Food Intake, Masticatory Function, Tooth Mobility, Loss of Posterior Support and Diminished Quality of Life Are Associated with More Advanced Periodontitis Stage Diagnosis

Periodontitis and Oral Health-Related Quality of Life: A Systematic Review and Meta-Analysis

AIM

To investigate the association between periodontitis and oral health-related quality of life (OHRQoL) in adults, and to compare OHRQoL across different severities of the disease.

MATERIALS AND METHODS

Searches were conducted in five electronic databases up to December 2023. Observational studies that provided a clear definition of periodontitis and used validated measures of OHRQoL were included. Meta-analyses were performed both overall and based on factors that could explain heterogeneity between studies.

RESULTS

Sixty studies comprising 14,851 individuals were included in the review. Meta-analyses showed that periodontitis was associated with impaired OHRQoL: any OHRQoL instruments (n = 33 studies; SMD: 0.75, 95% CI: 0.53-0.93), solely using the OHIP-14 (n = 26 studies; MD: 5.14, 95% CI: 3.64-6.64), and risk assessment (n = 9 studies; adjusted RR: 1.42, 95% CI: 1.12-1.78). Stages III-IV periodontitis had a greater impact than Stages I-II periodontitis. Subgroup and meta-regression analyses indicated smaller effect size estimates for individuals with comorbidities.

CONCLUSIONS

Periodontitis negatively impacts OHRQoL, with a positive score-response relationship found between periodontitis severity and poorer OHRQoL. However, the magnitude of this association appears to be diminished in individuals with comorbidities.

Association of unreplaced missing posterior teeth with migraine or severe headaches in US adults: A cross-sectional population study

STATEMENT OF PROBLEM

The association between unreplaced missing posterior teeth and migraine has not been sufficiently reported.

PURPOSE

The purpose of this cross-sectional study was to investigate the relationships between unreplaced missing posterior teeth and migraine or severe headaches.

MATERIAL AND METHODS

Data from the US National Health and Nutrition Examination Survey 1999-2004 on 12 662 participants aged between 20 and 85 years were analyzed. The survey produced complete data on dentition examination, dietary intakes, and self-reported migraine or severe headaches. Weighted multivariable logistic regression analyses were performed (α=.05).

RESULTS

A total of 20.28% of the participants had migraine or severe headaches. After adjusting demographic, clinical, and dietary covariates, the total number of missing teeth was not significantly associated with migraine or severe headaches, and only having both anterior and posterior missing teeth was significantly associated with migraine or severe headaches. The odds ratio (OR) and confidence interval (CI) was 1.32(1.09, 1.60) (P=.007). A significantly positive correlation was found between the number of unreplaced missing teeth and migraine or severe headaches. An increase of 1 in the number of unreplaced missing teeth was associated with a 3% increase in migraine or severe headaches (OR and CI: 1.03(1.01, 1.06), P=.012). However, no significant relationship was found between replaced missing teeth and migraine or severe headaches (OR and CI: 1.00(0.99, 1.01), P=.800). Furthermore, unreplaced missing posterior teeth and both unreplaced anterior and posterior teeth were significantly related with more migraine or severe headaches, but no significant association of unreplaced teeth was found with migraine or severe headaches only in the anterior zone in the adjusted model (OR and CI: anterior teeth unreplaced: 0.90(0.43, 1.88), P=.800; posterior teeth unreplaced: 1.14(1.00, 1.30), P=.047; both anterior and posterior teeth unreplaced: 1.61(1.16, 2.22), P=.007). Because of the important association between posterior missing teeth and migraine or severe headaches, further analyses found a 1 tooth increase in unreplaced posterior teeth was related to a 4% increment in migraine or severe headaches (OR and CI: 1.04(1.01, 1.07), P=.017); however, the number of replaced posterior teeth was not associated with migraine or severe headaches (OR and CI: 1.00(0.99, 1.02), P=.900).

CONCLUSIONS

The number of unreplaced missing posterior teeth was positively associated with migraine or severe headaches, while missing but restored posterior teeth were not associated with migraine or severe headaches in a US population.

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.

Low energy intake and nutritional maladaptation in terminal stage IV periodontitis

AIM

Impairment of masticatory function in elderly patients with terminal dentition due to stage IV periodontitis (TDS4P) may lead to lower nutritional intake. The study aimed to report the dietary intake and nutrition status of elderly patients with TDS4P and compare them with those of the elderly Chinese population and the Chinese Dietary Reference Intakes (DRIs).

MATERIALS AND METHODS

Fifty-one consecutive subjects (≥55 years old) with TDS4P were enrolled. Average dietary intake was evaluated based on a 3-day 24-h dietary recall (24HR) and food frequency questionnaire (FFQ). The daily intake of fresh vegetables and fruits, dietary energy as well as macro and micronutrients were calculated and compared with matched national data and the Chinese DRIs. Nutritional status was assessed by Short-Form Mini-Nutritional assessment.

