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Lee CT, Meng HW, Tran D, Brandon R, Ayilavarapu S, Walji MF, Angelov N. Using precision periodontal health care chart (PPHCC) to improve periodontal health. Clin Oral Investig 2024; 28:542. [PMID: 39312010 DOI: 10.1007/s00784-024-05947-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 09/14/2024] [Indexed: 09/28/2024]
Abstract
OBJECTIVES Developing a Precision Periodontal Health Care Chart (PPHCC) in the electronic dental record (EDR) system and evaluating its clinical usability and effects on clinical outcomes. MATERIALS AND METHODS A survey with ten questions based on the System Usability Scale (SUS) and six questions about assessing clinical impact was used to evaluate the satisfaction of periodontitis patients and care providers with PPHCC before and after non-surgical periodontal therapy (NSPT). The clinical outcomes, including probing depth (PD), interdental clinical attachment loss (CAL), and bleeding on probing (BOP), in patients who used PPHCC (PC) were compared to those in patients without using PPHCC (control). The associations between risk assessments included in PPHCC and clinical outcomes of NSPT were also analyzed. RESULTS The mean scores of SUS questions at the initial periodontal examination were 74.26 ± 18.89 (n = 37) for patients and 88.31 ± 14.14 (n = 37) for care providers. The mean scores of SUS questions at re-evaluation were 74.84 ± 17.78 (n = 16) for patients and 89.63 ± 13.48 (n = 20) for care providers. The changes in the percentages of teeth with interdental CAL 1-2 mm (p = 0.019) and CAL 3-4 mm (p = 0.026) at the re-evaluation visit were significantly different between the PC and control groups, but the other parameters were not. CONCLUSIONS Both patients and care providers were satisfied with using PPHCC in the clinic. However, the short-term clinical outcomes in the PC group were similar to those in the control group. CLINICAL RELEVANCE PPHCC, as a tool for delivering clinical and educational information, can motivate patients to control periodontitis and assist clinicians in making a personalized treatment plan.
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Affiliation(s)
- Chun-Teh Lee
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge Street, Suite 6470, Houston, TX, 77054, USA.
| | - Hsiu-Wan Meng
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge Street, Suite 6470, Houston, TX, 77054, USA
| | - Duong Tran
- Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston School of Dentistry, 7000 Fannin St, Houston, TX, 77030, USA
- The Institute for Medical Research, 508 Fulton St, Durham, NC, 27705, USA
| | - Ryan Brandon
- Willamette Dental Group and Skourtes Institute, 6950 NE Campus Way, Hillsboro, OR, 97124, USA
| | - Srinivas Ayilavarapu
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge Street, Suite 6470, Houston, TX, 77054, USA
| | - Muhammad F Walji
- Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston School of Dentistry, 7000 Fannin St, Houston, TX, 77030, USA
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, 7000 Fannin St, Houston, TX, 77030, USA
| | - Nikola Angelov
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge Street, Suite 6470, Houston, TX, 77054, USA
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Slots J, Slots V. Severe periodontitis and congenital cytomegalovirus: Cleft lip and cleft palate. Periodontol 2000 2024. [PMID: 39262100 DOI: 10.1111/prd.12606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 09/13/2024]
Abstract
Severe periodontitis lesions can harbor several hundred-thousand copies of active cytomegalovirus, and this paper proposes that cytomegalovirus in maternal periodontitis can infect the fetus. Cleft lips and palates may be oral examples of congenital cytomegalovirus infection. Anti-cytomegalovirus periodontal treatment is indicated for high-risk women who exhibit severe periodontitis and weakened immune system and are contemplating pregnancy or are in the first trimester of pregnancy.
