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Dibello V, Custodero C, Cavalcanti R, Lafornara D, Dibello A, Lozupone M, Daniele A, Pilotto A, Panza F, Solfrizzi V. Impact of periodontal disease on cognitive disorders, dementia, and depression: a systematic review and meta-analysis. GeroScience 2024; 46:5133-5169. [PMID: 38943006 PMCID: PMC11336026 DOI: 10.1007/s11357-024-01243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/05/2024] [Indexed: 06/30/2024] Open
Abstract
A growing body of research suggested that there was a link between poor periodontal health and systemic diseases, particularly with the early development of cognitive disorders, dementia, and depression. This is especially true in cases of changes in diet, malnutrition, loss of muscular endurance, and abnormal systemic inflammatory response. Our study aimed to determine the extent of these associations to better target the multi-level healthy aging challenge investigating the impact of periodontal disease on cognitive disorders (cognitive impairment and cognitive decline), dementia, and depression. We conducted a comprehensive literature search up to November 2023 using six different electronic databases. Two independent researchers assessed the eligibility of 7363 records against the inclusion criteria and found only 46 records that met the requirements. The study is registered on PROSPERO (CRD42023485688). We generated random effects pooled estimates and 95% confidence intervals (CI) to evaluate whether periodontal disease increased the risk of the investigated outcomes. The quality assessment revealed moderate quality of evidence and risk of bias. Periodontal disease was found to be associated with both cognitive disorders (relative risk (RR) 1.25, 95% CI 1.11-1.40, in the analysis of cross-sectional studies); cognitive impairment (RR 3.01, 95% CI 1.52-5.95 for longitudinal studies, cognitive decline); and dementia (RR 1.22, 95% CI 1.10-1.36). However, no significant increased risk of depression among subjects with periodontal disease was found (RR 1.07, 95% CI 0.95-1.21). Despite the association with two of the three explored outcomes, the available evidence on periodontal diseases and dementia, cognitive disorders, and depression is controversial due to several limitations. Therefore, further investigations involving validated and standardized tools are required.
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Affiliation(s)
- Vittorio Dibello
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Carlo Custodero
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Raffaele Cavalcanti
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy
| | - Domenico Lafornara
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Antonio Dibello
- Stella Maris Nursing Home and Day Care Center, Monopoli, Bari, Italy
| | - Madia Lozupone
- Department of Translational Biomedicine & Neuroscience 'DiBraiN', University of Bari Aldo Moro, Bari, Italy
| | - Antonio Daniele
- Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy
- Neurology Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Alberto Pilotto
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Francesco Panza
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy.
| | - Vincenzo Solfrizzi
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
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Rajendran V, Uppoor A, Nayak SU, Rao SB, Dasson Bajaj P. Unraveling the cognitive implications among individuals with co-occurring chronic periodontitis and type 2 diabetes mellitus: A cross-sectional study. J Oral Biosci 2024; 66:605-611. [PMID: 38815752 DOI: 10.1016/j.job.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES Chronic periodontitis and type 2 diabetes mellitus (T2DM) are associated with cognitive decline when examined individually. To gain deeper insight into the combined effects of these conditions on cognitive decline, the present study aimed to examine the cognitive status of individuals with co-occurring T2DM and chronic periodontitis. METHODS We recruited 220 participants categorized into four groups: Group I, healthy subjects; Group II, individuals with chronic periodontitis; Group III, individuals with T2DM; and Group IV, individuals with both T2DM and chronic periodontitis. Medical histories were recorded for all participants, followed by periodontal examination and evaluation of cognitive status using the Montreal Cognitive Assessment (MoCA) scale. Finger dexterity was assessed using the nine-hole peg test. RESULTS A statistically significant increase in the proportion of mild cognitive impairment (MCI) was observed between groups I and IV (p < 0.001). Logistic regression analysis revealed that, among the parameters assessed in this study, the adjusted odds ratio (OR) was significant for age, finger dexterity scores, and co-occurrence of T2DM and periodontitis. CONCLUSIONS The findings of this study suggest that the co-occurrence of chronic periodontitis and T2DM can have a detrimental effect on the cognitive abilities of an individual. Subsequent research should include longitudinal monitoring of the cognitive status in patients with concurrent conditions during treatment to gain deeper prognostic insights into the relationship between these co-occurring conditions and cognitive decline.
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Affiliation(s)
- Valliammai Rajendran
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India.
| | - Ashita Uppoor
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India.
| | - Sangeeta Umesh Nayak
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India.
| | - Satish B Rao
- Department of Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India.
| | - Parul Dasson Bajaj
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India.
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Chen L, Li X, Liu J, Hou Z, Wei Y, Chen M, Wang B, Cao H, Qiu R, Zhang Y, Ji X, Zhang P, Xue M, Qiu L, Wang L, Li H. Distinctive subgingival microbial signatures in older adults with different levels of cognitive function. J Clin Periodontol 2024; 51:1066-1080. [PMID: 38769711 DOI: 10.1111/jcpe.13997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
AIM To examine association between subgingival microbial signatures and levels of cognitive impairment in older adults. MATERIALS AND METHODS We analysed subgingival plaque samples and 16S ribosomal RNA sequences for microbiota among 165 participants (normal controls [NCs]: 40, subjective cognitive decline [SCD]: 40, mild cognitive impairment [MCI]: 49 and dementia: 36). RESULTS The bacterial richness was lower among individuals with worse cognitive function, and subgingival microbial communities differed significantly among the four groups. Declining cognitive function was associated with decreasing relative abundance of genera Capnocytophaga, Saccharibacteria_genera_incertae_sedis, Lautropia and Granulicatella, and increasing abundance of genus Porphyromonas. Moreover, there were differentially abundant genera among the groups. Random forest model based on subgingival microbiota could distinguish between cognitive impairment and NC (AUC = 0.933, 95% confidence interval 0.873-0.992). Significant correlations were observed between oral microbiota and sex, Montreal Cognitive Assessment (MoCA) score and Mini-Mental State Examination score. Partial correlation analysis showed that Leptotrichia and Burkholderia were closely negatively associated with the MoCA score after adjusting for multiple covariates. Gene function was not significantly different between SCD and NC groups, whereas three homozygous genes were altered in MCI patients and two in dementia patients. CONCLUSIONS This is the first study to demonstrate an association between the composition, function and metabolic pathways of subgingival microbiota and different levels of cognitive function among older individuals. Future cohort studies should assess its diagnostic usefulness for cognitive impairment.
