1
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Li Q, Ouyang X, Lin J. The impact of periodontitis on vascular endothelial dysfunction. Front Cell Infect Microbiol 2022; 12:998313. [PMID: 36118034 PMCID: PMC9480849 DOI: 10.3389/fcimb.2022.998313] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022] Open
Abstract
Periodontitis, an oral inflammatory disease, originates from periodontal microbiota dysbiosis which is associated with the dysregulation of host immunoinflammatory response. This chronic infection is not only harmful to oral health but is also a risk factor for the onset and progress of various vascular diseases, such as hypertension, atherosclerosis, and coronary arterial disease. Vascular endothelial dysfunction is the initial key pathological feature of vascular diseases. Clarifying the association between periodontitis and vascular endothelial dysfunction is undoubtedly a key breakthrough for understanding the potential relationship between periodontitis and vascular diseases. However, there is currently a lack of an updated review of their relationship. Therefore, we aim to focus on the implications of periodontitis in vascular endothelial dysfunction in this review.
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Affiliation(s)
- Qian Li
- Department of Stomatology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiangying Ouyang
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
- *Correspondence: Xiangying Ouyang, ; Jiang Lin,
| | - Jiang Lin
- Department of Stomatology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xiangying Ouyang, ; Jiang Lin,
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2
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Abstract
Cardiovascular diseases (CVDs) still remain the leading concern of global health, accounting for approximately 17.9 million deaths in 2016. The pathogenetic mechanisms of CVDs are multifactorial and incompletely understood. Recent evidence has shown that alterations in the gut microbiome and its associated metabolites may influence the pathogenesis and progression of CVDs such as atherosclerosis, heart failure, hypertension, and arrhythmia, yet the underlying links are not fully elucidated. Owing to the progress in next-generation sequencing techniques and computational strategies, researchers now are available to explore the emerging links to the genomes, transcriptomes, proteomes, and metabolomes in parallel meta-omics approaches, presenting a panoramic vista of culture-independent microbial investigation. This review aims to outline the characteristics of meta-omics pipelines and provide a brief overview of current applications in CVDs studies which can be practical for addressing crucial knowledge gaps in this field, as well as to shed its light on cardiovascular risk biomarkers and therapeutic intervention in the near future.
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Affiliation(s)
- Jing Xu
- State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital & National Center for Cardiovascular Diseases, Beijing, China,Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital & National Center for Cardiovascular Diseases, Beijing, China,Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,CONTACT Yuejin Yang State Key Laboratory of Cardiovascular Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Beijing, China; Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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3
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Zuo N, Liu W, Hu T, Liu Y, Li B, Liu H, Jing H, Chen X, Li Y, Du J, Hu T, Dong Z, Niu Y, Shi J. Microvesicles, blood cells, and endothelial cells mediate phosphatidylserine-related prothrombotic state in patients with periodontitis. J Periodontol 2021; 93:287-297. [PMID: 34155635 DOI: 10.1002/jper.21-0025] [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: 01/18/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Phosphatidylserine (PS) is essential for inflammation-associated thrombogenesis, but the exact effect of PS on the prothrombotic state in periodontitis is uncertain. This study aimed to determine the PS-related procoagulant state in patients with periodontitis. METHODS A total of 138 patients with periodontitis were examined compared with 42 healthy controls. PS-exposing cells and microvesicles in blood samples were detected by confocal microscopy and flow cytometry. The clotting time assay and prothrombinase complex formation assay were used to measure the procoagulant activity of microvesicles, blood cells and endothelial cells. Periodontal clinical parameters and laboratory characteristics of patients with severe periodontitis were recorded and analyzed at baseline and 6 months after non-surgical periodontal therapy. RESULTS Total PS-positive (PS+ ) microvesicles and the percentage of PS+ blood cells increased in patients with severe periodontitis compared with patients with moderate/mild periodontitis or healthy controls. Endothelial cells cultured in serum from patients with severe periodontitis expressed more PS compared with those cultured in serum from healthy controls. Specifically, PS exposure on blood cells and endothelial cells significantly decreased after inhibiting the effect of inflammatory cytokines. The elevated levels of PS+ cells and microvesicles in severe periodontitis shortened clotting time and led to increased prothrombinase complex formation. Non-surgical periodontal therapy significantly attenuated the release of microvesicles and the PS exposure of blood cells in severe periodontitis. CONCLUSIONS The prothrombotic state of patients with periodontitis is mediated by PS+ cells and microvesicles stimulated by elevated levels of inflammatory cytokines.
