Periodontal disease: the influence of metabolic syndrome

Sugar-sweetened beverage consumption and periodontitis among adults: A population-based cross-sectional study

AIM

Investigating the association between sugar-sweetened beverages (SSBs) and periodontitis and whether the awareness of diabetes modifies this relationship.

MATERIALS AND METHODS

Cross-sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES III) data involving US adults aged 30-50. Periodontitis was classified according to the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC-AAP), and SSB consumption as dichotomous (<5 or ≥5, <7 or ≥7 and <14 or ≥14 times/week), ordinal and continuous variables. Confounders included family income poverty ratio, education, race/ethnicity, sex, age, food energy intake, smoking and alcohol. Odds ratios (ORs) were obtained by logistic regressions using inverse probability weighting. Effect modification analysis was performed considering self-reported diabetes.

RESULTS

Among 4473 cases analysed, 198 self-reported diabetes. SSBs were associated with periodontitis when individuals consumed ≥5 (OR 1.64; 95% confidence interval [CI] = 1.30-2.06), ≥7 (OR 1.92; 95% CI = 1.50-2.46) and ≥14 (OR 2.19; 95% CI = 1.50-3.18) times/week. The combined effect of consuming SSBs (≥5 and ≥14 times/week) and self-reported diabetes had less impact than the cumulative effect.

CONCLUSIONS

SSB consumption was associated with higher odds of periodontitis, and the estimates were reduced among those with awareness of diabetes.

Observational study of selective screening for prediabetes and diabetes in a real-world setting: an interprofessional collaboration method between public dental services and primary health care in Sweden

OBJECTIVE

Describe a method in a real-world setting to identify persons with undiagnosed prediabetes and type 2 diabetes through an interprofessional collaboration between Public Dental Services and Primary Health Care in Regions Stockholm.

DESIGN

A descriptive observational study.

SETTING

The study was conducted at seven sites in the region of Stockholm, Sweden. Each collaborating site consisted of a primary health clinic and dental clinic.

SUBJECTS

Study participants included adults over 18 years of age who visited the Public Dental Services and did not have a medical history of prediabetes or type 2 diabetes.

MAIN OUTCOME MEASURES

Selective screening is conducted in accordance with a risk assessment protocol at the Public Dental Services. In the investigated method, DentDi (Dental and Diabetes), adults diagnosed with caries and/or periodontitis over a cut-off value are referred to the Primary Health Care clinic for screening of prediabetes and type 2 diabetes.

RESULTS

DentDi, introduced at seven sites, between the years 2017 and 2020, all of which continue to use the method today. A total of 863 participants from the Public Dental Services were referred to the Primary Health Care. Of those 396 accepted the invitation to undergo screening at the primary health care centre. Twenty-four individuals did not meet the inclusion criteria, resulting in a total of 372 persons being included in the study. Among the 372 participants, 27% (101) had elevated glucose levels, of which 12 were diagnosed with type 2 diabetes and 89 with prediabetes according to the study classification.

CONCLUSIONS

DentDi is a feasible method of interprofessional collaboration where each profession contributes with the competence included in everyday clinical practice for early identification of persons with prediabetes and type 2 diabetes with a complete chain of care. The goal is to disseminate this method throughout Stockholm County and even other regions in Sweden.

[Utilization of dental care by adults with and without impairments and disabilities-results of the GEDA 2014/2015-EHIS study]

BACKGROUND

Impairments and disabilities can have a negative impact on oral health. However, studies on the oral health of people with impairments and disabilities are rare. This article examines the 12-month prevalence of dental utilization among adults with and without impairments and disabilities in Germany.

METHODS

Analyses are based on data from 23,372 persons aged 18 years and older with permanent residency in Germany from the GEDA 2014/2015-EHIS study. Participants were asked when they last visited a dentist or orthodontist on their own behalf - "less than 6 months ago," "6 to less than 12 months ago," "12 months ago or longer," or "never." For the analyses, the first two and the last two response options were combined, giving the 12-month prevalence of dental utilization.

RESULTS

Adults with impairments and disabilities were slightly more likely not to have visited a dental practice in the year prior to the survey than adults without impairments and disabilities (21.5% and 18.4%, respectively; p = 0.002). However, the association between the presence of impairments and disabilities and lower dental utilization did not persist after controlling for age, gender, partnership, and socioeconomic status.

DISCUSSION

There are hardly any differences in the dental utilization between persons with and without impairments and disabilities. However, due to their poorer oral health on average, it is necessary to consider how the dental care of this very heterogeneous group can be further improved. The analyses point to the need for care and prevention potentials.

Repurposing Metformin for periodontal disease management as a form of oral-systemic preventive medicine

BACKGROUND

Despite the improvements in treatment over the last decades, periodontal disease (PD) affects millions of people around the world and the only treatment available is based on controlling microbial load. Diabetes is known to increase the risk of PD establishment and progression, and recently, glucose metabolism modulation by pharmaceutical or dietarian means has been emphasised as a significant modulator of non-communicable disease development.

METHODS

The impact of pharmaceutically controlling glucose metabolism in non-diabetic animals and humans (REBEC, UTN code: U1111-1276-1942) was investigated by repurposing Metformin, as a mean to manage periodontal disease and its associated systemic risk factors.

RESULTS

We found that glucose metabolism control via use of Metformin aimed at PD management resulted in significant prevention of bone loss during induced periodontal disease and age-related bone loss in vivo. Metformin also influenced the bacterial species present in the oral environment and impacted the metabolic epithelial and stromal responses to bacterial dysbiosis at a single cell level. Systemically, Metformin controlled blood glucose levels and age-related weight gain when used long-term. Translationally, our pilot randomized control trial indicated that systemic Metformin was safe to use in non-diabetic patients and affected the periodontal tissues. During the medication window, patients showed stable levels of systemic blood glucose, lower circulating hsCRP and lower insulin levels after periodontal treatment when compared to placebo. Finally, patients treated with Metformin had improved periodontal parameters when compared to placebo treated patients.

CONCLUSION

This is the first study to demonstrate that systemic interventions using Metformin in non-diabetic individuals aimed at PD prevention have oral-systemic effects constituting a possible novel form of preventive medicine for oral-systemic disease management.

Periodontal Disease and Its Association with Metabolic Syndrome-A Comprehensive Review

Periodontal disease is a complex and progressive chronic inflammatory condition that leads to the loss of alveolar bone and teeth. It has been associated with various systemic diseases, including diabetes mellitus and obesity, among others. Some of these conditions are part of the metabolic syndrome cluster, a group of interconnected systemic diseases that significantly raise the risk of cardiovascular diseases, diabetes mellitus, and stroke. The metabolic syndrome cluster encompasses central obesity, dyslipidemia, insulin resistance, and hypertension. In this review, our objective is to investigate the correlation between periodontal disease and the components and outcomes of the metabolic syndrome cluster. By doing so, we aim to gain insights into the fundamental mechanisms that link each systemic condition with the metabolic syndrome. This deeper understanding of the interplay between these conditions and periodontal disease can pave the way for more effective treatments that take into account the broader impact of managing periodontal disease on the comprehensive treatment of systemic diseases, and vice versa.