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Affiliation(s)
- Lili Chen
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Nursing, Fujian Provincial Hospital, Fuzhou, China
| | - Xiuli Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jinxiu Liu
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Zhaoyi Hou
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Yongbao Wei
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Mingfeng Chen
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Bixia Wang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Huizhen Cao
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Rongyan Qiu
- Department of Surgery, Fujian Provincial Governmental Hospital, Fuzhou, China
| | - Yuping Zhang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Xinli Ji
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Ping Zhang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Mianxiang Xue
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Linlin Qiu
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Linlin Wang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Hong Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
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Marruganti C, Gaeta C, Falciani C, Cinotti E, Rubegni P, Alovisi M, Scotti N, Baldi A, Bellan C, Defraia C, Fiorino F, Valensin S, Bellini E, De Rosa A, D'Aiuto F, Grandini S. Are periodontitis and psoriasis associated? A pre-clinical murine model. J Clin Periodontol 2024; 51:1044-1053. [PMID: 38699834 DOI: 10.1111/jcpe.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/26/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
AIM To investigate the bidirectional influence between periodontitis and psoriasis, using the respective experimental models of ligature- and imiquimod-induced diseases on murine models. MATERIALS AND METHODS Thirty-two C57/BL6J mice were randomly allocated to four experimental groups: control (P- Pso-), ligature-induced periodontitis (P+ Pso-), imiquimod-induced psoriasis (P- Pso+) and periodontitis and psoriasis (P+ Pso+). Samples (maxilla, dorsal skin and blood) were harvested immediately after death. Measures of periodontitis (distance between the cemento-enamel junction and alveolar bone crest [CEJ-ABC] and the number of osteoclasts) and psoriasis (epidermal thickness and infiltrate cell [/0.03mm2]) severity as well as systemic inflammation (IL-6, IL-17A, TNF-α) were collected. RESULTS The P+ Pso+ group exhibited the most severe experimental periodontitis and psoriasis, with the highest values of CEJ-ABC, number of osteoclasts, epidermal thickness and infiltrate cells in the dorsal skin, as well as the highest blood cytokine concentration. The P+ Pso- group presented with higher cell infiltrate (/0.03mm2) compared to the control group (p <.05), while the P- Pso+ group showed substantially higher alveolar bone loss (CEJ-ABC) than the control group (p <.05). CONCLUSIONS Experimental periodontitis may initiate and maintain psoriasiform skin inflammation and, vice versa, experimental psoriasis may contribute to the onset of periodontitis. In a combined model of the diseases, we propose a bidirectional association between periodontitis and psoriasis via systemic inflammation.
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Affiliation(s)
- Crystal Marruganti
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Carlo Gaeta
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Chiara Falciani
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Mario Alovisi
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Nicola Scotti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Andrea Baldi
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Cristiana Bellan
- Unit of Anatomical Pathology, Department of Human Pathology and Oncology, University of Siena, Siena, Italy
| | - Chiara Defraia
- Unit of Anatomical Pathology, Department of Human Pathology and Oncology, University of Siena, Siena, Italy
| | - Fabio Fiorino
- Laboratory of Molecular Microbiology and Biotechnology (LAMMB), Department of Medical Biotechnologies, University of Siena, Siena, Italy
- LUM University "Giuseppe Degennaro", Casamassima (Bari)
| | | | | | | | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Simone Grandini
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Zhang YL, Jia SY, Yang B, Miao J, Su C, Cui ZG, Yang LM, Guo JH. Non-linear association of liver enzymes with cognitive performance in the elderly: A cross-sectional study. PLoS One 2024; 19:e0306839. [PMID: 39042647 PMCID: PMC11265699 DOI: 10.1371/journal.pone.0306839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/23/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Although liver metabolic dysfunction has been found to potentially elevate susceptibility to cognitive impairment and dementia, there is still insufficient evidence to explore the non-linear association of liver enzymes with cognitive performance. Therefore, we aimed to elucidate the non-linear relationship between liver enzymes and cognitive performance. METHODS In this cross-sectional study, 2764 individuals aged ≥ 60 who participated in the National Health and Nutrition Survey (NHANES) between 2011 and 2014 were included. The primary data comprised liver enzyme levels (alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), AST/ALT ratio, and gamma-glutamyl transferase (GGT)), and cognitive performance was the major measured outcome. The associations were analyzed using weighted multivariate logistic regression, subgroup analysis, a generalized additive model, smooth fitting curves, and threshold effects. RESULTS The results of the fully adjusted model indicated that ALP was negatively associated with the animal fluency test (AFT) score (OR = 1.48, 95% CI: 1.11-1.98), whereas ALT demonstrated a positive association with the consortium to establish a registry for Alzheimer's disease (CERAD) test score (OR = 0.72, 95% CI: 0.53-0.97). Additionally, the AST/ALT ratio was negatively associated with the global cognitive test (OR = 2.39, 95% CI: 1.53-3.73), CERAD (OR = 2.61, 95% CI: 1.77-3.84), and digit symbol substitution test (DSST) scores (OR = 2.51, 95% CI: 1.57-4.02). GGT was also negatively associated with the AFT score (OR = 1.16, 95% CI: 1.01-1.33) in unadjusted model. A non-linear relationship was observed between liver enzymes and the risk of cognitive impairment as assessed by the global cognitive test. Specifically, when ALP > 60 U/L, 0.77 < AST/ALT < 1.76, and 25 < GGT < 94 U/L, higher liver enzyme levels were significantly associated with an elevated cognitive impairment risk, while a lower cognitive impairment risk when ALT level was > 17 U/L. CONCLUSIONS There is a non-linear relationship between liver enzymes and cognitive performance, indicating that liver enzyme levels should be maintained within a certain level to mitigate the risk of cognitive impairment.
