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Camoni N, Conti G, Majorana A, Bardellini E, Salerno C, Wolf TG, Campus G, Cagetti MG. Oral Microbiota of Infants in Maternal Gestational Diabetes: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:421. [PMID: 38671638 PMCID: PMC11049358 DOI: 10.3390/children11040421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
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.
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Affiliation(s)
- Nicole Camoni
- ASST Valle Olona, Dental Unit, 21052 Gallarate, Italy;
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20112 Milano, Italy
| | - Giulio Conti
- Department of Medicine and Surgery, School of Dentistry, University of Insubria, 21100 Varese, Italy;
| | - Alessandra Majorana
- Department of Oral Medicine and Paediatric Dentistry, University of Brescia, 25121 Brescia, Italy; (A.M.); (E.B.)
| | - Elena Bardellini
- Department of Oral Medicine and Paediatric Dentistry, University of Brescia, 25121 Brescia, Italy; (A.M.); (E.B.)
| | - Claudia Salerno
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, 3012 Bern, Switzerland; (C.S.); (T.G.W.); (G.C.)
- Graduate School for Health Sciences, University of Bern, 3012 Bern, Switzerland
| | - Thomas Gerard Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, 3012 Bern, Switzerland; (C.S.); (T.G.W.); (G.C.)
- Department of Periodontology and Operative Dentistry, University Medical Center of the Jhoannes Gutenberg University Mainz, 55116 Mainz, Germany
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, 3012 Bern, Switzerland; (C.S.); (T.G.W.); (G.C.)
| | - Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20112 Milano, Italy
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Raeesi SA, Matrooshi KA, Khamis AH, Tawfik AR, Bain C, Jamal M, Atieh M, Shah M. Awareness of Periodontal Health among Pregnant Females in Government Setting in United Arab Emirates. Eur J Dent 2024; 18:368-377. [PMID: 37591285 PMCID: PMC10959595 DOI: 10.1055/s-0043-1771451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE Periodontal disease is one of the most common infectious diseases. Several factors are associated with increased susceptibility of periodontal disease such as hormonal changes during pregnancy. Although pregnancy does not directly cause gingivitis, it can aggravate preexisting periodontal disease. This study aimed to evaluate knowledge of the association between periodontal disease and pregnancy in pregnant females. MATERIALS AND METHODS A convenience sample of pregnant females attending two United Arab Emirates government hospitals was recruited for this study. A 23-item questionnaire was developed with four sections, covering sociodemographic details, oral hygiene, oral symptoms during pregnancy, and knowledge of periodontal health during pregnancy. The study was conducted between April and October 2017. All participants consented to the survey. RESULTS A total of 100 participants with a mean age of 31 years (± 5.9) completed the survey. Most respondents brushed their teeth 2 to 3 times a day (65%), used a manual toothbrush (93%) but only visited the dentist when in pain (62%). Few respondents self-reported any gingival signs and symptoms during pregnancy; 38% had bleeding gums, 27% had no gum swelling, and 34% had bad odor/taste/smell. Only 21% of pregnant females lost a tooth/teeth during pregnancy, 15% believed that pregnancy increased the likelihood of gum disease, and 66% of gynecologists did not advise a visit to the dentist.Housewives were significantly less knowledgeable about periodontal health than students/employed respondents (p = 0.01). Quality of knowledge was not associated with educational attainment (< 0.06). Respondents > 30 years of age were more likely to believe in "a tooth for a baby" than younger participants aged < 30 years (p < 0.05). A logistic regression model showed that educational attainment was not a predictor for the belief in "a tooth for a baby" but age was a significant predictor (odds ratio = 2.0). CONCLUSION Protocols should be developed in antenatal clinics in order to improve periodontal health in pregnant females and to prevent complications that can result in adverse pregnancy outcomes.
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Affiliation(s)
- Sireen Al Raeesi
- Emirates Heath Services, Ministry of Health and Prevention, Dubai, United Arab Emirates
| | - Khawla Al Matrooshi
- Emirates Heath Services, Ministry of Health and Prevention, Dubai, United Arab Emirates
| | - Amar Hassan Khamis
- Hamdan Bin Mohammed College of Dental Medicine Dubai Healthcare City, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Abdel Rahman Tawfik
- Hamdan Bin Mohammed College of Dental Medicine Dubai Healthcare City, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Crawford Bain
- Hamdan Bin Mohammed College of Dental Medicine Dubai Healthcare City, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Mohamed Jamal
- Hamdan Bin Mohammed College of Dental Medicine Dubai Healthcare City, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Momen Atieh
- Hamdan Bin Mohammed College of Dental Medicine Dubai Healthcare City, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Maanas Shah
- Hamdan Bin Mohammed College of Dental Medicine Dubai Healthcare City, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Spatafora G, Li Y, He X, Cowan A, Tanner ACR. The Evolving Microbiome of Dental Caries. Microorganisms 2024; 12:121. [PMID: 38257948 PMCID: PMC10819217 DOI: 10.3390/microorganisms12010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Dental caries is a significant oral and public health problem worldwide, especially in low-income populations. The risk of dental caries increases with frequent intake of dietary carbohydrates, including sugars, leading to increased acidity and disruption of the symbiotic diverse and complex microbial community of health. Excess acid production leads to a dysbiotic shift in the bacterial biofilm composition, demineralization of tooth structure, and cavities. Highly acidic and acid-tolerant species associated with caries include Streptococcus mutans, Lactobacillus, Actinomyces, Bifidobacterium, and Scardovia species. The differences in microbiotas depend on tooth site, extent of carious lesions, and rate of disease progression. Metagenomics and metatranscriptomics not only reveal the structure and genetic potential of the caries-associated microbiome, but, more importantly, capture the genetic makeup of the metabolically active microbiome in lesion sites. Due to its multifactorial nature, caries has been difficult to prevent. The use of topical fluoride has had a significant impact on reducing caries in clinical settings, but the approach is costly; the results are less sustainable for high-caries-risk individuals, especially children. Developing treatment regimens that specifically target S. mutans and other acidogenic bacteria, such as using nanoparticles, show promise in altering the cariogenic microbiome, thereby combatting the disease.
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Affiliation(s)
- Grace Spatafora
- Biology and Program in Molecular Biology and Biochemistry, Middlebury College, Middlebury, VT 05753, USA
| | - Yihong Li
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY 14853, USA;
| | - Xuesong He
- ADA-Forsyth Institute, Cambridge, MA 02142, USA;
| | - Annie Cowan
- The Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
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Corrêa JD, Faria GA, Fernandes LL. The oral microbiota and gestational diabetes mellitus. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1120920. [PMID: 36993820 PMCID: PMC10012133 DOI: 10.3389/fcdhc.2023.1120920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/07/2023] [Indexed: 03/06/2023]
Abstract
Gestational diabetes mellitus (GDM) is one of the most frequent endocrine conditions during pregnancy. GDM is linked to adverse pregnancy outcomes and has implications for maternal health. Studies have demonstrated the link between pathogenic periodontal bacteria, glycemic control, and the risk of diabetes. The objective of the current study is to perform a mini-review of the available literature on the potential changes in the oral microbiota of women with GDM. The review was conducted by two independent reviewers (LLF and JDC). Indexed electronic databases (PubMed/Medline, Cochrane Library, Web of Science, and Scopus) were searched, including articles published in English and Portuguese. A manual search was also performed to identify related articles. The oral microbial community of pregnant women with GDM is unique from that of healthy pregnant women. The majority of the alterations found in the oral microbiota of women with GDM point to a pro-inflammatory environment with high levels of bacteria associated with periodontitis (Prevotella, Treponema, anaerobic bacteria) and a depletion of bacteria associated with periodontal health maintenance (Firmicutes, Streptococcus, Leptotrichia). More well-designed studies differentiating between pregnant women with good oral health and those with periodontitis are needed to ascertain which differences are due to GDM or periodontitis.
