Contemporary approaches for identifying individual risk for periodontitis

Hydrogel-based radio frequency H2S sensor for in situ periodontitis monitoring and antibacterial treatment

Periodontitis, a chronic disease, can result in irreversible tooth loss and diminished quality of life, highlighting the significance of timely periodontitis monitoring and treatment. Meanwhile, hydrogen sulfide (H2S) in saliva, produced by pathogenic bacteria of periodontitis, is an important marker for periodontitis monitoring. However, the easy volatility and chemical instability of the molecule pose challenges to oral H2S sensing. Here, we report a wearable hydrogel-based radio frequency (RF) sensor capable of in situ H2S detection and antibacterial treatment. The RF sensor comprises an agarose hydrogel containing conjugated silver nanoparticles-chlorhexidine (AG-AgNPs-CHL hydrogel) integrated with split-ring resonators. Adhered to a tooth, the hydrogel-based RF sensor enables wireless transmission of sensing signals to a mobile terminal and a concurrent release of the broad-spectrum antibacterial agent chlorhexidine without complex circuits. With the selective binding of the AgNPs to the sulfidion, the RF sensor demonstrates good sensitivity, a wide detection range (2-30 μM), and a low limit of detection (1.2 μM). Compared with standard H2S measurement, the wireless H2S sensor can distinguish periodontitis patients from healthy individuals in saliva sample tests. The hydrogel-based wearable sensor will benefit patients with periodontitis by detecting disease-related biomarkers for practical oral health management.

Realizing the clinical utility of saliva for monitoring oral diseases

In the era of personalized/precision health care, additional effort is being expended to understand the biology and molecular mechanisms of disease processes. How these mechanisms are affected by individual genetics, environmental exposures, and behavioral choices will encompass an expanding role in the future of optimally preventing and treating diseases. Considering saliva as an important biological fluid for analysis to inform oral disease detection/description continues to expand. This review provides an overview of saliva as a diagnostic fluid and the features of various biomarkers that have been reported. We emphasize the use of salivary biomarkers in periodontitis and transport the reader through extant literature, gaps in knowledge, and a structured approach toward validating and determine the utility of biomarkers in periodontitis. A summation of the findings support the likelihood that a panel of biomarkers including both host molecules and specific microorganisms will be required to most effectively identify risk for early transition to disease, ongoing disease activity, progression, and likelihood of response to standard periodontal therapy. The goals would be to develop predictive algorithms that serve as adjunctive diagnostic tools which provide the clinician and patient important information for making informed clinical decisions.

Point-of-care diagnostic devices for periodontitis - current trends and urgent need

Point of care (POC) diagnostic devices provide a method for rapid accurate identification of disease through analysis of biologically relevant substances. This review focuses on the utility of POC testing for early detection of periodontitis, a critical factor in treating the disease. Accessing the oral cavity for biological sampling is less invasive when compared to other internal test sites, and oral fluids contain biomarkers indicative of periodontitis. The ease of access makes the mouth an excellent target location for the development of POC devices. In this review, accepted standards in industry by which these devices must adhere, provided by the World Health Organization such as REASSURED and CLIA, are discussed. An overview is provided for many periodontal biomarkers currently being investigated as a means of predicting periodontal disease and its progression. POC devices currently being investigated for the identification and monitoring of periodontal disease such as paper-based and lab-on-a-chip based devices are outlined. Limitations of current POC devices on the market are provided and future directions in leveraging biomarkers as an adjunctive method for oral diagnosis along with AI-based analysis systems are discussed. Here, we present the ESSENCE sensor platform, which combines a porous non-planar electrode with enhanced shear flow to achieve unprecedented sensitivity and selectivity. The combination of the ESENCE chip with an automated platform allows us to meet the WHO's ASSURED criteria. This platform promises to be an exciting POC candidate for early detection of periodontitis.

Therapeutic Strategies and Genetic Implications for Periodontal Disease Management: A Systematic Review

The objective of this review is to identify the microbiological alterations caused by various therapy modalities by critically analyzing the current findings. We limited our search to English-language papers published between 1 January 2004 and 7 May 2024 in PubMed, Scopus, and Web of Science that were relevant to our topic. In the search approach, the Boolean keywords "microbio*" AND "periodontitis" were used. A total of 5152 papers were obtained from the databases Web of Science (2205), PubMed (1793), and Scopus (1154). This resulted in 3266 articles after eliminating duplicates (1886), and 1411 entries were eliminated after their titles and abstracts were examined. The qualitative analysis of the 22 final articles is included in this study. Research on periodontal disease shows that periodontitis alters the oral microbiome and increases antibiotic resistance. Treatments like scaling and root planing (SRP), especially when combined with minocycline, improve clinical outcomes by reducing harmful bacteria. Comprehensive mechanical debridement with antibiotics, probiotics, EMD with bone grafts, and other adjunctive therapies enhances periodontal health. Personalized treatment strategies and advanced microbial analyses are crucial for effective periodontal management and antibiotic resistance control.

