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Yan Q, Liao L, He D. Risk factors associated with temporomandibular joint disorder: A mendelian randomization analysis. J Oral Rehabil 2024. [PMID: 39041331 DOI: 10.1111/joor.13795] [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: 04/20/2024] [Revised: 06/08/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Temporomandibular joint disorder (TMD), a prevalent orofacial disorder with complex aetiologies and considerable socioeconomic costs. This underscores the critical importance of developing a comprehensive understanding of the risk factors associated with TMD, as existing research is hindered by deficiencies in establishing causal relationships and the limitations of traditional research methodologies. OBJECTIVES This research explores the causal link between certain risk factors and temporomandibular joint disorder (TMD) through Mendelian randomization (MR), providing multidimensional perspectives in addressing this worldwide health issue. METHODS Utilizing instrumental variables, we applied advanced statistical methods, including the weighted median, inverse variance weighted (IVW) and MR-Egger, to evaluate the impact of twelve potential risk factors on TMD. RESULTS Our results identified a significant positive association of TMD with malocclusion (p < .001), sleeping disorders (p = .006), anxiety (p = .002), major depression (p = .0002), daily cigarettes consumption (p = .029) and autoimmune diseases (p = .039). Conversely, a negative association was observed with educational attainment (p = .003). CONCLUSION These findings suggest that malocclusion, sleeping disorders, anxiety, major depression, daily cigarettes consumption and autoimmune diseases, could potentially increase TMD risk while educational attainment might mitigate its increase. No direct causal relationships were established between serum 25-hydroxyvitamin D levels, menopause, frequent alcohol consumption, coffee intake and severely worn dentition and TMD.
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Affiliation(s)
- Qinghan Yan
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Lingzi Liao
- Department (Hospital) of Stomatology, Lanzhou University, Lanzhou, China
| | - Dengqi He
- Department (Hospital) of Stomatology, Lanzhou University, Lanzhou, China
- Department of Stomatology, The First Hospital of Lanzhou University, Lanzhou, China
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Chen X, Cheng Z, Xu J, Wang Q, Zhao Z, Jiang Q. Causal effects of autoimmune diseases on temporomandibular disorders and the mediating pathways: a Mendelian randomization study. Front Immunol 2024; 15:1390516. [PMID: 39044823 PMCID: PMC11263080 DOI: 10.3389/fimmu.2024.1390516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
Background The role of autoimmune diseases (ADs) in temporomandibular disorders (TMDs) has been emphasized in observational studies. However, whether the causation exists is unclear, and controversy remains about which specific disorder is destructive in TMDs. This Mendelian randomization (MR) study aims to estimate the causal effect of common ADs on TMDs. Methods Genetic data from published genome-wide association studies for fourteen common ADs, specifically multiple sclerosis (MS, N = 15,283), ankylosing spondylitis (AS, N = 22,647), asthma (N = 408,422), celiac disease (N = 15,283), Graves' disease (N = 458,620), Hashimoto thyroiditis (N = 395,640), primary biliary cirrhosis (PBC, N = 11,375), primary sclerosing cholangitis (PSC, N = 14,890), psoriasis vulgaris (N = 483,174), rheumatoid arthritis (RA, N = 417,256), systemic lupus erythematosus (SLE, N = 23,210), Type 1 diabetes (T1D, N = 520,580), inflammatory bowel disease (IBD, N = 34,652), and Sjogren's syndrome (SS, N = 407,746) were collected. Additionally, the latest summary-level data for TMDs (N = 228,812) were extracted from the FinnGen database. The overall effects of each immune traits were assessed via inverse-variance weighted (IVW), weighted median, and MR-Egger methods, and performed extensive sensitivity analyses. Finally, 731 immune cell phenotypes (N = 3,757) were analyzed for their mediating role in the significant causality. Results Univariable MR analyses revealed that genetically predicted RA (IVW OR: 1.12, 95% CI: 1.05-1.19, p < 0.001) and MS (IVW OR: 1.06, 95% CI: 1.03-1.10, p = 0.001) were associated with increased risk of TMDs. Two out of 731 immune cell phenotypes were identified as causal mediators in the associations of RA with TMDs, including "CD25++ CD8+ T cell % CD8+ T cell" (mediation proportion: 6.2%) and "CD3 on activated CD4 regulatory T cell" (5.4%). Additionally, "CD127 on granulocyte" mediated 10.6% of the total effect of MS on TMDs. No reverse directions, heterogeneity, and pleiotropy were detected in the analyses (p > 0.05). Conclusion This MR study provides new evidence regarding the causal impact of genetic predisposition to RA or MS on the increased risk of TMDs, potentially mediated by the modulation of immune cells. These findings highlight the importance for clinicians to pay more attention to patients with RA or MS when consulting for temporomandibular discomfort. The mediating role of specific immune cells is proposed but needs further investigation.
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Affiliation(s)
- Xin Chen
- Department of Oral and Maxillofacial Surgery, Jiangyin People’s Hospital Affiliated to Nantong University, Jiangyin, China
| | - Zheng Cheng
- Department of Oral and Maxillofacial Surgery, Jiangyin People’s Hospital Affiliated to Nantong University, Jiangyin, China
| | - Junyu Xu
- Department of Oral and Maxillofacial Surgery, Jiangyin People’s Hospital Affiliated to Nantong University, Jiangyin, China
| | - Qianyi Wang
- Department of Cardiology, Jiangyin People’s Hospital Affiliated to Nantong University, Jiangyin, China
| | - Zhibai Zhao
- Department of Oral Mucosal Diseases, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
| | - Qianglin Jiang
- Department of Oral and Maxillofacial Surgery, Jiangyin People’s Hospital Affiliated to Nantong University, Jiangyin, China
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Benli M, Huck O, Özcan M. Effect of low-level gallium aluminum arsenide laser therapy on the chewing performance and pain perception of patients with systemic lupus erythematosus: A randomized controlled clinical trial. Cranio 2024; 42:411-420. [PMID: 34455912 DOI: 10.1080/08869634.2021.1971888] [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: 10/20/2022]
Abstract
OBJECTIVE To evaluate the effect of low-level laser therapy (LLLT) on pain intensity (PI) and chewing performance (CP) in systemic lupus erythematosus (SLE) patients with myogenic temporomandibular disorder (TMD). METHODS Ninety-one patients were randomly allocated to three groups: Group L (intervention), Group P (placebo), and Group C (control). Outcomes were PI (assessed with visual analog scale (VAS)) and CP (assessed with the geometric mean diameter (GMD) of crushed test food). Measurements were performed at T0 (before the LLLT), T1 (immediately after the LLLT), and T2 (1-month follow-up). Data were analyzed using Generalized Linear Models, Kruskal-Wallis, and Friedman tests. RESULTS For T1 and T2, Group L demonstrated the lowest values for both GMD (6283.7 ± 257.2 µm; 6382.7 ± 303.7 µm) and VAS (5;6) (p < 0.001). CONCLUSION LLLT was an effective therapeutic approach in reducing pain and improving CP for one month in SLE patients with myogenic TMD.
