Impact of the treatment of periodontitis on systemic health and quality of life: A systematic review

Dental Pathophysiology of Odontogenic Sinusitis: Periodontitis

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.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Periodontal disease: A systemic condition

For decades, periodontitis has been considered to be a local inflammatory disease of the periodontal tissues in the oral cavity. Initially, associations of periodontitis with a multitude of noncommunicable diseases were each studied separately, and relationships were shown. The associations of periodontitis with morbidities, such as cardiovascular diseases, rheumatoid arthritis, diabetes mellitus, respiratory diseases, have been demonstrated. As most such studies were cross-sectional in nature, questions about causality cannot be univocally answered. And periodontitis as an independent risk factor for one systemic disease, becomes even more difficult to assess since recently periodontitis has also been associated with multimorbidity. Periodontitis and many systemic diseases share environmental, lifestyle and genetic risk factors, and share immunopathology. Moreover, suffering from one common noncommunicable disease may increase the susceptibility for another such chronic disease; the systemic effects of one condition may be one of various risk factors for another such disease. The overarching effect of any systemic disease is it causing a pro-inflammatory state in the individual; this has also been shown for periodontitis. Moreover, in periodontitis a prothrombotic state and elevated immunological activity have been shown. As such, when we consider periodontal disease as another systemic disease, it can affect the susceptibility and progression of other systemic diseases, and importantly, vice versa. And with this, it is not surprising that periodontitis is associated with a variety of other noncommunicable diseases. The medical definition of a systemic disease includes diseases that affect different organs and systems. Thus, the aim of this opinion paper is to propose that periodontitis should be considered a systemic disease in its own right and that it affects the individual's systemic condition and wellbeing. The dental and medical profession and researchers alike, should adapt this paradigm shift, advancing periodontal disease out of its isolated anatomical location into the total of chronic noncommunicable diseases, being for some conditions a comorbid disease and, vice versa, comorbidities can affect initiation and progression of periodontal disease.

Navigating the Landscape of Periodontitis Nonsurgical Treatment: A Metatrend Study of The Scientific Production and Trends From 2001-2020

Nonsurgical therapies have been recommended and employed as a less invasive and cost-effective modality in managing periodontitis. In this context, different therapeutic protocols have been tested in the last decades. Therefore, mapping the scientific trends and patterns provides critical insights into the state of research in the field, which has not been explored for overall nonsurgical periodontitis treatment studies. Articles from 2001 to 2020 were retrieved from the Web of Science database using appropriate terms and keywords. Article selection and data extraction were performed by calibrated examiners. All articles focusing on nonsurgical periodontitis treatment were included. Descriptive, bivariate, and multivariate logistic regression analyses were conducted. 1,519 articles were included. Randomized clinical trials (RCTs) were the most used design (44.1%), and professional biofilm control was the topic most studied (35.6%). Europe published the most significant number of articles (41.1%). The USA was the country that collaborated more with other countries. Asia (p<0.001), South America (p=0.004), and Oceania/Africa (p=0.016) showed a lower chance to have international collaboration. Studies from North America were more likely to be RCTs than studies from Europe (p=0.050); studies focusing on professional biofilm control (p<0.001) and other topics (p<0.001) were less likely to be evaluated by RCTs. The nonsurgical periodontitis treatment field mainly conducted RCTs, and the topic most explored by all studies was professional biofilm control. International collaboration and conduct of RCTs in this field occurred mainly among high-income countries. Decentralizing scientific resources, making integrative connections globally, and evaluating new topics may improve evidence-based periodontology.

Impact of Periodontal Diseases on Oral Health-Related Quality of Life: A Study with a Condition-Specific Questionnaire in Croatian Population

OBJECTIVES

 The aim of this study was to translate and validate the condition-specific Oral Health Impact Profile (OHIP) in the Croatian cultural context and assess the impact of periodontal diseases and nonsurgical periodontal therapy on quality of life (QoL).

MATERIALS AND METHODS

 A cross-sectional study was carried out on 150 individuals: 50 periodontally healthy, 50 with gingivitis, and 50 with periodontitis who self-administrated the OHIP. The participants' age ranged between 18 and 71 years, with the median age of 45 (34-57) years. Forty-seven percent of the participants were females. The validity and reliability of the Croatian OHIP version were tested. The impact of gingivitis and periodontitis on QoL was assessed. Changes in QoL induced by nonsurgical periodontal therapy in 20 patients with periodontitis were analyzed.

STATISTICAL ANALYSIS

 Categorical data were presented by absolute and relative frequencies. The normality of the distribution of continuous variables was tested by the Shapiro-Wilk test. Continuous data were described by the median and the limits of the interquartile range (IQR). Differences in continuous variables between two independent groups were tested with the Mann-Whitney U test, and between three groups with the Kruskal-Wallis test (post hoc Conover). The Wilcoxon signed-rank test was used to examine the differences in the total score before and after therapy. All p values were two-sided. The level of significance was set at alpha of 0.05.

RESULTS

 The analysis detected a single-factor structure that explained for the 56.9% of the variance. Cronbach's alpha value was 0.937, which indicated an excellent internal consistency. Overall OHIP score reported a strong correlation with the subjective estimate of periodontal problems (Rho = 0.92; p < 0.001). Test-retest reliability was high (r = 0.984; p < 0.001). The periodontitis group had the highest OHIP score (28 [23-34]), followed by the gingivitis group (14 [12-20]) and the periodontally healthy group (9 [5-11]; p < 0.001). Nonsurgical periodontal therapy significantly improved the QoL in those with periodontitis (p < 0.001).

CONCLUSION

 The condition-specific Croatian version of the OHIP instrument can be considered adequate to measure the impact of periodontal diseases on oral health-related QoL. Periodontal diseases, especially periodontitis, have a negative effect on the patient's QoL. Nonsurgical periodontal treatment can improve patients' QoL.

Differential expression of FSTL1 and its correlation with the pathological process of periodontitis

AIMS

This study aimed to elucidate the alterations in Follistatin-like protein 1 (FSTL1) and its association with the pathological process of periodontitis.

METHODS

This study included 48 patients with periodontitis and 42 healthy controls. The expression level of FSTL1 in the gingiva was determined by RT-qPCR, validated using the dataset GSE16134, and subsequently examined by western blotting. Bioinformatics analysis revealed a single-cell distribution of FSTL1, characteristic of angiogenesis and immune cell infiltration. The expression and distribution of FSTL1, vascular endothelial marker protein CD31 and myeloperoxidase (MPO), the indicator of neutrophil activity, were determined by immunohistochemistry (IHC). A series of correlation analyses was performed to determine the associations between FSTL1 and clinical parameters, including probing depth (PD) and clinical attachment loss (CAL), and their potential role in angiogenesis (CD31) and neutrophil infiltration (MPO).

RESULTS

FSTL1 was significantly upregulated in the gingiva of patients with periodontitis compared to their healthy counterparts. In addition, FSTL1 was positively correlated with the clinical parameters PD (r = .5971, p = .0005) and CAL (r = .6078, p = .0004). Bioinformatic analysis and IHC indicated that high FSTL1 expression was significantly correlated with angiogenesis and neutrophil infiltration in periodontitis. Moreover, receiver operating characteristic (ROC) analysis demonstrated that FSTL1 could serve as an independent indicator for evaluating the severity of periodontitis (area under the curve [AUC] = 0.9011, p < .0001).

CONCLUSION

This study demonstrated FSTL1 upregulation in periodontitis and its potential contribution to the disease via angiogenesis and neutrophil infiltration.

Association of periodontitis with cardiometabolic and haemostatic parameters

OBJECTIVE

To investigate the association between periodontitis and cardiometabolic and haemostatic parameters.

MATERIALS AND METHODS

Between 2014 and 2019, 54 individuals needing full mouth extraction, and 50 control individuals, were recruited for a combined cross-sectional (individuals versus controls) and longitudinal (individuals before and after extraction) study. Periodontitis severity was measured using the periodontal inflamed surface area (PISA). Blood was drawn to measure the haemostatic (Factor VIII, von Willebrand factor [VWF], endogenous thrombin potential, d-dimer, clot lysis time) and cardiovascular risk (C-reactive protein [CRP], lipid profile) parameters, prior to and 12 weeks post-extraction. The results were analysed group-wise.

