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Ying XX, Hou Y, Zheng X, Ma JX, Wu ML, Liu M, Liu XY, Zhang KL. Exploring Putative Causal Associations between Diet and Periodontal Disease Susceptibility. JDR Clin Trans Res 2024:23800844241247485. [PMID: 38708597 DOI: 10.1177/23800844241247485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION Dietary factors may play an important role in periodontal health. However, current evidence from observational studies remains inconclusive. OBJECTIVE This study aimed to investigate the causal relationships between dietary exposures and periodontal disease risks using Mendelian randomization analysis. METHODS Large-scale genome-wide association study summary statistics for 20 dietary factors were obtained from the MRC-IEU consortium. Multivariable and univariable 2-sample Mendelian randomization analyses were performed to assess the causal effects of each dietary exposure on 6 periodontal outcomes, including gingivitis and periodontitis. RESULTS Genetically predicted higher dried fruit intake was significantly associated with reduced risks of acute gingivitis (odds ratio [OR]: 0.02; 95% confidence interval [CI]: 0.00-0.42; P = 0.01) and bleeding gums (OR: 0.96; 95% CI: 0.93-0.99; P = 0.01). Higher fresh fruit and water intake showed protective effects against chronic gingivitis (OR: 0.18; 95% CI: 0.04-0.91; P = 0.04 and OR: 0.15; 95% CI: 0.04-0.53; P = 0.00) and bleeding gums (OR: 0.95; 95% CI: 0.92-0.981; P = 0.00 and OR: 0.98; 95% CI: 0.96-0.99; P = 0.02). Alcohol intake frequency and processed meat intake were risk factors for bleeding gums (OR: 1.01; 95% CI: 1.00-1.02; P = 0.01 and OR: 1.05; 95% CI: 1.01-1.08; P = 0.00) and painful gums (OR: 1.01; 95% CI: 1.00-1.01; P = 0.00 and OR: 1.02; 95% CI: 1.01-1.03; P = 0.00). Most of the causal relationships between genetic predisposition to the specified dietary factors and periodontal diseases remained statistically significant (P < 0.05) after adjusting for genetic risks associated with dentures, smoking, and type 2 diabetes in multivariable Mendelian randomization models. CONCLUSIONS The findings suggest potential protective effects of higher fruit and water intake against gingivitis and other periodontal problems, while alcohol and processed meat intake may increase the risks of periodontal disease. Our study provides preliminary causal evidence on the effects of diet on periodontal health and could inform prevention strategies targeting dietary habits to improve oral health. KNOWLEDGE TRANSFER STATEMENT This study suggests that fruit and water intake may protect against periodontal disease, while alcohol and processed meats increase risk, informing dietary guidelines to improve oral health.
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Affiliation(s)
- X X Ying
- Department of Oral Prosthodontics, School of Stomatology, Dalian Medical University, Dalian, China
| | - Y Hou
- School of Stomatology, China Medical University, Shenyang, China
| | - X Zheng
- Department of Cell Biology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - J X Ma
- Department of Cell Biology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - M L Wu
- Department of Cell Biology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - M Liu
- Department of Cell Biology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - X Y Liu
- Department of Cell Biology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - K L Zhang
- Department of Cell Biology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
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Chechani B, Roat P, Hada S, Yadav DK, Kumari N. Psidium guajava: An Insight into Ethnomedicinal Uses, Phytochemistry, and Pharmacology. Comb Chem High Throughput Screen 2024; 27:2-39. [PMID: 37170987 DOI: 10.2174/1386207326666230426093315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND Psidium guajava (guava) is widely distributed in tropical and subtropical regions and adapted to various environmental conditions. Guava is an important economic fruit widely used as food and folk medicine. It contains flavonoids, alkaloids, tannins, triterpenoids, reducing sugars, essential oils, carotenoids, polyphenols, etc. The presence of triterpenoid acids such as guavacoumaric, ursolic, jacoumaric, guajavanoic, guavenoic, and Asiatic acids helps to develop novel drugs against various diseases. It is used traditionally for medicinal purposes, mainly for antioxidant, antimicrobial, antispasmodic, antidiabetic, anticancer, antiallergy, anti-inflammatory, and hepato-protective properties. OBJECTIVE The systematic literature study aims to summarize its botanical description, phytochemicals, pharmacological activities, and clinical trials. This review focuses on the plant's chemical composition and scientific approaches to human welfare. METHODS A systematic literature search was done on Psidium guajava through previous literature and online databases such as Google Scholar, Pubmed, Science Direct, etc., to explain its ethnomedicinal uses, phytochemistry, and pharmacological applications. RESULTS Previous literature studies of Psidium guajava suggest it can serve as antioxidant, antimicrobial, antispasmodic, antidiabetic, anticancer, anti-allergy, anti-inflammatory, and hepatoprotective effects. Successful clinical trials performed on the plant extracts against infantile rotaviral enteritis and infectious gastroenteritis showed future directions to work with the plant for clinical applications. CONCLUSION In this review, an attempt is made to show all literature studied, especially in phytochemistry, pharmacology, clinical trials and uses as traditional folk medicine around the world. The leaves have been used by folklore over the years to treat various ailments such as skin ulcers, diarrhoea, vaginal irritation, cough, conjunctivitis, etc. Further studies are required to explore more therapeutic remedies and to develop new medicines for future perspectives.
