Periodontal diseases and adverse pregnancy outcomes: Mechanisms

Can oral microbiome predict low birth weight infant delivery?

OBJECTIVES

This study aimed to identify the oral microbiota factors contributing to low birth weight (LBW) in Chinese pregnant women and develop a prediction model using machine learning.

METHODS

A nested case-control study was conducted in a prospective cohort of 580 Chinese pregnant women, with 23 LBW cases and 23 healthy delivery controls matched for age and smoking habit. Saliva samples were collected at early and late pregnancy, and microbiome profiles were analyzed through 16S rRNA gene sequencing.

RESULTS

The relative abundance of Streptococcus was over-represented (median 0.259 vs. 0.116) and Saccharibacteria_TM7 was under-represented (median 0.033 vs. 0.068) in the LBW case group than in controls (p < 0.001, p = 0.015 respectively). Ten species were identified as microbiome biomarkers of LBW by LEfSe analysis, which included 7 species within the genus of Streptococcus or as part of 'nutritionally variant streptococci' (NVS), 2 species of opportunistic pathogen Leptotrichia buccalis and Gemella sanguinis (all LDA score>3.5) as risk biomarkers, and one species of Saccharibacteria TM7 as a beneficial biomarker (LDA= -4.5). The machine-learning model based on these 10 distinguished oral microbiota species could predict LBW, with an accuracy of 82 %, sensitivity of 91 %, and specificity of 73 % (AUC-ROC score 0.89, 95 % CI: 0.75-1.0). Results of α-diversity showed that mothers who delivered LBW infants had less stable salivary microbiota construction throughout pregnancy than the control group (measured by Shannon, p = 0.048; and Pielou's, p = 0.021), however the microbiome diversity did not improve the prediction accuracy of LBW.

CONCLUSIONS

A machine-learning oral microbiome model shows promise in predicting low-birth-weight delivery. Even in cases where oral health is not significantly compromised, opportunistic pathogens or rarer taxa associated with adverse pregnancy outcomes can still be identified in the oral cavity.

CLINICAL SIGNIFICANCE

This study highlights the potential complexity of the relationship between oral microbiome and pregnancy outcomes, indicating that mechanisms underlying the association between oral microbiota and adverse pregnancy outcomes may involve complex interactions between host factors, microbiota, and systemic conditions. Using machine learning to develop a predictive model based on specific oral microbiota biomarkers provides a potential for personalized medicine approaches. Future prediction models should incorporate clinical metadata to be clinically useful for improving maternal and child health.

Fusobacterium nucleatum-infected periodontitis promotes renal interstitial fibrosis in rats through the TGF-β/SMAD2/3 and β-catenin signaling pathways

OBJECTIVES

Periodontitis is associated with Fusobacterium nucleatum (F.n) infection. Although the colonization of renal tissue by F.n is well documented, its specific role in kidney disease has yet to be determined. This study aimed to investigate the potential association between F.n-induced periodontitis and renal interstitial fibrosis.

METHODS

The rat gingival sulcus was injected with F.n suspension, while the control group (NC) was injected with PBS. The levels of total protein (TP), albumin (ALB), creatinine, and urea nitrogen (BUN) in rat serum and/or urine were quantified using the appropriate kits. Renal interstitial fibrosis and epithelial-mesenchymal transition (EMT) were evaluated in rats using Masson staining, Periodic Schiff-Methenamine (PASM) staining, and immunohistochemical staining. The levels of fibrosis- and EMT-related proteins and the TGF-β/SMAD2/3 and β-catenin signaling pathways were determined using Western blot analysis. F.n in the kidney tissues was quantitatively determined using bacterial 16S rRNA technology.

RESULTS

Serum levels of TP, ALB, creatinine, and BUN were not significantly decreased in F.n-infected rats with periodontitis. The levels of creatinine and ALB in the urine were not statistically different between two groups. Masson and PASM staining showed that F.n-induced periodontitis could promote renal interstitial fibrosis in rats. The levels of collagen I, fibronectin (FN), vimentin, and α-SMA were upregulated in the kidney tissues of rats with F.n-induced periodontitis and in F.n-treated HK-2 cells. However, E-cadherin levels were reduced. F.n promoted renal interstitial and HK-2 cell fibrosis in rats by modulating the TGF-β/SMAD2/3 and β-catenin signaling pathways. F.n colonization increased renal interstitial fibrosis in rats.

CONCLUSION

F.n-induced periodontitis promoted EMT by activating the TGF-β/SMAD2/3 and β-catenin signaling pathways, thus promoting renal interstitial fibrosis in rats.

A prospective study on maternal periodontal diseases and neonatal adverse outcomes

OBJECTIVE

It is evident that periodontitis is linked to various adverse pregnancy outcomes. This prospective study explored the potential link of maternal periodontal diseases to neonatal adverse outcomes.

MATERIALS AND METHODS

A total of 193 generally healthy females in their third trimester (34-36 weeks) of pregnancy were enrolled. All subjects received full-mouth periodontal assessment, and the periodontal inflamed surface area (PISA) was calculated. Demographic data, lifestyles and anthropometric measurements of the neonates (e.g., body length and head circumference) were recorded. Herein, small-for-gestational age (SGA) referred to gender- and age-adjusted birth weight below the 10th percentile in line with the standard reference. Multivariable logistic regression analysis and restricted cubic spline were performed for examining the association of periodontal parameters with SGA.  Results: There were 8.3% (16/193) of neonates with SGA. Significantly positive correlation existed between the percentage of tooth sites with increased probing depth and an elevated risk of SGA (OR: 1.052; P < 0.05). Yet, the PISA was positively associated with the risk of SGA (OR: 1.002; P < 0.05) as well. No significant link occurred between maternal periodontal status and other neonatal outcome measures.

CONCLUSION

Within the limitations of this study, the findings suggest that there could be a link between maternal periodontal diseases and neonatal adverse outcomes like SGA. Further investigation is required to clarify the current findings and potential implications for promoting maternal oral/periodontal health and newborn health.

Long intergenic non-coding RNA 01126 activates IL-6/JAK2/STAT3 pathway to promote periodontitis pathogenesis

OBJECTIVES

Periodontitis seriously affects oral-related quality of life and overall health. Long intergenic non-coding RNA 01126 (LINC01126) is aberrantly expressed in periodontitis tissues. This study aimed to explore the possible pathogenesis of LINC01126 in periodontitis.

METHODS

Inflammatory model of human gingival fibroblasts (HGFs) was established. Cell Counting Kit-8 (CCK-8), wound healing assay, and flow cytometry were utilized to detect biological roles of LINC01126. Binding site of miR-655-3p to LINC01126 and IL-6 was predicted. Then, subcellular localization of LINC01126 and the binding ability of miR-655-3p to LINC01126 and IL-6 in HGFs were verified. Hematoxylin-Eosin (H&E) staining and immunohistochemistry (IHC) staining were utilized to detect tissue morphology and proteins expression of clinical samples.

RESULTS

LINC01126 silencing can alleviate cell inflammation induced by lipopolysaccharide derived from Porphyromonas gingivalis, reduce cell apoptosis, and promote cell migration. As a "sponge" for miR-655-3p, LINC01126 inhibits its binding to mRNA of IL-6, thereby promoting inflammation progression and JAK2/STAT3 pathway activation. Quantitative real-time PCR, Western Blot, and IHC results of clinical tissue samples further confirmed that miR-655-3p expression was down-regulated and IL-6/JAK2/STAT3 was abnormally activated in periodontitis tissues.

CONCLUSIONS

In summary, serving as an endogenous competitive RNA of miR-655-3p, LINC01126 promotes IL-6/JAK2/STAT3 pathway activation, thereby promoting periodontitis pathogenesis.

Association Between Periodontitis and Adverse Pregnancy Outcomes: Two-Sample Mendelian Randomisation Study

AIM

This Mendelian randomisation (MR) study endeavoured to delineate the causal relationship between periodontitis and adverse pregnancy outcomes (APOs), encompassing low birthweight (LBW), pre-term birth (PTB), stillbirth, miscarriage, and gestational hypertension (GH).