Serum vitamin D, hemoglobin A1c and vitamin B12 levels in patients with gingivitis and periodontitis stages

Aim: To compare the serum vitamin D, hemoglobin A1c (HbA1c) and vitamin B12 levels in patients with gingivitis and four different periodontitis stages diagnosed according to the 2017 Periodontal Disease Classification. Materials & methods: A total of 606 patients were included in the study who were diagnosed with gingivitis and stage I-IV periodontitis. Patients were divided into groups based on disease stage, and the HbA1c, vitamin D and B12 levels of the patients were compared and analyzed. Result: The highest HbA1c level and the lowest vitamin D level were seen in stage III-IV periodontitis. The highest vitamin D and B12 levels were seen in the gingivitis group. Conclusion: Serum HbA1c, vitamin D and B12 levels might vary depending on the presence or severity of periodontitis.Clinical Trial Registration: NCT05745779 (This study was registered and approved by www.clinicaltrials.gov).

Lipoxin A4 levels predict site-specific clinical improvements post scaling and root planing and correlate negatively with periodontal pathogens in severe periodontitis

BACKGROUND

Serving as a stop signal of inflammation, the role of lipoxin A4 (LXA4) in periodontitis remains to be clarified. This study is aimed to examine the changes in LXA4 levels in gingival crevicular fluid (GCF) after scaling and root planing (SRP) and to determine the relationship between LXA4 levels and treatment outcomes and periodontal pathogens in severe periodontitis.

METHODS

A total of 74 GCF samples were collected from 21 severe periodontitis participants at the deepest affected sites. These sites were re-sampled at 1, 3, and 6 months after SRP. Besides, GCF samples were also collected from 25 periodontally healthy participants. Clinical parameters including probing depth (PD) and clinical attachment level (CAL) in periodontitis group were recorded. LXA4 levels and periodontal pathogens in the GCF were analyzed by ELISA and PCR, respectively. Correlations between GCF LXA4 levels and treatment effect and periodontal pathogens were assessed.

RESULTS

LXA4 levels in GCF significantly increased after SRP (p < 0.05), but remained lower than those observed in healthy individuals (p < 0.05). Sites with lower baseline LXA4 concentrations were more likely to experience greater improvements in PD at 6 months post-SRP (area under the curve [AUC] = 0.792), and the improvements were positively correlated with the increase of LXA4 at these sites post-treatment (p < 0.05). Furthermore, more elevated LXA4 levels were observed in sites that became negative for Prevotella intermedia or Tannerella forsythia after SRP.

CONCLUSION

Baseline LXA4 in GCF has the potential to predict the site-specific response of severe periodontal lesions to SRP. The increase of LXA4 levels after treatment was positively correlated with clinical improvements and negatively correlated with the presence of Prevotella intermedia or Tannerella forsythia.

Effect of scaling and root planing with and without minocycline HCl microspheres on periodontal pathogens and clinical outcomes: A randomized clinical trial

BACKGROUND

This study tests the effects of scaling and root planing (SRP) versus SRP plus minocycline hydrochloride microspheres (SRP+MM) on 11 periodontal pathogens and clinical outcomes in Stage II-IV Grade B periodontitis participants.

METHODS

Seventy participants were randomized to receive SRP (n = 35) or SRP+MM (n = 35). Saliva and clinical outcomes were collected for both groups at baseline before SRP, 1-month reevaluation, and at 3- and 6-month periodontal recall. MM were delivered to pockets ≥5 mm immediately after SRP and immediately after the 3-month periodontal maintenance in the SRP+MM group. A proprietary saliva test* was utilized to quantitate 11 putative periodontal pathogens. Microorganisms and clinical outcomes were compared between groups using generalized linear mixed-effects models with fixed effects and random effects terms. Mean changes from baseline were compared between groups via group-by-visit interaction tests.

RESULTS

Significant reduction in Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, Prevotella intermedia, Parvimonas micra, and Eikenella corrodens were identified at the 1-month reevaluation after SRP+MM. Six months after SRP with a re-application of MM 3 months after SRP, Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Eikenella corrodens were significantly reduced. SRP+MM participants had significant clinical outcome reductions in pockets ≥5 mm at the reevaluation, 3- and 6-month periodontal maintenance, and clinical attachment loss gains at the 6-month periodontal maintenance.

