Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology

Gelatin methacryloyl @MP196/exos hydrogel induced neutrophil apoptosis and macrophage M2 polarization to inhibit periodontal bone loss

OBJECTIVES

Periodontitis is an inflammatory and destructive disease caused by dental plaque, which can result in the immune microenvironment disorders and loss of periodontal support tissue. In order to promote the restoration of local microenvironment stability, a functional biomaterial Gelatin methacryloyl @MP196/exos based on characteristics of disease occurrence is designed.

METHODS

Transmission electron microscopy, nanosight particle tracking analysis and western blot analysis were applied to prove the presence of exos in GelMA@MP196/exos. The swelling and degradation rates of GelMA@MP196/exos were evaluated. Cell proliferation, antibacterial ability and cellular uptake and intracellular internalization of exos were assessed in the study. Efferocytosis and M2 polarization of macrophages was estimated and the effects of GelMA@MP196/exos were proved in vivo.

RESULTS

GelMA@MP196/exos upregulated the expression of genes and proteins related to neutrophil apoptosis and promoted neutrophil apoptosis, macrophage M2 polarization, and efferocytosis. Furthermore, GelMA@MP196/exos exhibited significant antibacterial activity against Streptococcus gordonii, Fusobacterium nucleatum, and Porphyromonas gingivalis. GelMA@MP196/exos alleviated periodontitis and reduced alveolar bone loss in vivo in rat models.

CONCLUSIONS

GelMA@MP196/exos can serve as a potential strategy for the treatment of periodontitis.

CLINICAL SIGNIFICANCE

The main aim of periodontal therapy is to remove dental plaque and eliminate inflammation. However, some patients with low plaque scores and insufficient neutrophil clearance, resulting in poor responsiveness to periodontal therapy. Under the circumstances, local Application of drug that regulate the immune microenvironment had significance in controlling the progression of inflammation.

Oral health practices and literacy in Hungarian diabetes patients: insights from a pilot-study using a WHO-adapted questionnaire

INTRODUCTION

This study aimed to compare the self-reported oral health status, knowledge, and habits of individuals living with diabetes mellitus and healthy controls. To achieve this, the modified version of the World Health Organization's Oral Health Questionnaire for Adults (ANNEX 7; Google Forms) was employed for data collection.

METHODS

The study included 99 diabetes patients (33 with type 1 and 66 with type 2 diabetes mellitus) and 102 non-diabetic controls. Logistic regression models, adjusted for demographic factors, were applied to examine associations between oral hygiene practices, dietary habits, and the number of natural teeth.

RESULTS

Individuals with diabetes exhibited a greater frequency of oral pathological conditions. Despite 74% of people with diabetes mellitus (PwDM) brushing their teeth twice daily, they had fewer natural teeth compared to the control group (20 or more teeth: DM: 54.5%, controls: 70.6%). In our study, there is no evidence that number of teeth is dependent on HbA1c levels, and we found that neither age nor gender influenced the change in HbA1c levels. Lower interdental cleaning habits and frequent fruit consumption were identified as significant risk factors for severe tooth loss.

CONCLUSION AND CLINICAL RELEVANCE

This study highlights significant oral health disparities in diabetes patients, particularly those with T2DM, who reported poorer oral health, more frequent denture use, and fewer natural teeth. These findings underscore the need for integrating oral health education, preventive care, and interdisciplinary collaboration into diabetes management to improve overall health outcomes.

Effects of periodontal treatment on periodontal status in Finland: a register-based study

OBJECTIVE

This register-based follow-up study investigated periodontal status after periodontal treatment (PT) based on need following oral health examination (OHE).

MATERIALS AND METHODS

A total of 42,533 adults aged 18-89 years receiving OHE in the public oral health clinics of the City of Helsinki in 2009 were included. Dentists recorded periodontal status by the Community Periodontal Index (CPI), and determined the individual recall interval (IRI). Follow-up OHE between 2010 and 2015 was performed for 16,040 adults based on IRI or later. Outcome of interest was change of CPI during follow-up and was modelled with proportional odds model for each sextant separately. Results were reported as odds ratios (ORs).

RESULTS

Signs of periodontal disease were present in 95% of the study population. Symptoms of periodontitis (CPI score 3 or 4) were observed in 24% of patients. In models, PT indicated better outcome in all six sextants and in sextant 5 after one treatment (OR 5.05, 95% confidence interval [CI] 4.53-5.63). A poorer outcome was observed in patients with diabetes or severe mental disorders and in men.

CONCLUSIONS

The study population had a high prevalence of periodontal diseases. Men and patients with diabetes or severe mental disorders should be specifically targeted by dentists.

Periodontal Status and Herpesiviridae, Bacteria, and Fungi in Gingivitis and Periodontitis of Systemically Compromised Pediatric Subjects: A Systematic Review

BACKGROUND

Gingivitis and periodontitis are microbially associated diseases, with some features characteristic of pediatric age and others linked to systemic diseases. While the role of periodontal pathogenic bacteria is well recognized, the contribution of fungi and viruses, particularly Herpesviridae, remains controversial. Studies in adults have highlighted the presence of Herpesviridae, but evidence in pediatric subjects, especially systemically compromised, is limited. This systematic review aimed to assess periodontal status (e.g., health, gingivitis, periodontitis, necrotizing gingivitis, and/or periodontitis) and the subgingival and/or salivary microbial (bacterial, viral, and fungal) profile in systemically compromised pediatric (≤18 years) subjects with gingivitis and/or periodontitis compared to clinical periodontal health.

METHODS

The review protocol was registered on PROSPERO (CRD42024597695) and followed the PRISMA statement. Data from eight studies were descriptively analyzed and qualitatively assessed through ROBINS-I and JBI tools.

RESULTS

CMV was frequently detected, particularly in necrotizing gingivitis (19.40%). EBV was found in necrotizing gingivitis (20.69%) and periodontitis (10.34%); HSV was mainly associated with gingivitis and necrotizing gingivitis. Bacteria species in periodontitis included Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium, and Campylobacter species. Candida albicans was detected in periodontitis, suggesting a fungal involvement in the disease's pathogenesis. Although the bacterial and fungal profile was not investigated, limited viral presence was noted in subjects with healthy periodontium, indicating a stable microbiome.

CONCLUSIONS

These findings underscore the dynamics of microbial interactions in the progression of periodontal disease in systemically compromised pediatric subjects.

Inflammatory Mediators in the Oral Fluids and Blood Samples of Type 1 Diabetic Patients, According to Periodontal Status-A Systematic Review

There is currently little information on the immune profile of adult type 1 diabetes patients diagnosed with periodontal disease. The aim of this systematic review is to bring together the known evidence of which inflammatory markers, measured in salivary flow or gingival crevicular fluid and serum blood, are present in both pathologies. Following the Preferred Reporting Items for Systematic reviews and Meta-Analys guidelines, we systematically searched in the PubMed, Web of Science, Scopus and Cochrane Library databases for studies on the associations of different chemokines with type 1 diabetes mellitus and periodontal disease. From a total of 703 patients, of which 526 were patients diagnosed with type 1 diabetes and 215 were controls without diabetes, multiple inflammatory mediators, such as interleukin 8, which showed higher concentrations in the crevicular fluid in several studies of type 1 diabetes patients and a greater severity in its effects on the periodontal status, as well as osteoprotegerin and tumor necrosis factor alpha, have been found elevated in diabetic patients with poor periodontal control. The results suggest that interleukin 8, tumor necrosis factor alpha and osteoprotegerin may be promising novel biomarkers of type 1 diabetes mellitus, and may also indicate the susceptibility profile in these individuals for the worsening of the patient's periodontal status.

Clinical Response Characteristics of Salivary Proteins in the Management Strategy of Diabetes-Associated Periodontitis

Diabetes and periodontitis, as widespread chronic diseases, often exacerbate each other's conditions. Nonsurgical periodontal treatments can improve the oral and systemic health in these patients, with salivary proteins offering potential insights into disease mechanisms and treatment effectiveness. However, there is a lack of comprehensive data on salivary proteomics in this context. By assigning patients with diabetes-associated periodontitis to a test group (supragingival scaling, subgingival scraping and root planing) or a control group (supragingival scaling only), analyzing nonstimulated whole saliva samples using liquid chromatography-tandem mass spectrometry, and establishing the in vivo and in vitro models, we found significant differential expression of salivary proteins related to Apelin signaling pathway, hematopoietic cell profiling, stress response and immune regulation, identifying four candidate proteins: superoxide dismutase 1 (SOD1), profilin 1 (PFN1), S100 calcium-binding protein A11 (S100A11) and kallikrein-related peptidase 6 (KLK6). All four proteins were significantly elevated, with a combined area under the curve of 0.933, while SOD1 alone reached 0.915. Additionally, we observed high glucose and inflammatory conditions reduced SOD1 expression. In conclusion, SOD1 emerges as a promising regulatory target for managing diabetes and periodontitis by modulating the oral oxidative stress microenvironment.

BMP2 peptide-modified polycaprolactone-collagen nanosheets for periodontal tissue regeneration

Introduction

Periodontitis leads to the degradation of tooth-supporting tissues, ultimately causing tooth mobility and loss. Guided tissue regeneration (GTR) surgery employs barrier membranes to facilitate tissue regeneration. However, conventional membranes lack bone-inducing properties, thereby limiting their efficacy. Our objective was to develop a bifunctional GTR membrane that combines mechanical stability with bone-inducing capabilities. To achieve this, we engineered BMP2 peptide-modified polycaprolactone-collagen nanosheets (BPCNs) to enhance periodontal regeneration by improving cell adhesion, osteogenesis, and anti-inflammatory activity.

