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Tonetti MS. Dental Pathophysiology of Odontogenic Sinusitis: Periodontitis. Otolaryngol Clin North Am 2024:S0030-6665(24)00117-8. [PMID: 39227245 DOI: 10.1016/j.otc.2024.07.020] [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: 09/05/2024]
Abstract
Periodontitis is a highly prevalent oral microbial biofilm-driven chronic inflammatory disease. If unmanaged, periodontitis leads to progressive destruction of the ligamentous attachments of teeth to the alveolar bone and resorption of the alveolar bone. It eventually leads to tooth hypermobility and loss. Periodontitis commonly causes overlying maxillary sinus inflammation (mucositis), reflected on radiographic imaging as maxillary sinus mucosal thickening. While uncommon, advanced periodontitis (stage III/IV) or chronic perio-endo lesions can lead to purulent odontogenic sinusitis (ODS). This article describes periodontitis pathophysiology, diagnostic features, and its potential to cause ODS. Clinical practice guideline conform therapy is very successful in managing periodontitis and enabling long-term tooth retention. Localized tooth extration is reserved to end-stage disease.
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Affiliation(s)
- Maurizio S Tonetti
- Shanghai Perio-Implant Innovation Center, Institute for Integrated Oral-Craniofacial and Multisensory Research, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center of Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China; European Research Group on Periodontology, Genova, Italy.
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Wiernik E, Renuy A, Kab S, Steg PG, Goldberg M, Zins M, Caligiuri G, Bouchard P, Carra MC. Prevalence of self-reported severe periodontitis: Data from the population-based CONSTANCES cohort. J Clin Periodontol 2024; 51:884-894. [PMID: 38430050 DOI: 10.1111/jcpe.13969] [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: 06/29/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 03/03/2024]
Abstract
AIM To assess the prevalence of severe periodontitis based on the population-based CONSTANCES cohort using a validated self-reported questionnaire. MATERIALS AND METHODS Individuals were selected from the adult population in France using a random sampling scheme. Analyses were restricted to those invited in 2013-2014 who completed the periodontal health questionnaire at the 2017 follow-up. The risk of severe periodontitis was assessed using the periodontal screening score (PESS) and weighting coefficients were applied to provide representative results in the general French population. RESULTS The study included 19,859 participants (9204 men, mean age: 52.8 ± 12.6 years). Based on a PESS ≥ 5, 7106 participants were at risk of severe periodontitis, corresponding to a weighted prevalence of 31.6% (95% confidence interval: 30.6%-32.7%). This prevalence was higher among participants aged 55 and over, those with lower socio-economic status as well as current smokers, e-cigarette users and heavy drinkers. Among individuals at risk of severe periodontitis, only 18.8% (17.3%-20.4%) thought they had gum disease, although 50.5% (48.6%-52.5%) reported that their last dental visit was less than 6 months. CONCLUSIONS The present survey indicates that (1) self-reported severe periodontitis is highly prevalent with marked disparities between groups in the general French adult population, and (2) periodontitis could frequently be under-diagnosed given the low awareness.
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Affiliation(s)
- Emmanuel Wiernik
- UMS 011 Population-based Cohorts Unit, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Paris, France
| | - Adeline Renuy
- UMS 011 Population-based Cohorts Unit, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Paris, France
| | - Sofiane Kab
- UMS 011 Population-based Cohorts Unit, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Paris, France
| | - Philippe Gabriel Steg
- UFR de Médecine, Université Paris-Cité, Paris, France
- Cardiology Department, AP-HP, Hôpital Bichat, Paris, France
- Laboratory for Vascular Translational Science, INSERM U1148, Paris, France
- Institut Universitaire de France, Paris, France
| | - Marcel Goldberg
- UMS 011 Population-based Cohorts Unit, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Paris, France
| | - Marie Zins
- UMS 011 Population-based Cohorts Unit, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Paris, France
- UFR de Médecine, Université Paris-Cité, Paris, France
| | - Giuseppina Caligiuri
- UFR de Médecine, Université Paris-Cité, Paris, France
- Cardiology Department, AP-HP, Hôpital Bichat, Paris, France
- Laboratory for Vascular Translational Science, INSERM U1148, Paris, France
| | - Philippe Bouchard
- UFR of Odontology, Université Paris Cité, Paris, France
- URP 2496, Montrouge, France
| | - Maria Clotilde Carra
- UMS 011 Population-based Cohorts Unit, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Paris, France
- UFR of Odontology, Université Paris Cité, Paris, France
- Service of Odontology, Rothschild Hospital (AP-HP) and Department of Periodontology, UFR of Odontology, Université Paris Cité, Paris, France
- INSERM-Sorbonne Paris Cité Epidemiology and Statistics Research Centre, Paris, France
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Li Y, Wu X, Liu M, Deng K, Tullini A, Zhang X, Shi J, Lai H, Tonetti MS. Enhanced control of periodontitis by an artificial intelligence-enabled multimodal-sensing toothbrush and targeted mHealth micromessages: A randomized trial. J Clin Periodontol 2024. [PMID: 38631679 DOI: 10.1111/jcpe.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/19/2024]
Abstract
AIM Treatment of periodontitis, a chronic inflammatory disease driven by biofilm dysbiosis, remains challenging due to patients' poor performance and adherence to the necessary oral hygiene procedures. Novel, artificial intelligence-enabled multimodal-sensing toothbrushes (AI-MST) can guide patients' oral hygiene practices in real-time and transmit valuable data to clinicians, thus enabling effective remote monitoring and guidance. The aim of this trial was to assess the effect of such a system as an adjunct to clinical practice guideline-conform treatment. MATERIALS AND METHODS This was a single-centre, double-blind, standard-of-care controlled, randomized, parallel-group, superiority trial. Male and female adults with generalized Stage II/III periodontitis were recruited at the Shanghai Ninth People's Hospital, China. Subjects received a standard-of-care oral hygiene regimen or a technology-enabled, theory-based digital intervention consisting of an AI-MST and targeted doctor's guidance by remote micromessaging. Additionally, both groups received guideline-conform periodontal treatment. The primary outcome was the resolution of inflamed periodontal pockets (≥4 mm with bleeding on probing) at 6 months. The intention-to-treat (ITT) analysis included all subjects who received the allocated treatment and at least one follow-up. RESULTS One hundred patients were randomized and treated (50 tests/controls) between 1 February and 30 November 2022. Forty-eight tests (19 females) and 47 controls (16 females) were analysed in the ITT population. At 6 months, the proportion of inflamed periodontal pockets decreased from 80.7% (95% confidence interval [CI] 76.5-84.8) to 52.3% (47.7-57.0) in the control group, and from 81.4% (77.1-85.6) to 44.4% (39.9-48.9) in the test group. The inter-group difference was 7.9% (1.6-14.6, p < .05). Test subjects achieved better levels of oral hygiene (p < .001). No significant adverse events were observed. CONCLUSIONS The tested digital health intervention significantly improved the outcome of periodontal therapy by enhancing the adherence and performance of self-performed oral hygiene. The model breaks the traditional model of oral health care and has the potential to improve efficiency and reduce costs (NCT05137392).