CONCLUSION

MM delivered immediately after SRP and reapplication at 3 months appeared to contribute to improved clinical outcomes and sustained decreased numbers of Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Eikenella corrodens at 6 months.

The Role and Involvement of Stem Cells in Periodontology

Periodontitis is a widespread inflammatory condition, characterized by a progressive deterioration of the supporting structures of the teeth. Due to the complexity of periodontal tissue and the surrounding inflammatory microenvironment, the repair of lesions at this level represents a continuous challenge. The regeneration of periodontal tissues is considered a promising strategy. Stem cells have remarkable properties, such as immunomodulatory potential, proliferation, migration, and multilineage differentiation. Thus, they can be used to repair tissue damage and reduce inflammation, potentially leading to periodontal regeneration. Among the stem cells used for periodontal regeneration, we studied dental mesenchymal stem cells (DMSCs), non-dental stem cells, and induced pluripotent stem cells (IPSCs). Although these cells have well documented important physiological characteristics, their use in contemporary practice to repair the affected periodontium is still a challenge.

Periodontal disease progression and gene polymorphisms: results after 3 years of active periodontal treatment

BACKGROUND

Although non-surgical periodontal treatment is considered the gold standard, a subgroup of patients displays recurrence/progression of periodontitis after treatment. The aim of the present prospective study was to assess the effect of IL-6 -572 G/C and IL-10 -592 C/A gene polymorphisms on the risk of disease recurrence/progression at 3 years following non-surgical periodontal treatment.

METHODS

Thirty-seven patients diagnosed with chronic periodontitis received oral hygiene instructions and non-surgical periodontal treatment and were monitored for 3 years. All individuals were clinically evaluated for PPD, CAL and BOP at baseline and 3 years. Based on the clinical findings at 3 years, all subjects were considered either "at risk" or "not at risk" of periodontal disease progression based on specific criteria. Blood samples were collected at baseline and genotyping of the polymorphisms in IL-6 (rs1800796) and IL-10 (rs1800872) genes were performed by PCR.

RESULTS

Following DNA separation and genotyping, 70.3% of the patients were homozygous carriers of the IL-6 -572G and 45.9% were carriers of the IL-10 -592A allele. Individuals at risk of disease progression ranged from 16.2% to 56.8% based on the criteria used. IL-6 -572 G/C and IL-10 -592 C/A polymorphisms were not associated with an increased risk of further disease progression (P>0.05) when the three criteria were examined. All examined periodontal clinical measures were significantly improved (P<0.05) after treatment. Males showed a significantly higher risk of disease progression than females when full-mouth BOP ≥30% was considered (P=0.008).

CONCLUSIONS

Within the limitations of this 3-year prospective study, individuals susceptible to periodontal disease as determined by the presence of the IL-6 -572GG genotype or the IL-10 -592A allele were not associated with an increased risk of further disease progression and the potential need for further treatment following non-surgical periodontal treatment. Males were more prone to be at risk of disease progression than females.

Peridontitis as a Risk Factor for Attention Deficit Hyperactivity Disorder: Possible Neuro-inflammatory Mechanisms

Periodontitis is a condition caused mostly by the creation of a biofilm by the bacterium P. gingivalis, which releases toxins and damages the tooth structure. Recent research studies have reported association between dental health and neuropsychiatric illnesses. Neuroinflammation triggered by the first systemic inflammation caused by the bacterium present in the oral cavities is a plausible explanation for such a relationship. Substantial amount of evidence supports the role of neuroinflammation and dysfunction of the dopaminergic system in the pathology of ADHD (Attention deficit hyperactivity disorders). Recent epidemiological, microbiological and inflammatory findings strengthen that, periodontal bacteria, which cause systemic inflammation can contribute to neuroinflammation and finally ADHD. Although both diseases are characterized by inflammation, the specific pathways and crosslink's between periodontitis and ADHD remain unknown. Here, the authors describe the inflammatory elements of periodontitis, how this dental illness causes systemic inflammation, and how this systemic inflammation contributes to deteriorating neuroinflammation in the evolution of ADHD. Therefore, the aim of this review is to present possible links and mechanisms that could confirm the evidence of this association.