RESULTS

Of the subjects, 19.6% (95% CI: 7.2%-28.1%) were at risk of malnutrition. The mean daily energy intake was 1517.4 kcal (95% CI: 1400.5-1634.3) for males and 1110.7 kcal (95% CI: 1001.5-1219.9) for females, which were very low compared with both the national data and the DRIs. Females derived a higher percentage of energy from fat. The mean daily intake of vegetables was 151.4 g (95% CI: 128.1-174.8) by FFQ and 130.9 g (95% CI: 104.6-157.3) by 24HR. Both results were significantly lower than the national reports (95% CI: 310.3-340.1) and the DRIs (300-450 g). Insufficient micronutrient intake, especially vitamins A, C and E, was also found.

CONCLUSIONS

Elderly subjects with TDS4P had a lower daily energy intake, vegetable and fruit consumption and essential macro and micronutrient intake. More studies are needed to clarify the impact of periodontitis and tooth loss/replacement on nutrition and healthy ageing.

Maintaining periodontally compromised teeth seems more cost-effective than replacing them with dental implants

DESIGN

A systematic appraisal without statistical aggregation.

DATA SOURCES

The researchers utilized Ovid (Medline), Embase, Web of Science, and CINAHL databases. They performed a comprehensive literature search, which concluded in July 2023. References of selected studies and systematic reviews were examined for additional relevant articles.

STUDY SELECTION

The review included studies (randomized controlled trials [RCTs], systematic reviews [SRs], narrative reviews, retrospective studies, cross-sectional studies, case series, case reports) discussing the cost-effectiveness of preserving teeth versus replacing them with implants in patients with severe periodontal disease. Non-English publications, letters, conference abstracts, and brief reports were excluded.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened titles and abstracts using a systematic review screening tool, resolving conflicts with a third reviewer. The extracted data included study design, patient demographics, treatment details, economic models, costs, and clinical implications. Quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools, with scores converted to percentages.

RESULTS

A total of 633 studies were identified for periodontal treatment, with 9 included after screening, while 114 studies were identified for dental implants, of which 3 were included after screening. The included studies were published between 2008 and 2018, predominantly from Germany, and mainly comprised retrospective designs, along with some prospective and model-based analyses. Follow-up periods ranged from 36 months to 33 years. Treatment costs were found to increase with disease severity, with surgical treatments being more expensive than nonsurgical ones, and supportive periodontal treatment (SPT) representing the highest cost share in periodontal treatment. Maintaining implants proved more costly than maintaining teeth, especially in cases of peri-implantitis. For chronic periodontitis, total treatment costs per tooth were €222 ± €98 over 18.7 years, and for aggressive periodontitis, €267 ± €148 over 16.9 years. Regular SPT cost €806 per tooth per year over 28.7 years, with significant cost variations across studies. A 2013 study found that maintaining implants was five times costlier than maintaining teeth, particularly if peri-implantitis developed. A 2018 study indicated that implant-supported crowns (ISCs) were the most expensive therapy. Only one study directly compared costs within the same patient, finding periodontal treatment to be more cost-effective than implants. Costs also increased with irregular SPT, aggressive periodontitis, and specialist treatments compared to regular SPT, chronic periodontitis, and treatments by general dental practitioners. The quality of included studies scored between 45% and 84.6%, indicating moderate to high quality, with methodological issues including unclear strategies for handling confounding factors and incomplete follow-up.

CONCLUSIONS

Implants are effective for replacing missing teeth but are associated with higher long-term costs and complications. Maintaining periodontally compromised teeth is generally more cost-effective, therefore, maintenance costs and potential complications should be carefully considered in treatment planning. There is a need for studies comparing the long-term cost-effectiveness of saving teeth compared to replacing them with implants, considering several variables for informed clinical decision-making.

Exploring medical and dental practitioner perspectives and developing a knowledge attitude and practice (KAP) evaluation tool for the common risk factor approach in managing non-communicable and periodontal diseases

BACKGROUND

The Common Risk Factor Approach (CRFA) is one of the methods to achieve medical-dental integration. CRFA addresses shared risk factors among major Non-communicable Diseases (NCDs). This study aimed to explore the perspectives of dental and medical practitioners concerning CRFA for managing NCDs and periodontal diseases and to create and validate a tool to evaluate the Knowledge, Attitude, and Practice (KAP) of medical and dental practitioners in relation to utilization of CRFA for management of NCDs and Periodontal diseases.

