands out, whose main pathogenic agent is the species Streptococcus mutans, present in about 80–90% of the oral cavity. In this context, this study aimed to produce and semi-purify BLIS from Lactobacillus plantarum ST16 Pa, Bifidobacteriumlactis BL 04, Lactococcus lactis CECT-4434 and Lactobacillus lactis 27 as well as to assess their antimicrobial potential against important dental caries causing pathogens like S. mutans UA159, Listeria innocua 2711, Carnobacterium maltaromaticum CECT 4020, Staphylococcus aureus CECT 239, and Escherichia coli ATCC 25922. While BLIS from L. plantarum ST16 Pa and L. lactis CECT-4434 were able to inhibit the growth only of S. mutans UA159, that which was produced by B. lactis BL 04 did so against all bioindicator strains; therefore, this suggests that its application could be important in the control of cariogenic microorganisms.

Blood Biomarkers and Serologic Immunological Profiles Related to Periodontitis in Abdominal Aortic Aneurysm Patients

Background

Periodontitis is a chronic inflammatory gum disease associated with systemic diseases such as cardiovascular diseases.

Aim

To investigate the association of systemic blood biomarkers, C-reactive protein (CRP), levels of lipopolysaccharide (LPS), and IgG levels against periodontal pathogens Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) with the stability, based on the aortic diameter, the growth rate and the eligibility for surgical intervention, of patients with abdominal aortic aneurysm (AAA).

Methods

Patients with stable AAA (n = 30) and unstable AAA (n = 31) were recruited. The anti-A. actinomycetemcomitans and anti-P. gingivalis IgG levels were analyzed by ELISA, the LPS analysis was performed by using the limulus amebocyte lysate (LAL) test, and plasma levels of CRP were determined using an immune turbidimetric method. The association between these blood systemic biomarkers, AAA features, periodontal clinical parameters and oral microbial profiles were explored. Regression models were used to test the relationship between variables.

Results

The presence of antibodies against Pg and Aa, LPS and high CRP concentrations were found in all AAA patients. The IgG levels were similar in patients with stable and unstable AAA (both for Aa and Pg). Among investigated blood biomarkers, only CRP was associated with AAA stability. The amount of LPS in saliva, supra, and subgingival plaque were significantly associated with the systemic LPS (p <0.05).

Conclusions

This post-hoc study emphasizes the presence of antibodies against Pg and Aa, LPS and high CRP concentrations in all AAA patients. The presence of Pg in saliva and subgingival plaque was significantly associated with the blood LPS levels. For further studies investigating periodontitis and systemic diseases, specific predictive blood biomarkers should be considered instead of the use of antibodies alone.

Outer membrane vesicles of Porphyromonas gingivalis: Novel communication tool and strategy

Extracellular vesicles (EVs) have been recognized as a universal method of cellular communications and are reportedly produced in bacteria, archaea, and eukaryotes. Bacterial EVs are often called “Outer Membrane Vesicles” (OMVs) as they were the result of a controlled blebbing of the outer membrane of gram-negative bacteria such as Porphyromonas gingivalis (P. gingivalis). Bacterial EVs are natural messengers, implicated in intra- and inter-species cell-to-cell communication among microorganism populations present in microbiota. Bacteria can incorporate their pathogens into OMVs; the content of OMVs differs, depending on the type of bacteria. The production of distinct types of OMVs can be mediated by different factors and routes. A recent study highlighted OMVs ability to carry crucial molecules implicated in immune modulation, and, nowadays, they are considered as a way to communicate and transfer messages from the bacteria to the host and vice versa. This review article focuses on the current understanding of OMVs produced from major oral bacteria, P. gingivalis: generation, characteristics, and contents as well as the involvement in signal transduction of host cells and systemic diseases. Our recent study regarding the action of P. gingivalis OMVs in the living body is also summarized.

Peptidomic changes of saliva after nonsurgical treatment of stage I / II generalized periodontitis

OBJECTIVE

To explore the changes of peptidome profiles of saliva, serum and gingival crevicular fluid (GCF) before and after nonsurgical periodontal treatment in patients with generalized periodontitis (stage I / II).

SUBJECTS AND METHODS

Saliva, serum and GCF samples were collected from 17 patients at baseline (T₀ ), one week after ultrasonic supragingival scaling (T₁ ) and eight weeks after subgingival scaling and root planning (T₂ ). Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) was carried out to detect changes in peptidomic profiles. Then nano-liquid chromatography-electrospray ionization-tandem mass spectrometry (nano-LC/ESI-MS/MS) was performed to identify potential peptide biomarkers.

RESULTS

Most of the peptides from the patients exhibited a decreasing trend from the time point of pre-treatment to that of post-treatment. Cluster analysis and scatter plots using these peptides indicated that salivary peptidome has an acceptable capability of reflecting the status of stage I / II generalized periodontitis. Seven of these peptides were successfully identified as α-1-antitrypsin, immunoglobulin κ variable 4-1, haptoglobin and immunoglobulin heavy constant γ2.

CONCLUSIONS

Certain peptides in saliva, serum and GCF were down-regulated after nonsurgical periodontal treatment, demonstrating the application prospects of saliva in monitoring and surveillance of periodontal diseases in both clinical settings and communities.

Flavorless vs. Flavored Electronic Cigarette-Generated Aerosol and E-Liquid on the Growth of Common Oral Commensal Streptococci

Introduction

Electronic cigarette (ECIG) use or vaping has become popular globally. While the question “Is vaping safer than smoking?” continues, it is becoming clearer that one of the most dangerous components of E-liquids are the flavorings. Since the oral cavity is the first anatomical site to be assaulted by ECIG aerosol, the aim of this study is to test the hypothesis that flavored ECIG aerosols or E-liquids pose a more detrimental effect on the growth of commensal oral streptococcal bacteria compared to flavorless aerosols or E-liquids.

Methods

Kirby Bauer assays and 24-h planktonic growth curves were used to compare the effects of flavorless vs. flavored (tobacco, menthol, cinnamon, strawberry and blueberry) ECIG-generated aerosols and E-liquids on the growth of four common strains of oral commensal bacteria (Streptococcus gordonii, Streptococcus intermedius, Streptococcus mitis and Streptococcus oralis).