Methods

BPCNs with nanoscale thickness were fabricated using the spin-coating technique, incorporating BMP2 peptides, collagen, polycaprolactone (PCL), and polyvinyl alcohol (PVA). Successful conjugation of BMP2 to the BPCNs was verified through UV spectrophotometry and confocal laser scanning microscopy. The biocompatibility and cell adhesion properties of BPCNs were rigorously assessed using CCK-8 assays, microscopic imaging, and quantitative cell counting. In vitro osteogenic efficacy was evaluated by Alizarin Red S (ARS) staining and quantitative reverse transcription polymerase chain reaction (qRT-PCR) to analyze osteogenic marker gene expression. A rat periodontal defect model was established to assess in vivo regenerative performance, with outcomes analyzed through micro-CT, hematoxylin-eosin (H&E) staining, and Masson's trichrome staining, confirming enhanced tissue regeneration and the absence of systemic toxicity. The mechanistic pathways underlying BPCNs-mediated regeneration were elucidated via RNA sequencing (RNA-seq), revealing the activation of osteogenic signaling cascades and the suppression of proinflammatory pathways.

Results

BPCNs demonstrated excellent biocompatibility, promoted fibroblast and bone marrow stem cell (BMSC) adhesion, and enhanced BMSC osteogenesis. Furthermore, BPCNs significantly promoted periodontal tissue regeneration in a rat model. Mechanistically, RNA-seq analysis revealed that BPCNs upregulated genes involved in tissue regeneration and downregulated proinflammatory pathways.

Discussion

This study introduced a novel osteoinductive nanosheet, termed BPCNs, which provides a groundbreaking material-based approach for the regenerative repair of periodontal tissue defects. These findings position BPCNs as a highly promising candidate for GTR surgery, with significant potential to improve clinical outcomes in periodontal regenerative medicine.

Bioactive Zn-V-Si-Ca Glass Nanoparticle Hydrogel Microneedles with Antimicrobial and Antioxidant Properties for Bone Regeneration in Diabetic Periodontitis

Periodontitis is a chronic inflammatory condition affecting the periodontal tissue. This condition worsens in diabetic patients due to oxidative stress and inflammation. Herein, we investigated a treatment using bioactive Zn-V-Si-Ca glass nanoparticle hydrogel microneedles. The microneedles contain bioactive glass nanoparticles codoped with zinc and vanadium ions. They also include gallic acid and oxidized methacrylated hyaluronic acid. These microneedles address bacterial dysbiosis and oxidative stress in diabetic periodontitis. They provide antibacterial and antioxidant effects. The microneedles deliver therapeutic agents directly into the gingival tissue. This enhances drug retention and absorption by penetrating the mucosal barrier. In vitro studies demonstrated biocompatibility, excellent antioxidant properties, and acceptable mechanical properties. Meanwhile, the microneedle patches demonstrated antibacterial properties effective against a Gram-negative periodontal pathogen as well as a Gram-positive oral bacterium. In vivo experiments were performed using a diabetic rat model with periodontitis. Results showed significant improvement in alveolar bone regeneration. The hydrogel modulated the inflammatory microenvironment effectively. Ribonucleic acid sequencing revealed downregulation of JAK-STAT and NF-κB inflammation signaling pathways. This work presents a distinctive approach to suppressing the inflammatory response and modulate immune responses for the purpose of treating diabetic periodontitis early.

Attempts to Modify Periodontal Screening Models Based on a Self-Reported Oral Health Questionnaire in the Medical Care Setting

AIM

Periodontal disease (PD) screening models based on a self-reported questionnaire were previously established and externally validated. The aim of the present study is to explore whether the screening models could be modified to improve prediction performance; this methodology is called 'updating'.

METHODS

Updating the models for 'total' and 'severe' PD was performed using two datasets. One dataset from a previous study (n = 155) was used to explore the updating, and a second (n = 187, built for the current study) was used to validate whether updating improved performance. Updating was based on different statistical approaches, including model recalibration and revision. Discrimination and calibration were assessed after updating.

RESULTS

For 'total' PD, the update based on model revision improved its performance. However, still low AUCs were found: 0.64 (0.56-0.73) and 0.61 (0.53-0.69) with corresponding O:E ratios 1.00 (0.80-1.23) and 0.92 (0.75-1.13) in the update and validation cohorts, respectively. For 'severe' PD, performance of the original model without update performed still the best; AUCs were 0.72 (0.61-0.83) and 0.75 (0.66-0.84) in the update and validation cohorts, respectively, with corresponding O:E ratios 0.60 (0.38-0.84) and 0.62 (0.42-0.87).

CONCLUSIONS

The updating methodology did not further improve the performance of the original 'severe' PD screening model; it performed satisfactorily in the medical care setting. Despite updating attempts, the screening model for 'total' PD remained sub-optimal. Screening for 'severe' PD can now be implemented in the medical care setting.

Periodontitis associated with brain function impairment in middle-aged and elderly individuals with normal cognition

BACKGROUND

The present study aimed to investigate changes in intranetwork functional connectivity (FC) and internetwork FC in middle-aged and elderly individuals with normal cognition (NC) and varying degrees of periodontitis to determine the effects of periodontitis on brain function.

METHODS

Periodontal findings and resting-state functional magnetic resonance imaging data were acquired from 51 subjects with NC. Independent component analysis and correlation analysis were used for the statistical analysis of the data.

RESULTS

Differences in intranetwork FC were observed among groups in the anterior default-mode network (aDMN), dorsal attention network and dorsal sensorimotor network (dSMN). Compared with the nonperiodontitis (NP) group or the mild-periodontitis group, the analysis of internetwork FC showed increased FC between the auditory network and the ventral attention network (VAN), between the aDMN and the salience network (SN), and between the SN and the VAN and decreased FC between the posterior default-mode network and the right frontoparietal network in the moderate-to-severe periodontitis group. Additionally, internetwork FC between the dSMN and the VAN was also increased in the moderate-to-severe periodontitis group compared to the NP group. The altered intra- and internetwork FC were significantly correlated with the periodontal clinical index.

CONCLUSION

Our results confirmed that periodontitis was associated with both intra- and internetwork FC changes even in NC. The present study indicates that periodontitis might be a potential risk factor for brain damage and provides a theoretical clue and a new treatment target for the early prevention of Alzheimer disease.

PLAIN LANGUAGE SUMMARY

Recent research has proposed that periodontitis is a potential risk factor for Alzheimer disease (AD). However, the relationship between periodontitis and the brain function of middle-aged and elderly individuals with normal cognition (NC) remains unclear. Analyzing the effect of periodontitis on brain function in the NC stage can provide clues to AD development and help achieve early prevention of dementia. The present study aimed to investigate changes in brain functional connectivity (FC) in NC with different severity of periodontitis to determine the effects of periodontitis on brain function. Both changed intranetwork FC and internetwork FC were found in the moderate-to-severe periodontitis group, and periodontitis was associated with brain network function impairment in NC. The present study indicates that periodontitis might be a potential risk factor for brain damage even in NC stage, and provides a theoretical clue and a new treatment target for the early prevention of AD.

Glycemic Control and Implant Stability in Patients with Type II Diabetes: Narrative Review

Advancements in implant design, surface characteristics, and surgical protocols have made implant restorations safe and highly predictable procedures. Bone metabolism plays a central role in the success of implant therapy. Diabetes mellitus is a significant disease impacting bone metabolism, particularly during the initial stages of osseointegration and in long-term survival. Moreover, aging is linked to various systemic conditions, such as diabetes, which increase the susceptibility of the periodontium and teeth to disease, often resulting in tooth loss. Studies on the impact of glycemic control on the success and longevity of implant-prosthetic rehabilitation in diabetic patients highlight a significant association between hyperglycemia and complications in implant therapy. This review identified 18 relevant publications through Medline, and studies were screened against the aim and objectives of the review. A total of five articles were excluded because of lack of focus on the effect of glycemic control on dental implants. Diabetic patients with poorly controlled blood glucose levels may face a heightened risk of developing implant complications. Effective glycemic control plays a critical role in the long-term success of dental implants in these individuals. Marginal bone loss (MBL) is a critical indicator of implant health and success. Clinical studies generally show greater MBL in diabetic patients compared to non-diabetic individuals. Furthermore, controlled type 2 diabetes mellitus (T2DM) has been associated with significantly better maintenance.

Convertible Hydrogel Injection Sequentially Regulates Diabetic Periodontitis

Diabetes exacerbates periodontitis by overexpressing reactive oxygen species (ROS), which leads to periodontal bone resorption. Consequently, it is imperative to relieve inflammation and promote alveolar bone regeneration comprehensively for the development of diabetic periodontal treatment strategies. Furthermore, an orderly treatment to avoid interference between these two processes can achieve the optimal therapeutic effect. Thus, we constructed a sequential sustained release system based on the zeolitic imidazolate framework-8 (ZIF-8)-modified chitosan thermosensitive hydrogel (TOOTH) for diabetic periodontal therapy in this work. Chemically modified tetracycline-3 (CMT-3) and platelet-derived growth factor-BB (PDGF-BB) were loaded in the hydrogel and ZIF-8 for sequential release, respectively, with the aim of reducing inflammation and facilitating tissue regeneration. During the therapy, CMT-3 first escaped from the hydrogel due to degradation and diffusion for ROS elimination. Subsequently, ZIF-8 was dissociated under an acid microenvironment, and PDGF-BB was sustainably released to promote osteogenesis. The release intervals between CMT-3 and PDGF-BB could be regulated by the sizes of ZIF-8. The biocompatible TOOTH exhibited a favorable therapeutic effect for diabetic periodontitis in vitro and in vivo. The sequentially controlled release of CMT-3 and PDGF-BB facilitated by TOOTH holds promise for promoting periodontal tissue regeneration and offers potential for clinical translation.