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Affiliation(s)
- Yan-Li Zhang
- Department of Neurological Intensive Care Unit, Sixth Hospital of Shanxi Medical University (General Hospital of Tisco), Taiyuan, Shanxi, China
| | - Shi-Ying Jia
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Bo Yang
- Department of Hernia and Abdominal Wall Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jie Miao
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chen Su
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhi-Gang Cui
- Department of Neurology, The Third People’s Hospital of Datong, Datong, Shanxi, China
| | - Li-Ming Yang
- Department of Neurological Intensive Care Unit, Sixth Hospital of Shanxi Medical University (General Hospital of Tisco), Taiyuan, Shanxi, China
| | - Jun-Hong Guo
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Dong H, Wang X, Xiao N, Yang X, Zhang X, Niu P, Chen T. Association between volatile organic compounds exposure and periodontitis: A representative cross-sectional study. J Clin Periodontol 2024. [PMID: 39004511 DOI: 10.1111/jcpe.14041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 06/18/2024] [Accepted: 06/22/2024] [Indexed: 07/16/2024]
Abstract
AIM Periodontitis is one of the most common oral diseases and a major cause of tooth loss in adults. Environmental pollution is closely associated with the prevalence of periodontitis. However, few studies have focused on the association between volatile organic compounds (VOCs) and periodontitis. This cross-sectional study aims to examine whether exposure to VOCs is associated with periodontitis, based on data from the National Health and Nutrition Examination Survey (NHANES, 2011-2014). MATERIALS AND METHODS We analysed data on blood VOC levels, periodontitis and related covariates from 2772 participants of the NHANES. The association between the blood VOCs and periodontitis was analysed using weighted logistic regression analysis, the restricted cubic spline (RCS) model and the weighted quantile sum (WQS) regression model. Interaction tests and mediation analysis were also conducted. RESULTS After adjusting for covariates, for each natural constant-fold increase in 1,4-dichlorobenzene, the odds of having periodontitis increased by 16% (odds ratio = 1.16; 95% confidence interval: 1.08-1.24, p < .001). WQS regression model indicated that 1,4-dichlorobenzene contributed the most to the association between VOC co-exposure and periodontitis. Mediation analysis further revealed that total bilirubin levels mediated the association between 1,4-dichlorobenzene and the prevalence of periodontitis, accounting for 4.32%. In addition, the positive association between o-xylene and periodontitis was more pronounced in the <65-year-old group. CONCLUSIONS This study has provided relatively little evidence to demonstrate a specific link between VOCs and periodontitis. Nonetheless, exposure to VOCs remains a non-negligible public health concern, and further research is required to investigate the association and potential mechanisms of action between VOCs and periodontitis.
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Affiliation(s)
- Haitao Dong
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueting Wang
- Department of Occupational Health and Environmental Health, School of Public Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Ning Xiao
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Yang
- Department of Occupational Health and Environmental Health, School of Public Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Xin Zhang
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Piye Niu
- Department of Occupational Health and Environmental Health, School of Public Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Tian Chen
- Department of Occupational Health and Environmental Health, School of Public Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
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Marruganti C, Romandini M, Gaeta C, Trovato E, Cinotti E, Rubegni P, D'Aiuto F, Grandini S. Treatment of periodontitis ameliorates the severity and extent of psoriasis-A randomized clinical trial. J Periodontal Res 2024. [PMID: 38899599 DOI: 10.1111/jre.13314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
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).
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Affiliation(s)
- Crystal Marruganti
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Carlo Gaeta
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Emanuele Trovato
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | | | - Simone Grandini
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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8
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Newman-Norlund RD, Kudravalli S, Merchant AT, Fridriksson J, Rorden C. Exploring the link between tooth loss, cognitive function, and brain wellness in the context of healthy aging. J Periodontal Res 2024. [PMID: 38708940 DOI: 10.1111/jre.13280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/07/2024]
Abstract
AIMS The aim of this study was to evaluate the utility of using MRI-derived tooth count, an indirect and nonspecific indicator of oral/periodontal health, and brain age gap (BAG), an MRI-based measure of premature brain aging, in predicting cognition in a population of otherwise healthy adults. METHODS This retrospective study utilized data from 329 participants from the University of South Carolina's Aging Brain Cohort Repository. Participants underwent neuropsychological testing including the Montreal Cognitive Assessment (MoCA), completed an oral/periodontal health questionnaire, and submitted to high-resolution structural MRI imaging. The study compared variability on cognitive scores (MoCA) accounted for by MRI-derived BAG, MRI-derived total tooth count, and self-reported oral/periodontal health. RESULTS We report a significant positive correlation between the total number of teeth and MoCA total scores after controlling for age, sex, and race, indicating a robust relationship between tooth count and cognition, r(208) = .233, p < .001. In a subsample of participants identified as being at risk for MCI (MoCA <= 25, N = 36) inclusion of MRI-based tooth count resulted in an R2 change of .192 (H0 = 0.138 → H1 = 0.330), F(1,31) = 8.86, p = .006. Notably, inclusion of BAG, a valid and reliable measure of overall brain health, did not significantly improve prediction of MoCA scores in similar linear regression models. CONCLUSIONS Our data support the idea that inclusion of MRI-based total tooth count may enhance the ability to predict clinically meaningful differences in cognitive abilities in healthy adults. This study contributes to the growing body of evidence linking oral/periodontal health with cognitive function.
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Affiliation(s)
- Roger D Newman-Norlund
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, South Carolina, USA
| | - Santosh Kudravalli
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, South Carolina, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, College of Arts and Sciences, University of South Carolina, Columbia, South Carolina, USA
| | - Chris Rorden
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, South Carolina, USA
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Xie C, Zhang Q, Ye X, Wu W, Cheng X, Ye X, Ruan J, Pan X. Periodontitis-induced neuroinflammation impacts dendritic spine immaturity and cognitive impairment. Oral Dis 2024; 30:2558-2569. [PMID: 37455416 DOI: 10.1111/odi.14674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 06/03/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE This study investigated the spinal changes in ligature-induced periodontitis and the role of periodontitis in cognitive impairment. METHODS Twenty mice were randomized into the control and chronic periodontitis (CP) groups, with the latter receiving ligature-induced periodontitis. Cognitive performance was assessed by fear conditioning test. Periodontal inflammation and alveolar bone resorption were evaluated by micro-computed tomography and histopathology. The hippocampal microglial activation was evaluated by immunohistochemistry (IHC). The expressions of hippocampal cytokines (TNF-α, iNOS, IL-1β, IL-4, IL-10, and TREM2) were measured by reverse transcription-polymerase chain reaction. The morphology and density of the dendritic spines were determined by Golgi-Cox staining. RESULTS The CP mice reported significant inflammatory cell infiltration and alveolar bone resorption, with marked increases in cytokine levels (TNF-α, iNOS, IL-1β, and TREM2) in the brain. Moreover, the CP mice showed significantly reduced freezing to the conditioned stimulus in the cued and contextual tests, indicating impaired memory. Further analyses revealed, in the hippocampus of the CP mice, enhanced microglial activation, decreased dendritic spine density, and increased proportion of thin dendritic spines. CONCLUSIONS Periodontitis-induced neuroinflammation may impair the cognitive function by activating hippocampal microglia and inducing dendritic spine immaturity.