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Chen F, Fei X, Zhu W, Zhang Z, Shen Y, Mao Y, Zhu Q, Xu J, Zhou W, Li M, Du J. Placental DNA methylation changes in gestational diabetes mellitus. Epigenetics 2022; 17:2109-2121. [PMID: 35993280 PMCID: PMC9665131 DOI: 10.1080/15592294.2022.2110193] [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: 03/26/2022] [Accepted: 08/01/2022] [Indexed: 11/03/2022] Open
Abstract
In this study, we investigated the association between altered methylation in the maternal placenta and hyperglycaemia and explored the epigenetic mechanisms underlying gestational diabetes mellitus (GDM). Reduced representation bisulphite sequencing (RRBS) and RNA sequencing (RNA-seq) were performed on placental tissues obtained from women with GDM and healthy controls. Further, pyrosequencing, correlation analyses, and linear regression analyses were performed to valuate relationships between aberrantly methylated-differentially expressed genes and clinical parameters. The EMBOSS and JASPAR databases were used for a computational analysis of CpG islands and transcription factor-binding sites in the TRIM67 promoter region. A CpG island with a length of 264 bp in the placental TRIM67 promoter region in the GDM group exhibited significant hypermethylation at four CpG sites. The hypermethylation of the TRIM67 promoter region in the maternal placenta showed a significant, positive correlation with the 1 h and 2 h oral glucose tolerance test (OGTT) values and a negative correlation with lipoprotein(a). Placental DNA methylation levels in the TRIM67 promoter region were markedly elevated in GDM and were associated with blood glucose and lipid levels during healthy pregnancy.
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Affiliation(s)
- Fujia Chen
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Pharmacy, Fudan University, Shanghai, China
| | - Xiaoping Fei
- Obstetrics Department, The First People’s Hospital of Kunshan, Kunshan, China
| | - Weiqiang Zhu
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Pharmacy, Fudan University, Shanghai, China
| | - Zhaofeng Zhang
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Pharmacy, Fudan University, Shanghai, China
| | - Yupei Shen
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Pharmacy, Fudan University, Shanghai, China
| | - Yanyan Mao
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Pharmacy, Fudan University, Shanghai, China
| | - Qianxi Zhu
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Pharmacy, Fudan University, Shanghai, China
| | - Jianhua Xu
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Pharmacy, Fudan University, Shanghai, China
| | - Weijin Zhou
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Pharmacy, Fudan University, Shanghai, China
| | - Min Li
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Pharmacy, Fudan University, Shanghai, China
| | - Jing Du
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Pharmacy, Fudan University, Shanghai, China
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Bunpeng N, Boriboonhirunsarn D, Boriboonhirunsarn C, Sawangpanyangkura T, Tansriratanawong K. Association between gestational diabetes mellitus and periodontitis via the effect of reactive oxygen species in peripheral blood cells. J Periodontol 2022; 93:758-769. [PMID: 34787908 DOI: 10.1002/jper.21-0455] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Periodontitis (P) has emerged as a risk factor for gestational diabetes mellitus (GDM) through immune cell function alterations, elevated proinflammatory mediators, and increased reactive oxygen species (ROS). The main objective of present study was to determine associations between pregnancy with and without GDM and P. The secondary objective was to compare ROS production in peripheral blood cells (PBCs) of pregnant women with and without GDM. METHODS This cross-sectional case-control study included 128 pregnant women: 64 with and 64 without GDM. All participants were examined for clinical parameters of GDM and periodontal conditions. Associations between GDM-related periodontal data and GDM risk were evaluated by multiple logistic regression. PBCs were isolated and cultured. ROS productions in each PBCs types was investigated by flow cytometry with ROS antibodies. RESULTS P was significantly more prevalent in pregnant women with GDM than in those without GDM (57.8% versus 37.5%), with an odds ratio (OR) of 2.28, and a 95% confidence interval (CI) of 1.12 to 4.64 (P = 0.022). The OR (95% CI) was 2.59 (1.19 to 5.65) (P = 0.017) after adjusting for potential confounding factors, including diabetes mellitus (DM) family history, age ≥30 years, body mass index, and maternal age. ROS levels in all PBCs types were significantly higher in the GDM than in the non-GDM group (P < 0.05). CONCLUSION This study supported the association between P and GDM and indicated that P may be a risk factor for GDM. High levels of ROS production in the PBCs of pregnant women with GDM emphasized the association with GDM.
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Affiliation(s)
- Nattawan Bunpeng
- Department of Oral Medicine and Periodontology, Mahidol University, Bangkok, Thailand
| | - Dittakarn Boriboonhirunsarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Teerat Sawangpanyangkura
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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Sawangpanyangkura T, Laohapand P, Boriboonhirunsarn D, Boriboonhirunsarn C, Bunpeng N, Tansriratanawong K. Upregulation of microRNA-223 expression in gingival crevicular blood of women with gestational diabetes mellitus and periodontitis. J Dent Sci 2022; 17:863-869. [PMID: 35756772 PMCID: PMC9201537 DOI: 10.1016/j.jds.2021.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background/Purpose MicroRNA-223 (miR-223) is involved in several inflammatory diseases, including gestational diabetes mellitus (GDM) and periodontitis. We first described a procedure for purifying miR-223 from gingival crevicular blood (GCB) of pregnant women with or without GDM and periodontitis. This study aimed to determine whether GDM and/or periodontitis modifies miR-223 expression in pregnant women and to analyze miR-223-targeted messenger RNA (mRNA) expression levels in GCB compared to peripheral blood (PB). Materials and methods Pregnant women were allocated to 4 groups: 10 women with GDM and periodontitis (GDM/P), 10 women with GDM without periodontitis (GDM/NP), 9 women with periodontitis and without GDM (NGDM/P) and 10 women without either condition (NGDM/NP). Clinical parameters of GDM and periodontal status were examined. GCB and PB were collected to assess miR-223, ICAM-1, IL-1β and β1-integrin gene expression by quantitative real-time polymerase chain reaction. Results The GDM/P group demonstrated the highest miR-223 expression levels among the 4 groups in GCB. A significant difference was found between GDM/P and GDM/NP group (P = 0.04). In contrast, the GDM/P showed the lowest miR-223 expression level in PB among the 4 groups. Moreover, ICAM-1 and IL-1β mRNA expression exhibited the opposite trend of miRNA-223, indicating that miRNA-223 might regulate the mRNA function of those genes by epigenetic events. Conclusion The upregulation of miR-223 expression in GCB but downregulation in PB, ICAM-1 and IL-1β genes expression in women with GDM and periodontitis suggest a promising role of miR-223 in the association between GDM and periodontitis.
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Affiliation(s)
- Teerat Sawangpanyangkura
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Penpan Laohapand
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Dittakarn Boriboonhirunsarn
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Nattawan Bunpeng
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kallapat Tansriratanawong
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
- Corresponding author. Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, 10400. Thailand.
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Zheng M, Wang C, Ali A, Shih YA, Xie Q, Guo C. Prevalence of periodontitis in people clinically diagnosed with diabetes mellitus: a meta-analysis of epidemiologic studies. Acta Diabetol 2021; 58:1307-1327. [PMID: 34028620 DOI: 10.1007/s00592-021-01738-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/06/2021] [Indexed: 12/19/2022]
Abstract
AIMS The relationship between diabetes mellitus and periodontitis has long been discussed, but the conclusion of this relationship was controversial. We conducted this meta-analysis to explore the association between diabetes mellitus and the prevalence of periodontitis. METHODS PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies reporting associations of periodontitis with diabetes. Gray literature was integrated from the Open-Gray database. Prevalence estimates and odds ratios were extracted by two independent reviewers and synthesized through meta-analyses. RESULTS Twenty-seven papers met the inclusion criteria involving 3092 diabetic patients and 23,494 controls. Overall prevalence of periodontitis was 67.8% in diabetics (combined types) and 35.5% in patients without diabetes (OR, 1.85; 95%CI, 1.61-2.11). Probing depth (MD 0.23; 95% CI, 0.17-0.29; I2 = 25%) and plaque index (MD, 0.20; 95% CI, 0.18-0.23; P = 0.59; I2 = 0%) severity scores were significantly greater among the diabetic group. CONCLUSIONS The prevalence and severity of periodontitis are greater in patients with diabetes than in non-diabetic populations.