Results

Kirby Bauer assays revealed inhibition of growth for all bacteria tested when exposed to 100% menthol, cinnamon or strawberry flavors. In contrast, 5% flavor in E-liquid had no effect. When exposed to 100 puffs of ECIG-generated aerosol ± flavors (≈ 0.05% flavor in brain heart infusion media) or an equivalent amount of E-liquid ± flavors, twenty-four hour planktonic growth curves indicated no effect on growth for all streptococci tested. Subsequent twenty-four hour planktonic growth curves testing the effects of E-liquid ± flavors (0.0625, 0.125, 0.25, 0.3125, 0.625, and 1.25% flavor in brain heart infusion media) revealed dose-dependent inhibition of growth, particularly for menthol, cinnamon and strawberry), for all bacteria tested.

Conclusion

These results support the hypothesis that flavored E-liquids are more detrimental to the growth of oral commensal bacteria than unflavored E-liquids. The streptococci tested in this study are early colonizers and part of the foundation of oral biofilms and dental plaque. Disturbances in the composition and growth of these primary colonizers is crucial to the development of a healthy dental plaque and host-bacteria interactions. E-liquids and their aerosols containing flavoring agents alter the growth of these bacteria. Such perturbations of pioneering oral communities pose a potential risk to the health of the oral cavity and, ultimately, health in general.

Influence of Periodontal Infection as a Possible Risk Factor for Preterm Low Birth Weight

Background:

There is emerging interest and increasing amount of evidence that support the interrelationship between periodontitis and systemic conditions. Epidemiological and microbiological–immunological studies have lent credence to the concept that periodontal disease may be a separate risk factor for cardiovascular disease, cerebrovascular disease, and respiratory disease, as well as preterm delivery of low-birth-weight infants.

Aim:

The aim of this study was to evaluate the influence of periodontal infection as a possible risk factor for preterm low birth weight (LBW) based on age, literacy, and hemoglobin level of mother.

Materials and Methods:

The observational study was conducted on 200 subjects, which were selected from the free labor ward, District Hospital, Saifai, Etawah, UP, India. Periodontal examinations were performed using the World Health Organization criteria. The periodontal status of the mother was recorded using Community Periodontal Index.

Results:

For this study, chi-square test was performed to know the effect of variables and to find out the statistical significance of the study. Age of mother shows statistical insignificant association with periodontal disease, whereas literacy of mothers showed statistical significant association with periodontal disease, and periodontal status and hemoglobin levels of the mothers also showed a significant association.

Conclusion:

The prevalence of LBW infants was considerably less in mothers with a healthy periodontium and increased with progressive periodontal disease.

Factors affecting awareness and practice of primary health care professionals towards interaction of various medications used in systemic conditions, and its effect on periodontal health

Background:

Interaction of various drugs and its effects on gingival and periodontal health is the area of concern; hence the aim of the present study was to explore factors affecting the awareness and practice of primary health care professionals towards the interaction of various medications used for systemic diseases on periodontal health.

Materials and Methods:

It was a cross-sectional, descriptive, questionnaire study conducted among 203 primary health care professionals which include 94 medical officers and 109 nurses working in primary health centers in rural areas of Udaipur district. The study was conducted in December 2019. Sampling techniques was stratified random sampling technique. A close-ended questionnaire was prepared to conduct an interview schedule.

Results:

The majority of health professionals had poor awareness (157 [77.33%]) and poor practice (168 [82.75%]) regarding the interaction of various medications used in systemic conditions and periodontal health. Factors that significantly affect awareness and practice of study participants were age (0.01*), degree (0.05*), and number of patients with oral problems seen in a week (0.05*), gender (0.05*), designation (0.05*).

Conclusion:

From above it was concluded that awareness and practice of primary care health professionals were poor. The factors that affect significantly affect awareness and knowledge of study participants was age, degree and number of patients with oral problems seen in a week, gender, designation, no. of patient attended in a day.

Oral Pathogen Porphyromonas gingivalis Can Escape Phagocytosis of Mammalian Macrophages

Macrophages are phagocytic cells that play a key role in host immune response and clearance of microbial pathogens. Porphyromonas gingivalis is an oral pathogen associated with the development of periodontitis. Escape from macrophage phagocytosis was tested by infecting THP-1-derived human macrophages and RAW 264.7 mouse macrophages with strains of P. gingivalis W83 and 33277 as well as Streptococcus gordonii DL1 and Escherichia coli OP50 at MOI = 100. CFU counts for all intracellular bacteria were determined. Then, infected macrophages were cultured in media without antibiotics to allow for escape and escaping bacteria were quantified by CFU counting. P. gingivalis W83 displayed over 60% of the bacterial escape from the total amount of intracellular CFUs, significantly higher compared to all other bacteria strains. In addition, bacterial escape and re-entry were also tested and P. gingivalis W83, once again, showed the highest numbers of CFUs able to exit and re-enter macrophages. Lastly, the function of the PG0717 gene of P. gingivalis W83 was tested on escape but found not related to this activity. Altogether, our results suggest that P. gingivalis W83 is able to significantly avoid macrophage phagocytosis. We propose this ability is likely linked to the chronic nature of periodontitis.

Further evidence on the relationship between abdominal aortic aneurysm and periodontitis: A cross-sectional study

BACKGROUND

Periodontitis is a chronic inflammatory disease characterized by Gram-negative bacteria responsible for the degradation of tissues surrounding tooth. Moreover, periopathogens can invade the bloodstream, disseminate and promote cardiovascular disease, such as the link between Porphyromonas gingivalis and atherosclerosis. The aim of this study was to explore the relationship between the severity of periodontitis and of abdominal aortic aneurysm (AAA).

METHODS

This cross-sectional study compared patients with stable AAA (n = 30) and patients with unstable AAA (n = 31) based on aortic diameter, growth rate, and eligibility for surgical intervention. Periodontal clinical parameters were recorded as well as the Periodontal Inflamed Surface Area and the Periodontal Index for Risk of Infectiousness (PIRI). Microbiological analyses were performed on saliva and supragingival and subgingival plaque. Quantification of Tannerella forsythia (Tf), Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), Fusobacterium nucleatum (Fn), and Prevotella intermedia (Pi) was done by quantitative polymerase chain reaction.