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Affiliation(s)
- Changfu Xie
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Qiuyang Zhang
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
- Fuzhou Second Hospital, Fuzhou, China
| | - Xinyi Ye
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Weiliang Wu
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Xiaojuan Cheng
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
- Institute of Clinical Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Xiaoan Ye
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Jianyong Ruan
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Xiaodong Pan
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
- Institute of Clinical Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
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De Lauretis A, Øvrebø Ø, Romandini M, Lyngstadaas SP, Rossi F, Haugen HJ. From Basic Science to Clinical Practice: A Review of Current Periodontal/Mucogingival Regenerative Biomaterials. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308848. [PMID: 38380549 PMCID: PMC11077667 DOI: 10.1002/advs.202308848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/23/2024] [Indexed: 02/22/2024]
Abstract
Periodontitis is a dysbiosis-driven inflammatory disease affecting the tooth-supporting tissues, characterized by their progressive resorption, which can ultimately lead to tooth loss. A step-wise therapeutic approach is employed for periodontitis. After an initial behavioral and non-surgical phase, intra-bony or furcation defects may be amenable to regenerative procedures. This review discusses the regenerative technologies employed for periodontal regeneration, highlighting the current limitations and future research areas. The search, performed on the MEDLINE database, has identified the available biomaterials, including biologicals (autologous platelet concentrates, hydrogels), bone grafts (pure or putty), and membranes. Biologicals and bone grafts have been critically analyzed in terms of composition, mechanism of action, and clinical applications. Although a certain degree of periodontal regeneration is predictable in intra-bony and class II furcation defects, complete defect closure is hardly achieved. Moreover, treating class III furcation defects remains challenging. The key properties required for functional regeneration are discussed, and none of the commercially available biomaterials possess all the ideal characteristics. Therefore, research is needed to promote the advancement of more effective and targeted regenerative therapies for periodontitis. Lastly, improving the design and reporting of clinical studies is suggested by strictly adhering to the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.
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Affiliation(s)
- Angela De Lauretis
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Øystein Øvrebø
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Mario Romandini
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
| | - Ståle Petter Lyngstadaas
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
| | - Filippo Rossi
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Håvard Jostein Haugen
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
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11
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Baima G, Ferrocino I, Del Lupo V, Colonna E, Thumbigere-Math V, Caviglia GP, Franciosa I, Mariani GM, Romandini M, Ribaldone DG, Romano F, Aimetti M. Effect of Periodontitis and Periodontal Therapy on Oral and Gut Microbiota. J Dent Res 2024; 103:359-368. [PMID: 38362600 DOI: 10.1177/00220345231222800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Mounting evidence indicates that periodontitis-related oral bacteria may contribute to gut microbial dysbiosis. This clinical study aimed to explore the oral-gut microbial signatures associated with periodontitis and to longitudinally evaluate the effect of periodontal treatment on the oral and gut microbial composition. Stool and saliva samples from generalized stage III/IV periodontitis patients (n = 47) were collected and analyzed by 16S ribosomal RNA gene amplicon sequencing, before and 3 mo after steps I to II of periodontal therapy. Periodontally healthy matched subjects (n = 47) were used as controls. Principal component analysis was carried out to identify oral-gut microbial profiles between periodontitis patients at baseline and healthy subjects; periodontitis samples were longitudinally compared before and after treatment. β-Diversity of gut microbial profiles of periodontitis patients before treatment significantly differed from healthy controls (P < 0.001). Periodontal therapy was associated with a significant change in gut microbiota (P < 0.001), with post-treatment microbial profiles similar to healthy volunteers. A higher abundance of Bacteroides, Faecalibacterium, Fusobacterium, and Lachnospiraceae was noted in fecal samples of periodontitis patients at baseline compared to healthy controls. In contrast, Lactobacillus was the only genus more abundant in the latter. Additionally, periodontal therapy led to a parallel reduction in the salivary carriage of periodontal pathobionts, as well as gut Bacteroides, Lachnoclostridium, Lachnospiraceae, Oscillospiraceae, and Ruminococcaceae, to levels similar to healthy controls. Collectively, discriminating oral-gut microbial signatures of periodontitis were found. Periodontal treatment both mitigated oral dysbiosis and altered gut microbial composition, signifying potential broader implications for gastrointestinal health and disease.
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Affiliation(s)
- G Baima
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - I Ferrocino
- Department of Agricultural, Forestry and Food Science, University of Turin, Turin, Italy
| | - V Del Lupo
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - E Colonna
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - V Thumbigere-Math
- Division of Periodontology, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - G P Caviglia
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - I Franciosa
- Department of Agricultural, Forestry and Food Science, University of Turin, Turin, Italy
| | - G M Mariani
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - M Romandini
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - D G Ribaldone
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - F Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - M Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
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Rubinstein T, Brickman AM, Cheng B, Burkett S, Park H, Annavajhala MK, Uhlemann A, Andrews H, Gutierrez J, Paster BJ, Noble JM, Papapanou PN. Periodontitis and brain magnetic resonance imaging markers of Alzheimer's disease and cognitive aging. Alzheimers Dement 2024; 20:2191-2208. [PMID: 38278517 PMCID: PMC10984451 DOI: 10.1002/alz.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/28/2024]
Abstract
INTRODUCTION We examined the association of clinical, microbiological, and host response features of periodontitis with MRI markers of atrophy/cerebrovascular disease in the Washington Heights Inwood Columbia Aging Project (WHICAP) Ancillary Study of Oral Health. METHODS We analyzed 468 participants with clinical periodontal data, microbial plaque and serum samples, and brain MRIs. We tested the association of periodontitis features with MRI features, after adjusting for multiple risk factors for Alzheimer's disease/Alzheimer's disease-related dementia (AD/ADRD). RESULTS In fully adjusted models, having more teeth was associated with lower odds for infarcts, lower white matter hyperintensity (WMH) volume, higher entorhinal cortex volume, and higher cortical thickness. Higher extent of periodontitis was associated with lower entorhinal cortex volume and lower cortical thickness. Differential associations emerged between colonization by specific bacteria/serum antibacterial IgG responses and MRI outcomes. DISCUSSION In an elderly cohort, clinical, microbiological, and serological features of periodontitis were associated with MRI findings related to ADRD risk. Further investigation of causal associations is warranted.