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Affiliation(s)
- Mengwen Zheng
- Department of Stomatology, School of Medicine, The First Affiliated Hospital, Shihezi University, Shihezi, Xinjiang, China
| | - Cheng Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ali Ali
- Sheffield Teaching Hospitals NIHR Biomedical Research Centre, Glossop Rd, Sheffield, S10 2JF, UK
| | - Yi An Shih
- School of Nursing, Peking University, Beijing, China
| | - Qinqin Xie
- Department of Stomatology, The Second Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chao Guo
- Department of Stomatology, School of Medicine, The First Affiliated Hospital, Shihezi University, Shihezi, Xinjiang, China.
- The Affiliated Hospital of Qingdao University, Qingdao,Shangdong, China.
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Oral microflora and pregnancy: a systematic review and meta-analysis. Sci Rep 2021; 11:16870. [PMID: 34413437 PMCID: PMC8377136 DOI: 10.1038/s41598-021-96495-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
Understanding changes in oral flora during pregnancy, its association to maternal health, and its implications to birth outcomes is essential. We searched PubMed, Embase, Web of Science, and Cochrane Library in May 2020 (updated search in April and June 2021), and conducted a systematic review and meta-analyses to assess the followings: (1) oral microflora changes throughout pregnancy, (2) association between oral microorganisms during pregnancy and maternal oral/systemic conditions, and (3) implications of oral microorganisms during pregnancy on birth outcomes. From 3983 records, 78 studies were included for qualitative assessment, and 13 studies were included in meta-analysis. The oral microflora remains relatively stable during pregnancy; however, pregnancy was associated with distinct composition/abundance of oral microorganisms when compared to postpartum/non-pregnant status. Oral microflora during pregnancy appears to be influenced by oral and systemic conditions (e.g. gestational diabetes mellitus, pre-eclampsia, etc.). Prenatal dental care reduced the carriage of oral pathogens (e.g. Streptococcus mutans). The Porphyromonas gingivalis in subgingival plaque was more abundant in women with preterm birth. Given the results from meta-analyses were inconclusive since limited studies reported outcomes on the same measuring scale, more future studies are needed to elucidate the association between pregnancy oral microbiota and maternal oral/systemic health and birth outcomes.
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Bobetsis YA, Graziani F, Gürsoy M, Madianos PN. Periodontal disease and adverse pregnancy outcomes. Periodontol 2000 2020; 83:154-174. [PMID: 32385871 DOI: 10.1111/prd.12294] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Periodontal diseases are considered not only to affect tooth-supporting tissues but also to have a cause-and-effect relationship with various systemic diseases and conditions, such as adverse pregnancy outcomes. Mechanistic studies provide strong evidence that periodontal pathogens can translocate from infected periodontium to the feto-placental unit and initiate a metastatic infection. However, the extent and mechanisms by which metastatic inflammation and injury contribute to adverse pregnancy outcomes still remain unclear. The presence of oral bacteria in the placenta of women with term gestation further complicates our understanding of the biology behind the role of periodontal pathogens in pregnancy outcomes. Epidemiological studies demonstrate many methodological inconsistencies and flaws that render comparisons difficult and conclusions insecure. Therefore, despite the fact that a number of prospective studies show a positive association between periodontal diseases and various adverse pregnancy outcomes, the evidence behind it is still weak. Future well-designed explanatory studies are necessary to verify this relationship and, if present, determine its magnitude. The majority of high-quality randomized controlled trials reveal that nonsurgical periodontal therapy during the second trimester of gestation does not improve pregnancy outcomes. From a biological standpoint, this can be partially explained by the fact that therapy rendered at the fourth to sixth months of pregnancy is too late to prevent placental colonization by periodontal pathogens and consequently incapable of affecting pathogen-induced injury at the feto-placental unit. Thus, interventions during the preconception period may be more meaningful. With the increase in our understanding on the potential association between periodontal disease and adverse pregnancy outcomes, it is clear that dental practitioners should provide periodontal treatment to pregnant women that is safe for both the mother and the unborn child. Although there is not enough evidence that the anti-infective therapy alters pregnancy outcomes, it improves health-promoting behavior and periodontal condition, which in turn advance general health and risk factor control.
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Affiliation(s)
- Yiorgos A Bobetsis
- Department of Periodontology, National and Kapodistrian University of Athens, Athens, Greece
| | - Filippo Graziani
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Mervi Gürsoy
- Department of Periodontology, University of Turku, Turku, Finland
| | - Phoebus N Madianos
- Department of Periodontology, National and Kapodistrian University of Athens, Athens, Greece
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Francis EC, Li M, Hinkle SN, Cao Y, Chen J, Wu J, Zhu Y, Cao H, Kemper K, Rennert L, Williams J, Tsai MY, Chen L, Zhang C. Adipokines in early and mid-pregnancy and subsequent risk of gestational diabetes: a longitudinal study in a multiracial cohort. BMJ Open Diabetes Res Care 2020; 8:8/1/e001333. [PMID: 32747382 PMCID: PMC7398109 DOI: 10.1136/bmjdrc-2020-001333] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/07/2020] [Accepted: 05/18/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Several adipokines are implicated in the pathophysiology of gestational diabetes mellitus (GDM), however, longitudinal data in early pregnancy on many adipokines are lacking. We prospectively investigated the association of a panel of adipokines in early and mid-pregnancy with GDM risk. RESEARCH DESIGN AND METHODS Within the National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singletons cohort (n=2802), a panel of 10 adipokines (plasma fatty acid binding protein-4 (FABP4), chemerin, interleukin-6 (IL-6), leptin, soluble leptin receptor (sOB-R), adiponectin, omentin-1, vaspin, and retinol binding protein-4) were measured at gestational weeks (GWs) 10-14, 15-26, 23-31, and 33-39 among 107 GDM cases (ascertained on average at GW 27) and 214 non-GDM controls. Conditional logistic regression was used to estimate ORs of each adipokine and GDM, controlling for known GDM risk factors including pre-pregnancy body mass index. RESULTS Throughout pregnancy changes in chemerin, sOB-R, adiponectin, and high-molecular-weight adiponectin (HMW-adiponectin) concentrations from 10-14 to 15-26 GWs were significantly different among GDM cases compared with non-GDM controls. In early and mid-pregnancy, FABP4, chemerin, IL-6 and leptin were positively associated with increased GDM risk. For instance, at 10-14 GWs, the OR comparing the highest versus lowest quartile (ORQ4-Q1) of FABP4 was 3.79 (95% CI 1.63 to 8.85). In contrast, in both early and mid-pregnancy adiponectin (eg, ORQ4-Q1 0.14 (0.05, 0.34) during 10-14 GWs) and sOB-R (ORQ4-Q1 0.23 (0.11, 0.50) during 10-14 GWs) were inversely related to GDM risk. At 10-14 GWs a model that included conventional GDM risk factors and FABP4, chemerin, sOB-R, and HMW-adiponectin improved the estimated prediction (area under the curve) from 0.71 (95% CI 0.66 to 0.77) to 0.77 (95% CI 0.72 to 0.82). CONCLUSIONS A panel of understudied adipokines including FABP4, chemerin, and sOB-R may be implicated in the pathogenesis of GDM with significant associations detected approximately 10-18 weeks before typical GDM screening.