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Affiliation(s)
- Jørgen Slots
- Division of Periodontology and Diagnostic Sciences, University of Southern California School of Dentistry, Los Angeles, California, USA
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Rams TE, Slots J. Elevated subgingival temperature infers high bacterial pathogen counts in severe periodontitis. Clin Exp Dent Res 2024; 10:e891. [PMID: 38706420 PMCID: PMC11070767 DOI: 10.1002/cre2.891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/15/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVES Periodontal inflammation may be assessed by bleeding on probing and subgingival temperature. This pilot study evaluated the intrapatient relationship between subgingival temperature and selected bacterial groups/species in deep periodontal pockets with bleeding on probing. MATERIALS AND METHODS In each of eight adults, an electronic temperature probe identified three "hot" pockets with elevated subgingival temperature and three "cool" pockets with normal subgingival temperature among premolars/molars with 6‒10 mm probing depths and bleeding on probing. Microbial samples collected separately from the hot and cool periodontal pockets were cultured for selected periodontal pathogens. RESULTS Hot compared to cool periodontal pockets revealed significantly higher absolute and normalized subgingival temperatures and yielded higher mean proportions of Porphyromonas gingivalis (10.2% for hot vs. 2.5% for cool, p = 0.030) and total red/orange complex periodontal pathogens (48.0% for hot vs. 24.6% for cool, p = 0.012). CONCLUSIONS Hot versus cool deep periodontal pockets harbored significantly higher levels of major periodontal pathogens. Subgingival temperature measurements may potentially be useful to assess risk of periodontitis progression and the efficacy of periodontal therapy.
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Affiliation(s)
- Thomas E. Rams
- Department of Periodontology and Oral ImplantologyTemple University School of DentistryPhiladelphiaPennsylvaniaUSA
| | - Jørgen Slots
- Division of Periodontology and Diagnostic SciencesUniversity of Southern California School of DentistryLos AngelesCaliforniaUSA
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Rams TE, Contreras A, Slots J. Aggressive periodontitis in southwestern American Indian adolescents. J Periodontol 2024; 95:594-602. [PMID: 37910464 DOI: 10.1002/jper.23-0410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/07/2023] [Accepted: 10/08/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND This study determined the prevalence of aggressive (molar-incisor pattern) (Ag/MI) periodontitis and assessed the associated subgingival bacterial-herpesvirus microbiota in Pueblo Indian adolescents in the southwestern United States. METHODS The study included 240 Pueblo Indian adolescents, aged 13-20 years old, residing in three Rio Grande River villages in New Mexico and the Hopi Pueblo reservation in Arizona. Adolescents with Ag/MI periodontitis or periodontal health provided subgingival samples for culture of bacterial pathogens and for polymerase chain reaction detection of periodontal herpesviruses. RESULTS Ag/MI periodontitis was detected in 22 (9.2%) Pueblo Indian adolescents, with 21 exhibiting a localized molar-incisor breakdown pattern. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and other red/orange complex bacterial pathogens predominated in Ag/MI periodontitis, whereas periodontal health yielded mainly viridans streptococci and Actinomyces species. Periodontal herpesviruses demonstrated a 3.5 odds ratio relationship with Ag/MI periodontitis. The only adolescent with generalized Ag/MI periodontitis harbored viral co-infection by cytomegalovirus plus Epstein-Barr virus Type 1, in addition to A. actinomycetemcomitans, P. gingivalis, and several other periodontopathic bacteria. CONCLUSIONS Pueblo Indian adolescents showed an unusually high prevalence of early-age Ag/MI periodontitis predominated by periodontopathic bacteria and herpesviruses suspected to be major etiologic agents of the disease.
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Affiliation(s)
- Thomas E Rams
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, Pennsylvania, USA
| | - Adolfo Contreras
- Periodontal Medicine Research Group, Department of Periodontology, Universidad del Valle School of Dentistry, Cali, Colombia
| | - Jørgen Slots
- Division of Periodontology and Diagnostic Sciences, University of Southern California School of Dentistry, Los Angeles, California, USA
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Slots J, Rams TE. Herpesvirus-Bacteria pathogenic interaction in juvenile (aggressive) periodontitis. A novel etiologic concept of the disease. Periodontol 2000 2024; 94:532-538. [PMID: 37345343 DOI: 10.1111/prd.12501] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023]
Abstract
Localized juvenile (aggressive) periodontitis starts at puberty in otherwise healthy individuals and involves the proximal surfaces of permanent incisors and first molars. The disease destroys a sizeable amount of periodontal bone within a few months despite minimal dental plaque and gingival tissue inflammation. Cytomegalovirus and Epstein-Barr virus, as well as the two main periodontopathic bacteria Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, are linked to juvenile periodontitis. Juvenile periodontitis-affected teeth show cementum hypoplasia. We hypothesize that an active herpesvirus infection, at the time of root formation, hampers cementum formation and, at puberty, herpesvirus reactivation triggers an upgrowth of bacterial pathogens which produce rapid periodontal destruction on teeth with a defective periodontium. A pathogenic interaction between active herpesviruses and bacterial pathogens can potentially explain the etiology and incisor-first molar destructive pattern of juvenile periodontitis. Effective treatment of juvenile periodontitis may target the herpesvirus-bacteria co-infection.
