Role of periodontal therapy in management of common complex systemic diseases and conditions: An update

Epidemiological associations between periodontitis and cancer

There is a postulated association of periodontitis with a number of human cancers. This narrative review provides current epidemiological evidence on the association between periodontitis and cancer. A PubMed search with the relevant keywords (periodontal disease, periodontitis, cancer, and malignancy) was completed to identify relevent articles. We present a narrative review on the association between periodontal disease and a range of cancers, including oral cancer, stomach and esophageal cancer, colorectal cancer, lung cancer, pancreatic cancer, prostate cancer, hematological malignancies, liver cancer, breast cancer, and ovarian cancer. While there is a considerable body of epidemiological evidence that supports the association between periodontal disease and cancer, this is largely from cohort and case-control studies and the association may therefore be circumstantial as little evidence exists in the form of treatment trials that would validate the role of periodontal disease in the process of cancer initiation and development.

Comparison of growth factor levels in injectable platelet-rich fibrin obtained from healthy individuals and patients with chronic periodontitis: a pilot study

BACKGROUND

This study aimed to assess and compare the concentrations of growth factors, white blood cells (WBCs), and platelets in injectable platelet-rich fibrin (i-PRF) derived from people with healthy periodontal conditions and those with chronic periodontitis.

METHODS

Venous blood samples were obtained from 30 patients diagnosed with chronic periodontitis (test group) and 30 participants with healthy periodontal conditions (control group). The i-PRF was then acquired from centrifuged blood. The growth factors (VEGF, IGF-1, TGF-β1, PDGF-BB and EGF) released from the i-PRF samples were compared between groups with ELISA testing. The amounts of WBCs and platelets were also compared.

RESULTS

No significant differences in the concentrations of growth factors were found between the groups (the mean values for the control and test groups were, respectively: IGF: 38.82, 42.46; PDGF: 414.25, 466.28; VEGF: 375.69, 412.18; TGF-β1: 21.50, 26.21; EGF: 138.62, 154.82). The test group exhibited a significantly higher WBC count than the control group (8.80 vs. 6.60, respectively). However, the platelet count did not show a statistically significant difference between the groups (control group 242.0 vs. test group 262.50). No significant correlation was observed between WBC count and growth factor level in either group.

CONCLUSIONS

The growth factor levels in i-PRFs did not exhibit significant difference between the two groups. This suggests that the levels of these growth factors may be unaffected by the periodontal disease.

SorCS2 is involved in promoting periodontitis-induced depression-like behaviour in mice

BACKGROUND

Emerging evidence supports the association between periodontitis and depression, although the mechanisms are unclear. This study investigated the role of SorCS2 in the pathogenesis of periodontitis-induced depression.

MATERIALS AND METHODS

An experimental periodontitis model was established using SorCS2 knockout mice and their wild-type littermates, and depression-like behaviour was evaluated. The expression of proBDNF signalling, neuronal activity, and glutamate-associated signalling pathways were further measured by western blotting and immunofluorescence. In addition, neuroinflammatory status, astrocytic and microglial markers, and the expression of corticosterone-related factors were measured by immunofluorescence, western blotting, and enzyme-linked immunosorbent assays.

RESULTS

SorCS2 deficiency alleviated periodontitis-induced depression-like behaviour in mice. Further results suggested that SorCS2 deficiency downregulated the expression of pro-BDNF and glutamate signalling and restored neuronal activities in mice with periodontitis. Neuroinflammation in the mouse hippocampus was triggered by experimental periodontitis but was not affected by SorCS2 deficiency. The levels of corticosterone and the expression of glucocorticoid receptors were also not altered.

CONCLUSION

Our study, for the first time, reveals the critical role of SorCS2 in the pathogenesis of periodontitis-induced depression. The underlying mechanism involves proBDNF and glutamate signalling in the hippocampus, providing a novel therapeutic target for periodontitis-associated depression.

Association between ethylene oxide exposure and periodontitis: a cross-sectional study from NHANES 2013-2014

BACKGROUND

Exposure to ethylene oxide (EO) induces inflammation and oxidative stress, which are the main mechanisms of periodontitis. However, the effect of EO on periodontal health is not unclear. In this study, we aimed to explore the relationship between EO exposure and the risk of periodontitis in general US adults.

METHODS

Data used in our study from the National Health and Nutritional Examination Survey (NHANES) 2013-2014. The EO biomarker, hemoglobin adduct of EO (HbEO), was measured in blood samples utilizing high-performance liquid chromatography-tandem mass spectrometry. Periodontitis category was defined by the CDC/AAP according to clinical periodontal parameters. Natural cubic spline, weight multivariable logistic regression analyses and subgroup analysis were used to explore the association between EO exposure and the risk of periodontitis.

RESULTS

A total of 1497 participants over the age of 30 were included in our study. A non-linear positive association with periodontitis was identified for HbEO levels. Participants in the highest tertile of HbEO levels were more likely to have poorer periodontal health compared to the lowest tertile (ORtertile3vs1 = 2.80, 95% CI: 1.85-4.24). Similar results were also found in different subgroups.

CONCLUSIONS

HbEO levels are positively associated with poor periodontal health in US adults. Additional longitudinal studies are necessary to further enhance our comprehension of the impact of exposure to EO on periodontal status.

Knowledge and practice attitudes regarding the relationship between diabetes and periodontitis: a survey among Swiss endocrinologists and general physicians

BACKGROUND

The objective of the present survey is to assess the knowledge about the relationship between oral health and diabetes and to identify the practice behaviors of Swiss endocrinologists and general practitioners regarding oral health in diabetic patients.

METHODS

A thirty- item questionnaire was mailed to 428 internists and 99 endocrinologists working in the French speaking part of Switzerland. Participants were asked about their awareness of the relationship between diabetes and periodontal disease, their practice behaviors as well as their willingness for an interdisciplinary education and collaboration with oral health professionals. The questions were answered according to a three-point or five-point Likert scale.

RESULTS

The response rate was 23%. All participants were aware of the inflammatory and infectious nature of periodontal disease. They all agreed that good periodontal health is important for overall health. However, most of the practitioners responded that only rarely received information during their education curricula on the link between systemic and oral health or concerning periodontal problems in diabetic patients (60.9% for endocrinologists and 54.1% for general physicians); thus, only a minority of health practitioners addresses oral health care to their patients (13% and 15.3%, respectively). Both endocrinologists and general health physicians agreed that an oral health screening could be included in their practice (79% for both groups).

CONCLUSIONS

An interdisciplinary education and collaboration among medical and dental health providers should be established to effectively prevent, manage, and control both diabetes and periodontal disease in diabetic patients.

Effect of non-surgical periodontal treatment on cytokines/adipocytokines levels among periodontitis patients with or without obesity: a systematic review and meta-analysis

BACKGROUND

The objective of this systematic review and meta-analysis was to evaluate the effects of non-surgical periodontal therapy (NSPT) on inflammatory-related cytokines/adipocytokines in periodontitis patients with or without obesity.

METHODS

We followed the preferred reporting items for systematic reviews and meta-analyses statement and registered the study (CRD42022375331) in the Prospective International Register of Systematic Reviews. We screened randomized-controlled trials and controlled clinical trials from six databases up to December 2022. Quality assessment was performed with RoB-2 and ROBINS-I tools for randomized trials and non-randomized trials, respectively. Meta-analysis was carried out using a random-effect model.

RESULTS

We included seventeen references in the systematic analysis, and sixteen in the meta-analysis. Baseline results of pro-inflammatory biomarkers, including serum interleukin (IL)-6, serum and gingival crevicular fluid (GCF), tumor necrosis factor (TNF)-a, serum C-reactive protein (CRP)/hs-CRP, and serum and GCF resistin, were higher in obesity subjects than in normal weight subjects. The effect of NSPT with respect to levels of cytokines/adipocytokines, including IL-6, TNF-a, CRP/hs-CRP, resistin, adiponectin, leptin and retinol binding protein 4 (RBP4), were then analyzed in the systematic and meta-analysis. After three months of NSPT, serum (MD = -0.54, CI = -0.62 - -0.46), and GCF (MD = -2.70, CI = -4.77 - -0.63) levels of IL-6, along with the serum RBP4 (MD = -0.39, CI = -0.68-0.10) decreased in periodontitis individuals with obesity. NSPT also improved GCF adiponectin levels after three months (MD = 2.37, CI = 0.29 - 4.45) in periodontitis individuals without obesity.