METHODS

This research employed a concurrent mixed-method model and was carried out from January 2021 to February 2022, focusing on medical and dental practitioners in South India. In the qualitative phase, online interviews were conducted with dental and medical practitioners, recorded, and transcribed. Thematic analysis was applied after achieving data saturation. In the quantitative phase, a KAP questionnaire was developed. The sample size was determined by using the G power statistical power analysis program. A sample size of 220 in each group (dentists and medical practitioners) was estimated. Systematic random sampling was used to recruit the potential participants. The data obtained through the online dissemination of KAP tool was analysed and scores were standardized to categorize the KAP.

RESULTS

Qualitative thematic analysis identified four major themes: understanding of common risk factors, risk factor reduction and disease burden, integrating CRFA into clinical practice, and barriers to CRFA. In addition, thematic analysis revealed seventeen subthemes. For the quantitative phase, standardization was applied to a 14-item KAP questionnaire for medical practitioners and a 19-item KAP questionnaire for dental practitioners. The total KAP score for medical practitioners in the study was 21.84 ± 2.87, while dental practitioners scored 22.82 ± 3.21, which indicated a high level of KAP regarding CRFA. Meta integration of qualitative and quantitative data identified eight overarching themes: four were concordant, three were discordant, and one theme provided the explanatory component.

CONCLUSION

The study's structured, validated questionnaire showed that both medical and dental professionals had a high knowledge of CRFA. However, they were not appreciably aware of the risk factors that are shared between NCDs and periodontal disease. Both groups were interested in the idea of using CRFA in integrated medical and dental care.

Burden of severe periodontitis and edentulism in 2021, with projections up to 2050: The Global Burden of Disease 2021 study

AIM

To (i) assess the prevalence, incidence, and burden of severe periodontitis and edentulism in 2021, and (ii) forecast their rates in 2050.

METHODS

Prevalence, incidence, and Years Lived with Disability (YLDs) for severe periodontitis and edentulism in 2021 were gathered globally, covering 204 countries, seven super regions, and 21 regions from the Global Burden of Disease (GBD) 2021 study. Prevalence, incidence, and YLDs due to periodontitis and edentulism to 2050 were projected using mixed-effects models with the socio-demographic index as the main covariate.

RESULTS

In 2021, over 1 billion people were affected by severe periodontitis (1066.95 million; 95% UI: 896.55-1234.84), with a global age-standardized prevalence of 12.50% (10.53-14.49). South Asia had the highest prevalence rate, at 17.57% (14.73; 20.14). Edentulism affected 353 million people globally (300.60-416.20), resulting in an age-standardized prevalence of 4.11% (3.50; 4.83). The highest edentulism prevalence was found in Latin America and the Caribbean, at 7.39% (6.44; 8.39). By 2050, more than 1.5 billion people (+44.32%) are projected to have severe periodontitis, and over 660 million (+84.40%) to be edentulous. In the same year, 19.67% (130.23 million) of the edentulous people worldwide will be located in China. Severe periodontitis is expected to move up one position, and edentulism nine positions, among the most impactful Level 4 diseases/conditions affecting YLDs worldwide by 2050.

CONCLUSION

Severe periodontitis and edentulism remain major public health challenges in 2021, with the number of affected individuals projected to rise significantly in the coming decades.

Based on network pharmacology and molecular docking to explore the potential mechanism of shikonin in periodontitis

OBJECTIVES

To investigate the potential mechanisms of shikonin in preventing and treating periodontitis using network pharmacology and molecular docking methods.

MATERIALS AND METHODS

The targets of shikonin were obtained in TCMSP and SEA databases, and targets of periodontitis were gathered from the OMIM, GeneCards and Drugbank Databases. The intersecting targets were entered into the DAVID database to obtain the relevant biological functions and pathways by GO and KEGG enrichment analysis. The obtained targets were analysed the protein-protein interaction (PPI) in STRING platform. In Cytoscape 3.8.0, the network analysis function with the MCODE plug-in were used to obtain the key targets, of shikonin and periodontitis. Molecular docking and molecular dynamics simulation (MD) were used to assess the affinity between the shikonin and the key targets.

RESULTS

Shikonin was screened for 22 targets and periodontitis was screened for 944 targets, the intersecting targets were considered as potential therapeutic targets. The targets played important roles in cellular response to hypoxia, response to xenobiotic stimulus and positive regulates of apoptotic process by GO enrichment analysis. 10 significant pathways were analyzed by KEGG, such as human cytomegalovirus infection and PI3K-Akt signaling pathway, etc. Cytoscape software screened the key genes including AKT1, CCL5, CXCR4, PPARG, PTEN, PTGS2 and TP53. Molecular docking and MD results showed that shikonin could bind stably to the targets.

CONCLUSIONS

The present study enriched the molecular mechanisms in periodontitis with shikonin, providing potential therapeutic targets for periodontitis.

