Periodontal disease and a poor response to periodontal treatment were associated with an increased risk of incident diabetes: A longitudinal cohort study in Sweden

LIGHT protein: A novel gingival crevicular fluid biomarker associated with increased probing depth after periodontal surgery

AIM

To evaluate the protein profiles in gingival crevicular fluid (GCF) in relation to clinical outcomes after periodontal surgery and examine if any selected proteins affect the mRNA expression of pro-inflammatory cytokines in human gingival fibroblasts.

MATERIALS AND METHODS

This exploratory study included 21 consecutive patients with periodontitis. GCF was collected, and the protein pattern (n = 92) and clinical parameters were evaluated prior to surgery and 3, 6 and 12 months after surgery. Fibroblastic gene expression was analysed by real-time quantitative polymerase chain reaction.

RESULTS

Surgical treatment reduced periodontal pocket depth (PPD) and changed the GCF protein pattern. Twelve months after surgery, 17% of the pockets showed an increase in PPD. Levels of a number of proteins in the GCF decreased after surgical treatment but increased with early signs of tissue destruction, with LIGHT being one of the proteins that showed the strongest association. Furthermore, LIGHT up-regulated the mRNA expression of pro-inflammatory cytokines interleukin (IL)-6, IL-8 and MMP9 in human gingival fibroblasts.

CONCLUSIONS

LIGHT can potentially detect subjects at high risk of periodontitis recurrence after surgical treatment. Moreover, LIGHT induces the expression of inflammatory cytokines and tissue-degrading enzymes in gingival fibroblasts.

Periodontal treatment and subsequent clinical outcomes and medical care costs: A retrospective cohort study

INTRODUCTION

Periodontitis is a common oral disease associated with coronary artery disease (CAD), cerebrovascular disease (CBVD) and type 2 diabetes (T2D). We studied if periodontitis treatment improves clinical outcomes and reduces medical care costs in patients with CAD, CBVD or T2D.

METHODS

We used clinic records and claims data from a health care system to identify patients with periodontitis and CAD, CBVD or T2D, and to assess periodontal treatments, hospitalizations, medical costs (total, inpatient, outpatient, pharmacy), glycated hemoglobin, cardiovascular events, and death following concurrent disease diagnoses. We compared clinical outcomes according to receipt of periodontal treatment and/or maintenance care in the follow-up period, and care costs according to treatment status within one year following concurrent disease diagnoses, while adjusting for covariates. The data were analyzed in 2019-21.

RESULTS

We identified 9,503 individuals, 4,057 of whom were in the CAD cohort; 3,247 in the CBVD cohort; and 4,879 in the T2D cohort. Patients who were selected and elected to receive treatment and maintenance care were less likely to be hospitalized than untreated individuals (CAD: OR = 0.71 (95% CI: 0.55, 0.92); CBVD: OR = 0.73 (0.56, 0.94); T2D: OR = 0.80 (0.64, 0.99)). Selection to treatment and/or maintenance care was not significantly associated with cardiovascular events, mortality, or glycated hemoglobin change. Total care costs did not differ significantly between treated and untreated groups over 4 years. Treated patients experienced lower inpatient costs but higher pharmacy costs.

CONCLUSIONS

Patients with periodontitis and CAD, CBVD or T2D who were selected and elected to undergo periodontal treatment or maintenance care had lower rates of hospitalizations, but did not differ significantly from untreated individuals in terms of clinical outcomes or total medical care costs.

The critical issue linking lipids and inflammation: Clinical utility of stopping oxidative stress

The formation of an atheroma begins when lipoproteins become trapped in the intima. Entrapped lipoproteins become oxidized and activate the innate immune system. This immunity represents the primary association between lipids and inflammation. When the trapping continues, the link between lipids and inflammation becomes chronic and detrimental, resulting in atherosclerosis. When entrapment ceases, the association between lipids and inflammation is temporary and healthy, and the atherogenic process halts. Therefore, the link between lipids and inflammation depends upon lipoprotein retention in the intima. The entrapment is due to electrostatic forces uniting apolipoprotein B to polysaccharide chains on intimal proteoglycans. The genetic transformation of contractile smooth muscle cells in the media into migratory secretory smooth muscle cells produces the intimal proteoglycans. The protein, platelet-derived growth factor produced by activated platelets, is the primary stimulus for this genetic change. Oxidative stress is the main stimulus to activate platelets. Therefore, minimizing oxidative stress would significantly reduce the retention of lipoproteins. Less entrapment decreases the association between lipids and inflammation. More importantly, it would halt atherogenesis. This review will analyze oxidative stress as the critical link between lipids, inflammation, and the pathogenesis of atherosclerosis. Through this perspective, we will discuss stopping oxidative stress to disrupt a harmful association between lipids and inflammation. Numerous therapeutic options will be discussed to mitigate oxidative stress. This paper will add a new meaning to the Morse code distress signal SOS-stopping oxidative stress.

