Dental caries is associated with severe periodontitis in Chilean adults: a cross-sectional study

Viral shedding and viraemia of Andes virus during acute hantavirus infection: a prospective study

BACKGROUND

Andes virus (ANDV) is a zoonotic Orthohantavirus leading to hantavirus cardiopulmonary syndrome. Although most transmissions occur through environmental exposure to rodent faeces and urine, rare person-to-person transmission has been documented, mainly for close contacts. This study investigates the presence and infectivity of ANDV in body fluids from confirmed cases and the duration of viraemia.

METHODS

In this prospective study, 131 participants with confirmed ANDV infection were enrolled in Chile in a prospective study between 2008 and 2022. Clinical samples (buffy coat, plasma, gingival crevicular fluid [GCF], saliva, nasopharyngeal swabs [NPS], and urine) were collected weekly for 3 weeks together with clinical and epidemiological data. Samples were categorised as acute or convalescent (up to and after 16 days following onset of symptoms). Infectivity of positive fluids was assessed after the culture of samples on Vero E6 cells and use of flow cytometry assays to determine the production of ANDV nucleoprotein.

FINDINGS

ANDV RNA was detected in 100% of buffy coats during acute phase, declining to 95% by day 17, and to 93% between days 23-29. ANDV RNA in GCF and saliva decreased from 30% and 12%, respectively, during the acute phase, to 12% and 11% during the convalescent phase. Successful infectivity assays of RT-qPCR-positive fluids, including GCF, saliva, NPS, and urine, were observed in 18 (42%) of 43 samples obtained during the acute phase of infection. After re-culture, the capacity to infect Vero E6 cells was maintained in 16 (89%) of 18 samples. Severity was associated with the presence of ANDV RNA in one or more fluids besides blood (odds ratio 2·58 [95% CI 1·42-5·18]).

INTERPRETATION

ANDV infection is a systemic and viraemic infection, that affects various organs. The presence of infectious particles in body fluids contributes to our understanding of potential mechanisms for person-to-person transmission, supporting the development of preventive strategies. Detection of ANDV RNA in additional fluids at hospital admission is a predictor of disease severity.

FUNDING

National Institutes of Health and Agencia de Investigación y Desarrollo.

TRANSLATION

For the Spanish translation of the abstract see Supplementary Materials section.

Association between periodontitis and dental caries: a systematic review and meta-analysis

OBJECTIVES

Recent evidence suggested a link between periodontitis (PD) and dental caries, but the trends and nature of this association remained unclear. The overall aim of this study was to critically assess the correlation of two disorders.

METHODS

A comprehensive search was conducted within the PUBMED and EMBASE databases including grey literatures up to July 5th, 2023. The Newcastle-Ottawa scale was used to qualitatively evaluate the risk of bias.

RESULTS

Overall, 18 studies were included. In terms of caries risk in PD patients, the prevalence of caries was increased by PD (OR = 1.57, 95%CI:1.20-2.07), both in crown (OR = 1.03, 95%CI:1.01-1.05) and root caries (OR = 2.10, 95%CI:1.03-4.29). Odds of caries were also raised by PD severity (OR moderate = 1.38, 95%CI:1.15-1.66; OR severe = 2.14, 95%CI:1.74-2.64). Besides, patients with PD exhibited a higher mean number of decayed, missing and filled teeth (DMFT) and decayed and filled root teeth (DFR) [weighted mean difference (WMD)DMFT = 0.87, 95%CI: -0.03-1.76; WMDDFR = 1.13, 95%CI: 0.48-1.78]. Likewise, patients with caries had an elevated risk of PD (OR = 1.79, 95%CI:1.36-2.35). However, Streptococcus mutans, one of the main pathogens of caries, was negatively correlated with several main pathogens of periodontitis.

CONCLUSIONS

This study indicated a positive correlation between dental caries and periodontitis clinically, while the two disease-associated pathogens were antagonistic.