RESULTS

The two AAA groups were homogeneous for age, sex, and most risk factors except hypertension and chronic obstructive pulmonary disease. Periodontal parameters were comparable but the proportion of patients with high PIRI scores was greater in those with unstable AAA (51.6% versus 23.3%). The probing depth (PD) and the proportion of PD >6 mm were positively correlated with AAA size and thrombus volume. Several associations were found between periopathogens such as Pg and AAA diameters and volumes, but no difference could be evidenced between stable and unstable AAA groups.

CONCLUSIONS

Periodontitis was highly prevalent in both stable and unstable AAA patients. Severe and progressive periodontitis (stage IV and grade C) tended to be more frequent in the group of patients with unstable AAA. Moreover, Pg was observed in all the samples (saliva, supragingival, and subgingival plaque) and was correlated with AAA diameters and volumes. The study evidenced potential relationships between periodontitis severity and size of AAA.

Macrophage inducible C-type lectin (Mincle) recognizes glycosylated surface (S)-layer of the periodontal pathogen Tannerella forsythia

The oral pathogen Tannerella forsythia is implicated in the development of periodontitis, a common inflammatory disease that leads to the destruction of the gum and tooth supporting tissues, often leading to tooth loss. T. forsythia is a unique Gram-negative organism endowed with an elaborate protein O-glycosylation system that allows the bacterium to express a glycosylated surface (S)-layer comprising two high molecular weight glycoproteins modified with O-linked oligosaccharides. The T. forsythia S-layer has been implicated in the modulation of cytokine responses of antigen presenting cells, such as macrophages, that play a significant role during inflammation associated with periodontitis. The macrophage-inducible C-type lectin receptor (Mincle) is an FcRγ-coupled pathogen recognition receptor that recognizes a wide variety of sugar containing ligands from fungal and bacterial pathogens. In this study, we aimed to determine if Mincle might be involved in the recognition of T. forsythia S-layer and modulation of cytokine response of macrophages against the bacterium. Binding studies using recombinant Mincle-Fc fusion protein indicated a specific Ca2+-dependent binding of Mincle to T. forsythia S-layer. Subsequent experiments with Mincle-expressing and Mincle-knockdown macrophages revealed a role for Mincle/S-layer interaction in the induction of both pro- and anti-inflammatory cytokine secretion in macrophages stimulated with T. forsythia as well as its S-layer. Together, these studies revealed Mincle as an important macrophage receptor involved in the modulation of cytokine responses of macrophages against T. forsythia, and thus may play a critical role in orchestrating the host immune response against the bacterium.

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.

Is periodontitis an independent risk factor for subclinical atherosclerosis?

OBJECTIVES

The aim of this study was to assess the interrelationship between periodontitis and atherosclerosis by comparing the ultrasound and clinical markers of atherosclerosis in systemically healthy patients with and without periodontitis and whether periodontitis can be an independent risk factor for atherosclerosis.

MATERIALS AND METHODS

Total 40 subjects, of same socioeconomic status, belonging to age group of 35-65 years, were recruited and divided into two groups - Group I (Chronic Generalised Periodontitis without any systemic disease: CP-SH), Group II (Normal healthy patients without periodontitis and any systemic disease - SH). Clinical measurements and ultrasound examinations were carried out. Qualitative variables were analyzed using Chi square test and qualitative variables using Unpaired Student t test. Statistical significance was accepted for p≤0.05.

RESULTS

Carotid ultrasound revealed right and left intima media thickness (IMT) of 0.626±0.016mm and 0.715±0.037mm respectively in cases versus 0.495±0.009mm and 0.518±0.009mm respectively in controls, with the difference being statistically significant. In cases, mean diastolic blood pressure (DBP) was 83.45±4.07mmHg versus 79.25±3.63mmHg in controls, with the difference being statistically significant.

CONCLUSION

In this study, we found statistically significant differences in carotid IMT and DBP values between cases and controls. These findings suggest independent role of periodontal disease in subclinical atherosclerosis.

Awareness of periodontal disease and its management among medical faculty in Guntur district: A questionnaire-based study

Aim:

The aim of this study was to assess the awareness of periodontal disease, its influence on general health, and attitude toward periodontal disease management among medical faculty in Guntur district.

Materials and Methods:

In this cross-sectional study, 150 medical faculty members from different specialties in Guntur district were included in the study. A self-administered questionnaire was prepared based on knowledge, attitude, and practice surveys to assess the awareness of periodontal disease and its management.

Results:

Majority of the study participants (82%) had a previous dental visit. Only 31.3% believed that plaque is the major cause for periodontal disease. 56.7% responded that the relation between periodontal disease and systemic diseases is bidirectional. Only 39.3% were aware that periodontal disease is a risk factor for preterm low-birth weight infants. 52.6% of the medical faculty thought that scaling causes loss of enamel. 54.7% were aware that light amplification by stimulated emission of radiation is used in the periodontal treatment. Medical professionals who visited specialist in their previous dental visit obtained mean periodontal score (5.35 ± 1.686) greater than those who had visited general dentist and the difference is statistically significant (0.024).

Conclusion:

This study clearly demonstrates that medical practitioners had fair knowledge about various aspects of periodontal disease. This was particularly evident among those who have had a previous visit to a dentist. It was also found that young professionals with limited experience in the profession had better knowledge.

Biomarker levels in gingival crevicular fluid of subjects with different periodontal conditions: A cross-sectional study

OBJECTIVE

To compare five biomarker levels in gingival crevicular fluid (GCF) in different tooth-sites of subjects with healthy periodontium, aggressive periodontitis and severe chronic periodontitis, and to evaluate the value of these biomarker levels for diagnosis of the type and activity of periodontitis.

MATERIALS AND METHODS

Prior to therapy, GCF samples were collected using filter paper strip at different tooth-sites of 10 subjects with healthy periodontium (H), 15 with severe chronic periodontitis (CP) and 15 with aggressive periodontitis (AgP). The strips were weighed and the periodontal clinical parameters were recorded. Levels of interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and alkaline phosphatase (ALP) in GCF were assessed by enzyme-linked immunosorbent assay (ELISA).