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Affiliation(s)
- Nan Zuo
- Department of Stomatology, the First Hospital, Harbin Medical University, Harbin, China
| | - Wenhui Liu
- Department of Stomatology, the First Hospital, Harbin Medical University, Harbin, China
| | - Tenglong Hu
- Department of Stomatology, the First Hospital, Harbin Medical University, Harbin, China.,Department of Oral Anatomy & Physiology, Stomatology School, Harbin Medical University, Harbin, China
| | - Yingmiao Liu
- Department of Stomatology, the First Hospital, Harbin Medical University, Harbin, China
| | - Baorong Li
- Department of Stomatology, the First Hospital, Harbin Medical University, Harbin, China
| | - Huan Liu
- Department of Stomatology, the First Hospital, Harbin Medical University, Harbin, China
| | - Haijiao Jing
- Department of Hematology, the First Hospital, Harbin Medical University, Harbin, China
| | - Xiaojing Chen
- Department of Nephrology, the First Hospital, Harbin Medical University, Harbin, China
| | - Yueyue Li
- Department of Hematology, the First Hospital, Harbin Medical University, Harbin, China
| | - Jingwen Du
- Department of Hematology, the First Hospital, Harbin Medical University, Harbin, China
| | - Tianshui Hu
- Department of Stomatology, the First Hospital, Harbin Medical University, Harbin, China
| | - Zengxiang Dong
- Department of Cardiology, the First Hospital, Harbin Medical University, Harbin, China
| | - Yumei Niu
- Department of Stomatology, the First Hospital, Harbin Medical University, Harbin, China
| | - Jialan Shi
- Department of Hematology, the First Hospital, Harbin Medical University, Harbin, China.,Departments of Research and Surgery, VA Boston Healthcare System, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Kaszuba-Zwoińska J, Novak P, Nowak B, Furgała A, Wójcik-Piotrowicz K, Piszczek P, Guzdek P, Pytko-Polończyk J. Low-frequency electromagnetic field influences human oral mucosa keratinocyte viability in response to lipopolysaccharide or minocycline treatment in cell culture conditions. Biomed Pharmacother 2021; 137:111340. [DOI: 10.1016/j.biopha.2021.111340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 01/09/2023] Open
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5
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Sun M, Ji Y, Li Z, Chen R, Zhou S, Liu C, Du M. Ginsenoside Rb3 Inhibits Pro-Inflammatory Cytokines via MAPK/AKT/NF-κB Pathways and Attenuates Rat Alveolar Bone Resorption in Response to Porphyromonas gingivalis LPS. Molecules 2020; 25:molecules25204815. [PMID: 33092290 PMCID: PMC7588009 DOI: 10.3390/molecules25204815] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 12/19/2022] Open
Abstract
Conventional treatments for chronic periodontitis are less effective in controlling inflammation and often relapse. Therefore, it is necessary to explore an immunomodulatory medication as an adjuvant. Ginsenoside Rb3 (Rb3), one of the most abundant active components of ginseng, has been found to possess anti-inflammatory and immunomodulatory properties. Here, we detected the anti-inflammatory effect of Rb3 on Porphyromonas gingivalis LPS-stimulated human periodontal ligament cells and experimental periodontitis rats for the first time. We found that the expression of pro-inflammatory mediators, including IL-1β, IL-6 and IL-8, upregulated by lipopolysaccharide (LPS) stimulation was remarkably downregulated by Rb3 treatment in a dose-dependent manner at both transcriptional and translational levels. Network pharmacological analysis of Rb3 showed that the mitogen-activated protein kinase (MAPK) signaling pathway had the highest richness and that p38, JNK, and ERK molecules were potential targets of Rb3 in humans. Western blot analysis revealed that Rb3 significantly suppressed the phosphorylation of p38 MAPK and p65 NF-κB, as well as decreased the expression of total AKT. In experimental periodontitis rat models, reductions in alveolar bone resorption and osteoclast generation were observed in the Rb3 treatment group. Thus, we can conclude that Rb3 ameliorated Porphyromonas gingivalis LPS-induced inflammation by inhibiting the MAPK/AKT/NF-κB signaling pathways and attenuated alveolar bone resorption in experimental periodontitis rats.