RESULTS

The mean VWF and CRP levels were higher and the high-density lipoprotein levels were lower in the individuals prior to extraction compared to the controls. The VWF was significantly correlated with the PISA (a 21% unit increase in VWF per 1000 mm2 increase in PISA, 95%CI: 6-36%, p = 0.01). The other analyses were comparable between the individuals and controls, and did not change in the individuals after the extraction.

CONCLUSION

VWF levels are associated with periodontitis severity; they do not improve after full-mouth extraction. Severe periodontitis in control individuals does not induce substantial changes in their haemostatic or inflammatory systems.

CLINICAL RELEVANCE

Treatment of periodontitis has been shown to improve the cardiometabolic blood profile of patients with established cardiometabolic disease. However, whether periodontitis treatment improves cardiometabolic and haemostatic profiles in people without cardiometabolic disease is uncertain.

Effects of a 4-week free-sugar avoidance during periodontal therapy: An explorative randomized controlled clinical trial

BACKGROUND

This study investigated the effect of a 4-week free-sugar avoidance on periodontal parameters during periodontal therapy.

METHODS

Twenty-one patients with untreated periodontitis and daily free-sugar intake were allocated to a sugar avoidance group (SAG) and a control group (CG). The SAG received a 45-min dietary consultation and was instructed to avoid free sugars during the following 4 weeks after subgingival instrumentation, while the CG continued with their regular diet. Bleeding on probing (BOP), plaque control record, body weight (BW), visceral fat (FATv), and a food frequency questionnaire (FFQ) were collected at baseline (T1), 4 weeks (T2), and 8 weeks (T3) after subgingival instrumentation.

RESULTS

The main outcome parameter BOP was significantly reduced at T2 by 40.3% ± 15.54 in the SAG and 34% ± 12.47 in the CG (intra-p value both <0.001, inter-p value 0.361). A linear regression analysis of changes at patient level adjusted for age and FATv revealed a significant group difference for BOP (regression coefficient = -6.8; p = 0.019). Significant reductions were observed in BW, FATv and mean daily intake of free sugars (-14.4 g/day), and a significant increase of vitamin C derived from fruits (75.89 mg/day) at T2 in the SAG only.

CONCLUSION

This study may indicate additional beneficial effects of a sugar avoidance on periodontal and metabolic parameters, and nutritional intake during periodontal therapy. German Clinical Trials Register (DRKS00026699).

PLAIN LANGUAGE SUMMARY

The current widespread free-sugar consumption is linked to an increasing incidence of chronic non-communicable diseases. Data indicate a relationship between sugar intake and a higher prevalence of periodontitis and increased gingival inflammation. This study showed that free-sugar avoidance after periodontal therapy had additional beneficial effects on periodontal and metabolic parameters in 10 test and 11 control patients. After 4 weeks of avoiding free sugars like sweets, processed white flour, juice, and so forth, periodontal bleeding was significantly reduced in both groups (-40.3% test group, -34% control group). Further regression analysis revealed a significant difference between groups favoring the intervention. Additionally, body weight and visceral fat were significantly reduced in the intervention group, only. To avoid sugar, patients were allowed to replace it with whole fruit, which led to increased levels of micronutrients such as vitamin C. Therefore, free-sugar avoidance may be of therapeutic benefit in addition to periodontal therapy. Further research is needed to investigate this effect in larger cohorts.

Association between periodontitis and cardiovascular risk in Spanish employed adults-The Workers' Oral Health study

AIMS

Periodontitis and cardiovascular diseases (CVD) are highly prevalent non-communicable diseases, sharing an inflammatory pathogenesis and common risk factors. The objective of the present research is to assess the association between periodontitis and cardiovascular disease risk in a representative sample of the Spanish-employed population.

METHODS

Cross-sectional data were obtained between 2008 and 2011 in the Workers' Oral Health (WORALTH) epidemiological study. Periodontal examinations were based on the evaluation of clinical attachment loss (CAL) and community periodontal index (CPI). Participants also underwent a medical check-up and answered a comprehensive health questionnaire. With this information, participants were categorized into three levels of CVD risk using the systemic coronary risk estimation (SCORE) algorithm for low-risk European countries. Crude and adjusted odds ratios (ORs) were determined with multiple logistic regression models for the association between periodontal status and CVD risk.

RESULTS

Data from 4224 individuals were analyzed. The overall prevalence of high CVD risk (SCORE ≥ 5%) was 5.1%. The prevalence of SCORE ≥ 5% was 3.4%, 9.4%, and 15.2% for CAL 0-3 mm, 4-5 mm, and ≥6 mm, respectively (p < .001), and 6.2%, 6.5%, and 14.6% for CPI ≤2, 3, and 4, respectively (p < .001). Individuals with CPI = 4 presented an OR of 1.50 (95% confidence interval, CI [1.04; 2.17]) for high SCORE values, after adjusting for confounders (age, sex, and smoking habit).

CONCLUSIONS

Periodontitis, defined by the presence of deep periodontal pockets (≥6 mm), was significantly associated with high CVD risk (SCORE ≥ 5%) in a representative sample of the employed population in Spain.

Erythrocyte-Mimicking Nanovesicle Targeting Porphyromonas gingivalis for Periodontitis

Porphyromonas gingivalis has been demonstrated to have the strongest association with periodontitis. Within the host, P. gingivalis relies on acquiring iron and heme through the aggregation and lysis of erythrocytes, which are important factors in the growth and virulence of P. gingivalis. Additionally, the excess obtained heme is deposited on the surface of P. gingivalis, protecting the cells from oxidative damage. Based on these biological properties of the interaction between P. gingivalis and erythrocytes, this study developed an erythrocyte membrane nanovesicle loaded with gallium porphyrins to mimic erythrocytes. The nanovesicle can target and adhere with P. gingivalis precisely, being lysed and utilized by P. gingivalis as erythrocytes. Ingested gallium porphyrin replaces iron porphyrin in P. gingivalis, causing intracellular metabolic disruption. Deposited porphyrin generates a large amount of reactive oxygen species (ROS) under blue light, causing oxidative damage, and its lethality is enhanced by bacterial metabolic disruption, synergistically killing P. gingivalis. Our results demonstrate that this strategy can target and inhibit P. gingivalis, reduce its invasion of epithelial cells, and alleviate the progression of periodontitis.

The role of periodontitis in cancer development, with a focus on oral cancers

Periodontitis is a severe gum infection that begins as gingivitis and can lead to gum recession, bone loss, and tooth loss if left untreated. It is primarily caused by bacterial infection, which triggers inflammation and the formation of periodontal pockets. Notably, periodontitis is associated with systemic health issues and has been linked to heart disease, diabetes, respiratory diseases, adverse pregnancy outcomes, and cancers. Accordingly, the presence of chronic inflammation and immune system dysregulation in individuals with periodontitis significantly contributes to the initiation and progression of various cancers, particularly oral cancers. These processes promote genetic mutations, impair DNA repair mechanisms, and create a tumor-supportive environment. Moreover, the bacteria associated with periodontitis produce harmful byproducts and toxins that directly damage the DNA within oral cells, exacerbating cancer development. In addition, chronic inflammation not only stimulates cell proliferation but also inhibits apoptosis, causes DNA damage, and triggers the release of pro-inflammatory cytokines. Collectively, these factors play a crucial role in the progression of cancer in individuals affected by periodontitis. Further, specific viral and bacterial agents, such as hepatitis B and C viruses, human papillomavirus (HPV), Helicobacter pylori (H. pylori), and Porphyromonas gingivalis, contribute to cancer development through distinct mechanisms. Bacterial infections have systemic implications for cancer development, while viral infections provoke immune and inflammatory responses that can lead to genetic mutations. This review will elucidate the link between periodontitis and cancers, particularly oral cancers, exploring their underlying mechanisms to provide insights for future research and treatment advancements.