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Affiliation(s)
- Yuan Li
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xinyu Wu
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Min Liu
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Ke Deng
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Annamaria Tullini
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xiao Zhang
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Junyu Shi
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Hongchang Lai
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Maurizio S Tonetti
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- European Research Group on Periodontology, Genova, Italy
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Marini L, Tonetti MS, Nibali L, Sforza NM, Landi L, Cavalcanti R, Rojas MA, Pilloni A. Implementation of a software application in staging and grading of periodontitis cases. Oral Dis 2024; 30:719-728. [PMID: 36083695 DOI: 10.1111/odi.14370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the diagnostic accuracy and the inter-rater agreement among general dentists when staging and grading periodontitis cases with the aid of a software application (SA) developed by the Italian Society of Periodontology and Implantology. MATERIALS AND METHODS Ten general dentists were asked to independently assess 25 periodontitis cases using the SA. Accuracy was estimated using quadratic weighted kappa and examiners' percentage of agreement with a reference diagnosis provided by a gold standard examiner. Inter-rater agreement was evaluated using Fleiss kappa statistics. RESULTS The overall case definition agreed with the reference diagnosis in 53.6% of cases. The agreements for each general dentist's pairwise comparisons against the reference definition were at least substantial in 100% of cases for stage, in 70% of cases for grade and in none of the cases for extent. Fleiss kappa was 0.818, 0.608, and 0.632 for stage, extent, and grade, respectively. The study recognized possible reasons that could lead to decreased accuracy using the SA. CONCLUSIONS Supported by the SA, general dentists have reached substantial inter-rater agreement and highly accurate assignments of stage and grade. However, complete case definitions were correctly diagnosed in slightly over half of the cases.
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Affiliation(s)
- Lorenzo Marini
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Maurizio S Tonetti
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Stomatology, Shanghai Ninth People Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dental and Craniofacial Sciences, King's College London, London, UK
| | | | | | - Raffaele Cavalcanti
- Section of Periodontology, Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Mariana A Rojas
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Pilloni
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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Liu Y, Qin H, Li T, Feng C, Han H, Cao Y, Su Y, He H, Yuan C, Sun M, Clarke R, Gan W, Tonetti M, Zong G. Denture use and risk for cardiometabolic disease: observational and Mendelian randomization analyses. Eur J Prev Cardiol 2024; 31:13-20. [PMID: 37697428 PMCID: PMC10767255 DOI: 10.1093/eurjpc/zwad295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/13/2023] [Accepted: 09/07/2023] [Indexed: 09/13/2023]
Abstract
AIMS Denture use may potentially increase the risk of cardiometabolic diseases (CMDs), but the casual relevance and strength of the associations are currently unknown. METHODS AND RESULTS A total of 495 938 participants from the UK Biobank were included in the observational analyses. Linkage disequilibrium score (LDSC) regression and Mendelian randomization analyses were employed to estimate genetic correlation and the associations between the genetic liability for denture use with coronary artery disease, myocardial infarction, heart failure (HF), any stroke (AS), ischaemic stroke, haemorrhagic stroke, type 2 diabetes (T2D), and related clinical risk factors. In observational analysis, denture use was associated with 14-25% higher risks of various CMDs. The LDSC analysis found that denture use showed a positive genetic correlation with CMDs (rg 0.21-0.38). Genetic liability for denture use was associated with an elevated risk of HF [odds ratio: 1.49 (1.20-1.83)] and T2D [1.11 (1.01-1.24)]. By integrating genetic summary data of denture use with the sum of decayed, missing, and filled tooth surfaces (DMFS), a clinical measure of dental caries obtained from an independent source, genetically determined denture use/DMFS was also associated with an elevated risk of AS [1.21 (1.04-1.40)]. Furthermore, genetically predicted denture use/DMFS was significantly associated with established cardiometabolic risk factors, including HDL cholesterol, triglycerides, waist circumference, waist-to-hip ratio, and height. CONCLUSION Our study supported potential causal associations between the genetic liability for denture use and risks for HF, AS, T2D, and related clinical risk factors. These findings may inform prevention and intervention strategies targeting dental diseases and CMDs.
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Affiliation(s)
- Yunan Liu
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Haiqiang Qin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Tongtong Li
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Chengwu Feng
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Han Han
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Yaying Cao
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Yang Su
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Haihao He
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Changzheng Yuan
- Department of Big Data in Health Science, Zhejiang University School of Public Health, Hangzhou, Zhejiang 310058, China
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Meng Sun
- NHS Blood and Transplant (NHSBT) Blood Donor Centre, John Radcliffe Hospital, Oxford OX39BQ, UK
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX37LF, UK
- Medical Research Council, Population Health Research Unit, University of Oxford, Old Road Campus, Headington, Oxford OX37LF, UK
| | - Wei Gan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX37LF, UK
- Medical Research Council, Population Health Research Unit, University of Oxford, Old Road Campus, Headington, Oxford OX37LF, UK
- Genetics Department, Novo Nordisk Research Centre Oxford, Innovation Building, Old Road Campus, Headington, Oxford OX37LQ, UK
| | - Maurizio Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Oral Diseases, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
- European Research Group on Periodontology, WTC Tower Genoa, Via De Marini, 1-16149 Genoa, Italy
| | - Geng Zong
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China
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Broomhead T, Gibson BJ, Parkinson C, Robinson PG, Vettore MV, Baker SR. Development and psychometric validation of the gum health experience questionnaire. J Clin Periodontol 2024; 51:33-42. [PMID: 37735867 DOI: 10.1111/jcpe.13878] [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: 01/25/2023] [Revised: 07/10/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023]
Abstract
AIM To develop and validate a new health-related quality of life measure to capture a wide range of gum-related impacts. MATERIALS AND METHODS The measure was developed using a multi-stage approach and a theoretical model. Development involved semi-structured interviews, pilot testing, cross-sectional analysis among a general population (n = 152) to assess psychometric properties and test-retest reliability among a subsample (n = 27). RESULTS Psychometric analysis supports the validity and reliability of the measure's impact scale. The measure has excellent internal reliability (nearly all item-total correlations above .4; Cronbach's alpha between .84 and .91 for subscales), with test-retest reliability also performing well (Intra-class correlation coefficient [ICC] of .91-.97 for subscales). Good content validity (indicated by large standard deviations for item and total scores) and construct validity (correlations of .54-.73 with global gum health rating for subscales, all p < .05) were also observed. Qualitative and quantitative data indicate that people with gum health-related symptoms experience different degrees of discomfort and impacts caused by their condition. CONCLUSIONS The gum health experience questionnaire holds substantial promise as a measure of gum-related quality of life in people across the gum health-disease continuum. Further face validity, refining and reducing the number of items and longitudinal studies to test evaluative properties are required before the measure can be used with confidence.