Impact of Three Nonsurgical, Full-Mouth Periodontal Treatments on Total Bacterial Load and Selected Pathobionts

For the treatment of periodontitis stage III/IV, a quadrant/week-wise debridement (Q-SRP) was compared with three full-mouth approaches: full-mouth scaling (FMS, accelerated Q-SRP within 24 h), full-mouth scaling with chlorhexidine-based disinfection (FMD), and FMD with adjuvant erythritol air polishing (FMDAP). The objective of this prospective, randomized study (a substudy of ClinicalTrials.gov, identifier: NCT03509233) was to compare the clinical and microbiological effects of the treatments. In total, 105 patients were randomized to one of the four aforementioned treatment groups, with n = 25, 28, 27, and 25 patients allocated to each group, respectively. At baseline and 3 and 6 months after treatment, the clinical parameters, including the pocket probing depths, clinical attachment level, and bleeding on probing, were recorded, and the prevalence of the total bacteria and four periodontal pathobionts (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Tannerella forsythia) was determined using real-time quantitative PCR. Concerning the clinical outcomes, all the treatment modalities were effective, but the full-mouth approaches, especially FMDAP, were slightly superior to Q-SRP. Using the FMD approach, the reduction in the bacterial load and the number of pathobionts was significantly greater than for FMS, followed by Q-SRP. FMDAP was the least effective protocol for microbial reduction. However, after a temporary increase 3 months after therapy using FMDAP, a significant decrease in the key pathogen, P. gingivalis, was observed. These findings were not consistent with the clinical results from the FMDAP group. In conclusion, the dynamics of bacterial colonization do not necessarily correlate with clinical outcomes after full-mouth treatments for periodontitis stage III/IV.

P4 Medicine as a model for precision periodontal care

Objectives

P4 Medicine is based on a proactive approach for clinical patient care incorporating the four “pillars” of prediction, prevention, personalization, and participation for patient management. The purpose of this review is to demonstrate how the concepts of P4 medicine can be incorporated into the management of periodontal diseases (particularly periodontitis) termed P4 periodontics.

Methods

This is a narrative review that used current literature to explore how P4 periodontics can be aligned with the 2018 Classification of Periodontal Diseases, current periodontal treatment paradigms, and periodontal regenerative technologies.

Results

The proposed model of P4 periodontics is highly aligned with the 2018 Classification of Periodontal Diseases and represents a logical extension of this classification into treatment paradigms. Each stage of periodontitis can be related to a holistic approach to clinical management. The role of “big data” in future P4 periodontics is discussed and the concepts of a treat-to-target focus for treatment outcomes are proposed as part of personalized periodontics. Personalized regenerative and rejuvenative periodontal therapies will refocus our thinking from risk management to regenerative solutions to manage the effects of disease and aging.

Conclusions

P4 Periodontics allows us to focus not only on early prevention and intervention but also allow for personalized late-stage reversal of the disease trajectory and the use of personalized regenerative procedures to reconstruct damaged tissues and restore them to health.

Clinical Significance

P4 Periodontics is a novel means of viewing a holistic, integrative, and proactive approach to periodontal treatment.

Evidence-based Recommendations on Periodontal Practice and the Management of Periodontal Patients During and After the COVID-19 Era: Challenging Infectious Diseases Spread by Airborne Transmission

Background:

Periodontal care, which was completely suspended during the peak of the SARS-Cov-2 pandemic and was delayed and recurrently discontinued during the succeeding waves, must be safely provided in the COVID-19 era.

Objectives:

The study aimed to provide recommendations on periodontal practice, optimizing safety, ergonomics, and economic resources, and the management of periodontal patients, ensuring continuity, timing, and effectiveness of periodontal care in the COVID-19 era.

Methods:

Reported protocols for the dental practice in the context of the COVID-19 and current evidence on periodontitis treatment and prevention were reviewed.

Results:

Evidence-based recommendations on contamination control and ergonomic improvements for periodontal practice and the management of periodontal patients challenging COVID-19 and airborne infectious diseases have been provided.

Conclusion:

Due to the economic, ergonomic, and ethical concerns raised by limited periodontal care due to the SARS-Cov-2 pandemic, and awareness of other emerging airborne transmitted infections, the periodontal practice should integrate measures minimizing airborne cross-infections and optimizing time-space and economic resources. The management of periodontal patients in the COVID-19 era should comprise less complex treatments and more comprehensive and definitive approaches, reducing emergencies, session length and number, and, concurrently, extending the recall and maintenance intervals. Moreover, it should implement prevention strategies through teledentistry tools and apps, improving periodontal awareness and self-care, and also through the self-reporting of periodontitis and periodontal risk assessment tools, performing both “population-based” and “high-risk” surveillance of periodontitis. Finally, it should enhance inter-professional collaboration, through telehealth networks, especially targeting subjects at high-risk of both periodontitis and systemic disorders, each of the two variously linked to COVID-19 onset and worsening.