CONCLUSIONS

Obese status altered the baseline levels of cytokines/adipocytokines (serum IL-6, serum and GCF TNF-a, serum CRP/hs-CRP, and serum and GCF resistin). Then NSPT can shift the levels of specific pro-inflammatory mediators and anti-inflammatory mediators in biological fluids, both in obesity and non-obesity individuals. NSPT can reduce serum and GCF IL-6 levels together with serum RBP4 level in individuals with obesity after 3 months, besides, there is no sufficient evidence to prove that obese patients have a statistically significant decrease in the levels of other cytokines compared to patients with normal weight. NSPT can also increase GCF adiponectin level in normal weight individuals after 3 months. Our findings imply the potential ideal follow-up intervals and sensitive biomarkers for clinical bioanalysis in personalized decision-making of effect of NSPT due to patients' BMI value.

Macrophages polarize to the pro-inflammatory phenotype and delay neutrophil efferocytosis to augment Aggregatibacter actinomycetemcomitance JP2 clearance

OBJECTIVE

The study examines how neutrophils cross-talk with macrophages during JP2 Aggregatibacter actinomycetemcomitance infection and factors that are involved in inflammatory resolution and efferocytosis.

BACKGROUND

Although sub-gingival bacteria constitute the primary initiating factor in the pathogenesis of molar-incisor pattern periodontitis (MIPP), the non-resolved host response has a major role in tissue destruction. While evidence links neutrophils to MIPP pathogenesis, their clearance during inflammatory resolution, governed by macrophages, is poorly understood.

METHODS

Human neutrophils (differentiated from HL60 cells) and macrophages (differentiated from THP1 cells) were inoculated with JP2. The supernatants were collected and exposed to naïve neutrophils or macrophages with or without exposure to JP2. Reactive oxygen species (ROS) were measured with 2'-7'-dichlorofluorescein-diacetate and a fluorescent plate reader. Immunofluorescence labeling of CD47 and cell vitality were examined using flow cytometry. Macrophage polarization was tested by immunofluorescence staining for CD163 and CD68 and a fluorescent microscope, and TNFα and IL-10 secretion was tested using ELISA and RT-PCR. Efferocytosis was examined by pHrodo and carboxyfluorescein succinimidyl ester staining and fluorescent microscopy. In vivo, macrophages were depleted from C57Bl/6 mice and neutrophil CD47 levels were tested using the subcutaneous chamber model.

RESULTS

Neutrophils exposed to macrophage supernatant show increased ROS, mainly extracellularly, that increased during JP2 infection. Macrophages showed pro-inflammatory M1 phenotype polarization during JP2 infection, and their supernatants prolonged neutrophil survival by inhibiting CD47 down-expression and reducing neutrophil necrosis and apoptosis. Also, the macrophages delay neutrophil efferocytosis during JP2 infection which, in turn, enhanced JP2 clearance. Depletion of macrophages in mice mildly prevented neutrophils CD47 reduction and reduced JP2 clearance. The JP2 infection in mice also led to macrophage M1 polarization similar to the in vitro results.

CONCLUSIONS

As shown in this study, neutrophil efferocytosis potentially may be reduced during JP2 infection, promoting JP2 clearance, which may contribute to the inflammatory-mediated periodontal tissue damage.

Awareness of physicians and dentists in Serbia about the association between periodontitis and systemic diseases: a cross-sectional study

BACKGROUND

Strong evidence supports the association between periodontitis and certain systemic diseases. The aim of the present study was to evaluate the knowledge of a group of physicians and dentists in Serbia regarding this topic and assess their professional actions to prevent and control both periodontal and systemic diseases.

METHODS

An anonymous self-administered structured questionnaire was sent to the available e-mail addresses of randomly selected healthcare providers working in Serbia. According to the inclusion criteria, general practitioners, specialists, general dentists, and specialists working in government hospitals and private practices in various cities in Serbia were recruited in the study. The questionnaire consisted of 17 questions divided into three parts. The first part recorded the sociodemographic characteristics of participants, the second part included questions about the clinical manifestation and etiology of periodontitis, as well as knowledge of the association between periodontitis and systemic diseases, and the third part included questions about professional procedures for the prevention and control of periodontitis and systemic diseases.

RESULTS

A total of 1301 health participants, 739 (57.8%) physicians and 562 (43.2%) dentists, were included in this cross-sectional study. Most respondents (94.7%) were aware of the association between periodontitis and general health. The highest percentage of respondents associated diabetes mellitus and periodontitis. Factors significantly associated with higher knowledge were female sex (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.37-2.52; p < 0.001) and dental profession (OR, 5.86; 95% CI], 4.03-8.53; p < 0.001). Participants who had higher knowledge score were more likely to ask their patients about gum/systematic health (p < 0.001) and refer them to dentists/physicians (p < 0.001).

CONCLUSIONS

It was concluded that compared to the group of dentists, the group of physicians had less knowledge of the relationship between periodontitis and systemic diseases. The female gender was significantly associated with better knowledge. A better understanding of this topic is associated with better clinical practice.

The Role of Vitamin C and Vitamin D in the Pathogenesis and Therapy of Periodontitis-Narrative Review

Periodontitis is a common disorder affecting the bone and soft tissues of the periodontal complex. When untreated, it may lead to severe mobility or even loss of teeth. The pathogenesis of periodontitis is complex, with crucial factors being chronic inflammation in gingival and periodontal tissues and oral microbiome alterations. However, recent studies highlight the alleged role of vitamins, such as vitamin C (VitC) and vitamin D (VitD), in the development of the disease. VitC regulates numerous biochemical reactions, but foremost, it is involved in synthesizing collagen. It was reported that VitC deficiency could lead to damage to the periodontal ligaments. VitC supplementation improves postoperative outcomes in patients with periodontitis. VitD is a steroid derivative that can be produced in the skin under ultraviolet radiation and later transformed into an active form in other tissues, such as the kidneys. VitD was established to decrease the expression of proinflammatory cytokines in gingiva and regulate the proper mineral density of teeth. Moreover, the supplementation of VitD was associated with better results in the nonsurgical treatment of periodontitis. In this review, we summarize recent knowledge on the role of vitamins C and D in the pathogenesis and treatment of periodontitis.

The Bidirectional Relationship between Periodontal Disease and Diabetes Mellitus-A Review

Periodontitis is a chronic inflammatory disease caused by the presence of a bacterial biofilm known as dental plaque. This biofilm affects the supporting apparatus of the teeth, especially the periodontal ligaments and the bone surrounding the teeth. Periodontal disease and diabetes seem to be interrelated and in a bidirectional relationship, and have been increasingly studied in recent decades. For example, diabetes mellitus has a detrimental effect on periodontal disease, increasing its prevalence, extent, and severity. In turn, periodontitis negatively affects glycemic control and the course of diabetes. This review aims to present the most recently discovered factors that contribute to the pathogenesis, therapy, and prophylaxis of these two diseases. Specifically, the article focuses on microvascular complications, oral microbiota, pro- and anti-inflammatory factors in diabetes, and periodontal disease. As presented in this review, these two diseases require specific/ complementary therapeutic solutions when they occur in association, with new clinical trials and epidemiological research being necessary for better control of this interdependent pathogenic topic.

Association between retinol intake and periodontal health in US adults

BACKGROUND

Inflammation and oxidative stress are two hallmarks of periodontitis. Retinol is an antioxidant and suppresses expression of pro-inflammatory factors. However, the evidence for an association between retinol intake and periodontitis is limited. Thus, the aim of this study is to assess the association between retinol intake and periodontal health.

METHODS

Data used in this cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 (n = 9081). Dietary intake of retinol was measured based on two 24-h dietary recall interviews. The category of periodontitis was defined by the CDC/AAP according to clinical periodontal parameters. Univariate and multivariate logistic regression analyses were applied to investigate the relationship between retinol intake and the risk of periodontitis.

RESULTS

Compared with the lowest tertile, individuals in the highest tertile of retinol intake were less likely to be periodontitis (OR_tertile3vs1 = 0.79, 95% CI: 0.65-0.96). The association was still significant in populations who were less than 60 years old (OR_tertile3vs1 = 0.80, 95% CI: 0.65-0.97), non-Hispanic black (OR_tertile3vs1 = 0.62, 95% CI: 0.42-0.94), PI ≤ 1.3 (OR_tertile3vs1 = 0.72, 95% CI: 0.55-0.93), 1.3 < PI ≤ 3.5 (OR_tertile3vs1 = 0.70, 95% CI: 0.55-0.89), non-smoker (OR_tertile3vs1 = 0.63, 95% CI: 0.48-0.81), obesity (OR_tertile3vs1 = 0.68, 95% CI: 0.49-0.94) and who had not diabetes mellitus (OR_tertile3vs1 = 0.79, 95% CI: 0.65-0.95) or had hypertension (OR_tertile3vs1 = 0.63, 95% CI: 0.47-0.84).