Association of Adiposity with Periodontitis and Metabolic Syndrome: From the Third National Health and Nutrition Examination Survey of United States

This study explored the epidemiological role of central adiposity and body mass index (BMI) in terms of clinical attachment loss (CAL)/pocket depth (PD) and metabolic syndrome components. This study included data from the National Health and Nutrition Examination Survey III of America on 12,254 adults aged 20 years of age or older with a blood sample, anthropometric measurements, and a periodontal examination. Clinical periodontitis measurements, including CAL and PD, were classified into quintiles or quartiles and compared. CAL was positively associated with central adiposity, hypertension, and hyperglycemia; the relationship between CAL and diabetes was stronger when central adiposity was absent (odds ratio [OR] and 95% confidence interval: 6.33, 2.14-18.72 vs. 3.14, 1.78-5.56). The relationship between CAL and impaired fasting glucose (IFG) differed slightly with BMI. The IFG ORs for normal, overweight, and obese patients were 1.63 (1.08-2.45), 1.76 (1.05-2.97), and 1.43 (0.88-2.30), respectively. CAL was positively correlated with all metabolic syndrome components except hypertriglyceridemia. Associations between CAL, diabetes, and IFG significantly varied with BMI. Periodontitis in individuals without central obesity or with normal bodyweight may independently indicate diabetes and IFG. Therefore, preventive measures against periodontitis without obesity are necessary to improve general and oral health.

Correlation of salivary visfatin levels in obese and NON-OBESE population with periodontal status

Background

Visfatin is an inflammatory adipokine that has been linked to obesity and plays a key function in immune response modulation. It's also been proposed that it's a pro-inflammatory marker for periodontitis. Hence, the aim of the present study was to assess the salivary Visfatin levels in obese and non-obese population and correlate with the periodontal status.

Materials and methods

A total of 40 individuals aged between 21 and 35 years (Group 1: n = 20, non-obese and Group 2: n = 20, obese) were enrolled in this case-control study. Clinical parameters such as periodontal probing depth (PPD) and clinical attachment level (CAL) were recorded. Body Mass Index (BMI) was recorded. Unstimulated salivary samples were collected and the samples were assayed for Visfatin using human Visfatin ELISA kit. The results were analysed using SPSS Software, Version 23.0. Unpaired t-test and Mann-Whitney U test was used to compare the clinical parameters and salivary Visfatin level between both the groups. Also, Spearman's rank correlation test was done for correlation of BMI with salivary Visfatin levels and clinical parameters.

Results

The salivary Visfatin level was higher in group 2 (33.1070 ± 0.81 ng/mL) as compared to group 1 (22.2310 ± 1.33 ng/mL). Moderate positive statistically significant association was found between BMI and Visfatin (r = 0.738, p = 0.000). Also when Visfatin and PPD and CAL were correlated, moderate positive statistically significant association was found (r = 0.625, p = 0.000 and r = 0.630, p = 0.000).

Conclusion

The present study suggests that there exists a positive correlation between BMI and salivary Visfatin and BMI and periodontal parameters including probing depth and clinical attachment level. This illustrates that salivary Visfatin may be a potential marker for periodontal inflammation in obese population.

Impact of Intermittent Fasting on Metabolic Syndrome and Periodontal Disease-A Suggested Preventive Strategy to Reduce the Public Health Burden

Metabolic syndrome (MetS) prevalence continues to climb significantly worldwide in today's ad libitum society. MetS has tremendous societal and economic ramifications, making it imperative to develop effective strategies for preventing and controlling it to alleviate this growing burden. Periodontal disease and MetS are associated with several risk factors. Studies in the past have demonstrated that obesity, cardiovascular illness, and type 2 diabetes mellitus have a negative effect on the severity of the periodontal disease. Patients with metabolic syndrome have elevated serum levels of proinflammatory mediators such as tumor necrosis factor-alpha interleukin-6 and C-reactive protein. Similar inflammatory mediators, such as interleukin-6, tumor necrosis factor-alpha, and C-reactive protein, are increased in patients with severe periodontal disease. Remarkably, intermittent fasting is underpinned by scientific evidence, claiming to be the most effective non-pharmacological, potential therapeutic alternative for combating a wide range of metabolic, inflammatory, and lifestyle-related diseases. Nonetheless, an insufficient investigation has been performed to determine whether intermittent fasting has therapeutic benefits on periodontal inflammation and diseases. Here, we show the interrelationship between metabolic syndrome and periodontal disease and contextualize the beneficial impact of intermittent fasting in modulating the chronic metabolic and periodontal inflammatory response. We also anticipate that this review paves the way for further exploration of intermittent fasting as a unique research paradigm representing a cost-effective alternative strategy to conventional disease management in patients with periodontal diseases and metabolic syndrome which may serve as the foundation for an integrative vision relevant to primary, diagnostic, and therapeutic purposes.

Protective Effect of Virgin Coconut Oil on Osteopenia Induced by High Refined Carbohydrate-Containing Diet in Mice

Background: Obesity leads to chronic low-grade inflammation, promoting detrimental effects on bone. The consumption of virgin coconut oil (VCO) is associated with benefits related to meta-inflammation. We evaluated the effect of VCO supplementation on osteopenia promoted by diet-induced obesity in mice. Methods: Male BALB/c mice were fed a control (C) or highly refined carbohydrate-containing (HC) diet for eight weeks. After that, the HC diet group was supplemented with three doses of VCO for four weeks. Results: The HC diet increased the adiposity and leptin levels associated with augmented systemic inflammatory cells improved with VCO supplementation. The HC diet reduced the trabecular bone in the tibia, lumbar vertebrae, distal and proximal femur, as well as the bone mineral density of the femur and alveolar bone. The VCO supplementation reverted bone osteopenia by increasing the trabecular bone in different sites and improving femur and alveolar bone microarchitecture. Although the reduced number of osteoblasts in the alveolar bone of the HC diet group was not significantly enhanced by VCO supplementation, the reduced Alp expression in the HC diet group was enhanced in the VCO group. These beneficial effects were associated with lowering the Rankl/Opg ratio. Conclusion: VCO supplementation might be an effective strategy to attenuate bone osteopenic effects induced by obesity.

Impact of Periodontitis on Glycemic Control and Metabolic Status in Diabetes Patients: Current Knowledge on Early Disease Markers and Therapeutic Perspectives

Diabetes mellitus and periodontitis are two of the most common chronic diseases affecting the world's population, and they are intimately linked. For several years, in fact, it has been known that there is an interdependent relationship between the two diseases: Diabetes promotes the destruction of periodontal tissues, and periodontal disease negatively affects glycemic control. In relation to the control of dental plaque and oral dysbiosis responsible for periodontal disease, both nonsurgical and surgical therapy associated with proper home hygiene procedures have emerged as essential for good glycemic control. Moreover, several evidences suggest the essential role played by the control of periodontal disease in preventing the onset of the most common complications of diabetes: cardiovascular diseases, retinopathies, and other systemic diseases. The aim of this study is to update the current knowledge on the bi-univocal relationship between diabetes and periodontitis and the impact of therapy in the optimal management of these two disorders. From the information found in the literature, it has emerged that the correct treatment of periodontal disease in diabetic patients represents one of the main mechanisms and means currently established and valid to control periodontal disease and glucose metabolism and prevent the onset or development of diabetic complications.

Metabolic syndrome and periodontitis among adults: The 2018 Indonesia National Health Survey

Aim

This study aimed to examine the association between metabolic syndrome (MetS), its components, and periodontitis among Indonesian adults.

Materials and Methods

Cross‐sectional data from the 2018 Indonesia National Health Survey (Riskesdas) was analysed. The sample included dentate individuals aged 35 years or older for whom complete information was available on components of MetS and periodontitis, including bleeding on probing (BOP) (N = 13,356), pocket depth (PD) (N = 13,273), and clinical attachment loss (CAL) (N = 13,000). Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated with negative binomial regression models.