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Affiliation(s)
- Merve Benli
- University of Pittsburgh, School of Dental Medicine, Department of Oral Biology, Pittsburgh, PA, USA
- Istanbul University, Faculty of Dentistry, Department of Prosthodontics, Istanbul, Turkey
| | - Olivier Huck
- Inserm, Umr 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculty of Medicine, Strasbourg, France
- University of Strasbourg, Faculty of Dentistry, Department of Periodontology, Strasbourg, France
| | - Mutlu Özcan
- University of Zurich, Dental Materials Unit, Center for Dental and Oral Medicine Clinic for Fixed and Removable Prosthodontics and Dental Materials Science, Zurich, Switzerland
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Prabhakar V, Rajvikram N, Ramachandran U, Saravanan R, Ponsekar AA, Thomas DC. Knowledge and awareness about temporomandibular disorder among dentists in India: Questionnaire study and review. J Indian Prosthodont Soc 2024; 24:284-291. [PMID: 38946513 DOI: 10.4103/jips.jips_573_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/15/2024] [Indexed: 07/02/2024] Open
Abstract
AIM Temporomandibular disorders (TMD) comprise ailments involving the jaw joint (temporomandibular joint) and its associated anatomical structures. The complexity involved in TMD is primarily due to its broad spectrum of conditions, clinical signs and symptoms variability, and multifactorial etiology. Considering the above, the present study was performed to help understand the prevailing knowledge and awareness of TMD among Indian dentists in the context of the new specialty "orofacial pain". SETTINGS AND DESIGN Questinnaire study and review. MATERIALS AND METHODS The questionnaire was distributed using a web-based portal nationwide among Indian dentists. Dentists were invited to participate, clearly stating that the intent and purpose of the questionnaire was to record the existing knowledge and awareness concerning temporomandibular disorders among Indian dentists. The questionnaire was segregated into three sections: pathogenesis, diagnosis, and management of TMDs. The questions were recorded using a Likert three-point scale (1=agree; 2=disagree; 3=not aware). 310 dentists participated in the survey, among which 105 were general dentists (BDS [Bachelor of Dental Surgery] graduates), and 205 were dentists with specialist training (MDS [Masters of Dental Surgery] graduates). STATISTICAL ANALYSIS USED The results obtained from the study participants was used to calculate the percentage and frequency, following which tabulations were made based on graduate type and clinical experience. The values obtained from all three sections were recorded, and the responses were analysed using Pearson's Chi-Square test with statistical significance kept at P < 0.05. RESULTS Results of the study disclosed that only 58.1% of general dentists and 46.8% of specialists were confident in handling temporomandibular disorder patients. Splint therapy was the preferred treatment modality for general dentists, whereas dentists with specialist training preferred occlusal rehabilitation. CONCLUSION The results of the current survey indicate that Indian dentists lack sufficient training in dental schools on all three sections and face difficulty diagnosing and treating TMDs.
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Affiliation(s)
- Vaishnavi Prabhakar
- Department of Dental Sciences, Dr. MGR Educational and Research Institute, Chennai, Tamil Nadu, India
| | - N Rajvikram
- Department of Orthodontics and Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Umamaheshwari Ramachandran
- Department of Department of Orthodontics, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - R Saravanan
- Department of Orthodontics and Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | | | - Davis C Thomas
- Centre for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, Newark, NJ, USA
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de Arruda JAA, Villarroel-Dorrego M, Freire CH, Molina-Ávila I, Pimentel-Solá JM, Gilligan G, Piemonte E, Panico R, Panico JCR, Aranda-Romo S, Tejeda-Nava FJ, Israel MS, Cunha JLS, de Medeiros VA, Nonaka CFW, Alves PM, Cavalcante IL, Ventura JVL, de Lima FS, Drumond VZ, Abreu LG, Silva TA, Fonseca FP, Mesquita RA, Martínez-Flores R, Cordero-Torres K, Ahumada-Ossandón R, Guzmán J, Toro R, Xavier-Júnior JCC, Sousa-Neto SS, Arantes DAC, Mendonça EF, Palma VDM, de Oliveira MG, Visioli F, Ortega KL, Tenório JR, de Andrade BAB. Oral lesions of systemic lupus erythematosus: A collaborative Latin American study. Lupus 2024; 33:864-873. [PMID: 38686816 DOI: 10.1177/09612033241252042] [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: 05/02/2024]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease that may affect the oral mucosa. The variable spectrum of oral lesions observed in SLE can pose challenges in diagnosis, particularly when the lesions occur in isolation. The aim of this study was to describe the oral lesions occurring in patients with SLE from Latin America. METHODS This collaborative record-based study involving 11 oral and maxillofacial pathology and medicine services across Venezuela, Argentina, Chile, Brazil, and Mexico describes the clinicopathological profile of SLE-related oral lesions. RESULTS Seventy patients with SLE and oral lesions were included in the study. The majority were females (75.7%; female/male ratio: 3.1:1) and white (62.1%), with a mean age of 38.4 years (range: 11-77 years). The most common site of oral lesions was the hard/soft palate (32.0%). Clinically, oral lesions predominantly presented as ulcers (26.6%), erosions (26.6%), and white lesions (23.4%). Isolated oral lesions occurred in 65.2% of individuals, while cutaneous manifestations occurred in 80.3%. The main clinical diagnostic hypothesis in 71.4% of cases was an immune-mediated disease. Oral biopsies followed by histopathological analysis were performed in 50 cases. CONCLUSION Oral lesions of SLE exhibit a variety of clinical and histopathological features. A key point in diagnosis is that unusual oral changes without an obvious local cause may indicate a possible systemic condition presenting with oral lesions. A multidisciplinary approach, which includes regular oral examination, is warranted to identify oral lesions and provide treatment.