The potential causal path between periodontitis stage diagnosis and vegetable consumption is mediated by loss of posterior functional tooth units and masticatory function

AIM

Emerging evidence points to a two-way relationship between periodontitis and dietary choices and, thus, nutrition. This study aimed to assess the potential cause-effect relationship between the periodontitis stage, loss of functional tooth units (FTUs), masticatory function, and intake of different food groups using path analysis.

MATERIALS AND METHODS

A single calibrated examiner determined the periodontitis stage of a consecutive sample of 241 Chinese subjects reporting for tooth replacement. Their masticatory function was quantified by the mixing ability of a two-colour chewing gum. Validated food frequency questionnaires were used to calculate the intake of 33 food group items by an experienced calibrated rater. After verification of assumptions, visual structural equation modeling was performed with Amos 23. The consistency of results and the potential modifying effect of age were assessed in 9043 subjects from the NHANES database.

RESULTS

Highly significant models were constructed using periodontitis stage and age as exogenous factors. Periodontitis stage diagnosis significantly affected the number of posterior FTUs and oral health-related quality of life (OHRQoL, path coefficient [PC] = -0.55 and -0.20, p < .05, respectively). In the model, FTUs also had an independent effect on OHRQoL (PC = 0.23, p < .05). FTUs determined the level of masticatory function (PC = -0.38, p < .05), which in turn affected vegetable intake but not fruit or meat intake (PC = -0.18, p < .0.5, PC = 0.06, NS and PC = 0.11, NS, respectively). The effect of age was significant for vegetable and meat intake and was also correlated with periodontitis stage diagnosis. Analysis of the NHANES database confirmed the negative impact of periodontitis on the number of occluding pairs and vegetable consumption for the 18-44, 45-60 and >60 age groups.

CONCLUSIONS

Periodontitis showed a potential cause-effect pathway affecting vegetable intake across cultures and age groups. The size of the effect is potentially of clinical and public health significance. Additional studies, including intervention trials, are required to test this potential mechanism linking oral health to nutrition.

Clinical decision-making and management of stage IV periodontitis: A survey

OBJECTIVE

To investigate the clinical management of stage IV periodontitis patients among clinicians within the Italian Society of Periodontology and Implantology.

METHODS

A cross-sectional study was designed on a web-based anonymous survey. Comparison between ordinary members (OMs) versus active and certified members (ACMs) and comparison between members with at least 10 years of experience in periodontology (Ov10) and members with less than 10 years of experience in periodontology (Un10) were performed.

RESULTS

A total of 324 out of 1362 members (response rate of 24%) responded to the questionnaire. ACMs and Ov10 more often reported their teams hold adequate skills to manage cases. Step I and II periodontal therapy took more time in the ACMs and Ov10 groups. ACMs used different strategies to perform step I-II therapy, and antibiotics were used less frequently than OMs. Unresponsive sites were treated more often with surgery by ACMs compared to OMs. ACMs adopted different treatment sequences compared to OMs. Ov10 group used more often CBCT, lateral cephalogram, and wax-up while Un10 group tend to avoid orthodontic therapy.

CONCLUSIONS

More experienced members spent more time in step I and II of periodontal therapy, used more diagnostic tools, and performed more often surgery and orthodontics in the treatment of stage IV periodontitis patients.

Effect of Periodontal Treatment on Reducing Chronic Inflammation in Systemically Healthy Patients With Periodontal Disease

BACKGROUND

We determined the effects and an accurate marker of periodontal treatment on serum interleukin (IL)-6 and high-sensitivity C-reactive protein (HsCRP) levels in systemically healthy individuals with periodontal disease.

METHODS

This multicenter study included systemically healthy individuals with periodontal disease who received initial periodontal treatment and had no periodontal treatment history. Periodontal parameters, including periodontal inflamed surface area, masticatory efficiency, and periodontal disease classification; serum IL-6 and HsCRP levels; and serum immunoglobulin (Ig)G titers against periodontal pathogens were evaluated at baseline and after treatment. Subjects were classified as low or high responders (group) based on periodontal inflamed surface area changes.

RESULTS

There were 153 participants. Only periodontal inflamed surface area changes were markedly different between low and high responders. Periodontal treatment (time point) decreased both serum IL-6 and HsCRP levels. The interaction between group and time point was remarkable only for serum IL-6 levels. Changes in serum immunoglobulin (Ig)G titers against periodontal pathogens were not associated with IL-6 changes in high responders. We analyzed the indirect effect of serum anti-Porphyromonas gingivalis type 2 IgG titer changes using mediation analysis and found no significance. However, the direct effect of group (low or high responder) on IL-6 changes was considerable.

CONCLUSIONS

Periodontal treatment effectively decreased serum IL-6 levels, independent of periodontal pathogen infection, in systemically healthy individuals with periodontal disease.

The relationship of dietary flavonoids and periodontitis in US population: a cross-sectional NHANES analysis

OBJECTIVES

We investigated the association between dietary flavonoids intake and periodontitis.