CONCLUSION

Retinol intake is inversely associated with poor periodontal health in US adults.

A Commentary on the Potential Use of Oral Microbiome in Prediction, Diagnosis or Prognostics of a Distant Pathology

In health, the oral microbiome is in balance with its host. If this balance is lost, this symbiosis is replaced by dysbiotic microbial communities, which are thought to affect the rest of the body either directly or via metabolites or pro-inflammatory molecules. The association of oral microbiome with general health has led to attempts to use oral microbial biomarkers for the prediction, diagnosis or prognosis of distant pathologies such as colorectal carcinoma or pancreatic cancer. These attempts however have no chance to succeed if the complexity of the oral ecosystem and the interplay of environmental, behavioral and biological factors is not taken into account. Standardized, well-documented oral sample collection procedures together with detailed clinical oral examination and behavioral data are the prerequisites for the successful evaluation of the oral microbiome as a potential biomarker for distant pathologies.

Oral health associated with incident diabetes but not other chronic diseases: A register-based cohort study

Introduction

Oral infectious diseases are common chronic oral diseases characterized by a chronic inflammatory condition. We investigated chronic oral diseases as potential risk factors for systemic chronic diseases, diabetes mellitus, connective tissue diseases, seropositive rheumatoid arthritis, ulcerative colitis, and Crohn's disease, as well as severe psychotic and other severe mental disorders.

Methods

The cohort comprised 68,273 patients aged ≥ 29 years with at least one dental visit to the Helsinki City Health Services between 2001 and 2002. The cohort was linked to the data on death (Statistics Finland), cancer (Finnish Cancer Registry), and drug reimbursement (Finnish Social Insurance Institution) and followed until death or the end of 2013. The outcomes of interest were the incidences of chronic diseases measured starting with special refund medication, which means Social Insurance Institution partly or fully reimburses medication costs. Outcomes of interest were diabetes mellitus, connective tissue diseases, seropositive rheumatoid arthritis, ulcerative colitis and Crohn's disease, and severe mental disorders.

Results

The mean follow-up time was 9.8 years. About 25% of the study population had periodontitis, 17% caries, over 70% apical periodontitis, and 9% <24 teeth at the start of follow-up. Diabetes was the only chronic systemic condition associated with oral health variables. Having 24 to 27 teeth was associated with a higher incidence rate ratio (IRR) (1.21, 95% confidence interval 1.09-1.33) compared to having 28 or more teeth; the IRR for having 23 or less was 1.40 (1.22-1.60). Having periodontitis (1.10, 1.01-1.20), caries (1.12, 1.01-1.23), or apical periodontitis (1.16, 1.04-1.30) is also associated with a higher risk of diabetes.

Conclusion

Our epidemiological 10 years follow-up study suggests that the association exists between chronic oral diseases and diabetes, warranting close collaboration among patient's healthcare professionals.

Health behaviors and tooth retention among older adults in China: findings from the 4th Chinese national oral health survey

Background

This study aimed to examine the association between oral health behaviors and tooth retention among Chinese older adults.

Methods

Data were used from the 4th Chinese National Oral Health Survey, a nationally representative sample. The sample included 9054 older adults aged 55 to 74. Control variables and oral health behaviors were measured through a questionnaire interview, and the number of remaining teeth and periodontal health were obtained from an oral health examination. A chi-square test was used for univariate analysis. Multivariate Logistic regression was used to explore the association between health behaviors and the number of remaining teeth.

Results

The average number of remaining teeth in the sample was 24.4 ± 7.7. There was a higher proportion of older adults living in urban areas with 20 or more teeth than those living in rural areas (83.2% vs. 79.4%, P < 0.001); and a higher proportion of individuals with high education levels with 20 or more teeth compared to those with low education levels (P < 0.001). Logistic regression models showed that older adults who used toothpicks `(OR = 3.37, 95% CI 2.94–3.85), dental floss (OR = 1.93, 95% CI 1.05–3.53), toothpaste (OR = 3.89, 95% CI 3.14–4.83); and never smoked (OR = 1.43 95% CI 1.20–1.70) were more likely to retain 20 or more natural teeth; whereas older adults who had a dental visit were less likely to retain 20 or more natural teeth (OR = 0.45, 95% CI 0.39–052).

Conclusion

Good oral hygiene practices, never smoking, and regular dental visits focusing on prevention are significantly associated with teeth retention. It is critical to promote a healthy lifestyle and improve prevention-oriented oral health care systems.

Association between Endodontic Infection, Its Treatment and Systemic Health: A Narrative Review

The 'Focal Infection Era in Dentistry' in the late 19th and early 20th century resulted in widespread implementation of tooth extraction and limited the progress of endodontics. The theory proposed that bacteria and toxins entrapped in dentinal tubules could disseminate systemically to remote body parts, resulting in many types of degenerative systemic diseases. This theory was eventually refuted due to anecdotal evidence. However, lately there has been increased interest in investigating whether endodontic disease could have an impact on general health. There are reviews that have previously been carried out on this subject, but as new data have emerged since then, this review aims to appraise the available literature investigating the dynamic associations between apical periodontitis, endodontic treatment, and systemic health. The available evidence regarding focal infection theory, bacteraemia and inflammatory markers was appraised. The review also collated the available research arguing the associations of apical periodontitis with cardiovascular diseases, diabetes mellitus, adverse pregnancy outcome and autoimmune disorders, along with the effect of statins and immunomodulators on apical periodontitis prevalence and endodontic treatment prognosis. There is emerging evidence that bacteraemia and low-grade systemic inflammation associated with apical periodontitis may negatively impact systemic health, e.g., development of cardiovascular diseases, adverse pregnancy outcomes, and diabetic metabolic dyscontrol. However, there is limited information supporting the effect of diabetes mellitus or autoimmune disorders on the prevalence and prognosis post endodontic treatment. Furthermore, convincing evidence supports that successful root canal treatment has a beneficial impact on systemic health by reducing the inflammatory burden, thereby dismissing the misconceptions of focal infection theory. Although compelling evidence regarding the association between apical periodontitis and systemic health is present, further high-quality research is required to support and establish the benefits of endodontic treatment on systemic health.

CD18 Mediates Neutrophil Imperviousness to the Aggregatibacter actinomycetemcomitans JP2 Clone in Molar-Incisor Pattern Periodontitis

Introduction

Molar-incisor pattern periodontitis (MIPP) in the absence of significant local risk factors or systemic disease, is a rare, early onset periodontal disease phenotype, with 0.5% to 2.5% global prevalence. The condition is characterized by impaired neutrophil function and persistent Aggregatibacter actinomycetemcomitans (JP2 clone) infection. The aim of this study was to characterize neutrophil functional responses to JP2 and to investigate the neutrophil receptors involved.

Materials and Methods

Neutrophils were obtained from whole blood samples of periodontally healthy and MIPP subjects and incubated with the JP2 clone or a non-JP2 clone of A. actinomycetemcomitans. Bacterial survival was tested by blood agar culture; neutrophil death was tested with propidium iodide and flow cytometry; Reactive oxygen production (ROS) was measured with 2',7'-dichlorofluorescein diacetate and a fluorescence plate reader; the cytokinome was analysed using an array profiler, ELISA and RT-PCR. Receptors binding to JP2 were isolated using a novel immunoprecipitation assay and validated functionally using specific blocking antibodies.

Results

JP2 and non-JP2 survival was comparable between all the neutrophil groups. Resistance to neutrophil necrosis following exposure to JP2 was significantly lower in the MIPP group, than in all the other groups (p<0.0001). Conversely, MIPP neutrophils showed lower levels of ROS production in response to JP2 infection compared with that of healthy neutrophils (p<0.001). Furthermore, significantly lower levels of cytokines, such as IL8, IL10 and TNFα, were observed during JP2 incubation with MIPP neutrophils than upon incubation with periodontally healthy neutrophils. Various proteins expressed on neutrophils bind to JP2. Of these, CD18 was found to mediate neutrophil necrosis. The CD18 receptor on MIPP neutrophils acts differently from that on periodontally healthy patients neutrophils, and appears to reflect differential neutrophil reactions to JP2.