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Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Clara Herrera Freire
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Gerardo Gilligan
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Eduardo Piemonte
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - René Panico
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Juan Cruz Romero Panico
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Saray Aranda-Romo
- Diagnostic Clinic, School of Dentistry, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | | | - Mônica Simões Israel
- Department of Diagnosis and Therapeutics, School of Dentistry, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - John Lennon Silva Cunha
- Department of Dentistry, School of Dentistry, Universidade Estadual da Paraíba, Campina Grande, Brazil
| | - Vanessa Alves de Medeiros
- Department of Dentistry, School of Dentistry, Universidade Estadual da Paraíba, Campina Grande, Brazil
| | | | - Pollianna Muniz Alves
- Department of Dentistry, School of Dentistry, Universidade Estadual da Paraíba, Campina Grande, Brazil
| | - Israel Leal Cavalcante
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Dentistry, Universidade de Fortaleza, Fortaleza, Brazil
| | - José Victor Lemos Ventura
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Silva de Lima
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - René Martínez-Flores
- Department of Oral Medicine and Oral Pathology, School of Dentistry, Universidad Andres Bello, Viña del Mar, Chile
| | - Karina Cordero-Torres
- Department of Oral Pathology and Diagnosis, School of Dentistry, Universidad de Valparaíso, Valparaíso, Chile
| | - Richard Ahumada-Ossandón
- Department of Oral Pathology and Diagnosis, School of Dentistry, Universidad de Valparaíso, Valparaíso, Chile
| | - Jorge Guzmán
- Department of Oral Medicine, School of Dentistry, Universidad Central de Venezuela, Caracas, Venezuela
| | - Raiza Toro
- Department of Oral Medicine, School of Dentistry, Universidad Central de Venezuela, Caracas, Venezuela
| | - José Cândido Caldeira Xavier-Júnior
- School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, Araçatuba, Brazil
- Pathology Institute of Araçatuba, Araçatuba, Brazil
- Botucatu Medical School, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, Brazil
| | - Sebastião Silvério Sousa-Neto
- Department of Oral Diagnosis, Piracicaba School of Dentistry, Universidade Estadual de Campinas, Piracicaba, Brazil
- Department of Stomatology (Oral Pathology), School of Dentistry, Universidade Federal de Goiás, Goiânia, Brazil
| | - Diego Antônio Costa Arantes
- Department of Stomatology (Oral Pathology), School of Dentistry, Universidade Federal de Goiás, Goiânia, Brazil
| | | | - Victor de Mello Palma
- Department of Oral Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Fernanda Visioli
- Department of Oral Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Karem L Ortega
- Department of Stomatology, School of Dentistry, Universidade de São Paulo, São Paulo, Brazil
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jefferson R Tenório
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Lobognon VD, Alard JÉ. [Autoimmunity and oral cavity, where are we in 2023?]. Med Sci (Paris) 2024; 40:49-56. [PMID: 38299903 DOI: 10.1051/medsci/2023195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Autoimmune diseases (AIDs) remain an enigma to the current understanding of immune system functioning. Identifying their etiologies remains a major challenge, despite growing knowledge. The oral cavity has a very special place in regard to AIDs. The oral mucosa, the most exposed body's natural barrier to pathogens, plays a role in both education of the immune system and the organism's daily protection. On the one hand, systemic disturbance of the immune system can impact the oral sphere with early signs which are useful diagnostic tools. On the other hand, the current research efforts on interactions between microbiota and the immune system allow an update of the old hypothesis involving an initial infection to trigger autoimmunity. Dysbiosis of our microbiota, especially in the oral sphere, could lead to a breakdown in tolerance mechanisms. Immune tolerance has to maintain the integrity of the organism but also cohabitation with commensal microbiota. The relationship between periodontitis, a chronic infectious disease, and rheumatoid arthritis, one of the most common systemic autoimmune disorders, illustrates the possible relationship between chronic infections and the etiopathogenesis of autoimmunity. Indeed, its association with oral pathogens involved in periodontal damage raises questions about a possible infectious etiology of rheumatoid arthritis (RA) which would place the management of periodontitis not only as mandatory RA's support therapy but also as a prophylactic gesture to prevent autoimmunity.
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Affiliation(s)
| | - Jean-Éric Alard
- Lymphocytes B, autoimmunité et immunothérapies (LBAI), UMR1227, Univ Brest, Inserm, Brest, France - Service d'odontologie, CHU de Brest, Brest, France
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Reckelkamm SL, Kamińska I, Baumeister SE, Ponce-de-Leon M, Ehmke B, Rodakowska E, Baginska J, Nolde M, Kamiński KA. Targeted proteomics in a population-based study identifies serum PECAM-1 and TRIM21 as inflammation markers for periodontitis. Clin Oral Investig 2023; 28:59. [PMID: 38157091 PMCID: PMC10756891 DOI: 10.1007/s00784-023-05442-z] [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: 07/18/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Periodontitis (PD) can cause systematic inflammation and is associated with various metabolic processes in the body. However, robust serum markers for these relationships are still lacking. This study aims to identify novel circulating inflammation-related proteins associated with PD using targeted proteomics. MATERIALS AND METHODS We used population-based, cross-sectional data from 619 participants of the Polish Longitudinal University Study (Bialystok PLUS). Mean pocket probing depth (mPPD) and proportion of bleeding on probing (pBOP) served as exposure variables. Fifty-two inflammation-related proteins were measured using the Olink Target 96 Cardiovascular III and the Olink Target 96 Immune Response panels. Associations between periodontal measures and proteins were tested using covariate-adjusted linear regression models. RESULTS At a false discovery rate of < 0.05, we identified associations of mPPD and pBOP with platelet-endothelial cell adhesion molecule-1 (PECAM-1) and tripartite motif-containing protein 21 (TRIM21). CONCLUSION This study revealed novel associations between PD and serum levels of PECAM-1 and TRIM21. Our results suggest that these proteins might be affected by molecular processes that take place in the inflamed periodontium. CLINICAL RELEVANCE Novel associations of PECAM-1 and TRIM21 with PD indicate promising serum markers for understanding the disease's pathophysiological processes and call for further biomedical investigations.