MATERIALS AND METHODS

This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey 2009-2010 on 3025 participants aged between 30 and 80 years who had full-mouth periodontal examination and dietary flavonoids intake data. This study used periodontal pocket depth (PPD) and clinical attachment loss (CAL) as periodontitis markers. Data were analyzed using multivariate linear regression.

RESULTS

After adjusting confounders, the middle tertile of total dietary flavonoids was associated with decreased mean PPD (0.06 mm, P = 0.016) and mean CAL (0.13 mm, P = 0.001) and the top tertile of total dietary flavonoids was significantly associated with decreases in mean PPD (0.05 mm, P = 0.029) and mean CAL (0.11 mm, P = 0.010). Both the middle and top tertiles of total flavonoids intake were significantly related with decreased mean CAL in females, those flossing 0 days/week, overweight and non-diabetic population but not in males, smokers, those flossing 1-6 days/week and diabetic population. Higher anthocyanidins, flavones and flavonols intake was significantly associated with decreased mean PPD and mean CAL while higher flavanones intake was only significantly associated with decreased mean CAL. Higher anthocyanidins intake was particularly related with greatest decreases in mean CAL (top tertile: 0.22 mm, middle tertile: 0.17 mm, both P < 0.010). However, no significant associations were found between isoflavones and flavan_3_ols intake and mean CAL.

CONCLUSIONS

Higher dietary flavonoids intake may be beneficial for periodontal health.

CLINICAL RELEVANCE

Additional anthocyanidins, flavanones, flavones and flavonols intake was associated with improved periodontal health.

Association between shortened dental configurations and health outcomes: a scoping review

This study mapped definitions of shortened dental configurations and health outcomes employed in association studies. A scoping review was conducted using the PubMed/Medline, Scopus, Web of Science, SciELO and Cochrane databases. Two trained researchers selected studies and extracted data. Studies that investigated the association between shortened dental configurations (exposure) and person-centered outcomes (general and oral health) related to health behavior (dietary patterns). Clinical outcomes were classified according to the International Classification of Functioning, Disability and Health and the International Classification of Diseases of the World Health Organization (WHO). Shortened dental configurations were defined as at least 20/21 teeth or the position of the teeth, including esthetics, dental occlusion and periodontal status (Eichner Index, Shortened Dental Arches, Functional Dentition Classification System, Posterior Occluding Pairs, Functional Tooth Units). The initial search resulted in 12,525 records in English, Portuguese and Spanish, 432 of which addressed the association of interest. General health (n = 203) and oral health (n = 201) were addressed in a similar number of studies. Most outcomes were related to general health (n = 184), the most frequent of which were endocrine, nutritional or metabolic diseases (n = 57) and mental functions (n = 26). Person-centered measures were addressed in 153 studies, most of which were about oral health and oral health-related quality of life (n = 62). Oral health outcomes were predominantly related to intake functions (n = 44) and diseases or disorders of the orofacial complex (n = 24). Dietary patterns (n = 43) and mortality (n = 38) were also studied. The cross-sectional design (n = 257) and non-probabilistic sampling (n = 218) were more frequent. The shortened dental configurations defined by the WHO were the most frequent in the studies (n = 206). The effects of shortened dental configurations have been investigated mainly in relation to endocrine, nutritional or metabolic diseases and measures of oral health-related quality of life. The findings point to a diversity of health outcomes assessed and substantial methodological variability.

Factors Associated with Periodontitis in Younger Individuals: A Scoping Review

Periodontitis is a disease that affects many young adults, and if left untreated, it can have lasting and permanent effects on an individual's oral health. The purpose of this scoping review was to review the recent literature to identify factors that place young individuals at risk of stage II or III periodontitis. Using the PRISMA guidelines for scoping reviews, three databases were systematically searched for peer-reviewed human studies published in English that investigated risk factors associated with stage II and/or III periodontitis in individuals less than 40 years of age. This review excluded abstracts, literature reviews, including narrative, scoping, and systematic reviews and meta-analyses, conference proceedings, letters to the editor, and editorials. The authors then extracted data from the relevant studies using a predefined form to summarize the aims, design, results, risk factors examined, and the type and severity of periodontitis. Among a total of 2676 articles screened, only three articles met the review's inclusion criteria. Of these articles, one was a longitudinal case-control study and two were cross-sectional studies. Identified risk factors associated with stage II or III periodontitis included self-reported bleeding when brushing, low bone mineral density, being overweight, and smoking in young adults. Of note, only three studies met the inclusion criteria, suggesting a gap in the research literature.