Results

The prevalence of MetS was 41.0%. The prevalence of individuals having at least one tooth with BOP, one tooth with PD ≥4 mm, or one sextant with CAL ≥4 mm was 74.9%, 40.7%, and 40.6%, respectively. No associations were observed between MetS and BOP, PD, or CAL, but hyperglycaemia was constantly positively associated with BOP (RR = 1.06; 95% CI 1.01–1.11), PD (RR = 1.13; 95% CI 1.03–1.23), and CAL (RR = 1.15; 95% CI 1.08–1.23).

Conclusions

Our findings support the potential influence of hyperglycaemia on periodontitis. Incorporating oral disease prevention strategies into the management of systemic diseases could be beneficial for reducing the burden of these diseases in Indonesia.

Chronic metabolic and induced stress impacts mesenchymal stromal cell differentiation and modulation of dental origin in-vitro

The impact of induced (smoking) and metabolic stress (diabetes) on dental stem cells with respect to pre-impact consideration on differentiation and bone formation were investigated. The progenitor stem cells isolated from dental pulp, follicle and gingival tissues were phenotyped and subjected to nicotine and high glucose stress mimicking the smoking and diabetic condition in-vitro. The results showed that the cellular viability post treatment with 100 µM nicotine and 10uM glucose was about 86% to 89% respectively in all the three cell types while about 73% in combined nicotine and glucose treatment. No variation in the expression of pro-inflammatory TNF-α, IL-1β and IL-12 in all the three cell types were noticed. The observed viability in nicotine treated cells were due to elevated IL-6, IL-10 while in glucose was due to brain derived neurotropic factor (BDNF). Higher expression of IL-4, IL-6, IL-10, TGF-β and heme oxygenase −1 (HO-1) were found high in both stressors treated cells. Differentiation and mineralization markers Alkaline phosphatase (ALP), Collagenase I (COL1), Osteocalcin, Runt related transcription factor 2 (RUNX2), Osteopontin and Bone sialoprotein were expressed in the dental pulp stem cells (DPSCs) and gingival mesenchymal stem cells (GMSCs) at varying levels post nicotine or glucose treatment while not significantly observed in dental follicular stem cells (DFSCs). Therefore, it is evident that the stem cells of varied dental origin responded to the stress are more or less uniform with physiological delay in differentiation into osteoblast. It is evident from the study that, the metabolic or induced stress subverts the process of regenerative healing by mesenchymal stromal cells with their anatomical niche.

Development and Initial Validation of the Oral Health Activities Questionnaire

Background: The purpose of this study was to introduce a new Oral Health Activities Questionnaire (OHAQ, hereinafter) that examines different activities and behaviours related to the oral hygiene regimen of each analysed subject. Methods: A sample of 658 students was analysed to determine the OHAQ scale’s basic metric characteristics. To determine the construct validity of the OHAQ, descriptive statistics and correlation analysis, as well as differences testing, were applied to groups of subjects on the basis of self-reported oral status measures. Results: The dimensions of oral health activities were determined, and the scales for their measurement were constructed. Females and males differed in the OHAQ questionnaire measures. Significant but low intercorrelations were found among the measures. In the female and male subsample, four different oral health (OH, hereinafter) types of subjects were identified, exhibiting different characteristic behaviours regarding oral health. OHAQ scales showed good discriminant validity, revealing the differences related to specific self-reported oral status measures (e.g., frequency of toothache and the number of filled teeth). Conclusions: The OHAQ represents a satisfactory measurement instrument for determining the level of OH activities and for doing quick and reliable classifications of the participating subjects according to their OH activities and behaviours. The process of further validation and advancements of the OHAQ scales and measures should be continued through a clinical examination of subjects.

A brief review of vitamin D as a potential target for the regulation of blood glucose and inflammation in diabetes-associated periodontitis

Diabetes is a metabolic disorder associated with various complications, including periodontitis. The risk of periodontitis is increased in patients with diabetes, while vitamin D deficiency is associated with both diabetes and periodontitis. Thus, there is a need to identify the molecular effects of vitamin D on the regulation of inflammation and glucose in diabetes-associated periodontitis. The Web of Science, Scopus, and PubMed databases were searched for studies of the molecular effects of vitamin D. Molecular effects were reportedly mediated by salivary secretions, interactions of advanced glycation end products (AGEs) with receptors of AGEs (RAGEs), cytokines, and oxidative stress pathways linking diabetes with periodontitis. Vitamin D supplementation attenuates inflammation in diabetes-associated periodontitis by reducing the levels of inflammatory cytokines and numbers of immune cells; it also has antibacterial effects. Vitamin D reduces cytokine levels through regulation of the extracellular signal-related kinase 1/2 and Toll-like receptor 1/2 pathways, along with the suppression of interleukin expression. Glucose homeostasis is altered in diabetes either because of reduced insulin production or decreased insulin sensitivity. These vitamin D-related alterations of glucoregulatory factors may contribute to hyperglycaemia; hyperglycaemia may also lead to alterations of glucoregulatory factors. This review discusses the pathways involved in glucose regulation and effects of vitamin D supplementation on glucose regulation. Further studies are needed to characterise the effects of vitamin D on diabetes-associated periodontitis.

Metal versus Fiberglass Post-Orthodontic Retainers Short-Term Effects on Plaque Index and Microbial Colonization: An Observational Study

In orthodontics, post-treatment retention phase is crucial for maintaining the obtained clinical results. In cases of crowding, a bonded fixed retainer is often chosen to maintain teeth alignment in the anterior sector of the lower dental arch. A fixed retainer can remain in the mouth for years. Therefore, it is important that it is applied with harmless materials for the level of plaque control. The present study aimed to investigate the salivary concentrations of Streptococcus mutans (S. mutans) and Lactobacilli, and the Sillness and Loe plaque index, in patients wearing metal wire versus fiberglass orthodontic retainers. Forty post-orthodontic patients were included in the sample: in 20 subjects a metal wire retainer was applied (MR), while in the others a fiberglass retainer was applied (FR). The variables were recorded at baseline (T0), after 1 month (T1), and after 2 months (T2) of follow-up. The percentage of patients with a level of S. mutans and Lactobacilli colonization > 105 increased over time in the FR group (T0 = 0%, T1 = 5%, T2 = 35%), compared with the MR group. PI increased in the FR group (T0 = 0, T1 = 14, T2 = 27), and remained almost the same in the MR group (T0 = 3, T1 = 0, T2 = 2). From the present results it appears that the metal wire retainer is better than the fiberglass retainer for the level of plaque control performed by the patients.

Periodontal Pathogens and Neuropsychiatric Health

Increasing evidence incriminates low-grade inflammation in cardiovascular, metabolic diseases, and neuropsychiatric clinical conditions, all important causes of morbidity and mortality. One of the upstream and modifiable precipitants and perpetrators of inflammation is chronic periodontitis, a polymicrobial infection with Porphyromonas gingivalis (P. gingivalis) playing a central role in the disease pathogenesis. We review the association between P. gingivalis and cardiovascular, metabolic, and neuropsychiatric illness, and the molecular mechanisms potentially implicated in immune upregulation as well as downregulation induced by the pathogen. In addition to inflammation, translocation of the pathogens to the coronary and peripheral arteries, including brain vasculature, and gut and liver vasculature has important pathophysiological consequences. Distant effects via translocation rely on virulence factors of P. gingivalis such as gingipains, on its synergistic interactions with other pathogens, and on its capability to manipulate the immune system via several mechanisms, including its capacity to induce production of immune-downregulating micro-RNAs. Possible targets for intervention and drug development to manage distal consequences of infection with P. gingivalis are also reviewed.