Innovations in Craniofacial Bone and Periodontal Tissue Engineering - From Electrospinning to Converged Biofabrication

From a materials perspective, the pillars for the development of clinically translatable scaffold-based strategies for craniomaxillofacial (CMF) bone and periodontal regeneration have included electrospinning and 3D printing (biofabrication) technologies. Here, we offer a detailed analysis of the latest innovations in 3D (bio)printing strategies for CMF bone and periodontal regeneration and provide future directions envisioning the development of advanced 3D architectures for successful clinical translation. First, the principles of electrospinning applied to the generation of biodegradable scaffolds are discussed. Next, we present on extrusion-based 3D printing technologies with a focus on creating scaffolds with improved regenerative capacity. In addition, we offer a critical appraisal on 3D (bio)printing and multitechnology convergence to enable the reconstruction of CMF bones and periodontal tissues. As a future outlook, we highlight future directions associated with the utilization of complementary biomaterials and (bio)fabrication technologies for effective translation of personalized and functional scaffolds into the clinics.

Efficacy of Complex Phytoadaptogens as an Adjunct to Non-surgical Treatment of Chronic Periodontitis: A Randomized Clinical Trial

Background:

Many herbal formulas are used in dentistry in the complex treatment and prevention of periodontitis, but it is not always possible to achieve a long-term remission and stimulate regeneration of periodontal structures.

Aim:

The aim of this randomized clinical trial was to assess the efficacy of chronotherapy with complex phytoadaptogens (CFA) as an adjunct to non-surgical periodontal treatment (NSPT) and to achieve long-term remission.

Materials and Methods:

Forty systemically healthy patients with chronic generalized periodontitis (probing pocket depth ≥5 mm) were randomly divided into two groups: patients in one group received treatment with NSPT alone (group 2), whereas patients in another group received CFA in addition to NSPT (group 3). Twenty individuals with healthy periodontium (group 1) composed a control group. The clinical outcomes, Simplified Oral Hygiene Index (OHI-S), Sulcus Bleeding Index (SBI), Periodontal Index (PI), and Doppler ultrasound results, were assessed on baseline, after treatment, and 6 months after treatment.

Results:

There was a statistically significant difference between groups 2 and 3, in favor of group 3 in terms of microcirculation parameters—S (P = 0.03), M (P = 0.02), D (P = 0.03), and RI (P = 0.005); indicators of PI (P = 0.005), SBI (P = 0.03), and OHI-S (P = 0.006) were closer to the normal values during 6-month follow-up. Also there was a statistical difference (P < 0.05) at all time points compared with controls, for several parameters in intragroup comparison.

Conclusion:

The data obtained confirm the hypothesis that CFA application in chronic periodontitis treatment is more than appropriate for long-term prevention due to their immunomodulatory, anti-inflammatory, antioxidant, stress-limiting, chronotropic effects.

Oral Health Behaviour and Predictors of Oral Health Behaviour Among Patients With Diabetes in the Republic of Mauritius

OBJECTIVES

To investigate the oral care habits and assess the determinants of oral care behaviour among people with diabetes in the Republic of Mauritius.

METHODS

The present study draws on data collected from 589 dentate persons with diabetes by means of a close-ended questionnaire. Multivariate logistic regression analyses were used to estimate the association of different demographic and clinical factors with recommended dental hygiene practices.

RESULTS

The majority of the participants brushed at least twice daily (84.2%), never flossed (88.6%), attended dental clinics on need only (87.1%), and did not monitor their blood glucose levels regularly (69.9%). Neither awareness about the increased risk of periodontal disease and xerostomia nor receiving advice from diabetes care providers was found to be associated with good oral hygiene or increased service utilisation. The experience of oral diseases did not encourage recommended oral health practice, with participants without experience with periodontal disease being 3 times more likely to floss (odds ratio [OR], 2.9; P = .045). Regular dental visits were strongly associated with self-reported type 1 diabetes (OR, 7.8; P = .025). Participants from urban areas were more than twice as likely to visit their dental care provider at least once annually (OR, 2.3; P = .006). Regular dental attendance (OR, 3.7; P = .011) and flossing (OR, 4.5; P = .012) were strongly associated with one another.

CONCLUSION

There is widespread noncompliance with regular flossing and dental service utilisation. Our findings highlight the need for an emphasis on preventive care through the provision of integrated medical and dental interventions to high-risk individuals suffering from both diabetes and chronic periodontitis.