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Affiliation(s)
- Bhawna Chechani
- Department of Chemistry, Mohanlal Sukhadia University, Udaipur-313001, India
| | - Priyanka Roat
- Department of Chemistry, Mohanlal Sukhadia University, Udaipur-313001, India
| | - Sonal Hada
- Department of Chemistry, Mohanlal Sukhadia University, Udaipur-313001, India
| | - Dinesh Kumar Yadav
- Department of Chemistry, Mohanlal Sukhadia University, Udaipur-313001, India
| | - Neetu Kumari
- Department of Chemistry, Mohanlal Sukhadia University, Udaipur-313001, India
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Gawish AS, ElMofty MS, Jambi S, Felemban D, Ragheb YS, Elsayed SA. Phytotherapy in periodontics as an effective and sustainable supplemental treatment: a narrative review. J Periodontal Implant Sci 2023; 54:54.e1. [PMID: 38290997 DOI: 10.5051/jpis.2301420071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/27/2023] [Accepted: 11/02/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Periodontal disease is a chronic condition caused by microbial infection and mediated by the host's immune response. Phytotherapy is a therapeutic approach that utilizes a renewable resource capable of supplying less expensive medicines for the world's growing population. This review aimed to present clinical evidence on the use of complementary medicinal herbs in the treatment of periodontal diseases. METHODS Different databases were searched using the terms "herbal" and "periodontitis." All included studies were examined with a focus on herbal indications, type, and prescription length. Dentists' therapeutic and prophylactic herbal prescribing habits were also assessed. RESULTS Various herbs such as turmeric, neem, aloe-vera, pomegranate, catechu, tulsi, cloves, lemon grass, green tea, tea tree oil, peppermint, garlic, pineapple, oak bark, babul, bakul, sage, coriander, moringa, amla, guava, and grape seed extract have been used in the treatment of periodontitis. These herbs have been reported to exhibit a range of therapeutic effects, including anti-inflammatory, antiplaque, antihalitosis, antiresorptive, antioxidant, antibacterial, antifungal, antiviral, and antimicrobial properties. These components can be utilized in various forms such as mouth rinse, gel, oil, toothpaste, aqueous extract, mouthwash, or tooth powder. CONCLUSIONS Several readily available herbal formulations are now available on the market and have been shown to be effective as supplemental periodontal phytotherapy. However, these should be used under the supervision of a dental professional to ensure optimal benefits and effectiveness. Therefore, it is necessary to improve the understanding of suggested herbal prescription practices among dental professionals.
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Affiliation(s)
- Abeer Saad Gawish
- Dean of Postgraduate Faculty, Sinai University, El Arish Branch, El Arish, Egypt
- Department of Oral Medicine and Periodontology, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Sherif ElMofty
- Community Service and Environmental Development, Faculty of Dentistry, Nahda University, Beni Suef, Egypt
- Department of Oral Medicine, Periodontology and Oral Diagnosis Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Safa Jambi
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | - Doaa Felemban
- Department of Oral & Maxillofacial Diagnostic Sciences, College of Dentistry, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | | | - Shadia Abdelhameed Elsayed
- Department of Oral Medicine and Periodontology, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt
- Department of Oral & Maxillofacial Diagnostic Sciences, College of Dentistry, Taibah University, Almadinah Almunawwarah, Saudi Arabia.