METHODS

Utilising genetic instruments for periodontitis (acute and chronic periodontitis) from the Genome-Wide Association Study (GWAS) database among individuals of European descent, this study explored the causal relationship with adverse pregnancy outcomes, and vice versa. The Inverse Variance Weighted (IVW) method was employed as the primary analytical approach to assess causality, with MR-Egger serving as a sensitivity analysis method.

RESULTS

The primary analytical method employed in this study, IVW, did not reveal any impact of periodontitis (acute and chronic periodontitis) on PTB, stillbirth, miscarriage, and gestational hypertension, and vice versa. Heterogeneity testing using the MR-Egger method confirmed the null causal hypothesis, with odds ratios (OR) approximating 1, and P-values exceeding 0.05. Notably, the results from the IVW analysis (OR 1.410, CI 1.039-1.915, P-value 0.028) indicate statistically significant evidence supporting a causal relationship between chronic periodontitis and LBW. However, caution is advised in interpreting the causal relationship, considering the non-significant P-values obtained from other methods.

CONCLUSION

Within the limitations of this MR study, the findings do not support the influence of periodontitis on LBW, PTB, stillbirth, miscarriage, and GH, nor vice versa.

Periodontopathogen-Related Cell Autophagy-A Double-Edged Sword

The periodontium is a highly organized ecosystem, and the imbalance between oral microorganisms and host defense leads to periodontal diseases. The periodontal pathogens, mainly Gram-negative anaerobic bacteria, colonize the periodontal niches or enter the blood circulation, resulting in periodontal tissue destruction and distal organ damage. This phenomenon links periodontitis with various systemic conditions, including cardiovascular diseases, malignant tumors, steatohepatitis, and Alzheimer's disease. Autophagy is an evolutionarily conserved cellular self-degradation process essential for eliminating internalized pathogens. Nowadays, increasing studies have been carried out in cells derived from periodontal tissues, immune system, and distant organs to investigate the relationship between periodontal pathogen infection and autophagy-related activities. On one hand, as a vital part of innate and adaptive immunity, autophagy actively participates in host resistance to periodontal bacterial infection. On the other, certain periodontal pathogens exploit autophagic vesicles or pathways to evade immune surveillance, therefore achieving survival within host cells. This review provides an overview of the autophagy process and focuses on periodontopathogen-related autophagy and their involvements in cells of different tissue origins, so as to comprehensively understand the role of autophagy in the occurrence and development of periodontal diseases and various periodontitis-associated systemic illnesses.

Periodontitis and the risk of oral cancer: a meta-analysis of case-control studies

OBJECTIVE

The current studies have yielded inconclusive findings regarding the connection between periodontitis  and oral cancer (OC). Therefore, our goal is to elucidate this relationship.

MATERIALS AND METHODS

We conducted a thorough search of electronic databases (EMBASE, PubMed, Web of Science, and Cochrane Library) up to September 2023. The Newcastle-Ottawa Scale (NOS) was applied to assess study quality. To evaluate potential publication bias, both a funnel plot and Egger's test were employed. Additionally, a sensitivity analysis was conducted to explore the source of heterogeneity when the I2 statistic exceeded 50%.

RESULTS

This systematic review encompassed 16 studies, involving a total of 6,032 OC patients and 7,432 healthy controls. Our meta-analysis, incorporating data from nine studies, revealed a significant correlation between periodontitis and the risk of OC (OR [odds ratio] = 2.94, 95% CI [confidence interval] (2.13, 4.07); five studies, 6,927 participants; low certainty of evidence). Findings also suggested that individuals with more than 15 missing teeth may have a heightened risk of OC (OR = 1.91, 95% CI (1.01, 3.62)). Furthermore, clinical attachment loss (CAL) and decayed, missing, and filled teeth (DMFT) in OC patients were more pronounced compared to the control group (CAL, SMD = 1.94, 95% CI (0.22, 3.66); DMFT, SMD = 0.65, 95% CI (0.12, 1.18)).

CONCLUSION

Periodontitis may serve as a potential risk factor for OC. However, caution is warranted in interpreting these findings due to the substantial level of heterogeneity.

Maternal periodontal diseases affect the leukocyte profiles of umbilical cord blood: A cohort study

AIM

This study evaluated the connection of periodontal status with the leukocyte profiles of maternal peripheral blood (MPB) and umbilical cord blood (UCB).

MATERIALS AND METHODS

Ninety-nine pregnant females were recruited, and their data were collected via questionnaire and from medical records, including demographics, systemic conditions, complete blood count (CBC) and C-reaction protein (CRP) level in MPB. Full-mouth periodontal assessment was performed. CBC and CRP levels in UCB were measured after parturition.

RESULTS

All subjects and their neonates were generally healthy. 30.3% of the participants presented with periodontal health condition, whereas 69.7% had different severities of periodontal diseases. The counts/percentages of eosinophils and monocytes in UCB from the subjects with periodontal diseases elevated, and the percentage of neutrophils decreased referencing to that from the counterparts (p < 0.05). There were positive correlations for total leukocyte count, neutrophils and lymphocytes counts/percentages in MPB and UCB among the periodontally healthy subjects (r > 0.4, p < 0.05), but such findings did not exist in those with periodontal diseases. Moreover, periodontal diseases independently accounted for the counts/percentages of neutrophils and eosinophils in UCB after controlling confounders in four testing models (ANCOVA, p < 0.05).

CONCLUSION

Maternal periodontal diseases could to some extent disturb the leukocyte profiles of umbilical cord blood.

Fusobacterium nucleatum: An Overview of Evidence, Demi-Decadal Trends, and Its Role in Adverse Pregnancy Outcomes and Various Gynecological Diseases, including Cancers

Gynecological and obstetric infectious diseases are crucial to women's health. There is growing evidence that links the presence of Fusobacterium nucleatum (F. nucleatum), an anaerobic oral commensal and potential periodontal pathogen, to the development and progression of various human diseases, including cancers. While the role of this opportunistic oral pathogen has been extensively studied in colorectal cancer in recent years, research on its epidemiological evidence and mechanistic link to gynecological diseases (GDs) is still ongoing. Thus, the present review, which is the first of its kind, aims to undertake a comprehensive and critical reappraisal of F. nucleatum, including the genetics and mechanistic role in promoting adverse pregnancy outcomes (APOs) and various GDs, including cancers. Additionally, this review discusses new conceptual advances that link the immunomodulatory role of F. nucleatum to the development and progression of breast, ovarian, endometrial, and cervical carcinomas through the activation of various direct and indirect signaling pathways. However, further studies are needed to explore and elucidate the highly dynamic process of host-F. nucleatum interactions and discover new pathways, which will pave the way for the development of better preventive and therapeutic strategies against this pathobiont.

Oral Microbiota of Infants in Maternal Gestational Diabetes: A Systematic Review

Gestational diabetes mellitus (GDM) affects approximately 5-20% of pregnant women and is associated with adverse pregnancy outcomes. This review aimed to assess whether the oral microbiota of infants and their mothers with GDM had a different composition from that found in unaffected women and offspring. PubMed, Embase, Scopus, and Google Scholar were searched in December 2023 after protocol registration in the International Prospective Register of Systematic Reviews (CRD42023406505). Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tools. Overall, 1113 articles were identified; after evaluating the full texts, 12 papers were included in the qualitative analysis. In six studies of the eight included, significant differences in microbiota between M-GDM and M-nGDM were found. In four studies, a depletion of Firmicutes and an enrichment of Proteobacteria was found in the microbiota of infants. Since all included studies were judged to have high risk of bias, a quantitative synthesis of the results was not carried out. In conclusion, although the oral microbiota of infants from mothers with GDM could be different from that of infants from mothers without GDM, there is insufficient evidence to clarify this aspect so far.

Parental concerns about oral health of children: Is ChatGPT helpful in finding appropriate answers?

INTRODUCTION

Artificial intelligence (AI) is becoming an important part of our lives owing to increased data availability and improved power of computing. One of the recently launched modalities of AI, ChatGPT, is being enormously used worldwide for different types of tasks. In medical context, its use is being explored for clinical queries, academia, research help, etc. Further, literature suggests that parents seek information about health of their children using different Internet resources and would surely turn toward ChatGPT for the same, as this chatbot model is easy to use, generates "one" response, and is available without any subscription. ChatGPT generates a response using text cues and applying different algorithms on prepublished literature but is still in its naïve state; hence, it is imperative to validate the generated responses. Accordingly, we planned this study to determine the clarity, correctness, and completeness of some Frequently asked questions (FAQs) about child's oral health, from a mother's perspective.