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Affiliation(s)
- Stefan Lars Reckelkamm
- Institute of Health Services Research in Dentistry, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
- Clinic for Periodontology and Conservative Dentistry, University of Münster, Münster, Germany.
| | - Inga Kamińska
- Department of Integrated Dentistry, Medical University of Bialystok, Bialystok, Poland
| | - Sebastian-Edgar Baumeister
- Institute of Health Services Research in Dentistry, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Mariana Ponce-de-Leon
- Chair of Epidemiology at the University Augsburg, University Hospital Augsburg, Augsburg, Germany
| | - Benjamin Ehmke
- Clinic for Periodontology and Conservative Dentistry, University of Münster, Münster, Germany
| | - Ewa Rodakowska
- Department of Clinical Dentistry-Cariology Section, University of Bergen, 5020, Bergen, Norway
| | - Joanna Baginska
- Department of Dentistry Propaedeutics, Medical University of Bialystok, 15-295, Białystok, Poland
| | - Michael Nolde
- Institute of Health Services Research in Dentistry, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Karol Adam Kamiński
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Bialystok, Poland
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Koppolu P, Sheethi KV, Swapna LA, Priyanka M, Abdelrahim RK, Basireddy A, Mandil O. Treatment of aggressive periodontitis in a patient with systemic lupus erythematosus: A case report with 8 years follow-up. Ann Afr Med 2023; 22:549-553. [PMID: 38358160 PMCID: PMC10775935 DOI: 10.4103/aam.aam_128_22] [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: 08/29/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 02/16/2024] Open
Abstract
Systemic lupus erythematosus (SLE) with oral desquamative lesions is one of the rare clinical entities. Periodontal disease and SLE display various mechanisms and possess a wide range of pathological characteristics. The tissue destruction mechanism of periodontitis and autoimmune diseases share similar pathways, and mounting reports studied the association between these two entities. The present case is of a 24-year-old female patient who complained of generalized widening of spaces in between the teeth. Along with it, She suffered from loss of hair, weakness, edema in the legs as well as arthralgia. The patient was identified to be suffering from SLE according to the American Rheumatism Association and European Academy of Dermatology and Venereology criteria 1 year before she reported to the dentist. She suffered from hair loss, weakness, arthralgia as well as edema in the legs. Based on the oral, clinical, and radiographic findings, she was diagnosed with aggressive periodontitis case. After nonsurgical periodontal treatment, the flap was reflected, debridement was done, after root conditioning with tetracycline, bovine osseous xenograft was placed in all the sites where ever there is angular bone loss, later sutured with interrupted direct loop suturing technique with 4-0 silk suture. Clinical and radiographic evaluation was done every 6 weeks to check the progress of the treatment. 6 months and 8-year follow-up revealed satisfactory clinical and radiographic outcomes. Based on the present case report and the previous literature, we recommend the use of xenograft in treating aggressive periodontitis patients.
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Affiliation(s)
- Pradeep Koppolu
- UWA Dental School, The University of Western Australia, Perth, Australia
| | | | - Lingam Amara Swapna
- Department of Surgical and Diagnostic Sciences, College of Dentistry Dar AlUloom University, Hyderabad, India
| | | | | | - Aravinda Basireddy
- Department of Periodontics, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
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Alrashdan MS, Arzmi MH, Ahmad Kamil WN, Al Kawas S, Leao JC. Immune-mediated oral mucosal pathology: a comprehensive review and update for clinicians. Part I. Ital J Dermatol Venerol 2023; 158:408-418. [PMID: 37916401 DOI: 10.23736/s2784-8671.23.07676-4] [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] [Indexed: 11/03/2023]
Abstract
The oral mucosa can be involved in a wide variety of mucocutaneous conditions that may present primarily in the mouth or affect other cutaneous or mucosal sites. Many of these conditions are immune mediated and typically present as inflammatory mucosal pathology. Patients experiencing such conditions usually seek medical evaluation and treatment due to the associated pain and discomfort and occasionally taste disturbance or dysphagia and the overall deterioration in the oral health-related quality of life. These conditions share some common features and there could be some overlapping in their clinical presentation, which can lead to delays in diagnosis and proper management of patients. Clinicians dealing with such disorders, including dermatologists, need to be aware of the oral manifestations of mucocutaneous conditions, their clinical features, underlying mechanisms, diagnostic approaches, and treatment options, as well as the recent advances in the research on these conditions. This review provides a comprehensive, evidence-based reference for clinicians, with updated insights into a group of immune mediated conditions known to cause oral mucosal pathology. Part one will cover oral lichen planus, erythema multiforme and systemic lupus erythematosus, while part two will cover pemphigus vulgaris and mucous membrane pemphigoid, recurrent aphthous stomatitis, in addition to the less common disorders linear IgA disease, dermatitis herpetiformis and epidermolysis bullosa.
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Affiliation(s)
- Mohammad S Alrashdan
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates -
- Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan -
| | - Mohd H Arzmi
- Kulliyyah of Dentistry, International Islamic University Malaysia, Pahang, Malaysia
- Cluster of Cancer Research Initiative IIUM (COCRII), International Islamic University Malaysia, Pahang, Malaysia
- Jardin Pharma Berhad, Selangor, Malaysia
| | - Wan N Ahmad Kamil
- Kulliyyah of Dentistry, International Islamic University Malaysia, Pahang, Malaysia
- Cluster of Cancer Research Initiative IIUM (COCRII), International Islamic University Malaysia, Pahang, Malaysia
- Faculty of Dentistry, MARA University of Technology (UiTM), Selangor, Malaysia
| | - Sausan Al Kawas
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Jair C Leao
- Department of Clinics and Preventive Dentistry, Federal University of Pernambuco, Recife, Brazil
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Mirfendereski P, Magee R, France K. Scaling and Root Planning in a Patient Taking Chronic Corticosteroid Therapy for Lupus Erythematosus. Dent Clin North Am 2023; 67:649-651. [PMID: 37714616 DOI: 10.1016/j.cden.2023.05.018] [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: 09/17/2023]
Abstract
The dental provider should be aware of the oral manifestations of systemic lupus erythematosus (SLE). Patients with SLE may be on chronic oral corticosteroids, which can increase the risk for periodontitis and opportunistic oral infections in addition to inducing multiple systemic adverse effects. Disease complications such as lupus nephritis and comorbid antiphospholipid antibody syndrome can further impact dental decision-making including around medications to prescribe or hemostatic measures to employ during treatment. Patients with SLE on systemic corticosteroid therapy usually do not require steroid supplementation before or after non-surgical or surgical dental treatment.