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Staufenbiel I, Adam K, Hahn A, Kerlikowsky F, Flohr M, Schlueter N, Vach K. Influence of Nutrition and Physical Activity on Local and Systemic Inflammatory Signs in Experimentally Induced Gingivitis. Nutrients 2023; 15:3344. [PMID: 37571281 PMCID: PMC10420680 DOI: 10.3390/nu15153344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Although numerous studies have been published investigating the relationship between various dietary components and inflammatory periodontal disease, it has not yet been possible to clearly distinguish between periodontally healthy and unhealthy diets. This clinical study aimed to assess the association of specific food ingredients and physical activity on local and systemic inflammatory signs in experimentally induced gingivitis. Thirty-nine non-smoking periodontally healthy volunteers (mean age 23.2 ± 3.8 years) refrained from oral hygiene in the right maxilla for 21 days to induce an experimental gingivitis. Clinical examination (baseline and day 21) included plaque index, bleeding on probing (BOP), gingival crevicular fluid volume and high sensitive C-reactive protein levels (blood sample). Accompanying the intervention, volunteers documented with validated questionnaires their physical activity converted into metabolic equivalent (MET) and their nutrition converted into the dietary inflammatory index (DII). Significantly lower BOP (p = 0.039) was found for subjects with a more anti-inflammatory DII than for those with a more pro-inflammatory DII; higher MET values were correlated with lower BOP at day 21 (correlation coefficient -0.36). The results show an influence of nutrition and physical activity on periodontal inflammation signs. The DII may be a suitable parameter to verify the relationship between nutrition and inflammatory periodontal diseases.
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Affiliation(s)
- Ingmar Staufenbiel
- Hannover Medical School, Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.A.); (M.F.); (N.S.); (K.V.)
| | - Knut Adam
- Hannover Medical School, Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.A.); (M.F.); (N.S.); (K.V.)
| | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Am Kleinen Felde 30, 30167 Hannover, Germany; (A.H.); (F.K.)
| | - Felix Kerlikowsky
- Institute of Food Science and Human Nutrition, Am Kleinen Felde 30, 30167 Hannover, Germany; (A.H.); (F.K.)
| | - Marco Flohr
- Hannover Medical School, Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.A.); (M.F.); (N.S.); (K.V.)
| | - Nadine Schlueter
- Hannover Medical School, Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.A.); (M.F.); (N.S.); (K.V.)
| | - Kirstin Vach
- Hannover Medical School, Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.A.); (M.F.); (N.S.); (K.V.)
- Center for Dental Medicine, Department of Operative Dentistry and Periodontology, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
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Woelber JP, Reichenbächer K, Groß T, Vach K, Ratka-Krüger P, Bartha V. Dietary and Nutraceutical Interventions as an Adjunct to Non-Surgical Periodontal Therapy-A Systematic Review. Nutrients 2023; 15:nu15061538. [PMID: 36986267 PMCID: PMC10052653 DOI: 10.3390/nu15061538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
The aim of this study was to conduct a systematic literature review on the influence of dietary and nutraceutical interventions as an adjunct to non-surgical periodontal therapy (NSPT). A literature search for randomized, controlled clinical trials (RCTs) was performed in PubMed, the Cochrane Library, and the Web of Science. Trial inclusion criteria included the application of a defined nutritional intervention (food, beverages, or supplements) adjunctive to NSPT compared to NSPT alone with at least one measured periodontal parameter (pocket probing depths (PPD) or clinical attachment level (CAL)). Of 462 search results, 20 clinical trials relating to periodontitis and nutritional interventions were identified, of which, in total, 14 studies could be included. Eleven studies examined supplements containing lycopene, folate, chicory extract, juice powder, micronutrients and plant extracts, omega-3 fatty acids, vitamin E, or vitamin D. Three studies examined food-based interventions (kiwifruit, green or oolong tea). Due to limited information on within-group differences in the studies, results were descriptively analyzed. A significant positive effect on periodontal parameters (PPD, bleeding on probing) was found for vitamin E, chicory extract, juice powder, green tea, and oolong tea. Heterogeneous effects were found for lycopene, folate, omega-3 fatty acids, and vitamin D. No effects on PPD were found for adjunct kiwifruit (in combination with NSPT). Risk of bias via RoB2 revealed a low risk of bias with some concerns. There was a high heterogeneity in the type of nutritional interventions. The adjunctive use of various supplements and green/oolong tea led to positive and significant effects of the nutritional interventions on clinical periodontal outcome parameters. In the context of non-surgical periodontal therapy, an adjunctive intake of micronutrients, omega-3 fatty acids, green/oolong tea, and polyphenols and flavonoids could be beneficial. Long-term clinical studies with full data reports (especially within-group differences) are needed for conducting a meta-analysis.