METHODS

The study design was a vignette-based survey and included a set of 23 questions, for which ChatGPT was interviewed from the perspective of an imaginary parent. The answers responded by ChatGPT were copied "verbatim," and a Google survey form was designed. The survey form was validated and then sent to 15 pediatric dentists, and the responses were mainly collected on the Likert's scale with a provision of one open-ended question aiming to determine "what they would have added" to this generated response as an expert in the field.

RESULTS

The responses on Likert's scale were condensed and values ≥4 were considered 'adequate and acceptable' while scores ≤3, were considered 'inadequate'. The generated responses and comments mentioned by different respondents in the open-ended question were critiqued in reference to the existing literature.

CONCLUSION

Overall, the responses were found to be complete and logical and in clear language, with only some inadequacies being reported in few of the answers.

The NFκB Signaling Pathway Is Involved in the Pathophysiological Process of Preeclampsia

The high prevalence of preeclampsia (PE) is a major cause of maternal and fetal mortality and affects the long-term prognosis of both mother and baby. Termination of pregnancy is currently the only effective treatment for PE, so there is an urgent need for research into its pathogenesis and the development of new therapeutic approaches. The NFκB family of transcription factors has an essential role in inflammation and innate immunity. In this review, we summarize the role of NFκB in normal and preeclampsia pregnancies, the role of NFκB in existing treatment strategies, and potential NFκB treatment strategies.

The Impact of Periodontal Disease on Preterm Birth and Preeclampsia

This review delves into the possible connection between periodontitis and negative pregnancy outcomes, such as preeclampsia and preterm birth. It highlights the potential influence of an unidentified microbial factor on preeclampsia and the effects of inflammatory responses on the rate of preterm births. Furthermore, it underscores the prevalent occurrence of oral ailments within the populace and their significant repercussions on quality of life. Hormonal fluctuations during pregnancy may exacerbate oral conditions such as pregnancy gingivitis and periodontitis, necessitating bespoke therapeutic approaches that take into account potential fetal ramifications. Periodontal disease, characterized by microbial attack and inflammatory response, results in tissue destruction and tooth loss. The oral cavity's susceptibility to bacterial colonization, which is primarily due to its role as a site for food intake, is highlighted. Furthermore, research indicates a correlation between inflammatory responses and factors such as prostaglandin E2 and IL-1β, and preterm birth. Therapeutic interventions are a focus of international research, with efforts being aimed at optimizing outcomes through larger studies involving pregnant women.

Comparative Evaluation and Correlation of Periodontal Status With Inflammatory Markers in Pregnant Women With or Without Chronic Periodontitis: A Clinico-Hematological Study

Background The research delves into the intricate relationship between periodontal health and specific blood biomarkers in pregnant women during their second trimester. It specifically focuses on the levels of interleukin-6 (IL-6), lactate dehydrogenase (LDH), and C-reactive protein (CRP) in those suffering from chronic periodontitis compared to healthy controls. Methodology A detailed approach was taken involving 60 pregnant women categorized into two groups based on the presence or absence of chronic periodontitis. Out of 60 pregnant women, 30 had chronic periodontitis, while the other 30 served as controls selected from the regular patient population of the college. The study utilized blood sample analysis and advanced statistical tools for data analysis, ensuring precise and reliable results. Levels of IL-6, LDH, and CRP in those suffering from chronic periodontitis compared to healthy controls were checked. Results The findings revealed a notable variance in IL-6, LDH, and CRP levels between the two groups. Women with chronic periodontitis exhibited significantly higher levels of these biomarkers. The statistical analysis reinforced the validity of these differences, highlighting their significance. Conclusions The study underscored a clear link between higher levels of IL-6, LDH, and CRP and the presence of chronic periodontitis in pregnant women. These biomarkers emerge as potential indicators for early detection and monitoring of periodontal health in this demographic.

Periodontitis links to concurrent metabolic disorders and abnormal liver function in pregnant women

OBJECTIVE

This cross-sectional study investigated the association of periodontitis with the metabolic status and hepatic function in pregnant women.

MATERIALS AND METHODS

Full-mouth periodontal conditions, metabolic profiles, and hepatic function were assessed in 219 self-reported healthy pregnant females. The association of periodontal status with the systemic parameters was evaluated by parametric and non-parametric tests, and multivariate logistic regression analysis.

RESULTS

Overall, periodontal status was positively associated with the metabolic profiles and hepatic function test results. The subjects with periodontitis exhibited higher levels of body mass index (BMI) (p < 0.01) and serum aspartate transaminase (AST) (p < 0.05), elevated diastolic blood pressure (DBP) (p < 0.05), and lower levels of high-density lipoprotein cholesterol (p < 0.05) than those of the counterparts. The periodontitis severity was strongly correlated with BMI and AST levels, and the extent of periodontal inflammation was related to DBP (p < 0.01). The periodontitis patients at 34-36 gestational weeks showed higher blood pressure and AST levels than those of non-periodontitis subjects (p < 0.05).

CONCLUSION

Our findings on the notable links of periodontitis to concurrent metabolic disorders and abnormal liver function in pregnant women highlight the need of proactive integration of regular periodontal screening and healthcare in maternal programs for promoting optimal health and wellbeing of mothers-to-be and newborns.

Pregnancy trained decidual NK cells protect pregnancies from harmful Fusobacterium nucleatum infection

Natural killer cells (NKs) found during pregnancy at the maternal-fetal interface named decidual (d)NKs, show signs of education following first pregnancy, resulting in better placentation and fetus-growth, hence termed pregnancy trained dNKs (PTdNKs). Here we show that PTdNKs provide increased protection of the fetus from Fusobacterium nucleatum (FN) infection. We demonstrate that PTdNKs secrete elevated amounts of the bacteriocidal protein granulysin (GNLY) upon incubation with FN compared to dNKs derived from first pregnancies, which leads to increased killing of FN. Furthermore, we showed mechanistically that the GNLY secretion is mediated through the interaction of the FN's Fap2 protein with Gal-GalNAc present on PTdNKs. Finally, we show in vivo, using GNLY-tg mice that enhanced protection of the fetuses from FN infection is observed, as compared to wild type and that this enhance protection is NK cell dependent. Altogether, we show a new function for PTdNKs as protectors of the fetus from bacterial infection.

Factors associated with periodontal diseases in pregnancy: Findings of the 2015 Pelotas Birth Cohort Study

Although periodontal disease is common during pregnancy, little is known about socioeconomic, behavioral, or biological determinants related to clinically assessed periodontal condition during this period. We assessed the prevalence of periodontal disease and associated factors in pregnant women. This population-based survey used data used from the 2015 Pelotas Birth Cohort Study, Brazil. Pregnant women expected to give birth between December 2014 and May 2016 were interviewed and clinically examined by trained dentist, with periodontal measures collected in all teeth, six sites per tooth. Outcomes were periodontitis (using the 2012 Centers for Disease Control and Prevention and the American Academy of Periodontology criteria) and gingivitis (by the 2018 European Federation of Periodontology/ American Academy of Periodontology classification). Multivariate hierarchical Poisson regression was used to assess the associations between socioeconomic, systemic, and clinical oral factors and periodontal disease. A total of 2,474 pregnant women participated in the study. Prevalence of periodontitis and gingivitis was 14.63% and 21.67%, respectively. Lower educational level and calculus were associated with higher prevalence periodontitis and gingivitis (P<0.05). Smoking was also associated with periodontitis (P=0.05), and lower frequency of toothbrushing (P=0.005) with gingivitis. Periodontal disease, especially gingivitis, was prevalent in pregnant women and their determinants were socioeconomic, environmental, and clinical oral health factors.