"Medicine food homology" plants promote periodontal health: antimicrobial, anti-inflammatory, and inhibition of bone resorption

"Medicine food homology" (MFH) is a term with a lengthy history. It refers to the fact that a lot of traditional natural products have both culinary and therapeutic benefits. The antibacterial, anti-inflammatory and anticancer effects of MFH plants and their secondary metabolites have been confirmed by numerous research. A bacterially generated inflammatory illness with a complicated pathophysiology, periodontitis causes the loss of the teeth's supporting tissues. Several MFH plants have recently been shown to have the ability to prevent and treat periodontitis, which is exhibited by blocking the disease's pathogens and the virulence factors that go along with them, lowering the host's inflammatory reactions and halting the loss of alveolar bone. To give a theoretical foundation for the creation of functional foods, oral care products and adjuvant therapies, this review has especially explored the potential medicinal benefit of MFH plants and their secondary metabolites in the prevention and treatment of periodontitis.

Association between masticatory performance and oral conditions in adults: A systematic review and meta-analysis

OBJECTIVES

To give an overview of the evidence on the associations between oral condition factors and masticatory performance of adults, and to evaluate the direction and level of the associations.

DATA/SOURCES

Medline (PubMed), Embase (Ovid) and CINAHL Plus (EBSCOhost) were searched up to May 2022 for cross-sectional studies on oral conditions and masticatory performance in adults. Methodological quality of the included studies was independently evaluated based on the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Data on the associations between oral condition factors and masticatory performance were extracted. Meta-analysis was conducted on correlation coefficients.

STUDY SELECTION

Of the 8,035 records identified, 97 articles (88 studies) were included in the qualitative synthesis, and 18 studies were included in the meta-analyses. Among the oral condition factors that had associations with masticatory performance, the number of natural/remaining teeth or functional tooth pairs was reported by the largest number of studies, followed by perioral muscle status, dental prosthetic status, oral moisture status and periodontal status. Results of the meta-analyses showed that the positive association with the number of natural/remaining teeth was the strongest (pooled correlation coefficient: 0.51, 95%CI: 0.48 to 0.54), followed by the number of functional tooth pairs, maximum tongue force/pressure, while the association with the oral moisture status was the weakest.

CONCLUSIONS

Number of natural/remaining teeth and functional tooth pairs, perioral muscle status, oral moisture status, dental prosthetic status and periodontal status are the main oral condition factors influencing masticatory performance. Based on the limited evidence available, among these factors, the number of natural/remaining teeth has the strongest positive association, with a very low quality of evidence.

CLINICAL SIGNIFICANCE

This study provides valuable information on the oral condition factors associated with masticatory performance, which would be important for policymakers and clinical practitioners when deciding on the strategies for improving the masticatory performance of adults. This review highlights the need for standardization of measures and classifications of masticatory performance and oral conditions.

REGISTRATION

PROSPERO (registration number: CRD42021256824).

Association of the number of natural teeth with dietary diversity and nutritional status in older adults: A cross-sectional study in China

AIM

To investigate the association of the number of natural teeth with overall dietary diversity and nutritional status in a nationally representative study among older adults in China.

MATERIALS AND METHODS

A cross-sectional analysis was conducted among community-dwelling adults aged 65 years or older from the Chinese Longitudinal Healthy Longevity Study. According to the self-reported number of natural teeth, participants were categorized into ≥20, 10-19, 1-9 natural teeth, and edentulous. Dietary diversity score (DDS) was constructed based on intake frequencies of 10 food groups assessed by a simplified food frequency questionnaire. The geriatric nutritional risk index was used to measure the malnutrition status (i.e., normal, mild malnutrition, and moderate-to-severe malnutrition) among a subgroup of participants. Linear and multinomial logistic regression models were used to examine the corresponding associations.

RESULTS

Among 54,796 study participants, the mean (SD) age was 87.86 (11.45) years, 82.7% had poor dentition (<20 natural teeth), and 27.3% wore dentures. After multivariable adjustment, participants with poor dentition had lower DDSs (β_edentulous  = -0.39, 95% confidence interval [CI], -0.48, -0.30; β_{1-9 teeth}  = -0.46, 95% CI, -0.55, -0.37; β_{10-19 teeth}  = -0.36, 95% CI, -0.46, -0.26) than those with 20 natural teeth or more. For individual food items, edentulous, 1-9 and 10-19 natural teeth were associated with lower odds of regular intake of fresh fruits, fresh vegetables, meat, fish and aquatic products, eggs, legumes, preserved vegetables, tea, and garlic, but higher odds of regular intake of sugar and sweets. Among participants with poor dentition, individuals without dentures had lower intake frequencies of most food groups than those wearing dentures. In addition, poor dentition was related to lower odds of normal nutritional status (odds ratio = 0.49, 95% CI, 0.27, 0.89).

CONCLUSIONS

Older adults with poor dentition had significantly lower dietary diversity and worse nutritional status. Future studies are warranted to identify effective interventions to improve the dietary quality and nutrition status among partially and fully edentulous individuals, including those with Stage IV periodontitis.