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Affiliation(s)
- T Broomhead
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - B J Gibson
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | | | - P G Robinson
- Bristol Dental School, University of Bristol, Bristol, UK
| | - M V Vettore
- Department of Health and Nursing Sciences, Universitet i Agder, Kristiansand, Norway
| | - S R Baker
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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Larvin H, Kang J, Aggarwal VR, Pavitt S, Wu J. Periodontitis and risk of immune-mediated systemic conditions: A systematic review and meta-analysis. Community Dent Oral Epidemiol 2023; 51:705-717. [PMID: 36377800 DOI: 10.1111/cdoe.12812] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/22/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of this review is to examine and quantify the long-term risk of immune-mediated systemic conditions in people with periodontitis compared to people without periodontitis. METHODS Medline, EMBASE and Cochrane databases were searched up to June 2022 using keywords and MeSH headings. The 'Risk of Bias in Non-Randomised Studies of Interventions' tool was used to assess bias. Cohort studies comparing incident metabolic/autoimmune/inflammatory diseases in periodontitis to healthy controls were included. Meta-analysis and meta-regression quantified risks and showed impact of periodontitis diagnosis type and severity. RESULTS The search retrieved 3354 studies; 166 studies were eligible for full-text screening, and 30 studies were included for review. Twenty-seven studies were eligible for meta-analysis. The risks of diabetes, rheumatoid arthritis (RA) and osteoporosis were increased in people with periodontitis compared to without periodontitis (diabetes-relative risk [RR]: 1.22, 95% CI: 1.13-1.33; RA-RR: 1.27, 95% CI: 1.07-1.52; osteoporosis-RR: 1.40, 95% CI: 1.12-1.75). Risk of diabetes showed gradient increase by periodontitis severity (moderate-RR = 1.20, 95% CI = 1.11-1.31; severe-RR = 1.34, 95% CI = 1.10-1.63). CONCLUSION People with moderate-to-severe cases of periodontitis have the highest risk of developing diabetes, while the effect of periodontal severity on risk of other immune-mediated systemic conditions requires further investigation. More homologous evidence is required to form robust conclusions regarding periodontitis-multimorbidity associations.
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Affiliation(s)
| | - Jing Kang
- Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | | | - Susan Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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Enevold C, Nielsen CH, Christensen LB, Kongstad J, Fiehn NE, Hansen PR, Holmstrup P, Havemose-Poulsen A, Damgaard C. Suitability of machine learning models for prediction of clinically defined Stage III/IV periodontitis from questionnaires and demographic data in Danish cohorts. J Clin Periodontol 2023. [PMID: 37691160 DOI: 10.1111/jcpe.13874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/14/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
AIM To evaluate if, and to what extent, machine learning models can capture clinically defined Stage III/IV periodontitis from self-report questionnaires and demographic data. MATERIALS AND METHODS Self-reported measures of periodontitis, demographic data and clinically established Stage III/IV periodontitis status were extracted from two Danish population-based cohorts (The Copenhagen Aging and Midlife Biobank [CAMB] and The Danish Health Examination Survey [DANHES]) and used to develop cross-validated machine learning models for the prediction of clinically established Stage III/IV periodontitis. Models were trained using 10-fold cross-validations repeated three times on the CAMB dataset (n = 1476), and the resulting models were validated in the DANHES dataset (n = 3585). RESULTS The prevalence of Stage III/IV periodontitis was 23.2% (n = 342) in the CAMB dataset and 9.3% (n = 335) in the DANHES dataset. For the prediction of clinically established Stage III/IV periodontitis in the CAMB cohort, models reached area under the receiver operating characteristics (AUROCs) of 0.67-0.69, sensitivities of 0.58-0.64 and specificities of 0.71-0.80. In the DANHES cohort, models derived from the CAMB cohort achieved AUROCs of 0.64-0.70, sensitivities of 0.44-0.63 and specificities of 0.75-0.84. CONCLUSIONS Applying cross-validated machine learning algorithms to demographic data and self-reported measures of periodontitis resulted in models with modest capabilities for the prediction of Stage III/IV periodontitis in two Danish cohorts.
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Affiliation(s)
- C Enevold
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - C H Nielsen
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Copenhagen, Denmark
- Research Area Periodontology, Section for Oral Biology and Immunopathology, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L B Christensen
- Research Area Periodontology, Section for Oral Biology and Immunopathology, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J Kongstad
- Research Area Periodontology, Section for Oral Biology and Immunopathology, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - N E Fiehn
- Costerton Biofilm Centre, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - P R Hansen
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Holmstrup
- Research Area Periodontology, Section for Oral Biology and Immunopathology, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A Havemose-Poulsen
- Research Area Periodontology, Section for Oral Biology and Immunopathology, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - C Damgaard
- Research Area Periodontology, Section for Oral Biology and Immunopathology, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Sáenz-Ravello G, Matamala L, Cisternas P, Gamonal J, Hernández P, Santos NCD, Deng K, Baeza M. Association between the Mediterranean Diet Index and self-reported Gingival Health Status Indicators in a population of Chilean adults: a cross-sectional study. J Appl Oral Sci 2023; 31:e20230100. [PMID: 37403879 DOI: 10.1590/1678-7757-2023-0100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Despite the recognized impact of diet on non-communicable diseases, the association between the Mediterranean diet and periodontal diseases is still uncertain. This study aimed to determine the association between adherence to the Mediterranean Diet Index (MDI) and self-reported gingival health status in Chilean adults, exploring the feasibility of using validated web-based survey questionnaires. METHODOLOGY Cross-sectional data were collected from a representative sample of a population of Chilean adults (18-60 years old) using a low-cost and time-saving methodology. By the PsyToolkit platform, anonymous survey data were downloaded and analyzed in bivariate (crude) and backward stepwise selection multivariate logistic regression models adjusted for sociodemographic determinants, smoking, and dental attendance using STATA 17. Odds ratios (OR) [95% confidence intervals] were estimated. RESULTS In total, 351 complete statistical data were mostly obtained from female university students who had never smoked and reported having visited a dentist in the previous year. Multivariate regression models showed an association between MDI and very good/good gingival health status (OR 1.18 [95% CI 1.04-1.34], p=0.013), absence of bleeding on toothbrushing (OR 1.12 [95% CI 1.01-1.25], p=0.035), and absence of clinical signs of gingival inflammation (OR 1.24 [95% CI 1.10-1.40], p<0.001), after controlling for age, sex, educational level, smoking, and dental attendance. CONCLUSIONS We associated adherence to the Mediterranean diet with better self-reported gingival health status in a population of Chilean adults in an entirely web-based research environment. Longitudinal studies with random sampling are required to establish the effect of diet on gingival and periodontal health. Nevertheless, this evidence could contribute to the design of low-cost surveillance programs to reduce the burden of periodontal disease and related "common risk factors".