Individual predisposition and the intricate interplay between systemic biomarkers and periodontal risk in a general population

BACKGROUND

Increasing age is associated with systemic diseases as well as with periodontal diseases. We wondered whether a biological age score constructed exclusively from systemic biomarkers would reflect periodontal risk factors at baseline and tooth loss as well as periodontal outcome during 10 years follow-up.

METHODS

From the Study of Health in Pomerania (SHIP) 2256 participants (1072 male, 1184 female) were studied for the relationship of the systemic biomarkers glycated hemoglobin (HbA1c), low density lipoprotein cholesterol (LDL), fibrinogen, white blood cell count, blood pressure, and waist circumference to their age. Construction of a biological age (BA) score allowed its comparison with the participants' actual chronological age (CA) and their predisposition to periodontal disease.

RESULTS

Though nearly identical in CA, participants appearing younger than their true age had a significantly reduced burden of periodontal risk factors. If BA > CA, then risk factors were more frequent including smoking, oral hygiene, dental visits, education, and income. After 10 years, in participants with identical CA, tooth loss followed their BA calculated at baseline, that is, with BA > CA fewer teeth were preserved. Similarly, periodontal measures varied according to BA; sex differences were obvious. Most significant were BA-related differences in inflammatory and anthropometry parameters.

CONCLUSIONS

The results support the assumption that risk profiles aggregated in BA constitute a characteristic susceptibility pattern unique to each individual, common to both systemic and periodontal diseases. Although BA was constructed exclusively from systemic measures at baseline, BA reflects the oral conditions at follow-up.

Effects of Chlorine Dioxide on Oral Hygiene - A Systematic Review and Meta-analysis

Background

Effective and selective oral rinses are required in the daily medical and dental practice. Currently mouthwashes used have substantial side effects.

Objectives

Our aim was to evaluate the efficacy of chlorine dioxide-containing mouthwashes in comparison with other previously established mouth rinses in healthy adults using oral hygiene indices.

Methods

This work was registered in PROSPERO (CRD42018099059) and carried out using multiple databases and reported according to the PRISMA statement. The search terms used were “chlorine dioxide” AND “oral”, and only randomised controlled trials (RCTs) were included. The primary outcome was the alteration of the plaque index (PI), while the secondary outcomes were the gingival index (GI) and bacterial counts. For the risk of bias assessment, the Cochrane Risk of Bias Tool was used. Statistical analysis for data heterogeneity was performed by Q-value and I²-tests.

Results

364 articles were found in the databases. After the selection process, only five RCTs were eligible for meta-analysis. Data heterogeneity was low. There were no statistical differences in effectiveness between chlorine dioxide and other effective mouth rinses in PI (0.720±0.119 vs 0.745±0.131; 95%; confidence intervals (CIs): 0.487-0.952 vs 0.489-1.001, respectively) and GI (0.712±0.130 vs 0.745±0.131; 95% CIs: 0.457–0.967 vs 0.489–1.001, respectively) and also in bacterial counts.

Conclusion

Chlorine dioxide reduces both plaque and gingival indices and bacterial counts in the oral cavity similar to other routinely used oral rinses, however, the evidence supporting this outcome is very limited. Therefore, further large scale RCTs are needed to decrease the risk of bias.

The combined use of salivary biomarkers and clinical parameters to predict the outcome of scaling and root planing: A cohort study

AIM

To explore the application of the combined use of baseline salivary biomarkers and clinical parameters in predicting the outcome of scaling and root planing (SRP).

MATERIALS AND METHODS

Forty patients with advanced periodontitis were included. Baseline saliva samples were analysed for interleukin-1β (IL-1β), matrix metalloproteinase-8 and the loads of Porphyromonas gingivalis, Prevotella intermedia, Aggregatibacter actinomycetemcomitans and Tannerella forsythia. After SRP, pocket closure and further attachment loss at 6 months post-treatment were chosen as outcome variables. Models to predict the outcomes were established by generalized estimating equations.

RESULTS

The combined use of baseline clinical attachment level (CAL), site location and IL-1β (area under the curve [AUC] = 0.764) better predicted pocket closure than probing depth (AUC = 0.672), CAL (AUC = 0.679), site location (AUC = 0.654) or IL-1β (AUC = 0.579) alone. The combination of site location, tooth loss, percentage of deep pockets, detection of A. actinomycetemcomitans and T. forsythia load (AUC = 0.842) better predicted further clinical attachment loss than site location (AUC = 0.715), tooth loss (AUC = 0.530), percentage of deep pockets (AUC = 0.659) or T. forsythia load (AUC = 0.647) alone.