Oral Microbiome and Alzheimer's Disease

The accumulation of amyloid-beta plaques in the brain is a central pathological feature of Alzheimer's disease. It is believed that amyloid responses may be a result of the host immune response to pathogens in both the central nervous system and peripheral systems. Oral microbial dysbiosis is a chronic condition affecting more than 50% of older adults. Recent studies have linked oral microbial dysbiosis to a higher brain Aβ load and the development of Alzheimer's disease in humans. Moreover, the presence of an oral-derived and predominant microbiome has been identified in the brains of patients with Alzheimer's disease and other neurodegenerative diseases. Therefore, in this opinion article, we aim to provide a summary of studies on oral microbiomes that may contribute to the pathogenesis of the central nervous system in Alzheimer's disease.

The Salivary Microbiome During Pregnancy: Associations With Clinical and Sociodemographic Characteristics

PURPOSE

Poor oral health has been associated with adverse pregnancy outcomes, and the oral microbiome may play a role in these mechanisms. We aimed to examine the salivary microbiome for alterations in diversity or relative abundance throughout pregnancy and its associations with adverse pregnancy outcomes and sociodemographic characteristics.

STUDY DESIGN AND METHODS

We conducted an ancillary study from a previous cohort study of 37 women during their second and third trimesters of pregnancy using preexisting, participant-collected salivary samples to examine the oral microbiome using 16S rRNA sequencing.

RESULTS

The salivary microbiome demonstrated stability throughout pregnancy, as there were no significant differences in alpha or beta diversity. Individuals who were diagnosed with preeclampsia had differences in beta diversity at the genus level (F = 2.65, df = 1, P = .015). There were also differences in beta diversity at the species level in Hispanic individuals compared with non-Hispanic individuals (F = 1.7183, df = 1, P = .04).

CONCLUSION

The salivary microbiome demonstrated stability throughout the second and third trimesters but may be different in Hispanics or those diagnosed with preeclampsia. As such, clinical providers need to demonstrate culturally competent care during pregnancy and continue to educate women about the importance of oral healthcare during the perinatal period. Future research is needed to examine the mechanisms associated with oral microbiome dysbiosis in Hispanic women during pregnancy and in women with preeclampsia.

Dental Insurance Coverage, Dentist Visiting, and Oral Health Status among Asian Immigrant Women of Childbearing Age in Canada: A Comparative Study

OBJECTIVES

This study examined the dental insurance coverage, dentist visits, self-perceived oral health status, and dental problems among Asian immigrant women of childbearing age in contrast to Canadian women of childbearing age and non-Asian immigrant women of childbearing age. Potential barriers to dental care services among Asian immigrant women were explored.

METHODS

This analysis utilized data from the combined Canadian Community Health Survey from 2011 to 2014. The analytical sample consisted of 5737 females whose age was between 20 and 39 years. Multivariable logistic regression models assessed immigrant status and other factors in relation to the indicators of dental health (i.e., dental visit, self-perceived oral health, acute teeth issue, and teeth removed due to decay).

RESULTS

Amongst Asian women immigrants of childbearing age, there was a significantly lower frequency of dentist visits compared to non-immigrant counterparts (OR = 0.53; 95% CI: 0.37-0.76). The most commonly reported reason for not seeking dental care in the last three years was that the "respondent did not think it was necessary". Relative to Canadian born women of same age bracket, Asian women of childbearing age reported fewer acute teeth issues (OR = 0.67; 95% CI: 0.49-0.91) and had a greater risk of tooth extracted due to tooth decay (OR = 3.31; 95% CI: 1.64-6.68). Furthermore, for Asian women immigrants, their major barriers to dental care included low household income (≤$39,999 vs. $40,000-$79,999 OR = 0.26) and a lack of dental insurance (no vs. yes OR = 0.33).

CONCLUSIONS

Asian immigrant women showed lower utilization of dental services than non-immigrant women. A perceived lack of necessity, lower household income, and dental insurance coverage were major barriers to professional dental usage for most Asian immigrants of childbearing age.

Impact of local drug delivery and natural agents as new target strategies against periodontitis: new challenges for personalized therapeutic approach

Periodontitis is a persistent inflammation of the soft tissue around the teeth that affects 60% of the population in the globe. The self-maintenance of the inflammatory process can cause periodontal damage from the alveolar bone resorption to tooth loss in order to contrast the effects of periodontitis, the main therapy used is scaling and root planing (SRP). At the same time, studying the physiopathology of periodontitis has shown the possibility of using a local drug delivery system as an adjunctive therapy. Using local drug delivery devices in conjunction with SRP therapy for periodontitis is a potential tool since it increases drug efficacy and minimizes negative effects by managing drug release. This review emphasized how the use of local drug delivery agents and natural agents could be promising adjuvants for the treatment of periodontitis patients affected or not by cardiovascular disease, diabetes, and other system problems. Moreover, the review evidences the current issues and new ideas that can inspire potential later study for both basic research and clinical practice for a tailored approach.

Obesity is related to maternal periodontitis severity in pregnancy: a cross-sectional study

OBJECTIVES

To evaluate the relationship between obesity and periodontitis staging compared with periodontal healthy or gingivitis in pregnant women.

MATERIALS AND METHODS

An analytical cross-sectional study was conducted on pregnant women between 11 and 14 weeks of pregnancy. Sociodemographic, clinical, obstetric, and periodontal variables were studied. The exposure variable was obesity (body mass index [BMI] ≥ 30), and the primary outcome was periodontitis staging versus periodontal healthy/gingivitis. Data were analysed and estimated by multinomial logistic regression models.

RESULTS

The present study screened 1086 pregnancies and analysed 972 women with a median age of 29 years; 36.8% were diagnosed as obese. 26.9% of patients were diagnosed as periodontal healthy or gingivitis, 5.5% with stage I periodontitis, 38.6% with stage II periodontitis, 24% with stage III periodontitis, and 5.1% with stage IV periodontitis. After identifying and adjusting for confounding variables (educational level and plaque index), obesity had a relative risk ratio (RRR) of 1.66 (95% CI: 1.05-2.64; p = 0.03) and 1.57 (95% CI: 1.09-2.27; p = 0.015) for stage III periodontitis compared to periodontal healthy/gingivitis and stage II periodontitis, respectively.

CONCLUSION

Besides the already known risk indicators for periodontitis (age, smoking, and educational level), our study suggests a relationship between obesity and periodontitis staging in pregnancy.

CLINICAL RELEVANCE

Obesity can alter host immune responses, leading to increased susceptibility to infections and overactive host immunity, which could influence the prevalence and severity of maternal periodontitis in pregnancy.

The role of neutrophils in chorioamnionitis

Chorioamnionitis, commonly referred to as intrauterine infection or inflammation, is pathologically defined by neutrophil infiltration and inflammation at the maternal-fetal interface. Chorioamnionitis is the common complication during late pregnancy, which lead to a series of serious consequences, such as preterm labor, preterm premature rupture of the fetal membranes, and fetal inflammatory response syndrome. During infection, a large number of neutrophils migrate to the chorio-decidua in response to chemokines. Although neutrophils, a crucial part of innate immune cells, have strong anti-inflammatory properties, over-activating them can harm the body while also eliminating pathogens. This review concentrated on the latest studies on chorioamnionitis-related consequences as well as the function and malfunction of neutrophils. The release of neutrophil extracellular traps, production of reactive oxygen species, and degranulation from neutrophils during intrauterine infection, as well as their pathological roles in complications related to chorioamnionitis, were discussed in detail, offering fresh perspectives on the treatment of chorioamnionitis.

The Oral Microbiome Throughout Pregnancy: A Scoping Review

INTRODUCTION

Oral health is associated with systemic health, including adverse pregnancy outcomes. Understanding the oral microbiome during pregnancy may lead to targeted interventions for prevention of adverse outcomes. The purpose of this review is to examine the literature on the oral microbiome throughout pregnancy.

METHODS

We conducted a literature search with four electronic databases for original research conducted between 2012 and 2022 that examined the oral microbiome longitudinally using 16s rRNA sequencing during pregnancy.

RESULTS

We identified six studies that examined the oral microbiome longitudinally throughout pregnancy, though comparisons of oral niches, oral microbiome measures, and findings between studies were not consistent. Three studies identified alterations in alpha diversity throughout pregnancy and two studies identified increased pathogenic bacteria during pregnancy. Three studies reported no changes in the oral microbiome throughout pregnancy, and one study identified differences in the composition of the microbiome based on socioeconomic status and antibiotic exposure. Two studies examined adverse pregnancy outcomes in association with the oral microbiome, one reporting no associations and one reported difference in community gene composition in those diagnosed with preeclampsia.