Quality Assessment of Internet Information Regarding Periodontitis in Persons Living with HIV

The Internet is the most used source of HIV information second to information received from healthcare professionals. The aim of this study was to assess the quality of Internet information about periodontitis in people living with HIV (PLWH). An Internet search was performed on 18 April 2024 using the search terms "Periodontitis", "Periodontal disease", and "Gum disease" in combination with "HIV" in the most popular search engines (Google™, Bing™, and YAHOO!®). The first 20 results from each search term engine were pooled for analysis. Quality was assessed by JAMA benchmarks. Readability was assessed using the Flesch reading ease score (FRES). Origin of the site, type of author, and information details were also recorded. The quality of Internet information about periodontitis in PLWH varied. The mean JAMA score was 2.81 (SD = 1.0). The websites were generally fairly difficult to read (mean FRES = 57.1, SD = 15.0). Most websites provided some advice about self-treatment of oral problems, accompanied by a strong recommendation to seek professional dental care. In conclusion, advanced reading skills on periodontitis in PLWH were required and quality features were mostly not provided. Therefore, healthcare professionals should be actively involved in developing high-quality information resources and direct patients to evidence-based materials on the Internet.

Treatment of periodontitis ameliorates the severity and extent of psoriasis-A randomized clinical trial

AIM

To assess the impact of non-surgical periodontitis treatment over conventional dermatological treatment on the severity and extent of psoriasis in patients affected by comorbid psoriasis and periodontitis.

METHODS

Seventy-four patients affected by both psoriasis and Stages I-IV periodontitis were randomized to receive either Steps 1-2 (non-surgical) of periodontal therapy (test group; n = 37) or no treatment (control group; n = 37). The two groups were balanced in terms of psoriasis medications, with the majority of the included patients undergoing biologics (74.0%) as monotherapy, while minor proportions were under systemic medications (13.7%) or none/topical/phototherapy (12.3%). The psoriasis area severity index (PASI) was regarded as the primary outcome. The Body Surface Area (BSA) and the Dermatology Life Quality Index (DLQI) were additionally considered as dermatological outcomes. Probing pocket depth, recession depth, clinical attachment level, periodontal inflamed surface area, and full-mouth plaque and bleeding scores were also measured. [Correction added on July 5, 2024, after first online publication: The preceding sentence has been revised].

RESULTS

Periodontal therapy in the test group led to statistically significant lower PASI scores at 10 weeks (mean = 3.15; standard deviation [SD] = 3.78) compared to the control group (mean = 7.11; SD = 6.09) (mean difference [MD] = -4.0; 95% confidence interval [CI]: -6.3, -1.6; p = .001). The test group also showed improvements in BSA (MD = -4.3) and periodontal parameters compared to the control group. DLQI only showed a non-statistically significant tendency (MD = -2.0).

CONCLUSION

Steps 1-2 of periodontal therapy showed an additional effect over conventional dermatological treatment in reducing the severity and extent of psoriasis (Clinicaltrials.gov: NCT05311501).

Effect of Treating Periodontal Disease in Pregnant Women to Reduce the Risk of Preterm Birth and Low Birth Weight: An Umbrella Review

Background: The aim of this review was to evaluate the effects of periodontal disease (PD) treatment in pregnant women to reduce the risk of preterm birth (PB) and low birth weight (LBW) by conducting an umbrella review. Methods: A comprehensive search for the literature up to April 2024 was conducted across multiple databases including PubMed, Cochrane Library, Scopus, EMBASE, Scielo, Web of Science, Google Scholar, Proquest Dissertations and Theses, and OpenGrey. We specifically targeted systematic reviews (SRs) with or without meta-analyses, irrespective of language or time constraints, focusing on primary studies examining the effect of PD treatment in pregnant women to reduce the risk of PB and LBW. Various types of non-systematic reviews, intervention studies, observational studies, preclinical and basic research, summaries, comments, case reports, protocols, personal opinions, letters, and posters were excluded from consideration. The quality and overall confidence of the included studies were assessed using the AMSTAR-2 tool. Results: After the initial search, 232 articles were identified, of which only 24 met the selection criteria after exclusion. The majority of these studies indicated that periodontal treatment reduces the risk of PB and LBW. Conclusions: According to the findings and conclusions drawn from the SRs with a high overall confidence level, PD treatment in pregnant women reduces the risk of PB and LBW.

Clinical Study on the Implications of Immunological Markers in the Diagnosis of Periodontitis in People with Diabetes Mellitus

The basic idea from which the working hypothesis for this study started is the fact that the only systemic disease today that is clearly linked to periodontal disease by biochemical mechanisms is diabetes mellitus, as well as the clinical finding that diabetes causes a number of specific periodontal changes. Highlighting the biochemical markers of inflammation during periodontal disease in patients diagnosed with type 2 diabetes is the main aim of the study. To achieve this objective, we used the human ELISA kit from Boster Biological Technology Co., Ltd. (Pleasanton, CA, USA), for the detection of IL-1β, IL-4, IL-8 and TNF-α. The data analysis shows that plasma levels of these cytokines are associated with the progression of periodontitis. In conclusion, we can state that the involvement of immunological markers is evident in the pathogenesis of periodontal disease.

V, Sinha SP, Singh A, Karmakar S. Development and validation of a structured questionnaire to assess the Knowledge, Attitude and Practice (KAP) regarding the effect of yoga on periodontal health among Indian adults

Background

Periodontal disease is a chronic inflammatory disease of structures surrounding the teeth. Its etiology is multifactorial. The primary etiological factor is the microbial component; the other factors are systemic, behavioral, environmental, and psychological. Conventional management includes routine periodontal therapy involving prophylactic and surgical management. In developing countries like India, complementary medicine and alternative medicines like yoga are gaining popularity for improving systemic health. Hence this pilot study was designed to assess the psychometric properties of a structured questionnaire that can assess knowledge, attitude, and practice (KAP) regarding the impact of yoga on oral and periodontal health in Indian population.

Methods

The KAP questionnaire was developed (Stage One) using a deductive approach, and a psychometric evaluation of the questionnaire was performed to evaluate it's reliability and validity (Stage Two). Initial content validation and test re-test reliability were assessed using kappa statistics with binary responses. An intraclass correlation coefficient (ICC) was used to assess the questions in the practice and attitude category with categorical variables. Further assessment of psychometric properties of the questionnaire was done using item response theory. The developed questionnaire had four principal sections: demography of participants; knowledge regarding yoga and oral health; attitude towards yoga and oral health; and practice towards implementing yoga for oral health.

Results

The ICC for all the assessed questions was greater than 0.60 suggesting satisfactory stability. Internal consistency measured using Cronbach's alpha for knowledge, attitude, and practice items were reported to be 0.632, 0.923, and 0.591 respectively and that of the KAP total was 0.632.

Conclusions

The findings of this study showed that the questionnaire had an acceptable psychometric property for measuring KAP regarding yoga and it's role in oral and periodontal health among Indian adults. The analysis of participant responses revealed that they had a medium level of knowledge regarding yoga and periodontal disease.

Oral health as a modifiable risk factor for cardiovascular diseases

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide with a high socioeconomic burden. Increasing evidence supports a convincing connection with increased cardiovascular risk of periodontal diseases (PD), a group of widespread, debilitating, and costly dysbiotic relapsing-remitting inflammatory diseases of the tissues supporting the teeth. Herein, we ensembled the best available evidence on the connection between CVDs and PD to review the recently emerging concept of the latter as a non-traditional risk factor for CVDs. We focused on oral dysbiosis, inflammation-associated molecular and cellular mechanisms, and epigenetic changes as potential causative links between PD and CVDs. The available evidence on the effects of periodontal treatment on cardiovascular risk factors and diseases was also described.

The economic and societal impact of periodontal and peri-implant diseases

Periodontal and peri-implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality-of-life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri-implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.