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Affiliation(s)
- Tom Rubinstein
- Division of PeriodonticsSection of OralDiagnostic and Rehabilitation SciencesCollege of Dental MedicineNew YorkNew YorkUSA
| | - Adam M. Brickman
- Department of NeurologyVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and Gertrude H. Sergievsky CenterNew YorkNew YorkUSA
| | - Bin Cheng
- Department of BiostatisticsMailman School of Public HealthNew YorkNew YorkUSA
| | - Sandra Burkett
- Division of PeriodonticsSection of OralDiagnostic and Rehabilitation SciencesCollege of Dental MedicineNew YorkNew YorkUSA
| | - Heekuk Park
- Division of Infectious DiseasesDepartment of MedicineVagelos College of Physicians and, Surgeons, Irving Medical CenterColumbia UniversityNew YorkNew YorkUSA
| | - Medini K. Annavajhala
- Division of Infectious DiseasesDepartment of MedicineVagelos College of Physicians and, Surgeons, Irving Medical CenterColumbia UniversityNew YorkNew YorkUSA
| | - Anne‐Catrin Uhlemann
- Division of Infectious DiseasesDepartment of MedicineVagelos College of Physicians and, Surgeons, Irving Medical CenterColumbia UniversityNew YorkNew YorkUSA
| | - Howard Andrews
- Department of BiostatisticsMailman School of Public HealthNew YorkNew YorkUSA
| | - Jose Gutierrez
- Department of NeurologyVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Bruce J. Paster
- The Forsyth InstituteCambridgeMassachusettsUSA
- Department of Oral Medicine, Infection and ImmunityHarvard School of Dental MedicineBostonMassachusettsUSA
| | - James M. Noble
- Department of NeurologyVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and Gertrude H. Sergievsky CenterNew YorkNew YorkUSA
| | - Panos N. Papapanou
- Division of PeriodonticsSection of OralDiagnostic and Rehabilitation SciencesCollege of Dental MedicineNew YorkNew YorkUSA
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13
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Marruganti C, Gaeta C, Romandini M, Ferrari Cagidiaco E, Parrini S, Discepoli N, Grandini S. Multiplicative effect of stress and poor sleep quality on periodontitis: A university-based cross-sectional study. J Periodontol 2024; 95:125-134. [PMID: 37477025 DOI: 10.1002/jper.23-0209] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the association of perceived stress and poor sleep quality with periodontitis in a university-based cohort of individuals. METHODS A total of 235 individuals were included in this cross-sectional study. Perceived stress and sleep quality were evaluated through validated questionnaires, while periodontitis was identified with a full-mouth periodontal examination protocol using both European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) and Centers for Disease Control and Prevention (CDC)/AAP case definitions. Simple and multiple linear and ordinal logistic regression analyses were performed to evaluate the association between perceived stress and sleep quality with periodontitis prevalence and severity. RESULTS Stage III/IV periodontitis resulted associated with both moderate/high perceived stress (odds ratio [OR] = 5.4; 95% confidence interval [CI]: 2.2-13.5; p < 0.001) and poor sleep quality (OR = 3.0; 95% CI: 1.2-7.4; p < 0.05). The interaction between moderate/high perceived stress and poor sleep quality presented a multiplicative association with stage III/IV periodontitis (EFP/AAP; OR = 5.8; 95% CI: 1.6-21.3; p < 0.001). Multiple linear regression analyses indicated a similar trend of association also with linear periodontal parameters, that is, mean clinical attachment level (CAL) and mean probing pocket depth (PPD). CONCLUSIONS The findings from the present study suggest that stress and poor sleep quality may exert a multiplicative effect on periodontitis prevalence and severity.
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Affiliation(s)
- Crystal Marruganti
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Carlo Gaeta
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Edoardo Ferrari Cagidiaco
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Stefano Parrini
- Unit of Oral Surgery, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Nicola Discepoli
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Simone Grandini
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Karaduran K, Aydogdu A, Gelisin O, Gunpinar S. Investigating the potential clinical impact of periodontitis on the progression of Alzheimer's disease: a prospective cohort study. Clin Oral Investig 2023; 28:67. [PMID: 38159159 DOI: 10.1007/s00784-023-05445-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES This study aimed to investigate the effect of periodontitis and current occlusal relationship on the progression rate of Alzheimer's disease (AD). METHODS Ninety Alzheimer's patients, who were divided into three groups as Stage I (n=42), Stage II (n=29), and Stage III (n=19), based on the Clinical Dementia Rating Scale, were included in the study. Cognitive status of the patients was evaluated with Standardized Mini-Mental Test (SMMT) at baseline and repeated 6 months later. Clinical periodontal examinations were recorded and occlusal relationship status was classified according to the Eichner Index. RESULTS Of 90 Alzheimer's patients, 65 were toothed individuals with periodontitis and 25 were edentulous individuals without active periodontal disease. Stage II and Stage III toothed Alzheimer's patients had higher percentage of bleeding on probing (BOP%) and clinical attachment level (CAL) values than Stage I patients (p<0.05). Stage III Alzheimer's patients had significantly higher probing pocket depth (PPD) values than Stage I individuals (p<0.05). ΔSMMT values showed positive correlation with BOP% (r=0.308, p=0.013) and PPD (r=0.275, p=0.027). Among the evaluated parameters, being in the AD Stage II-Stage III, having periodontitis and age variable had significant effects on ΔSMMT levels (p<0.05). CONCLUSIONS Within the limits of our study, it can be concluded that periodontitis may increase the severity and also accelerate the progression rate of AD. CLINICAL RELEVANCE These results are precious to show the necessity of proper oral hygiene activities and regular dental visits in patients with toothed AD. CLINICAL TRIAL REGISTRATION This study was registered and approved by clinical trials (NCT05807100).