CLINICAL IMPLICATIONS

There is limited research on the composition of the oral microbiome throughout pregnancy. There may be alterations in the oral microbiome during pregnancy such as increased relative abundance of pathogenic bacteria. Socioeconomic status, antibiotic use, and education may contribute to differences in the microbiome composition over time. Clinicians should evaluate oral health and educate on the importance of oral health care during the prenatal and perinatal time period.

Physiology of pregnancy and oral local anesthesia considerations

Background

Safe and effective local anesthesia is a prerequisite for emergency oral surgeries and most dental treatments. Pregnancy is characterized by complex physiological changes, and increased sensitivity to pain. Pregnant women are particularly vulnerable to oral diseases, such as caries, gingivitis, pyogenic granuloma and third molar pericoronitis. Maternally administered drugs can affect the fetus through the placenta. Therefore, many physicians and patients are reluctant to provide or accept necessary local anesthesia, which leads to delays in the condition and adverse consequences. This review is intended to comprehensively discuss the instructions for local anesthesia in the oral treatment of pregnant patients.

Methodology

An in-depth search on Medline, Embase, and the Cochrane Library was performed to review articles concerned with maternal and fetal physiology, local anesthetic pharmacology, and their applications for oral treatment.

Results

Standard oral local anesthesia is safe throughout the pregnancy. At present, 2% lidocaine with 1:200,000 epinephrine is considered to be the anesthetic agent that best balances safety and efficacy for pregnant women. Maternal and fetal considerations must be taken into account to accommodate the physiological and pharmacological changes in the gestation period. Semi-supine position, blood pressure monitoring, and reassurance are suggested for high-risk mothers to reduce the risk of transient changes in blood pressure, hypoxemia, and hypoglycemia. For patients with underlying diseases, such as eclampsia, hypertension, hypotension, and gestational diabetes, the physicians should use epinephrine cautiously and control the dose of anesthetic. New local anesthesia formulations and equipment, which contribute to minimizing injection pain and relieving the anxiety, have and are being developed but remain understudied.

Conclusions

Understanding the physiological and pharmacological changes during pregnancy is essential to ensure the safety and efficiency of local anesthesia. Optimal outcomes for the mother and fetus hinge on a robust understanding of the physiologic alterations and the appropriate selection of anesthetic drugs and approaches.

Prematurely delivering mothers show reductions of lachnospiraceae in their gut microbiomes

BACKGROUND

Preterm birth is the leading cause of perinatal morbidity and mortality. Despite evidence shows that imbalances in the maternal microbiome associates to the risk of preterm birth, the mechanisms underlying the association between a perturbed microbiota and preterm birth remain poorly understood.

METHOD

Applying shotgun metagenomic analysis on 80 gut microbiotas of 43 mothers, we analyzed the taxonomic composition and metabolic function in gut microbial communities between preterm and term mothers.

RESULTS

Gut microbiome of mothers delivering prematurely showed decreased alpha diversity and underwent significant reorganization, especially during pregnancy. SFCA-producing microbiomes, particularly species of Lachnospiraceae, Ruminococcaceae, and Eubacteriaceae, were significantly depleted in preterm mothers. Lachnospiraceae and its species were the main bacteria contributing to species' differences and metabolic pathways.

CONCLUSION

Gut microbiome of mothers delivering prematurely has altered and demonstrates the reduction of Lachnospiraceae.

Photothermally responsive icariin and carbon nanofiber modified hydrogels for the treatment of periodontitis

Introduction: Periodontitis is a chronic inflammatory disease brought on by various bacteria, and effective antibacterial, anti-inflammatory and alveolar bone regeneration are the main goals of treating periodontal disease. Methods: In the current work, we employed Icariin (ICA) into a hydrogel modified with carbon nanofiber (CNF) to create a multifunctional composite nanoplatform. The composite was activated in the near infrared (NIR) to treat periodontitis. Results: The antibacterial results showed that the ICA+CNF@H showed 94.2% and 91.7% clearance of S. aureus and E. coli, respectively, under NIR irradiation. In vitro experiments showed that NIR-irradiated composites suppressed inflammatory factor (IL-6) and ROS expression and up-regulated the performance of anti-inflammatory factor (IL-10) in RAW264.7 cells. At the same time, the composites promoted the production of osteogenic factors in BMSCs, with an approximately 3-fold increase in alkaline phosphatase activity after 7 days and an approximately 2-fold increase in the rate of extracellular matrix mineralization after 21 days. In vivo tests showed that the alveolar bone height was clearly greater in the ICA+CNF@H (NIR) group compared to the periodontitis group. Discussion: In conclusion, ICA+CNF@H under NIR irradiation achieved a synergistic effect of antibacterial, anti-inflammatory, reduction of reactive oxygen species and promotion of osteogenesis, offering a novel approach for treating periodontitis.

The Role of Placental Non-Coding RNAs in Adverse Pregnancy Outcomes

Non-coding RNAs (ncRNAs) are transcribed from the genome and do not encode proteins. In recent years, ncRNAs have attracted increasing attention as critical participants in gene regulation and disease pathogenesis. Different categories of ncRNAs, which mainly include microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), are involved in the progression of pregnancy, while abnormal expression of placental ncRNAs impacts the onset and development of adverse pregnancy outcomes (APOs). Therefore, we reviewed the current status of research on placental ncRNAs and APOs to further understand the regulatory mechanisms of placental ncRNAs, which provides a new perspective for treating and preventing related diseases.

Porphyromonas gingivalis Outer Membrane Vesicles Promote Apoptosis via msRNA-Regulated DNA Methylation in Periodontitis

The outer membrane vesicles (OMVs) produced by Porphyromonas gingivalis contain a variety of bioactive molecules that may be involved in the progression of periodontitis. However, the participation of P. gingivalis OMVs in the development of periodontitis has not been elucidated. Here, we isolated P. gingivalis OMVs and confirmed their participation in periodontitis both in vivo and in vitro. Microcomputed tomography (micro-CT) and histological analysis showed that under stimulation with P. gingivalis OMVs, the alveolar bone of rats was significantly resorbed in vivo. We found that P. gingivalis OMVs were taken up by human periodontal ligament cells ([hPDLCs]) in vitro, which subsequently resulted in apoptosis and inflammatory cytokine release, which was accomplished by the microRNA-size small RNA (msRNA) sRNA45033 in the P. gingivalis OMVs. Through bioinformatics analysis and screening of target genes, chromobox 5 (CBX5) was identified as the downstream target of screened-out sRNA45033. Using a dual-luciferase reporter assay, overexpression, and knockdown methods, sRNA45033 was confirmed to target CBX5 to regulate hPDLC apoptosis. In addition, CUT&Tag (cleavage under targets and tagmentation) analysis confirmed the mechanism that CBX5 regulates apoptosis through the methylation of p53 DNA. Collectively, these findings indicate that the role of P. gingivalis OMVs is immunologically relevant and related to bacterial virulence during the development of periodontitis. IMPORTANCE P. gingivalis is a bacterium often associated with periodontitis. This study demonstrates that (i) sRNA45033 in P. gingivalis OMVs targets CBX5, (ii) CBX5 regulates the methylation of p53 DNA and its expression, which is associated with apoptosis, and (iii) a novel mechanism of interaction between hosts and pathogens is mediated by OMVs in the occurrence of periodontitis.

Advances in the oral microbiota and rapid detection of oral infectious diseases

Several studies have shown that the dysregulation of the oral microbiota plays a crucial role in human health conditions, such as dental caries, periodontal disease, oral cancer, other oral infectious diseases, cardiovascular diseases, diabetes, bacteremia, and low birth weight. The use of traditional detection methods in conjunction with rapidly advancing molecular techniques in the diagnosis of harmful oral microorganisms has expanded our understanding of the diversity, location, and function of the microbiota associated with health and disease. This review aimed to highlight the latest knowledge in this field, including microbial colonization; the most modern detection methods; and interactions in disease progression. The next decade may achieve the rapid diagnosis and precise treatment of harmful oral microorganisms.