Enhanced control of periodontitis by an artificial intelligence-enabled multimodal-sensing toothbrush and targeted mHealth micromessages: A randomized trial

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).

NHANES-based analysis of the correlation between leisure-time physical activity, serum cotinine levels and periodontitis risk

OBJECTIVE

To investigate the association of leisure-time physical activity and serum cotinine levels with the risk of periodontitis in the general population and to further analyze the interaction between leisure-time physical activity and serum cotinine levels on the risk of periodontitis.

METHODS

This was a cross-sectional study, extracting data from 9605 (56.19%) participants in the National Health and Nutrition Examination Survey (NHANES) database from 2009 to 2014, and analyzing the relationship and interaction effects of serum cotinine level, leisure time physical activity, and risk of periodontitis by weighted univariate logistic modeling; Effect sizes were determined using ratio of ratios (OR), 95% confidence intervals (95% CI).

RESULTS

5,397 (56.19%) of 9,605 participants had periodontitis; an increased risk of periodontitis was found in those in the leisure time physical activity intensity < 750 MET × min/week group (OR = 1.44, 95% CI: 1.17-1.78). Serum cotinine levels ≥ 0.05 ng/ml were associated with an increased risk of periodontitis (OR = 1.99, 95% CI: 1.69-2.33). The group with low leisure physical activity and serum cotinine levels ≥ 0.05 ng/ml had an increased risk of periodontitis compared to the group with high leisure physical activity and serum cotinine levels < 0.05 ng/ml (OR = 2.48, 95% CI: 1.88-3.27). Interaction metrics RERI = 0.90 (95% CI: 0.44-1.36) and API = 0.36 (95% CI: 0.18-0.55); CI for SI = 2.55 (95% CI: 1.03-6.28). for API 0.36.

CONCLUSION

Leisure time physical activity intensity interacted with smoking exposure on periodontitis risk and may provide the general population with the opportunity to Increasing leisure-time physical activity and smoking cessation may provide recommendations for the general population.

Systemic Impact of Subgingival Infection Control in Periodontitis Patients with Cardiovascular Disease: A Narrative Review

INTRODUCTION

Periodontitis, an infectious inflammatory condition, is a key contributor to sustained systemic inflammation, intricately linked to atherosclerotic cardiovascular disease (CVD), the leading cause of death in developed nations. Treating periodontitis with subgingival mechanical instrumentation with or without adjunctive antimicrobials reduces the microbial burden and local inflammation, while also potentially bringing systemic benefits for patients with both periodontitis and CVD. This review examines systemic effects of subgingival instrumentation with or without antimicrobial products in individuals with periodontitis and CVD, and explores intricate pathogenetic interactions between periodontitis and CVD.

MATERIAL AND METHODS

English-language databases (PubMed MEDLINE and Cochrane Library) were searched for studies assessing the effects of nonsurgical periodontal therapies in periodontitis patients with or without CVD.

RESULTS

While the ability of periodontal therapy to reduce mortality- and morbidity-related outcomes in CVD patients with periodontitis remains uncertain, some studies indicate a decrease in inflammatory markers and blood cell counts. Subgingival mechanical instrumentation delivered over multiple short sessions carries lower risks of adverse effects, particularly systemic inflammation, compared to the full-mouth delivery, making it a preferable option for CVD patients.

CONCLUSIONS

Subgingival mechanical instrumentation, ideally conducted in a quadrant-based therapeutic approach, to decontaminate periodontal pockets has the potential to reduce both local and systemic inflammation with minimal adverse effects in patients suffering from periodontitis and concurrent CVD.

Temporal and spatial effects on C-reactive protein's regulation of inducible nitric oxide synthase production in periodontal disease

BACKGROUND

Inducible nitric oxide synthase (iNOS) is associated with inflammation and osteoclastic differentiation in periodontal disease. This study was conducted to compare the time-dependent variation in iNOS production between the gingiva and other periodontal tissues and to explore the potential association with C-reactive protein (CRP) in early periodontal disease.

METHODS

Ligature-induced periodontal disease models (0-14 days) were established in wild-type and CRP knockout rats. Changes in CRP, iNOS, and autophagy levels were examined in the gingiva and other periodontal tissues. Macrophages were treated with lipopolysaccharide and chloroquine to explore the role of autophagy in iNOS production. iNOS, CRP, and autophagy-related proteins were analyzed using Western blotting, immunostaining, and enzyme-linked immunosorbent assays. mRNA expression was detected by quantitative real-time polymerase chain reaction. Hematoxylin and eosin staining was used for histological analysis. Cathepsin K immunostaining and microcomputed tomography of the maxillae were performed to compare alveolar bone resorption.

RESULTS

iNOS and CRP levels increased rapidly in periodontal tissues, as observed on Day 2 of ligature, then decreased more rapidly in the gingiva than in other periodontal tissues. CRP deficiency did not prevent iNOS generation, but effectively accelerated iNOS reduction and delayed alveolar bone loss. The CRP effect on iNOS was accompanied by a change in autophagy, which was reduced by CRP knockout.

CONCLUSIONS

The regulation of iNOS by CRP shows temporospatial variation in early periodontal disease and is potentially associated with autophagy. These findings may contribute to the early detection and targeted treatment of periodontal disease.

Association between periodontitis and disc structural failures in patients with cervical degenerative disorders

OBJECTIVE

Recent studies have shown that the mouth-gut-disc axis may play a key role in the process of disc structural failures (including intervertebral disc degeneration (IDD) and endplate change) in the cervical spine and neck pain. However, the potential mechanisms underlying the mouth-gut-disc axis remain elusive. Therefore, we explored whether periodontal disease is associated with disc structural failures in patients with cervical degeneration disorders and clinical outcomes.

METHODS

Adults (aged > 18 years) who met open surgery criteria for cervical spine were enrolled in this prospective cohort study. Participants were allocated into two groups based on periodontal examinations before surgery: no/mild periodontitis group and moderate/severe periodontitis group. Data were evaluated using an independent t test and Pearson's correlation analysis.

RESULTS

A total of 108 patients were enrolled, including 68 patients in the no/mild periodontitis group and 40 patients in the moderate/severe periodontitis group. The number of common causes of missing teeth (P = 0.005), plaque index (PLI) (P = 0.003), bleeding index (BI) (P = 0.000), and probing depth (PD) (P = 0.000) significantly differed between the two groups. The incidence rate of endplate change (P = 0.005) was higher in the moderate/severe periodontitis group than in the no/mild periodontitis group. A moderate negative association was found between the neck disability index (NDI) score and periodontal parameters (PLI: r = - 0.337, P = 0.013; BI: r = - 0.426, P = 0.001; PD: r = - 0.346, r = - 0.010).

CONCLUSIONS

This is the first study to provide evidence that severe periodontitis is associated with a higher occurrence rate of disc structural failures and poor clinical outcomes in patients with cervical degenerative disorders.

Health topics emerged from brief-motivational interviewing: A randomized clinical trial

OBJECTIVE

The goal of this study was to analyse transcription of audio recordings to determine health topics that emerged from brief-motivational interviewing (MI) compared to traditional oral hygiene instructions (OHI).

METHODS

Fifty-eight periodontal maintenance patients were randomized to a brief-MI or traditional OHI group for a longitudinal 1-year clinical trial. Both groups received four patient education sessions per their assigned group. Audio recordings were transcribed and coded. The overarching themes and subthemes emerged were quantified and reported as the number of instances per participant. Global scores and behavioural counts were compared across baseline, 4, 8, and 12-month research visits using mixed-effect models.

RESULTS

Of the six overarching themes, the brief-MI group evoked more topics toward total health. Oral home care behaviours (15 vs. 10.2) and oral diseases/conditions (3.3 vs. 1.9) were discussed more in the brief-MI group compared to the traditional OHI group. This positive outcome for the average number of times a health topic was discussed in the brief-MI group compared to the traditional OHI group continued for the remaining major themes: lifestyle behaviours (1.0 vs. 0.4), nutrition (2.6 vs. 0.8), emotional/mental health (1.8 vs. 0.8) and general health (1.2 vs. 0.4).