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Affiliation(s)
- Payam Mirfendereski
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
| | - Rogan Magee
- Department of Neurology, Penn Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Katherine France
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
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11
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García-Ríos P, Pecci-Lloret MP, Oñate-Sánchez RE. Oral Manifestations of Systemic Lupus Erythematosus: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11910. [PMID: 36231212 PMCID: PMC9565705 DOI: 10.3390/ijerph191911910] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that is characterized by clinical heterogeneity and irregularities in its course. The etiology and pathogenesis of this pathology are not well-understood, so there is difficulty in establishing a diagnosis and treatment plan with certainty. The aim of this systematic review is to present a qualitative synthesis of studies referring to the oral manifestations of systemic lupus erythematosus (SLE). This systematic review was performed following the PRISMA guideline. On this basis, a search for articles was performed in the PubMed, Web of Science, and Scopus databases on 19 November 2021 and updated on 15 February 2022. We chose articles published between 2012 and 2022 that analyzed the oral manifestations of SLE patients. The quality of all these studies was analyzed following the STROBE scale. A total of 15 articles were included in this study after selection. The selected articles were cross-sectional, case-control, and cohort studies. The most frequently associated oral manifestations with SLE were oral ulcers, hyposalivation, pigmentations, glossodynia, cleft tongue, cheilitis, arthritis, and secondary Sjögren's syndrome. However, despite the importance of the perception of these oral manifestations in the early diagnosis of SLE, there are still not enough studies about them.
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12
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Lu MC, Hsu CW, Koo M. Patterns of Outpatient Phecodes Predating the Diagnosis of Systemic Lupus Erythematosus in Taiwanese Women. J Clin Med 2022; 11:jcm11185406. [PMID: 36143053 PMCID: PMC9506474 DOI: 10.3390/jcm11185406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 11/24/2022] Open
Abstract
Shortening the time to diagnosis and initiating early treatment are imperative to improve outcomes in patients with systemic lupus erythematosus (SLE). The aim of this case-control study, based on the data from the Taiwan’s National Health Insurance Research Database (NHIRD), was to investigate the patterns of diagnoses of disease phenotypes in female patients with SLE up to eight years prior to its definitive diagnosis. The 547 cases were selected from the 2000–2012 NHIRD catastrophic illness datafile and frequency-matched with 2188 controls. The primary diagnosis based on the first ICD-9-CM code for each outpatient visit was converted to Phecodes. Separate regression models, based on least absolute shrinkage and selection operator (lasso) regularization, with seven different lag periods from 1–2 to 7–8 years, were conducted. Results showed that SLE was associated with 46 disease phenotypes in a lag period of 2–3 years, but fewer in other lag periods. A number of SLE-associated disease phenotypes, such as primary thrombocytopenia, thyroid diseases, Raynaud’s syndrome, renal disease, and several infectious diseases, occurred mainly in the first few years prior to SLE diagnosis. In conclusion, SLE should be suspected when the disease phenotypes identified in the present study occurred concomitantly.
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Affiliation(s)
- Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin 622401, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien City 97004, Hualien, Taiwan
| | - Chia-Wen Hsu
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin 622401, Chiayi, Taiwan
| | - Malcolm Koo
- Graduate Institute of Long-Term Care, Tzu Chi University of Science and Technology, Hualien City 970302, Hualien, Taiwan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Correspondence:
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13
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Dias LNDS, Coêlho MDC, Persuhn DC, Ribeiro ILA, Freire EAM, de Oliveira NFP, de Aquino SG. DNMT3B (rs2424913) polymorphism is associated with systemic lupus erythematosus alone and with co-existing periodontitis in a Brazilian population. J Appl Oral Sci 2022; 30:e20210567. [PMID: 35507987 PMCID: PMC9064189 DOI: 10.1590/1678-7757-2021-0567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/14/2022] [Accepted: 02/23/2022] [Indexed: 11/21/2022] Open
Abstract
The association between Periodontitis and Systemic Lupus Erythematosus (SLE) has been primarily based on their similar pathophysiology and both are associated with genetic polymorphisms. OBJECTIVES To investigate an association between the methylation-related gene polymorphisms DNMT3B (rs2424913) and MTHFR (rs1801133) to Systemic Lupus Erythematosus (SLE) and Periodontitis. METHODOLOGY In total, 196 individuals of all genders aged 24 to 60 years old were allocated into four groups based on their systemic and periodontal status, namely: Healthy control (n=60), periodontitis (n=51), SLE (n=47), and SLE + periodontitis (n=38). Individuals with SLE were stratified according to disease activity (SLEDAI) in inactive or active. We performed polymorphism analysis using PCR-RFLP with genomic DNA from mouthwash. We analyzed data using Fisher's Exact, Chi-square test, and regression models. RESULTS Periodontal status were similar in subjects with periodontitis alone and combined with SLE. SLE patients with periodontitis had a longer SLE diagnosis than SLE only (p=0.001). For DNMT3 B polymorphism, the periodontitis, SLE, and Inactive SLE + periodontitis groups showed a higher frequency of T allele and TT genotypes compared to healthy controls (p<0.05). Regression analyses showed that the TT genotype is a strong risk factor for periodontitis (OR=4.53; CI95%=1.13-18.05) and also for SLE without periodontitis (OR=11.57; CI95%=3.12-42.84) and SLE with periodontitis (OR=5.27; CI95%=1.25-22.11) when compared to control. CONCLUSION SLE patients with periodontitis had a longer length of SLE diagnosis. The DNMT3B (rs2424913) polymorphism was associated with periodontitis and SLE alone or combined with periodontitis. Our study contributes to understanding the genetic mechanisms involved in periodontitis and SLE susceptibility.