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Affiliation(s)
- Ellen C Francis
- Colorado School of Public Health, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Mengying Li
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Stefanie N Hinkle
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Yaqi Cao
- Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jinbo Chen
- Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jing Wu
- Glotech, Rockville, Maryland, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Haiming Cao
- Cardiovascular Branch, National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Karen Kemper
- Department of Public Health Sciences, Clemson University College of Behavioral, Social and Health Sciences, Clemson, South Carolina, USA
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University College of Behavioral, Social and Health Sciences, Clemson, South Carolina, USA
| | - Joel Williams
- Department of Public Health Sciences, Clemson University College of Behavioral, Social and Health Sciences, Clemson, South Carolina, USA
| | - Michael Y Tsai
- Laboratory Medicine and Pathology, University of Minnesota System, Minneapolis, Minnesota, USA
| | - Liwei Chen
- Epidemiology, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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12
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Chaparro A, Zúñiga E, Varas-Godoy M, Albers D, Ramírez V, Hernández M, Kusanovic JP, Acuña-Gallardo S, Rice G, Illanes SE. Periodontitis and placental growth factor in oral fluids are early pregnancy predictors of gestational diabetes mellitus. J Periodontol 2019; 89:1052-1060. [PMID: 29790168 DOI: 10.1002/jper.17-0497] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 01/30/2018] [Accepted: 02/16/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) affects around 7% to 10% of all pregnancies. Early detection of predisposition to GDM is the first step in developing efficacious preventive treatment. The objective of the present study was to establish the utility of placental proteins presents in oral fluids (gingival crevicular fluid [GCF] and saliva), and periodontal disease status as early pregnancy predictors of GDM. METHODS A nested case control within a prospective cohort was conducted. Pregnant systemically healthy women, aged between 18 and 40 years at 11 to 14 weeks gestation were included. Samples of oral fluids were collected and a complete maternal/obstetric and periodontal history was obtained. The concentration of placental growth factor (PlGF) and soluble Fms-like tyrosine kinase 1 (sFlt-1) were measured by enzyme-linked immunosorbent assay in a nested case control sample of the prospective cohort. Multiple logistic regression models assessed the association. The evaluation of the diagnostic accuracy of the biomarkers was performed through receiver operating characteristic (ROC) curves by calculating the area under the curve (AUC). RESULTS There were recruited 212 pregnant women at 11 to 14 weeks of pregnancy, of these, 14 women (i.e., 6.6%) developed GDM, and displayed significant greater bleeding on probing (BOP) [P = 0.0003]; periodontal probing depth (PD) [P = 0.0028]; clinical attachment level (AL) [P = 0.0008] and periodontal inflamed surface area (PISA) [P = 0.0001]. Similarly, initial glycemia and GCF-PlGF concentrations were significantly greater in women with GDM [P = 0.0012, and P = 0.0019, respectively]. When data were subjected to ROC curve analysis, the combination of initial glycemia and GCF-PlGF concentration delivered an area under the ROC curve of 0.897. Multiple logistic regression analyses demonstrate an association between glycemia (OR 1.21, 95% confidence interval [CI] 1.06 to 1.38; P = 0.005) and GCF-PlGF concentrations in women who developed GDM (OR 1.68, CI 1.05 to 2.68 P = 0.03). CONCLUSIONS Within the limitations of the present study, the results support that first trimester maternal glycemia combined with GCF-PlGF concentrations could be a surrogate biomarker for the future development of GDM in pre-symptomatic women.
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Affiliation(s)
- Alejandra Chaparro
- Department of Periodontology, Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
| | - Edgardo Zúñiga
- Department of Periodontology, Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
| | - Manuel Varas-Godoy
- Department of Obstetrics and Gynecology, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de los Andes
| | - Daniela Albers
- Department of Statistics, Faculty of Dentistry, Universidad Mayor, Santiago, Chile
| | - Valeria Ramírez
- Department of Public Health and Epidemiology, Faculty of Dentistry, Universidad de los Andes
| | - Marcela Hernández
- Department of Pathology, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.,Dentistry Unit, Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | - Juan Pedro Kusanovic
- Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Department of Obstetrics and Gynecology, Sótero del Río Hospital, Santiago, Chile.,Center of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Stephanie Acuña-Gallardo
- Department of Obstetrics and Gynecology, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de los Andes
| | - Gregory Rice
- Exosome Biology Laboratory, Center for Clinical Diagnostics, Royal Brisbane and Women's Hospital, University of Queensland Center for Clinical Research, Brisbane, Australia
| | - Sebastián E Illanes
- Department of Obstetrics and Gynecology, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de los Andes
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13
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Quantitative analysis of key periodontopathic bacteria in gestational diabetic and non-diabetic women. J Diabetes Metab Disord 2019; 18:363-369. [PMID: 31890661 DOI: 10.1007/s40200-019-00420-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
Purpose The aim of this study is to compare the periodontal status and quantify Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi) from plaque samples of both gestational diabetic mellitus (GDM) and non diabetic pregnant women. Materials and methods Sixty first time pregnant women were selected after adjusting for age, duration of pregnancy and educational status. They were then categorized into gestational diabetic women (GDM) (Group A) and healthy pregnant women (non GDM) (Group B). Periodontal examination was done by assessing gingival index, periodontal disease index and probing depth. Microbial analysis on sub-gingival plaque was performed using polymerase chain reaction (PCR). Statistical analysis was done by student t test, chi square test and Fischer exact test. Results Group A showed higher gingival index, probing depth and periodontal disease index scores than group B at p < 0.001. Pg was detected in 80% of group A and 40% of group B. Amongst these; it was measured over 2.0 × 104 in 33% of group A, while in the group B it never scored more than 1.0 × 104. While Pi were also detected in 73% of group A women and 40% Group B women but quantification showed Pi > 2.0 × 104 in more number of group A women. Conclusion This study showed that there is significant association between the severity of periodontal disease and increased levels of Pg and Pi in gestational diabetic women.
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14
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Levin G, Rottenstreich A. Gestational diabetes mellitus and periodontal diseases: a well-known association. Arch Gynecol Obstet 2018; 302:535-536. [PMID: 30426191 DOI: 10.1007/s00404-018-4963-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 11/03/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, Israel.
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, Israel
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15
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Kumar A, Sharma DS, Verma M, Lamba AK, Gupta MM, Sharma S, Perumal V. Association between periodontal disease and gestational diabetes mellitus—A prospective cohort study. J Clin Periodontol 2018; 45:920-931. [DOI: 10.1111/jcpe.12902] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Ashok Kumar
- Department of Obstetrics and GynaecologyMaulana Azad Medical College New Delhi India
| | - Deepika S. Sharma
- Department of Obstetrics and GynaecologyMaulana Azad Medical College New Delhi India
| | - Mahesh Verma
- Maulana Azad Institute of Dental Sciences New Delhi India
| | | | - Madhavi M. Gupta
- Department of Obstetrics and GynaecologyMaulana Azad Medical College New Delhi India
| | - Shashi Sharma
- Institute of Cytology and Preventive Oncology Noida Uttar Pradesh India
| | - Vanamail Perumal
- Department of Obstetrics and GynaecologyAll India Institute of Medical Sciences New Delhi India
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16
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Graziani F, Gennai S, Solini A, Petrini M. A systematic review and meta-analysis of epidemiologic observational evidence on the effect of periodontitis on diabetes An update of the EFP-AAP review. J Clin Periodontol 2017; 45:167-187. [PMID: 29277926 DOI: 10.1111/jcpe.12837] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2017] [Indexed: 12/23/2022]
Abstract
AIM To update the available evidence on the impact of periodontitis on diabetes control, incidence and complications. METHODS Observational studies on the effect of periodontitis on diabetes, published after 2012, were identified through electronic databases and hand-searched journals. Findings were summarized by evidence tables, using PRISMA statement. Quality of the included studies was evaluated through the Newcastle Ottawa scale. RESULTS Healthy individuals with periodontitis exhibit a poor glycaemic control and a higher risk of developing diabetes. Individuals affected by diabetes show a deterioration of glycaemic control if also affected by periodontitis and significantly higher prevalence of diabetes-related complications. Limited evidence is available on gestational diabetes and type 1 diabetes. CONCLUSIONS Periodontitis has a significant impact on diabetes control, incidence and complications. Nevertheless, the heterogeneity and quality of the included publications suggest that caution should be exercised when interpreting the data and that there remains an important need for additional evidence.