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Affiliation(s)
- Gustavo Sáenz-Ravello
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiologia y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Departmento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Santiago, Chile
| | - Loreto Matamala
- Universidad de Chile, Facultad de Odontología, Departmento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Santiago, Chile
| | | | - Jorge Gamonal
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiologia y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Departmento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Santiago, Chile
| | - Patricia Hernández
- Universidad de Chile, Facultad de Odontología, Departmento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Santiago, Chile
| | - Nidia Castro Dos Santos
- Universidade Guarulhos, Divisão de Pesquisa Odontológica, Guarulhos, SP, Brasil
- The Forsyth Institute, Cambridge, MA, United States
| | - Ke Deng
- The University of Hong Kong, Faculty of Dentistry, Division of Periodontology and Implant Dentistry, Hong Kong SAR, China
| | - Mauricio Baeza
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiologia y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Departmento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Santiago, Chile
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10
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Kurushima Y, Wells P, Bowyer R, Zoheir N, Doran S, Richardson J, Sprockett D, Relman D, Steves C, Nibali L. Host Genotype Links to Salivary and Gut Microbiota by Periodontal Status. J Dent Res 2023; 102:146-156. [PMID: 36214094 PMCID: PMC9986680 DOI: 10.1177/00220345221125402] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Limited evidence describing how host genetic variants affect the composition of the microbiota is currently available. The aim of this study was to assess the associations between a set of candidate host genetic variants and microbial composition in both saliva and gut in the TwinsUK registry. A total of 1,746 participants were included in this study and provided stool samples. A subset of 1,018 participants also provided self-reported periodontal data, and 396 of those participants provided a saliva sample. Host DNA was extracted from whole-blood samples and processed for Infinium Global screening array, focusing on 37 selected single-nucleotide polymorphisms (SNPs) previously associated with periodontitis. The gut and salivary microbiota of participants were profiled using 16S ribosomal RNA amplicon sequencing. Associations between genotype on the selected SNPs and microbial outcomes, including α diversity, β diversity, and amplicon sequence variants (ASVs), were investigated in a multivariate mixed model. Self-reported periodontal status was also compared with microbial outcomes. Downstream analyses in gut microbiota and salivary microbiota were carried out separately. IL10 rs6667202 and VDR 2228570 SNPs were associated with salivary α diversity, and SNPs in IL10, HSA21, UHRF2, and Fc-γR genes were associated with dissimilarity matrix generated from salivary β diversity. The SNP that was associated with the greatest number of salivary ASVs was VDR 2228570 followed by IL10 rs6667202, and that of gut ASVs was NPY rs2521364. There were 77 salivary ASVs and 39 gut ASVs differentially abundant in self-reported periodontal disease versus periodontal health. The dissimilarity between saliva and gut microbiota within individuals appeared significantly greater in self-reported periodontal cases compared to periodontal health. IL10 and VDR gene variants may affect salivary microbiota composition. Periodontal status may drive variations in the salivary microbiota and possibly, to a lesser extent, in the gut microbiota.
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Affiliation(s)
- Y. Kurushima
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King’s College London, London, UK
| | - P.M. Wells
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King’s College London, London, UK
| | - R.C.E. Bowyer
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King’s College London, London, UK
| | - N. Zoheir
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
| | - S. Doran
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
| | - J.P. Richardson
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
| | - D.D. Sprockett
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - D.A. Relman
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - C.J. Steves
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King’s College London, London, UK
| | - L. Nibali
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
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11
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Broomhead T, Gibson B, Parkinson CR, Vettore MV, Baker SR. Gum health and quality of life—subjective experiences from across the gum health-disease continuum in adults. BMC Oral Health 2022; 22:512. [PMCID: PMC9675234 DOI: 10.1186/s12903-022-02507-5] [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: 05/06/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background There has been a lack of qualitative work investigating the effects of the wide range of gum-related symptoms, and the perceived everyday impacts associated with these including on quality of life. While periodontal disease has been shown to have significant effects on quality of life, fewer studies have researched the perceived impacts of gingivitis and symptoms from across the entire gum health-disease continuum, despite evidence that these can also negatively affect quality of life. The aim of this study was to investigate perceived everyday impacts and explore the subjective experiences of adults with a variety of symptoms from across the self-reported gum health-disease continuum, and how these may affect quality of life. Methods Participants were recruited at a large UK University using purposive sampling, for self-reported symptoms ranging from mild gingivitis to severe periodontal disease. Semi-structured interviews gathered details on symptom history, changes occurring over time and associated beliefs, as well as perceived impacts on everyday life, and links between these experiences and identity. Interviews were analysed using framework analysis based on the Wilson and Cleary health-related quality of life model. Results Twenty-seven participants were recruited − 15 with symptoms of gingivitis, 12 with more severe periodontal symptoms. Prominent themes included description of symptoms, changes in daily life, social impacts, psychological impacts, identity, and overall impacts and quality of life. Differences were noted in severity, extent and frequency of symptoms and participant experiences, with greater perceived impacts often felt by those with periodontal disease. However, participants from across the gum health-disease continuum often expressed similar experiences and concerns. Conclusion Findings demonstrate the range of experiences from participants with a variety of gum-related symptoms; notably, gingivitis was reported to have a range of perceived impacts on quality of life alongside those reported by periodontal disease sufferers. Future work should look to include symptoms from across the entire gum health-disease continuum when considering quality of life, as well as considering a more patient-centred approach which could be valuable in both clinical and research settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02507-5.