CONCLUSION

This study identified that brief-MI was a more successful communication approach to increase discussions of oral home care behaviours, oral diseases/conditions, lifestyle behaviours, nutrition, emotional/mental health and general health compared to traditional OHI in individuals with periodontitis.

Association between peri-implantitis and systemic inflammation: a systematic review

Background

Peri-implantitis is an infectious/inflammatory disease with similar clinical and radiographic features to periodontitis. Overwhelming evidence confirmed that periodontitis causes elevations in systemic inflammatory mediators; this is unclear for peri-implantitis. Hence, this study aimed to appraise all available evidence linking peri-implantitis with systemic inflammation.

Methods

A systematic review was completed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, Dentistry & Oral Sciences Source, Scopus, LILACS, and China Online), ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP), and gray literature were searched up to February 9, 2023. Human studies of randomized controlled trials, non-randomized intervention studies, cohort studies, case-control, and cross-sectional studies were eligible for inclusion. Quantitative analyses were performed using random effects models.

Results

A total of 27 full-text articles were retrieved, and 11 clinical studies were included in the final analyses. All evidence gathered demonstrated a consistent association between peri-implantitis and systemic inflammation. Patients with peri-implantitis exhibited higher levels of serum C-reactive protein (CRP) (standard mean difference (SMD): 4.68, 98.7% CI: 2.12 to 7.25), interleukin-6 (IL-6) (weighted mean difference (WMD): 6.27 pg/mL, 0% CI: 5.01 to 7.54), and white blood cell counts (WMD: 1.16 * 103/μL, 0% CI: 0.61 to 1.70) when compared to participants without peri-implantitis.

Conclusion

Peri-implantitis is associated with higher systemic inflammation as assessed by serum CRP, IL-6, and white blood cell counts. Further research is needed to clarify the nature of this association.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=246837, identifier CRD42021246837.

Potential Clinical Application of Organs-on-a-Chip in Periodontal Diseases: A Systematic Review of In Vitro Studies

The periodontium is a unique organ from the standpoint of building an organ-on-a-chip (OoC) since it is a system that is continually threatened by microorganisms, their noxious compounds, and antigenic components. At the same time, periodontal health depends on a balanced connection between the host and the bacteria in the oral cavity, which is a complex micro-ecological environment. The objective of this systematic review of in vitro studies is to revise the potential clinical application of OoC in periodontal diseases. PRISMA was used to guide this analysis. The review framework made use of several databases, including SCOPUS, PubMed/MEDLINE, SCIELO, and LILACS as well as the gray literature. This systematic review comprised seven studies. The clinical efficacy of OoC in periodontal diseases was observed in models of the gingival crevice for the research of periodontitis, periodontal medication analysis, the interaction of multiple microbial species, pH measurements in in situ-grown biofilm, testing antimicrobial reagents, evaluation of mucosal interactions with microorganisms, and a device for quantitative exploration of microorganisms. OoC has the potential to advance our understanding of periodontal diseases by providing a more accurate representation of the oral microenvironment and enabling the development of new treatments.

Periodontal inflammation is associated with increased circulating levels of endothelial progenitor cells: a retrospective cohort study in a high vascular risk population

Background

One of the main biological mechanisms behind the link between periodontitis and atherosclerotic vascular diseases is vascular endothelial dysfunction. Particularly, circulating endothelial progenitor cells (EPCs) have been considered a biomarker of altered vascular endothelial function.

Objectives

The aim of this study was to investigate relationship between periodontal inflammation and increased number of circulating EPCs.

Design

This is retrospective cohort study.

Methods

In this study, 85 elderly patients with a previous history of hypertension were followed up to 12 months. A baseline full-mouth periodontal assessment was carried out, and the amount of periodontal tissue inflamed per subject was calculated as a proxy of periodontal inflammation [periodontal inflamed surface area (PISA)]. The number of circulating EPCs (CD34+/CD133+/KDR+) was determined by flow cytometry from peripheral blood samples collected at baseline and 12 months.

Results

Mean concentrations of CD34+/CD133+/KDR+ progenitor cells were higher in periodontitis patients than in those without periodontitis at baseline [55.4, 95% confidence interval (CI) = 20.8 to 90.0 versus 27.2, 95% CI = 13.6 to 40.8, p = 0.008] and 12 months (114.6, 95% CI = 53.5 to 175.7 versus 19.1, 95% CI = 10.8 to 27.4, p = 0.003). A significant increase over the follow-up was noticed in the group of subjects with periodontitis (p = 0.049) but not in the nonperiodontitis group (p = 0.819). PISA was independently associated with CD34+/CD133+/KDR+ EPCs at baseline (B coefficient = 0.031, 95% CI = 0.005 to 0.058; p = 0.021). The relationship between PISA and CD34+/CD133+/KDR+ EPCs at 12 months was confounded by increased baseline body mass index (B coefficient = 0.064, 95% CI = -0.005 to 0.132; p = 0.066).

Conclusion

Periodontal inflammation is associated with high number of CD34+/CD133+/KDR+ EPCs, thus supporting a potential link between periodontitis and endothelial dysfunction.

Optimizing a Diagnostic Model of Periodontitis by Using Targeted Proteomics

Periodontitis (PD), a widespread chronic infectious disease, compromises oral health and is associated with various systemic conditions and hematological alterations. Yet, to date, it is not clear whether serum protein profiling improves the assessment of PD. We collected general health data, performed dental examinations, and generated serum protein profiles using novel Proximity Extension Assay technology for 654 participants of the Bialystok PLUS study. To evaluate the incremental benefit of proteomics, we constructed two logistic regression models assessing the risk of having PD according to the CDC/AAP definition; the first one contained established PD predictors, and in addition, the second one was enhanced by extensive protein information. We then compared both models in terms of overall fit, discrimination, and calibration. For internal model validation, we performed bootstrap resampling (n = 2000). We identified 14 proteins, which improved the global fit and discrimination of a model of established PD risk factors, while maintaining reasonable calibration (area under the curve 0.82 vs 0.86; P < 0.001). Our results suggest that proteomic technologies offer an interesting advancement in the goal of finding easy-to-use and scalable diagnostic applications for PD that do not require direct examination of the periodontium.

Clinics and Practice: Consolidating Best Practices in Periodontal Management

Periodontitis is a multifactorial inflammatory disease [...].

Antenatal interventions to reduce risk of low birth weight related to maternal infections during pregnancy

BACKGROUND

Maternal infections during pregnancy have been linked to increased risk of adverse birth outcomes, including low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), and stillbirth (SB).

OBJECTIVES

The purpose of this article was to summarize evidence from published literature on the effect of key interventions targeting maternal infections on adverse birth outcomes.

METHODS

We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL Complete between March 2020 and May 2020 with an update to cover until August 2022. We included randomized controlled trials (RCTs) and reviews of RCTs of 15 antenatal interventions for pregnant women reporting LBW, PTB, SGA, or SB as outcomes.

RESULTS

Of the 15 reviewed interventions, the administration of 3 or more doses of intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine [IPTp-SP; RR: 0.80 (95% CI: 0.69, 0.94)] can reduce risk of LBW compared with 2 doses. The provision of insecticide-treated bed nets, periodontal treatment, and screening and treatment of asymptomatic bacteriuria may reduce risk of LBW. Maternal viral influenza vaccination, treatment of bacterial vaginosis, intermittent preventive treatment with dihydroartemisinin-piperaquine compared with IPTp-SP, and intermittent screening and treatment of malaria during pregnancy compared with IPTp were deemed unlikely to reduce the prevalence of adverse birth outcomes.

CONCLUSIONS

At present, there is limited evidence from RCTs available for some potentially relevant interventions targeting maternal infections, which could be prioritized for future research.