CLINICAL RELEVANCE

Further research, including clinical cohort studies and mechanisms of pathogens interaction is needed on this link for better prevention and treatment of PD and caries. In addition, innovative prevention strategies need to be developed and incorporated in dental practices to prevent these two highly prevalent oral diseases.

Association between oral health status and occlusal bite force in young adults

Background/purpose

Oral health is related to general health and a person's overall well-being. The aim of the present study was to explore the association between oral health status and bite force among young adults.

Materials and methods

Maximum bite force (MBF) was measured using Dental Prescale II in conjunction with a pressure-sensitive film and bite force analyzer in 40 young adults aged 20 to 40. Supragingival dental plaque was collected and cultured. Plaque weight, pH, and colony counts were assessed. The decayed, missing, and filled teeth index (DMFT) and body mass index (BMI) were recorded.

Results

Bite force was negatively correlated with the number of missing teeth and the sum of missing and filled teeth. When the filled-to-remaining-teeth ratio (F/R ratio) was less than 8%, the bite force was significantly higher compared to an F/R ratio of 8-25%. Additionally, the amount of total bacteria was positively correlated with total bite force, and the quantity of Streptococcus mutans (S. mutans) along with total bacteria was positively correlated with bite force in the molar region (∗P < 0.05). The molar region predominantly contributed to bite force.

Conclusion

Elevated levels of cariogenic bacteria may increase the risk of tooth loss, subsequently leading to reduced bite force. This reduction in bite force can further impact the efficiency of chewing function and, consequently, the quality of life. An F/R ratio above 8% could be easily calculated clinically and could serve as a guide to identify patients, particularly young adults, at risk of reduced bite force.

Are periodontitis and dental caries associated? A systematic review with meta-analyses

AIM

The epidemiological relationship between periodontitis and caries remains controversial, and evidence synthesis is currently lacking. Therefore, this systematic review was designed to answer the following PECO question: 'In human adults (P), do subjects suffering from periodontitis (E) have higher presence/number of untreated carious lesions and caries experience (O) than subjects not suffering from periodontitis (C)?'.

MATERIALS AND METHODS

Observational studies that met specific inclusion criteria established to answer to the PECO question were included. Two review authors independently searched for eligible studies, screened the titles and abstracts, carried out the full text analysis, extracted the data and performed the risk of bias assessment. In case of disagreement, a third review author took the final decision during ad hoc consensus meetings. Data synthesis was carried out through random-effects meta-analyses.

RESULTS

A total of 18 studies on 21 cohorts, involving 135,018 participants, were included. Meta-analyses showed a significant association between periodontitis and the presence of at least one tooth with either untreated carious lesions (odds ratio [OR] = 1.63; 95% confidence interval [CI]: 1.32-2.01; p <.00; I2  = 83.0%) or caries experience (decayed and filled teeth ≥ 1) (OR = 1.27; 95% CI: 1.01-1.59; p = .038; I2  = 90.0%). Moreover, subjects with periodontitis exhibited a higher number of surfaces (difference in means [MD] = 0.86; 95% CI: 0.46-1.27; p <.001; I2  = 0.0%) and teeth (MD = 0.35; 95% CI: 0.28-0.42; p <.001; I2  = 69.6%) with untreated carious lesions, as well as a higher number of teeth with caries experience (standardized difference in means  [SMD] = 1.46; 95% CI: 0.15-2.78; p = .029; I2  = 98.9%) compared with those without periodontitis. Sensitivity analyses focusing on severe periodontitis as exposure mostly showed consistent results. Estimates for caries experience were only slightly attenuated in adjusted models compared with crude models. Subgroup analyses by caries location also indicated that periodontitis was associated only with root caries, while it was not with caries affecting the anatomical crown.

CONCLUSIONS

Periodontitis was found to be associated with the presence and number of treated/untreated root carious lesions. Therefore, caries-specific preventive measures (e.g., fluorides) should be considered for individuals with periodontitis.