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Affiliation(s)
- Larissa Nadine da Silva Dias
- Universidade Federal da ParaíbaCentro de Ciências da SaúdePrograma de Pós Graduação em OdontologiaJoão PessoaPBBrasilUniversidade Federal da Paraíba - UFPB, Centro de Ciências da Saúde, Programa de Pós Graduação em Odontologia, João Pessoa, PB, Brasil.
| | - Marina de Castro Coêlho
- Universidade Federal da ParaíbaCentro de Ciências da SaúdePrograma de Pós Graduação em OdontologiaJoão PessoaPBBrasilUniversidade Federal da Paraíba - UFPB, Centro de Ciências da Saúde, Programa de Pós Graduação em Odontologia, João Pessoa, PB, Brasil.
| | - Darlene Camati Persuhn
- Universidade Federal da ParaíbaCentro de Ciências Exatas e da NaturezaDepartamento de Biologia MolecularJoão PessoaPBBrasilUniversidade Federal da Paraíba - UFPB, Centro de Ciências Exatas e da Natureza, Departamento de Biologia Molecular, João Pessoa, PB, Brasil.
| | - Isabella Lima Arrais Ribeiro
- Universidade Federal da ParaíbaCentro de Ciências da SaúdePrograma de Pós Graduação em OdontologiaJoão PessoaPBBrasilUniversidade Federal da Paraíba - UFPB, Centro de Ciências da Saúde, Programa de Pós Graduação em Odontologia, João Pessoa, PB, Brasil.
| | - Eutilia Andrade Medeiros Freire
- Universidade Federal da ParaíbaCentro de Ciências MédicasDepartamento de Medicina InternaJoão PessoaPBBrasilUniversidade Federal da Paraíba - UFPB, Centro de Ciências Médicas, Departamento de Medicina Interna, João Pessoa, PB-Brasil.
| | - Naila Francis Paulo de Oliveira
- Universidade Federal da ParaíbaCentro de Ciências da SaúdePrograma de Pós Graduação em OdontologiaJoão PessoaPBBrasilUniversidade Federal da Paraíba - UFPB, Centro de Ciências da Saúde, Programa de Pós Graduação em Odontologia, João Pessoa, PB, Brasil.
- Universidade Federal da ParaíbaCentro de Ciências Exatas e da NaturezaDepartamento de Biologia MolecularJoão PessoaPBBrasilUniversidade Federal da Paraíba - UFPB, Centro de Ciências Exatas e da Natureza, Departamento de Biologia Molecular, João Pessoa, PB, Brasil.
| | - Sabrina Garcia de Aquino
- Universidade Federal da ParaíbaCentro de Ciências da SaúdeDepartamento de Odontologia Clínica e SocialJoão PessoaPBBrasilUniversidade Federal da Paraíba- UFPB, Centro de Ciências da Saúde, Departamento de Odontologia Clínica e Social, João Pessoa, PB, Brasil.
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Hassona Y, Salim NA, Tarboush N, Sartawi S, Alrashdan M, Rajab L, Sawair F. Knowledge about oral manifestations of systemic diseases among medical and dental students from Jordan: An interdisciplinary educational gap. SPECIAL CARE IN DENTISTRY 2022; 42:383-389. [PMID: 34984709 DOI: 10.1111/scd.12692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess the ability of medical students to recognize oral manifestation of selected systemic diseases and compare their performance with dental students. MATERIALS AND METHODS A total of 400 senior medical and dental students were approached to participate. The study protocol involved two parts; a self-administered survey and a direct interview involving clinical photographs for oral signs of systemic diseases. RESULTS A total of 283 (70.8%) agreed to participate and completed the two- part study. The study population was made of 110 (38.9%) [82 females and 28 males] dental students, and 173(61.1%) [98 females and 75 males] medical students. The knowledge score regarding questions about the normal mouth and oral structures was 15.7 ± 6 out of 22. Dental students had a significantly higher knowledge score about normal mouth and oral structures (20.9 ± 4; range from 17 to 22) compared to medical students (10.6 ± 7; range from 4 to 21) (p = .029). The knowledge score regarding questions about oral manifestations of systemic diseases was 26.8 ± 6 out of 40. Dental students had a significantly higher knowledge score about oral manifestations of systemic diseases (30.8 ± 7; range from 15 to 37) compared to medical students (22.9 ± 4; range from 10 to 36) (p = .031). Only 24.3% (n = 42) medical students reported having adequate training to be able to distinguish between normal mouth and diseases. Nearly all medical students (91.3%; n = 158) felt that it is important to have more formal training in oral examination and disease diagnosis. CONCLUSION Medical students lack adequate knowledge, diagnostic ability, and confidence with regard to diagnosis of oral signs of systemic diseases. To ensure that medical students have necessary skills in assessing oral diseases, curricula revisions and modifications are required, and specific oral health-related learning outcomes should be introduced and reinforced through clinical training.
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Affiliation(s)
- Yazan Hassona
- Department of Oral and Maxillofacial Surgery, Oral Medicine, and Periodontics, School of Dentistry, The University of Jordan, Amman, Jordan
| | - Nesreen A Salim
- Department of Prosthodontics, School of Dentistry, The University of Jordan, Amman, Jordan
| | - Nafez Tarboush
- Department of Biochemistry and Physiology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Samiha Sartawi
- Department of Prosthodontics, School of Dentistry, The University of Jordan, Amman, Jordan
| | - Mohammad Alrashdan
- Department of Oral Surgery and Oral Medicine, School of Dentistry, Jordan University for Science and Technology, Amman, Jordan
| | - Lamis Rajab
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, The University of Jordan, Amman, Jordan
| | - Faleh Sawair
- Department of Oral and Maxillofacial Surgery, Oral Medicine, and Periodontics, School of Dentistry, The University of Jordan, Amman, Jordan
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15
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Maybodi FR, Bashiri H, Sezavar K, Owlia F. Effect of periodontal treatment on serum inflammatory parameters and disease activity in patients with systemic lupus erythematosus: A randomized controlled trial. J Indian Soc Periodontol 2022; 26:564-569. [PMID: 36582961 PMCID: PMC9793920 DOI: 10.4103/jisp.jisp_607_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/04/2022] [Accepted: 05/08/2022] [Indexed: 12/07/2022] Open
Abstract
Background Several descriptive studies have shown an association between periodontitis and systemic lupus erythematosus (SLE), but clinical trials evaluating the effect of periodontal treatment on serological inflammatory parameters or disease activity in SLE patients are very limited. The aim of this study was to see how periodontal treatment affects the status of SLE patients. Materials and Methods Ninety patients with active SLE and periodontitis were randomly assigned to one of two groups: case (oral hygiene instructions + scaling and root planning) or control (oral hygiene instructions only). Periodontal parameters, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) and SLE Disease Activity Index (SLEDAI) levels were monitored at baseline and 3 months later. Results Periodontal parameters in the case group were significantly reduced both statistically and clinically after 3 months. However, in the control group, these indices decreased statistically (P < 0.05) but not clinically. The score of SLEDAI in both the groups showed a significant downward trend (P < 0.05) from the start of the study, but the differences in this index between the two groups were not statistically significant (P = 0.894). Although there was a significant decrease in CRP and ESR (P = 0.001) after 3 months in the case group, indicating a positive effect of periodontal treatment on inflammation reduction, there was no significant decrease in CRP and ESR in the control group. Conclusion According to our findings, it appears to be no statistically significant association between periodontal treatment and SLEDAI level. However, this treatment seems to be effective in reducing acute phase biomarkers such as CRP and ESR.