Adverse Pregnancy Outcomes and Maternal Periodontal Disease: An Overview on Meta-Analytic and Methodological Quality

This umbrella review aims to appraise the methodological quality and strength of evidence on the association between maternal periodontitis and adverse pregnancy outcomes (APOs). PubMed, CENTRAL, Web-of-Science, LILACS, and Clinical Trials were searched until February 2023, without date or language restrictions. Two authors independently screened studies, extracted data, performed the risk-of-bias analysis, and estimated the meta-analytic strengths and validity and the fail-safe number (FSN). A total of 43 SRs were identified, of which 34 conducted meta-analyses. Of the 28 APOs, periodontitis had a strong association with preterm birth (PTB), low birth weight (LBW), and gestational diabetes mellitus (GDM), PTB and LBW showed all levels of strength, and pre-eclampsia showed only suggestive and weak strength. Regarding the consistency of the significant estimates, only 8.7% were likely to change in the future. The impact of periodontal treatment on APOs was examined in 15 SRs, 11 of which conducted meta-analyses. Forty-one meta-analyses were included and showed that periodontal treatment did not have a strong association with APOs, although PTB revealed all levels of strength and LBW showed only suggestive and weak evidence. Strong and highly suggestive evidence from observational studies supports an association of periodontitis with a higher risk of PTB, LBW, GDM, and pre-eclampsia. The effect of periodontal treatment on the prevention of APOs is still uncertain and requires future studies to draw definitive and robust conclusions.

Effects of periodontitis on cancer outcomes in the era of immunotherapy

Periodontitis results from dysbiosis of the oral microbiome and affects up to 70% of US adults aged 65 years and older. More than 50 systemic inflammatory disorders and comorbidities are associated with periodontitis, many of which overlap with immunotherapy-associated toxicities. Despite the increasing use of immunotherapy for the treatment of cancer, uncertainty remains as to whether the microbial shift associated with periodontal disease can influence response rates and tolerance to cancer immunotherapy. We herein review the pathophysiology of periodontitis and the local and systemic inflammatory conditions related to oral dysbiosis, and discuss the overlapping adverse profiles of periodontitis and immunotherapy. The effects of the presence of Porphyromonas gingivalis, a key pathogen in periodontitis, highlight how the oral microbiome can affect the hosts' systemic immune responses, and further research into the local and systemic influence of other microorganisms causing periodontal disease is necessary. Addressing periodontitis in an ageing population of people with cancer could have potential implications for the clinical response to (and tolerability of) immunotherapy and warrants further investigation.

Role of prebiotic dietary fiber in periodontal disease: A systematic review of animal studies

Background

Periodontitis is a chronic inflammatory condition affecting the supporting structures of a tooth in the oral cavity. The relationship between dietary fiber and periodontitis is poorly understood. The objective of this systematic review is to investigate if an intake of dietary fiber modulates periodontal disease in animal models and any concomitant effects on systemic inflammation, microbiota and their metabolites.

Methods

Animal studies using periodontitis models with any form of fiber intervention were included. Studies with comorbidities that were mutually inclusive with periodontitis and animals with physiological conditions were excluded. Search strategy with MeSH and free-text search terms were finalized and performed on the 22nd of September 2021.CINAHL Complete, EMBASE, MEDLINE, SciVerse Scopus® and Web of Science Core Collection databases were used to identify studies. SYRCLE’s risk of bias tool and CAMARADES were used for quality assessment. Results were synthesized utilizing Covidence© web-based platform software to remove duplicates, and the remaining studies were manually filtered.

Results

A total of 7,141 articles were retrieved from all databases. Out of 24 full-text articles assessed for eligibility, four studies (n = 4) were included. Four studies involved the use of β-(1,3/1,6)-glucan (n = 3) and mannan oligosaccharide (n = 1) at differing dosages for different study durations. All studies utilized a ligature-induced model of periodontitis in rats, either Wistar (n = 3) or Sprague–Dawley (n = 1). A dose-dependent relationship between the increased fiber intake and decrease in alveolar bone loss and pro-inflammatory markers was observed.

Conclusion

The number of included studies is limited and narrow in scope. They highlight the importance of pre-clinical trials in this field with broader dietary fiber intervention groups before proceeding to clinical trials. The use of dietary fiber as an intervention shows promise in the reduction of inflammatory conditions like periodontitis. However, further research is required to delineate the relationship between diet and its effects on microbiota and their metabolites such as short chain fatty acids in animal models of periodontitis.

People's Willingness to Pay for Dental Checkups and the Associated Individual Characteristics: A Nationwide Web-Based Survey among Japanese Adults

This study aimed to determine the willingness-to-pay (WTP) values for dental checkups and analyze the association between the values and individual characteristics. This cross-sectional study was conducted using a nationwide web-based survey, and 3336 participants were allocated into groups that received regular dental checkups (RDC; n = 1785) and those who did not (non-RDC; n = 1551). There was a statistically significant difference in the WTP value for dental checkups between the RDC (median: 3000 yen [22.51 USD]) and non-RDC groups (2000 yen [15.01 USD]). In the RDC group, age 50-59 years, household income <2 million yen, homemaker and part-time worker employment status, and having children were significantly associated with decreased WTP values; male sex, household incomes ≥8 million yen, and tooth brushing ≥3 times daily were associated with increased WTP values. In the non-RDC group, age ≥30 years, household incomes <4 million yen, and having ≥28 teeth were significantly associated with decreased WTP values; household income ≥8 million yen was associated with increased WTP values. Conclusively, WTP values for dental checkups were lower in the non-RDC group than in the RDC group; in the non-RDC group, those with lower household income aged ≥30 years were more likely to propose lower WTP values, suggesting the need for policy intervention to improve access to RDC.

Provision of Dental Care to Indigenous South Australians and Impacts on Improved General Health: Study Protocol

BACKGROUND

Indigenous South Australians carry a disproportionate burden of dental diseases, with approximately 80 percent of Indigenous adults having both periodontal disease and dental caries. The chronic inflammatory nature of many dental conditions means there are widespread systemic impacts, particularly on type 2 diabetes, chronic kidney disease and cardiovascular disease. Evidence suggests there are barriers experienced by Indigenous South Australians in accessing timely and culturally safe dental care. This study aims to: (1) elicit the views of Indigenous South Australians regarding their perspectives of what comprises culturally safe dental care; (2) provide such dental care and; (3) assess any changes in both oral and general health using point-of-care testing following receipt of timely, comprehensive and culturally safe dental care.

METHODS/DESIGN

This mixed-methods study will involve qualitative interviews and an intervention without randomisation. The qualitative component will comprise seeking perspectives of Indigenous South Australians regarding what culturally safe dental care means for them. For the intervention component, participants will take part in oral epidemiological examinations at baseline and 12-month follow-up (after receipt of dental care), which will include collection of saliva, plaque and calculus, as well as completion of a self-report questionnaire. The primary outcome measures-changes in type 2 diabetes (HbA1c), cardiovascular disease (CRP) and chronic kidney disease (ACR)-will be obtained by blood/urine spot from a finger prick/urine collection at baseline and 12-month follow-up via point-of-care testing.

RESULTS

Participant recruitment will commence in July 2022. The first results are expected to be submitted for publication one year after recruitment begins.

DISCUSSION

The project will have a number of important outcomes, including increased understanding of what culturally safe dental care means for Indigenous South Australians, the delivery of such care, and empirical evidence of how culturally safe dental care leads to better prognosis for chronic diseases linked with poor oral health. This will be important for health services planning, especially in the Aboriginal Community Controlled Health Organisation sector, where the management of dental diseases in a culturally safe manner for better chronic disease outcomes is currently insufficiently understood, planned and budgeted for.

Can the Correlation of Periodontopathies with Gastrointestinal Diseases Be Used as Indicators in Severe Colorectal Diseases?