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Affiliation(s)
- Johan Peter Woelber
- Department for Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 75, 79106 Freiburg, Germany
| | - Katharina Reichenbächer
- Department for Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 75, 79106 Freiburg, Germany
| | - Tara Groß
- Department for Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 75, 79106 Freiburg, Germany
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Zinkmattenstr. 6A, 79108 Freiburg, Germany
| | - Petra Ratka-Krüger
- Department for Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 75, 79106 Freiburg, Germany
| | - Valentin Bartha
- Department for Conservative Dentistry, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Gutierrez-Montiel D, Guerrero-Barrera AL, Chávez-Vela NA, Avelar-Gonzalez FJ, Ornelas-García IG. Psidium guajava L .: From byproduct and use in traditional Mexican medicine to antimicrobial agent. Front Nutr 2023; 10:1108306. [PMID: 36761221 PMCID: PMC9902774 DOI: 10.3389/fnut.2023.1108306] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/02/2023] [Indexed: 01/26/2023] Open
Abstract
Mexico is one of the largest guava producers in the world, so it has access to a huge amount of waste and byproducts obtained after the industrial processing of the fruit. This review discusses the potential recovery of this residue for its application as an antimicrobial agent, considering the phytochemical composition, the bioactivity reported in-vivo and in-vitro, and the toxicology of the plant. Nowadays there is a growing demand for more natural and safer products, so the use of guava extracts is an interesting initiative, especially due to its availability in the country, its wide variety of traditional uses, and its phytochemical profile. This review highlights the importance and potential antimicrobial use of this plant in today's world.
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Affiliation(s)
- Daniela Gutierrez-Montiel
- Laboratorio de Biología Celular y Tisular, Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - Alma L. Guerrero-Barrera
- Laboratorio de Biología Celular y Tisular, Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico,*Correspondence: Alma L. Guerrero-Barrera ✉
| | - Norma A. Chávez-Vela
- Laboratorio de Biotecnología, Departamento Ingeniería Bioquímica, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - Francisco J. Avelar-Gonzalez
- Laboratorio de Estudios Ambientales, Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - Ingrid G. Ornelas-García
- Laboratorio de Biología Celular y Tisular, Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
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Marmitt DJ. Potential plants for inflammatory dysfunction in the SARS-CoV-2 infection. Inflammopharmacology 2022; 30:749-773. [PMID: 35389124 PMCID: PMC8987270 DOI: 10.1007/s10787-022-00981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 11/24/2022]
Abstract
The inflammatory process is a biological response of the organism to remove injurious stimuli and initiate homeostasis. It has been recognized as a key player in the most severe forms of SARS-CoV-2, characterized by significantly increased pro-inflammatory cytokine levels, the so-called "cytokine storm" that appears to play a pivotal role in this disease. Therefore, the aim of this systematic review was to select clinical trials with anti-inflammatory plants and relate the activity of these plants to inflammatory markers of SARS-CoV-2 infection. PRISMA guidelines are followed, and studies of interest are indexed in PubMed and ClinicalTrials.gov databases. As a result, 32 clinical trials encompassing 22 plants were selected. The main anti-inflammatory mechanisms described in the studies are the inhibition of inflammatory cytokines, such as IL-6, TNF-a, IFN-γ, and IL-1; decreased CRP and oxidative marker levels; increased endogenous antioxidant levels; modulation of cardiovascular risk markers. The data found are not directly related to SARS-CoV-2 infection. However, they provide possibilities for new studies as plants have a wide array of phytochemicals, and detecting which ones are responsible for anti-inflammatory effects can provide invaluable contribution to studies aiming to evaluate efficacy in scenarios of SARS-CoV-2 infection.