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Affiliation(s)
- Kubra Karaduran
- Faculty of Dentistry, Department of Periodontology, Bezmialem Vakif University, Istanbul, Turkey.
| | - Ahmet Aydogdu
- Faculty of Dentistry, Department of Periodontology, Istanbul Galata University, Istanbul, Turkey
| | - Ozlem Gelisin
- Department of Neurology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Sadiye Gunpinar
- Faculty of Dentistry, Department of Periodontology, Bezmialem Vakif University, Istanbul, Turkey
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Baima G, Minoli M, Michaud DS, Aimetti M, Sanz M, Loos BG, Romandini M. Periodontitis and risk of cancer: Mechanistic evidence. Periodontol 2000 2023. [PMID: 38102837 DOI: 10.1111/prd.12540] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 12/17/2023]
Abstract
This review aims to critically analyze the pathways of interaction and the pathogenic mechanisms linking periodontitis and oral bacteria with the initiation/progression of cancer at different body compartments. A higher risk of head and neck cancer has been consistently associated with periodontitis. This relationship has been explained by the local promotion of dysbiosis, chronic inflammation, immune evasion, and direct (epi)genetic damage to epithelial cells by periodontal pathobionts and their toxins. Epidemiological reports have also studied a possible link between periodontitis and the incidence of other malignancies at distant sites, such as lung, breast, prostate, and digestive tract cancers. Mechanistically, different pathways have been involved, including the induction of a chronic systemic inflammatory state and the spreading of oral pathobionts with carcinogenic potential. Indeed, periodontitis may promote low-grade systemic inflammation and phenotypic changes in the mononuclear cells, leading to the release of free radicals and cytokines, as well as extracellular matrix degradation, which are all mechanisms involved in carcinogenic and metastatic processes. Moreover, the transient hematogenous spill out or micro-aspiration/swallowing of periodontal bacteria and their virulence factors (i.e., lipopolysaccharides, fimbriae), may lead to non-indigenous bacterial colonization of multiple microenvironments. These events may in turn replenish the tumor-associated microbiome and thus influence the molecular hallmarks of cancer. Particularly, specific strains of oral pathobionts (e.g., Porphyromonas gingivalis and Fusobacterium nucleatum) may translocate through the hematogenous and enteral routes, being implicated in esophageal, gastric, pancreatic, and colorectal tumorigenesis through the modulation of the gastrointestinal antitumor immune system (i.e., tumor-infiltrating T cells) and the increased expression of pro-inflammatory/oncogenic genes. Ultimately, the potential influence of common risk factors, relevant comorbidities, and upstream drivers, such as gerovulnerability to multiple diseases, in explaining the relationship cannot be disregarded. The evidence analyzed here emphasizes the possible relevance of periodontitis in cancer initiation/progression and stimulates future research endeavors.
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Affiliation(s)
- Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Margherita Minoli
- Department of Periodontology, Università Vita-Salute San Raffaele, Milan, Italy
| | - Dominique S Michaud
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Mariano Sanz
- Faculty of Odontology, University Complutense, Madrid, Spain
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Bruno G Loos
- Department of Periodontology, ACTA - Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Baima G, Shin HS, Arrica M, Laforí A, Cordaro M, Romandini M. The co-occurrence of the two main oral diseases: periodontitis and dental caries. Clin Oral Investig 2023; 27:6483-6492. [PMID: 37714978 PMCID: PMC10630193 DOI: 10.1007/s00784-023-05253-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES Limited studies are available testing through multiple regression models the association between the two main oral diseases: dental caries and periodontitis. The aim of this cross-sectional population-based study was to verify whether dental caries and periodontitis co-occur in a representative sample of the South Korea population. MATERIALS AND METHODS A total of 23,405 subjects representative of 36.2 million of adults (KNHANES) were examined. Univariate and multiple regression analyses using 7 different models were applied, controlling for age, gender, smoking status, frequency of toothbrushing, use of interproximal toothbrushes and flossing, educational level, income, gum diseases treatment and tooth filling in the previous year, BMI, Vitamin D serum levels, alcoholism, diabetes status, stress and carbohydrates dietary intake. RESULTS In the fully adjusted model, participants with periodontitis had, respectively, a mean of 0.82 (95% CI: 0.41-1.23) and of 0.36 (95% CI: 0.22-0.50) more untreated decayed surfaces and teeth than participants without periodontitis, with an OR to have at least one untreated decayed surface of 1.96 (95% CI: 1.66-2.32). However, cumulative caries experience (DF scores) and periodontitis were not associated. CONCLUSIONS In this large nationally representative population, periodontitis and untreated dental caries co-occur. However, when considering cumulative caries experience (DF scores), the two diseases do not appear related. CLINICAL RELEVANCE In light of their possible co-occurrence, clinicians should implement integrative diagnostic, preventive and treatment strategies for both diseases.
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Affiliation(s)
- Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Hye-Sun Shin
- Department of Dental Hygiene, Dongnam Health University, Suwon-Si, Gyeonggi-Do, Korea
| | - Mariantonietta Arrica
- Department of Medical, Surgical and Experimental Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | - Andreina Laforí
- Division of Fixed Prosthodontics and Biomaterials, Clinic of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Massimo Cordaro
- Institute of Dentistry and Maxillofacial Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, 69, 0455, Geitmyrsveien, Oslo, Norway.
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Ferrarotti F, Baima G, Rendinelli M, Citterio F, Mariani GM, Mussano F, Romano F, Romandini M, Aimetti M. Pocket closure after repeated subgingival instrumentation: a stress test to the EFP guideline for stage III-IV periodontitis. Clin Oral Investig 2023; 27:6701-6708. [PMID: 37773418 PMCID: PMC10630226 DOI: 10.1007/s00784-023-05279-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES To study the effects of one or two repeated subgingival instrumentations (RSI) in achieving the endpoints of therapy (EoT) in open pockets [residual probing pocket depth (PPD) ≥ 6 mm and PPD 4-5 mm with bleeding on probing (BoP)] after steps I-II of therapy. MATERIALS AND METHODS Twenty-five patients (3,552 total sites; 1,450 open pockets) with stage III-IV periodontitis received steps I-II of periodontal therapy and were re-evaluated after 4-6 weeks (T1). Residual pockets received RSI at T1 and at 3 months (T2). EoT (PPD < 4 or PPD < 6 BoP-) rate at T1, T2 and 6 months (T3) was computed. The number of needed surgeries and treatment costs were calculated. RESULTS At T1, 67.6% of open pockets achieved EoT. At residual PPD ≥ 6 mm at T1 (n = 172), one and two RSI resulted in 33.1% and 45.9% of EoT at T2 and T3, respectively. At residual PPD 4-5 mm with BoP at T1 (n = 298), one and two RSI resulted in 66.8% and 72.1% of EoT at T2 and T3, respectively. PPD at T1 predicted EoT after RSI in both cases, while tooth type only in residual PPD 4-5 mm BoP + . At T1, mean number of surgeries per patient and associated costs were significantly higher than after one/two RSI. CONCLUSIONS RSI may achieve EoT in residual PPD 4-5 mm BoP + and PPD ≥ 6 mm in a considerable number of cases. CLINICAL RELEVANCE These findings may support the administration of one/two cycles of RSI prior to surgical approach. PROTOCOL REGISTRATION ClinicalTrials.gov identification number: NCT04826926.