Association of self-rated chewing function and oral health status with metabolic syndrome

PURPOSE

The study aimed to examine the association of self-rated chewing function, the number of teeth and periodontal status with metabolic syndrome.

METHODS

The participants were 11,119 adults aged 40-74 years who underwent specific health checkups, including an oral health examination, in 2018 in Japan. This study used the standard questions of the specific health checkups to obtain information on self-rated chewing function. A multinomial logistic regression analysis was performed with metabolic syndrome status as the dependent variable, and age, sex, lifestyle questions, self-rated chewing function, number of teeth, and periodontal status as the independent variables.

RESULTS

Number of teeth and periodontal status were significantly associated with metabolic syndrome after adjusting for confounding variables. Self-rated chewing function was significantly associated with metabolic syndrome in the crude analysis, but not after adjustment for confounding variables. Both number of teeth and periodontal status were significantly associated with self-rated chewing function.

CONCLUSION

There was no significant direct association between self-rated chewing function and metabolic syndrome. Self-rated chewing function may be an indicator of poor oral condition that links to metabolic syndrome.

Tooth Mobility among Patients visiting a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction

Periodontitis is a chronic inflammatory disease that results in the destruction of supporting tissue and bone leading to tooth mobility. Tooth mobility if untreated can lead to tooth loss. However, very few studies exist for its assessment. The aim of this study was to find out the prevalence of tooth mobility among patients visiting a tertiary care centre.

Methods

This descriptive cross-sectional study was conducted among individuals visiting a tertiary care dental hospital from 1st April to 30th June 2022 after obtaining ethical clearance from the Institutional Review Committee (Reference number: 2202202202). Individuals more than 13 years who gave consent and fulfilled the study criteria were enrolled. Tooth mobility was assessed using Lindhe and Nyman's classification. Proforma also included demographics, simplified oral hygiene index, gingival index, body mass index, and smoking status. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated.

Results

Among 163 patients, 65 (39.88%) patients (32.36-47.40, 95% Confidence Interval) had tooth mobility.

Conclusions

The prevalence of tooth mobility was higher than in studies done in similar settings.

Keywords

periodontitis; prevalence; tooth mobility.

Periodontitis in a 65-year-old population: risk indicators and impact on oral health-related quality of life

AIMS

The aims of the present study were to investigate socioeconomic and behavioral risk indicators for severe periodontitis in a 65-year-old Norwegian population, and to investigate how periodontitis impacts oral health-related quality of life.

MATERIAL AND METHODS

A sample of 65-year-old residents in Oslo, born in 1954, was randomly selected for this study. The participants answered a questionnaire regarding country of birth, education, diabetes, smoking habits, dental attendance pattern, and tooth-brushing habits. In addition, oral health-related quality of life (OHRQoL) was assessed by the Oral Health Impact Profile-14 questionnaire (OHIP-14). Negative impact on OHRQoL was defined as responding "fairly often" or "very often" to at least one of the OHIP-14 items. The diagnosis of periodontitis was based on clinical and radiographic periodontal measurements and classified based on the consensus report from the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

RESULTS

Of 796 eligible participants, 460 individuals agreed to participate in the present study (response rate 58%). Seven participants were excluded from the analyses due to < 2 remaining teeth (n = 3) or missing questionnaire (n = 4), resulting in a study sample of 453 individuals (233 men and 220 women). An association was found between non-western country of birth, diabetes type 2, lower education, smoking, non-regular dental visits, and severe periodontitis (stage III or IV, n = 163) in bivariate analyses (Chi-square test). However, in the multiple logistic regression model, only non-western country of birth, diabetes type 2 and smoking (former and current), were associated with higher odds of severe periodontitis. The overall mean OHIP-14 total score was 3.6 (SD: 6.1). Participants with stage III or IV periodontitis reported a significantly higher OHIP-14 total score (mean: 4.7, SD: 7.4), indicating a lower OHRQoL, compared to non-periodontitis participants (mean: 2.9, SD: 4.9).

CONCLUSIONS

In the present study, non-western birth country, diabetes type 2, and smoking were found as significant risk indicators for severe periodontitis. Overall, results indicate a good OHRQoL among 65-year-olds in Oslo, however, a tendency of reduced OHRQoL with increasing severity of periodontitis was observed.

Assessment of early wound healing, pain intensity, quality of life and related influencing factors during periodontal surgery: a cross-sectional study

BACKGROUND

This cross-sectional study assessed early wound healing, pain intensity, quality of life, surgical satisfaction, and related factors during periodontal surgery.