Conclusion

This study portrays a fundamental difference in neutrophil response to JP2 infection between periodontally healthy and MIPP patients. This was evident in the resistance to necrosis, and lower ROS and cytokine production, despite the persistent presence of viable JP2. Whilst in periodontally healthy neutrophils, JP2 binds to CD18 on cell surfaces, this is not the case in MIPP neutrophils, suggesting a potential role for CD18 in the periodontal susceptibility of MIPP patients.

Effects of Curcumin and Tetracycline Gel on Experimental Induced Periodontitis as an Anti-Inflammatory, Osteogenesis Promoter and Enhanced Bone Density through Altered Iron Levels: Histopathological Study

Adjunctive use of antimicrobials with scaling and root planing (SRP) is necessary to better eradicate dental biofilm. Tetracycline (T) is the most commonly used antimicrobial; however, it has limitations. This study evaluates the effect of curcumin (CU) as adjunct to SRP on inflammatory markers, collagen fiber deposition, and altered iron level. A total of 32 Wistar rats were divided into five groups: no experimental periodontitis (healthy control), experimental periodontitis (EPD), EPD treated with SRP alone (SRP), EPD treated with SRP+T (SRP+T), and EPD treated with SRP+CU (SRP+CU). After 2 and 4 weeks of treatment, tissue samples were assessed by hematoxylin and eosin, and special stains (Perls’ stain and Masson’s Trichrome) for counting of inflammatory cells, angiogenesis, collagen fibers, and iron deposition. Significant reductions in inflammatory cells infiltration and alveolar bone resorption with angiogenesis and collagen fibers deposition were detected after 2 and 4 weeks in both SRP+T and SRP+CU groups. SRP+CU resulted in a significant reduction in osteoclast numbers (week 2) and iron deposition (week 4) in bone trabeculae as compared to SRP and SRP+T groups. The adjunctive use of CU showed comparable results to T in the reduction in inflammation and bone resorption. Furthermore, CU has potential osteogenesis and healing effects.

The Relationships Among Periodontitis, Pneumonia and COVID-19

Periodontitis is a chronic inflammatory disease of the supporting structures of the teeth that affects approximately half of adults 30 years and older. There is increasing interest in the direct and indirect relationships between periodontitis and systemic diseases, including respiratory diseases. The aim of this study was to assess the evidence on links among periodontitis, pneumonia, and COVID-19. Oral and periodontal bacteria may be linked to respiratory disease directly by aspiration of pathogens into the lungs causing pneumonia. As SARS-CoV-2 began to spread worldwide in 2020, questions have arisen of how periodontal disease may also be connected to SARS-CoV-2 infection and severity, including potential replication and dissemination of the virus from periodontal pockets. Some proposed mechanisms include the oral cavity acting as a reservoir or point of entry for SARS-CoV-2, overgrowth of periodontal pathogens, and increased production of proinflammatory cytokines. Due to potential links between periodontal disease and respiratory infections like pneumonia and SARS-CoV-2, oral hygiene and management of periodontitis remain essential to help reduce infection and transmission of SARS-CoV-2.

Dental Students' Awareness After Clinical Training Between Dental Treatment and Systemic Health: A Questionnaire-Based Survey

Clinical training is an essential program for dental students to learn clinical skills. The aim of this study was to survey whether dental students who had undergone clinical training understood the clinical significance of dental treatment and its connection to systemic health. An awareness survey was conducted in dentistry students both before and after undergraduate clinical training. A total of 42 dental students were recruited before clinical training, and 32 dental students responded to the survey. In addition, all of the 42 dental students responded to the survey after clinical training. A total of 53 medical students were recruited as control subjects. Differences between the 2 groups were analyzed using Fisher's exact test. Before clinical training, a higher percentage of dental students felt the positive effects of periodontal treatment on systemic health. A higher percentage of dental students also recognized the positive effects of prosthetic treatment on geriatric conditions. After clinical training, no significant differences were found between periodontal and prosthetic treatment when surveyed about the positive effects of dental treatment on geriatric conditions. Undergraduate clinical training is essential for improving the students' understanding of the clinical significance of dental treatment. These surveys suggest that dental education supported by clinical experience contributes to understand the role of dental treatment.

The Effects of Nutraceuticals and Bioactive Natural Compounds on Chronic Periodontitis: A Clinical Review

The paper aims to review the current clinical evidence of various herbal agents as an adjunct treatment in the management of chronic periodontitis patients. Gingivitis and periodontitis are two common infectious inflammatory diseases of the supporting tissues of the teeth and have a multifactorial etiology. An important concern about chronic periodontitis is its association with certain systemic disease. New treatment strategies for controlling the adverse effects of chronic periodontitis have been extensively assessed and practiced in sub-clinical and clinical studies. It has been shown that the phytochemical agents have various therapeutic properties such as anti-inflammatory and antibacterial effects which can be beneficial for the treatment of periodontitis. The findings of this review support the adjunctive use of herbal agents in the management of chronic periodontitis. Heterogeneity and limited data may reduce the impact of these conclusions. Future long-term randomized controlled trials evaluating the clinical efficacy of adjunctive herbal therapy to scaling and root planing are needed.

Effect of periodontal disease on oxidative stress markers in patients with atherosclerosis

OBJECTIVES

The aim of this study was to investigate the effect of periodontal inflammation on oxidative stress in patients with atherosclerosis by considering serum and saliva total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI).

MATERIALS AND METHODS

In the study, there were 4 groups, with 20 individuals in each group. These groups consisted of individuals who had periodontitis with atherosclerosis (group A-P), were periodontally healthy with atherosclerosis (group A-C), were systemically healthy with periodontitis (group P), and were systemically and periodontally healthy (group C). Clinical periodontal parameters were recorded. PISA values were calculated. Atherosclerosis severity was determined by the Gensini score. The ratio of TAS/TOS resulting in the OSI levels of the serum and saliva samples was examined biochemically.

RESULTS

Group A-P serum TAS and group C saliva OSI values were lower than those of the other groups (p < 0.05). Group A-P serum TOS and OSI values were higher than those of the other groups (p < 0.05). Groups A-C and P serum TOS and OSI values were higher than those of group C (p < 0.05). In the multivariate linear regression analysis, group A-P and PISA values were independently associated with serum TOS and OSI values (p < 0.05). Group A-P, group P, and PISA values were independently associated with saliva OSI values (p < 0.05).

CONCLUSIONS

Periodontitis and atherosclerosis may have systemic oxidative stress-increasing effects. The coexistence of periodontitis and atherosclerosis increases oxidative stress beyond that seen in either condition alone. Periodontitis can be associated with increased systemic TOS and OSI values in patients with atherosclerosis.

STATEMENT OF CLINICAL RELEVANCE

Oxidative status is affected more severely when periodontitis and atherosclerosis coexist rather than when either exists alone. Periodontitis can cause increasing effect on serum TOS and OSI and decreasing effect on TAS in patients with atherosclerosis. The increase in oxidative stress markers with the presence of periodontal disease in patients with atherosclerosis emphasizes that controlling periodontal diseases, a treatable disease, may contribute to the prognosis of atherosclerosis.

IMPACT OF NON-SURGICAL PERIODONTAL TREATMENT ON SERUM TNF-α LEVELS IN INDIVIDUALS WITH TYPE 2 DIABETES: A SYSTEMATIC REVIEW AND META-ANALYSIS

OBJECTIVE

The objective of this systematic review and meta-analysis was to search for scientific evidence on the impact of non-surgical periodontal therapy on tumor necrosis factor alpha (TNF-α) in type 2 diabetics.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement has been followed. The study was registered (CRD42020192790) in the International prospective register of systematic reviews. Searches were conducted in five databases. Restrictions on publication date were not imposed in anyway. The studies reporting the serum TNF-α levels of individuals with type 2 diabetes mellitus (DM) before and after non-surgical periodontal therapy were included. Studies' selection, extraction of data and risk of bias assessment were performed in duplicate. Consensus was achieved. Meta-analysis was carried out. The 95% confidence interval and odds ratio were provided.

RESULTS

Six hundred and twenty-three references were retrieved and eighteen studies were included. Meta-analysis demonstrated that the serum levels of TNF-α in individuals with type 2 DM decreased six months after non-surgical periodontal therapy (mean difference = -1.90, confidence interval = -3.05--0.74). Included studies presented low risk of bias.