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Affiliation(s)
- Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology, Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology, Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Anna Solini
- Department of Surgical, Medical and Molecular Pathology, Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy.,Unit of Internal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Morena Petrini
- Department of Surgical, Medical and Molecular Pathology, Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
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17
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Esteves Lima RP, Cota LOM, Silva TA, Cortelli SC, Cortelli JR, Costa FO. Periodontitis and type 2 diabetes among women with previous gestational diabetes: epidemiological and immunological aspects in a follow-up of three years. J Appl Oral Sci 2017; 25:130-139. [PMID: 28403353 PMCID: PMC5393533 DOI: 10.1590/1678-77572016-0367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/06/2016] [Accepted: 09/22/2016] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim of this study was to verify the incidence on the development of type 2 diabetes in women with previous gestational diabetes with and without periodontitis after a three-year time interval. MATERIAL AND METHODS Initial sample of this follow-up study consisted of 90 women diagnosed with gestational diabetes who underwent periodontal examination. After three years, 49 women were subjected to new periodontal examination and biological, behavioral, and social data of interest were collected. Additionally, the quantification of the C-reactive protein in blood samples was performed. Fasting glucose and glycated hemoglobin levels were requested. Saliva samples were collected for quantification of interleukin 6 and 10, tumor necrosis factor α, matrix metalloproteinase 2 and 9. RESULTS The incidence of type 2 diabetes mellitus was 18.4% and of periodontitis was 10.2%. There was no significant difference in the incidence of type 2 diabetes mellitus among women with and without periodontitis. It was observed impact of C-reactive protein in the development of type 2 diabetes mellitus. However, it was not observed impact of periodontitis on the development of type 2 diabetes mellitus among women with previous gestational diabetes. CONCLUSIONS It was not observed impact of periodontitis on the development of type 2 diabetes among women with previous gestational diabetes. The impact of C-reactive protein in the development of type 2 diabetes mellitus highlights the importance of an inflammatory process in the diabetes pathogenesis.
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Affiliation(s)
- Rafael Paschoal Esteves Lima
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Periodontologia e Patologia, Belo Horizonte, MG, Brasil
| | - Luis Otávio Miranda Cota
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Periodontologia e Patologia, Belo Horizonte, MG, Brasil
| | - Tarcília Aparecida Silva
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Periodontologia e Patologia, Belo Horizonte, MG, Brasil
| | | | | | - Fernando Oliveira Costa
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Periodontologia e Patologia, Belo Horizonte, MG, Brasil
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18
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Clinical periodontal status and inflammatory cytokines in gestational diabetes mellitus. Arch Oral Biol 2016; 72:87-91. [DOI: 10.1016/j.archoralbio.2016.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/10/2016] [Accepted: 08/10/2016] [Indexed: 11/18/2022]
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19
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Abariga SA, Whitcomb BW. Periodontitis and gestational diabetes mellitus: a systematic review and meta-analysis of observational studies. BMC Pregnancy Childbirth 2016; 16:344. [PMID: 27825315 PMCID: PMC5101727 DOI: 10.1186/s12884-016-1145-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is glucose intolerance with first onset during pregnancy and is associated with serious maternal and fetal complications. The etiology of GDM is not well understood, but systemic inflammation effects on insulin signaling and glucose metabolism is suspected. Periodontal disease is a chronic inflammatory condition that induces local and host immune responses and has been evaluated for a potential role in development of GDM. Results from studies evaluating the association between periodontitis and GDM are mixed. We performed a systematic review and meta-analysis to summarize available data regarding the association between periodontitis and GDM. METHODS Twelve electronic databases were searched for observational studies of the association between periodontitis and GDM through March 2016. Eligible studies were assessed for quality and heterogeneity. Random effects models were used to estimate summary measures of association. RESULTS We identified 44 articles from 115 potentially relevant reports of which 10 studies met our eligibility criteria. Clinical diagnostic criteria for periodontitis and GDM varied widely among studies, and moderate heterogeneity was observed. Random effects meta-analysis of all included studies with a total of 5724 participants including 624 cases, showed that periodontitis is associated with an increased risk of GDM by 66 %, (OR = 1.66, 95 % CI: 1.17 to 2.36; p < 0.05), I2 = 50.5 %. Similar results were seen in sub-analysis restricted to data from methodologically high quality case-control studies including 1176 participants including 380 cases, (OR = 1.85, 95 % CI: 1.03 to 3.32); p < 0.05), I2 = 68.4 %. Meta-analysis of studies that adjusted for potential confounders estimated more than 2-fold increased odds of GDM among women with periodontitis (aOR = 2.08, 95 % CI: 1.21 to 3.58, p = 0.009, I2 = 36.9 %). CONCLUSION Meta-analysis suggests that periodontitis is associated with a statistically significant increased risk for GDM compared to women without periodontitis. Robust prospective study designs and uniform definition for periodontitis and GDM definitions are urgently needed to substantiate these findings.
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Affiliation(s)
- Samuel A Abariga
- Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, 415 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA.
| | - Brian W Whitcomb
- Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, 415 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
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20
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Taylor JJ, Preshaw PM, Lalla E. A review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes. J Clin Periodontol 2016; 40 Suppl 14:S113-34. [PMID: 23627323 DOI: 10.1111/jcpe.12059] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/16/2022]
Abstract
AIMS To review the evidence for the molecular and cellular processes that may potentially link periodontal disease and diabetes. The pathogenic roles of cytokines and metabolic molecules (e.g. glucose, lipids) are explored and the role of periodontal bacteria is also addressed. Paradigms for bidirectional relationships between periodontitis and diabetes are discussed and opportunities for elaborating these models are considered. METHODS Database searches were performed using MeSH terms, keywords, and title words. Studies were evaluated and summarized in a narrative review. RESULTS Periodontal microbiota appears unaltered by diabetes and there is little evidence that it may influence glycaemic control. Small-scale clinical studies and experiments in animal models suggest that IL-1β, TNF-α, IL-6, OPG and RANKL may mediate periodontitis in diabetes. The AGE-RAGE axis is likely an important pathway of tissue destruction and impaired repair in diabetes-associated periodontitis. A role for locally activated pro-inflammatory factors in the periodontium, which subsequently impact on diabetes, remains speculative. CONCLUSION There is substantial information on potential mechanistic pathways which support a close association between diabetes and periodontitis, but there is a real need for longitudinal clinical studies using larger patient groups, integrated with studies of animal models and cells/tissues in vitro.