Spermidine alleviates diabetic periodontitis by reversing human periodontal ligament stem cell senescence via mitophagy

Type 2 Diabetes Mellitus (T2DM) exacerbates periodontal disease lesions, and human periodontal ligament stem cells (PDLSCs) depletion may be the key to periodontal healing impair by T2DM. This study aims to explore the mechanism of PDLSCs depletion in diabetes periodontitis (DP). Firstly, we observed aggravated periodontal destruction in the DP animal model, accompanied by oxidative damage and accumulation of senescent cells. In the high-glucose inflammatory environment in vitro, we revealed that PDLSCs underwent senescence, oxidative stress, mitochondrial dysfunction, and activation of cGAS-STING signaling pathway triggered by mitochondrial DNA. Lineage tracing confirmed that SPD recruited Tdtomato-Gli1+ PDLSCs to the damaged area and alleviated periodontal destruction in DP models. Evidence in vitro further showed that SPD inhibited PDLSCs senescence and oxidative stress, enhanced mitochondrial function, reduced membrane permeability transition pore opening, and reduced DNA leakage, which blocked the STING activation. Mechanistically, SPD reduced STING-TBK1 phosphorylation by scavenging mitochondrial-derived dsDNA in a mitophagy-dependent manner, its therapeutic effect was abolished by incorporation of cGAMP, a STING activator. In summary, our study reveals the mechanism of PDLSCs depletion due to excessive oxidative damage in the DP environment. Local injection of SPD reactivates mitophagy, recruits Gli1+ stem cells by inhibiting STING activation for periodontal regeneration.

Salivary microbiome and biomarker characteristics of diabetics with periodontitis

OBJECTIVE

To examine the characteristics of the salivary microbiome in Type 2 diabetes mellitus (T2DM) patients with or without periodontitis.

BACKGROUND

Periodontitis has been identified as clear sequelae of T2DM. This chronic oral disease also impacts the management of the clinical features of diabetes. The oral microbiome characteristics in T2DM with and without periodontitis, as well as the response of this oral microbiome to nonsurgical therapy have not been well described. Knowledge of key oral biological features could help address the observed poorer clinical presentation of T2DM patients.

METHODS

The oral microbiome in saliva of adult cohorts periodontally healthy/non-diabetic (non-periodontitis; NP; n = 31), T2DM without periodontitis (DWoP; n = 32), and T2DM with periodontitis (DWP; n = 29) were characterized by microbial molecular analysis using V3-V4 sequencing and Luminex or ELISA techniques for salivary host analytes.

RESULTS

Phyla distribution showed DWP with significantly lower levels of Firmicutes and Actinobacteria and higher levels of Fusobacteria and Spirochetes compared to the healthier groups. Approximately 10% of the detected microbial species showed significant differences in frequency and level of colonization among the DWP, DWoP, and NP samples. A subset of bacteria were significantly correlated with clinical disease features, as well as a specific repertoire of salivary analytes, in particular matrix metalloproteinase (MMP)8/MMP9, interleukin-1ß, B-cell activating factor, and resistin differed between the groups and were related to specific taxa. Principal component analysis that identified a majority of the DWP subjects microbiome was unique based upon an array of 27 taxa out of up to 255 detected in the saliva samples.

CONCLUSION

T2DM patients with periodontitis show unique oral microbiome and salivary analyte composition compared to diabetics or non-diabetic persons without periodontitis. Specific members of the oral microbiome relate directly to the clinical disease features and/or salivary biomolecules in T2DM individuals.

Association between periodontal disease and gestational diabetes: Systematic review and meta-analysis

AIM

Periodontal disease (PD) can aggravate insulin resistance during pregnancy and trigger the development of gestational diabetes mellitus (GDM).

METHODS

A systematic review and meta-analysis was carried out. Two researchers carried out a literature search using internet databases. Studies that met the inclusion criteria were selected. OR was used as the measure of association. The fixed effects model was applied, and due to the presence of heterogeneity, the DerSimonian and Laird random effects model was applied. The level of significance was p < 0.05. The presence of biases was assessed using the Egger test and the funnel plot.

RESULTS

Of the 176 articles found, 11 were included. 2032 pregnant women were analyzed, of which 572 developed GDM. It was found that PD was a risk factor for developing GDM when all studies were assessed (OR=1.83 95 % CI 1.25-2.69, p < 0.0017) and when analyzing only those that included an adjusted OR (OR= 1.83 95 % CI 1.31-2.56, p < 0.004).

CONCLUSIONS

PD poses a high risk of suffering from GDM. The development of oral health programs in women who wish to conceive is essential to improve metabolic control and reduce obstetric and perinatal complications.

The role of professional oral hygiene in enhancing outcomes of maxillofacial trauma surgery

BACKGROUND

The oral cavity poses challenges in surgical interventions due to its microbial flora. Maxillofacial trauma surgeries are vulnerable to infections, complicating recovery. Traditional methods, including antibiotic prophylaxis, have limitations, highlighting the need for complementary strategies.

OBJECTIVE

This study evaluated the impact of professional oral hygiene protocol on infection rates, mucosal health, and pain levels in maxillofacial trauma patients.

MATERIAL AND METHODS

A retrospective study analyzed 529 patients treated for maxillofacial trauma at the Maxillo-Facial Surgery Unit of "Azienda Ospedaliera Ospedali Riuniti" in Ancona, Italy, from 2018 to 2023. Patients were divided into two groups: Period 1 (2018-2020, no protocol) and Period 2 (2021-2023, protocol implemented). All patients were in good general health, with no systemic diseases compromising immunity or influencing surgical outcomes. The protocol included supragingival scaling 48 h preoperatively, chlorhexidine 0.20 % three times daily postoperatively, and standardized antibiotic and analgesic regimens. Data included infection rates, modified Beck Oral Assessment Scores and Numerical Rating Scale pain scores. Statistical analyses included independent t-tests and Chi-square tests, with significance set at p < 0.05.

RESULTS

Period 2 showed significantly lower infection rates (13.44 % vs. 19.48 %, p = 0.023), reduced pain scores (mean NRS: 4.6 vs. 5.4, p < 0.01) and improved mucosal health (mean BOAS: 2.91 vs. 3.75, p < 0.001).

DISCUSSION

The professional oral hygiene protocol reduced postoperative complications, improved oral health, and enhanced patient comfort. These findings support the integration of structured oral hygiene measures into standard maxillofacial surgical care to optimize outcomes and quality of life.

Salivary proteomic analysis in patients with type 2 diabetes mellitus and periodontitis

OBJECTIVE

This study aimed to compare the salivary protein profile in individuals with Type 2 Diabetes Mellitus (DM2) and periodontitis and their respective controls.

METHODS

Eighty participants were included in the study. The four groups were formed by individuals with DM2 and periodontitis (DM2 + P, n = 20), DM2 without periodontitis (DM2, n = 20), periodontitis without DM2 (P, n = 20) and individuals without periodontitis and without DM2 (H, n = 20). Periodontal clinical examinations were performed and unstimulated saliva was collected. Proteomic analysis was performed by shotgun mass spectrometry. The results were obtained by searching the Homo sapiens database of the UniProt catalog.

RESULTS

A total of 220 proteins were identified in saliva samples. In the comparison between DM2 + P and DM2 groups, 27 proteins were up-regulated [e.g. S100-A8 was 6 times up-regulated (humoral immune response pathway)]. The DM2 + P and P groups had 26 up-regulated proteins [e.g. Immunoglobulin lambda constant 7 more than 2 times up-regulated (complement activation pathway)]. The non-DM2 groups (P and H) presented 22 up-regulated proteins [e.g. Glyceraldehyde-3-phosphate dehydrogenase more than 2 times up-regulated (Peptidyl-cysteine S-nitrosylation pathway)]. The groups without periodontitis (DM2 and H) showed 23 were up-regulated proteins [e.g. Hemoglobin subunit alpha that was more than 10 times up-regulated (cellular oxidant detoxification pathway)].

CONCLUSION

The presence of DM2 and periodontitis significantly impacts the salivary proteome. Our proteomic analysis demonstrated that changes in the S100 family proteins (S100A8 and S100 A9) are highly related to the presence of DM2 and periodontitis.

CLINICAL RELEVANCE

Diabetes Mellitus (DM) and periodontitis are highly prevalent chronic diseases that present a wide variety of signs and symptoms. They present a bidirectional relationship, where patients with DM have a higher prevalence and severity of periodontitis, and patients with periodontitis have a higher prevalence of DM, worse glycemic control, and more diabetic complications. Diagnosing periodontitis requires specific clinical examinations, which require a highly trained operator. In this study, we used high throughput proteomics in order to evaluate non-invasive biomarkers for periodontitis in type 2 DM subjects. The results can contribute to earlier, more accurate, and less costly diagnosis of periodontitis in diabetic subjects, enabling better diabetes control.