CONCLUSION

Non-surgical periodontal therapy has an impact on serum TNF-α levels at six months in type 2 DM patients.

A meta-analysis on the effect of periodontal treatment on the glomerular filtration rate of chronic kidney disease individuals: A systematic review and meta-analysis was conducted to assess the impact of the periodontal treatment on the glomerular filtration rate of individuals with chronic kidney disease

AIMS

The purpose of the present systematic review and meta-analysis was to assess the impact of periodontal treatment on the glomerular filtration rate (GFR) of individuals with chronic kidney disease (CKD).

METHODS

Searches were conducted in five databases. Restrictions on publication date or language were not imposed. Studies reporting the GFR of CKD individuals before and after periodontal treatment were included. Studies' selection, extraction of data and assessment of risk of bias were performed by two reviewers independently. The Methodological Index for non-randomized studies was employed for risk of bias assessment. Meta-analysis was carried out.

RESULTS

One hundred ninety-two references were retrieved and three studies were included. In all studies included, the periodontal intervention performed was non-surgical therapy. The three studies together assessed 77 individuals. The follow-up of participants after periodontal treatment varied between 3 and 6 months. Meta-analysis demonstrated that the GFR of individuals with CKD increased (improvement) after periodontal treatment (mean difference = 7.01, confidence interval = 0.66 - 13.36, I²  = 0%). Overall, included studies presented low risk of bias.

CONCLUSION

Despite the limited evidence of this systematic review and meta-analysis, periodontal treatment seems to improve the GFR of CKD individuals, with positive repercussions on their renal function.

HbA1c changes in patients with diabetes following periodontal therapy

Purpose

This retrospective cohort study aimed to assess the effect of nonsurgical periodontal therapy on glycated hemoglobin (HbA1c) levels in patients with both type 2 diabetes and chronic periodontitis.

Methods

The intervention cohort (IC) comprised 133 patients with type 2 diabetes who received nonsurgical periodontal treatment, while the matching cohort (MC) included 4787 patients with type 2 diabetes who visited the Department of Endocrinology and Metabolism of Asan Medical Center. The patients in each cohort were divided into 3 groups according to their baseline HbA1c level: subgroup 1, HbA1c <7%; subgroup 2, 7%≤ HbA1c <9%; and subgroup 3, HbA1c ≥9%. Changes in HbA1c levels from baseline to 6 and 12 months were analyzed. In addition, the association between changes in HbA1c levels and the number of periodontal maintenance visits was investigated.

Results

There were no statistically significant changes in HbA1c levels in the IC and MC or their subgroups when evaluated with repeated-measures analysis of variance. However, the IC showed maintenance of baseline HbA1c levels, while the MC had a trend for HbA1c levels to steadily increase as shown by pairwise comparisons (baseline to 6 months and baseline to 12 months). IC subgroup 1 also maintained steady HbA1c levels from 6 months to 12 months, whereas MC subgroup 1 presented a steady increase during the same period. The number of periodontal maintenance visits had no association with changes in HbA1c levels during the 1-year study duration.

Conclusions

For patients with both type 2 diabetes and periodontitis, nonsurgical periodontal treatment and periodontal maintenance may help to control HbA1c levels.

Visfatin regulates Pg LPS-induced proinflammatory/prodegradative effects in healthy and inflammatory periodontal cells partially via NF-κB pathway

Periodontitis is a widespread chronic infectious-inflammatory disease associated with multiple systemic diseases. Visfatin is an adipokine-enzyme that can be locally produced by human periodontal ligament cells (hPDLCs) and human gingival fibroblasts (hGFs). It can upregulate proinflammatory cytokines and matrix metalloproteinases (MMPs) in various types of cells. However, the effects of visfatin on healthy and inflammatory human periodontal cells as well as the underlying molecular mechanisms remain unclear. This study firstly demonstrated visfatin expression was highly elevated in inflamed human gingiva and Pg LPS-treated hPDLCs. Moreover, recombinant visfatin significantly upregulated the expression of proinflammatory cytokines (TNF-α, IL-1β and IL-6) and prodegradative factors (EMPPRIN, MMP1, MMP3 and MMP13) in hPDLCs. Next, we found the levels of proinflammatory and prodegradative cytokines were significantly increased in visfatin-overexpressing hPDLCs, and decreased in visfatin-silencing inflammatory hGFs (iGFs) when treated with Pg LPS. In the absence of Pg LPS, visfatin silencing failed to affect the expression of these factors in iGFs, and overexpression of visfatin upregulated MMPs but no other factors in hPDLCs. Furthermore, marked NF-κB pathway activation with increased phosphorylation of p65 was observed in visfatin-overexpressing hPDLCs. BAY11-7082, a specific inhibitor of NF-κB, partially reversed the upregulation proinflammatory and prodegradative factors induced by visfatin overexpression. Taken together, this study showed that visfatin critically regulates Pg LPS-induced proinflammatory/prodegradative effects in healthy and inflammatory periodontal cells partially via NF-κB pathway. The findings suggest that visfatin is closely involved in the development of periodontitis, and may serve as a promising novel biomarker and therapeutic target for periodontitis management.

Nanozymes go oral: nanocatalytic medicine facilitates dental health

Nanozymes are multi-functional nanomaterials with enzyme-like activity, which rapidly won a place in biomedicine due to their number of nanocatalytic materials types and applications. Yan and Gao first discovered horseradish peroxidase-like activity in ferromagnetic nanoparticles in 2007. With the joint efforts of many scientists, a new concept-nanocatalytic medicine-is emerging. Nanozymes overcome the inherent disadvantages of natural enzymes, such as poor environmental stability, high production costs, difficult storage and so on. Their progress in dentistry is following the advancement of materials science. The oral research and application of nanozymes is becoming a new branch of nanocatalytic medicine. In order to highlight the great contribution of nanozymes facilitating dental health, we first review the overall research progress of multi-functional nanozymes in oral related diseases, including treating dental caries, dental pulp diseases, oral ulcers and peri-implantitis; the monitoring of oral cancer, oral bacteria and ions; and the regeneration of soft and hard tissue. Additionally, we also propose the challenges remaining for nanozymes in terms of their research and application, and mention future concerns. We believe that the new catalytic nanomaterials will play important roles in dentistry in the future.

Periodontal and caries status in unexplained female infertility: A case-control study

BACKGROUND

The aim of this study was to investigate the possible association between maternal periodontal disease and dental caries that affect oral health and unexplained infertility.

METHODS

This cross-sectional case-control study included 50 fertile women and 50 women with unexplained infertility aged 21 to 39 years. Dental and periodontal parameters were examined to evaluate the oral health of the participants. According to the new periodontal disease classification, periodontitis severity was determined.

RESULTS

In infertile women, the number of advanced caries lesions, the percentage of bleeding on probing (BOP), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were higher (P < 0.05). The DMFT and mean plaque index (PI) were not statistically different between the two groups. The PISA and PESA values were higher in women with unexplained infertility than in fertile women (P = 0.005 and P = 0.002, respectively). In multivariate analysis showed that association of DMFT and BOP variables with periodontitis was found to be significant for all women included in the study and for infertile women only (P = 0.000 and P = 0.012 for DMFT, respectively; P = 0.000 and P = 0.016 for BOP, respectively).

CONCLUSION

The chronic inflammatory environment caused by periodontitis and advanced carious lesions in women with unexplained infertility should be of great concern as it may have a role in the etiology of infertility.

Prediction of Chronic Periodontitis Severity Using Machine Learning Models Based On Salivary Bacterial Copy Number

Periodontitis is a widespread chronic inflammatory disease caused by interactions between periodontal bacteria and homeostasis in the host. We aimed to investigate the performance and reliability of machine learning models in predicting the severity of chronic periodontitis. Mouthwash samples from 692 subjects (144 healthy controls and 548 generalized chronic periodontitis patients) were collected, the genomic DNA was isolated, and the copy numbers of nine pathogens were measured using multiplex qPCR. The nine pathogens are as follows: Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn), Campylobacter rectus (Cr), Aggregatibacter actinomycetemcomitans (Aa), Peptostreptococcus anaerobius (Pa), and Eikenella corrodens (Ec). By adding the species one by one in order of high accuracy to find the optimal combination of input features, we developed an algorithm that predicts the severity of periodontitis using four machine learning techniques. The accuracy was the highest when the models classified “healthy” and “moderate or severe” periodontitis (H vs. M-S, average accuracy of four models: 0.93, AUC = 0.96, sensitivity of 0.96, specificity of 0.81, and diagnostic odds ratio = 112.75). One or two red complex pathogens were used in three models to distinguish slight chronic periodontitis patients from healthy controls (average accuracy of 0.78, AUC = 0.82, sensitivity of 0.71, and specificity of 0.84, diagnostic odds ratio = 12.85). Although the overall accuracy was slightly reduced, the models showed reliability in predicting the severity of chronic periodontitis from 45 newly obtained samples. Our results suggest that a well-designed combination of salivary bacteria can be used as a biomarker for classifying between a periodontally healthy group and a chronic periodontitis group.