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6
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Isola G, Giudice AL, Polizzi A, Alibrandi A, Patini R, Ferlito S. Periodontitis and Tooth Loss Have Negative Systemic Impact on Circulating Progenitor Cell Levels: A Clinical Study. Genes (Basel) 2019; 10:E1022. [PMID: 31817862 PMCID: PMC6947645 DOI: 10.3390/genes10121022] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/25/2019] [Accepted: 12/05/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of the present study was to investigate the association and impact of periodontitis and tooth loss on a subtype of endothelial progenitor cell (EPC) levels (CD133+/KDR+). Furthermore, the objective was to determine if the periodontal status influenced CD133+/KDR+ levels. In all, 88 patients with periodontitis and 79 healthy controls (HCs) were enrolled in the study. Enrolled patients were examined and characterized by clinical and blood sample analysis. Spearman's correlation test was applied in order to assess the interdependence between CD133+/KDR+ levels and all periodontal parameters. In order to estimate a statistically significant trend (p-trend) for ordered CD133++/KDR+ quartiles, the Jonckheere-Terpstra test was applied for all variables. Patients in the periodontitis group presented significantly lower CD133+/KDR+ levels (66.4 (45.5-269.6 cells/µL)) compared to the HC group (76.7 (24.3-313.2 cells/µL), p < 0.001). Lower CD133+/KDR+ levels negatively correlated with C-reactive protein (CRP), with the number of teeth, and with all periodontal parameters (p < 0.001). Moreover, there was a proportional increase in CD133+/KDR+ levels with a progressive increase in number of teeth (p-trend < 0.001), while there was a proportional decrease in CD133+/KDR+ levels with a proportional increase in clinical attachment level (CAL, p-trend = 0.003), probing depth (PD, p-trend = 0.007), and bleeding sites (bleeding on probing (BOP), p-trend < 0.001) as an extent measure of periodontitis. This study demonstrated that patients with periodontitis presented significantly lower CD133+/KDR+ levels compared to HCs. Moreover, all patients presented an increase in the CD133+/KDR+ EPC levels with an extended level of periodontitis and tooth loss.
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Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95123 Catania, Italy, (A.L.G.); (A.P.)
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95123 Catania, Italy, (A.L.G.); (A.P.)
- Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, 98100 Messina, Italy
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95123 Catania, Italy, (A.L.G.); (A.P.)
| | - Angela Alibrandi
- Department of Economical, Business and Environmental Sciences and Quantitative Methods, University of Messina, Piazza Pugliatti 1, 98100 Messina, Italy
| | - Romeo Patini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Institute of Dentistry and Maxillofacial Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Sebastiano Ferlito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95123 Catania, Italy, (A.L.G.); (A.P.)
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7
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Alqaderi H, Goodson JM, Agaku I. Association between sleep and severe periodontitis in a nationally representative adult US population. J Periodontol 2019; 91:767-774. [DOI: 10.1002/jper.19-0105] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 09/10/2019] [Accepted: 09/27/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Hend Alqaderi
- Department of Oral Health Policy and EpidemiologyHarvard School of Dental Medicine Boston MA
- The Forsyth Institute Cambridge MA
| | | | - Israel Agaku
- Department of Oral Health Policy and EpidemiologyHarvard School of Dental Medicine Boston MA
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Saffi MAL, Rabelo-Silva ER, Polanczyk CA, Furtado MV, Montenegro MM, Ribeiro IWJ, Kampits C, Rösing CK, Haas AN. Periodontal therapy and endothelial function in coronary artery disease: A randomized controlled trial. Oral Dis 2018; 24:1349-1357. [PMID: 29873864 DOI: 10.1111/odi.12909] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/24/2018] [Accepted: 05/31/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the effects of periodontal treatment on endothelial function in patients with coronary artery disease. MATERIALS AND METHODS A randomized controlled trial was conducted with 69 patients with stable coronary disease and severe periodontitis. The test group received nonsurgical periodontal therapy consisting of personalized oral hygiene instructions, subgingival scaling, and root planing per quadrant, whereas the control group received equal treatment after the study period. Endothelial function was assessed by measurement of brachial artery flow-mediated dilation, concentrations of sVCAM-1, sICAM-1, and P-selectin in serum before and 3 months after periodontal therapy. RESULTS The test group exhibited statistically better periodontal parameters-plaque, probing depth, periodontal attachment loss, and bleeding on probing. No significant improvements were observed in the control (1.37%) and test (1.39%) groups in flow-mediated dilation, with no significant between-group difference. sVCAM-1 concentration increased in the control group (997.6 ± 384.4-1201.8 ± 412.5; p = 0.03), whereas in the test group, no significant changes were observed (915.1 ± 303.8-1050.3 ± 492.3; p = 0.17), resulting in a significant difference between the two groups (p = 0.04). The same pattern was observed for concentrations of sICAM-1. CONCLUSION Periodontal treatment did not provide better vasodilation in patients with coronary disease in a short-term follow-up period, although it maintained blood concentrations of markers of vascular inflammation.