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Affiliation(s)
- Tom Broomhead
- grid.11835.3e0000 0004 1936 9262Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - B Gibson
- grid.11835.3e0000 0004 1936 9262Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | | | - MV Vettore
- grid.23048.3d0000 0004 0417 6230Department of Health and Nursing Sciences, Universitet i Agder, Kristiansand, Norway
| | - SR Baker
- grid.11835.3e0000 0004 1936 9262Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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12
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Wadhwa S, Dave S, Daily M, Nardone A, Li R, Rosario J, Cantos A, Shah J, Lu H, McMahon D, Yin M. The Role of Oral Health in the Acquisition and Severity of SARS-CoV-2: A Retrospective Chart Review. Saudi Dent J 2022; 34:596-603. [PMID: 35974970 PMCID: PMC9371763 DOI: 10.1016/j.sdentj.2022.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/29/2022] [Accepted: 08/07/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Studies have shown that gingival crevices may be a significant route for SARS-CoV-2 entry. However, the role of oral health in the acquisition and severity of COVID-19 is not known. Design A retrospective analysis was performed using electronic health record data from a large urban academic medical center between 12/1/2019 and 8/24/2020. A total of 387 COVID-19 positive cases were identified and matched 1:1 by age, sex, and race to 387 controls without COVID-19 diagnoses. Demographics, number of missing teeth and alveolar crestal height were determined from radiographs and medical/dental charts. In a subgroup of 107 cases and controls, we also examined the rate of change in alveolar crestal height. A conditional logistic regression model was utilized to assess association between alveolar crestal height and missing teeth with COVID-19 status and with hospitalization status among COVID-19 cases. Results Increased alveolar bone loss, OR = 4.302 (2.510 - 7.376), fewer missing teeth, OR = 0.897 (0.835-0.965) and lack of smoking history distinguished COVID-19 cases from controls. After adjusting for time between examinations, cases with COVID-19 had greater alveolar bone loss compared to controls (0.641 ± 0.613 mm vs 0.260 ± 0.631 mm, p < 0.01.) Among cases with COVID-19, increased number of missing teeth OR = 2.1871 (1.146- 4.174) was significantly associated with hospitalization. Conclusions Alveolar bone loss and missing teeth are positively associated with the acquisition and severity of COVID-19 disease, respectively.
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Affiliation(s)
- S. Wadhwa
- Division of Growth and Development, Columbia University College of Dental Medicine, New York, NY, USA
| | - S. Dave
- Division of Growth and Development, Columbia University College of Dental Medicine, New York, NY, USA
| | - M.L. Daily
- Division of Growth and Development, Columbia University College of Dental Medicine, New York, NY, USA
| | - A. Nardone
- Division of Growth and Development, Columbia University College of Dental Medicine, New York, NY, USA
| | - R. Li
- Division of Growth and Development, Columbia University College of Dental Medicine, New York, NY, USA
| | - J. Rosario
- Division of Growth and Development, Columbia University College of Dental Medicine, New York, NY, USA
| | - A. Cantos
- Department of Medicine Infectious Disease, Columbia University Irving Medical Center, New York, NY, USA
| | - J. Shah
- Department of Medicine Infectious Disease, Columbia University Irving Medical Center, New York, NY, USA
| | - H.H. Lu
- Division of Growth and Development, Columbia University College of Dental Medicine, New York, NY, USA
| | - D.J. McMahon
- Department of Medicine Infectious Disease, Columbia University Irving Medical Center, New York, NY, USA
| | - M.T. Yin
- Department of Medicine Infectious Disease, Columbia University Irving Medical Center, New York, NY, USA
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13
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Li H, Zhao D, Xu X, Yu R, Zhang F, Cheng T, Zheng Z, Yang H, Yang C, Yao J, Wen P, Jin L. Diagnostic performance of the AAP/EFP classification and the CDC/AAP case definition among pregnant women and a practical screening tool for maternal periodontal diseases. J Periodontal Res 2022; 57:960-968. [PMID: 35815371 PMCID: PMC9543595 DOI: 10.1111/jre.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/20/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE There is a limited number of studies on the performance assessment of the 2017 AAP/EFP classification and the CDC/AAP case definition among pregnant females. This study evaluated the agreement between these two systems and explored a practical tool for screening maternal periodontal diseases by general dentists. MATERIALS AND METHODS Totally, 204 systemically healthy females at different phases of pregnancy underwent a full-mouth periodontal examination. Demographic characteristics, lifestyles, and systemic conditions were recorded. Referring to the CDC/AAP definition, the diagnostic performance of the AAP/EFP classification was evaluated by the area under the ROC curve (AUC) and statistical tests (e.g., Youden's index and kappa coefficient). Additionally, a modified scoring system of the FDI Periodontal Diseases Chairside Guide (FDI-CG) was formulated with the addition of pregnancy for testing accordingly. RESULTS Overall, there were 22.1% of the participants in early phase of pregnancy (7-13 weeks) and 77.9% in late phase (34-36 weeks). The majority of them were below 35 years and non-smokers without gestational diabetes. Notably, 30.9% of subjects presented with Moderate/Severe periodontitis (CDC/AAP), and 35.8% with Stages II-IV periodontitis (AAP/EFP). Referring to the CDC/AAP definition, the AUC, Youden's index, and κ of the AAP/EFP classification were 0.979, 0.890, and 92.9%, respectively. The modified FDI-CG system improved the AUC (0.815), Youden's index (63.0%), and κ (0.544) with reference to the original one. CONCLUSIONS This study shows that the AAP/EFP classification is in high agreement with the CDC/AAP definition among the pregnant women. The phases of pregnancy-integrated FDI scoring system may serve as a convenient screening tool for maternal periodontal diseases in general dental practice.