Effects of the Oral Health Promotion Program on oral health and oral microbiota changes in diabetic elderly individuals: a quasi-experimental study

BACKGROUND

Diabetes with its highly prevalence has become a major contributor to the burden of health care costs worldwide. Recent unequivocal evidence has revealed a bidirectional link between oral health and diabetes. In this study, the effects of the Oral Health Promotion Program (OHPP) on oral hygiene, oral health-related quality of life and glycated haemoglobin (HbA1c) levels in diabetic elderly were examined. Moreover, microbial changes in the saliva microbiota community were also emphatically investigated.

METHODS

A quasi-experiment was conducted in regionally representative communities to assess oral health and oral microbiota of the elderly diabetic participants. The participants in the intervention group (n = 26) received OHPP including three phases of cognition, intensification and consolidation during the program, when those in the control group (n = 26) received routine oral care. Clinical parameters were recorded at two different time points as before the study (T0), and 3 months after intervention onset (T1). Oral health was measured via the oral health impact profile (OHIP-14) questionnaire, dental plaque index, HbA1c and mastery of oral health knowledge, and sequencing of the 16S rRNA gene from saliva samples was used to analyze the oral microbiota.

RESULTS

The average age of the final sample was 71.77 years (SD = 6.06), 53.8% (28/52) of whom were male. A reduction in the plaque index and improvements in oral health-related quality of life and mastery of oral health knowledge were observed in the intervention group. Meanwhile, the α-diversity of the microbiota increased in both groups, but more significant in the intervention group. PCoA analyses showed significant differences in microbial community structure in both groups, and LEfSe analyses revealed a decrease of g_Streptococcus and g_Rothia after the implementation of OHPP and a decrease of g_Streptococcusa, g_Porphyromonas, g_Gemella after the routine oral care. There was no statistically significant difference in the HbA1c level between two groups.

CONCLUSIONS

OHPP superiorly contributes to the improvement of oral health and oral microbiota in elderly diabetic patients. The overarching goal is to introduce attention to the importance of good oral health as a crucial point in preventing and managing diabetes mellitus and thereby make it a meaningful contribution to public health and geriatric care.

TRIAL REGISTRATION

This study was retrospectively registered in Chinese Clinical Trial on October 9, 2022 (ID ChiCTR2200064453).

Immunopathogenesis and immunotherapy of diabetes-associated periodontitis

OBJECTIVES

This paper aims to review the immunopathogenesis of Diabetes-associated periodontitis (DPD) and to propose a description of the research progress of drugs with potential clinical value from an immunotherapeutic perspective.

MATERIALS AND METHODS

A comprehensive literature search was conducted in PubMed, MEDLINE, Embase, Web of Science, Scopus and the Cochrane Library. Inclusion criteria were studies on the association between diabetes and periodontitis using the Boolean operator "AND" for association between diabetes and periodontitis, with no time or language restrictions. Search terms included diabetes mellitus, periodontitis, immunopathogenesis, specific immunity, non-specific immunity, flora, estrogen, pharmacological treatment, immunotherapy.

RESULTS

Alterations in the subgingival flora environment in a hyperglycemic environment elicit an immune response. Overactivity/suppression of nonspecific immune cells and impaired cellular defenses trigger specific immune responses. Epigenetics as well as female hormones also play a role. There is already a small amount of clinical evidence for the role of metronidazole, subantimicrobial doses of doxycycline, minocycline hydrochloride, and metformin in the treatment of DPD. Some preclinical studies have also accumulated experimental evidence for the improved effects of vitamin D3 and other drugs on DPD.

CONCLUSIONS

The development of diabetic periodontitis is immunologically linked to a state of immune imbalance and therefore holds great promise for the use of immunotherapeutic drugs.

CLINICAL SIGNIFICANCE

Immunotherapy with drugs along with periodontal nonsurgical treatment could provide ideas for DPD treatment based on the immunopathogenesis of DPD.

Umbilical cord mesenchymal stem cells improve bone regeneration in diabetes mellitus animal model with apical periodontitis

Background

Previous studies revealed diabetes mellitus subjects tend to have persistent apical periodontitis. Regenerative stem cells therapy through endodontic procedure is hoped to be a solution. This study assessed bone regeneration in diabetic rats with apical periodontitis through histopathological analysis of osteoblasts and immunohistochemical analysis of runt-related transcription factor 2 (Runx2) and Osterix.

Methods

Diabetes mellitus and apical periodontitis was induced on 20 rats. Apical periodontitis was induced on mandibular right first molars under anesthesia. The teeth were left open for 7 days following access cavity and pulp extirpation, then the rats' teeth were endodontically treated and randomly allocated into 4 groups (5 rats per group). The first and second groups was ended at 30 days (C30) and 60 days (C60) and labelled as control. The third and fourth groups was given umbilical cord mesenchymal stem cells and ended at 30 days (T30) and 60 days (T60). The osteoblasts, Runx2 and Osterix were analyzed. ANOVA and Tukey HSD tests were used for analysis. Differences with p values < 0.05 were considered significant.

Results

The number of osteoblasts in the apical area in control groups (C30 and C60) and treatment groups (T30 and T60) showed a significant increase (p < 0.05). The expressions of Runx2 and Osterix in osteoblasts showed a significant increase among the control (C30 and C60) and treatment groups (T30 and T60) (p < 0.05).

Conclusion

Umbilical cord mesenchymal stem cells improve bone regeneration in diabetic animal model with apical periodontitis, in terms of osteoblasts, Runx2 and Osterix.

Gut microbial dysbiosis and inflammation: Impact on periodontal health

Periodontitis is widely acknowledged as the most prevalent type of oral inflammation, arising from the dynamic interplay between oral pathogens and the host's immune responses. It is also recognized as a contributing factor to various systemic diseases. Dysbiosis of the oral microbiota can significantly alter the composition and diversity of the gut microbiota. Researchers have delved into the links between periodontitis and systemic diseases through the "oral-gut" axis. However, whether the associations between periodontitis and the gut microbiota are simply correlative or driven by causative mechanistic interactions remains uncertain. This review investigates how dysbiosis of the gut microbiota impacts periodontitis, drawing on existing preclinical and clinical data. This study highlights potential mechanisms of this interaction, including alterations in subgingival microbiota, oral mucosal barrier function, neutrophil activity, and abnormal T-cell recycling, and offers new perspectives for managing periodontitis, especially in cases linked to systemic diseases.

Periodontal Treatment to Improve General Health and Manage Systemic Diseases

Periodontitis is increasingly recognized for its role in overall health and its associations with systemic conditions. Shared etiological factors, including microbiological, immunological, genetic, and environmental influences, have prompted interest in the potential impact of periodontal therapy on broader health outcomes. The oral microbiome plays a key role in the pathogenesis of periodontitis, with microbial imbalances (dysbiosis) contributing to inflammation and systemic disease progression. Additionally, immune responses to periodontal infection, such as chronic inflammation and dysregulated immune activity, are central to linking periodontitis with conditions like diabetes, cardiovascular disease, and autoimmune disorders. This chapter explores the connections between periodontal treatment and systemic diseases, such as diabetes, rheumatoid arthritis, cardiovascular disease, chronic kidney disease, Alzheimer's disease, digestive disorders, and respiratory disease. It also reviews the current research on the mechanisms, including microbial and immune factors, that underlie these associations. By emphasizing the role of periodontal health, the oral microbiome, and immune regulation in disease prevention and management, this chapter underscores the importance of integrated healthcare approaches to improve patient outcomes.

Gum-on-a-Chip Exploring Host-Microbe Interactions: Periodontal Disease Modeling and Drug Discovery

Periodontal disease is a pervasive and serious health issue, affecting millions globally and leading to severe oral and systemic health complications. This underscores the urgent need to thoroughly understand the complex host-microbe interactions involved. Developing models that allow crosstalk among various bacteria, periodontal component cells, and circulating immune cells is crucial for investigating periodontal disease and discovering new treatments. This study aimed to develop a biomimetic gum tissue model. Within four days, a bio-fabricated tissue with well-established barrier and immune functions was created. In this model, the key periodontal pathogen, Porphyromonas gingivalis, was observed to suppress the recruitment and migration of immune cells and dysregulate CD14 expression in THP-1 cells, leading to significant inflammation and tissue damage. Conversely, the probiotic Akkermansia muciniphila enhanced the host's defensive immune response, highlighting its potential as a therapeutic agent in periodontal disease.

Salivary features of periodontitis and gingivitis in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is associated with cellular abnormalities, tissue and organ dysfunctions, and periodontitis. This investigation examined the relationship between the oral microbiome and salivary biomarkers in T2DM patients with or without periodontitis. This cohort (35-80 years) included systemically healthy non-periodontitis (NP; n = 31), T2DM without periodontitis (DWoP; n = 32) and T2DM with periodontitis (DWP; n = 29). The oral microbiome [Operational Taxonomic Units (OTUs)] (16 s rRNA sequencing) and targeted host salivary biomarkers (immunoassays) were assessed. We identified 47 OTUs that were significantly different in abundance between NP samples and any disease subset or between disease subgroups. The most unique microbiome patterns were observed in the DWP group. Differences in genera/species abundance were also observed when T2DM patients were stratified by extent of periodontal inflammation and disease (i.e., generalized versus localized gingivitis/periodontitis). Salivary biomarkers showed significant elevations in MMP-8, MMP-9, resistin, IL-1β, IL-6, IFNα, and BAFF (THFSR13b) comparing generalized to localized periodontitis. Salivary analytes showed significant positive correlations with specific microbiome members, predominantly in DWP patients. Odds ratio analyses reinforced that a panel of biologic markers (IL-6, MMP-8) and bacteria (e.g., Bacteroidetes, Fusobacteria, Spirochaetes) discriminated the severity and extent of periodontal disease in this diabetic population.