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Affiliation(s)
- John J Taylor
- Centre for Oral Health Research and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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21
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Borgnakke WS, Ylöstalo PV, Taylor GW, Genco RJ. Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence. J Periodontol 2016; 84:S135-52. [PMID: 23631574 DOI: 10.1902/jop.2013.1340013] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Periodontal disease and diabetes mellitus are common, chronic diseases worldwide. Epidemiologic and biologic evidence suggest periodontal disease may affect diabetes. OBJECTIVE To systematically review non-experimental, epidemiologic evidence for effects of periodontal disease on diabetes control, complications and incidence. DATA SOURCES Electronic bibliographic databases, supplemented by hand searches of recent and future issues of relevant journals. Study eligibility criteria and participants: Longitudinal and cross-sectional epidemiologic, non-interventional studies that permit determination of directionality of observed effects were included. STUDY APPRAISAL AND SYNTHESIS METHODS Four reviewers evaluated pair-wise each study. Review findings regarding study results and quality were summarized in tables by topic, using the PRISMA Statement for reporting and the Newcastle-Ottawa System for quality assessment, respectively. From 2246 citations identified and available abstracts screened, 114 full-text reports were assessed and 17 included in the review. RESULTS A small body of evidence supports significant, adverse effects of periodontal disease on glycaemic control, diabetes complications, and development of type 2 (and possibly gestational) diabetes. LIMITATIONS There were only a limited number of eligible studies, several of which included small sample sizes. Exposure and outcome parameters varied, and the generalizability of their results was limited. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Current evidence suggests that periodontal disease adversely affects diabetes outcomes, and that further longitudinal studies are warranted.
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Affiliation(s)
- Wenche S Borgnakke
- School of Dentistry, University of Michigan, 1011 North University Avenue, Ann Arbor, MI 48109-1078, USA.
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22
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Madianos PN, Bobetsis YA, Offenbacher S. Adverse pregnancy outcomes (APOs) and periodontal disease: pathogenic mechanisms. J Periodontol 2016; 84:S170-80. [PMID: 23631577 DOI: 10.1902/jop.2013.1340015] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM To evaluate the evidence on potential biological pathways underlying the possible association between periodontal disease (PD) and adverse pregnancy outcomes (APOs). MATERIAL & METHODS Human, experimental and in vitro studies were evaluated. RESULTS Periodontal pathogens/byproducts may reach the placenta and spread to the foetal circulation and amniotic fluid. Their presence in the foeto-placental compartment can stimulate a foetal immune/inflammatory response characterized by the production of IgM antibodies against the pathogens and the secretion of elevated levels of inflammatory mediators, which in turn may cause miscarriage or premature birth. Moreover, infection/inflammation may cause placental structural changes leading to pre-eclampsia and impaired nutrient transport causing low birthweight. Foetal exposure may also result in tissue damage, increasing the risk for perinatal mortality/morbidity. Finally, the elicited systemic inflammatory response may exacerbate local inflammatory responses at the foeto-placental unit and further increase the risk for APOs. CONCLUSIONS Further investigation is still necessary to fully translate the findings of basic research into clinical studies and practice. Understanding the systemic virulence potential of the individual's oral microbiome and immune response may be a distinctly different issue from categorizing the nature of the challenge using clinical signs of PD. Therefore, a more personalized targeted therapy could be a more predictive answer to the current "one-size-fits-all" interventions.
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Affiliation(s)
- Phoebus N Madianos
- Department of Periodontology, School of Dentistry, University of Athens, Athens, Greece.
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23
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Borgnakke WS, Ylöstalo PV, Taylor GW, Genco RJ. Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence. J Clin Periodontol 2016; 40 Suppl 14:S135-52. [PMID: 23627324 DOI: 10.1111/jcpe.12080] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Periodontal disease and diabetes mellitus are common, chronic diseases worldwide. Epidemiologic and biologic evidence suggest periodontal disease may affect diabetes. OBJECTIVE To systematically review non-experimental, epidemiologic evidence for effects of periodontal disease on diabetes control, complications and incidence. DATA SOURCES Electronic bibliographic databases, supplemented by hand searches of recent and future issues of relevant journals. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS: Longitudinal and cross-sectional epidemiologic, non-interventional studies that permit determination of directionality of observed effects were included. STUDY APPRAISAL AND SYNTHESIS METHODS Four reviewers evaluated pair-wise each study. Review findings regarding study results and quality were summarized in tables by topic, using the PRISMA Statement for reporting and the Newcastle-Ottawa System for quality assessment, respectively. From 2246 citations identified and available abstracts screened, 114 full-text reports were assessed and 17 included in the review. RESULTS A small body of evidence supports significant, adverse effects of periodontal disease on glycaemic control, diabetes complications, and development of type 2 (and possibly gestational) diabetes. LIMITATIONS There were only a limited number of eligible studies, several of which included small sample sizes. Exposure and outcome parameters varied, and the generalizability of their results was limited. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Current evidence suggests that periodontal disease adversely affects diabetes outcomes, and that further longitudinal studies are warranted.
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Affiliation(s)
- Wenche S Borgnakke
- University of Michigan School of Dentistry, Ann Arbor, MI 48109-1078, USA.
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24
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Madianos PN, Bobetsis YA, Offenbacher S. Adverse pregnancy outcomes (APOs) and periodontal disease: pathogenic mechanisms. J Clin Periodontol 2016; 40 Suppl 14:S170-80. [PMID: 23627327 DOI: 10.1111/jcpe.12082] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 01/07/2023]
Abstract
AIM To evaluate the evidence on potential biological pathways underlying the possible association between periodontal disease (PD) and adverse pregnancy outcomes (APOs). MATERIAL & METHODS Human, experimental and in vitro studies were evaluated. RESULTS Periodontal pathogens/byproducts may reach the placenta and spread to the foetal circulation and amniotic fluid. Their presence in the foeto-placental compartment can stimulate a foetal immune/inflammatory response characterized by the production of IgM antibodies against the pathogens and the secretion of elevated levels of inflammatory mediators, which in turn may cause miscarriage or premature birth. Moreover, infection/inflammation may cause placental structural changes leading to pre-eclampsia and impaired nutrient transport causing low birthweight. Foetal exposure may also result in tissue damage, increasing the risk for perinatal mortality/morbidity. Finally, the elicited systemic inflammatory response may exacerbate local inflammatory responses at the foeto-placental unit and further increase the risk for APOs. CONCLUSIONS Further investigation is still necessary to fully translate the findings of basic research into clinical studies and practice. Understanding the systemic virulence potential of the individual's oral microbiome and immune response may be a distinctly different issue from categorizing the nature of the challenge using clinical signs of PD. Therefore, a more personalized targeted therapy could be a more predictive answer to the current "one-size-fits-all" interventions.
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Affiliation(s)
- Phoebus N Madianos
- Department of Periodontology, School of Dentistry, University of Athens, Athens, Greece.
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25
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Esteves Lima RP, Cyrino RM, de Carvalho Dutra B, Oliveira da Silveira J, Martins CC, Miranda Cota LO, Costa FO. Association Between Periodontitis and Gestational Diabetes Mellitus: Systematic Review and Meta-Analysis. J Periodontol 2015; 87:48-57. [PMID: 26334246 DOI: 10.1902/jop.2015.150311] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To the best of the authors' knowledge, there is no systematic review of the potential association between periodontitis and gestational diabetes mellitus (GDM) in the current literature. The aim of the present systematic review and meta-analysis is to search for scientific evidence regarding the association between periodontitis and GDM. METHODS The present study was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered (CRD2014010728) with PROSPERO (International prospective register for systematic reviews, University of York, York, UK). A search was conducted in three electronic databases without restrictions regarding language or date of publication. From 190 studies selected, 15 underwent full-text analysis. Eight studies were eligible (five cross-sectional and three case-control studies), and seven were entered in the meta-analysis. Meta-analysis was performed with tests for sensitivity and statistical heterogeneity. Summary effect measures were calculated by odds ratio (OR) and 95% confidence interval (CI). RESULTS There was a significant association between periodontitis and GDM in the meta-analyses of four cross-sectional studies (OR 1.67, 95% CI 1.20 to 2.32) and two case-control studies (OR 2.66, 95% CI 1.52 to 4.65). However, sensitivity tests for case-control studies showed a lack of consistency in data; when including one case-control study, the significance was null (meta-analysis of three case-control studies: OR 1.69, 95% CI 0.68 to 4.21). CONCLUSIONS There was substantial clinical, methodologic, and statistical heterogeneity among the studies. The scientific evidence cannot affirm a positive association between periodontitis and GDM. Future studies with different designs in distinct populations should be conducted to investigate this association.