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Affiliation(s)
- Diorge Jônatas Marmitt
- Programa de Pós-Graduação em Biotecnologia, Universidade Do Vale Do Taquari - Univates, Avelino Talini Street, 171, Lajeado, RS, 95914-014, Brazil.
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Takeda LN, Laurindo LF, Guiguer EL, Bishayee A, Araújo AC, Ubeda LCC, Goulart RDA, Barbalho SM. Psidium guajava L.: A Systematic Review of the Multifaceted Health Benefits and Economic Importance. FOOD REVIEWS INTERNATIONAL 2022. [DOI: 10.1080/87559129.2021.2023819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Larissa Naomi Takeda
- Department of Biochemistry, School of Food and Technology of Marília, University of Marília, São Paulo, Brazil
| | - Lucas Fornari Laurindo
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília, São Paulo, Brazil
| | - Elen Landgraf Guiguer
- Department of Biochemistry, School of Food and Technology of Marília, University of Marília, São Paulo, Brazil
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília, São Paulo, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil
| | - Anupam Bishayee
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Adriano Cressoni Araújo
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília, São Paulo, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil
| | | | - Ricardo de Alvares Goulart
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil
| | - Sandra Maria Barbalho
- Department of Biochemistry, School of Food and Technology of Marília, University of Marília, São Paulo, Brazil
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília, São Paulo, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil
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Hujoel PP, Kato T, Hujoel IA, Hujoel MLA. Bleeding tendency and ascorbic acid requirements: systematic review and meta-analysis of clinical trials. Nutr Rev 2021; 79:964-975. [PMID: 33517432 DOI: 10.1093/nutrit/nuaa115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
CONTEXT The World Health Organization set the recommended daily vitamin C intake, henceforth referred to as ascorbic acid (AA), on the basis of scurvy prevention. Double-blind AA depletion-repletion studies suggest that this recommended AA dose may be too low to prevent microvascular fragility. OBJECTIVES (1) To conduct a systematic review and meta-analysis of controlled clinical trials on whether AA supplementation leads to a reduced gingival bleeding tendency, a manifestation of microvascular fragility; and (2) to relate AA plasma levels to retinal hemorrhaging, another manifestation of microvascular fragility. DATA SOURCES Data were reviewed from 15 trials conducted in 6 countries with 1140 predominantly healthy participants with measures of gingival bleeding tendency, and from the National Health and Nutrition Examination Survey (NHANES) III of 8210 US residents with measures of retinal hemorrhaging. RESULTS In clinical trials, AA supplementation reduced gingival bleeding tendency when estimated baseline AA plasma levels were < 28 μmol/L (standardized mean difference [SMD], -0.83; 95%CI, -1.16 to -0.49; P < 0.002). Supplementation with AA did not unequivocally reduce gingival bleeding tendency when baseline estimated AA plasma levels were >48 μmol/L or unknown (respective standardized mean differences: -0.23, 95%CI, -0.45 to -0.01, P < 0.05; and -0.56; 95%CI: -1.19 to 0.06, P < 0.08). In NHANES III, prevalence of both retinal hemorrhaging and gingival bleeding tendency increased when AA plasma levels were within the range that protects against scurvy (11-28 μmol/L; respective prevalence ratios adjusted for age and sex: 1.47; 95%CI: 1.22-1.77; and 1.64; 95%CI: 1.32-2.03; P < 0.001 for both). CONCLUSION Consistent evidence from controlled clinical trials indicates that setting human AA requirements based on scurvy prevention leads to AA plasma levels that may be too low to prevent an increased gingival bleeding tendency. Gingival bleeding tendency and retinal hemorrhaging coincide with low AA plasma levels and thus may be reflective of a systemic microvascular pathology that is reversible with an increased daily AA intake.