Evaluation of the Relationship between Drink Intake and Periodontitis Using KoGES Data

It was hypothesized that periodontal diseases could be influenced by nutrition and food types. However, the role of nutritional factors in the risk of periodontal disease has not been clearly elucidated. This study was aimed at investigating the relationship between coffee, green tea, or soft drink intake and periodontitis. This prospective cohort study used epidemiological data from 2004 to 2016 from the Korean Genome and Epidemiology Study. Among 173,209 participants, 9,933 with periodontitis and 124,922 controls were selected. The frequency histories of coffee/green tea/soft drink intake among the participants were analyzed, and intake was categorized as no drink, mild drink (one time a month through six times a week), and heavy drink (one or more times a day). Variable factors were adjusted using logistic regression analysis (adjusted model). The chi-square test and independent t-test were used for statistical analysis. Adjusted odds ratio (aOR) for coffee or green tea intake and periodontitis were not statistically significant. The aOR was 1.16 (95% confidence interval (CI) = 1.11–1.21, P < 0.001) for mild soft drink intake and 1.02 (95%CI = 0.96–1.09, P = 0.518) for heavy soft drink intake. Subgroup analysis showed that mild soft drink intake was significant across all groups (P < 0.05), whereas coffee and green tea intakes were not significant in any subgroup. Overall, the study elucidated an association between mild soft drink intake and periodontitis.

Accuracy of a salivary examination kit for the screening of periodontal disease in a group medical check-up (Japanese-specific health check-up)

The purpose of the present study was to investigate the accuracy of a screening method using salivary tests to screen for periodontal disease.In total, 1888 individuals older than 30 years in 2017 and 2296 in 2018 who underwent medical check-ups for metabolic syndrome agreed to participate and simultaneously underwent a dental examination by dentists and salivary tests. Salivary occult blood, protein, and ammonia levels and white blood cell counts were evaluated in salivary tests using commercially available kits. The relationship between the results of the salivary tests and dental examination was examined and classification performance was analyzed.The prevalence of periodontal disease was 69.9% in 2017 and 66.8% in 2018. Salivary ammonia showed the highest classification performance in both years (sensitivity 83.5 and 83.1%, precision 73.0 and 69.3%, F-measure 0.779 and 0.756). Occult blood, which was assessed using a monoclonal antibody to human hemoglobin, also showed good performance (sensitivity 69.5%, precision 70.6%, F-measure 0.701). Questions regarding self-reported gingival bleeding were not sufficient to screen for periodontitis. The present results suggest that screening tests using salivary samples may detect periodontal disease in approximately 70% to 80% of subjects in a large population.Conclusion: Salivary ammonia and hemoglobin have potential as salivary markers in the screening of periodontal disease.

Risk of incident cardiovascular disease in people with periodontal disease: A systematic review and meta-analysis

OBJECTIVES

Cardiovascular disease (CVD) is a major cause of mortality; periodontal disease (PD) affects up to 50% of the world's population. Observational evidence has demonstrated association between CVD and PD. Absent from the literature is a systematic review and meta-analysis of longitudinal cohort studies quantifying CVD risk in PD populations compared to non-PD populations. To examine the risk of incident CVD in people with PD in randomised controlled trials and longitudinal cohort studies.

MATERIAL AND METHODS

We searched Medline, EMBASE and Cochrane databases up to 9th Oct 2019 using keywords and MeSH headings using the following concepts: PD, CVD, longitudinal and RCT study design. CVD outcomes included but were not restricted to any CVD, myocardial infarction, coronary heart disease (CHD) and stroke. Diagnosis method and severity of PD were measured either clinically or by self-report. Studies comparing incident CVD in PD and non-PD populations were included. Meta-analysis and meta-regression was performed to determine risk of CVD in PD populations and examine the effects of PD diagnosis method, PD severity, gender and study region.

RESULTS

Thirty-two longitudinal cohort studies were included after full text screening; 30 were eligible for meta-analysis. The risk of CVD was significantly higher in PD compared to non-PD (relative risk [RR]: 1.20, 95% CI: 1.14-1.26). CVD risk did not differ between clinical or self-reported PD diagnosis (RR = 0.97, 95% CI: 0.87-1.07,). CVD risk was higher in men (RR: 1.16, 95% CI: 1.08-1.25) and severe PD (RR: 1.25, 95% CI: 1.15-1.35). Among all types of CVD, the risk of stroke was highest (RR = 1.24; 95% CI:1.12-1.38), the risk of CHD was also increased (RR = 1.14; 95% CI:1.08-1.21).

CONCLUSION

This study demonstrated modest but consistently increased risk of CVD in PD populations. Higher CVD risk in men and people with severe PD suggests population-targeted interventions could be beneficial.

Functional haplotype in the Interleukin8 (CXCL8) gene is associated with type 2 Diabetes Mellitus and Periodontitis in Brazilian population

BACKGROUND AND AIM

Type 2 Diabetes Mellitus (T2DM) and Periodontitis (P) are prevalent multifactorial disorders worldwide, sharing a bidirectional relationship influenced by the genetic susceptibility of the host immune system. We investigated whether SNPs in the Interleukin 8 (IL8, alias CXCL8) gene could be associated with T2DM and Periodontitis.

METHODS

Genomic DNA was obtained from 874 Brazilian individuals divided into: Healthy group (n = 307), Periodontitis group (n = 334), and individuals affected by both T2DM and Periodontitis (T2DM_P) group (n = 233). The SNPs -251(T>A) rs4073, +396(T>G) rs2227307 and +781(C>T) rs2227306 were genotyped by TaqMan®. Multiple logistic regressions were used to determine the degree of association between polymorphisms (and haplotypes) with periodontitis and T2DM adjusted for known confounders.

RESULTS

The additive model revealed that the heterozygous AT(-251), GT(+396) and CT(+781) genotypes showed a lower risk for the diseased phenotypes, and carriers of the TTC/TTC haplotype were significantly susceptible to T2DM and Periodontitis concomitantly, as well to isolated Periodontitis (mainly the severe form).

CONCLUSIONS

We concluded, for the first time, that these functional CXCL8 SNPs, and the homozygous TTC haplotype are relevant genetic factors for T2DM and Periodontitis as comorbidities, as well as for severe Periodontitis susceptibility in Brazilian population.

Periodontitis is an inflammatory disease of oxidative stress: We should treat it that way

Periodontitis is a highly prevalent disease. As it progresses, it causes serious morbidity in the form of periodontal abscesses and tooth loss and, in the latter stages, pain. It is also now known that periodontitis is strongly associated with several nonoral diseases. Thus, patients with periodontitis are at greater risk for the development and/or exacerbation of diabetes, chronic obstructive pulmonary disease, and cardiovascular diseases, among other conditions. Although it is without question that specific groups of oral bacteria which populate dental plaque play a causative role in the development of periodontitis, it is now thought that once this disease has been triggered, other factors play an equal, and possibly more important, role in its progression, particularly in severe cases or in cases that prove difficult to treat. In this regard, we allude to the host response, specifically the notion that the host, once infected with oral periodontal pathogenic bacteria, will mount a defense response mediated largely through the innate immune system. The most abundant cell type of the innate immune system - polymorphonuclear neutrophils - can, when protecting the host from microbial invasion, mount a response that includes upregulation of proinflammatory cytokines, matrix metalloproteinases, and reactive oxygen species, all of which then contribute to the tissue damage and loss of teeth commonly associated with periodontitis. Of the mechanisms referred to here, we suggest that upregulation of reactive oxygen species might play one of the most important roles in the establishment and progression of periodontitis (as well as in other diseases of inflammation) through the development of oxidative stress. In this overview, we discuss both innate and epigenetic factors (eg, diabetes, smoking) that lead to the development of oxidative stress. This oxidative stress then provides an environment conducive to the destructive processes observed in periodontitis. Therefore, we shall describe some of the fundamental characteristics of oxidative stress and its effects on the periodontium, discuss the diseases and other factors that cause oxidative stress, and, finally, review potentially novel therapeutic approaches for the management (and possibly even the reversal) of periodontitis, which rely on the use of therapies, such as resveratrol and other antioxidants, that provide increased antioxidant activity in the host.