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Affiliation(s)
- Jørgen Slots
- Division of Periodontology and Diagnostic Sciences, University of Southern California School of Dentistry, Los Angeles, California, USA
| | - Thomas E Rams
- Department of Periodontology and Oral Implantology, and Oral Microbiology Testing Service Laboratory, Temple University School of Dentistry, Philadelphia, Pennsylvania, USA
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Song C, Zhang X, Lu M, Zhao Y. Bee Sting-Inspired Inflammation-Responsive Microneedles for Periodontal Disease Treatment. RESEARCH (WASHINGTON, D.C.) 2023; 6:0119. [PMID: 37223473 PMCID: PMC10202374 DOI: 10.34133/research.0119] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/26/2023] [Indexed: 01/21/2024]
Abstract
Periodontal lesions are common and frustrating diseases that impact life quality. Efforts in this aspect aim at developing local drug delivery systems with better efficacy and less toxicity. Herein, inspired by the sting separation behavior of bees, we conduct novel reactive oxygen species (ROS)-responsive detachable microneedles (MNs) that carry antibiotic metronidazole (Met) for controllable periodontal drug delivery and periodontitis treatment. Benefiting from the needle-base separation ability, such MNs can penetrate through the healthy gingival to reach the gingival sulcus's bottom while offering minimal impact to oral function. Besides, as the drug-encapsulated cores were protected by poly (lactic-co-glycolic acid) (PLGA) shells in MNs, the surrounding normal gingival tissue is not affected by Met, resulting in excellent local biosafety. Additionally, with the ROS-responsive PLGA-thioketal-polyethylene glycol MN tips, they can be unlocked to release Met directly around the pathogen under the high ROS in the periodontitis sulcus, bringing about improved therapeutic effects. Based on these characteristics, the proposed bioinspired MNs show good therapeutic results in treating a rat model with periodontitis, implying their potential in periodontal disease.
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Affiliation(s)
- Chuanhui Song
- Department of Rheumatology and Immunology, Institute of Translational Medicine,
The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210002, China
| | - Xiaoxuan Zhang
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering,
Southeast University, Nanjing 210096, China
| | - Minhui Lu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering,
Southeast University, Nanjing 210096, China
| | - Yuanjin Zhao
- Department of Rheumatology and Immunology, Institute of Translational Medicine,
The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210002, China
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering,
Southeast University, Nanjing 210096, China
- Chemistry and Biomedicine Innovation Center,
Nanjing University, Nanjing 210023, China
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Rams TE, Slots J. Antimicrobial Chemotherapy for Recalcitrant Severe Human Periodontitis. Antibiotics (Basel) 2023; 12:265. [PMID: 36830176 PMCID: PMC9951977 DOI: 10.3390/antibiotics12020265] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
This study evaluated a combined systemic and topical anti-infective periodontal treatment of 35 adults who had experienced ongoing periodontal breakdown following conventional surgical periodontics. The prescribed anti-infective therapy, based on microbiological testing, consisted of a single course of metronidazole plus ciprofloxacin (23 patients), metronidazole plus amoxicillin/clavulanic acid (10 patients), and metronidazole plus ciprofloxacin followed by metronidazole plus amoxicillin/clavulanic acid (2 patients). In addition, the study patients received 0.1% povidone-iodine subgingival disinfection during non-surgical root debridement and daily patient administered oral irrigation with 0.1% sodium hypochlorite. At 1 and 5 years post-treatment, all study patients showed gains in clinical periodontal attachment with no further attachment loss, and significant decreases in pocket probing depth, bleeding on probing, and subgingival temperature. The greatest disease resolution occurred in patients who at baseline harbored predominantly major periodontal pathogens which post-antibiotics became non-detectable and substituted by non-periodontopathic viridans streptococci. The personalized and minimally invasive anti-infective treatment regimen described here controlled periodontitis disease activity and markedly improved the clinical and microbiological status of the refractory periodontitis patients.
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Affiliation(s)
- Thomas E. Rams
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA 19140, USA
| | - Jørgen Slots
- Division of Periodontology and Diagnostic Sciences, University of Southern California School of Dentistry, Los Angeles, CA 90089, USA
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