RESULTS

The volumes of the GCF samples obtained in CP and AgP subjects were significantly higher than those from subjects with healthy periodontium (P<0.05). Levels of IL-6, TNF-α, CRP and ALP were significantly higher in the untreated disease sites in the CP and AgP groups compared to those in control sites in the H group, while IL-10 levels were lower in the CP and AgP groups than those in the control sites in the H group. However, the levels of all five biomarker levels showed significant correlation with the clinical parameters.

CONCLUSION

The measurement of five biomarker levels in GCF may facilitate overall screening of periodontitis patients in epidemiological studies and allow estimation of periodontitis activity.

Application of transtheoretical model to assess the compliance of chronic periodontitis patients to periodontal therapy

BACKGROUND

The present cross-sectional survey study was conducted to assess whether the transtheoretical model for oral hygiene behavior was interrelated in theoretically consistent directions in chronic periodontitis patients and its applicability to assess the compliance of the chronic periodontitis patients to the treatment suggested.

MATERIALS AND METHODS

A total of 150 chronic periodontitis patients were selected for the proposed study. The selected patients were given four questionnaires that were constructed based on transtheoretical model (TTM), and the patients were divided subsequently into five different groups (precontemplation, contemplation, preparation, action, and maintenance groups) based on their answers to the questionnaires. Then, each patient was given four appointments for their periodontal treatment spaced with a time gap of 10 days. The patients visit for each appointments scheduled to them was documented. The results obtained were assessed using TTM.

RESULTS

Higher mean pro scores of decisional balance, self-efficacy, and process of change scores was recorded in maintenance group followed by action group, preparation group, contemplation group, and precontemplation group, respectively, whereas higher mean cons score was recorded in precontemplation group followed by contemplation group, preparation group, action group, and maintenance group, respectively. The difference scores of TTM constructs were statistically highly significant between all the five groups. Furthermore, the number of appointment attended in were significantly more than maintenance group followed by action group, preparation group, contemplation group, and precontemplation group.

CONCLUSION

Within the limitations of this study, it can be concluded that transtheoretical model can be successfully applied to chronic periodontitis patients to assess their compliance to the suggested periodontal treatment.

In vitro study on regeneration of periodontal tissue microvasculature using human dedifferentiated fat cells

BACKGROUND

Human dedifferentiated fat cells (HDFATs) may be a new cell type suitable for regenerative therapies. The aim of this study is to assess the potential of HDFATs for vascular regeneration of periodontal tissue. To do this, HDFATs and human gingival endothelial cells (HGECs) were cocultivated, and vascular regeneration was examined in vitro.

METHODS

HDFATs were isolated from subcutaneous adipose tissue, and HGECs were isolated from gingival cells using anti-cluster of differentiation 31 antibody-coated magnetic beads. HDFATs were cocultured with HGECs in microvascular endothelial cell growth medium-2 (EGM-2MV) for 7 days. Expression of endothelial cell (EC) markers, the formation of capillary-like tubes, and the expression of pericyte markers were determined.

RESULTS

HDFATs, cultured in EGM-2MV or cocultured with HGECs, expressed EC markers. HDFATs in both conditions initiated tube formation within 5 hours of seeding and formed extensive capillary-like structures within 12 hours. These structures disintegrated within 24 hours when cells were cultured in EGM-2MV alone, whereas cocultured HDFATs maintained tubes for >24 hours. Cocultured HDFATs significantly increased expression of pericyte markers, a cell type associated with microvasculature.

CONCLUSION

HDFATs possess the ability to express EC markers, and coculture with HGECs promotes differentiation into pericytes involved in the maturation and stabilization of the microvasculature.

Assessment of the prevalence of periodontal diseases and treatment needs: A hospital-based study

Background:

The periodontal diseases are the most prevalent oral diseases worldwide especially in developing countries like India. The objective of this cross-sectional survey was to determine the prevalence of periodontal diseases and treatment needs (TNs) in a hospital-based population.

Materials and Methods:

Totally, 500 men and women (15-74 years) were recruited and periodontal status of each study subject and sextant was evaluated on the basis of community periodontal index of TNs, and thereafter TN for each subject and sextant was categorized on the basis of the highest code recorded during the examination.

Results:

A total of 500 subjects (59% males and 41% females) was divided into seven age groups, that is, 15-19, 20-24, 25-34, 35-44, 45-54, 55-64, and 65-74 years and sextants were included from the 486 subjects. Healthy periodontium, bleeding on probing, calculus, shallow pockets, and deep pockets were found in 3.9%, 6.58%, 50.61%, 20.98%, and 17.90% subjects, respectively. Males were more affected with shallow and deep pockets as compared to females. Periodontal diseases in the early stages were more prevalent in the younger age groups, whereas advanced stages were more prevalent in older age groups. 17.90% subjects and 11.48% sextants need complex treatment. About 77.98% subjects and 73.15% sextants require either oral hygiene instructions or oral hygiene instructions and oral prophylaxis. Only 3.9% subjects and 15.36% sextants were healthy and needed no treatment.

Conclusions:

Periodontal diseases were found to be 96.30% in the study population and the results indicate that majority of the population need primary and secondary level of preventive program to reduce the chances of initiation or progression of periodontal diseases thereby improving their systemic health overall.

Effect of Non-surgical Periodontal Therapy on Serum and Salivary Concentrations of Visfatin in Patients with Chronic Periodontitis

Background and aims. Visfatin, mainly secreted by visceral adipose tissue, especially by macrophages, plays an important role in regulating the defense and immune functions, and functions as a growth factor, a cytokine, an enzyme and more importantly as a proinflammatory mediator. The aim of the present study was to evaluate the effect of non-surgical periodontal treatment on serum and salivary levels of visfatin in patients with generalized moderate-to-severe chronic periodontitis. Materials and methods. Eighteen patients with generalized moderate-to-severe chronic periodontitis were selected based on periodontal parameters of gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL) and radiographic parameters. Serum and salivary samples were collected at baseline and one month following non-surgical periodontal therapy (scaling and root planing ([SRP]). Visfatin levels were measured using an ELISA kit. Data were analyzed by SPSS 15, using paired t-test and Pearson's correlation coefficient. Results. Mean salivary and serum levels of visfatin significantly decreased after non-surgical periodontal treatment (P<0.05). Changes in salivary visfatin levels were more prominent. Conclusion. According to the findings of this study it seems that there is a direct relationship between periodontal tissue inflammation and disease activity with salivary and serum visfatin levels.