METHODS

A total of 369 patients completed the questionnaire before undergoing periodontal surgery (baseline), immediately after the operation (phase I), on the day of suture removal (phase II), and one month later (phase III). The Early Wound Healing Score (EHS) was assessed, and the short-form McGill Pain Questionnaire (SF-MPQ), tooth hypersensitivity visual analog scale (VAS), oral health-related quality of life measure (OHQoL-UK), and surgical satisfaction VAS were administered and analysed.

RESULTS

The EHS was 8.41 ± 2.74 and was influenced by disease severity and surgical factors. Scores on the SF-MPQ, pain intensity scores, and OHQoL-UK scores were significantly increased in phase I and decreased later. Tooth sensitivity decreased significantly one month after periodontal surgery. Psychological factors were positively related to SF-MPQ, pain intensity, OHQoL-UK and tooth sensitivity VAS scores in all phases, while disease severity and surgical factors were only related to these scores at baseline or in phases I/II/III. Surgical acceptance and reoperation willingness continuously decreased after surgery, and all these scores were related to surgical satisfaction.

CONCLUSIONS

EHS, pain intensity and quality of life were closely related to disease severity, psychological factors and surgical factors in phase I (i.e., immediately after surgery). The findings suggest that surgical details should be enhanced and that behavioural and psychological interventions measures should be implemented to improve outcomes during periodontal operation and during the early postoperative period as well as to improve patient-oriented periodontal surgery experiences. Trial registration This cross-sectional study did not include interventions with human participants, and all the experimental procedures involving humans in this study were approved by the Ethics Committee of West China College of Stomatology, Sichuan University (WCHSIRB-D-2020-284).

Effects of Dental Implants and Nutrition on Elderly Edentulous Subjects: Protocol for a Factorial Randomized Clinical Trial

Background

Loss of masticatory function consequent to tooth loss has been associated with changes in food choices and insufficient nutritional intake. To date, interventions based on dental prostheses alone did not significantly improve nutrient intake. Pilot studies have shown positive impacts of interventions combining implant-supported fixed dental prosthesis with brief dietary advice. The relative contribution and the potential synergy of the components of such interventions need to be determined as it has major public health implications for the community-dwelling aging population that continues to disproportionately suffer from tooth loss and its consequences.

Objective

To assess the effect of rehabilitation of masticatory function with fixed implant supported dentures and nutrition education in older subjects with terminal dentition (stage IV periodontitis) or full edentulism.

Methods

A 2 × 2 factorial randomized controlled trial with 16-month follow-up of eligible adults (≥60 years) with loss of masticatory function consequent to full arch edentulism or terminal dentition (n = 120) will be conducted to test whether the rehabilitation of masticatory function with fixed implant supported dentures, nutrition education and/or their combination improves intake of fresh fruits and vegetables for aging subjects. The study has been designed to detect changes in fresh fruits and fresh vegetables intake at 4 months using the 24-h dietary recall method. Changes in protein as percentage of total energy, nutritional biomarkers, plasma metabolomics, oral and gut microbiome, quality of life and masticatory function will also be assessed.

Discussion

We hypothesize that receiving rehabilitation of masticatory function with fixed implant dentures together with nutrition education is the most effective intervention for improving nutrient intake in aging community-dwelling subjects with extensive tooth loss. The results of this study will assist in designing better treatment regimens, guide medical care for individual subjects, and inform public health and policy.

Clinical Trials Registration

NCT05334407.

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.

Assessment of masticatory function in the differential diagnosis of stage IV periodontitis: A pilot diagnostic accuracy study

BACKGROUND

After diagnosis of periodontitis is made, detection of stage IV cases is critical for appropriate management that may call for interdisciplinary care. This study aims to identify and assess the accuracy of a simple screening approach for practice and surveillance of stage IV periodontitis.

METHODS

Masticatory function assessments by both validated self-reported masticatory dysfunction questionnaire and dual-color chewing gum mixing ability test (index test) were conducted in 214 consecutive patients, followed by a full-mouth periodontal examination. Periodontal diagnosis was based on the 2017 World Workshop classification of periodontal diseases (reference standard). Multivariate logistic regression and area under the receiver operating characteristic curve (AUROC) analyses were performed.

RESULTS

Overall, the individual patient-reported masticatory dysfunction questions showed low to moderate accuracy for predicting Stage IV periodontitis. The objective measures of masticatory function by calculating the variance of hue from the chewing gum test performed better with an AUROC of 0.840. A diagnostic approach based on age, self-report of altered food type intake, and chewing gum test result exhibited excellent performance for predicting Stage IV periodontitis (sensitivity: 89.7%; specificity:76.3%; AUROC:0.912).

CONCLUSIONS

Once the presence of periodontitis has been established, a simple diagnostic approach that does not require specialized workforce, complex or lengthy assessment allows identification of Stage IV periodontitis patients. This is important as these patients require specific case work up and interdisciplinary care pathways. Additional studies are required to validate the findings in multiple populations. This article is protected by copyright. All rights reserved.