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Affiliation(s)
- Hui‐Jun Li
- Division of StomatologyShenzhen Maternity & Child Healthcare HospitalShenzhenChina
| | - Dan Zhao
- Beijing Stomatological HospitalCapital Medical UniversityBeijingChina
- Division of Periodontology & Implant Dentistry, Faculty of DentistryThe University of Hong KongHong KongChina
| | - Xiaoyi Xu
- Division of StomatologyShenzhen Maternity & Child Healthcare HospitalShenzhenChina
| | - Rong Yu
- Division of StomatologyShenzhen Maternity & Child Healthcare HospitalShenzhenChina
| | - Feng Zhang
- Division of StomatologyShenzhen Maternity & Child Healthcare HospitalShenzhenChina
| | - Tianfan Cheng
- Division of Periodontology & Implant Dentistry, Faculty of DentistryThe University of Hong KongHong KongChina
| | - Zheng Zheng
- Division of Obstetrics & GynecologyShenzhen Maternity & Child Healthcare HospitalShenzhenChina
| | - Hong Yang
- Division of Obstetrics & GynecologyShenzhen Maternity & Child Healthcare HospitalShenzhenChina
| | - Chuanzhong Yang
- Division of NeonatologyShenzhen Maternity & Child Healthcare HospitalShenzhenChina
| | - Jilong Yao
- Division of Obstetrics & GynecologyShenzhen Maternity & Child Healthcare HospitalShenzhenChina
| | - Ping Wen
- Division of Science & EducationShenzhen Maternity & Child Healthcare HospitalShenzhenChina
| | - Lijian Jin
- Division of Periodontology & Implant Dentistry, Faculty of DentistryThe University of Hong KongHong KongChina
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14
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Deng K, Wei S, Xu M, Shi J, Lai H, Tonetti MS. Diagnostic accuracy of active matrix metalloproteinase-8 point-of-care test for the discrimination of periodontal health status: Comparison of saliva and oral rinse samples. J Periodontal Res 2022; 57:768-779. [PMID: 35575900 DOI: 10.1111/jre.12999] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/25/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Assessment of biomarkers, specifically active matrix metalloproteinase-8 (aMMP-8), in saliva/oral rinses is a promising diagnostic approach for periodontal health and disease. Different oral fluids have specific advantages and limitations. This study investigates the effect of sampling different fluids on the accuracy of an aMMP-8 point of care test (POCT). METHODS Unstimulated whole saliva, a first, and a second oral rinse were sequentially taken from 95 consecutive adults. aMMP-8 was quantitatively determined with a lateral flow immunoassay (index test). A full-mouth periodontal examination was used to establish a diagnosis according to the 2017 World Workshop classification of periodontal diseases (reference standard). Diagnostic measures of the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity were assessed and compared. RESULTS In all oral fluid samples, periodontitis patients (N = 61) had significantly elevated aMMP-8 levels and increased test positivity rates compared with subjects with periodontal health or gingivitis (N = 34). The intra-individual comparison showed that aMMP-8 levels were significantly higher in 1st oral rinse compared with other samples (1st oral rinse > saliva = 2nd oral rinse, p = .007). The aMMP-8 test using 1st oral rinse exhibited the best accuracy for detecting periodontitis with a sensitivity of 80.3%, a specificity of 67.8% and an AUROC of 0.740. CONCLUSIONS A 30-second oral rinse with water omitting the prerinse provided the best accuracy to discriminate periodontal health and disease with an aMMP-8 POCT. This regimen seems promising for further studies in large representative populations to verify the current findings.
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Affiliation(s)
- Ke Deng
- Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Shanghai Perio-Implant Innovation Center, School of Medicine, Ninth People' Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shimin Wei
- Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Shanghai Perio-Implant Innovation Center, School of Medicine, Ninth People' Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Xu
- Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Shanghai Perio-Implant Innovation Center, School of Medicine, Ninth People' Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Junyu Shi
- Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Shanghai Perio-Implant Innovation Center, School of Medicine, Ninth People' Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hongchang Lai
- Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Shanghai Perio-Implant Innovation Center, School of Medicine, Ninth People' Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Maurizio S Tonetti
- Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Shanghai Perio-Implant Innovation Center, School of Medicine, Ninth People' Hospital, Shanghai Jiao Tong University, Shanghai, China.,European Research Group on Periodontology, Genoa, Italy
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15
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Pimentel RP, Bittencourt LF, Miller LM, Borges RB, Oppermann RV, Gomes SC. Self-reported questionnaire on periodontal condition validated for use in Brazil. Braz Oral Res 2022; 36:e060. [PMID: 36507747 DOI: 10.1590/1807-3107bor-2022.vol36.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/12/2022] [Indexed: 12/15/2022] Open
Abstract
There is a current expectation of instruments for periodontal condition surveillance worldwide. The present study aimed to validate the Oral Health Questions Set B (OHQB) for the Brazilian Portuguese and evaluate its temporal stability. This is a sequential mixed-method investigation. After the forward-backward translation process to the Brazilian Portuguese, the OHQB Brazil (OHQB-Br) was applied to 156 participants (39.5 ± 14.14 years; 51.9% males). In sequence, through a full-mouth six-sites/teeth examination and in accordance with the original instrument, the periodontal diagnosis was obtained (March 2020). In January 2021, the OHB-BR was reapplied (n = 71). Ordinal alpha and McDonald's omega tested the internal consistency of the OHQB-Br. Temporal stability was investigated [Spearman correlation, intraclass correlation coefficient (ICC), and the Bland-Altman]. The concurrent validity was also verified, considering the periodontal clinical diagnosis (Kruskal Wallis). The ordinal alpha (0.69) and McDonald's omega (0.73) coefficients showed an adequate internal consistency of the OHQB-Br. The OHQB-Br temporal stability was high, as demonstrated by the Spearman coefficient (0.80) and ICC (0.79) and by the Bland-Altman plot. A concurrent validity showed a direct relationship between the OHQB-Br and the clinical condition of no periodontitis, mild, moderate, and severe periodontitis (p < 0.05). Because the OHQB-Br shows internal validity, temporal stability, and adequately identifies periodontal health and moderate/severe periodontitis, the instrument might represent an important tool, at the public level or other settings, for periodontal surveillance in Brazil.