Protein interactome mapping of Porphyromonas gingivalis provides insights into the formation of the PorQ-Z complex of the type IX secretion system

Porphyromonas gingivalis is an anaerobic Gram-negative human oral pathogen highly associated with the more severe forms of periodontal disease. Porphyromonas gingivalis utilises the type IX secretion system (T9SS) to transport ∼30 cargo proteins, including multiple virulence factors, to the cell surface. The T9SS is a multiprotein system consisting of at least 20 proteins, and recently, we characterised the protein interactome of these components. Similar to the T9SS, almost all biological processes are mediated through protein-protein interactions (PPIs). Therefore, mapping PPIs is important to understand the biological functions of many proteins in P. gingivalis. Herein, we provide native migration profiles of over 1000 P. gingivalis proteins. Using the T9SS, we demonstrate that our dataset is a useful resource for identifying novel protein interactions. Using this dataset and further analysis of T9SS P. gingivalis mutants, we discover new mechanistic insights into the formation of the PorQ-Z complex of the T9SS. This dataset is a valuable resource for studies of P. gingivalis.

The bidirectional relationship between periodontal disease and pregnancy via the interaction of oral microorganisms, hormone and immune response

Periodontal disease has been suggested to be linked to adverse pregnancy outcomes such as preterm birth, low birth weight, and preeclampsia. Adverse pregnancy outcomes are a significant public health issue with important clinical and societal repercussions. This article systematically reviews the available epidemiological studies involving the relationship between periodontal disease and adverse pregnancy outcomes over the past 15 years, and finds a weak but independent association between adverse pregnancy outcomes and periodontal disease. The bidirectional association and the potential mechanisms are then explored, focusing on three possible mechanisms: inflammatory reaction, oral microorganisms and immune response. Specifically, elevated systemic inflammation and increased periodontal pathogens with their toxic products, along with a relatively suppressed immune system may lead to the disruption of homeostasis within fetal-placental unit and thus induce adverse pregnancy outcomes. This review also explains the possible mechanisms around why women are more susceptible to periodontal disease. In conclusion, pregnant women are more likely to develop periodontal disease due to hormonal changes, and periodontal disease has also been suspected to increase the incidence of adverse pregnancy outcomes. Therefore, in order to lessen the risk of adverse pregnancy outcomes, both obstetricians and dentists should pay attention to the development of periodontal diseases among women during pregnancy.

Gain a Baby Lose a Tooth-Is There an Association between Periodontitis and Preterm Birth?

Preterm birth serves as one of the leading causes of neonatal mortality worldwide. The underlying mechanisms that contribute to preterm birth are not yet fully understood. However, an association between periodontitis and preterm birth has been proposed. The periodontal status and presence of periodontal pathogens in women with different birth outcomes have been previously examined. However, varying definitions of periodontitis and different microbiological methods make their interpretation challenging. The aim of this case-control study on women with and without preterm birth was to investigate their periodontal status using the current classification system for periodontal diseases. Moreover, differences in the periodontal microbiome of the study participants were investigated. Therefore, we collected data on oral and periodontal parameters in 77 puerperal women divided into two groups based on gestational age at delivery: 33 patients with preterm birth (PTB, <37 weeks) and 44 patients with term birth (TB, >37 weeks). These data included pocket probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), gingival-bleeding index, DMFT index, and gynecologic and dental history. In addition, their oral microbiome was explored. Median CAL and percentage PPD ≥ 4 mm were significantly higher in the PTB group than in the TB group (p = 0.0128 and p = 0.047, respectively). Birth weight was significantly higher in periodontally healthy women than in those with gingivitis (p = 0.0078) or periodontitis (p = 0.0127). The periodontal microbiome differed significantly between groups. Our results are underlining the possible association between periodontitis and preterm delivery. Women with periodontitis had babies with significantly lower birth weights. The microbiome varied between the groups.

Investigating the impact of oral health on pregnancy and offspring outcomes: protocol for the Lifetime Impact of ORal heAlth (LIORA) cohort study

INTRODUCTION

Oral health is a fundamental component of well-being, and is closely associated with overall health and quality of life. Oral health may also affect the next generation. The children of mothers with poor oral health are likely to also have poor oral health as they go through life. We aim to investigate associations between maternal oral health and general health, pregnancy outcomes, offspring oral health and offspring general health.

METHODS AND ANALYSIS

The Lifetime Impact of Oral Health study is a prospective, observational cohort study being done at a single centre in Chongqing, China. A total of 1000 pregnant women will be recruited in their first trimester (11-14 weeks gestation). After obtaining informed consent, general and oral health assessments will be undertaken. Maternal lifestyle, demographic data and biospecimens (blood, hair, urine, nail clippings, saliva, dental plaque, buccal, vaginal and anal swabs) will be collected. Pregnancy outcomes will be recorded at the time of delivery. Cord blood and placenta samples will be collected. The offspring will be followed up for general and oral health examinations, neurodevelopmental assessments and biospecimen (dental plaque, saliva, buccal swabs, exfoliated primary dentition, urine, hair, nail clippings) collection until they are 15 years old. Biological samples will undergo comprehensive metabolomic, microbiome and epigenome analyses. Associations between maternal oral health and general health, pregnancy outcomes, offspring oral health and offspring general health will be investigated and the underlying mechanisms explored.

ETHICS AND DISSEMINATION

This project has been approved by the Research Ethics Committee of the Affiliated Hospital of Stomatology of Chongqing Medical University (CQHS-REC-2021 LSNo.23). Participants will be required to provide informed consent to participate in the study. Dissemination of findings will take the form of publications in peer-reviewed journals and presentations at national and international conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2100046898.

Relationship between Periodontal Condition of the Pregnant Woman with Preterm Birth and Low Birth Weight

The aim of this study was to determine the association between the mother’s periodontal condition and perinatal complications, such as preterm birth (PTB) and/or low birth weight (LBW), in a cohort of women in Valencia, Spain. Other related factors, such as tobacco, were also analysed. A prospective cohort study was carried out in a sample of 102 women with a single foetus and ages ranging between 18 and 42 years. Sociodemographic and obstetric variables, caries status, percentage of bleeding, clinical attachment loss (CAL), and probing pocket depth (PPD) data have been collected and analysed. The mean age was 32.4 years, and the BMI was normal. The average weight of new-borns (NB) was 3034 g. A total of 9.8% of the women smoked during their pregnancy. Bleeding percentage was 16.43% (SD 14.81%) and PPDs > 3 mm 8.8 (SD 11.08). The mean of CAL > 0 mm was 1.14 (SD 2.83). The frequency of PTB and LBW was 26%. No statistically significant differences were found between probing depth > 3 mm or CAL > 1 mm, with PTB and/or LBW. Periodontal disease in the mother was not statistically significantly related to either PTB or LBW. Tobacco use during pregnancy showed a statistical significance linked to LBW, but not with PTB.

Is overweight associated with periodontitis in pregnant women? Systematic review and meta-analysis

This systematic review and meta-analysis aimed to generate pooled evidence for the association between excessive weight and pregnancy induced periodontitis. EMBASE, SCOPUS, PubMed/MEDLINE, Web of Science, BVS/LILACS, Cochrane Library and SCIELO databases were accessed. Eligibility criteria were: human clinical studies published between year 2000 and 2021. Newcastle-Ottawa scale was used to evaluate risk of bias of the studies. Meta-analysis was performed using MedCalc® Statistical Software. Eleven studies were included, evaluating 2152 pregnant women (743 with overweight/obesity and 1409 with normal body mass index - BMI), with a mean age of 29.62 years. Most studies had low risk of bias. A positive association between overweight/obesity and periodontitis was found, with an average of 61.04% of women with overweight/obesity and periodontitis, showing the overall random-effects relative risk and 95% CI of 2.21 (1.53–3.17) (p < 0.001). Arterial hypertension, gestational diabetes mellitus and excessive gestational weight gain were the most common adverse effects of maternal obesity that may have been linked to periodontitis induced pro-inflammatory state. In conclusion, a positive association was found between overweight/obesity and periodontitis during pregnancy. However, the high heterogeneity between the studies related to sample size, periodontal classification and the cutoff-points for BMI are the main limitation.