Co-occurrence of dental caries and periodontitis: multilevel modelling approach

BACKGROUND

Previous studies reported varyingly positive, negative, or no relationships between caries and periodontitis. Therefore, the aim was to assess the potential co-occurrence of caries experience and periodontal inflammation on the same teeth.

METHODS

This cross-sectional study used data from the Lithuanian National Oral Health Survey. The study included a stratified random sample of 1405 individuals aged 34-78, recruited from 5 Lithuanian cities and 10 peri-urban/rural areas (response rate 52%). Information about sociodemographic (age, sex, education, residence), behavioral (sugar-containing diet, tooth brushing frequency, use of interdental care products, last dental visit, smoking) and biological (systemic disease, use of medication and xerostomia) determinants was collected using the World Health Organization (WHO) Oral Health Questionnaire for Adults supplemented with additional questions. Clinical data were recorded using the WHO criteria and collected by one trained and calibrated examiner. Dental caries status was recorded as sound, decayed, missing, filled surfaces. Subsequently for the analyses, status was recorded at a tooth-level as decayed- and filled-teeth (DT and FT) including proximal, buccal, and oral surfaces. Two measures were used for periodontal status. The probing pocket depth (PPD) was measured at six sites and recorded at a tooth level into the absence of PPD or presence of PPD ≥ 4 mm. Bleeding on probing (BOP) was measured at the same six sites and was recorded as either present or absent at a tooth-level. Univariable and multivariable 2-level random intercept binary logistic regression analyses were utilized.

RESULTS

Positive associations were found between DT and BOP (OR 1.42, 95% CI 1.20-1.67), FT and BOP (OR 2.07, 95% CI 1.82-2.23), DT and PPD (OR 1.38, 95% CI 1.15-1.67) and FT and PPD (OR 2.01, 95% CI 1.83-2.20).

CONCLUSIONS

Our findings add evidence for the co-occurrence of periodontal inflammation and caries on the same teeth. This suggests the need for increased emphasis on a transdisciplinary approach in designing oral health interventions that target dental caries and periodontal disease simultaneously. In addition, longitudinal studies exploring the co-occurrence of caries and periodontal disease at the same sites, taking into consideration the levels of both conditions and genetic variation, are warranted.

The co-occurrence of the two main oral diseases: periodontitis and dental caries

OBJECTIVES

Limited studies are available testing through multiple regression models the association between the two main oral diseases: dental caries and periodontitis. The aim of this cross-sectional population-based study was to verify whether dental caries and periodontitis co-occur in a representative sample of the South Korea population.

MATERIALS AND METHODS

A total of 23,405 subjects representative of 36.2 million of adults (KNHANES) were examined. Univariate and multiple regression analyses using 7 different models were applied, controlling for age, gender, smoking status, frequency of toothbrushing, use of interproximal toothbrushes and flossing, educational level, income, gum diseases treatment and tooth filling in the previous year, BMI, Vitamin D serum levels, alcoholism, diabetes status, stress and carbohydrates dietary intake.

RESULTS

In the fully adjusted model, participants with periodontitis had, respectively, a mean of 0.82 (95% CI: 0.41-1.23) and of 0.36 (95% CI: 0.22-0.50) more untreated decayed surfaces and teeth than participants without periodontitis, with an OR to have at least one untreated decayed surface of 1.96 (95% CI: 1.66-2.32). However, cumulative caries experience (DF scores) and periodontitis were not associated.

CONCLUSIONS

In this large nationally representative population, periodontitis and untreated dental caries co-occur. However, when considering cumulative caries experience (DF scores), the two diseases do not appear related.

CLINICAL RELEVANCE

In light of their possible co-occurrence, clinicians should implement integrative diagnostic, preventive and treatment strategies for both diseases.

Epidemiology of mid-buccal gingival recessions according to the 2018 Classification System in South America: Results from two population-based studies

AIM

The aim of this investigation was to estimate the prevalence, severity and extent of mid-buccal gingival recessions (GRs; classified according to the 2018 Classification System) and to identify their risk indicators in the South American population.