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Affiliation(s)
- Marco Aurélio L Saffi
- Graduate Program in Cardiovascular Sciences: Cardiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Eneida R Rabelo-Silva
- Graduate Program in Cardiovascular Sciences: Cardiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Carisi A Polanczyk
- Graduate Program in Cardiovascular Sciences: Cardiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Mariana V Furtado
- Graduate Program in Cardiovascular Sciences: Cardiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Marlon M Montenegro
- Periodontology, Federal University of Rio Grande do Sul, Faculty of Dentistry, Porto Alegre, Brazil
| | - Ingrid W J Ribeiro
- Periodontology, Federal University of Rio Grande do Sul, Faculty of Dentistry, Porto Alegre, Brazil
| | - Cassio Kampits
- Periodontology, Federal University of Rio Grande do Sul, Faculty of Dentistry, Porto Alegre, Brazil
| | - Cassiano K Rösing
- Periodontology, Federal University of Rio Grande do Sul, Faculty of Dentistry, Porto Alegre, Brazil
| | - Alex N Haas
- Periodontology, Federal University of Rio Grande do Sul, Faculty of Dentistry, Porto Alegre, Brazil
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9
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Zhou QB, Xia WH, Ren J, Yu BB, Tong XZ, Chen YB, Chen S, Feng L, Dai J, Tao J, Yang JY. Effect of Intensive Periodontal Therapy on Blood Pressure and Endothelial Microparticles in Patients With Prehypertension and Periodontitis: A Randomized Controlled Trial. J Periodontol 2017; 88:711-722. [PMID: 28452620 DOI: 10.1902/jop.2017.160447] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although some studies show a positive association between periodontitis and blood pressure (BP) elevation, research on the effect of intensive periodontal treatment on decline in BP levels and endothelial microparticles (EMPs) without any antihypertensive management is lacking. Therefore, the present clinical trial explores whether intensive periodontal therapy would lower BP levels and EMPs of patients with prehypertension with periodontitis. METHODS From a total 107 patients, 95 underwent randomization (47 assigned to control-treatment [CT] group and 48 assigned to intensive-treatment [IT] group) and completed the trial. Patients received intervention for 4 consecutive weeks and were followed for 6 months. Levels of BP and EMPs were evaluated at baseline and 1, 3, and 6 months after intervention. RESULTS Periodontal conditions were significantly improved (P <0.05) 6 months after intensive periodontal treatment. In parallel, the primary outcomes including systolic and diastolic BP and EMPs were markedly reduced in the IT group compared with the CT group (absolute difference: 12.57 and 9.65 mm Hg and 581.59/μL, respectively; 95% confidence intervals: 10.45 to 14.69, 7.06 to 12.24, and 348.12 to 815.06, respectively; P <0.05). Reduction in BP levels and EMPs was related to improvement in probing depth (r = 0.358, 0.363, and 0.676, respectively, by the Pearson product-moment correlation; P = 0.009, 0.008, and P <0.001, respectively). CONCLUSION To the best knowledge of the authors, the present study demonstrates for the first time that intensive periodontal intervention without any antihypertensive medication therapy may be an effective means to lower levels of BP and EMPs in patients with prehypertension with periodontitis.
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Affiliation(s)
- Qian-Bing Zhou
- Department of Stomatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Stomatology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Wen-Hao Xia
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University
| | - Jing Ren
- Department of Stomatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bing-Bo Yu
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University
| | - Xin-Zhu Tong
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University
| | - Yan-Bin Chen
- Department of Stomatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shan Chen
- Department of Stomatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lei Feng
- Department of Stomatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jing Dai
- Department of Stomatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jun Tao
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University
| | - Jun-Ying Yang
- Department of Stomatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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10
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Alqaderi H, Tavares M, Hartman M, Goodson JM. Effect of Sleep and Salivary Glucose on Gingivitis in Children. J Dent Res 2016; 95:1387-1393. [PMID: 27470068 DOI: 10.1177/0022034516661509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
It has been shown that inadequate sleep has deleterious effects on health by suppressing immunity and promoting inflammation. The aim of this study was to investigate the effect of sleep and salivary glucose levels on the development of gingivitis in a prospective longitudinal study of Kuwaiti children. Data were collected from 10-y-old children ( N = 6,316) in 2012 and again in 2014. Children were approximately equally distributed from 138 elementary schools representing the 6 governorates of Kuwait. Calibrated examiners conducted oral examination, self-reported sleep evaluation interviews, anthropomorphic measurements, and unstimulated whole saliva sample collection. Salivary glucose levels were measured by a florescent glucose oxidase method; values of salivary glucose ≥1.13 mg/dL were defined as high glucose levels. A multilevel random intercept and slope analysis was conducted to determine the relationship between sleep duration and gingivitis on 3 levels: within schools, among children, and over time. The outcome was the progression of the extent of gingival inflammation in children over time. The main independent variables were the number of daily sleep hours and salivary glucose levels. Other explanatory variables and confounders assessed were governorate, dental caries and restorations, and obesity by waist circumference (adjusted for snacking and sex). Gingivitis increased over time in children who had shorter sleep duration ( P < 0.05). Salivary glucose levels >1.13 mg/dL predicted gingivitis ( P < 0.05). Children who had more decayed or filled teeth had more gingivitis ( P < 0.05). No significant association was found between gingivitis and obesity. The level of gingivitis was different among the 6 governorates of Kuwait. Additionally, there was a strong clustering effect of the observations within schools and among children across time. Longitudinal analysis of 6,316 Kuwaiti children revealed that shorter sleep duration and higher salivary glucose levels were both associated with increased gingival inflammation.