Relationship between Apical Periodontitis and Metabolic Syndrome and Cardiovascular Events: A Cross-Sectional Study

Aim: Both apical periodontitis (AP) and metabolic syndrome (MetS) are associated with atherosclerotic cardiovascular disease (ACVD), the main cause of cardiovascular events. The aim of this study was to investigate the prevalence of AP and the oral inflammatory burden in control subjects and patients suffering cardiovascular events, analyzing the possible association between AP and the oral inflammatory burden with MetS. Materials and Methods: Using a cross-sectional design, 83 patients suffering a cardiovascular event were recruited in the study group (SG), and 48 patients without cardiovascular events were included in the control group (CG). Periapical index (PAI) was used to diagnose AP, and total dental index (TDI) was used to assess the total oral inflammatory burden. Diagnosis of MetS was made by meeting three or more American Heart Association Scientific Statement components. Results: In the multivariate logistic regression analysis, the number of teeth with AP (OR = 2.3; 95% C.I. = 1.3–4.3; p = 0.006) and TDI scores (OR = 1.5; 95% C.I. = 1.2–1.9; p = 0.001), significantly correlated with cardiovascular events. MetS was strongly associated (OR = 18.0; 95% C.I. = 6.5–49.7; p = 0000) with cardiovascular events. Higher TDI scores were significantly associated with MetS (OR = 1.3; 95% C.I. = 1.1–1.6; p = 0.003. Neither the number of root-filled teeth (RFT) (OR = 0.9; 95% C.I. = 0.6–1.3; p = 0.61) nor the number of teeth with apical periodontitis (OR = 1.1; 95% C.I. = 0.8–1.7; p = 0.49) were associated with MetS. Conclusions: Apical periodontitis is significantly associated with cardiovascular events. Total oral inflammatory burden assessed by TDI, but not AP alone, is associated with MetS.

The Relationship Between Polycystic Ovarian Syndrome, Periodontal Disease, and Osteoporosis

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder to affect women in their reproductive years. There has been growing concern that women with PCOS may suffer from long-term metabolic consequences due to the high degree of insulin resistance that is often present in PCOS. However, few longitudinal studies exist in this area and there is a paucity of data on whether women with PCOS are at risk of other chronic diseases as they age. Specifically, current evidence suggests that reproductive-age women with PCOS may be at increased risk for both osteoporosis and periodontal disease (PD)-both these chronic diseases can have serious implications for health and quality of life. However, few studies have addressed how risk factors for osteoporosis and PD may be altered by aging in PCOS. The PCOS phenotype of women beyond reproductive years is poorly understood, and it is not known whether the metabolic profile of older women with PCOS results in an increased risk of osteoporosis and PD. The objective of this review is to discuss the relationships between PCOS, osteoporosis, and PD, and how these relationships could be impacted during aging. The long-term goal of this review is to provide direction for future research that is needed to more clearly elucidate these relationships and eventually provide a basis for evidence-based health recommendations.

Efficacy of clindamycin compared with amoxicillin-metronidazole after a 7-day regimen in the treatment of periodontitis in patients with diabetes: a randomized clinical trial

OBJECTIVE

To determine the efficacy of clindamycin compared with amoxicillin-metronidazole after a 7-day regimen during nonsurgical treatment of periodontitis in patients with type 2 diabetes mellitus.

RESEARCH DESIGN AND METHODS

In this double-blind, randomized clinical trial, a total of 42 patients with chronic periodontitis and type 2 diabetes were included. Patients were randomly assigned to treatment with either clindamycin or amoxicillin-metronidazole three times a day during 7 days. Clinical determinations (probing depth, bleeding on probe, and plaque index) were performed to determine the extent and severity of periodontitis before and after the pharmacological treatment.

RESULTS

After 7 days of administration of clindamycin or amoxicillin-metronidazole, no differences were observed between the clinical determinations, probing depth (0.44 vs 0.50 mm, p=0.624), plaque index (17.62 vs 15.88%, p=0.910), and bleeding on probing (16.12 vs 22.17%, p=0.163), respectively. There were no adverse events in either group.

CONCLUSION

The administration during 7 days of clindamycin or amoxicillin/metronidazole showed the same efficacy for the reduction of probing depth, plaque index, and bleeding on probing in patients with periodontitis and type 2 diabetes.

Review of obesity and periodontitis: an epidemiological view

Obesity and periodontitis are among the most common non-communicable diseases, and epidemiological studies report the influence of obesity in the onset and progression of periodontitis. Data indicate that increased body mass index, waist circumference, percentage of subcutaneous body fat, and serum lipid levels are associated with increased risk to develop periodontitis. The underlying biological mechanisms of this association involve adipose tissue-derived cytokines, such as tumour necrosis factor-α and interleukin-6, which affect whole-body metabolism and contribute to the development of a low-grade systemic inflammation. Multiple studies report a positive association between these two diseases across diverse populations. Obesity does not appear to impair the success of periodontal therapy. However, currently available evidence is variable and therefore inconclusive. Despite the limited evidence about recommendations on treatment planning, oral healthcare professionals need to be aware of the complexity of obesity to counsel their patients about the importance of maintaining healthy body weight and performing good oral hygiene procedures.

Prevalence of comorbidities in periodontitis patients compared with the general Austrian population

BACKGROUND

The majority of patients with periodontitis present with comorbidities, however only little is known on prevalence of these comorbidities in comparison with the general population. This study aims to analyze the prevalence and impact of comorbidities in patients with periodontitis in Austria.

METHODS

Prevalence of comorbidities was evaluated in 1,199 patients with periodontitis (median age: 49, range: 14 to 83 years). These data were compared with a randomly selected age- and sex-matched cohort of the Austrian population by an unconditional logistic regression model.

RESULTS

Comorbidities were found in 821 of 1,199 (68.5%) patients. Allergies had the highest prevalence (29.2%), followed by hypertension (19.4%), musculoskeletal (11.2%), and endocrine disorders (9.7%). Chronic pulmonary disorders (no influenza/pneumonia) were associated with a higher approximal plaque index (72% versus 63%, P = 0.02). No association between characteristics of periodontitis and comorbidities was observed. Prevalence of allergies (29.2% versus 22.9%) and pulmonary disorders (8.5% versus 4.3%) was significantly higher in periodontitis patients compared with the Austrian population (P < 0.001), whereas asthma (1.5% versus 5.6%), cardiovascular disorders (1.8% versus 10.5%), depression (7.1% versus 10.4%), headache (1.3% versus 20%), hyperlipidemia (6.4% versus 14.8%), hypertension (14.2% versus 24.5%), musculoskeletal disorders (11.2% versus 41.7%), and osteoporosis (2.8% versus 5.1%) were found less frequently (P < 0.001). No differences were observed for cancer, diabetes mellitus, gastrointestinal disorders, or psychiatric disorders (P = 0.95, P = 0.76, P = 0.68, P = 0.23, respectively).