Expression of advanced glycation end products and receptors in gingival tissues of patients with noninsulin-dependent diabetes mellitus-associated periodontitis

Background/purpose

Advanced glycation end products (AGEs) are known to accumulate in the periodontal tissues of patients with diabetes mellitus (DM). Through this study, we aimed to investigate the distribution of AGEs and the receptor of AGEs (RAGE) in the gingival tissues of patients with chronic periodontitis with and without non-insulin-dependent diabetes mellitus (NIDDM).

Materials and methods

Gingival biopsy samples from 13 patients with both NIDDM and periodontitis and 6 patients with both non-DM (NDM) and periodontitis were collected. The tissue sections were processed using immunohistochemical (IHC) staining to detect the distributions of AGEs and RAGE. Spearman correlation coefficients of all samples were calculated (P < 0.05) for the AGE and RAGE rankings of the following clinical parameters: plaque score (PI), probing depth (PD), bleeding on probing (BOP), and tooth loss (TL).

Results

IHC analysis revealed that AGEs among patients with NIDDM had a significantly higher ranking than those of the NDM group (P < 0.05). Positive staining for RAGE was observed in both groups but was not significantly different (P > 0.05). A positive correlation between AGE ranking and TL was observed in the NIDDM group, but not between AGE ranking and PI, PD, or BOP. The distribution of RAGE was not correlated with PI, PD, BOP, or TL.

Conclusion

AGEs were particularly distributed in the highly inflamed gingiva of patients with NIDDM-associated periodontitis and was statistically correlated with the long-term parameter TL.

Preventive dental care is associated with improved health care outcomes and reduced costs for Medicaid members with diabetes

Introduction

Preventive dental services have been associated with improved health outcomes. This study expands on previous observations by examining the relationship between oral health care and health care outcomes and costs in a publicly insured population with diabetes.

Methods

Utilization of dental services, health care outcomes and costs were evaluated for New York State Medicaid members with a diagnosis of diabetes mellitus (DM), ages 42 to 64, who were continuously enrolled between July 1, 2012 and June 30, 2015. Utilization of dental services focused on preventive dental care (PDC), and extractions and endodontic treatment (both indicative of advanced dental infection). Data were analyzed using regression models with propensity score weighting to control for potential confounding.

Results

Receipt of PDC was associated with lower utilization rates and costs compared to members who did not access dental services. The most pronounced average cost difference was observed for inpatient admissions at $823 per year for members who had at least one PDC without extraction or endodontic treatment. Each additional PDC visit received was associated with an 11% lower rate of inpatient admissions and lower average inpatient costs by $407 per member. The need for a dental extraction or endodontic therapy was associated with relatively higher rates and costs.

Conclusions

These findings demonstrate an association between PDC and improved health care outcome rates and lower average costs among members with DM and suggest a general health benefit associated with provision of preventive dental care for persons with DM.

A Tale of Two Fimbriae: How Invasion of Dendritic Cells by Porphyromonas gingivalis Disrupts DC Maturation and Depolarizes the T-Cell-Mediated Immune Response

Porphyromonas gingivalis (P. gingivalis) is a unique pathogen implicated in severe forms of periodontitis (PD), a disease that affects around 50% of the US population. P. gingivalis is equipped with a plethora of virulence factors that it uses to exploit its environment and survive. These include distinct fimbrial adhesins that enable it to bind to other microbes, colonize inflamed tissues, acquire nutrients, and invade cells of the stroma and immune system. Most notable for this review is its ability to invade dendritic cells (DCs), which bridge the innate and adaptive immune systems. This invasion process is tightly linked to the bridging functions of resultant DCs, in that it can disable (or stimulate) the maturation function of DCs and cytokines that are secreted. Maturation molecules (e.g., MHCII, CD80/CD86, CD40) and inflammatory cytokines (e.g., IL-1b, TNFa, IL-6) are essential signals for antigen presentation and for proliferation of effector T-cells such as Th17 cells. In this regard, the ability of P. gingivalis to coordinately regulate its expression of major (fimA) and minor (mfa-1) fimbriae under different environmental influences becomes highly relevant. This review will, therefore, focus on the immunoregulatory role of P. gingivalis fimbriae in the invasion of DCs, intracellular signaling, and functional outcomes such as alveolar bone loss and immune senescence.