Modulation of P-selection and platelet aggregation in chronic periodontitis: A clinical study

Background:

The primary etiologic factor of periodontitis is the subgingival infection with a group of Gram negative pathogens. Transient bacteremia in periodontitis patients underlie chronic production and systemic increases of various proinflammatory mediators, including Interleukin (IL)-1α, IL-6, C-reactive protein and Tumor necrosis factor (TNF)-α. P- selectin is a member of selectin family of cell surface receptor which is located in the membrane of the secretory granules (alpha granules) of platelets and in the membrane of the Weibel-Palade bodies of the vascular endothelial cells. P selectin redistributes from the membrane of the granules to the plasma membrane when platelets and endothelial cells are activated and thus degranulated.

Aim:

To compare the level of platelet activation, soluble P Selectin level and morphological changes and aggregation of platelets in patients in periodontitis patients compared to healthy controls.

Materials and Methods:

80 patients were included in the study with the age group of 35-60. The patients were divided into 2 groups, 40 subjects with generalized chronic periodontitis and 40 healthy subjects taken as control. Periodontal Examination using clinical parameters namely, Bleeding Index, Plaque Index, Probing Pocket Depth and Clinical Attachment Level were recorded. Collection of blood samples for estimation of serum soluble P- selectin level by ELISA method. Evaluation of Platelet morphology and grading the platelet aggregation.

Results:

P-selectin expression shows that the mean value for control group is 4.97 ± 16.56 ng/mL and study group 13.05 ± 29.94 ng/mL which was significantly higher than control group with P value 0.001. Platelet morphological changes shows small form – mean value for control group is 75.83% ± 14.24% while for study group is 39.08%. ± 21.59; Big form – mean value for control group 0.80% ± 0.35% while for study group 0.48% ± 1.3%and Spider form- mean value for control group 23.88% ± 14.13 while study group 59.32% ±. 23.42. The observation showed high statistical significance with P- value < 0.001 for small and spider form and no statistical significance for big form P = 0.075.

Conclusion:

Increased expression of P-selectin, spider form of platelets and pathological aggregation pattern which indicates that platelet activation may be associated with chronic periodontitis. The results of the study showed, higher number of spider forms and significant pathological aggregation pattern in periodontitis patients which indicates activation of platelets thus emphasized that periodontitis can be an contributing factor in the development of cardiovascular disease.

Evaluation of periodontal pathogens in amniotic fluid and the role of periodontal disease in pre-term birth and low birth weight

BACKGROUND

Pre-term birth and/or low birth weight (PTLBW) is a serious problem in developing countries. The absence of known risk factors in ≈ 50% of PTLBW cases has resulted in a continued search for other causes. The aim of this study was to examine the effect of periodontitis on pregnancy outcomes.

METHODS

Samples were taken from 50 pregnant women who underwent amniocentesis. Polymerase chain reaction was performed on amniotic fluid samples obtained during amniocentesis and on subgingival plaque samples to determine the presence of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Treponema denticola, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus and Eikenella corrodens. Plaque index, gingival index, bleeding on probing, probing depth and clinical attachment level were evaluated. Medical records were obtained after birth.

RESULTS

Social and demographic variables were similar among the Gingivitis (G), Localized Periodontitis (LP) and Generalized Periodontitis (GP) groups. Four subjects gave birth to PTLBW neonates. Campylobacter rectus, T. forsythia, P. gingivalis and F. nucleatum were detected in the amniotic fluid and subgingival plaque samples of three patients who gave birth to PTLBW neonates. The amniotic fluid sample from the fourth patient was not positive for any of the tested pathogens.

CONCLUSION

These findings suggest that the transmission of some periodontal pathogens from the oral cavity of the mother may cause adverse pregnancy outcomes. The results contribute to an understanding of the association between periodontal disease and PTLBW, but further studies are required to better clarify the possible relationship.

Hyperglycemia induced and intrinsic alterations in type 2 diabetes-derived osteoclast function

Periodontal disease-associated alveolar bone loss is a comorbidity of type-2-diabetes, where the roles of osteoclasts are poorly understood.

OBJECTIVE

To evaluate osteoclast differentiation and function in the context of type-2-diabetes.

MATERIALS AND METHODS

Bone marrow-derived osteoclasts from db/db mice, a model of type-2-diabetes, as well as human osteoclasts derived from peripheral blood of individuals with type-2-diabetes were evaluated for differentiation, resorption, and soluble mediator expression.

RESULTS

While db/db mice were hyperglycemic at time of cell harvest, human participants were glycemically controlled. Although db/db cultures resulted in a higher number of larger osteoclasts, individual cell receptor activator of nuclear factor kappaB ligand (RANKL)-mediated bone resorption was similar to that observed in diabetes-free osteoclasts. Osteoclasts derived from individuals with type-2-diabetes differentiated similarly to controls with again no difference in bone resorbing capacity. Murine and human type-2-diabetes cultures both displayed inhibition of lipopolysaccharide (LPS)-induced deactivation and increased pro-osteoclastogenic mediator expression.

CONCLUSIONS

Hyperglycemia plays a role in aberrant osteoclast differentiation leading to an increased capacity for bone resorption. Osteoclasts derived from murine models of and individuals with type-2-diabetes are unable to be inhibited by LPS, again leading to increased capacity for bone resorption. Here, environmental and intrinsic mechanisms associated with the increased alveolar bone loss observed in periodontal patients with type-2-diabetes are described.

Association between MMP-1 g.-1607dupG polymorphism and periodontitis susceptibility: a meta-analysis

Background

Matrix metalloproteinase-1 (MMP-1) plays an important role during the destruction of periodontal tissue. Although multiple studies had focused on the association between MMP-1 g.-1607dupG and periodontitis susceptibility, the results remained inconclusive. The purpose of this meta-analysis was to explore its role in the development of periodontitis.