CONCLUSION

In Austria, the majority of patients with periodontitis present with comorbidities, and the adjusted prevalence differs significantly from the general population.

A hydrosilver gel for plaque control in adults affected by chronic periodontitis: Effects on the 'red complex' bacterial load. A prospective longitudinal pilot study using polymerase chain reaction analysis

In subjects affected by chronic periodontitis, the chemical control of plaque is a strategy aiming primarily at controlling infection and bacterial loading. The aim is to evaluate the bacterial loading of the so-called 'red complex' associated with a short-term use of a hydrosilver gel (HSG) by using an in vivo model in adult subjects affected by chronic periodontitis. This prospective short-term clinical trial involved 10 adult volunteers using a 15-day in vivo model. After receiving professional prophylaxis at baseline (t0), each volunteer performed daily applications of HSG at home. After 15 days (t1) from the first application, subgingival plaque samples were collected, and the bacterial loading of species belonging to the red complex was evaluated using polymerase chain reaction (PCR) analyses. The bacterial loading of the red complex showed no statistically significant difference between t0 and t1, although it tended to decrease. HSG can be used at home as an adjunct to domestic oral care because it seems a promising tool, but further studies are needed to involve a larger sample and a longer follow-up.

Oral Health in Women with a History of High Gestational Diabetes Risk

We studied oral health in 115 women with and without a history of gestational diabetes (GDM), expecting poorer oral health in the GDM group. Full-mouth examinations were performed 5 years postpartum and the number of teeth, total dental index (TDI) and decayed, missing, filled teeth (DMFT) index were calculated. Bleeding on probing (BOP), probing depth (PD), visible plaque index (VPI), and clinical attachment level (CAL) were recorded. The periodontal inflammatory burden index (PIBI) was calculated. Panoramic radiographs were taken and signs of infections recorded. Oral health habits, symptoms and participants' own opinion of oral health were recorded with questionnaires. At the time of examination, 45% of the women had a history of GDM in the index pregnancy. Mild periodontitis (62%) and bleeding on probing (46%) were common. VPI (13% and 17%, p = 0.009) and PIBI (13.1 and 17.5, p = 0.041) were lower among women with a history of GDM compared with those with no history of GDM. There was no difference between groups in DMFT scores. All women reported good subjective oral health. Thus, contrary to our hypothesis, women with a history of GDM showed better oral health parameters than women without a history of GDM.

Evaluation of IL6, IL10 and VDR alleles distribution in an Italian large sample of subjects affected by chronic periodontal disease

In recent decades, the role played by the immune response to bacteria in the pathogenesis of chronic periodontal disease (PD) has long been studied. Although from the clinical point of view, adequate oral hygiene is essential to ensure a satisfactory response of the host to infections, modulation of the reaction of immune system could be influenced by genetic factors. The aim of the present study was to investigate the distribution of alleles of polymorphisms relevant for chronic periodontitis in a sample of adult subjects affected by chronic PD. The present study was conducted with sample collected in Italian private practice offices from January 2013 to December 2017. The sample included 744 adult patients diagnosed with chronic periodontitis. The inclusion criteria were as follows: age > 18 years, diagnosis of chronic PD. The diagnosis of chronic periodontitis was based on the criteria established by the American Academy of Periodontology. No significant difference in allele distribution among patients from different Italian regions was found. Results, supporting absence of population heterogeneity for the investigated polymorphisms in Italy, suggest similar effect in periodontitis etiology.

Influence of polycystic ovary syndrome on the periodontal health of Indian women visiting a secondary health care centre

OBJECTIVES

Periodontal disease and polycystic ovary syndrome (PCOS) share risk factors like obesity, insulin resistance, and dyslipidemia, along with evidence of chronic inflammation in the two conditions. Evaluating the influence of PCOS on periodontal health would, therefore, identify a possible association.

MATERIALS AND METHODS

Sixty women, divided into equal groups of PCOS and healthy patients, were clinically examined for periodontal parameters like probing depth (PD), plaque index (PI), modified gingival index (mGI), and bleeding on probing (BOP). Fasting blood sugar (FBS), insulin (FI), triglycerides (TG), and free testosterone along with serum and gingival crevicular fluid (GCF) levels of malondialdehyde (MDA) and myeloperoxidase (MPO) were the biochemical parameters evaluated.

RESULTS

Women with PCOS had statistically significant differences in mGI, PI, testosterone, FBS, and TG when compared with healthy women (p < 0.05). MDA levels in serum and GCF between women with PCOS and controls were also significantly different. BOP and mGI showed a moderate positive correlation (r = 0.45 and 0.44) with serum levels of MDA. Relatively greater gingival inflammation was observed in patients with PCOS compared to healthy controls, independent of the risk factors present.

CONCLUSION

PCOS seemed to have an impact on gingival inflammation, in addition to the effect of dental plaque and other local factors in the oral cavity, in PCOS patients when compared with healthy individuals.

CLINICAL RELEVANCE

Women diagnosed with PCOS may have probabaility of co-existing gingival inflammation. Therefore, emphasis on medical treatment for PCOS and periodic screening for periodontal disease may be warranted.

Periodontal, metabolic, and cardiovascular disease: Exploring the role of inflammation and mental health

Previous evidence connects periodontal disease, a modifiable condition affecting a majority of Americans, with metabolic and cardiovascular morbidity and mortality. This review focuses on the likely mediation of these associations by immune activation and their potential interactions with mental illness. Future longitudinal, and ideally interventional studies, should focus on reciprocal interactions and cascading effects, as well as points for effective preventative and therapeutic interventions across diagnostic domains to reduce morbidity, mortality and improve quality of life.

Prevalence and Risk Factors for Periodontitis Among Patients with Metabolic Syndrome

BACKGROUND

The incidence of periodontitis is higher when metabolic syndrome (MS) is present. However, only few Korean studies have compared the risk factors for MS and periodontitis. Therefore, this study aimed to investigate the prevalence and risk factors for periodontitis relative to the presence of MS.

METHODS

The data collected from 13,196 respondents of the 2010-2015 Korea National Health and Nutrition Examination Survey in South Korea, which include periodontitis and MS parameters, were analyzed after propensity score matching of sex and age.

RESULTS

A total of 29% of the participants had periodontitis. The periodontitis group had more males (53%), lower number of participants who had a high educational level (66.6%), and higher body mass index (24.3 ± 3.2) and waist circumference (83.8 ± 9.2) than the nonperiodontitis group. Moreover, the periodontitis group exhibited higher systolic blood pressure and fasting plasma glucose and plasma triglyceride levels, but lower high-density lipoprotein cholesterol levels than the nonperiodontitis group (P < 0.001). Several patients in the periodontitis group had hypertension (43.3%) and diabetes mellitus (17.3%), but only few had chronic kidney disease (3.4%). Multiple regression analysis showed that the risk of periodontitis increased when MS, diabetes mellitus, and smoking history were present. Particularly, the risk of periodontitis increased as the number of MS components increased (P < 0.001).

CONCLUSIONS

Patients with MS had 1.12-fold higher risk of periodontitis than those without. Additionally, patients who had diabetes mellitus and were smokers had a particularly high risk of periodontitis. The risk of periodontitis increased as the number of MS components increased.