Renal alterations caused by ligature-induced periodontitis persist after ligature removal in rats

BACKGROUND AND OBJECTIVE

Periodontitis may crosstalk with renal diseases, yet that remains unclear. We investigated whether the renal alterations caused by induced periodontitis are reversible after removal of the ligatures in experimental ligature-induced periodontitis.

MATERIAL AND METHODS

Twenty-four female rats were divided into three groups: control (without periodontitis), periodontitis (20 days of ligature-induced periodontitis), and P20-20 (20 days of ligature-induced periodontitis and 20 days after ligature removal). The following periodontal parameters were assessed: gingival bleeding index, probing pocket depth, myeloperoxidase activity, and alveolar bone height. For renal tissues, histopathology, malonaldehyde (MDA) levels, glutathione (GSH) content, and renal weight were evaluated. In the blood, creatinine, uric acid, albumin, total cholesterol, total protein, and glucose levels were assessed. Total protein and creatinine levels in urine were also investigated.

RESULTS

Rat renal tissues did not demonstrate reversal of periodontitis-related changes in the P20-20 group in terms of MDA, GSH, and histopathological evaluations when compared to the periodontitis group. Accordingly, only total cholesterol levels were reversible in the P20-20.

CONCLUSION

Renal alterations caused by ligature-induced periodontitis persisted even after removal of ligatures in rats.

Microglial response to experimental periodontitis in a murine model of Alzheimer's disease

Periodontal disease (PD) has been suggested to be a risk factor for Alzheimer's disease (AD). We tested the impact of ligature-induced PD on 5xFAD mice and WT littermates. At baseline, 5xFAD mice presented significant alveolar bone loss compared to WT mice. After the induction of PD, both WT and 5xFAD mice experienced alveolar bone loss. PD increased the level of Iba1-immunostained microglia in WT mice. In 5xFAD mice, PD increased the level of insoluble Aβ42. The increased level in Iba1 immunostaining that parallels the accumulation of Aβ in 5xFAD mice was not affected by PD except for a decrease in the dentate gyrus. Analysis of double-label fluorescent images showed a decline in Iba1 in the proximity of Aβ plaques in 5xFAD mice with PD compared to those without PD suggesting a PD-induced decrease in plaque-associated microglia (PAM). PD reduced IL-6, MCP-1, GM-CSF, and IFN-γ in brains of WT mice and reduced IL-10 in 5xFAD mice. The data demonstrated that PD increases neuroinflammation in WT mice and disrupts the neuroinflammatory response in 5xFAD mice and suggest that microglia is central to the association between PD and AD.

Association of periodontitis with leukocyte telomere length in US adults: A cross-sectional analysis of NHANES 1999 to 2002

BACKGROUND

This study examines the association of periodontitis with telomere length (TL) and effect modification by population characteristics.

METHODS

We analyzed data from 3,478 participants from the 1999 to 2002 National Health and Nutrition Examination Survey. Probing depth, attachment loss, and bleed on probing (BOP, available for 1,973 participants only) were examined on the distal, mesial, or mid-facial site of each tooth in two randomly selected quadrants. We defined periodontitis severity according to the Centers for Disease Control/American Academy of Periodontology guideline. TL from leukocytes was measured with qPCR. We used linear and logistic regression to examine the adjusted association of different severity of periodontitis and BOP with continuous TL (bp) and dichotomized short TL (<median), respectively. To assess effect modification, we stratified the analyses by a priori selected population characteristics including sex, age, body weight status, smoking, and cardiometabolic comorbidity.

RESULTS

Moderate BOP (<10% bleeding sites) was significantly associated with a shorter continuous TL (β = -89.0, SE = 37.8). Moderate to severe periodontitis was significantly associated with 47% (95% confidence interval [IL], 1.04 to 2.09) higher odds of shorter TL, compared with those with mild or no periodontitis. The association was stronger in those who were female (adjusted OR, 1.76; 95% CI, 1.10 to 2.83), overweight or obese (adjusted OR, 1.64; 95% CI, 1.12 to 2.41), or had cardiometabolic comorbidities (adjusted OR, 2.13; 95% CI, 1.38 to 3.29).

CONCLUSIONS

Periodontitis was associated with TL, a biomarker of cellular aging. The association was stronger in females, overweight or obese, or those with cardiometabolic diseases. Treatment on periodontitis could potentially protect individuals from aging-related diseases.

Effect of periodontal treatment on diabetes-related healthcare costs: a retrospective study

INTRODUCTION

Periodontitis has been considered a sixth complication of diabetes. The aim of this study was to assess the impact of periodontal treatment on diabetes-related healthcare costs in patients with diabetes.

RESEARCH DESIGN AND METHODS

A retrospective analysis was done, exploiting unique and large-scale claims data of a Dutch health insurance company. Data were extracted for a cohort of adults who had been continuously insured with additional dental coverage for the years 2012-2018. Individuals with at least one diabetes-related treatment claim in 2012 were included for analysis. A series of panel data regression models with patient-level fixed effects were estimated to assess the impact of periodontal treatment on diabetes-related healthcare costs.

RESULTS

A total of 41 598 individuals with diabetes (age range 18-100 years; 45.7% female) were included in the final analyses. The median diabetes-related healthcare costs per patient in 2012 were €38.45 per quarter (IQR €11.52-€263.14), including diagnoses, treatment, medication and hospitalization costs. The fixed effect models showed €12.03 (95% CI -€15.77 to -€8.29) lower diabetes-related healthcare costs per quarter of a year following periodontal treatment compared with no periodontal treatment.

CONCLUSIONS

Periodontitis, a possible complication of diabetes, should receive appropriate attention in diabetes management. The findings of this study provide corroborative evidence for reduced economic burdens due to periodontal treatment in patients with diabetes.

Periodontal Status and Microbiologic Pathogens in Patients with Chronic Obstructive Pulmonary Disease and Periodontitis: A Case-Control Study

Purpose

To evaluate clinical periodontal status and microbiologic pathogens in patients with chronic obstructive pulmonary disease (COPD) and periodontitis.

Patients and Methods

We conducted a case–control study of 60 periodontitis patients with COPD (case group) and 60 periodontitis patients with normal pulmonary function (control group). Their periodontal status and respiratory function were clinically examined. Real-time polymerase chain reaction assays were used to measure five dental pathogens and four respiratory pathogens in subgingival dental plaque. Spearman’s rank correlation coefficients (r²) were calculated to assess correlations of pathogens. Principal component analysis (PCA) was employed to assess the similarity of bacterial diversity between the two groups. Logistic regression was performed to examine the associations of periodontal variables and pathogens with COPD risk.

Results

COPD patients had fewer remaining teeth, higher plaque index (PLI), and more severe site percentages of clinical attachment level (CAL) than the controls. Although COPD patients tended to have relatively higher ranked means of Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, and Haemophilus influenza than control participants, the differences were not significant. Some periodontal pathogens and respiratory pathogens were positively correlated with each other (r² =0.29 to 0.47, all P < 0.05). The PCA graph showed that the distributions of pathogens were more dispersed but less discriminated in the COPD group than those in the control group. PLI (P = 0.045) and CAL ≥ 5mm site percentages (P = 0.01) were significantly associated with an increased risk of COPD, while pathogens were not associated with COPD.

Conclusion

Our results from this study do not indicate periodontal pathogens as potential predictors of COPD risk, despite significantly poor periodontal status associated with COPD.