Methods

Retrieved studies from Pubmed, Web of Science, Medline and Google Scholar Search regarding MMP-1 g.-1607dupG and periodontitis susceptibility were included into the final analysis with definite selection and exclusion criteria. Overall and stratified analyses based on disease type, severity, ethnicity and smoking status were performed. Odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the association between MMP-1 g.-1607dupG and periodontitis susceptibility, while Q test and Egger’s test were adopted respectively to assess heterogeneity among studies and publication bias.

Results

A total of 1580 periodontitis cases and 1386 controls in 11 case-control studies were included in the meta-analysis. The pooled results showed significant association between periodontitis susceptibility and MMP-1 g.-1607dupG polymorphism in homozygote (2G/2G versus 1G/1G, OR = 1.50, 95% CI = 1.02–2.20) and dominant model analysis (2G/2G+2G/1G versus 1G/1G, OR = 1.28, 95% CI = 1.04–1.57). For subgroups by type of periodontitis, increased risk of chronic periodontitis was observed on heterozygote (2G/1G versus 1G/1G, OR = 2.01, 95% CI = 1.58–2.56) and dominant model (OR = 1.27, 95% CI = 1.03–1.57). Furthermore, similar association was also detected in severe chronic periodontitis (2G/2G versus 1G/1G, OR = 2.15, 95% CI = 1.35–3.43; 2G/2G+2G/1G versus 1G/1G, OR = 1.64, 95% CI = 1.12–2.39; 2G/2G versus 2G/1G+1G/1G, OR = 1.86, 95% CI = 1.31–2.64).

Conclusions

Our meta-analysis demonstrated that MMP-1 g.-1607dupG polymorphism was associated with chronic periodontitis, especially the severity of the disease condition.

The relationship between maternal periodontitis and preterm low birth weight: A case-control study

Background:

The relationship between periodontal diseases in pregnancy and children born prematurely or with low birth weight has been increasingly investigated, showing positive and negative results, respectively. Objective: To evaluate the association between Maternal Periodontitis and Preterm delivery or Low Birth Weight.

Materials and Methods:

In this case-control study, 104 pregnant women without systemic disease or other risk factors for preterm labor were chosen. The control group (n = 52) had term labor (infants ≥37 weeks) and the case group (n = 52) had preterm labor (infants <37 weeks). Plaque index, bleeding index, and birth weight were measured.

Results:

The data of plaque index (cases 1.21±0.56; controls 0.63±0.31), bleeding index (cases, 2.08±0.62; controls, 1.52±0.61), birth weight (cases, 2.01±0.36; controls 2.87±0.32), and Probing Pocket Depth (PPD) ≥4mm and Clinical Attachment Level (CAL) ≥3mm in at least 4 teeth (odds ratio 137.50, P value < 0.0001) revealed a statistically significant difference between the two groups P< 0.05).

Conclusions:

A noticeable relationship between periodontal health and duration of pregnancy; periodontal disease could be a risk factor for preterm labor. Oral hygiene maintenance should be a part of prenatal care protocol.

Oral health status of CHD and non-CHD adults of Lahore, Pakistan

BACKGROUND

Evidence on association of oral health and coronary heart diseases (CHD) is mounting in the literature. This study was designed to observe an association between status of oral health and cardiac diseases in Pakistani adults.

MATERIALS AND METHODS

A case-control study was conducted on CHD and non-CHD adults aged >30 years. Age-gender matched individuals without CHD, fulfilling the inclusion criteria as for CHD patients were selected for comparison. Bleeding on probing (BOP), periodontal pocket depth (PPD) and tooth loss were noted as oral health parameters.

RESULTS

45 CHD patients and 35 non-CHD individuals were examined. 53.75% were males and 46.25% females, 37.5% subjects were uneducated, 65% belonged to lower income group, 58.75% subjects were ≥obese and 88.75% were non-smokers. Mean of percent sites of BOP (P =0.007), PPD (P =0.031) and tooth loss (P =0.021) were significantly higher in study group. In stepwise logistic regression analysis, BOP and tooth loss showed a significant positive association with CHD; however, association of PPD was not significant.

CONCLUSION

Oral health parameters were significantly higher in CHD patients. Bleeding on probing and tooth loss was positively associated with CHD after adjusting for other socio-demographic variables.

Periodontal infection as a risk factor for preterm low birth weight

Introduction:

There is an overwhelming body of evidence strongly suggesting that periodontal infection may have a significant negative impact on pregnancy outcome in some women. The aim of this study was to determine the association, if any, between periodontal disease and preterm low birth weight.

Materials and Methods:

A total of 211 mothers between the ages of 17 and 35 were grouped into two categories based on the gestational age and weight of the baby as cases (< 37 weeks, < 2500 g) and controls (>37 weeks, >2500 g). Relevant obstetric history and information on other primary risk factors for preterm low birth weight were obtained. Investigation reports on blood group, Rh factor and hemoglobin (Hb) were also gathered. Oral assessments included: simplified oral hygiene index (OHI-S), gingival bleeding index, probing pocket depth and clinical attachment level (CAL).

Results:

Cases had significantly more attachment loss and probing pocket depth, poor oral hygiene, more percentage of sites with attachment loss (Extent) and more mean attachment loss per site (Severity) and less Hb than controls. The number of visits for prenatal care and the percentage of sites with CAL≥2mm (Extent 2) remained significant when compared to other variables.

Conclusions:

The study indicated that periodontal disease is a contributing factor for preterm low birth weight.

Awareness regarding the systemic effects of periodontal disease among medical interns in India

BACKGROUND

Medical curriculum does not provide required space for oral health; hence, many medical interns are unfamiliar with the oral cavity and oral health research.

AIMS

To study the level of awareness regarding systemic effects of periodontal disease among medical interns.

SETTINGS AND DESIGN

A cross-sectional qualitative study recruiting medical interns from two medical institutions affiliated to two different universities in Southern India.

MATERIALS AND METHODS

Study was carried out in two medical institutions affiliated to two different universities in Southern India. A total of 143 interns participated in the study. Each participant was given a self-administered, pre-tested, multiple choice question-type questionnaire to solve on the spot. In order to summarise the awareness level, respondents were graded on a five-level scale as poor, fair, good, very good, and excellent.