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Affiliation(s)
| | - Renata Magalhães Cyrino
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Bernardo de Carvalho Dutra
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Carolina Castro Martins
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais
| | - Luis Otávio Miranda Cota
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Fernando Oliveira Costa
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Bao W, Baecker A, Song Y, Kiely M, Liu S, Zhang C. Adipokine levels during the first or early second trimester of pregnancy and subsequent risk of gestational diabetes mellitus: A systematic review. Metabolism 2015; 64:756-64. [PMID: 25749468 PMCID: PMC4625979 DOI: 10.1016/j.metabol.2015.01.013] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/06/2015] [Accepted: 01/23/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We aimed to systematically review available literature linking adipokines to gestational diabetes mellitus (GDM) for a comprehensive understanding of the roles of adipokines in the development of GDM. METHODS We searched PubMed/MEDLINE and EMBASE databases for published studies on adipokines and GDM through October 21, 2014. We included articles if they had a prospective study design (i.e., blood samples for adipokines measurement were collected before GDM diagnosis). Random-effects models were used to pool the weighted mean differences comparing levels of adipokines between GDM cases and non-GDM controls. RESULTS Of 1523 potentially relevant articles, we included 25 prospective studies relating adipokines to incident GDM. Our meta-analysis of nine prospective studies on adiponectin and eight prospective studies on leptin indicated that adiponectin levels in the first or early second trimester of pregnancy were 2.25 μg/ml lower (95% CI: 1.75-2.75), whereas leptin levels were 7.25 ng/ml higher (95% CI 3.27-11.22), among women who later developed GDM than women who did not. Prospective data were sparse and findings were inconsistent for visfatin, retinol binding protein (RBP-4), resistin, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and vaspin. We did not identify prospective studies for several novel adipokines, including chemerin, apelin, omentin, or adipocyte fatty acid-binding protein. Moreover, no published prospective studies with longitudinal assessment of adipokines and incident GDM were identified. CONCLUSION Adiponectin levels in the first or second trimester of pregnancy are lower among pregnant women who later develop GDM than non-GDM women, whereas leptin levels are higher. Well-designed prospective studies with longitudinal assessment of adipokines during pregnancy are needed to understand the trajectories and dynamic associations of adipokines with GDM risk.
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Affiliation(s)
- Wei Bao
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD
| | - Aileen Baecker
- Department of Epidemiology, University of California, Los Angeles, CA
| | - Yiqing Song
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN
| | - Michele Kiely
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD
| | - Simin Liu
- Departments of Epidemiology and Medicine, Brown University, Providence, RI
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD.
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Gogeneni H, Buduneli N, Ceyhan-Öztürk B, Gümüş P, Akcali A, Zeller I, Renaud DE, Scott DA, Özçaka Ö. Increased infection with key periodontal pathogens during gestational diabetes mellitus. J Clin Periodontol 2015; 42:506-12. [PMID: 25959628 PMCID: PMC4699310 DOI: 10.1111/jcpe.12418] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 12/13/2022]
Abstract
AIM Gestational diabetes mellitus (GDM), gingivitis, infection with specific periodontal pathogens and systemic inflammation each increase the risk for poor pregnancy outcome. We set out to monitor the interactions of gingivitis and GDM with respect to oral infection and the systemic inflammatory burden. MATERIALS AND METHODS Four case-control groups (n = 117) were recruited, (1) No gingivitis, No GDM (n = 27); (2) Gingivitis, No GDM (n = 31); (3) No gingivitis, GDM (n = 21); and (4) Gingivitis, GDM (n = 38). Oral infection with three key periodontal pathogens was determined by PCR. Systemic inflammation was determined by quantification of CRP by EIA. RESULTS Gingivitis during pregnancy was associated with oral infection with Porphyromonas gingivalis, Filifactor alocis and Treponema denticola and combinations thereof (all p < 0.01). GDM was also associated with increased infection with individual and multiple oral pathogens (all p < 0.05). Gingivitis during pregnancy led to a 325% increase in systemic CRP (mean, 2495 versus 8116 ng/ml, p < 0.01). CONCLUSIONS Diabetes and gingivitis act in concert to increase risk biomarkers for poor pregnancy outcome.
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Affiliation(s)
- Himabindu Gogeneni
- Oral Immunology & Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - Nurcan Buduneli
- Periodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - Banu Ceyhan-Öztürk
- Department of Endocrine and Metabolic Diseases, Aydın State Hospital, Aydın, Turkey
| | - Pınar Gümüş
- Periodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - Aliye Akcali
- Periodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - Iris Zeller
- Oral Immunology & Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - Diane E. Renaud
- Oral Immunology & Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - David A. Scott
- Oral Immunology & Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - Özgün Özçaka
- Periodontology, School of Dentistry, Ege University, Izmir, Turkey
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Haraszthy VI, Sreenivasan PK, Zambon JJ. Community-level assessment of dental plaque bacteria susceptibility to triclosan over 19 years. BMC Oral Health 2014; 14:61. [PMID: 24889743 PMCID: PMC4075995 DOI: 10.1186/1472-6831-14-61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 05/27/2014] [Indexed: 11/10/2022] Open
Abstract
Background Triclosan is a broad-spectrum antimicrobial agent used in toothpaste to reduce dental plaque, gingivitis and oral malodor. This community-level assessment evaluated the susceptibility of dental plaque bacteria to triclosan in samples collected over 19 years. Methods A total of 155 dental plaque samples were collected at eleven different times over 19 years from 58 adults using 0.3% triclosan, 2% copolymer, 0.243% sodium fluoride toothpaste and from 97 adults using toothpaste without triclosan. These included samples from 21 subjects who used triclosan toothpaste for at least five years and samples from 20 control subjects. The samples were cultured on media containing 0, 7.5 or 25 μg/ml triclosan. Descriptive statistics and p values were computed and a linear regression model and the runs test were used to examine susceptibility over time. Results Growth inhibition averaged 99.451% (91.209 - 99.830%) on media containing 7.5 μg/ml triclosan and 99.989% (99.670 - 100%) on media containing 25 μg/ml triclosan. There was no change in microbial susceptibility to triclosan over time discernible by regression analysis or the runs test in plaque samples taken over 19 years including samples from subjects using a triclosan-containing dentifrice for at least five years. Conclusions This community-level assessment of microbial susceptibility to triclosan among supragingival plaque bacteria is consistent with the long-term safety of a 0.3% triclosan, 2% copolymer, 0.243% sodium fluoride dentifrice.
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Affiliation(s)
| | | | - Joseph J Zambon
- University at Buffalo, School of Dental Medicine, 222 Foster Hall, 3435 Main Street, Buffalo NY 14214-3008, USA.
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Bullon P, Jaramillo R, Santos-Garcia R, Rios-Santos V, Ramirez M, Fernandez-Palacin A, Fernandez-Riejos P. Relation of Periodontitis and Metabolic Syndrome With Gestational Glucose Metabolism Disorder. J Periodontol 2014; 85:e1-8. [DOI: 10.1902/jop.2013.130319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
During pregnancy profound perturbations in innate and adaptive immunity impact the clinical course of a number of infectious diseases, including those affecting periodontal tissues. Conversely, it has been suggested that periodontal infections may increase the risk of adverse pregnancy outcomes. In this review, a summary of the literature associated with the bidirectional relationship between pregnancy and periodontal disease as well as the possible mechanisms behind this interaction were examined.