New Classification of Periodontal Diseases, the Obstacles Created and Opportunities for Growth

The purpose of this Editorial is to expose the gaps in the knowledge created by a decision by the World Workshop Consensus Conference (WWCC), held in 2017, which was focused on the re-classification of periodontal diseases [...].

The Prevalence of Metabolic Syndrome and Undiagnosed Diabetes in Periodontitis Patients and Non-Periodontitis Controls in a Dental School

Background/Objectives: Metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) are major global health concerns, and they often go undetected. Periodontitis shares risk factors and is associated with both conditions. Assessing MetS risk factors among dental patients, especially those with periodontitis, may contribute to early detection and prompt treatment. However, current information about MetS prevalence rates in dental settings is limited. Therefore, our aim was to investigate the prevalence of MetS among patients with generalized periodontitis stage III/IV (GenPD), localized periodontitis stage III/IV (LocPD), and non-periodontitis controls. We also investigated the prevalence of undiagnosed T2DM in the same population. Moreover, we performed a pilot study to evaluate the possibility of measuring fructosamine levels in oral rinse samples, as an alternative to HbA1c, to screen for hyperglycemia. Methods: Periodontitis patients and non-periodontitis controls were recruited from a dental school, all aged ≥ 40 years. MetS prevalence was determined according to four different MetS definitions. T2DM prevalence was based on elevated HbA1c levels (HbA1c ≥ 7.0%). Biochemical analysis from blood was carried out by finger stick sampling. A subset of participants was asked to provide an oral rinse sample for the measurement of fructosamine, which was correlated to HbA1c from blood. Results: A total of 105 patients with periodontitis (GenPD stage III/IV: n = 44, LocPD stage III/IV: n = 61) and 88 non-periodontitis controls, with a mean age of 54.4 years, were included. The prevalence of MetS, according to four different MetS definitions, was 68.2-81.8% in GenPD patients, 42.6-62.3% in LocPD patients, and 52.3-69.3% in controls. The prevalence of T2DM, as evidenced by elevated HbA1c, was 20.5% in GenPD patients, 18.3% in LocPD patients, and 10.2% in controls (p = 0.094). A substantial number of subjects were not aware that they were being suspected to have T2DM, i.e., 13.6% in GenPD patients, 8.2% in LocPD patients, and 8.0% in controls (p = 0.335). In a subset of participants (n = 48), we found no significant correlation between HbA1c and oral fructosamine (r= 0.24, p = 0.103). Conclusions: The overall results showed a relatively high prevalence of patients with MetS and/or elevated HbA1c among periodontitis patients and controls in the dental school. Of those with suspected T2DM, a substantial number were not aware of having T2DM. Oral health care professionals could therefore contribute to early detection for T2DM and/or create awareness in patients at risk for a disease related to MetS. To date, initial results on the use of oral fructosamine as an alternative for HbA1c cast doubt, and further research is needed.

Exploring the Feasibility and Acceptance of Delivering Oral Health Interventions in a Primary Care Diabetes Context in North East England: A Qualitative Two-Case Study

The evidence base supporting a bidirectional relationship between diabetes and periodontitis is well-established and published guidance recommends inter-professional management. This two-case study describes the development and implementation of an evidence-based oral health intervention delivered in diabetes review consultations in NHS primary medical care in Northeast England.

AIM

The intervention aim was to inform people with diabetes about the links between diabetes and periodontitis, and signpost them to a dental professional for assessment.

METHODS

The study utilised focus groups in the design phase and a mixture of focus groups and interviews in the evaluation phase.

RESULTS

Two research active primary care medical practices were recruited. The interventions were informed by their diabetes management protocols to reduce disruption. The interventions were piloted for 2 months, and staff and patient perceptions were evaluated. The findings from this study suggested that the oral health interventions were feasible and acceptable particularly for nurses and health care assistants when delivering diabetes education, but they caused disruption to the GPs review, which included complex medication reviews and referrals. The patients (n = 2) found the intervention to be acceptable and appropriate in the context of their diabetes review.

CONCLUSION

Medical staff and patient evaluation data appear to suggest acceptance of the introduction of an oral health intervention into the diabetes review, but it is difficult to assess the impact of the intervention. Further research, such as a realist review, is needed to evaluate the outcomes and utility of an oral health intervention in the context of the medical management of diabetes in primary care.

The mediating role of sugar and lipid metabolism and systemic inflammation in the association between breakfast skipping and periodontitis: A population-based study

BACKGROUND

This study investigated the association between breakfast skipping and periodontitis and the mediating role of sugar and lipid metabolism and systemic inflammation in this association using data from the Korea National Health and Nutrition Examination Survey 2016-2018.

METHODS

This study included 11,953 participants, representing an estimated 33.9 million people. Complex sample logistic regression was used to assess the independent association between breakfast skipping and periodontitis. Subgroup analysis was conducted with modifiers including age, sex, body mass index (BMI), urban residence, education level, marital status, and diabetes. Structural equation modeling assessed potential mediation by biomarkers related to glucose and lipid metabolism along with systemic inflammation.

RESULTS

The fully adjusted logistic regression model indicated a positive association between breakfast skipping and periodontitis (odds ratio [OR] = 1.234 (1.026-1.483), p = 0.025). This association was highlighted in middle-aged (40-60 years), female, highly educated, married individuals with BMI < 25 kg/m2, and those in urban areas without diabetes. Blood glucose (β ± SE = 0.006 ± 0.002, p = 0.014), triglycerides (β ± SE = 0.004 ± 0.002, p = 0.033), and white blood cell count (β ± SE = 0.011 ± 0.003, p = 0.003) were identified as partial mediators.

CONCLUSIONS

A new, independent association between breakfast skipping, and periodontitis has been discovered, which is partially mediated by sugar and lipid metabolism, and systemic inflammation. The findings provide new insights into the benefits of chrononutrition for periodontal health.

Periodontal diseases and cardiovascular diseases, diabetes, and respiratory diseases: Summary of the consensus report by the European Federation of Periodontology and WONCA Europe

BACKGROUND

Periodontitis is a chronic inflammatory non-communicable disease (NCD) characterised by the destruction of the tooth-supporting apparatus (periodontium), including alveolar bone, the presence of periodontal pockets, and bleeding on probing.

OBJECTIVES

To outline, for family doctors, the implications of the association between periodontal and systemic diseases; to explore the role of family doctors in managing periodontitis as an ubiquitous non-communicable disease (NCD).

METHODS

The consensus reports of previous focused collaborative workshops between WONCA Europe and the European Federation of Periodontology (using previously undertaken systematic reviews), and a specifically commissioned systematic review formed the technical papers to underpin discussions. Working groups prepared proposals independently, and the proposals were subsequently discussed and approved at plenary meetings.

RESULTS

Periodontitis is independently associated with cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, obstructive sleep apnoea, and COVID-19 complications. Treatment of periodontitis has been associated with improvements in systemic health outcomes. The article also presents evidence gaps. Oral health care professionals (OHPs) and family doctors should collaborate in managing these conditions, including implementing strategies for early case detection of periodontitis in primary medical care centres and of systemic NCDs in oral/dental care settings. There is a need to raise awareness of periodontal diseases, their consequences, and the associated risk factors amongst family doctors.

CONCLUSION

Closer collaboration between OHPs and family doctors is important in the early case detection and management of NCDs like cardiovascular diseases, diabetes mellitus, and respiratory diseases. Strategies for early case detection/prevention of NCDs, including periodontitis, should be developed for family doctors, other health professionals (OHPs), and healthcare funders. Evidence-based information on the reported associations between periodontitis and other NCDs should be made available to family doctors, OHPs, healthcare funders, patients, and the general population.

Clinical and Microbiological Periodontal Biofilm Evaluation of Patients with Type I Diabetes

Background/Objectives: The purpose of this study was to assess the microbial composition and density of subgingival plaque samples for periodontal pathogens while correlating the values with glycemic control levels via glycated hemoglobin (HbA1c), a type of hemoglobin that has chemically linked glucose, in type I diabetes individuals who will undergo complex oral rehabilitation through orthodontic treatment and implant surgery. Methods: A cohort of 42 adults with type I diabetes were included in this study. The subjects sustained a comprehensive periodontal clinical examination as well as microbiological assessments of their subgingival plaque samples through quantitative real-time PCR. The samples were collected from the two deepest pockets of each subject. Results: The highest number of periodontopathogenic bacteria was observed in the pockets of 5-7 mm. T. forsythia showed the highest prevalence (20.48%), with decreasing numbers as follows: T. denticola (13.31%), P. gingivalis (11.26%), A. actinomycetemcomitans (7%), and P. intermedia (4.9%). T. denticola and T. forsythia were significantly more commonly observed in individuals with elevated HbA1c serum levels. No correlation was observed between P. gingivalis, A. actinomycetemcomitans, P. intermedia presence, and the HbA1c value. Conclusions: Periodontopathogenic agents' presence in subgingival biofilm samples varied in accordance with the pocket probing depth and metabolic control of the diabetic individuals. In our study, the appearance of these periodontopathogenic agents was linked to lowered metabolic control in patients with type I diabetes mellitus.