Primer on etiology and treatment of progressive/severe periodontitis: A systemic health perspective

Periodontology is an infectious disease-based discipline. The etiopathology of progressive/severe periodontitis includes active herpesviruses, specific bacterial pathogens, and proinflammatory cytokines. Herpesviruses and periodontopathic bacteria may interact synergistically to produce periodontal breakdown, and periodontal herpesviruses may contribute to systemic diseases. The infectious agents of severe periodontitis reside in deep pockets, furcation lesions, and inflamed gingiva, sites inaccessible by conventional (purely mechanical) surgical or nonsurgical therapy but accessible by systemic antibiotic treatment. This brief overview presents an effective anti-infective treatment of severe periodontitis, which includes systemic chemotherapy/antibiotics against herpesviruses (valacyclovir [acyclovir]) and bacterial pathogens (amoxicillin + metronidazole or ciprofloxacin + metronidazole) plus common antiseptics (povidone-iodine and sodium hypochlorite) and select ultrasonic scaling. The proposed treatment can cause a marked reduction or elimination of major periodontal pathogens, is acceptably safe, and can be carried out in minimal time with minimal cost.

Fusobacterium nucleatum Interaction with Pseudomonas aeruginosa Induces Biofilm-Associated Antibiotic Tolerance via Fusobacterium Adhesin A

Respiratory infections with Pseudomonas aeruginosa or Fusobacterium nucleatum are associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and failure in antibiotic treatment. However, the impact of these dual-species interactions on the severity of chronic obstructive pulmonary disease (COPD) and biofilm antibiotic susceptibility remains poorly understood. This study demonstrated that F. nucleatum frequently coexisted with P. aeruginosa in the respiratory tract, and the number of F. nucleatum was negatively correlated with the lung function of AECOPD patients. The coculture of P. aeruginosa and F. nucleatum promoted bacterial proliferation and induced antibiotic tolerance through the formation of a dense biofilm surrounded by excessive Pel and Psl polysaccharides. Moreover, Fusobacterium adhesin A (FadA), rather than F. nucleatum spent medium, induced antibiotic tolerance of the P. aeruginosa biofilm. These results indicate that F. nucleatum is a biomarker of lung function decline in AECOPD patients and interacts with P. aeruginosa in vitro to resist antibiotics via FadA, which would be a potential anti-infective target of these dual-species infection.

Dental follow-up and maintenance index: the development of a novel multidisciplinary protocol

Objectives

To develop a comprehensive yet simple dental follow up and maintenance protocol based on existing guidelines and recommendations.

Methods

A multidisciplinary team reviewed available maintenance and follow up guidelines and recommendations then developed a single protocol for adult dental patients.

Results

The protocol includes ten questions that categorize dental patients into one of three risk categories. Based on the risk category, each patient is assigned a recall interval and recommendations for in office and at home dental care.

Conclusions

Development of a single multidisciplinary follow up and maintenance protocol.

Vitamin D Deficiency and Oral Health: A Comprehensive Review

Vitamin D (VD) levels have been gaining growing attention in Oral Health. During growth and adulthood, VD deficiency (VDD) is associated with a wide variety of oral health disorders, and impaired VD synthesis may expedite some of these conditions. In children, severe VDD can induce defective tooth mineralization, resulting in dentin and enamel defects. As a consequence, these defects may increase the risk of the onset and progression of dental caries. Further, VDD has been associated with higher prevalence of periodontitis and gingival inflammation, and several recent preclinical and clinical studies have unveiled potential pathways through which Vitamin D may interact with the periodontium. VDD correction through supplementation may contribute to a successful treatment of periodontitis; however, alveolar bone regeneration procedures performed in baseline VDD patients seem more prone to failure. Vitamin D may also be linked with some oral pathology entities such as certain oral cancers and events of osteonecrosis of the jaw. This review aims to provide comprehensive evidence of how VD levels should be considered to promote good oral health, and to summarize how VDD may hamper oral development and its role in certain oral conditions.

Drug-free and non-crosslinked chitosan scaffolds with efficient antibacterial activity against both Gram-negative and Gram-positive bacteria

Treatment of oral pathogens is important for both oral and systemic health. The antimicrobial activity of chitosan (CS)-based scaffolds either loading antibiotics or compositing with other agents are well documented. However, the intrinsic antibacterial activity of CS scaffolds alone has never been reported. Herein, we fabricated the non-crosslinked CS scaffold and investigated its antibacterial activity against typical oral pathogens, Gram-negative Porphyromonas gingivalis and Gram-positive Streptococcus mutans. We found both pathogens were completely killed by 1 mg CS scaffolds at 6 h, due largely to the CS-induced time-dependent bacteria clustering. Interestingly, β-glycerophosphate crosslinked scaffolds showed no antibacterial activity. In conclusion, the bactericidal activity of CS scaffolds alone is reported for the first time. Together with the biodegradability, physical stability, biocompatibility and great antibacterial activity, the non-crosslinked CS scaffolds may have great potentials not only in treating oral diseases but also in wound healing and tissue engineering.

Characterization of the subgingival microbiota in the peritoneal dialysis patients with periodontitis

BACKGROUND AND OBJECTIVE

Periodontitis is an oral chronic inflammatory disease caused by dental plaque. It is comorbid with numerous systemic diseases and associated with several predisposing factors, such as chronic kidney disease (CKD). Peritoneal dialysis is one of the ultimate treatments for patients with severe CKD. However, peritoneal dialysis patients with periodontitis often will be accompanied with more poor oral hygiene and periodontal clinical indexes. This study aimed to compare the microbial flora of periodontitis patients with or without peritoneal dialysis.

METHODS

Sixteen peritoneal dialysis patients with periodontitis (P group) and 16 patients with periodontitis only (C group) were selected. Subgingival plaque samples of them were processed for bioinformatics analysis by 16S rDNA gene sequencing.

RESULTS

The diversity indices and species richness in the P group were insignificantly higher than that in the C group (P > 0.05). The two groups exhibited different microbial community structure. At Genus level, Prevotellaceae, Selenomonas, Aggregatibacter, Anaeroglobus, TM7_[G-5], and Centipeda were significantly enriched in the P group than those in the C group.

CONCLUSIONS

This study demonstrated that specific microbes enriched in the subgingival flora of peritoneal dialysis patients with periodontitis.

Oral Health Knowledge Level of Nursing Staff Working in Semi-Intensive Heart Failure Units

PURPOSE

Critical care units, such as heart failure units, house inpatients with a compromised general health status that requires rigorous prevention of further complications. Oral health infections that gain access through the bloodstream or airway might represent such potential complications (eg, endocarditis pneumonia). Avoiding these critical occurrences requires that adequate oral health care be provided by nursing personnel. Here we assessed the knowledge of oral health care practices by nurses working in three Italian heart failure units in Umbria, Italy.

DESIGN

This was a cross-sectional study.

METHODS

Forty-four nurses were interviewed using a six-item modified Adams' questionnaire on the topic of oral health care. A multidisciplinary panel of experts established the criteria for answer correctness based on the most relevant dentistry literature evidence and judged each reply. The expected percentage of correctly replying nurses was 75%, and significant differences from this expected probability were calculated with one-sided binomial probability tests. Cronbach's α method was used to establish the questionnaire's internal consistency (reliability).

RESULTS

For five out of six questionnaire items, the percentage of nurses who correctly answered was significantly lower than the expected value of probability. Lack of knowledge was found for usefulness of checking the patients' mouths (p=0.003), the most relevant lesions affecting the mouth (p=0.0001), the tools/solutions for cleaning the mouth and dentures (p= 0.0416), and drugs that affect the mouth and their side effects (p<0.0001).

CONCLUSION

In this study, few nurses working in heart failure units showed both an adequate willingness to check inpatients and a good knowledge of oral health care (significantly lower than the expected 75%). Further studies that use validated questionnaires and include more participants should be conducted to confirm and elaborate on our preliminary data.

Herpesvirus-bacteria synergistic interaction in periodontitis

The etiopathogenesis of severe periodontitis includes herpesvirus-bacteria coinfection. This article evaluates the pathogenicity of herpesviruses (cytomegalovirus and Epstein-Barr virus) and periodontopathic bacteria (Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis) and coinfection of these infectious agents in the initiation and progression of periodontitis. Cytomegalovirus and A. actinomycetemcomitans/P. gingivalis exercise synergistic pathogenicity in the development of localized ("aggressive") juvenile periodontitis. Cytomegalovirus and Epstein-Barr virus are associated with P. gingivalis in adult types of periodontitis. Periodontal herpesviruses that enter the general circulation may also contribute to disease development in various organ systems. A 2-way interaction is likely to occur between periodontal herpesviruses and periodontopathic bacteria, with herpesviruses promoting bacterial upgrowth, and bacterial factors reactivating latent herpesviruses. Bacterial-induced gingivitis may facilitate herpesvirus colonization of the periodontium, and herpesvirus infections may impede the antibacterial host defense and alter periodontal cells to predispose for bacterial adherence and invasion. Herpesvirus-bacteria synergistic interactions, are likely to comprise an important pathogenic determinant of aggressive periodontitis. However, mechanistic investigations into the molecular and cellular interaction between periodontal herpesviruses and bacteria are still scarce. Herpesvirus-bacteria coinfection studies may yield significant new discoveries of pathogenic determinants, and drug and vaccine targets to minimize or prevent periodontitis and periodontitis-related systemic diseases.