Periodontal disease in pregnancy and adverse pregnancy outcomes: Progress in related mechanisms and management strategies

Periodontal disease is an inflammatory and destructive disease of tissues supporting the tooth. A large number of studies have confirmed that periodontal pathogens and their metabolites can lead to adverse pregnancy outcomes in direct or indirect ways. Adverse pregnancy outcomes, such as preterm birth, low birth weight, and pre-eclampsia, have a serious impact on human reproductive health. In recent years, although the level of global medical technology has gradually improved, the incidence of adverse pregnancy outcomes has not declined and is still a global public health problem. The purpose of this review is to summarize the current data on periodontal disease in pregnancy and adverse pregnancy outcomes, including the association between periodontal disease and adverse pregnancy outcomes, the pathogenic mechanism related to this association, the efficacy of different nutrition supplements for both periodontal disease and adverse pregnancy outcomes and the effect of providing periodontal treatment on the occurrence of adverse pregnancy outcomes, to provide guidance for the prevention and treatment of adverse pregnancy outcomes in clinical practice.

Physicians' awareness of oral-systemic links and its association with physician-reported patient referral to dentists

INTRODUCTION

Physicians promote oral health by screening for oral pathologies, providing emergency help, and referring patients to dentists. The literature consistently reports a robust association between periodontal disease and systemic diseases. However, it is not fully known if physicians in Saudi Arabia are aware of the oral-systemic disease links. Therefore, the study aimed to evaluate physicians' awareness of the oral-systemic disease links and their association with patients' referral to dentists and patients' access to oral care.

METHODS

This cross-sectional study was conducted (June 2019-January 2020) on physicians working in private and public hospitals in the Eastern province of Saudi Arabia. The physicians (n = 333) responded to a paper-based self-administered and pilot-tested questionnaire which inquired about their awareness of oral-systemic disease links and patient referral to dentists. The reliability of items of oral-systemic disease links was evaluated by calculating Cronbach's alpha (0.84).

RESULTS

Most participants (92.8%) agreed/strongly agreed that oral health is associated with systemic health. Half of the sample (50.8%) referred patients to dentists during the last month. Almost 80.5% believed that more patients will be referred to the dentists because of their awareness of the oral-systemic disease links and 84% believed that more patients will access oral care services if patients were aware of the oral-systemic disease links. The participants who referred patients to the dentists during the last month (P = 0.038), believed that more patients will be referred (P = 0.001), and believed that more patients will access oral care (P = 0.003) demonstrated significantly higher oral-systemic disease links awareness score. The adjusted model showed patients' referral to dentist (OR = 1.96.10, P = 0.006) and believing in more patients accessing oral care (OR = 2.05, P = 0.044) were associated with significantly increased awareness of the oral-systemic disease links.

CONCLUSION

Most physicians in the study were aware of the oral-systemic disease links. Increased awareness of the oral-systemic disease links was significantly associated with the referral of patients to dentists and belief in improved patients' access to oral care services.

Fulminant Sepsis and Perinatal Death at 23 Weeks Due to Fusobacterium nucleatum

Introduction: Fusobacterium nucleatum is a gram-negative anaerobe, a constituent of the oral microflora, responsible for chronic periodontal diseases. Case Report: We describe a preterm infant with premature rupture of membranes at 23 weeks of gestational age due to F. nucleatum. The newborn died soon after birth. Placental histopathology showed severe necrotizing chorioamnionitis and funisitis with gram-negative bacilli. After autopsy, F. nucleatum was microbiologically isolated from the lung. The mother had dental hygiene 1 day before delivery, presenting mild and diffuse gingivitis. At admission, she had leukocytosis, foul-smelling vaginal discharge, but no fever. Conclusion: This case highlights the possibility of F. nucleatum spreading from oral cavity after a dental procedure to the placenta with chorioamnionitis and fetal infection. This raises the question of whether dental procedures during pregnancy should be accompanied by prophylactic antibiotics.

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.

High-frequency pulsed diode laser irradiation inhibits bone resorption in mice with ligature-induced periodontitis

AIM

The purpose of this study was to elucidate the suppressive effect of high-frequency pulsed diode laser irradiation on bone resorption and its biological effects for gene expression and microbiome composition on the gingival tissue in ligature-induced periodontitis in mice.

MATERIALS AND METHODS

Ligating ligature around the teeth and/or laser irradiation was performed on the gingival tissue in mice as follows: Co (no ligature and no laser irradiation), Li (ligation without laser irradiation), La (no ligature but with laser irradiation), and LiLa (ligation with laser irradiation). Bone resorption was evaluated using micro-computed tomography. RNA-seq analysis was performed on gingival tissues of all four groups at 3 days post ligation. The differences in microbial composition between Li and LiLa were evaluated based on the number of 16S rRNA gene sequences.

RESULTS

Bone resorption caused by ligation was significantly suppressed by laser irradiation. RNA-seq in Co and La gingival tissue revealed many differentially expressed genes, suggesting diode laser irradiation altered gene expression. Gene set enrichment analysis revealed mTORC1 signaling and E2F target gene sets were enriched in gingival tissues both in La and LiLa compared to that in Co and Li, respectively. The amount of extracted DNA from ligatures was reduced by laser irradiation, and bacterial network structure was altered between the Li and LiLa.

CONCLUSIONS

High-frequency pulsed diode laser irradiation showed biological effects and suppressed bone resorption in ligature-induced periodontitis. This article is protected by copyright. All rights reserved.

Fusobacterium nucleatum and Malignant Tumors of the Digestive Tract: A Mechanistic Overview

Fusobacterium nucleatum (F. nucleatum) is an oral anaerobe that plays a role in several oral diseases. However, F. nucleatum is also found in other tissues of the digestive tract, and several studies have recently reported that the level of F. nucleatum is significantly elevated in malignant tumors of the digestive tract. F. nucleatum is proposed as one of the risk factors in the initiation and progression of digestive tract malignant tumors. In this review, we summarize recent reports on F. nucleatum and its role in digestive tract cancers and evaluate the mechanisms underlying the action of F. nucleatum in digestive tract cancers.

Fetal Cerebral Hemodynamic Changes in Preeclampsia Patients by Ultrasonic Imaging under Intelligent Algorithm

This study was aimed at evaluating the adoption value of ultrasound imaging features on fetal cerebral hemodynamics in preeclampsia patients based on the partial difference algorithm and the hybrid segmentation network (HSegNet) algorithm. Forty pregnant women with preeclampsia diagnosed by ultrasound examination were selected as the research objects, and another forty normal pregnant women were selected as the control. Then, by using the partial differential algorithm, the imaging of fetal cerebral hemodynamics in preeclampsia patients was enhanced and optimized, and the general clinical data and experimental results were collected. The results showed that the automatic labeling of fetal cerebral artery in fetal middle cerebral artery (MCA) hemodynamic images was realized by HSegNet algorithm model, and the final accuracy was 97.3%, which had a good consistency with the manual annotation of doctors. Education level was a protective factor for preeclampsia (odds ratio (OR) = 0.535). Body mass index (BMI) and family history of hypertension during pregnancy were independent risk factors for preeclampsia (OR = 1.286, and 2.774, respectively). MCA end-diastolic volume (EDV) of preeclampsia fetuses was higher than that of normal fetuses. The MCA systolic-diastolic ratio (S/D), the pulsatility index (PI), and the resistive index (RI) in the preeclampsia group were significantly lower than those in the normal pregnancy group. The results showed that MCA PI, MCA RI, and MCA S/D had certain predictive values for the occurrence of adverse pregnancy outcomes (P < 0.05). In summary, the intelligent algorithm-based fetal MCA hemodynamic ultrasound image in the study could effectively predict pregnancy outcomes of patients and provide certain theoretical support for the subsequent reduction of adverse pregnancy outcomes in patients with preeclampsia.

Obesity during pregnancy and its oral repercussions

Obesity during pregnancy and its oral repercussions: what is the current evidence?