Multimorbidity Patterns and Periodontal Diseases in a French Hospital-Based Dental School: A Retrospective Cross-Sectional Study

Objectives: To assess the prevalence of systemic pathologies associated with periodontal diseases to determine multimorbidity patterns and risk factors for periodontal care. Methods: A single-center cross-sectional study analyzed patient records from 1 January 2019 to 31 December 2021 at the Department of Periodontology, part of the Dental Service of a hospital-based dental school in Lyon, France. The anonymized data included patient-reported medical history (questionnaire) and billing for periodontal procedures. Data were compared between patients in the Department of Periodontology and from Other Departments of the Dental Service. The association between clinically relevant pathologies, as defined as multimorbidity, and admission in the Department of Periodontology were assessed with logistic regression. Prevalences between the Department of Periodontology and the Other Departments of the Dental Service were compared with chi-squared tests. Relationship among pathologies was described through correlation analysis. Statistical analyses were conducted using R software with a significance level set at p < 0.05. Results: This study included records of 20,945 patients in the Dental Service with 1205 periodontal procedures performed in the Department of Periodontology. Patients admitted for periodontal care were older and mostly female (p-value < 0.001). The most frequent systemic pathologies were hypertension and diabetes in the Department of Periodontology. Hypertension associated with diabetes was the most frequent multimorbidity pattern, while the most frequent triad of multimorbidity was hypertension/diabetes/cardiac rhythm disorders. Patients with diabetes had a 1.49 times higher likelihood of admission to the Department of Periodontology (OR = 1.49 [1.20; 1.86]), with age also being a significant risk factor but with a smaller effect size (OR = 1.02 [1.01; 1.03]). Conclusions: Within the limitations of this study, hypertension, diabetes, cardiac rhythm disorders, and chronic renal insufficiency were identified as prevalent multimorbidity in the Department of Periodontology. Multimorbidity including diabetes seems to constitute a risk factor requiring periodontal care.

Chronic periodontitis, dantamoolaroga, indicates chronic systemic inflammation and reduces longevity

A narrative review of chronic periodontitis, a dysfunctional inflammatory disease of the gums finds it is linked to over 60 systemic diseases and has been shown to reduce lifespan. Termed dantamoolaroga in Ayurvedic medicine, the causative vitiated doshas for the 17 types of dantamoolaroga have been described and give leads as to systemic imbalances behind the diseases. By improving periodontal (gum) health, improvements in type 2 diabetes, cardiovascular and other chronic inflammatory markers have been shown. Systemic chronic inflammation is the underlying cause of non-communicable diseases, including periodontitis, cardiovascular diseases, respiratory, diabetes and metabolic diseases, cancer and others, now contributing over 70% of worldwide deaths. It is found that oral health reflects systemic health and provides a window into general health. As personalised medicine is being developed to assess the multiple pathophysiological factors underlying systemic chronic inflammation, it is noted that Ayurveda has a comprehensive approach to diagnosis with the 10 fold assessment (Dashavidha Praiksha) and eight fold examinations (Astasthana Pariksha) being considered the original personalised medicine. There are Ayurvedic clinical correlates and causes of systemic chronic inflammation assisting clinical evaluation and treatment planning. Ayurvedic diagnostic measures for general health and periodontal health need validation in today's terms to strengthen the scientific credentials and enable better clinical use of both systems in an integrative manner. Inclusion of clinical assessment of periodontal health status at consultation, particularly for any chronic disease, is strongly recommended to gain insight into a widespread systemic chronic inflammation marker. The multiple Ayurvedic clinical measures for chronic inflammation provides potential for lines of research that complement the current molecular based approaches.

Diabetes mellitus exacerbates inflammation in a murine model of ligature-induced peri-implantitis: A histological and microtomographic study

AIM

To investigate the influence of diabetes mellitus (DM) in a murine model of peri-implantitis (PI).

MATERIALS AND METHODS

Twenty-seven 4-week-old C57BL/6J male mice had their first and second maxillary left molars extracted. Eight weeks later, one machined implant was placed in each mouse. Four weeks after osseointegration, the mice were divided into three groups: (a) control (C), (b) PI and (c) DM + PI. DM was induced by streptozotocin (STZ) administration. After DM induction, PI was induced using ligatures for 2 weeks. The hemimaxillae were collected for micro-CT and histological analyses. The primary outcomes consisted of linear (mm) and volumetric (mm3) bone loss. Secondary outcomes were based on histological analysis and included inflammatory infiltrate, osteoclastic activity, matrix organization, composition and remodelling. Data are presented as means ± SEM. Statistical analyses were performed using one-way ANOVA, followed by Tukey's test.

RESULTS

Gingival tissue oedema was detected in the PI and DM + PI groups. Micro-CT showed significantly increased linear and volumetric bone loss in the DM + PI group compared to the C and PI groups. H&E staining showed greater inflammatory response and bone resorption in the PI and DM + PI groups than in the C group. The DM + PI group had significantly higher osteoclast numbers than the C and PI groups. Picrosirius red stained less for types I and III collagen in the PI and DM + PI groups than in the C group. There was a significant increase in monocyte/macrophage (CD-11b) counts and matrix metalloproteinases (MMP-2 and MMP-8) marker levels and a significant decrease in the matrix metalloproteinases inhibition marker (TIMP-2) levels in the DM + PI group compared to the C and PI groups.

CONCLUSIONS

DM exacerbates PI-induced soft-tissue inflammation, matrix degradation and bone loss.

Polyphenol-mediated redox-active hydrogel with H2S gaseous-bioelectric coupling for periodontal bone healing in diabetes

Excessive oxidative response, unbalanced immunomodulation, and impaired mesenchymal stem cell function in periodontitis in diabetes makes it a great challenge to achieve integrated periodontal tissue regeneration. Here, a polyphenol-mediated redox-active algin/gelatin hydrogel encapsulating a conductive poly(3,4-ethylenedioxythiopene)-assembled polydopamine-mediated silk microfiber network and a hydrogen sulfide sustained-release system utilizing bovine serum albumin nanoparticles is developed. This hydrogel is found to reverse the hyperglycemic inflammatory microenvironment and enhance functional tissue regeneration in diabetic periodontitis. Polydopamine confers the hydrogel with anti-oxidative and anti-inflammatory activity. The slow, sustained release of hydrogen sulfide from the bovine serum albumin nanoparticles recruits mesenchymal stem cells and promotes subsequent angiogenesis and osteogenesis. Moreover, poly(3,4-ethylenedioxythiopene)-assembled polydopamine-mediated silk microfiber confers the hydrogel with good conductivity, which enables it to transmit endogenous bioelectricity, promote cell arrangement, and increase the inflow of calcium ion. In addition, the synergistic effects of hydrogen sulfide gaseous-bioelectric coupling promotes bone formation by amplifying autophagy in periodontal ligament stem cells and modulating macrophage polarization via lipid metabolism regulation. This study provides innovative insights into the synergistic effects of conductivity, reactive oxygen species scavenging, and hydrogen sulfide on the periodontium in a hyperglycemic inflammatory microenvironment, offering a strategy for the design of gaseous-bioelectric biomaterials to promote functional tissue regeneration in immune-related diseases.

Periodontitis and pre-eclampsia among pregnant women in Rwanda: A case-control study

INTRODUCTION

Several studies have indicated that the presence of periodontitis during pregnancy could increase the risk of developing pre-eclampsia, thereby negatively influencing pregnancy outcomes for both the mother and child. Notably, despite the high prevalence of both periodontitis and adverse pregnancy outcomes in Rwanda, there exists a crucial evidence gap concerning the precise relationship between periodontitis and pre-eclampsia.

OBJECTIVES

The aim of this study was to assess the association between periodontitis and pre-eclampsia amongst pregnant women in Rwanda.

METHODS AND MATERIALS

Employing an unmatched 1:2 case-control design, we studied 52 pre-eclamptic and 104 non-pre-eclamptic pregnant women aged ≥18 years at two referral hospitals in Rwanda. Pre-eclampsia was defined as a systolic blood pressure ≥ 140 and diastolic blood pressure ≥ 90 mm Hg, diagnosed after 20 weeks of gestation and proteinuria of ≥300mL in 24 hours of urine collection. Periodontitis was defined as the presence of two or more teeth with one or more sites with a pocket depth ≥ 4mm and clinical attachment loss >3 mm at the same site, assessed through clinical attachment loss measurement. Bivariate analysis and logistic regression were used to estimate Odds ratio (ORs) and 95% confidence interval.

RESULTS

The prevalence of periodontitis was significantly higher among women with pre-eclampsia, compared to pregnant women without pre-eclampsia, at 90.4% and 55.8%, respectively (p< 0.001). Pregnant Women with periodontitis were 3.85 times more likely to develop pre-eclampsia after controlling for relevant confounders (adjusted Odds Ratio [aOR] = 3.85, 95%CI = 1.14-12.97, p<0.05).

CONCLUSION

This study results indicates that periodontitis is significantly associated with pre-eclampsia among pregnant women in Rwanda. These findings suggest that future research should explore whether enhancing periodontal health during pregnancy could contribute to reducing pre-eclampsia in this specific population.

Benefits of Dental Scaling and Polishing in Adults: A Rapid Review and Evidence Synthesis

BACKGROUND

This rapid review assessed evidence to inform policy on the clinical effectiveness and optimal frequency of dental scaling and polishing (S&P) for adults, including those with low incomes eligible for the Canadian Dental Care Plan.