CONCLUSION

The combination of baseline salivary biomarkers and clinical parameters better predicted SRP outcomes than each alone. The current study indicates the possible usefulness of salivary biomarkers in addition to tooth-related parameters in predicting SRP outcomes.

Expression profile of lipoxygenases in gingival tissues of human periodontitis

OBJECTIVES

This study aimed to clarify the expression profile and significance of lipoxygenases in periodontitis.

MATERIALS AND METHODS

The mRNA levels of lipoxygenases in gingival tissues from 14 patients with periodontitis and 14 healthy individuals were determined by real-time PCR, and validated in datasets, GSE16134 and GSE10334, and by Western blotting. Correlation of differentially expressed lipoxygenases with clinical parameters and expression of tumor necrosis factor-α (TNF-α), interleukin-1β, matrix metalloproteinase (MMP)-8, MMP-9, and receptor activator of nuclear factor-κB ligand (RANKL) was investigated in patients with periodontitis by Spearman's correlation analysis.

RESULTS

The expression of ALOX5 (2.1-fold, p < .05), ALOX12B (2.9-fold, p < .001), and ALOX15B (9.4-fold, p < .001) was upregulated in gingival tissues from patients with periodontitis, which was validated by dataset analysis and Western blotting. Positive correlations were observed between ALOX5 and probing depth, and ALOX15B and probing depth and clinical attachment loss. Furthermore, ALOX5 expression was positively correlated with TNF-α, MMP-8, MMP-9, and RANKL expression, and ALOX15B was positively correlated with MMP-8 and RANKL.

CONCLUSIONS

Our findings indicated the upregulation of ALOX5 and ALOX15B in periodontitis and suggested that ALOX5 and ALOX15B may be involved in periodontitis pathogenesis, including inflammation, connective tissue destruction, and abnormal bone metabolism.

Immunomodulatory Properties of Stem Cells in Periodontitis: Current Status and Future Prospective

Periodontitis is the sixth-most prevalent chronic inflammatory disease and gradually devastates tooth-supporting tissue. The complexity of periodontal tissue and the local inflammatory microenvironment poses great challenges to tissue repair. Recently, stem cells have been considered a promising strategy to treat tissue damage and inflammation because of their remarkable properties, including stemness, proliferation, migration, multilineage differentiation, and immunomodulation. Several varieties of stem cells can potentially be applied to periodontal regeneration, including dental mesenchymal stem cells (DMSCs), nonodontogenic stem cells, and induced pluripotent stem cells (iPSCs). In particular, these stem cells possess extensive immunoregulatory capacities. In periodontitis, these cells can exert anti-inflammatory effects and regenerate the periodontium. Stem cells derived from infected tissue possess typical stem cell characteristics with lower immunogenicity and immunosuppression. Several studies have demonstrated that these cells can also regenerate the periodontium. Furthermore, the interaction of stem cells with the surrounding infected microenvironment is critical to periodontal tissue repair. Though the immunomodulatory capabilities of stem cells are not entirely clarified, they show promise for therapeutic application in periodontitis. Here, we summarize the potential of stem cells for periodontium regeneration in periodontitis and focus on their characteristics and immunomodulatory properties as well as challenges and perspectives.

Strong antimicrobial activity of collinin and isocollinin against periodontal and superinfectant pathogens in vitro

Periodontitis pathogenesis involves activation of host immune responses triggered by microbial dysbiosis. Therefore, controlling periodontal pathogens in-vivo is a main goal of periodontal therapy. New antimicrobials might help to control periodontal infection and improve treatment outcomes at "the dark times" of increasing antibiotic resistance. Here, we determined the biological activity of collinin and isocollinin against 8 bacterial strains. Antimicrobial activity of collinin and isocollinin, chlorhexidine digluconate (CHX) and sodium hypochlorite (NaClO) was evaluated against clinically relevant periodontal bacteria, like Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Fusobacterium nucleatum, Prevotella intermedia, Dialister pneumosintes strains and superinfectants like Escherichia coli, Staphylococcusaureus, and Pseudomonasaeruginosa strains. A broth microdilution test was carried out to determine the minimum inhibitory concentration of collinin and isocollinin against those strains, and bacterial viability was determined by resazurin assay at diverse concentration and exposure times. P. gingivalis was the most susceptible strain to collinin and isocollinin (MIC 2.1 μg/mL and 4.2 μg/mL respectively). Other periodontal pathogens showed MICs <17 μg/mL for collinin and MICs between 20 and 42 μg/mL for isocollinin, whereas CHX and NaClO showed MICs of 62 and 326 μg/mL, respectively. Collinin and isocollinin also exhibited antimicrobial activity against superinfectant bacteria (MIC < 21 and < 42 μg/mL, respectively). Overall, collinin and isocollinin showed a remarkable antibacterial activity against relevant periodontal and superinfective bacteria, especially against P. gingivalis (MIC 2.1 μg/mL and 4.2 μg/mL respectively) and the highly virulent P. aeruginosa (MIC 5.2 and 20.8 μg/mL, respectively).