Gastrointestinal problems are among the most common health problems which can acutely affect the healthy population and chronically involve health risks, seriously affecting the quality of life. Identifying the risk of gastrointestinal diseases in the early phase by indirect methods can increase the healing rate and the quality of life.: The proposal of this study is to verify a correlation between gastrointestinal and periodontal problems and the risk of inflammatory gastrointestinal diseases (IBD). The study was conducted on 123 people who were observed to have gastrointestinal and psychological problems. The participants were divided into three groups, depending on each one's diagnosis. The control group (CG) was composed of 37 people who did not fit either irritable bowel syndrome (IBS) according to the ROME IV criteria, nor were inflammatory markers positive for IBD. Group 2 (IBS) was composed of 44 participants diagnosed with IBS according to the ROME IV criteria. Group 3 was composed of 42 participants who were diagnosed with IBD. All study participants underwent anthropometric, micro-Ident, and quality of life tests. A directly proportional relationship of the presence of bacteria with IBD patients with the exception of Capnocytophaga spp. and Actinobacillus actinomycetemcomitans was observed. These two bacteria correlated significantly with IBS. Follow-up of the study participants will help determine whether periodontal disease can be used as an indicator of severe colorectal disease. In addition, this study should be continued especially in the case of IBD more thoroughly to follow and reduce the risk of malignancy.

An umbrella review of the evidence linking oral health and systemic noncommunicable diseases

Oral diseases are highly prevalent worldwide. Recent studies have been supporting a potential bidirectional association of oral diseases with systemic noncommunicable diseases (NCDs). Available evidence supports that people with NCDs have a greater prevalence of oral diseases particularly those with limited ability of oral self-care. Regarding the reverse relationship, the lines of evidence pointing out NCDs as putative risk factors for oral diseases have increased significantly but not with a consistent agreement. This umbrella review of meta-analyses appraises the strength and validity of the evidence for the association between oral health and systemic health (registered at PROSPERO, ID: CRD42022300740). An extensive search included systematic reviews that have provided meta-analytic estimates on the association of oral diseases with NCDs. The overall strength of evidence was found to be unfavorable and with methodological inconsistencies. Twenty-eight NCDs were strongly associated with oral diseases. Among those NCDs are five types of cancer, diabetes mellitus, cardiovascular diseases, depression, neurodegenerative conditions, rheumatic diseases, inflammatory bowel disease, gastric helicobacter pylori, obesity, and asthma. According to fail-safe number statistics, the evidence levels are unlikely to change in the future, indicating a fairly robust consistency.

The Significance of Oral Inflammation in Elite Sports: A Narrative Review

Recently, there has been intense discussion about sports dentistry and potential interactions between oral health and athletes' performance. This narrative review aims to provide a comprehensive overview of the available literature about oral inflammation in sports. For this purpose, it presents the most common types of oral inflammation (gingivitis, periodontitis, pericoronitis, apical periodontitis), and their prevalence in athletes. Both the impact of oral inflammation on performance and causes for oral inflammation in athletes are discussed by presenting current literature. Finally, international recommendations for dental care in sports are presented. Several studies stated a high prevalence of oral inflammation in athletes, especially of gingivitis (58-97%) and periodontitis (41%). Also, many athletes report oral pain (17-30%) and a negative impact of oral health on training (3-9%). Besides this, a systemic impact of oral inflammation is discussed: In periodontitis patients, blood parameters and physical fitness are changed. In athletes, associations between muscle injuries and poor oral health are reported. There are deficits in oral health behavior. Furthermore, systemic changes due to physical stress could influence oral tissues. Overall, complex bidirectional interactions between competitive sports and oral inflammation are possible. Regular dental examinations and prevention strategies should be implemented in sports.

Association between Dietary Habit and Clinical Parameters in Patients with Chronic Periodontitis Undergoing Supportive Periodontal Therapy

The recurrence risk evaluation has been emphasized in periodontal stabilization during supportive periodontal therapy (SPT). However, nutritional factors, e.g., dietary habits such as the frequency of eating vegetables, are rarely included in the evaluation. In this study, the effect of nutritional factors on clinical periodontal parameters was examined in a lifestyle-related investigation and a periodontal examination in patients with periodontitis undergoing SPT. A total of 106 patients were recruited. Tendencies toward a negative correlation were found between rate of a probing depth (PD) of 4-5 mm, rate of PD ≥ 6 mm, the bleeding on probing (BOP) rate, periodontal inflamed surface area (PISA), and various nutritional factors. The number of teeth was a clinical parameter with a significantly high R2 (≥0.10) influenced by environmental factors, whereas PD, PD of 4-5 mm, the BOP rate, and PISA were influenced by nutritional factors. These results suggested that environmental factors reflected clinical parameters showing long-term pathophysiology, such as the PD rate. Nutritional factors tended to affect the current inflammatory pathophysiology, such as the BOP rate, PISA, and PISA/periodontal epithelial surface area. Therefore, environmental and nutritional factors appear to be useful for evaluating the risk of periodontitis during SPT.

Serum Antioxidant Vitamins Mediate the Association between Periodontitis and Metabolically Unhealthy Overweight/Obesity

BACKGROUND

Periodontal disease is associated with metabolic syndrome and obesity. This cross-sectional study aimed to investigate whether serum antioxidant vitamins could mediate the association between periodontitis and a metabolically unhealthy phenotype in the overweight and obese population; Methods: We included 6158 Americans (body mass index (BMI) ≥ 25 kg/m²) from the Third National Health and Nutrition Examination Survey (NHANES III). Periodontitis was defined using a half-reduced CDC/AAP (Centers for Disease Control and Prevention/American Academy of Periodontology) definition. Having two or more metabolic abnormalities was defined as a metabolically unhealthy overweight and obese (MUO) phenotype. Mediation analysis of four oxidative stress biomarkers (serum antioxidant vitamins A, C, D, and E) was conducted; Results: Of participants with overweight and obesity, 2052 (33.3%) Americans were categorized as having periodontitis. Periodontitis increased dyslipidemia risk and systemic inflammation in the overweight and obese population. In the multivariable logistic regression model, periodontitis was positively associated with MUO (adjusted odds ratio = 1.238; 95% confidence interval: 1.091 to 1.406). These findings were validated in an independent cohort. Serum vitamins C and D were estimated to mediate 19.3% and 8.4% of the periodontitis-MUO association.

CONCLUSIONS

Periodontitis might decrease serum vitamins C and D and induce a metabolically unhealthy state among adults with overweight and obesity.

Efficacy of the Adjunct Use of Povidone-Iodine or Sodium Hypochlorite with Non-Surgical Management of Periodontitis: A Systematic Review and Meta-Analysis

This systematic review sought to assess the efficacy of combining either sodium hypochlorite or povidone-iodine as disinfection solutions with non-surgical treatment of periodontitis. An electronic search was conducted through PubMed, Scopus, Web of Science, CENTRAL, and Google Scholar from inception until 10 September 2022. Outcomes included clinical outcomes (probing pocket depth, plaque index, clinical attachment level, relative-horizontal attachment level, bleeding on probing, gingival recession, the position of gingival margin) and biochemical (BAPNA level) properties. A subgroup analysis was conducted according to the assessment timepoint. Ten studies reporting the use of povidone-iodine and five studies reporting the use of sodium hypochlorite were included in this review. Overall, in the meta-analysis of povidone-iodine, no significant changes were noted in any of the assessed outcomes; however, minor changes were noted in probing pocket depth and clinical attachment level at a specific timepoint. Regarding sodium hypochlorite, a significant reduction in all clinical outcomes, except for bleeding on probing, was noted. In conclusion, the use of povidone-iodine does not result in an improvement in clinical outcomes, whereas sodium hypochlorite has promising properties that result in significant improvement in probing pocket depth and clinical attachment level. However, more studies are needed to confirm these observations.

Biological Roles of Fibroblasts in Periodontal Diseases

Periodontal diseases include periodontitis and gingival overgrowth. Periodontitis is a bacterial infectious disease, and its pathological cascade is regulated by many inflammatory cytokines secreted by immune or tissue cells, such as interleukin-6. In contrast, gingival overgrowth develops as a side effect of specific drugs, such as immunosuppressants, anticonvulsants, and calcium channel blockers. Human gingival fibroblasts (HGFs) are the most abundant cells in gingival connective tissue, and human periodontal ligament fibroblasts (HPLFs) are located between the teeth and alveolar bone. HGFs and HPLFs are both crucial for the remodeling and homeostasis of periodontal tissue, and their roles in the pathogenesis of periodontal diseases have been examined for 25 years. Various responses by HGFs or HPLFs contribute to the progression of periodontal diseases. This review summarizes the biological effects of HGFs and HPLFs on the pathogenesis of periodontal diseases.