METHODS

A rapid review was conducted according to Cochrane Recommendations for Rapid Reviews. Populations included all adults, adults with periodontitis, and those with inequitable access to dental care. Primary outcomes included gingival inflammation, probing depths, and tooth loss. Secondary outcomes included oral health-related quality of life and economic impact. Four databases were searched for randomized clinical trials, systematic reviews, cohort studies, and practice guidelines. Risk of bias was evaluated using Cochrane Risk of Bias, Newcastle-Ottawa, ROBIS, and AGREE II tools. A qualitative synthesis was planned.

RESULTS

In total, 3,181 references were retrieved: 4 applied to "all adults" and 4 to those with periodontitis. All reports had low risk of bias. One systematic review and one multicenter trial of adults with regular dental care found no clinical benefit regardless of S&P interval; however, patients valued and were willing to pay for regular scaling. One claims-based study reported regular S&P reduced tooth loss, and 2 clinical practice guidelines found a reduced risk of future attachment and tooth loss, lower overall health care costs for diabetes, and reduced costs for and incidence of acute myocardial infarction in those with regular S&P. There were no studies of underserved populations.

CONCLUSIONS

For adults with no or early periodontal disease and regular access to dental care, routine S&P may have little clinical benefit but reduces tooth loss and some health care expenses. In patients with periodontitis, scaling intervals tailored to individual risk profile and periodontal status can maintain health. There is no evidence on the impact of routine S&P on patients with barriers accessing care.

KNOWLEDGE TRANSFER STATEMENT

In terms of the benefits of routine scaling and polishing in adults, this rapid review found mixed evidence with a high level of certainty due to minimal risk of bias in the appraised studies for "regular dental attenders" and those with a diagnosis of periodontal diseases. Tailored intervals for dental scaling are beneficial for those diagnosed with periodontitis but may not provide the clinical benefits previously expected for adults at low risk. There is no evidence that dental polishing is effective. No evidence was found to support recommendations about the clinical effectiveness of scaling or the most appropriate recall intervals for scaling for low-income Canadians eligible for dental services under the new Canadian Dental Care Plan.

Dental cementum anchored microspheres embedded in a self-healing hydrogel for the antibacterial, anti-inflammation, osteogenic, and anti-osteoclastic management of periodontitis disease

Periodontitis, a prevalent chronic oral disease, poses a significant threat to periodontal tissues, often resulting in substantial attachment loss and tooth shedding. Leveraging the principles of bone affinity and the mechanism underlying tetracycline pigmentation of teeth, this study strategically employed tetracycline (TC) as a bone-affinity group. We modified TC on the surface of polylactic-co-glycolic acid copolymer (PLGA) microspheres (MSs) through covalent binding, and then loaded berberine (BBR) MSs into a thermosensitive self-healing hydrogel delivery system (BBR/TC-MS). It was verified that the BBR/TC-MS gel rapidly formed an in situ reservoir in the periodontal pocket upon injection, and the chelation between TC and cementum in the periodontal pocket enhanced the anchoring effect of the TC-modified microspheres on cementum, preventing their loss through gingival crevicular fluid. Subsequently, we proved in vitro and in vivo that the BBR/TC-MS gel has excellent bacteriostatic effects against the periodontal pathogenic bacteria Fusobacterium necrophorum (Fn), anti-inflammation property in periodontal and gingival tissues, and osteogenic effect by regulating the RANKL-RANK-OPG pathway to diminish osteoclast activity, thus continuously exerting antibacterial, anti-inflammatory, osteogenic, and anti-osteoclastic effects. This innovative approach holds promise as a targeted and effective strategy for combating multifaceted challenges posed by periodontitis.

Oral health in patients with inflammatory bowel disease: A cross-sectional survey in Sweden

OBJECTIVES

The aim of this cross-sectional survey was to assess oral health, including prevalence of periodontitis and rate of tooth loss, in a Swedish cohort of patients with inflammatory bowel disease (IBD).

METHODS

A questionnaire on general anamnestic and socio-economic aspects, IBD diagnosis, and various oral health aspects was distributed online. The analyses focused on the comparison between patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) as well as on factors associated with self-reported severe periodontitis and tooth loss.

RESULTS

Analyses were based on answers from 786 patients; 415 with UC, 371 with CD, 74% female. In both disease entities, high prevalence of severe periodontitis (i.e., 38.5%) was reported, and about 19% of the population had less than 20 remaining teeth and 6.5% a poor oral health-related quality of life. CD patients tended to be more severely affected than UC patients (p > 0.05 in the adjusted analysis). Almost 90% of CD patients were aware of being entitled to a bi-annual governmental financial support for dental care due to IBD; however, 1 out of 4 UC patients did not. Furthermore, IBD patients largely believe that the interest of their physicians in any oral lesions due to IBD diagnosis is low.

CONCLUSIONS

Severe periodontitis and high rate of tooth loss are frequent in Swedish IBD patients.

CLINICAL RELEVANCE

Even though IBD patients receive bi-annually some special financial support for dental care, it seems this is still not sufficient and more preventive measures appear necessary.

The role of viruses in oral mucosal lesions

The mucosa of the oral cavity is exposed to a large number of different microorganisms such as archaea, bacteria, fungi, parasites, and viruses. Among those, viruses cause specific infections, which can easily be transmitted from one person to another. The infectious route may not only include patients and their relatives but also the dental professional team. Thus, a wide knowledge regarding specific viral infections is crucial for the daily routine. Signs and symptoms of oral viral infections can be completely absent or develop into a pronounced clinical picture, so that early detection and information determine the further course of the infection and its influence on other inflammatory diseases, such as periodontitis, as well as the safety of family members and the social environment. As the clinical manifestation of viral infections may be highly variable leading to heterogenous mucosal lesions it is, in most cases, mandatory to differentiate them by specific microbiological tests in addition to clinical examination procedures. This article will give an overview of the role of viruses infecting the oral mucosa, and in addition, describe their clinical manifestation and management.

Characterization of c-di-AMP signaling in the periodontal pathobiont, Treponema denticola

Pathobionts associated with periodontitis, such as Treponema denticola, must possess numerous sensory transduction systems to adapt to the highly dynamic subgingival environment. To date, the signaling pathways utilized by T. denticola to rapidly sense and respond to environmental stimuli are mainly unknown. Bis-(3'-5') cyclic diadenosine monophosphate (c-di-AMP) is a nucleotide secondary messenger that regulates osmolyte transport, central metabolism, biofilm development, and pathogenicity in many bacteria but is uncharacterized in T. denticola. Here, we studied c-di-AMP signaling in T. denticola to understand how it contributes to T. denticola physiology. We demonstrated that T. denticola produces c-di-AMP and identified enzymes that function in the synthesis (TDE1909) and hydrolysis (TDE0027) of c-di-AMP. To investigate how c-di-AMP may impact T. denticola cellular processes, a screening assay was performed to identify putative c-di-AMP receptor proteins. This approach identified TDE0087, annotated as a potassium uptake protein, as the first T. denticola c-di-AMP binding protein. As potassium homeostasis is critical for maintaining turgor pressure, we demonstrated that T. denticola c-di-AMP concentrations are impacted by osmolarity, suggesting that c-di-AMP negatively regulates potassium uptake in hypoosmotic solutions. Collectively, this study demonstrates T. denticola utilizes c-di-AMP signaling, identifies c-di-AMP metabolism proteins, identifies putative receptor proteins, and correlates c-di-AMP signaling to osmoregulation.

Prediabetes Associates with Matrix Metalloproteinase-8 Activation and Contributes to the Rapid Destruction of Periodontal Tissues

OBJECTIVE

 The aim of this cross-sectional study was to investigate the relationship between periodontitis, potential periodontitis oral fluid biomarkers, and prediabetes.

MATERIALS AND METHODS

 This study included 150 Greek adults aged 25 to 78 years who were tested with an Hemoglobin A1C (HBA1c) diagnostic system, an active-matrix metalloproteinase-8 (aMMP-8) point-of-care (PoC) test, and several salivary biomarkers enzyme-linked immunosorbent assay tests and gelatin zymography. A full-mouth clinical examination was performed to assess their periodontal and oral health status.

STATISTICAL ANALYSIS

 The Kruskal-Wallis test was used to determine the statistically significant difference in the levels of periodontal oral fluid biomarkers between the different periodontitis stages, periodontitis grades, and the stages and grades of periodontitis combined. Spearman's rank correlation was performed to assess the strength and direction of the association between aMMP-8 and HbA1c levels (<5.7 and ≥5.7%) and with the other oral fluid biomarkers among patients with severe periodontitis. A two-sided p-value below 0.05 was considered statistically significant in this study.

RESULTS

 aMMP-8, but not total MMP-8 or other biomarkers, associated significantly with the stage and grade of periodontitis combined (p < 0.001, Kruskal-Wallis test). Among stage III grade C periodontitis patients, aMMP-8 levels were significantly positively correlated with prediabetes (Spearman's rho = 0.646, p = 0.044), total MMP-8 (rho = 0.636, p = 0.048), PMN Elastase (rho = 0.729, p = 0.017), total MMP-9 (rho = 0.721, p = 0.019), and total MMP-8/TIMP-1 molar ratio (rho = 0.879, p < 0.001).