The interaction among obesity, Type 2 diabetes mellitus, and periodontitis in Vietnamese patients

To examine the relationship between obesity, Type 2 diabetes, and periodontal disease in Vietnamese patients. The sample included 712 patients aged 18 years or older who first visited the Institute of Traditional Medicine, Ho Chi Minh City. All participants completed a questionnaire and underwent anthropometric index measurements for obesity (height, weight, waist, and hip circumferences) and had their body fat percentage measured. A full periodontal examination was performed and a fasting glycemic level was determined. Occurrence and risk of periodontal outcomes were compared across 3 different measurements of obesity (body mass index, waist-hip ratio, and body fat percentage). The prevalence of periodontitis in obese group (37.0%, 36.4%, and 24.6% by body mass index, waist-hip ratio, and body fat percentage, respectively) or Type 2 diabetic group (50.7%) was significantly higher than those without these conditions (p < .05). Subjects with obesity or Type 2 diabetes had significantly greater pocket depth and clinical attachment loss than those who are not obese or diabetic (p < .001). Multivariate logistic regression, adjusted for confounding variables, showed that the likelihood (odds ratio, OR) for periodontitis was highest in the obese and Type 2 diabetic group (OR = 4.24, CI [2.29, 7.86]; OR = 4.06, CI [2.24, 7.36]; and OR = 5.44, CI [2.94, 10.03]), followed by the obese and non-Type 2 diabetic group (OR = 2.28, CI [1.05, 4.95]; OR = 2.02, CI [1.34, 3.56]), and then the nonobese and Type 2 diabetic group (OR = 2.20, CI [1.21, 3.98]; OR = 1.99, CI [0.93, 4.24] and OR = 5.22, CI [2.76, 9.84]) when obesity was defined by body mass index, waist-hip ratio, and body fat percentage, respectively, (p < .05). There was a significant association between obesity, Type 2 diabetes, or those with both systemic conditions and periodontitis in Vietnamese patients.

COMPARISON OF ANTI BACTERIAL EFFICACY OF PHOTODYNAMIC THERAPY AND DOXYCYCLINE ON AGGREGATIBACTER ACTINOMYCETEMCOMITANS

Background

Aggregatibacter actinomycetemcomitans (A.actinomycetemcomitans) is an anaerobic bacterium has been frequently associated with aggressive periodontitis. Photodynamic therapy (PDT) is a medical treatment to prevent infection progression that utilizes light to activate a photosensitizing agent. Doxycycline is an antibacterial having photosensitivity. This study aimed to evaluate potential doxycycline as an antibacterial and photosensitizer combine PDT against A.actinomycetemcomitans bacteria.

Material and methods

Samples were distributed to 4 groups as follow: (1) Groups A treated with a diode laser, (2) Group B treated with doxycycline 0,1% and laser, (3) Group C treated only with Doxycycline 0.1%, and (4) Group D no exposure doxycycline/laser. Data were analyzed by one-way ANOVA and Tukey's HSD test at 5% significance level.

Results

In this study, doxycycline 0.1% has the effect of reducing the bacterial viability of (59.60±3.26%). Whereas laser exposure 120 s combined with doxycycline produce the effect of bacterial viability reduction (88.50±2.83%) is not significantly different from the effect of laser 120 s exposure (88.79±2.60%). In clinical treatment, the application of laser exposure is generally at the duration of the exposure time of 30 s. The results of this study indicate that the duration of laser exposure 30 s shows a reduction in bacterial viability (44.91±1.69%) equal to the laser and with a combination of doxycycline and laser exposure (70.70±2.43%). So at low doses of laser exposure, doxycycline 0.1% combined with the laser results in the greatest reduction in bacterial viability, significantly different from laser exposure alone.

Conclusion

at low doses of laser exposure (30s with energy 3.68 J/cm²), doxycycline 0.1% combined with the laser results in the greatest reduction in bacterial viability, significantly different with laser exposure alone.

Periodontal disease and the metabolic syndrome

The metabolic syndrome (MetS) is a spectrum of conditions that increase the risk of cardiovascular disease and diabetes mellitus. The components of MetS include dysglycemia, visceral obesity, atherogenic dyslipidemia (elevated triglycerides and low levels of high-density lipoprotein) and hypertension. An association of periodontal disease and MetS has been suggested. This association is believed to be the result of systemic oxidative stress and an exuberant inflammatory response. When examined individually, the components of the MetS that are most closely related to the risk of periodontitis are dysglycemia and obesity, with lesser contributions by atherogenic dyslipidemia and hypertension. Data suggest that the odds of periodontitis increase with the number of MetS components present in an individual. The direction of the relationship between MetS and periodontal disease cannot currently be determined because the majority of studies are cross-sectional. The association between MetS and periodontitis, however, suggests that improved understanding of this association could promote interprofessional practice. Evidence suggests that periodontal therapy can reduce the levels of inflammatory mediators in serum. If this finding is confirmed, periodontal treatment could become part of therapy for MetS. Oral health providers who identify patients at risk for MetS could refer them to a medical provider, and physicians could refer patients to dentists to ensure that patients with MetS receive a dental evaluation and any necessary treatment. These clinical activities would improve both oral and general health outcomes.

Periodontitis in older Swedish individuals fails to predict mortality

OBJECTIVES

This study aims to assess mortality risk and its association to health aspects in dentate individuals 60 years of age and older.

MATERIALS AND METHODS

Medical and periodontal data from 870 dentate individuals (age range 60–96) participating in the Swedish National Study on Aging and Care in Blekinge (SNACBlekinge)with survival statistics over 6 years were studied.

RESULTS

During 6 years of follow-up, 42/474 of the individuals(8.9 %), who at baseline were between age 60 and 75, and 134/396 individuals of the individuals (33.9 %), who at baseline were ≥75 years, died. Surviving dentate individuals had more teeth (mean 19.3, S.D.±7.9) than those who died (mean 15.9,S.D.±7.3; mean diff 3,3; S.E. mean diff 0.7; 95 % CI 2.0, 4.6;p=0.001). A self-reported history of high blood pressure (F=15.0, p<0.001), heart failure (F=24.5, p<0.001, observed power=0.99), older age (F=34.7, p<0.001), male gender(F=6.3, p<0.01), serum HbA1c with 6.5 % as cutoff level(F=9.3, p=0.002) were factors associated with mortality. A medical diagnosis of heart disease, diabetes, any form of cancer,or periodontitis failed to predict mortality.

CONCLUSIONS

A self-reported history of angina pectoris, chronic heart failure, elevated serum HbA1c, and few remaining teeth were associated with mortality risk. A professional diagnosis of cardiovascular disease, diabetes, cancer, or periodontitis was not predictive of mortality.

CLINICAL RELEVANCE

Self-health reports are important to observe in the assessment of disease and survival in older individual.