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Affiliation(s)
- H Alqaderi
- 1 Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - M Tavares
- 1 Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.,2 Department of Applied Oral Sciences, Forsyth Research Institute, Cambridge, MA, USA
| | - M Hartman
- 2 Department of Applied Oral Sciences, Forsyth Research Institute, Cambridge, MA, USA
| | - J M Goodson
- 2 Department of Applied Oral Sciences, Forsyth Research Institute, Cambridge, MA, USA
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11
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Paccosi S, Giachi M, Di Gennaro P, Guglielmotti A, Parenti A. The chemokine (C-C motif) ligand protein synthesis inhibitor bindarit prevents cytoskeletal rearrangement and contraction of human mesangial cells. Cytokine 2016; 85:92-100. [PMID: 27309675 DOI: 10.1016/j.cyto.2016.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 01/08/2023]
Abstract
Intraglomerular mesangial cells (MCs) maintain structural and functional integrity of renal glomerular microcirculation and homeostasis of mesangial matrix. Following different types of injury, MCs change their phenotype upregulating the expression of α-smooth muscle actin (α-SMA), changing contractile abilities and increasing the production of matrix proteins, chemokines and cytokines. CCL2 is a chemokine known to be involved in the pathogenesis of renal diseases. Its glomerular upregulation correlates with the extent of renal damage. Bindarit is an indazolic derivative endowed with anti-inflammatory activity when tested in experimental diseases. It selectively inhibits the synthesis of inflammatory C-C chemokines including CCL2, CCL7 and CCL8. This work aims to analyse bindarit effects on ET1-, AngII- and TGFβ-induced mesangial cell dysfunction. Bindarit significantly reduced AngII-, ET1- and TGFβ-induced α-SMA upregulation. In a collagen contraction assay, bindarit reduced AngII-, ET1- and TGFβ-induced HRMC contraction. Within 3-6h stimulation, vinculin organization and phosphorylation was significantly impaired by bindarit in AngII-, ET1- and TGFβ-stimulated cells without any effect on F-actin distribution. Conversely, p38 phosphorylation was not significantly inhibited by bindarit. Our data strengthen the importance of CCL2 on ET-1, AngII- and TGFβ-induced mesangial cell dysfunction, adding new insights into the cellular mechanisms responsible of bindarit protective effects in human MC dysfunction.
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Affiliation(s)
- Sara Paccosi
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Matelda Giachi
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Paola Di Gennaro
- Unit of Plastic and Reconstructive Surgery - Regional Melanoma Referral Center, Tuscan Tumor Institute (ITT), Santa Maria Annunziata Hospital, Florence, Italy
| | | | - Astrid Parenti
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy.
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12
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Wang Q, Kang J, Cai X, Wu Y, Zhao L. The association between chronic periodontitis and vasculogenic erectile dysfunction: a systematic review and meta-analysis. J Clin Periodontol 2016; 43:206-15. [PMID: 26749274 DOI: 10.1111/jcpe.12512] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Qianting Wang
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu Sichuan China
| | - Jian Kang
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu Sichuan China
| | - Xiang Cai
- Department of Urology; West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Yafei Wu
- Department of Periodontics; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - Lei Zhao
- Department of Periodontics; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
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13
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Pires FR, da Silva PJS, Natal RF, Alves FA, Pinto CAL, Rumayor A, Miranda ÁMMA, de Almeida OP. Clinicopathologic features, microvessel density, and immunohistochemical expression of ICAM-1 and VEGF in 15 cases of secondary syphilis with oral manifestations. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 121:274-81. [PMID: 26682516 DOI: 10.1016/j.oooo.2015.09.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/16/2015] [Accepted: 09/27/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Several studies have reported the clinical aspects of oral syphilis, but few papers have considered the involved immunoinflammatory mechanisms. OBJECTIVE To analyze the clinicopathologic features and expression of immunoinflammatory and vascular proteins in oral secondary syphilis. STUDY DESIGN Fifteen patients with oral secondary syphilis were included; histologic features were analyzed using hematoxylin-eosin-stained histologic slides and immunohistochemical reactions were performed against intercellular adhesion molecule 1 (ICAM-1), vascular endothelial growth factor (VEGF), and CD34. RESULTS Lesions presented as multiple plaques and ulcers mostly located on the tongue, lips, and palate. They were covered by a stratified epithelium of irregular thickness showing exocytosis associated with a subjacent plasma cell infiltrate arranged in perivascular and perineural patterns. ICAM-1 and VEGF were expressed on endothelial cells and leukocytes, and microvessel density was similar on the superficial and deep regions of the connective tissue. CONCLUSIONS Expression of immunoinflammatory and vascular proteins was intense, suggesting their participation on the pathogenesis of oral secondary syphilis.