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Affiliation(s)
- Fahimeh Rashidi Maybodi
- Department of Periodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamidreza Bashiri
- Department of Periodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Kimiya Sezavar
- Department of Rheumatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran,Address for correspondence: Dr. Kimiya Sezavar, Department of Periodontics, Faculty of Dentistry, Birjand University of Medical Sciences, Birjand, Iran. E-mail:
| | - Fatemeh Owlia
- Department of Periodontics, Faculty of Dentistry, Birjand University of Medical Science, Birjand, Iran
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16
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Sedghi LM, Bacino M, Kapila YL. Periodontal Disease: The Good, The Bad, and The Unknown. Front Cell Infect Microbiol 2021; 11:766944. [PMID: 34950607 PMCID: PMC8688827 DOI: 10.3389/fcimb.2021.766944] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/11/2021] [Indexed: 01/08/2023] Open
Abstract
Periodontal disease is classically characterized by progressive destruction of the soft and hard tissues of the periodontal complex, mediated by an interplay between dysbiotic microbial communities and aberrant immune responses within gingival and periodontal tissues. Putative periodontal pathogens are enriched as the resident oral microbiota becomes dysbiotic and inflammatory responses evoke tissue destruction, thus inducing an unremitting positive feedback loop of proteolysis, inflammation, and enrichment for periodontal pathogens. Keystone microbial pathogens and sustained gingival inflammation are critical to periodontal disease progression. However, recent studies have revealed the importance of previously unidentified microbes involved in disease progression, including various viruses, phages and bacterial species. Moreover, newly identified immunological and genetic mechanisms, as well as environmental host factors, including diet and lifestyle, have been discerned in recent years as further contributory factors in periodontitis. These factors have collectively expanded the established narrative of periodontal disease progression. In line with this, new ideologies related to maintaining periodontal health and treating existing disease have been explored, such as the application of oral probiotics, to limit and attenuate disease progression. The role of systemic host pathologies, such as autoimmune disorders and diabetes, in periodontal disease pathogenesis has been well noted. Recent studies have additionally identified the reciprocated importance of periodontal disease in potentiating systemic disease states at distal sites, such as in Alzheimer's disease, inflammatory bowel diseases, and oral cancer, further highlighting the importance of the oral cavity in systemic health. Here we review long-standing knowledge of periodontal disease progression while integrating novel research concepts that have broadened our understanding of periodontal health and disease. Further, we delve into innovative hypotheses that may evolve to address significant gaps in the foundational knowledge of periodontal disease.
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Affiliation(s)
- Lea M. Sedghi
- School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Margot Bacino
- School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Yvonne Lorraine Kapila
- School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
- Department of Periodontology, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
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17
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Bolstad AI, Sehjpal P, Lie SA, Fevang BTS. Periodontitis in patients with systemic lupus erythematosus: A nation-wide study of 1990 patients. J Periodontol 2021; 93:364-372. [PMID: 34076274 DOI: 10.1002/jper.21-0181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/16/2021] [Accepted: 05/27/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study was to examine the association between systemic lupus erythematosus (SLE) and periodontitis in Norway during a 10-year period from 2008 through 2017. METHODS In this population-based study, 1990 patients were included in the SLE-cohort based on diagnostic codes registered in the Norwegian Patient Registry. The control group (n = 170,332) comprised patients registered with diagnostic codes for non-osteoporotic fractures or hip or knee replacement because of osteoarthritis. The outcome was periodontitis, defined by procedure codes registered in the Control and Payment of Health Refunds database. Logistic regression analyses were performed to estimate odds ratio for periodontitis in patients versus controls adjusted for potential covariates. RESULTS Periodontitis was significantly more common in SLE patients compared to controls (OR 1.78, 95% CI 1.47-2.14) and the difference was highest in SLE-patients 20 to 30 years of age (OR 3.24, 95% CI 1.23 - 8.52). The periodontitis rate in SLE patients was in the same range as for patients with diabetes mellitus type 2. CONCLUSIONS Patients with SLE had an almost doubled risk of periodontitis compared with the control population, and the difference was most accentuated in the young patients. These findings warrant an increased focus on dental health in SLE-patients.
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Affiliation(s)
- Anne Isine Bolstad
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Pria Sehjpal
- Department of Clinical Science, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Bjørg-Tilde Svanes Fevang
- Department of Clinical Science, The Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
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18
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Protudjer JLP, Billedeau C, Hurst K, Schroth R, Stavropoulou C, Kelekis-Cholakis A, Hitchon CA. Oral Health in Rheumatoid Arthritis: Listening to Patients. JDR Clin Trans Res 2021; 7:127-134. [PMID: 33949224 DOI: 10.1177/23800844211012678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Rates of periodontal disease and tooth loss are increased in individuals with rheumatoid arthritis (RA). Understanding factors that contribute to the increased burden of periodontal disease in RA is critical to improving oral health and arthritis outcomes. OBJECTIVES To determine the perceptions held by people with RA relating to their oral health, to identify patient-centered priorities for oral health research, and to inform optimal strategies for delivering oral health knowledge. METHODS Semistructured interviews were conducted with patients with RA. Recorded interview transcripts were iteratively reviewed to reveal surface and latent meaning and to code for themes. Constructs were considered saturated when no new themes were identified in subsequent interviews. We report themes with representative quotes. RESULTS Interviews were conducted with 11 individuals with RA (10 women [91%]; mean age, 68 y), all of whom were taking RA medication. Interviews averaged 19 min (range, 8 to 31 min) and were mostly conducted face-to-face. Three overall themes were identified: 1) knowledge about arthritis and oral health links; 2) oral health care in RA is complicated, both in personal hygiene practices and in professional oral care; and 3) poor oral health is a source of shame. Participants preferred to receive oral health education from their rheumatologists or dentists. CONCLUSIONS People with RA have unique oral health perceptions and experience significant challenges with oral health care due to their arthritis. Adapting oral hygiene recommendations and professional oral care delivery to the needs of those with arthritis are patient priorities and are required to improve satisfaction regarding their oral health. KNOWLEDGE TRANSLATION STATEMENT Patients living with long-standing rheumatoid arthritis described poor oral health-related quality of life and multiple challenges with maintaining optimal oral health. Study findings indicate a need for educational materials addressing oral health maintenance for patients with rheumatic diseases and their providers.