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Affiliation(s)
- Francesco Ferrarotti
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy.
- Politecnico di Torino, Turin, Italy.
| | - Martina Rendinelli
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Filippo Citterio
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Giulia Maria Mariani
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Federico Mussano
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Geitmyrsveien, 69, 0455, Oslo, Norway.
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
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18
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Baima G, Ribaldone DG, Romano F, Aimetti M, Romandini M. The Gum-Gut Axis: Periodontitis and the Risk of Gastrointestinal Cancers. Cancers (Basel) 2023; 15:4594. [PMID: 37760563 PMCID: PMC10526746 DOI: 10.3390/cancers15184594] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/01/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Periodontitis has been linked to an increased risk of various chronic non-communicable diseases, including gastrointestinal cancers. Indeed, dysbiosis of the oral microbiome and immune-inflammatory pathways related to periodontitis may impact the pathophysiology of the gastrointestinal tract and its accessory organs through the so-called "gum-gut axis". In addition to the hematogenous spread of periodontal pathogens and inflammatory cytokines, recent research suggests that oral pathobionts may translocate to the gastrointestinal tract through saliva, possibly impacting neoplastic processes in the gastrointestinal, liver, and pancreatic systems. The exact mechanisms by which oral pathogens contribute to the development of digestive tract cancers are not fully understood but may involve dysbiosis of the gut microbiome, chronic inflammation, and immune modulation/evasion, mainly through the interaction with T-helper and monocytic cells. Specifically, keystone periodontal pathogens, including Porphyromonas gingivalis and Fusobacterium nucleatum, are known to interact with the molecular hallmarks of gastrointestinal cancers, inducing genomic mutations, and promote a permissive immune microenvironment by impairing anti-tumor checkpoints. The evidence gathered here suggests a possible role of periodontitis and oral dysbiosis in the carcinogenesis of the enteral tract. The "gum-gut axis" may therefore represent a promising target for the development of strategies for the prevention and treatment of gastrointestinal cancers.
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Affiliation(s)
- Giacomo Baima
- Department of Surgical Sciences, University of Turin, 10125 Torino, Italy; (G.B.); (F.R.); (M.A.)
| | | | - Federica Romano
- Department of Surgical Sciences, University of Turin, 10125 Torino, Italy; (G.B.); (F.R.); (M.A.)
| | - Mario Aimetti
- Department of Surgical Sciences, University of Turin, 10125 Torino, Italy; (G.B.); (F.R.); (M.A.)
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, 0313 Oslo, Norway
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19
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Goyal L, Gupta S, Perambudhuru Y. Association between periodontitis and cognitive impairment in adults. Evid Based Dent 2023; 24:123-124. [PMID: 37433922 DOI: 10.1038/s41432-023-00915-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Abstract
DESIGN To summarize the data on association between periodontal diseases and cognitive impairment in adults this systematic review scrutinized various observational studies till September 2021. This review was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) guidelines. The authors used PECO framework question,: population-Adults (18 years or older), exposure-adults suffering from periodontitis, comparator-adult group without periodontitis, outcome-adults at high risk for cognitive impairment. CASE/CONTROL SELECTION Search for the literature was conducted on PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Search was limited to human studies with no limitation to year of publication prior to September 2021. Search terms used were related to gingiva, oral bacteria like Porphyromonas gingivalis, gum inflammation, periodontitis, dementia, neuroinflammation, cognitive impairment, Alzheimer's disease, Parkinson disease. Following research, all the studies providing association between periodontal diseases and neurodegenerative diseases with quantitative measures were included in the study. Non-human studies, studies on patients below 18 year old, studies related to influence of treatment and in subjects already suffering from neurological disease were excluded. After removing duplicates, eligible studies were identified and data extracted by two reviewers to make ensure inter examiner reliability and to prevent data entry errors. Data from the studies were tabulated as study design, sample characteristics, diagnosis, exposure biomarkers/measures, outcomes and results. DATA ANALYSIS Methodological quality of studies was assessed by adapted Newcastle-Ottawa scale. Selection of study groups, comparability and exposure/outcome were used as parameters. Case-control and cohort studies were considered as high-quality studies if six or more stars were awarded out of nine maximum stars and four or more stars for cross-sectional studies out of six stars. Comparability among the groups was studied by taking into account primary factors for Alzheimer's disease such as age and sex and secondary factors like hypertension, osteoarthritis, depression, diabetes mellitus, and cerebrovascular disease. For cohort studies, 10 year follow up and dropout of <10% was considered to be successful. RESULTS A total of 3693 studies were identified by two independent reviewers and finally 11 studies were included in the final analysis. Six cohort studies, three cross-sectional and two case-control studies were included after excluding remaining studies. Bias in studies was assessed by adapted Newcastle-Ottawa Scale. All included studies were of high methodological quality. Association between periodontitis and cognitive impairment was determined by using different criteria like International classification of disease, clinical measurement of periodontitis subjects, inflammatory biomarkers, microbes and antibodies. It was suggested that subjects with chronic periodontitis since 8 years or more, are at a higher risk of having dementia. Clinical measures of periodontal disease like probing depth, clinical attachment loss, alveolar bone loss were found to be positively associated with cognitive impairment. Inflammatory biomarkers and pre-existing elevated levels of serum IgG specific to periodontopathogens was reported to be associated with cognitive impairment. Within the limitations of the study, the authors concluded that though the patients with long-standing periodontitis are at greater risk for developing cognitive impairment by neurodegenerative diseases, the mechanism by which periodontitis can lead to cognitive impairment is still vague. CONCLUSIONS Evidence suggests a strong association between periodontitis and cognitive impairment. Still further studies should be done to explore the mechanism involved.