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Affiliation(s)
- Roberto Pereira Pimentel
- Universidade Federal do Rio Grande do Sul - UFRGS, School, of Dentistry, Porto Alegre, RS, Brasil
| | - Liana Flores Bittencourt
- Universidade Federal do Rio Grande do Sul - UFRGS, School, of Dentistry, Porto Alegre, RS, Brasil
| | - Luisa Martins Miller
- Universidade Federal do Rio Grande do Sul - UFRGS, School, of Dentistry, Porto Alegre, RS, Brasil
| | - Rogério Boff Borges
- Hospital de Clínicas de Porto Alegre - HCPA, Biostatistics Unit, Porto Alegre, RS, Brasil
| | - Rui Vicente Oppermann
- Universidade Federal do Rio Grande do Sul - UFRGS, School, of Dentistry, Department of Periodontics, Porto Alegre, RS, Brasil
| | - Sabrina Carvalho Gomes
- Universidade Federal do Rio Grande do Sul - UFRGS, School, of Dentistry, Department of Periodontics, Porto Alegre, RS, Brasil
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16
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Does Smoking Explain the Association Between Use of E-Cigarettes and Self-Reported Periodontal Disease? J Dent 2022; 122:104164. [DOI: 10.1016/j.jdent.2022.104164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 02/07/2023] Open
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17
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Deng K, Uy SNMR, Fok C, Fok MR, Pelekos G, Tonetti MS. Assessment of masticatory function in the differential diagnosis of stage IV periodontitis: A pilot diagnostic accuracy study. J Periodontol 2022; 93:803-813. [PMID: 35239983 DOI: 10.1002/jper.21-0660] [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: 11/20/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND After diagnosis of periodontitis is made, detection of stage IV cases is critical for appropriate management that may call for interdisciplinary care. This study aims to identify and assess the accuracy of a simple screening approach for practice and surveillance of stage IV periodontitis. METHODS Masticatory function assessments by both validated self-reported masticatory dysfunction questionnaire and dual-color chewing gum mixing ability test (index test) were conducted in 214 consecutive patients, followed by a full-mouth periodontal examination. Periodontal diagnosis was based on the 2017 World Workshop classification of periodontal diseases (reference standard). Multivariate logistic regression and area under the receiver operating characteristic curve (AUROC) analyses were performed. RESULTS Overall, the individual patient-reported masticatory dysfunction questions showed low to moderate accuracy for predicting Stage IV periodontitis. The objective measures of masticatory function by calculating the variance of hue from the chewing gum test performed better with an AUROC of 0.840. A diagnostic approach based on age, self-report of altered food type intake, and chewing gum test result exhibited excellent performance for predicting Stage IV periodontitis (sensitivity: 89.7%; specificity:76.3%; AUROC:0.912). CONCLUSIONS Once the presence of periodontitis has been established, a simple diagnostic approach that does not require specialized workforce, complex or lengthy assessment allows identification of Stage IV periodontitis patients. This is important as these patients require specific case work up and interdisciplinary care pathways. Additional studies are required to validate the findings in multiple populations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ke Deng
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Ninth People' Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Samantha N M R Uy
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Chris Fok
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Melissa R Fok
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - George Pelekos
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Maurizio S Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Ninth People' Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,European Research Group on Periodontology, Genova, Italy
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18
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Uy SNMR, Deng K, Fok CTC, Fok MR, Pelekos G, Tonetti MS. Food Intake, Masticatory Function, Tooth Mobility, Loss of Posterior Support and Diminished Quality of Life Are Associated with More Advanced Periodontitis Stage Diagnosis. J Clin Periodontol 2021; 49:240-250. [PMID: 34935175 DOI: 10.1111/jcpe.13588] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
AIMS To describe periodontal and functional characteristics of subjects diagnosed with different stages of periodontitis and to associate measures of masticatory function and quality of life with periodontitis stage. METHODS This was a cross-sectional study on a convenience sample of 214 subjects with periodontitis seeking oral care in a hospital setting. They received a full mouth intraoral examination including dental and periodontal charting by a single calibrated examiner who also established the periodontitis stage diagnosis. Subjects were assessed using the OHIP-14, a validated masticatory dysfunction questionnaire and a quantitative test based on the ability to mix a dual color chewing gum. Mixing was quantified based on variance of hue (VOH) with a colorimetric software. Descriptive, univariate and multivariate analyses were performed. RESULTS Subjects with stage IV periodontitis reported greater impairment of oral health related quality of life, reduced food intake or altered food type intake attributed to difficulties in chewing, objective measures of masticatory dysfunction, tooth loss as well as more advanced periodontal breakdown compared with subjects with stage I-III diagnosis. Quantitative assessment of masticatory function was associated in a multivariate analysis with: i) loss of functional tooth units in the premolar/molar region, presence of hypermobile teeth and severity of periodontal attachment loss; and ii) age, body mass index and periodontitis stage IV and grade C diagnosis. CONCLUSIONS Stage IV periodontitis subjects are characterized by a specific set of signs and symptoms of advanced periodontal breakdown and functional impairment which impact on quality of life and masticatory function/food intake choices. Stage IV periodontitis captures a clinical entity with distinct features and treatment needs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Samantha N M R Uy
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China
| | - Ke Deng
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China.,Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Ninth People' Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chris Tat Cheun Fok
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China
| | - Melissa R Fok
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China
| | - George Pelekos
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China
| | - Maurizio S Tonetti
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China.,Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Ninth People' Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,European Research Group on Periodontology, Genova, Italy
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Morales A, Strauss FJ, Hämmerle CHF, Romandini M, Cavalla F, Baeza M, Sanz M, Gamonal J. Performance of the 2017 AAP/EFP case definition compared to the CDC/AAP definition in population-based studies. J Periodontol 2021; 93:1003-1013. [PMID: 34625960 DOI: 10.1002/jper.21-0276] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/08/2021] [Accepted: 09/26/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Classification of the periodontal conditions is indispensable for epidemiological data in order to guide situational awareness and therapeutic strategies. The new classification of periodontal diseases and conditions introduced by the American Academy of Periodontology and the European Federation of Periodontology (AAP/EFP), however, has not yet been applied to population-based studies. The aim of the present study was to compare the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification system and to evaluate the accuracy of the new AAP/EFP classification system against the CDC/AAP case definition for population-based studies. METHODS Epidemiological data from two cross-sectional studies were obtained. One of them was a population-based study on Chilean adults (1.456 individuals; 35-44 years; 65-74 years) and the other one a sample of adolescents (1.070 individuals; 15-19 years) from 5 countries; Argentina, Chile, Colombia, Ecuador and Uruguay. All participants had undergone full-mouth periodontal examination by calibrated examiners. Epidemiological datasets were analyzed according to the AAP/EFP and the CDC/AAP case definitions. The accuracy of the AAP/EFP definition was examined by assessing the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating curve (ROC) using the CDC/AAP case definition as the reference standard. RESULTS According to the AAP/EFP, the prevalence of periodontitis in adolescents was 75.6%. The majority of the adolescents were classified either as stage I (39.2%) or stage II (28.2%). By using the CDC/AAP classification the prevalence of periodontitis in adolescents was 27.2%. The most common form of periodontitis with the CDC/AAP classification was moderate periodontitis (15.3%) followed by mild periodontitis (11.4%). The AAP/EFP revealed high sensitivity in moderate (95.7%) and severe periodontitis (100%) as well as a moderate (75%) to high specificity (92%) in moderate and severe periodontitis, respectively. The PPV was 41.6% in moderate and 5.7% in severe periodontitis while the NPV was high in both categories (moderate = 99%; severe = 100%). The AUC was 0.912 (95% CI = 0.89 - 0.93). In adults, the prevalence of periodontitis was 99% according to the AAP/EFP. The majority of adults were classified as stage IV (81.3%) whereas stage III amounted to 12.8%. By using the CDC/AAP classification, the prevalence of periodontitis in adults was 88.3% and the most common form of periodontitis was moderate periodontitis (57.2%) followed by severe periodontitis (29.7%). In adults, the AAP/EFP revealed high sensitivity in moderate (99.7%) and severe periodontitis (100%) but low specificity in both categories (moderate = 6.8%; severe = 8.3%). The PPV was 88.7% in moderate and 31.7% in severe periodontitis. The NPV was high in both categories (moderate = 76.5%; severe = 100%). The AUC was 0.573 (95% CI = 0.53 - 0.62). CONCLUSIONS This study revealed a clear discrepancy in the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification when using epidemiological data. The 2017 AAP/EFP classification system performs well compared to the CDC/AAP case definition in identifying adolescents with periodontitis. The AAP/EFP system seems less accurate in adults with high prevalence of periodontitis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alicia Morales