Periodontitis and implant complications in diabetes

Epidemiologic evidence indicates that periodontitis is more frequent in patients with uncontrolled diabetes mellitus than in healthy controls, suggesting that it could be considered the "sixth complication" of diabetes. Actually, diabetes mellitus and periodontitis are two extraordinarily prevalent chronic diseases that share a number of comorbidities all converging toward an increased risk of cardiovascular disease. Periodontal treatment has recently been shown to have the potential to improve the metabolic control of diabetes, although long-term studies are lacking. Uncontrolled diabetes also seems to affect the response to periodontal treatment, as well as the risk to develop peri-implant diseases. Mechanisms of associations between diabetes mellitus and periodontal disease include the release of advanced glycation end products as a result of hyperglycemia and a range of shared predisposing factors of genetic, microbial, and lifestyle nature. This review discusses the evidence for the risk of periodontal and peri-implant disease in diabetic patients and the potential role of the dental professional in the diabetes-periodontal interface.

Associations of Blood and Performance Parameters with Signs of Periodontal Inflammation in Young Elite Athletes-An Explorative Study

This retrospective cross-sectional study aimed to explore interactions between signs of periodontal inflammation and systemic parameters in athletes. Members of German squads with available data on sports medical and oral examination were included. Groups were divided by gingival inflammation (median of papillary bleeding index, PBI ≥ median) and signs of periodontitis (Periodontal Screening Index, PSI ≥ 3). Age, gender, anthropometry, blood parameters, echocardiography, sports performance on ergometer, and maximal aerobic capacity (VO2max) were evaluated. Eighty-five athletes (f = 51%, 20.6 ± 3.5 years) were included (PBI < 0.42: 45%; PSI ≥ 3: 38%). Most associations were not statistically significant. Significant group differences were found for body fat percentage and body mass index. All blood parameters were in reference ranges. Minor differences in hematocrit, hemoglobin, basophils, erythrocyte sedimentation rates, urea, and HDL cholesterol were found for PBI, in uric acid for PSI. Echocardiographic parameters (n = 40) did not show any associations. Athletes with PSI ≥ 3 had lower VO2max values (55.9 ± 6.7 mL/min/kg vs. 59.3 ± 7.0 mL/min/kg; p = 0.03). In exercise tests (n = 30), athletes with PBI < 0.42 achieved higher relative maximal load on the cycling ergometer (5.0 ± 0.5 W/kg vs. 4.4 ± 0.3 W/kg; p = 0.03). Despite the limitations of this study, potential associations between signs of periodontal inflammation and body composition, blood parameters, and performance were identified. Further studies on the systemic impact of oral inflammation in athletes, especially regarding performance, are necessary.

Treatment of gingivitis is associated with reduction of systemic inflammation and improvement of oral health-related quality of life: A randomized clinical trial

AIM

To compare the level of inflammatory markers, oral health-related quality of life (OHRQoL) and gingival parameters 1 month after introduction of electric toothbrush and intensive oral hygiene maneuvers adaptation (OHI) versus routine habits (no-OHI) in patients affected by generalized gingivitis.

METHODS

140 subjects with generalized gingivitis were randomized to receive either OHI or no-OHI. Full-mouth plaque/bleeding scores (FMPS/FMBS), serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6- (IL-6) and an Oral health impact profile-14 questionnaire (OHIP-14) were collected at baseline and at 1-month follow-up visit.

RESULTS

In the OHI, a significant FMPS and FMPBS reduction (p<0.01), a significant intragroup decrease in hs-CRP and IL-6 (p<0.01) and a significant improvement of OHRQoL (p<0.01) was noted at 1-month. In the no-OHI, lower-magnitude differences were noted only for oral parameters. Resolution of gingivitis varied between OHI and no-OHI (89% versus 7% respectively, p<0.01). A Logistic multivariate regression suggested that FMBS ≤8% was associated with odds ratio of 13 of having both CRP and IL-6 below the selected threshold for healthy young adults (p=0.04).

CONCLUSIONS

Gingivitis resolution determined important reductions of gingival inflammation and plaque levels, as well as systemic inflammatory markers and an improvement of quality of life (NCT03848351).

Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline

BACKGROUND

The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc.), which require additional interventions following completion of active periodontal therapy.

AIM

To develop an S3 Level CPG for the treatment of stage IV periodontitis, focusing on the implementation of inter-disciplinary treatment approaches required to treat/rehabilitate patients following associated sequelae and tooth loss.

MATERIALS AND METHODS

This S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and a structured consensus process with leading experts and a broad base of stakeholders.

RESULTS

The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care. Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment. The periodontal component of therapy should follow the CPG for the treatment of periodontitis in stages I-III.

CONCLUSIONS

The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication.

Biomimetic Design and Fabrication of Sericin-Hydroxyapatite Based Membranes With Osteogenic Activity for Periodontal Tissue Regeneration

The guided tissue regeneration (GTR) technique is a promising treatment for periodontal tissue defects. GTR membranes build a mechanical barrier to control the ingrowth of the gingival epithelium and provide appropriate space for the regeneration of periodontal tissues, particularly alveolar bone. However, the existing GTR membranes only serve as barriers and lack the biological activity to induce alveolar bone regeneration. In this study, sericin-hydroxyapatite (Ser-HAP) composite nanomaterials were fabricated using a biomimetic mineralization method with sericin as an organic template. The mineralized Ser-HAP showed excellent biocompatibility and promoted the osteogenic differentiation of human periodontal membrane stem cells (hPDLSCs). Ser-HAP was combined with PVA using the freeze/thaw method to form PVA/Ser-HAP membranes. Further studies confirmed that PVA/Ser-HAP membranes do not affect the viability of hPDLSCs. Moreover, alkaline phosphatase (ALP) staining, alizarin red staining (ARS), and RT-qPCR detection revealed that PVA/Ser-HAP membranes induce the osteogenic differentiation of hPDLSCs by activating the expression of osteoblast-related genes, including ALP, Runx2, OCN, and OPN. The unique GTR membrane based on Ser-HAP induces the differentiation of hPDLSCs into osteoblasts without additional inducers, demonstrating the excellent potential for periodontal regeneration therapy.

Diagnoses Based on C-Reactive Protein Point-of-Care Tests

C-reactive protein (CRP) is an important part of the immune system's reaction to various pathological impulses such as bacterial infections, systemic inflammation, and internal organ failures. An increased CRP level serves to diagnose the mentioned pathological states. Both standard laboratory methods and simple point-of-care devices such as lateral flow tests and immunoturbidimetric assays serve for the instrumental diagnoses based on CRP. The current method for CRP has many flaws and limitations in its use. Biosensor and bioassay analytical devices are presently researched by many teams to provide more sensitive and better-suited tools for point-of-care tests of CRP in biological samples when compared to the standard methods. This review article is focused on mapping the diagnostical relevance of CRP, the applicability of the current analytical methods, and the recent innovations in the measurement of CRP level.

Managing the Systemic Impact of Periodontitis

Periodontitis is a microbially driven host-mediated disease that leads to loss of periodontal attachment and bone. It is associated with elevation of systemic inflammatory markers and with the presence of systemic co-morbidities. Furthermore, periodontal treatment leads to a 24-48 h-long acute local and systemic inflammatory response. This systemic response might increase the burden of patients with compromised medical history and/or uncontrolled systemic diseases. The correlation between periodontitis and systemic diseases, the impact of periodontitis on the quality of life and public health, the effects of periodontal treatment on systemic health and disease, and the available methods to manage systemic inflammation after periodontal therapy are discussed. The main focus then shifts to a description of the existing evidence regarding the impact of periodontitis and periodontal treatment on systemic health and to the identification of approaches aiming to reduce the effect of periodontitis on systemic inflammation.