Genomics of periodontal disease and tooth morbidity

In this review we critically summarize the evidence base and the progress to date regarding the genomic basis of periodontal disease and tooth morbidity (ie, dental caries and tooth loss), and discuss future applications and research directions in the context of precision oral health and care. Evidence for these oral/dental traits from genome-wide association studies first emerged less than a decade ago. Basic and translational research activities in this domain are now under way by multiple groups around the world. Key departure points in the oral health genomics discourse are: (a) some heritable variation exists for periodontal and dental diseases; (b) the environmental component (eg, social determinants of health and behavioral risk factors) has a major influence on the population distribution but probably interacts with factors of innate susceptibility at the person-level; (c) sizeable, multi-ethnic, well-characterized samples or cohorts with high-quality measures on oral health outcomes and genomics information are required to make decisive discoveries; (d) challenges remain in the measurement of oral health and disease, with current periodontitis and dental caries traits capturing only a part of the health-disease continuum, and are little or not informed by the underlying biology; (e) the substantial individual heterogeneity that exists in the clinical presentation and lifetime trajectory of oral disease can be identified and leveraged in a precision medicine framework or, if unappreciated, can hamper translational efforts. In this review we discuss how composite or biologically informed traits may offer improvements over clinically defined ones for the genomic interrogation of oral diseases. We demonstrate the utility of the results of genome-wide association studies for the development and testing of a genetic risk score for severe periodontitis. We conclude that exciting opportunities lie ahead for improvements in the oral health of individual patients and populations via advances in our understanding of the genomic basis of oral health and disease. The pace of new discoveries and their equitable translation to practice will largely depend on investments in the education and training of the oral health care workforce, basic and population research, and sustained collaborative efforts..

Lifestyle and periodontitis: The emergence of personalized periodontics

Personalized medicine is a medical model that involves the tailoring of healthcare - with medical decisions, practices, and/or products being customized to an individual patient. In this model, diagnostic testing is often employed for selecting appropriate and optimal therapies based on the context of a patient's genetic content or other epidemiologic, sociologic, molecular, physiologic, or cellular analyses. With the advent of major advances in periodontal medicine, including genomic discoveries and greater understanding of the multifactorial nature of periodontitis, it seems that the time is ripe to use personalized medicine as a model for personalized periodontics. This volume of Periodontology 2000 explores how new advances in our understanding of periodontitis within a medical model can evolve into new treatment strategies tailor-made for individual patients and not merely based on wholesale treatment paradigms.

Influence of the Local and Systemic Oxidative Stress on Periodontitis: Role of Antioxidant Therapy

This study was divided into experimental part of study which was conducted on 75 Wistar rats with the modeled periodontitis and and clinical part of research which included 106 patients with the chronic generalized periodontitis (CGP). The study established an importance of the oxidative stress (both local and systemic) in development and progress of the disease. It is found out that the saliva of rats with the modeled periodontitis there is the reliable increase in the content of total protein, alkaline phosphatase (ALP) and malonic dialdehyde (MDA) in 1.2, 2.6 and 2.8 times respectively, with the reduced activity of catalase in 2.5 times (all p<0.05). It is determined that the gingiva tissue of rats with the modeled periodontitis has the reduced contents of total protein, collagen, elastin and sulfated glycosaminoglycans in 2.8, 1.5, 1.6 and 1.3 times respectively (all p<0.05). It is proved that the antioxidant (AO) therapy normalizes in the rat saliva the content of protein and MDA (decrease in 1,2 and 1,8 times accordingly, p<0.05) and increases the activity of catalase (in 2.5 times, p<0,05). Calcium D3 normalizes the protein content and activity of ALP (decrease in 1.2 and 1.5 times, respectively, p<0.05).

It is found out that the saliva of patients with CGP in the acute phase the content of protein, ALP and MDA increases in 1.9, 2.2 and 1.5 times accordingly (p<0,05) with the reduced catalase activity in 1,1 times (p<0,05). It is revealed that the inclusion of CGP patents in AO complex therapy results jointly with the best clinical effect in the more expressed reduction in generation of reactive oxygen species and lipid peroxidation and also the increased plasma APA.