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Affiliation(s)
- Philippe P Hujoel
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.,Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Tomotaka Kato
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Isabel A Hujoel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Margaux L A Hujoel
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Fageeh HN, Fageeh HI, Prabhu A, Bhandi S, Khan S, Patil S. Efficacy of vitamin C supplementation as an adjunct in the non-surgical management of periodontitis: a systematic review. Syst Rev 2021; 10:5. [PMID: 33397446 PMCID: PMC7780401 DOI: 10.1186/s13643-020-01554-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/02/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The antioxidant potential of vitamin C is useful in reducing oxidative stress, free radicals, and reactive oxygen species, which may assist in the improved outcomes of periodontal therapy. This systematic review was aimed to evaluate the effectiveness of vitamin C supplementation as an adjunct to non-surgical periodontal therapy, in the management of periodontitis. DATA SOURCES PubMed, EMBASE, Cochrane Library, and Web of Science. STUDY ELIGIBILITY CRITERIA Randomized controlled trials published between January 1990 and March 2020. PARTICIPANTS People 18 years and older with periodontitis. STUDY APPRAISAL AND SYNTHESIS METHODS The Critical Appraisal Skills Programme (CASP) quality appraisal tool. RESULTS The initial search yielded 441 articles out of which six studies fulfilled the inclusion criteria. Vitamin C supplementation helped improve bleeding indices in gingivitis but did not significantly lead to reduction of probing depths or clinical attachment gain for periodontitis. CONCLUSION Administration of vitamin C as an adjunct to non-surgical periodontal therapy did not result in clinically significant improvements in pocket probing depths at 3 months in periodontitis patients. With the limited evidence available, no recommendation can be made for supplementation of vitamin C in conjunction with initial periodontal therapy for subjects with periodontitis to improve primary treatment outcome measures.
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Affiliation(s)
- Hytham N Fageeh
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Hammam I Fageeh
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ashwin Prabhu
- Department of Periodontics, KLE Society's Institute of Dental Sciences, Bangalore, India
| | - Shilpa Bhandi
- Department of Restorative Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Shahrukh Khan
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Shankargouda Patil
- Department of Maxillofacial Surgery & Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia.
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11
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Aghazada R, Marini L, Zeza B, Trezza C, Vestri A, Mariotti A, Pilloni A. Experimental gingivitis in patients with and without altered passive eruption. J Periodontol 2019; 91:938-946. [PMID: 31833068 DOI: 10.1002/jper.19-0443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/25/2019] [Accepted: 12/06/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Individuals with altered passive eruption (APE) are assumed to be more susceptible to periodontal diseases. To date, this hypothesis has not been sufficiently supported by scientific evidence. The aim of this study, using an experimental gingivitis model, was to examine the development and resolution of gingival inflammation in patients with APE when compared to patients with normal gingival anatomy. METHODS A localized experimental gingivitis was induced in 9 patients with APE (test group) and 9 patients without APE (control group) in the maxillary right quadrant. After 21 days, patients were instructed to resume proper home oral hygiene procedures. At baseline (day 0) and at days 7, 14, 21, 28, 35, and 42, plaque index (PlI), gingival index (GI), and gingival crevicular fluid volume (GCF) were evaluated for teeth 6 (canine), 7 (lateral incisor) and 8 (central incisor) of test and control groups. RESULTS During the experimental gingivitis phase (days 0 to 21), the rate of change in gingival inflammation (GI) was dramatically different between the APE test group and the control group. On day 21, at the time of maximum plaque accumulation, the GI of the APE test group was a 109% greater than the GI of the test group (P ≤ 0.001) despite similar plaque levels (P = 0.436). During the resolution of inflammation phase (days 22 to 42), the APE test group continued to exhibit statistically higher GI scores than the control group (P = 0.029). CONCLUSION In the presence of similar amounts of plaque deposits and plaque accumulation rates, APE patients exhibited differences in the development and resolution of plaque-induced gingival inflammation when compared to controls.
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Affiliation(s)
- Rustam Aghazada
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Lorenzo Marini
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Blerina Zeza
- Division of Periodontology, Department of Dentistry, Albanian University, Tirana, Albania
| | - Cinzia Trezza
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Annarita Vestri
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Angelo Mariotti
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH
| | - Andrea Pilloni
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy.,Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH
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