CONCLUSION

 Prediabetic disease development can upregulate MMP-8 expression (total MMP-8) in rapidly progressing, severe periodontitis, where MMP-8 latent species are further activated into their active forms (aMMP-8). Simultaneously, several proinflammatory biomarker levels are elevated in this tissue-destructive biomarker cascade. This development is easily detectable online/in real-time within 5 minutes by aMMP-8 PoC testing at the dentist's office.

Periodontal disease and its impact on general health in Latin America - Diagnosis: Latin America and the Caribbean Consensus 2024

This is a new version of the LAOHA Consensus on Periodontal Disease and its impact on general health in Latin America. Five years after the first version, knowledge has increased, and diagnosis of periodontal disease has evolved. Of especial interest relative to this topic has been the emergence of studies that have used the AAP/EFP Classification of Periodontal and Peri-Implant Diseases and Conditions since it is the core (?)of the art of diagnosis in preventive and therapeutic strategies. To make an accurate and effective diagnosis, knowledge about the health-disease process is fundamental. This article updates and demonstrates challenges in periodontal diagnosis, especially in Latin American countries. Considering that periodontal diagnosis should be based on knowledge of the etiopathogenesis of periodontal diseases, this article points out aspects developed in the last few years and emphasizes the knowledge that has been established, considering diagnosis of periodontal diseases. The evidence available stresses the importance of interviewing the patient, by implementing periodontal charting, and requesting any imaging and other complementary tests necessary. An important observation is that the partial periodontal data recordings used for screening (up to now) are not diagnostic methods and might underestimate disease. Moreover, in this article approaches to other forms of recognizing periodontal diseases are described, which could be used, however, not for the purpose of diagnosis, but for increasing awareness and eventually for referring individuals. In Latin American countries there is a need to increase the awareness of periodontal diseases among both the population and the profession, with particular emphasis on prioritizing correct periodontal diagnosis. In Dental education, strategies need to be established with the purpose of understanding that diagnosis is pivotal to any clinical approach.

Correlation of disulfidptosis and periodontitis: New insights and clinical significance

OBJECTIVES

This study aims to investigate and predict the therapeutic agents associated with disulfidptosis in periodontitis.

DESIGN

The dataset GSE10334 was downloaded from the Gene Expression Omnibus (GEO) database and used to train a least absolute shrinkage and selection operator (LASSO) regression and support vector machine recursive feature elimination (SVM-RFE) algorithm to identify genes associated with disulfidptosis in periodontitis. GSE16134 validation sets, polymerase chain reaction (PCR), and gingival immunofluorescence were used to verify the results.Single-gene Gene Set Enrichment Analysis (GSEA) was performed to explore the potential mechanisms and functions of the characterized genes. Immune infiltration and correlation analyses were performed, and competing endogenous RNA (ceRNA) networks were constructed. Effective therapeutic drugs were then predicted using the DGIdb database, and molecular docking was used to validate binding affinity.

RESULTS

Six genes (SLC7A11, SLC3A2, RPN1, NCKAP1, LRPPRC, and NDUFS1) associated with disulfidptosis in periodontitis were obtained. Validation results from external datasets and experiments were consistent with the screening results. Single-gene GSEA analysis was mainly enriched for antigen presentation and immune-related pathways and functions.Immune infiltration and correlation analyses revealed significant regulatory relationships between these genes and plasma cells, resting dendritic cell, and activated NK cells. The ceRNA network was visualized. And ME-344, NV-128, and RILUZOLE, which have good affinity to target genes, were identified as promising agents for the treatment of periodontitis.

CONCLUSIONS

SLC7A11, SLC3A2, RPN1, NCKAP1, LRPPRC, and NDUFS1 are targets associated with disulfidptosis in periodontitis, and ME-344, NV-128, and RILUZOLE are promising agents for the treatment of periodontitis.

Sleep and periodontal health

Sleep is fundamental for health and well-being. An adequate amount and quality of sleep is a cardinal component of a healthy lifestyle at the basis of the prevention of many non-communicable chronic diseases. Recent evidence suggests that sleep disorders, particularly obstructive sleep apnea, represent an emerging risk factor for periodontal health. This review article provides a critical appraisal of the existing literature concerning the association between sleep duration, sleep quality, sleep disorders in general, and obstructive sleep apnea with periodontal diseases, including gingivitis and periodontitis. The putative mechanisms underlying these associations are described as well as the potential clinical implications for diagnosis and treatment.

Periodontitis and Metabolic Control of Adults with Type 1 Diabetes

INTRODUCTION

Periodontitis has been reported with increased incidence and prevalence in patients with diabetes mellitus (DM). Noncommunicable diseases burden the South African public health system, and there are no data reporting on this relationship in this population. This is required to inform management protocols in type 1 diabetes mellitus (T1DM), which currently exclude the importance of periodontal treatment.

OBJECTIVES

The aim of this study was to determine whether there was an association between periodontitis and the glycemic control of adult patients with T1DM at a tertiary institution in South Africa.

METHODS

A cross-sectional study was conducted on adults diagnosed with T1DM. Bleeding on probing, periodontal pocket depth, and radiographical bone loss were assessed and the periodontal status of the patient was compared to their glycemic control, measured by HbA1c. An HbA1c level of ≤7% was considered to indicate adequate glycemic control.

RESULTS

There were 120 adult participants, of whom 61.7% (74) were female and 38.3% (46) were male. The majority were nonsmokers and younger than 44 y. There were 78 (65%) participants with uncontrolled blood glucose and 42 (35%) with good control (HbA1c ≤ 7%). The median HbA1c level was 8.75 (range, 6.1 to 12.2). Most participants (94%) had periodontitis, and 97% of them had uncontrolled blood glucose.

CONCLUSION

There was an association between percentage bleeding score (P < 0.001) and metabolic control in adults with T1DM treated at a tertiary hospital in Cape Town, South Africa. Periodontitis severity as described by staging was not associated with T1DM in this sample. The high prevalence of periodontitis in this sample (94%) highlights the need for periodontal management to form a part of holistic patient care in patients with T1DM in this setting.

KNOWLEDGE TRANSFER STATEMENT

The study results highlight the role of periodontitis severity and gingival bleeding scores on the metabolic control of adults with T1DM and thus emphasizes the importance of periodontal care in whole-person health in this patient population.

Using precision periodontal health care chart (PPHCC) to improve periodontal health

OBJECTIVES

Developing a Precision Periodontal Health Care Chart (PPHCC) in the electronic dental record (EDR) system and evaluating its clinical usability and effects on clinical outcomes.

MATERIALS AND METHODS

A survey with ten questions based on the System Usability Scale (SUS) and six questions about assessing clinical impact was used to evaluate the satisfaction of periodontitis patients and care providers with PPHCC before and after non-surgical periodontal therapy (NSPT). The clinical outcomes, including probing depth (PD), interdental clinical attachment loss (CAL), and bleeding on probing (BOP), in patients who used PPHCC (PC) were compared to those in patients without using PPHCC (control). The associations between risk assessments included in PPHCC and clinical outcomes of NSPT were also analyzed.

RESULTS

The mean scores of SUS questions at the initial periodontal examination were 74.26 ± 18.89 (n = 37) for patients and 88.31 ± 14.14 (n = 37) for care providers. The mean scores of SUS questions at re-evaluation were 74.84 ± 17.78 (n = 16) for patients and 89.63 ± 13.48 (n = 20) for care providers. The changes in the percentages of teeth with interdental CAL 1-2 mm (p = 0.019) and CAL 3-4 mm (p = 0.026) at the re-evaluation visit were significantly different between the PC and control groups, but the other parameters were not.

CONCLUSIONS

Both patients and care providers were satisfied with using PPHCC in the clinic. However, the short-term clinical outcomes in the PC group were similar to those in the control group.

CLINICAL RELEVANCE

PPHCC, as a tool for delivering clinical and educational information, can motivate patients to control periodontitis and assist clinicians in making a personalized treatment plan.

Link between periodontitis and diabetic retinopathy: Inflammatory pathways and clinical implications

The bidirectional relationship between periodontitis and type 2 diabetes mellitus has been well-established. However, the underlying molecular mechanisms remain unclear. Diabetic retinopathy (DR) is an important complication of diabetes, but there are few studies on the relationship between DR and periodontitis, especially on the intrinsic inflammatory pathway mechanism. This article reviews the latest clinical data on how diabetes promotes susceptibility to periodontitis from the epidemiological and molecular perspectives, with a special focus on the key roles of systemic inflammation and endothelial dysfunction in the interplay between DR and periodontitis. Comprehension of the intertwined pathogenesis of DR and periodontitis can better guide the development of comprehensive management strategies for glycemic control and periodontal health, with the aim of mitigating the progression of DR and enhancing overall well-being.

Pathogenic Mechanisms That May Link Periodontal Disease and Type 2 Diabetes Mellitus-The Role of Oxidative Stress

Given the posited role of oxidative stress in the pathogenesis of both periodontitis and type 2 diabetes mellitus (T2DM), it may also serve as a link between these highly prevalent chronic inflammatory diseases. This view is supported by an ample body of evidence indicating that the severity and progression of periodontitis is in part driven by diabetes, while periodontal infection may hinder the attainment of adequate glycemic control in diabetic patients. Thus, this review focuses on the potential synergistic interactions along the oxidative stress-inflammation pathway characterizing both conditions. Because periodontitis and T2DM share the same risk factors and compromise patients' quality of life, to develop effective strategies for combatting both conditions, their mutual influence needs to be explored.