Relationship of periodontitis and edentulism to angiographically diagnosed coronary artery disease: A cross-sectional study

Calprotectin and periostin levels in periodontitis patients with coronary artery disease

OBJECTIVE

The aim of the study was to assess the effect of non-surgical periodontal therapy (NSPT) on periodontal and cardiac parameters as well as on the expression of calprotectin and periostin levels in periodontitis patients with and without coronary artery disease (CAD).

METHODS

Ninety subjects were categorised into three groups: Group H: periodontally and systemically healthy subjects, Group P: stage III grade B periodontitis subjects with no associated systemic diseases and Group P + CAD: stage III grade B periodontitis subjects diagnosed with CAD. Demographic, periodontal and cardiac parameters were recorded at baseline (0 day) and on the 180th day after NSPT. Gingival crevicular fluid was collected from all participants at baseline (0 day) and after the 180th day. Calprotectin and periostin expression were reassessed.

RESULTS

A significant increase in the levels of calprotectin (34.05 ± 11.72) was seen at baseline in the P + CAD group, whereas on the contrary, a decreased periostin (1.59 ± 0.41) was also noted at baseline. The study also showed a significant improvement in periodontal and cardiac parameters on the 180th day following NSPT.

CONCLUSION

Detection of calprotectin and periostin expression in GCF samples could represent a link to the association of periodontitis and CAD.

Systemic Multimorbidity Clusters in People with Periodontitis

This study aimed to identify systemic multimorbidity clusters in people with periodontitis via a novel artificial intelligence-based network analysis and to explore the effect of associated factors. This study utilized cross-sectional data of 3,736 participants across 3 cycles of the National Health and Nutrition Examination Survey (2009 to 2014). Periodontal examination was carried out by trained dentists for participants aged ≥30 y. The extent of periodontitis was represented by the proportion of sites with clinical attachment loss (CAL)≥ 3 mm, split into 4 equal quartiles. A range of systemic diseases reported during the survey were also extracted. Hypergraph network analysis with eigenvector centralities was applied to identify systemic multimorbidity clusters and single-disease influence in the overall population and when stratified by CAL quartile. Individual factors that could affect the systemic multimorbidity clusters were also explored by CAL quartile. In the study population, the top 3 prevalent diseases were hypertension (63.9%), arthritis (47.6%), and obesity (45.9%). A total of 106 unique systemic multimorbidity clusters were identified across the study population. Hypertension was the most centralized disease in the overall population (centrality [C]: 0.50), followed closely by arthritis (C: 0.45) and obesity (C: 0.42). Diabetes had higher centrality in the highest CAL quartile (C: 0.31) than the lowest (C: 0.26). "Hypertension, obesity" was the largest weighted multimorbidity cluster across CAL quartiles. This study has revealed a range of common systemic multimorbidity clusters in people with periodontitis. People with periodontitis are more likely to present with hypertension and obesity together, and diabetes is more influential to multimorbidity clusters in people with severe periodontitis. Factors such as ethnicity, deprivation, and smoking status may also influence the pattern of multimorbidity clusters.

Betulinic acid promotes the osteogenic differentiation of human periodontal ligament stem cells by upregulating EGR1

Periodontitis is one of the most common chronic inflammations of the oral cavity, which eventually leads to tooth loss. Betulinic acid (BetA) is an organic acid that has anti-inflammatory effects and is derived from fruits and plants, but its effect on the osteogenic differentiation of human periodontal ligament stem cells (hPDLSCs) is still unclear. This study aimed to explore the effect of BetA on the osteogenic differentiation of hPDLSCs and its mechanism. Our results revealed that BetA not only promoted the viability of hPDLSCs but also induced their osteogenic differentiation in a dose-dependent manner. In addition, RNA sequencing was used to screen the differentially expressed genes (DEGs) after hPDLSCs were treated with BetA, and 127 upregulated and 138 downregulated genes were identified. Gene Ontology enrichment analysis showed that DEGs were mainly involved in the response to lithium ions and the positive regulation of macrophage-derived foam cell differentiation. The Kyoto Encyclopedia of Genes and Genomes analysis results revealed that DEGs were enriched in the nuclear factor-κB and interleukin-17 signaling pathways. More importantly, we confirmed that early growth response gene 1 (EGR1), one of the three DEGs involved in bone formation, significantly promoted the expression of osteogenic markers and the mineralization of hPDLSCs. Knockdown of EGR1 obviously limited the effect of BetA on the osteogenic differentiation of hPDLSCs. In conclusion, BetA promoted the osteogenic differentiation of hPDLSCs through upregulating EGR1, and BetA might be a promising candidate in the clinical application of periodontal tissue regeneration.

Impact of Matrix Metalloproteinase-9 during Periodontitis and Cardiovascular Diseases

Matrix metalloproteinase-9 (MMP-9) has been shown to play a key role in endothelial function and perhaps pivotal in the correlation between periodontal disease and cardiovascular disease (CVD). For the study, the impact of MMP-9 of periodontitis and CVD on serum and saliva concentrations was analyzed. For the study patients with periodontitis (n = 31), CVD (n = 31), periodontitis + CVD (n = 31), and healthy patients (n = 31) were enrolled. Clinical and demographic characteristics as well as serum and salivary MMP-9 were evaluated. MMP-9 concentrations in serum and saliva were statistically elevated in patients with CVD (p < 0.01) and in patients with periodontitis plus CVD (p < 0.001) compared to patients with periodontitis and healthy subjects. Multivariate regression analysis showed that c-reactive protein (hs-CRP) was the only significant predictor for MMP-9 serum (p < 0.001), whereas hs-CRP (p < 0.001) and total cholesterol (p = 0.029) were the statistically significant salivary MMP-9 predictors. This study evidenced that patients with CVD and periodontitis + CVD presented elevated MMP-9 concentrations in serum and saliva compared to patients with periodontitis and healthy subjects. Furthermore, hs-CRP was a negative predictor of serum and salivary MMP-9.

Association of Systemic Sclerosis and Periodontitis with Vitamin D Levels

The aim of the present study was to analyze the association among systemic sclerosis (SSc), periodontitis (PT); we also evaluated the impact of PT and SSc on vitamin D levels. Moreover, we tested the association with potential confounders. A total of 38 patients with SSc, 40 subjects with PT, 41 subjects with both PT and SSc, and 41 healthy controls were included in the study. The median vitamin D levels in PT subject were 19.1 (17.6-26.8) ng/mL, while SSc + PT group had vitamin d levels of 15.9 (14.7-16.9) ng/mL, significantly lower with respect to SSc patients (21.1 (15.4-22.9) ng/mL) and to healthy subjects (30.5 (28.8-32.3) ng/mL) (p < 0.001). In all subjects, vitamin D was negatively associated with c-reactive protein (CRP) (p < 0.001) and with probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque score (PI) (p < 0.001 for all parameters) and positively related to the number of teeth (p < 0.001). Moreover, univariate regression analysis demonstrated an association among high low-density lipoproteins (LDL) cholesterol (p = 0.021), CRP (p = 0.014), and PT (p < 0.001) and reduced levels of vitamin D. The multivariate regression analysis showed that PT (p = 0.011) and CRP (p = 0.031) were both predictors of vitamin D levels. Subjects with PT and SSc plus PT had significant lower vitamin D values with respect to SSc and to healthy subjects. In addition, PT seems negatively associated with levels of vitamin D in all analyzed patients.