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Affiliation(s)
- Fábio Ramôa Pires
- Associate Professor, Oral Pathology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Paulo José Souza da Silva
- Undergraduate Student, School of Dentistry, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Renan Ferreira Natal
- Undergraduate Student, School of Dentistry, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fábio Abreu Alves
- Director, Stomatology Department, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Alícia Rumayor
- Graduate Student, Oral Pathology, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
| | | | - Oslei Paes de Almeida
- Titular Professor and Head, Oral Pathology, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
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14
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Zhu J, Li X, Zhu F, Chen L, Zhang C, McGrath C, He F, Xiao Y, Jin L. Multiple tooth loss is associated with vascular cognitive impairment in subjects with acute ischemic stroke. J Periodontal Res 2015; 50:683-8. [PMID: 25495425 DOI: 10.1111/jre.12251] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Emerging evidence shows that tooth loss is associated with cognitive impairment and dementia. Vascular cognitive impairment (VCI) is a common consequence of ischemic stroke. This study investigated the association of tooth loss with VCI in patients with acute stroke. MATERIAL AND METHODS A total of 161 subjects with acute ischemic stroke were recruited. Within 1 wk after admission, fasting blood tests were undertaken and the number of teeth present was recorded. VCI was evaluated with the Montreal Cognitive Assessment (MoCA). RESULTS The patients with loss of ≥ 8 teeth exhibited significantly lower MoCA values as compared to those with loss of ≤ 7 teeth (13.2 ± 6.6 vs. 17.3 ± 6.0, p < 0.001). Multivariate logistic regression analysis showed that loss of ≥ 8 teeth (OR = 3.1, 95% CI: 1.2-7.9, p = 0.02) and stroke history (OR = 3.8, 95% CI: 1.1-14.1, p = 0.04) were significantly associated with VCI (MoCA score ≤ 20.0). CONCLUSION Within the limitations of this study, the current findings provide the first evidence that multiple tooth loss is independently associated with VCI in patients with acute ischemic stroke.
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Affiliation(s)
- J Zhu
- Department of Neurology, the Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, China
| | - X Li
- Private dental practice, Hong Kong, China
| | - F Zhu
- Department of Neurology, the Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, China
| | - L Chen
- Department of Neurology, the Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, China
| | - C Zhang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - C McGrath
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - F He
- Clinical Laboratory, the Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, China
| | - Y Xiao
- Department of Ultrasonography, the Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, China
| | - L Jin
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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15
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Aarabi G, Eberhard J, Reissmann DR, Heydecke G, Seedorf U. Interaction between periodontal disease and atherosclerotic vascular disease--Fact or fiction? Atherosclerosis 2015; 241:555-60. [PMID: 26100678 DOI: 10.1016/j.atherosclerosis.2015.04.819] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/22/2015] [Accepted: 04/30/2015] [Indexed: 12/23/2022]
Abstract
C-reactive protein (CRP) level is associated with the 10-year risk of an atherosclerotic vascular disease (ASVD), suggesting presence of systemic inflammation probably long before ASVD is present. Where, however, does this systemic inflammation come from? One active area of research has been the study of dental infection and various forms of periodontal disease (PD), both of which are highly prevalent in populations at risk for ASVD. Recent data show that ASVD and PD interact with each other via systemic release of specific pro- and anti-inflammatory cytokines, small signal molecules and enzymes which modulate initiation and progression of the chronic inflammatory reaction involved in both diseases. In addition, periodontal pathogens were identified within atherosclerotic lesions and thrombi isolated from myocardial infarction patients. LDL cholesterol, a strong risk factor for ASVD, is also associated with PD; and statins, used to treat ASVD, are also active to prevent or reduce PD. Finally, there is growing evidence for common genetic susceptibility factors involved in both diseases. These findings support commonalities with respect to the pathogenic mechanisms involved in both inflammatory diseases. Conversely, a causative relationship cannot yet be concluded in the absence of data from large longitudinal cohort and randomized controlled intervention trials.