The Fused Methionine Sulfoxide Reductase MsrAB Promotes Oxidative Stress Defense and Bacterial Virulence in Fusobacterium nucleatum

Fusobacterium nucleatum, an anaerobic Gram-negative bacterium frequently found in the human oral cavity and some extra-oral sites, is implicated in several important diseases: periodontitis, adverse pregnancy outcomes, and colorectal cancer. To date, how this obligate anaerobe copes with oxidative stress and host immunity within multiple human tissues remains unknown. Here, we uncovered a critical role in this process of a multigene locus encoding a single, fused methionine sulfoxide reductase (MsrAB), a two-component signal transduction system (ModRS), and thioredoxin (Trx)- and cytochrome c (CcdA)-like proteins, which are induced when fusobacterial cells are exposed to hydrogen peroxide. Comparative transcriptome analysis revealed that the response regulator ModR regulates a large regulon that includes trx, ccdA, and many metabolic genes. Significantly, specific mutants of the msrAB locus, including msrAB, are sensitive to reactive oxygen species and defective in adherence/invasion of colorectal epithelial cells. Strikingly, the msrAB mutant is also defective in survival in macrophages, and it is severely attenuated in virulence in a mouse model of preterm birth, consistent with its failure to spread to the amniotic fluid and colonize the placenta. Clearly, the MsrAB system regulated by the two-component system ModRS represents a major oxidative stress defense pathway that protects fusobacteria against oxidative damage in immune cells and confers virulence by enabling attachment and invasion of multiple target tissues. IMPORTANCE F. nucleatum colonizes various human tissues, including oral cavity, placenta, and colon. How this obligate anaerobe withstands oxidative stress in host immune cells has not been described. We report here that F. nucleatum possesses a five-gene locus encoding a fused methionine sulfoxide reductase (MsrAB), a two-component signal transduction system (ModRS), and thioredoxin- and cytochrome c-like proteins. Regulated by ModRS, MsrAB is essential for resistance to reactive oxygen species, adherence/invasion of colorectal epithelial cells, and survival in macrophage. Unable to colonize placenta and spread to amniotic fluid, the msrAB mutant failed to induce preterm birth in a murine model.

Identification of the specific microbial community compositions in saliva associated with periodontitis during pregnancy

OBJECTIVE

To identify the specific microbial community compositions in saliva associated with periodontitis during pregnancy.

MATERIALS AND METHODS

Unstimulated saliva samples were collected from 53 pregnant women during weeks 24-28 of gestation, and the V3-V4 regions of the 16S rRNA gene were amplified from isolated saliva DNA and sequenced. Phylum-, genus-, and species-level taxonomic compositions were separately compared between subjects with (n = 12) and without (n = 41) periodontitis.

RESULTS

Taxa were selected using the random forest algorithm to distinguish subjects with periodontitis at each taxonomic level, and principal component biplots were constructed to visualize the composition of selected taxa in each subject. The genus-level biplot indicated that 44 subjects clustered around the origin. The prevalence of periodontitis was significantly higher among subjects outside the cluster compared with subjects inside the cluster (6/9 [67%] vs. 6/44 [14%], respectively; p = 0.002). Subjects outside the cluster also had significantly decreased abundance of Neisseria and increased abundances of several putative periodontopathic genera. Phylum- and species-level biplots failed to discriminate subjects with periodontitis more efficiently than the genus-level biplot.

CONCLUSIONS

The specific taxonomic composition of the saliva microbiota in pregnant women with periodontitis could be clearly identified at the genus level.

CLINICAL RELEVANCE

The formula developed based on the present findings, (%Treponema + %Tannerella + %Filifactor + %Anaeroglobus)/%Neisseria, can be used to predict periodontitis during pregnancy with sensitivity and specificity values of 0.67 (8/12) and 0.95 (39/41), respectively.

Placental colonization by Fusobacterium nucleatum is mediated by binding of the Fap2 lectin to placentally displayed Gal-GalNAc

While the existence of an indigenous placental microbiota remains controversial, several pathogens are known to be involved in adverse pregnancy outcomes. Fusobacterium nucleatum is an oral bacterium that is one of several bacteria associated with preterm birth. Oral fusobacteria translocate to the placenta hematogenously; however, the mechanisms localizing them to the placenta remain unclear. Here, using peanut agglutinin, we demonstrate that the level of Gal-GalNAc (Galβ1-3GalNAc; Thomsen Friedenreich antigen) found on trophoblasts facing entering maternal blood rises during gestation and is recognized by the fusobacterial Fap2 Gal-GalNAc lectin. F. nucleatum binding to human and mouse placenta correlates with Gal-GalNAc levels and is reduced upon O-glycanase treatment or with soluble Gal-GalNAc. Fap2-inactivated F. nucleatum shows reduced binding to Gal-GalNAc-displaying placental sections. In a mouse model, intravenously injected Fap2-expressing F. nucleatum, but not a Fap2 mutant, reduces mouse fetal survival by 70%.

Association between Maternal Periodontitis and Development of Systematic Diseases in Offspring

Periodontal disease (PD) is one of the most common oral conditions affecting both youths and adults. There are some research works suggesting a high incidence of PD in pregnant women. As an inflammatory disease of bacterial origin, PD may result in the activation of the pathways affecting the course and the pregnancy outcome. The authors, based on the literature review, try to answer the PICO question: Does maternal periodontitis (exposure) influence the incidence of complications rates in pregnancy and the development of systemic diseases in childhood and adult offspring (outcome) in the humans of any race (population) compared to the offspring of mothers with healthy periodontium (comparison)? The authors try to describe the molecular pathways and mechanisms of these interdependencies. There is some evidence that maternal periodontitis may affect the pregnancy course and outcome, resulting in preeclampsia, preterm delivery, vulvovaginitis and low birth weight. It can be suggested that maternal periodontitis may affect offspring epigenome and result in some health consequences in their adult life.

Physiological Changes and Interactions Between Microbiome and the Host During Pregnancy

In recent years, it has become clear that microbiome play a variety of essential roles in human metabolism, immunity, and overall health and that the composition of these microbiome is influenced by our environment, diet, weight, hormones, and other factors. Indeed, numerous physiological and pathological conditions, including obesity and metabolic syndrome, are associated with changes in our microbiome, referred to as dysbiosis. As a result, it is not surprising that such changes occur during pregnancy, which includes substantial weight gain and significant changes in metabolism and immune defenses. The present review relates physiological changes during pregnancy to alterations in the microbial composition at various sites, including the gut, oral cavity, and vagina. Pregnancy has been linked to such microbial changes, and we believe that, in contrast to certain disease states, these microbial changes are vital for a healthy pregnancy, probably through their influence on the mother’s immunological, endocrinological, and metabolic status.

Porphyromonas gingivalis Administration Induces Gestational Obesity, Alters Gene Expression in the Liver and Brown Adipose Tissue in Pregnant Mice, and Causes Underweight in Fetuses

Preventing adverse pregnancy outcomes is crucial for maternal and child health. Periodontal disease is a risk factor for many systemic diseases including adverse pregnancy outcomes, such as preterm birth and low birth weight. In addition, the administration of the periodontopathic bacterium Porphyromonas gingivalis exacerbates obesity, glucose tolerance, and hepatic steatosis and alters endocrine function in the brown adipose tissue (BAT). However, the effects of having periodontal disease during pregnancy remain unclear. Thus, this study investigates the effect of P. gingivalis administration on obesity, liver, and BAT during pregnancy. Sonicated P. gingivalis (Pg) or saline (Co) was injected intravenously and administered orally to pregnant C57BL/6J mice three times per week. Maternal body weight and fetal body weight on embryonic day (ED) 18 were evaluated. Microarray analysis and qPCR in the liver and BAT and hepatic and plasma triglyceride quantification were performed on dams at ED 18. The body weight of Pg dams was heavier than that of Co dams; however, the fetal body weight was decreased in the offspring of Pg dams. Microarray analysis revealed 254 and 53 differentially expressed genes in the liver and BAT, respectively. Gene set enrichment analysis exhibited the downregulation of fatty acid metabolism gene set in the liver and estrogen response early/late gene sets in the BAT, whereas inflammatory response and IL6/JAK/STAT3 signaling gene sets were upregulated both in the liver and BAT. The downregulation of expression levels of Lpin1, Lpin2, and Lxra in the liver, which are associated with triglyceride synthesis, and a decreasing trend in hepatic triglyceride of Pg dams were observed. P. gingivalis administration may alter lipid metabolism in the liver. Overall, the intravenous and oral administration of sonicated P. gingivalis-induced obesity and modified gene expression in the liver and BAT in pregnant mice and caused fetuses to be underweight.