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Affiliation(s)
- Lata Goyal
- Periodontics Division, Department of Dentistry, All India Institute of Medical Sciences, Bathinda, India
| | - Shipra Gupta
- Oral Health Sciences Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
| | - Yeshwanth Perambudhuru
- Periodontics Division, Department of Dentistry, All India Institute of Medical Sciences, Bathinda, India
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20
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Marruganti C, Romandini M, Gaeta C, Cagidiaco EF, Discepoli N, Parrini S, Graziani F, Grandini S. Healthy lifestyles are associated with a better response to periodontal therapy: A prospective cohort study. J Clin Periodontol 2023; 50:1089-1100. [PMID: 37013691 DOI: 10.1111/jcpe.13813] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Abstract
AIM To evaluate the association between lifestyle behaviours and clinical periodontal outcomes following Steps 1/2 of periodontal therapy. METHODS A total of 120 subjects with untreated Stage II/III periodontitis participated in this study. At baseline, questionnaires were administered to assess the following lifestyle behaviours: adherence to Mediterranean diet (MD), physical activity (PA) and stress levels, sleep quality, smoking and alcohol use. Participants received Steps 1/2 of periodontal therapy and were re-evaluated after 3 months. A composite outcome of the endpoint of therapy (i.e., no sites with probing pocket depth [PPD] ≥4 mm with bleeding on probing, and no sites with PPD ≥ 6 mm) was regarded as the primary outcome. Simple and multiple regression analyses were used to evaluate the association between lifestyle behaviours and clinical periodontal outcomes. Disease severity at baseline, body mass index, diabetes, household disposable income and plaque control were considered as confounders. RESULTS Multiple regression analyses showed significantly lower odds of achieving the endpoint of therapy in subjects with poor sleep quality (odds ratio [OR] = 0.13; 95% confidence interval [CI]: 0.03-0.47; p < .01), smoking (OR = 0.18; 95% CI: 0.06-0.52; p < .05) and alcohol use above the suggested intake (OR = 0.21; 95% CI: 0.07-0.63; p < .01). Subjects with a combination of 'unhealthy lifestyles' (low adherence to MD and low PA levels and high levels of stress and poor sleep quality) showed higher proportions of residual PPD≥6 mm (MD = 1.51; 95% CI: 0.23-2.80; p < .05) and lower odds of achieving the endpoint of therapy (OR = 0.85; 95% CI: 0.33-0.99; p < .05) at re-evaluation. CONCLUSIONS Subjects with unhealthy lifestyle behaviours showed worse clinical outcomes 3 months after Steps 1/2 of periodontal therapy.
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Affiliation(s)
- Crystal Marruganti
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Mario Romandini
- Faculty of Odontology, University Complutense, Madrid, Spain
| | - Carlo Gaeta
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | - Nicola Discepoli
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Stefano Parrini
- Unit of Oral Surgery, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Filippo Graziani
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Simone Grandini
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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21
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Huang X, Wang H, Wang C, Cao Z. The Applications and Potentials of Extracellular Vesicles from Different Cell Sources in Periodontal Regeneration. Int J Mol Sci 2023; 24:ijms24065790. [PMID: 36982864 PMCID: PMC10058679 DOI: 10.3390/ijms24065790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Periodontitis is a chronic infectious disease worldwide that can cause damage to periodontal supporting tissues including gingiva, bone, cementum and periodontal ligament (PDL). The principle for the treatment of periodontitis is to control the inflammatory process. Achieving structural and functional regeneration of periodontal tissues is also essential and remains a major challenge. Though many technologies, products, and ingredients were applied in periodontal regeneration, most of the strategies have limited outcomes. Extracellular vesicles (EVs) are membranous particles with a lipid structure secreted by cells, containing a large number of biomolecules for the communication between cells. Numerous studies have demonstrated the beneficial effects of stem cell-derived EVs (SCEVs) and immune cell-derived EVs (ICEVs) on periodontal regeneration, which may be an alternative strategy for cell-based periodontal regeneration. The production of EVs is highly conserved among humans, bacteria and plants. In addition to eukaryocyte-derived EVs (CEVs), a growing body of literature suggests that bacterial/plant-derived EVs (BEVs/PEVs) also play an important role in periodontal homeostasis and regeneration. The purpose of this review is to introduce and summarize the potential therapeutic values of BEVs, CEVs and PEVs in periodontal regeneration, and discuss the current challenges and prospects for EV-based periodontal regeneration.
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Affiliation(s)
- Xin Huang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Huiyi Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Chuan Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
- Department of Periodontology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Zhengguo Cao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
- Department of Periodontology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
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Bordoni B, Escher AR, Cannadoro G, Tobbi F. The Cognitive and Emotional Aspect in Fibromyalgia: The Importance of the Orofacial Sphere. Cureus 2023; 15:e36380. [PMID: 36945233 PMCID: PMC10025772 DOI: 10.7759/cureus.36380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/22/2023] Open
Abstract
Fibromyalgia syndrome (FMS) is a systemic and multifactorial disease of unknown etiology. There are many co-morbidities that the patient presents, making the clinical picture not immediate. Cognitive decline and emotional alteration (anxiety and depression) are found in fibromyalgic patients, as well as temporomandibular joint arthrokinematic disorders, dental malocclusion, and periodontitis. There seems to be a biunivocal relationship between oral and psychiatric dysfunctions in fibromyalgia. The article reviews the information regarding oral health alterations with respect to the patient's cognitive and emotional response, as the most recent information we have raises new hypotheses about the diagnosis of FMS.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Allan R Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | | | - Filippo Tobbi
- Osteopathy, Poliambulatorio Medico e Odontoiatrico, Varese, ITA
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23
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Air Pollution as a Risk Indicator for Periodontitis. Biomedicines 2023; 11:biomedicines11020443. [PMID: 36830979 PMCID: PMC9953183 DOI: 10.3390/biomedicines11020443] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Air pollutants can influence local and systemic inflammation, oxidative stress and microbiome composition. Therefore, air pollution may potentially represent an unexplored modifiable risk indicator for periodontitis. The aim of the current cross-sectional study was to investigate the epidemiological association between outdoor air pollution and periodontitis in a representative sample of the South Korean population. METHODS A total of 42,020 individuals, which were representative of 35.2 million South Koreans, were examined. The mean annual levels of particulate matter of 10 μm (PM10), ozone, sulfur dioxide (SO2), nitrogen dioxide (NO2) and humidity, were studied. Periodontitis was defined according to the Community Periodontal Index (CPI ≥ 3). Simple and multiple regression analyses using four different models were applied. RESULTS Every 5-μg/m3 increase in PM10 (OR = 1.17; 95% confidence interval-CI: 1.11-1.24) and of 0.005 ppm in ozone levels (OR = 1.4; 95% CI: 1.00-1.30) were positively associated with periodontitis prevalence. Conversely, every 5% increase in humidity (OR = 0.94; 95% CI: 0.90-0.99) and 0.003 ppm increase in NO2 levels (OR = 0.93; 95% CI: 0.89-0.96) were inversely associated with periodontitis occurrence. CONCLUSIONS In this nationally representative population several air pollutants were found to be associated with periodontitis occurrence. Hence, the present results suggest that air pollution may be a new modifiable risk indicator for periodontitis.
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