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile.,Center for Surveillance and Epidemiology of Oral Diseases, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Franz J Strauss
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile.,Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Mario Romandini
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Franco Cavalla
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile.,Center for Surveillance and Epidemiology of Oral Diseases, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Mauricio Baeza
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile.,Center for Surveillance and Epidemiology of Oral Diseases, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Jorge Gamonal
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile.,Center for Surveillance and Epidemiology of Oral Diseases, Faculty of Dentistry, University of Chile, Santiago, Chile
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Deng K, Pelekos G, Jin L, Tonetti MS. Gingival bleeding on brushing as a sentinel sign of gingival inflammation: A diagnostic accuracy trial for the discrimination of periodontal health and disease. J Clin Periodontol 2021; 48:1537-1548. [PMID: 34494292 PMCID: PMC9293219 DOI: 10.1111/jcpe.13545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 12/30/2022]
Abstract
AIM To assess the accuracy of self-reported gingival bleeding on brushing (GBoB) for differentiating between periodontal health and disease and explore the optimal haemoglobin concentration that enables visual detection of GBoB. MATERIALS AND METHODS Self-assessment of GBoB was conducted in supervised sessions for 408 consecutive adults. The haemoglobin levels in saliva/toothpaste slurry (TPS) were analysed, followed by a full-mouth periodontal examination. Periodontal diagnoses were made based on the 2017 classification of periodontal diseases. Gingival inflammation was defined as presence of at least 10% of sites with bleeding on probing (BOP). Logistic regression and area under the receiver operating characteristic curve (AUROC) analyses were applied to assess the accuracy of GBoB. RESULTS Overall, 37.1% of the subjects claimed self-reported GBoB, and they had higher values of BOP (median: 25.0%; interquartile range (IQR): 16.0%-37.5%) than those without GBoB (median: 13.5%; IQR: 8.0%-24.8%, p < .001). The concentration/total amount of haemoglobin in TPS was positively correlated with the number of bleeding sites (r = .409/r = .520, p < .001). Haemoglobin concentration of 90.58 μg/ml or 0.51 μl blood volume enabled visual detection of GBoB with an AUROC of 0.848. Self-reported GBoB exhibited significantly increased values of diagnostic odds ratios (3-8) for varying degrees of gingival inflammation and periodontal disease (gingivitis and periodontitis). It showed low to moderate accuracy for discriminating periodontitis and gingivitis from periodontal health, with a sensitivity of 37.1% and 61.3% and a specificity of 84.8% and 84.4%, respectively. Absence of self-reported GBoB and low levels of haemoglobin had 93%-98% predictive values for periodontal health. CONCLUSIONS Despite its low sensitivity for the discrimination of periodontitis, self-reported GBoB is a promising sentinel sign for periodontal health and disease, and gingival inflammation in particular. It is visually detectable after minor blood loss. After validation in an independent population, identification of GBoB may promote earlier detection and better prevention and treatment of periodontal disease, thereby eventually reducing the global burden of the disease.
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Affiliation(s)
- Ke Deng
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - George Pelekos
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Lijian Jin
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Maurizio S Tonetti
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,European Research Group on Periodontology, Genoa, Italy
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21
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Deng K, Pelekos G, Jin L, Tonetti MS. Reply to letter to the editor: "Diagnostic accuracy of a point-of-care aMMP-8 test in the discrimination of periodontal health and disease". J Clin Periodontol 2021; 48:1499-1500. [PMID: 34265866 DOI: 10.1111/jcpe.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Ke Deng
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.,Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Ninth People' Hospital, College of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - George Pelekos
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Lijian Jin
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Maurizio S Tonetti
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.,Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Ninth People' Hospital, College of Medicine, Shanghai Jiao Tong University, Shanghai, China.,European Research Group on Periodontology, Genoa, Italy
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Deng K, Pelekos G, Jin L, Tonetti MS. Diagnostic accuracy of a point-of-care aMMP-8 test in the discrimination of periodontal health and disease. J Clin Periodontol 2021; 48:1051-1065. [PMID: 33998040 PMCID: PMC8362205 DOI: 10.1111/jcpe.13485] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/29/2021] [Accepted: 04/22/2021] [Indexed: 12/17/2022]
Abstract
Aim To assess the diagnostic utility of an oral rinse active matrix metalloproteinase‐8 (aMMP‐8) point‐of‐care test (POCT) for differentiating periodontal health, gingivitis, as well as different stages and grades of periodontitis. Materials & Methods The aMMP‐8 index test was undertaken in 408 consecutive adults, followed by a full‐mouth periodontal examination. The reference standard was the 2017 World Workshop classification of periodontal diseases. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUROC) were assessed. Results 68.6% of the participants were diagnosed with periodontitis, including Stages I (15.9%), II (15.9%), III (29.7%) and IV (7.1%). A positive aMMP‐8 POCT was associated with periodontitis after adjusting for age, gender, tobacco smoking and systemic diseases, while it was unable to differentiate among the stages/grades of periodontitis and between gingivitis/periodontal health. This test showed a sensitivity of 33.2% and a specificity of 93.0% for detecting periodontitis (threshold level >10 ng/ml). The levels of aMMP‐8 adjusted by the number of teeth present (aMMP‐8/NTP) performed better for periodontitis (sensitivity: 67.1%; specificity: 68.8%). Notably, aMMP‐8/NTP were strongly predictive for Stage IV periodontitis (threshold level =0.4312 ng/ml) (sensitivity: 89.7%; specificity: 73.6%; and AUROC: 0.856). The test performance greatly improved in combination with age and smoking, with a sensitivity of 82.5%, a specificity of 84.4%, and an AUROC of 0.883. Conclusion This aMMP‐8 POCT is able to detect periodontitis with better specificity than sensitivity across the spectrum of its severity. This test may be useful for periodontal screening in conjunction with subject characteristics and/or other sensitive screening tools. Further validation studies are needed.
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Affiliation(s)
- Ke Deng
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Department of Oral Implantology, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology; National Center of Stomatology; National Clinical Research Center of Oral Diseases; Shanghai key Laboratory of Stomatology, Shanghai, China
| | - George Pelekos
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Lijian Jin
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Maurizio S Tonetti
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Department of Oral Implantology, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology; National Center of Stomatology; National Clinical Research Center of Oral Diseases; Shanghai key Laboratory of Stomatology, Shanghai, China.,European Research Group on Periodontology, Genova, Italy
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