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Affiliation(s)
- J L P Protudjer
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | | | - K Hurst
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - R Schroth
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, Canada
| | - C Stavropoulou
- Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, Canada
| | - A Kelekis-Cholakis
- Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, Canada
| | - C A Hitchon
- Department of Internal Medicine, Max Rady School of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
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19
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Sojod B, Pidorodeski Nagano C, Garcia Lopez GM, Zalcberg A, Dridi SM, Anagnostou F. Systemic Lupus Erythematosus and Periodontal Disease: A Complex Clinical and Biological Interplay. J Clin Med 2021; 10:jcm10091957. [PMID: 34063235 PMCID: PMC8125164 DOI: 10.3390/jcm10091957] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/12/2022] Open
Abstract
Reports on the association of periodontal disease (PD) with systemic lupus erythematosus (SLE) have regularly been published. PD is a set of chronic inflammatory conditions linked to a dysbiotic microbial biofilm, which affects the periodontal tissues, resulting eventually in their destruction and contributing to systemic inflammation. SLE is a multi-system chronic inflammatory autoimmune disease that has a wide range of clinical presentations, touching multiple organ systems. Many epidemiological studies have investigated the two-way relationship between PD and SLE, though their results are heterogeneous. SLE and PD are multifactorial conditions and many biological-based hypotheses suggest common physiopathological pathways between the two diseases, including genetics, microbiology, immunity, and environmental common risk factors. By focusing on recent clinical and translational research, this review aimed to discuss and give an overview of the relationship of SLE with PD, as well as looking at the similarities in the immune-pathological aspects and the possible mechanisms connecting the development and progression of both diseases.
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Affiliation(s)
- Bouchra Sojod
- Service d’Odontologie, Hôpital Universitaire Pitié Salpêtrière (AP-HP), 75013 Paris, France; (B.S.); (G.M.G.L.); (A.Z.)
- Faculté de Chirurgie Dentaire-Garancière, Université de Paris, 75006 Paris, France
| | | | - Glenda Melissa Garcia Lopez
- Service d’Odontologie, Hôpital Universitaire Pitié Salpêtrière (AP-HP), 75013 Paris, France; (B.S.); (G.M.G.L.); (A.Z.)
- Faculté de Chirurgie Dentaire-Garancière, Université de Paris, 75006 Paris, France
| | - Antoine Zalcberg
- Service d’Odontologie, Hôpital Universitaire Pitié Salpêtrière (AP-HP), 75013 Paris, France; (B.S.); (G.M.G.L.); (A.Z.)
- Faculté de Chirurgie Dentaire-Garancière, Université de Paris, 75006 Paris, France
| | | | - Fani Anagnostou
- Service d’Odontologie, Hôpital Universitaire Pitié Salpêtrière (AP-HP), 75013 Paris, France; (B.S.); (G.M.G.L.); (A.Z.)
- Faculté de Chirurgie Dentaire-Garancière, Université de Paris, 75006 Paris, France
- B3OA, CNRS UMR 7052-INSERM U1271, Université de Paris, 75010 Paris, France;
- Correspondence:
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20
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Charmelo-Silva S, Kilgore-Rodriguez R, Kurago Z. Painful nonhealing oral ulcers in a 60-year-old male patient. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:260-266. [PMID: 33985922 DOI: 10.1016/j.oooo.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Scarlet Charmelo-Silva
- Assistant Professor of Oral Medicine, Department of Oral Biology and Diagnostic Sciences, The Dental College of Georgia, Augusta, GA, USA.
| | | | - Zoya Kurago
- Associate Professor of Oral and Maxillofacial Pathology, Department of Oral Biology and Diagnostic Sciences, The Dental College of Georgia, Augusta, GA, USA
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21
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Inhibition of Endoplasmic Reticulum Stress by 4-Phenyl Butyric Acid Presents Therapeutic Effects on Periodontitis: Experimental Studies In Vitro and in Rats. Stem Cells Int 2021; 2021:6618943. [PMID: 33763140 PMCID: PMC7946453 DOI: 10.1155/2021/6618943] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/07/2023] Open
Abstract
This study investigated the probable mechanisms of endoplasmic reticulum (ER) stress involved in periodontitis in vitro and in vivo. We isolated periodontal ligament stem cells from periodontitis patients and healthy controls (P-PDLSCs and H-PDLSCs). To further simulate the periodontal microenvironment in patients, lipopolysaccharide (LPS) was used to treat H-PDLSCs. The results showed that periodontitis-related inflammation gave rise to the upregulated expression levels of ER stress representative genes including GRP78, PERK, ATF4, and CHOP. In contrast, the treatment of 4-phenyl butyric acid (4-PBA) remarkably suppressed ER stress and supported cell viability. The increased secretion of proinflammatory factors like TNF-α, IL-1β, and IL-6 and the activation of NF-κB pathway were also attenuated by 4-PBA treatment. Moreover, 4-PBA treatment restored the impaired osteogenic differentiation ability of PDLSCs, as demonstrated by the upregulated expression levels of Runx2 and OCN as well as the enhanced Alizarin red staining. Local administration of 4-PBA could rescue alveolar bone resorption of LPS-induced periodontitis rats. Thus, our findings suggested ER stress might act as a promising therapeutic target against periodontitis.
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Patel J. Medical problems dental students could identify part 3: Lupus. BDJ STUDENT 2021. [PMCID: PMC7829639 DOI: 10.1038/s41406-020-0178-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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