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Affiliation(s)
- Ghazal Aarabi
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jörg Eberhard
- Periimplant and Oral Infections, Department of Prosthetic Dentistry and Biomaterial Sciences, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Daniel R Reissmann
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Guido Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Udo Seedorf
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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16
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Gurav AN. The implication of periodontitis in vascular endothelial dysfunction. Eur J Clin Invest 2014; 44:1000-9. [PMID: 25104241 DOI: 10.1111/eci.12322] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/04/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Periodontitis is the most common oral infection seen in humans worldwide. It is characterized by gradual destruction of tooth supporting tissues, eventually leading to loss of tooth. The periodontal biofilm associated with periodontitis comprises of gram-positive and gram-negative bacteria, instrumental for the initiation and progression of periodontitis. Evidence-based literature has identified the nature of periodontal infection as a possible causative condition in the inducement of 'low-grade systemic inflammation and infection'. The periodontal pathogens exert systemic effects via the haematogenous route. AIM The present review provides an insight into the pathophysiology of the endothelial dysfunction with reference to periodontal infection and highlights the association between periodontitis and endothelial dysfunction. Various studies addressing the implication of periodontitis on endothelial dysfunction will be described, with a focus of periodontal treatment on improvement of endothelial function. MATERIALS AND METHODS Studies examining the effects of periodontitis on vascular endothelial function were segregated. Studies conducted on both animal and human models were identified using MEDLINE database search with key search terms such as 'Periodontitis', 'vascular endothelium', 'endothelial dysfunction', 'periodontal bacteria' and 'periodontal therapy'. Systematic reviews and meta-analysis were also screened. Only studies published in English language were considered. The review has been prepared by screening MEDLINE database from 1989 to 2012. RESULTS AND CONCLUSIONS Chronic periodontitis results in altered vascular response, increased expression of pro-inflammatory cytokines and adhesion molecules inducing vascular endothelial dysfunction. Periodontal therapy may ameliorate the perturbed vascular endothelial function.
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Affiliation(s)
- Abhijit N Gurav
- Department of Periodontics, Tatyasaheb Kore Dental College & Research Centre, Kolhapur, India
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17
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Auerkari E, Suhartono A, Djamal N, Verisqa F, Suryandari DA, Kusdhany L, Masulili S, Talbot C. CRP and IL-1B Gene Polymorphisms and CRP in Blood in Periodontal Disease. Open Dent J 2013; 7:88-93. [PMID: 24009648 PMCID: PMC3758952 DOI: 10.2174/1874210601307010088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 01/18/2023] Open
Abstract
Recent studies have suggested an association between periodontal disease (PD) and the systemic polygenic diseases such as cardiovascular disease (CVD). These are thought to be associated because of interrelated environmental, epigenetic, and genetic risk factors. The involved candidate genes include the IL-1B gene, encoding the pro-inflammatory cytokine IL-1β, and the CRP gene encoding the C-reactive protein (CRP), also a known marker of inflammation. However, as the details are not well known on the genetic variation influencing the risk factors, this work aimed to evaluate the distribution of selected polymorphisms of IL-1B and CRP genes, and serum CRP level, in comparison with the PD status. For this purpose, periodontal health was assessed, serum CRP levels measured and polymorphism status of IL-1B and CRP genes determined from samples of peripheral blood taken from 101 consenting Indonesian adult males. The results show that severe PD was significantly associated with age and smoking, as expected, but not with the polymorphisms of IL-1B or CRP (1444). However, a significantly lower fraction of subjects with normal periodontal health than subjects with PD showed the heterozygous type polymorphism of CRP (717). There was no significant difference in the fraction of cases with elevated serum CRP level between subjects with normal health and those with PD, and further study with a larger sample is recommended. The observed association between polymorphism of CRP (717) and periodontal health is suggested as a complementary indicator of the risk to PD for the Indonesian male population.
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Affiliation(s)
- Ei Auerkari
- Department of Oral Biology, Faculty of Dentistry, University of Indonesia, Jakarta Indonesia ; Centre for Ageing Studies, University of Indonesia, Jakarta Indonesia
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18
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Luo W, Wang CY, Jin L. Baicalin downregulates Porphyromonas gingivalis lipopolysaccharide-upregulated IL-6 and IL-8 expression in human oral keratinocytes by negative regulation of TLR signaling. PLoS One 2012; 7:e51008. [PMID: 23239998 PMCID: PMC3519831 DOI: 10.1371/journal.pone.0051008] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 10/31/2012] [Indexed: 11/18/2022] Open
Abstract
Periodontal (gum) disease is one of the main global oral health burdens and severe periodontal disease (periodontitis) is a leading cause of tooth loss in adults globally. It also increases the risk of cardiovascular disease and diabetes mellitus. Porphyromonas gingivalis lipopolysaccharide (LPS) is a key virulent attribute that significantly contributes to periodontal pathogenesis. Baicalin is a flavonoid from Scutellaria radix, an herb commonly used in traditional Chinese medicine for treating inflammatory diseases. The present study examined the modulatory effect of baicalin on P. gingivalis LPS-induced expression of IL-6 and IL-8 in human oral keratinocytes (HOKs). Cells were pre-treated with baicalin (0–80 µM) for 24 h, and subsequently treated with P. gingivalis LPS at 10 µg/ml with or without baicalin for 3 h. IL-6 and IL-8 transcripts and proteins were detected by real-time polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. The expression of nuclear factor-κB (NF-κB), p38 mitogen-activated protein kinase (MAPK) and c-Jun N-terminal kinase (JNK) proteins was analyzed by western blot. A panel of genes related to toll-like receptor (TLR) signaling was examined by PCR array. We found that baicalin significantly downregulated P. gingivalis LPS-stimulated expression of IL-6 and IL-8, and inhibited P. gingivalis LPS-activated NF-κB, p38 MAPK and JNK. Furthermore, baicalin markedly downregulated P. gingivalis LPS-induced expression of genes associated with TLR signaling. In conclusion, the present study shows that baicalin may significantly downregulate P. gingivalis LPS-upregulated expression of IL-6 and IL-8 in HOKs via negative regulation of TLR signaling.