STATISTICAL ANALYSIS USED

Percentages, proportions.

RESULTS

A total of 67 respondents (47%) had fair; 60(42%), poor; and 18(11%), good level of awareness regarding the systemic effects of periodontal disease. Only 23(16%), 17(12%), 12(8%), 6(4%) and 4(3%) respondents were aware that the periodontal disease may be the possible risk factor for coronary heart disease, cerebral infarction, diabetes mellitus, hospital-acquired pneumonia, and preterm labour (low birth-weight infants), respectively. Only 12 respondents (8%) would seek dentist's opinion for all patients with systemic diseases related to dental disease.

CONCLUSIONS

Medical interns had inadequate awareness regarding the systemic effects of periodontal disease. Therefore, an integrated teaching of medical and dental sciences is recommended.

Nasal immunization with a fusion protein consisting of the hemagglutinin A antigenic region and the maltose-binding protein elicits CD11c(+) CD8(+) dendritic cells for induced long-term protective immunity

We assessed the efficacy of a fusion protein consisting of the 25-kDa antigenic region of Porphyromonas gingivalis hemagglutinin A and the Escherichia coli maltose-binding protein (25k-hagA-MBP) as a nasal vaccine for the prevention of oral infection with P. gingivalis. Nasal immunization with 25k-hagA-MBP induced high levels of 25k-hagA-specific serum IgG, serum IgA, and salivary IgA antibodies in a Toll-like receptor 4 (TLR4)-dependent manner. These antibody responses were maintained for at least 1 year after immunization. Analysis of cytokine responses showed that nasal administration of 25k-hagA-MBP induced antigen-specific CD4(+) T cells producing interleukin 4 (IL-4) and IL-5, but not gamma interferon (IFN-γ), in the spleen and cervical lymph nodes (CLNs). Furthermore, increased numbers of CD11c(+) CD8α(+), but not CD11c(+) CD11b(+) or CD11c(+) B220(+), dendritic cells with upregulated expression of CD80, CD86, CD40, and major histocompatibility complex class II (MHC II) molecules were noted in the spleen, CLNs, and nasopharynx-associated lymphoreticular tissues (NALT). Interestingly, when 25k-hagA-MBP or cholera toxin (CT) was given intranasally to enable examination of their presence in neuronal tissues, the amounts of 25k-hagA-MBP were significantly lower than those of CT. Importantly, mice given 25k-hagA-MBP nasally showed a significant reduction in alveolar bone loss caused by oral infection with P. gingivalis, even 1 year after the immunization. These results suggest that 25k-hagA-MBP administered nasally would be an effective and safe mucosal vaccine against P. gingivalis infection and may be an important tool for the prevention of chronic periodontitis in humans.

Oral immunization with Porphyromonas gingivalis outer membrane protein and CpGoligodeoxynucleotides elicits T helper 1 and 2 cytokines for enhanced protective immunity

The aim of this study was to evaluate the efficacy of an oral vaccine containing the 40-kDa outer membrane protein of Porphyromonas gingivalis (40K OMP) and synthetic oligodeoxynucleotides containing unmethylated CpG dinucleotides (CpG ODN) to control oral infection by P. gingivalis. [run on]40K-OMP40K-OMP40K-OMPOral immunization with 40K-OMP plus CpG ODN induced significant 40K-OMP-specific serum IgG, IgA and saliva IgA antibody responses. The 40K-OMP-specific CD4(+) T cells induced by oral 40K-OMP plus CpG ODN produced both Th1 (IFN-gamma) and Th2 (IL-4) cytokines. Furthermore, increased frequencies of CD11c(+)B220(+) DCs and CD11c(+)CD11b(+) DCs with up-regulated expression of CD80, CD86, CD40 and MHC II molecules were noted in spleen, Peyer's patches and cervical lymph nodes. Immunized mice were then infected orally with P. gingivalis to determine whether the immune responses induced by oral 40K-OMP plus CpG ODN were capable of suppressing bone resorption caused by P. gingivalis infection. Mice given 40K-OMP plus CpG ODN showed significantly reduced bone loss associated with oral infection by P. gingivalis.Thus, oral administration of 40K-OMP together with CpG ODN induces Th1- and Th2-type cells, which provide help for protective immunity against P. gingivalis infection. This may be an important tool for prevention of chronic periodontitis.

Nasal vaccination with the 40-kilodalton outer membrane protein of Porphyromonas gingivalis and a nontoxic chimeric enterotoxin adjuvant induces long-term protective immunity with reduced levels of immunoglobulin E antibodies

In this study, we demonstrated that the 40-kDa outer membrane protein of Porphyromonas gingivalis (40-kDa OMP) nasally administered with a nontoxic chimeric adjuvant that combines the A subunit of mutant cholera toxin E112K with the pentameric B subunit of heat-labile enterotoxin from enterotoxigenic Escherichia coli (mCTA/LTB) elicited a long-term protective immune response. Immunization with the 40-kDa OMP and mCTA/LTB induced high levels of 40-kDa-OMP-specific immunoglobulin G (IgG) and IgA antibodies (Abs) in sera and elicited a significant IgA anti-40-kDa OMP Ab response in saliva. These Ab responses were maintained for at least 1 year after the immunization. Although using adjuvant mCTA/LTB gave Ab responses in the saliva comparable to those obtained using native cholera toxin (nCT) as the adjuvant, the levels of total IgE and 40-kDa-OMP-specific IgE Abs as well as interleukin-4 levels induced by the immunization with mCTA/LTB were lower than those induced by the immunization with nCT. Importantly, IgG Abs generated by nasal immunization with the 40-kDa OMP plus mCTA/LTB inhibited the coaggregation and hemagglutinin activities of P. gingivalis. Furthermore, the mice given nasal 40-kDa OMP plus mCTA/LTB showed a significant reduction of alveolar bone loss caused by oral infection with P. gingivalis even 1 year after the immunization compared to the loss in unimmunized mice. Because mCTA/LTB is nontoxic, nasally administered 40-kDa OMP together with mCTA/LTB should be an effective and safe mucosal vaccine against P. gingivalis infection in humans and may be an important tool for the prevention of chronic periodontitis.