Effect of stannous fluoride and zinc phosphate dentifrice on dental plaque and gingivitis: A randomized clinical trial with 6-month follow-up

OBJECTIVE

The objective of this study was to compare a stabilized stannous fluoride (SnF₂) dentifrice with zinc phosphate (Colgate Total^SF) with SnF₂ with zinc lactate and control fluoride dentifrices for gingivitis and plaque control over a 6-month period.

METHODS

A total of 135 adult participants were enrolled in this study. After randomization and blinding of examiners and patients, enrolled participants were provided instructions for use of assigned dentifrice. At 3 visits (0, 3, and 6 months), various gingival and plaque indexes were collected to determine the clinical efficacy of a stabilized SnF₂ dentifrice. These results were compared with a SnF₂ with zinc lactate dentifrice and with a control fluoride dentifrice.

RESULTS

A total of 135 participants completed the study. All groups reported statistically significant reductions in gingival inflammation and improvement in plaque control at 3- and 6-month follow-up. Both SnF₂ dentifrices showed statistically significant reductions in all indexes compared with the control dentifrice (P < .001). However, the test dentifrice showed higher but nonsignificant improvements in plaque and gingival indexes compared with the other SnF₂ dentifrice.

CONCLUSIONS

This study reports similar efficacy of a test dentifrice to a commercial SnF₂-containing dentifrice for plaque control and reduction in gingival inflammation and provides supporting evidence that the test dentifrice maintains its clinical efficacy with change of formulation.

PRACTICAL IMPLICATIONS

This newly formulated SnF₂ stabilized with zinc phosphate dentifrice may be of benefit to patients in controlling plaque biofilm and gingivitis.

Evaluation of a stabilized stannous fluoride dentifrice on dental plaque and gingivitis in a randomized controlled trial with 6-month follow-up

BACKGROUND

The objective of this study was to compare a stannous fluoride (SnF₂) dentifrice (Colgate Total^SF) stabilized with zinc phosphate with a sodium fluoride control dentifrice for gingivitis and plaque control over a 6-month period.

METHODS

One hundred adult participants were enrolled in this study conducted in Chengdu, China. After random assignment and blinding of examiners and patients, enrolled participants received instructions for use of the assigned dentifrice. At 3 visits (baseline and 3 and 6 months), the authors measured various gingival and plaque indexes to determine the clinical efficacy of the stabilized SnF₂ dentifrice compared with those of the control fluoride dentifrice (2 groups).

RESULTS

Ninety-eight participants completed the study. Both groups (test and control) had statistically significant reductions in gingival inflammation and improvement in plaque control at the 3- and 6-month follow-ups. In addition, the test dentifrice showed statistically significant reductions in all indexes compared with the control dentifrice (P < .001).

CONCLUSIONS

This study's results show statistically significantly improved clinical outcomes for reduction of gingival inflammation and improvement in biofilm control over a 6-month period through the use of a SnF₂ dentifrice stabilized with zinc phosphate when compared with results with a fluoride control dentifrice.

PRACTICAL IMPLICATIONS

This newly formulated dentifrice improves gingival health and plaque control and thereby may aid patients in attaining improved oral health.

Periodontitis and respiratory diseases: A systematic review with meta-analysis

OBJECTIVE

To conduct a systematic review and meta-analysis to evaluate the recent scientific literature addressing the association between periodontitis and asthma, chronic obstructive pulmonary disease (COPD), and pneumonia.

MATERIALS AND METHODS

The search for studies was carried out using MEDLINE/PubMed, EMBASE, Lilacs, Web of Science, Scopus, and SciELO databases, including the gray literature (ProQuest). Reference lists of selected articles were also searched. Studies having varying epidemiological designs assessing the association between periodontitis and respiratory diseases in human subjects were eligible for inclusion. Three independent reviewers performed the selection of articles and data extraction. Fixed and random effects meta-analysis were performed for the calculation of the association measurements (Odds Ratio-OR) and 95% confidence intervals (95% CI).

RESULTS

A total of 3,234 records were identified in the database search, with only 13 studies meeting the eligibility criteria and 10 studies contributed data for meta-analysis. Using a random effects models periodontitis was associated with asthma: ORadjusted: 3.54 (95% CI: 2.47-5.07), I²  = 0%; with COPD: OR adjusted: 1.78 (95% CI: 1.04-3.05), I²  = 37.9%; and with pneumonia: OR adjusted: 3.21 (95% CI: 1.997-5.17), I²  = 0%.

CONCLUSIONS

The main findings of this systematic review validated an association between periodontitis and asthma, COPD and pneumonia.

Apical Periodontitis Is Associated with Elevated Concentrations of Inflammatory Mediators in Peripheral Blood: A Systematic Review and Meta-analysis

INTRODUCTION

Apical periodontitis (AP), except for the local known consequences, may also be a systemic burden. Circulating inflammatory mediators that are released to sustain the AP lesion can in theory harm other bodily tissues. The aim of this systematic review was to summarize the existing evidence on the influence of AP on the peripheral blood levels of inflammatory mediators and markers of systemic stress.

METHODS

A search of MEDLINE-PubMed, Embase, and Cochrane was conducted up to and including February 2019 to identify studies in 5 different languages. The Newcastle-Ottawa Scale was used for quality assessment of the included studies.

RESULTS

Twelve of the 20 included studies were case-control studies, and 8 were intervention studies. The data of all the included studies were analyzed descriptively, whereas the data of 11 studies were available for meta-analyses. The study designs were heterogeneous. Nevertheless, the meta-analyses revealed statistically significant differences in C-reactive protein, interleukin 6, and asymmetric dimethylarginine levels between AP subjects and controls in peripheral blood. In addition, the concentration of C3 complement fragment in peripheral blood was significantly lower after the treatment and resolution of AP than before.

CONCLUSIONS

The existing literature indicates that AP adds on to systemic inflammation by elevating C-reactive protein, interleukin 6, asymmetric dimethylarginine, and C3 levels. In order to overcome the issue of large variation between study designs, future studies should have clear inclusion criteria, preferably larger cohorts, adequate follow-up of all subjects, and a thorough presentation of the data to enable further exploration of the possible burden of AP on general human health. Nevertheless, there is now stronger evidence that AP contributes to low-grade systemic inflammation.

Awareness of the Relationship between Systemic and Periodontal Diseases among Physicians and Dentists in Saudi Arabia and Kuwait: Cross-sectional Study

Background:

Previous studies have shown possible association between periodontal diseases and Diabetes Mellitus (DM), Cardiovascular Disease (CVD) and Adverse Pregnancy Outcomes (APO). Increasing the knowledge of physicians and dentists regarding the association between periodontal disease and systemic diseases should improve their ability to provide a high standard of treatment for the disease and prevent its consequences. In our study, we sought to identify knowledge gaps in the awareness of the relationship between systemic and periodontal diseases among dentists and physicians from the Kingdom of Saudi Arabia and the State of Kuwait.

Methods:

A cross-sectional study was performed with a convenient sample of selected physicians and dentists in Saudi Arabia and Kuwait using a self-developed structured questionnaire. Physicians’ and dentists’ awareness were assessed regarding current evidence of the relationship between systemic diseases and conditions (DM, CVD, APO) and periodontal diseases.

Results:

A total of 134 (21.5%) of the identified physicians and 485 (78%) of the identified dentists participated in this study. More than half of the participants (52.1% physicians and 67.5% dentists) agreed that there is a relationship between periodontal diseases and DM, CVD and APO. Dentists had a statistically higher level of awareness compared with the physicians. The findings related to the awareness of the dentist sub groups highlighted that periodontists were significantly more likely to have a good level of knowledge.

Conclusion:

Within the limitations of this study, we concluded that the awareness of physicians and dentists regarding the relationship between periodontal diseases and systemic diseases (DM, CVD, APO) is generally low, Therefore, improved collaboration between medical and dental health providers is recommended.