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Esteves Lima RP, Miranda Cota LO, Costa FO. Association Between Periodontitis and Gestational Diabetes Mellitus: A Case-Control Study. J Periodontol 2013; 84:1257-65. [DOI: 10.1902/jop.2012.120350] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Taylor JJ, Preshaw PM, Lalla E. A review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes. J Periodontol 2013; 84:S113-34. [DOI: 10.1902/jop.2013.134005] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Chokwiriyachit A, Dasanayake AP, Suwannarong W, Hormdee D, Sumanonta G, Prasertchareonsuk W, Wara-Aswapati N, Combellick J, Pitiphat W. Periodontitis and gestational diabetes mellitus in non-smoking females. J Periodontol 2012; 84:857-62. [PMID: 23075430 DOI: 10.1902/jop.2012.120344] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic inflammation has been implicated in the pathogenesis of gestational diabetes mellitus (GDM). Periodontal disease is associated with increased levels of inflammatory mediators and may be a risk factor for GDM. The authors aimed to examine the association between periodontitis and GDM among non-smoking pregnant females. METHODS This case-control study included 50 females who were diagnosed with GDM and 50 age- and hospital-matched females without diabetes in Khon Kaen, Thailand. Full-mouth periodontal examinations were performed during pregnancy by two calibrated dentists who were unaware of the case-control status. Periodontitis was defined as ≥1 site with probing depth (PD) ≥5 mm and clinical attachment level (CAL) ≥2 mm at the same site. Serum samples were collected to measure C-reactive protein (CRP), tumor necrosis factor-α, and interleukin-6 levels. Analyses were performed using conditional logistic regression. RESULTS Fifty percent of the case females had periodontitis compared to 26% of the controls. Females with GDM had significantly higher mean PD and CAL, more sites with bleeding on probing, and increased levels of CRP compared to the controls. Periodontitis was significantly associated with GDM (odds ratio = 3.00, 95% confidence interval = 1.19 to 7.56). The association remained significant with additional adjustment for family history of diabetes, prepregnancy body mass index, and weight gain during pregnancy. CONCLUSIONS The results suggest that periodontitis is associated with GDM. Therefore, clinicians should assess periodontal conditions of pregnant females.
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Affiliation(s)
- Anyarat Chokwiriyachit
- Department of Periodontology, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
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Ruiz DR, Romito GA, Dib SA. Periodontal disease in gestational and type 1 diabetes mellitus pregnant women. Oral Dis 2011; 17:515-21. [DOI: 10.1111/j.1601-0825.2011.01805.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Matevosyan NR. Periodontal disease and perinatal outcomes. Arch Gynecol Obstet 2010; 283:675-86. [DOI: 10.1007/s00404-010-1774-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 11/09/2010] [Indexed: 11/28/2022]
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Xiong X, Elkind-Hirsch KE, Vastardis S, Delarosa RL, Pridjian G, Buekens P. Periodontal disease is associated with gestational diabetes mellitus: a case-control study. J Periodontol 2009; 80:1742-9. [PMID: 19905944 DOI: 10.1902/jop.2009.090250] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Few studies have specifically examined the relationship between periodontal disease and gestational diabetes mellitus (GDM). The objective of this study was to examine whether maternal periodontal disease is associated with GDM. METHODS A case-control study was conducted of 53 pregnant women with GDM and 106 pregnant women without GDM at Woman's Hospital, Baton Rouge, Louisiana. The periodontal examinations were performed by a calibrated dentist who was masked to the diabetic status of the pregnant women. Periodontitis was defined as the presence of any site with a probing depth (PD) >or=4 mm or a clinical attachment loss (AL) >or=4 mm. The severity of periodontal disease was measured in quartiles of PD and clinical AL. Univariable analysis and multivariable logistic regression were used to examine the relationships between periodontal disease and GDM. RESULTS The percentage of periodontitis was 77.4% in women with GDM and 57.5% in women without GDM, with an odds ratio (OR) of 2.5 and a 95% confidence interval (CI) of 1.2 to 5.3. After adjusting for confounding variables of maternal age, parity, race, marital status, education, family income, smoking, alcohol consumption, systemic antibiotics during pregnancy, family history of diabetes, income, dental insurance coverage, and body mass index, the adjusted OR (95% CI) was 2.6 (1.1 to 6.1). The adjusted ORs (95% CIs) of GDM comparing the highest-to-lowest quartiles of PD and clinical AL were 3.8 (1.0 to 14.0) and 4.5 (1.2 to 16.9). CONCLUSION This study supports the hypothesis of an association between periodontal disease and GDM.
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Affiliation(s)
- Xu Xiong
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
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Abstract
OBJECTIVE To investigate changes in serum-advanced glycosylation end product (AGE) levels in gestation diabetic mothers (GDMs) and its relationship with adverse fetal outcome. STUDY DESIGN A total of 60 GDMs in mid-gestation and 72 late-gestation GDMs fulfilling the inclusion criteria were recruited. Seventy-two mid-gestation and 80 late-gestation mothers with no pregnancy complications acted as controls. Fasting blood glucose and serum AGE levels were analyzed in each group. Clinical data on these women and their perinatal outcomes were collected. Maternal serum AGE levels and changes in blood glucose between mid-gestation groups and late-gestation groups were compared. Factors, including AGE levels, affecting the prevalence of complications of fetal outcome in GDMs were investigated. RESULT Mid-gestation and late-gestation GDMs had significantly higher serum AGE levels and fasting blood glucose than their respective controls (P<0.001 and P<0.05, respectively). After treatment mid-gestation GDMs had significantly lower blood glucose levels at late gestation (P<0.05), but their serum AGE levels remained relatively high. There were no significant changes in serum AGE levels from mid- to late gestation. Women with GDM who had abnormal fetal outcomes had significantly higher maternal serum AGE levels than controls with normal fetal outcome (P<0.05). Particularly, those pregnancies that resulted in birth asphyxia, congenital malformations or stillbirth had higher serum AGEs (P<0.05). Logistic regression analysis showed elevated AGEs as a predictor of adverse perinatal outcome in GDMs, OR=6.285 (P<0.001, 95% CI 2.561 to 15.534). CONCLUSION High-serum AGE is an adverse factor in perinatal outcomes in GDMs. Sustained high AGE levels from mid- to late gestation could be an indicator of adverse perinatal outcomes.
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Bain J, Lester S, Henry W, Naftel J, Johnson R. Effects of induced periapical abscesses on rat pregnancy outcomes. Arch Oral Biol 2009; 54:162-71. [DOI: 10.1016/j.archoralbio.2008.09.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 08/11/2008] [Accepted: 09/25/2008] [Indexed: 01/04/2023]
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Enabling general physicians to perform periodontal screening during nationwide periodic health examinations. J Evid Based Dent Pract 2008; 8:186-94. [PMID: 18783766 DOI: 10.1016/j.jebdp.2008.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED Since 2005, Austrian physicians have screened for periodontal diseases during free-of-charge periodic health examinations (PHE). Various printed and online materials were designed to inform patients and to support general physicians (GPs) to perform this intervention. AIM The aim of this study was to examine whether existing clinical decision support (CDS) resources effectively enhance the potential benefits of periodontal screening (PS) by physicians. METHOD Existing printed and online CDS for PS were analyzed and experts were interviewed to ascertain the utility and use of these resources and the existence of Continuing Education (CE) courses to enable GPs to perform PS. The analysis followed the guidelines of the American Medical Informatics Association on determining the quality of CDS. We asked whether existing CDS for PS provided best knowledge when needed; whether it was easily accessible, accepted, widely used, and improved the quality of care; and whether there was continuing improvement based on feedback, experience, and scientific data. RESULTS Several Internet-based and printed CDS resources pertaining to PS were identified, with varying degrees of distribution and utilization. However, no formal evaluation had been conducted to determine whether existing CDS systems were used, whether physicians felt that they were of benefit, or whether they enhanced quality outcomes of PS. The findings correlated with other studies and showed that general use of CDS by clinicians was still low. CONCLUSION There is no evidence that Austrian physicians perform PS according to mandate. Current CDS requires evaluation and improvement and CE courses should be offered to support GPs in performing PSs.
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