Periodontal condition in diabetics in Belgrade

Background/Aim. Diabetes mellitus (DM) as a complex metabolic disease influences functioning of numerous organs. Therefore, frequent diabetic complication is chronic periodontitis. The aim of the study was to investigate the influence of various risk factors, like age, sex, duration of DM, oral hygiene, on oral manifestations of diabetes. Methods. The group of diabetics included 52 adult patients, 18-79-year of age, both sexes (33 females, 19 males) out of which 35 patients were with diabetes mellitus type I and 17 with type II. Mean age of the patients was 54.6 years and the mean duration of diabetes was 11.1 years. The controls consited of 67 volunteers from the city of Belgrade, 19-24-year of age, both sexes (47 females, 20 males) with no paradonthopathy and non-systemic diseases. Estimation of periodontal status of the patients was performed by measuring dental plaque index, gingival index and periodontal pockets' depth. Results. The results suggest an increased incidence and severity of periodontitis in diabetic patients. It was established that duration of diabetes, patients' age and bad oral hygiene had a negative influence on status of remained teeth in diabetics, while the sex had no influence on parameters monitored. Conclusion. Indices of oral hygiene level and periodontal status (dental plaque index, gingival index and periodontal pockets' depth) were significantly worsened in patients with diabetes. Negative influence on remained teeth had patients' age (>50 years), duration of diabetes (> 20 years) and bad oral hygiene. About half of the patients had a total or partial bridge suggesting that periodontitis is significant complication of diabetes mellitus.

Periodontal disease as a risk factor for adverse pregnancy outcomes: a prospective cohort study

AIM

The aim of this study was to determine the association between periodontitis and the incidence of preterm birth (PB), low birth weight (LBW) and preterm low birth weight (PLBW) MATERIAL AND METHODS: One thousand and ninety-six women were enrolled. Periodontal data, pregnancy outcome variables and information on other factors that may influence adverse pregnancy outcomes were collected. Data were analysed using a logistic regression model.

RESULTS

The incidence of PB and LBW was 6.6% and 6.0%, respectively. The incidence of PLBW was 3.3%. PB was related to mother's age, systemic diseases, onset of prenatal care, previous PBs, complications of pregnancy, type of delivery, the presence of untreated caries and the presence of periodontitis (odds ratio 1.77, 95% confidence interval: 1.08-2.88). LBW was related to mother's smoking habits, ethnicity, systemic diseases, previous LBW babies, complications of pregnancy and type of delivery. PLBW was related to mother's age, onset of prenatal care, systemic diseases, previous LBW babies, complications of pregnancy and type of delivery.

CONCLUSIONS

The factors involved in many cases of adverse pregnancy outcomes have still not being identified, although systemic infections may play a role. This study found a modest association between periodontitis and PB. Further research is required to establish whether periodontitis is a risk factor for PB and/or LBW.

Is pre-term labour associated with periodontitis in a Danish maternity ward?

OBJECTIVES

To reveal differences in periodontal status and presence of subgingival bacteria in a Scandinavian population of women with pre-term birth compared with women who delivered at term.

MATERIALS AND METHODS

Twenty-one women with pre-term labour (before week 35) and 33 women with term labour (between weeks 38 and 41) were included in this case-control study. Periodontal measurements included plaque index (PlI), probing pocket depth (PPD) and bleeding on probing (BOP). Inter-proximal distances from the cemento-enamel junction (CEJ) to the marginal bone crest (MBC) were measured on bitewing radiographs. In 31 patients (16 cases and 15 controls) the subgingival plaque was analysed using "checkerboard" DNA-DNA hybridization.

RESULTS

Differences between the two examined groups were found related to "Twin births" (p=0.0064) and "Smokers" (p=0.03). None of the periodontal measurements showed any association. Significant differences were found concerning presence of Tannerella forsythensis, Treponema denticola, Peptostreptococcus micros, Streptococcus intermedius, Streptococcus oralis, Streptococcus sanguis and Capnocytophaga ochracea but when defining sites with >10(5) bacteria as heavily colonized, no statistical difference was found between the two groups.

CONCLUSION

A relation between pre-term birth and periodontitis was not revealed in the present study.

Transcutaneous immunization with a 40-kDa outer membrane protein of Porphyromonas gingivalis induces specific antibodies which inhibit coaggregation by P. gingivalis

This study seeks to assess the potential of a 40-kDa outer membrane protein of Porphyromonas gingivalis (40k-OMP) as a transcutaneous vaccine against chronic periodontitis. Transcutaneous immunization (TCI) of mice with 40k-OMP alone elicited 40k-OMP-specific IgG antibody (Ab) responses in both serum and saliva. When administered with cholera toxin (CT) as adjuvant, TCI with 40k-OMP not only elevated IgG Abs as noted above, but also induced IgA responses in serum but not in saliva. Salivary IgG from mice given 40k-OMP alone or 40k-OMP plus CT showed higher binding levels to the 40k-OMP than did that of non-immunized mice. Ab-forming cell (AFC) analysis revealed high numbers of 40k-OMP-specific IgG AFCs in the spleen but low numbers in the salivary glands of mice given 40k-OMP alone or 40k-OMP plus CT. Since 40k-OMP-specific IgG inhibited the coaggregation of P. gingivalis vesicles and S. gordonii, TCI with 40k-OMP may be a useful tool in the quest to prevent P. gingivalis infection.

Binding of pro-matrix metalloproteinase 9 by Fusobacterium nucleatum subsp. nucleatum as a mechanism to promote the invasion of a reconstituted basement membrane

In this study, we investigated the ability of Fusobacterium nucleatum subsp. nucleatum to increase its tissue-invasive potential by acquiring cell-associated human matrix metalloproteinase 9 (MMP-9) activity. Binding of pro-MMP-9 to fusobacteria was demonstrated by enzyme-linked immunosorbent assay. Zymography and a colorimetric assay showed that bound pro-MMP-9 can be converted into a proteolytically active form. The potential contribution of this acquired host activity in tissue invasion was demonstrated using a reconstituted basement membrane (Matrigel).