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Affiliation(s)
- Wei Luo
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Cun-Yu Wang
- University of California Los Angeles, School of Dentistry, Los Angeles, California, United States of America
| | - Lijian Jin
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
- * E-mail:
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19
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Li X, Tse HF, Yiu KH, Zhang C, Jin LJ. Periodontal therapy decreases serum levels of adipocyte fatty acid-binding protein in systemically healthy subjects: a pilot clinical trial. J Periodontal Res 2012; 48:308-14. [PMID: 23057990 DOI: 10.1111/jre.12009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVE Adipocyte fatty acid-binding protein (A-FABP) is expressed in adipocytes, macrophages and microvascular endothelial cells, and it plays a central role in inflammation, atherosclerosis and metabolic responses. This pilot study investigated the effect of nonsurgical periodontal therapy on the serum levels of A-FABP in subjects with chronic periodontitis. MATERIAL AND METHODS A pilot clinical trial was conducted in 24 otherwise healthy Chinese subjects with moderate to severe chronic periodontitis. The treatment group (n = 12) received nonsurgical periodontal therapy immediately, whereas in the control group (n = 12) the treatment was delayed for 3 months. The serum levels of A-FABP were measured by ELISAs. Other inflammatory and endothelial biomarkers and periodontal conditions were evaluated at baseline and at the 3-month follow-up appointment. RESULTS A-FABP levels decreased significantly in the treatment group compared with the control group (treatment effect: -1.7 ng/mL; 95% confidence interval: -2.8 to -0.6; p = 0.003). The treatment also significantly improved periodontal conditions but had no significant effect on other biomarkers. In the multivariable regression model, the change in the percentage of sites with detectable plaque was significantly associated with the change in the level of A-FABP (beta: 0.04, 95% confidence interval: 0.01-0.06, p = 0.004). CONCLUSION Within the limitations of this pilot study, the current findings suggest that treatment of periodontitis may significantly decrease the serum levels of A-FABP. Further longitudinal study with a large sample size is warranted to confirm this finding and elaborate the relevant clinical implications.
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Affiliation(s)
- X Li
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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20
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Parnell LD. Advances in Technologies and Study Design. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2012; 108:17-50. [DOI: 10.1016/b978-0-12-398397-8.00002-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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21
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Jin L, Armitage G, Klinge B, Lang N, Tonetti M, Williams R. Global Oral Health Inequalities. Adv Dent Res 2011; 23:221-6. [DOI: 10.1177/0022034511402080] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Periodontal diseases constitute one of the major global oral health burdens, and periodontitis remains a major cause of tooth loss in adults worldwide. The World Health Organization recently reported that severe periodontitis exists in 5-20% of adult populations, and most children and adolescents exhibit signs of gingivitis. Likely reasons to account for these prevalent diseases include genetic, epigenetic, and environmental risk factors, as well as individual and socio-economic determinants. Currently, there are fundamental gaps in knowledge of such fundamental issues as the mechanisms of initiation and progression of periodontal diseases, which are undefined; inability to identify high-risk forms of gingivitis that progress to periodontitis; lack of evidence on how to prevent the diseases effectively; inability to detect disease activity and predict treatment efficacy; and limited information on the effects of integration of periodontal health as a part of the health care program designed to promote general health and prevent chronic diseases. In the present report, 12 basic, translational, and applied research areas have been proposed to address the issue of global periodontal health inequality. We believe that the oral health burden caused by periodontal diseases could be relieved significantly in the near future through an effective global collaboration.
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Affiliation(s)
- L.J. Jin
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - G.C. Armitage
- School of Dentistry, University of California at San Francisco, California, USA
| | - B. Klinge
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Stockholm, Sweden
| | - N.P. Lang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - M. Tonetti
- European Research Group on Periodontology, Berne, Switzerland
| | - R.C. Williams
- School of Dental Medicine, State University of New York at Stony Brook, New York, USA
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