Association of Alanine Aminotransferase and Periodontitis: A Cross-Sectional Analysis-NHANES 2009-2012

Objective. Alanine Aminotransferase is an enzyme associated with not only liver diseases, liver conditions, and metabolic syndrome, but also inflammation. Periodontitis is associated with increased cytokines and other markers of inflammation. The purpose of this study is to determine if an independent association between Alanine Aminotransferase and periodontitis exists. Methods. Data from the 2009-2010 and 2011-2012 National Health and Nutrition Surveys (NHANES) were combined. Data concerning periodontitis and Alanine Aminotransferase were extracted and analyzed with Rao Scott Chi-square and logistic regressions. Serum Alanine Aminotransferase was dichotomized at 40 units/liter, and periodontitis was dichotomized to the presence or absence of periodontitis. Results. In bivariate Chi-square analyses, periodontitis and Alanine Aminotransferase were associated (p = 0.0360) and remained significant in unadjusted logistic regression (OR = 1.30 [95% CI: 1.02, 1.65]). However, when other known risk factors of periodontitis were included in the analyses, the relationship attenuated and failed to reach significance (adjusted OR = 1.17 [95% CI: 0.85, 1.60]). Conclusion. Our study adds to the literature a positive but attenuated association of serum Alanine Aminotransferase with periodontitis which failed to reach significance when other known, strong risk factors of periodontitis were included in the analysis.

Comparison of prevalence of periodontal disease in women with polycystic ovary syndrome and healthy controls

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, affecting 4-18% of them. Previous studies also showed that periodontal diseases are associated with different components of the metabolic syndrome. The aim of this study is to determine the association between PCOS and periodontal diseases.

MATERIALS AND METHODS

A total of 196 women (98 with PCOS and 98 healthy controls) were enrolled. PCOS diagnosis was confirmed by history, clinical signs, physical examination, laboratory parameters, and ultrasound studies. Both cases and controls were examined by the same periodontist. Periodontal parameters including bleeding on probing (BOP), probing depth, clinical attachment loss (CAL), plaque index, and tooth loss were investigated in all participants. Pregnant women, smokers, individuals with a history of malignancy or osteoporosis, and those taking prophylactic antibiotics for dental procedures or receiving periodontal treatment during the 6-month period before examination were excluded. Data were analyzed using t-test, Chi-square test, and linear regression. Statistical significance was set at P < 0.05.

RESULTS

CAL and sites with BOP were significantly higher in women with PCOS (P < 0.05). However, no significant difference was observed in the tooth loss rate between PCOS and non-PCOS participants (P = 0.384).

CONCLUSION

The prevalence of periodontal disease seems to be higher in women with PCOS. This may be related to the role of chronic systemic inflammation in the pathophysiology of both PCOS and periodontal diseases.

Change of periodontal inflammatory indicators through a 4-week weight control intervention including caloric restriction and exercise training in young Koreans: a pilot study

BACKGROUND

Recent cross-sectional studies indicate that obesity is a risk factor for periodontal disease. Exercise training in high fat mice or rats can inhibit gingival inflammation effectively. The objective of this human intervention study was to investigate whether short-term weight control could affect periodontal indexes and serum and gingival crevicular fluid (GCF) biomarkers in young Koreans.

METHODS

Forty-one obese volunteers (body mass index (BMI) > 25.0) and 12 normal weight subjects (18.5 ≤ BMI ≤ 23.0) participated in a four-week weight control program to analyze the changes in anthropometric criteria, the concentrations of C-reactive protein (CRP), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides in serum, gingival index, bleeding on probing, periodontal biomarkers in GCF, and dental plaque index at the first and the 27th days.

RESULTS

The means of obesity measures decreased significantly more in the obese group (BMI 2.53 ± 0.96, waist-to-hip ratio (WHR) 4.88 ± 1.58 %, LDL 35.85 ± 21.74 mgdL(-1)) than in the normal weight group (BMI 0.78 ± 0.72, WHR 2.00 ± 0.95 %, LDL 15.58 ± 18.07 mgdL(-1)). While the obese group showed significant decreases in the biomarkers in GCF (IL-1β 58.38 ± 65.55 pgmL(-1), MMP-8 4.19 ± 5.61 ngmL(-1), MMP-9 3.36 ± 6.30 ngmL(-1)), the mean changes for the normal weight group (IL-1β 10.07 ± 21.08 pgmL(-1), MMP-8 1.49 ± 4.61 ngmL(-1), MMP-9 -1.52 ± 9.71 ngmL(-1)) were not statistically significant. Anthropometric measures and the amounts of GCF biomarkers had weak positive correlations (0.242 ≤ r ≤ 0.340), and LDL in serum correlated with MMP-8 (r = 0.332) and IL-1β (r = 0.342) in the obese group. Stepwise multiple linear regression analysis in the obese group showed that the relationship between the amount of IL-1β in GCF and predictor variables including LDL and BMI was highly significant and accounted for 19.1 % of the variance in IL-1β in GCF.

CONCLUSIONS

In periodontally healthy subjects, weight control could reduce the amounts of MMP-8, MMP-9, and IL-1β in GCF of the obese subjects. Further studies with periodontally unhealthy and obese people are needed to identify the mechanism of decreases in inflammation biomarkers in GCF through weight control.

TRIAL REGISTRATION

ISRCTN86753073 (2015.08.14).

A population-based study on the association between the intake of soft drinks and periodontal disease in Taiwanese adults aged 35-44 years (KCIS no. 33)

OBJECTIVE

To elucidate the association between the intake of soft drinks and periodontal disease (PD) among Taiwanese middle-aged adults.

DESIGN

The cross-sectional design was employed to assess a dose-response relationship between the intake of soft drinks and PD after controlling for relevant confounding factors, with adjusted odds ratios obtained from a multivariate logistic regression model.

SETTING

Keelung Community-based Integrated Screening (KCIS) programme, Keelung, Taiwan.

SUBJECTS

Participants (n 10 213) aged 35-44 years who had undergone oral checks for PD between 2005 and 2009.

RESULTS

A dose-response relationship between the intake of soft drinks and elevated risk for PD defined by community periodontal index ≥3 (the current status of PD) was noted (P=0·02 by trend test). Compared with infrequent intake of soft drinks (≤2 times/week), the adjusted OR increased from 1·05 (95 % CI 0·92, 1·20) for the frequency of 3-4 times/week to 1·17 (95 % CI 1·03, 1·34) for the frequency of ≥5 times/week. A similar trend (P<0·01) was also observed for PD defined by loss of attachment ≥1 (representing the long-term cumulative gum damage due to PD).

CONCLUSIONS

A dose-response relationship between the intake frequency of soft drinks and PD was observed in Taiwanese middle-aged adults. Such evidence could be used in health promotion to support reductions in soft drink intake.

Is gamma-glutamyl transpeptidase a biomarker for oxidative stress in periodontitis?

CONTEXT

Periodontal disease and oxidative stress (OS) are part of a vicious cycle with each causing a deleterious effect on the other causing changes in the levels of antioxidants, and enzymes of antioxidant defense. Biomarkers and methods used for measuring OS are very expensive.

AIMS

To see how gamma-glutamyltransferase (GGT) fares, as a biomarker for OS in periodontits along with other routinely used biomarkers.

DESIGN

A cross-sectional study involving 300 people of which 150 were cases and 150 were controls.

SETTING

Candidates enrolled were patients visiting the OPD of MGV's Dental College and Hospital, Nasik, India between January 2011 and December 2012.

MATERIALS AND METHODS

Serum samples of patients with periodontitis, and controls were analyzed for malondialdehyde, superoxide dismutase (SOD), glutathione peroxidase (GPx), uric acid, and GGT.

STATISTICAL ANALYSIS USED

Analysis was performed using Student's t test. P <0.05 were considered to be significant.

RESULTS

Malondialdehyde values were found to be significantly higher cases, while SOD, GPx and uric acid levels were found to be lower than controls. GGT levels were significantly higher in cases as compared to controls.

CONCLUSIONS

GGT may be used as a cheap, quick, easy and precise marker for measuring OS.