MATERIALS AND METHODS

Epidemiological data from two cross-sectional studies-performed on 1070 South American adolescents and 1456 Chilean adults-were obtained. All participants received a full-mouth periodontal examination by calibrated examiners. GR prevalence was defined as the presence of at least one mid-buccal GR ≥ 1 mm. GRs were also categorized into different recession types (RTs) according to the 2018 World Workshop Classification System. Analyses for RT risk indicators were also performed. All analyses were carried out at the participant level.

RESULTS

The prevalence of mid-buccal GRs was 14.1% in South American adolescents and 90.9% in Chilean adults. In South American adolescents, the prevalence of RTs was 4.3% for RT1 GRs, 10.7% for RT2 GRs and 1.7% for RT3 GRs. In Chilean adults, the prevalence of RT1 GRs was 0.3%, while the prevalence of RT2 and RT3 GRs was 85.8% and 77.4%, respectively. Full-Mouth Bleeding Score (FMBS; <25%) was associated with the presence of RT1 GRs in adolescents. The risk indicators for RT2/RT3 GRs mainly overlapped with those for periodontitis.

CONCLUSIONS

Mid-buccal GRs affected 14.1% of South American adolescents, whereas they affected most of the Chilean adult population (>90%). While RT1 GRs are more commonly observed in a non-representative cohort of South American adolescents (when compared to Chilean adults), the majority of Chilean adults exhibit RT2/RT3 GRs.

Head and neck cancer patients show poor oral health as compared to those with other types of cancer

PURPOSE

Several studies have found associations between periodontitis and various types of cancer. Since the site of head and neck cancer (HNC) has contiguity or proximity to the oral cavity, it may be particularly influenced by oral inflammation. This study aimed to determine whether HNC patients have poor oral health as compared to those with other types of cancer.

METHODS

This study retrospectively examined oral environmental factors including periodontal inflamed surface area (PISA), a new periodontal inflammatory parameter. A total of 1030 cancer patients were divided into the HNC (n = 142) and other cancer (n = 888) groups. Furthermore, the HNC group was divided into high (n = 71) and low (n = 71) PISA subgroups, and independent risk factors affecting a high PISA value were investigated.

RESULTS

Multivariate logistic regression analysis showed that number of missing teeth (odds ratio 1.72, 95% CI 1.15-2.56, P < 0.01), PISA (odds ratio 1.06, 95% CI 1.03-1.06, P < 0.05), and oral bacterial count (odds ratio 1.02, 95% CI 1.01-1.03, P < 0.01) were independent factors related to HNC. In addition, multivariate logistic regression analysis indicated that current smoker (odds ratio 7.51, 95% CI 1.63-34.71, P < 0.01) and presence of untreated dental caries (odds ratio 3.33, 95% CI 1.23-9.00, P < 0.05) were independent risk factors affecting high PISA values in HNC patients.

CONCLUSION

HNC patients have higher levels of gingival inflammation and poor oral health as compared to patients with other types of cancer, indicating that prompt oral assessment and an effective oral hygiene management plan are needed at the time of HNC diagnosis.

Association between inflammatory potential of diet and periodontitis disease risks: Results from a Korean population-based cohort study

AIM

To examine the association between a pro-inflammatory diet, estimated using the energy-adjusted dietary inflammatory index (E-DII), and the risk of periodontitis.

MATERIALS AND METHODS

Study subjects from the Korean Genome and Epidemiology Study Health Examinee (KoGES_HEXA) cohort were included for cross-sectional analysis (n = 168,378) using multivariate logistic regression and prospective analysis (n = 160,397) using Cox proportional hazard models respectively. DII and E-DII scores were calculated based on the intake reported on a validated semi-quantitative food frequency questionnaire (SQ-FFQ).

RESULTS

Cox proportional hazard models revealed a significantly increased risk of incident periodontitis in individuals consuming high E-DII (more pro-inflammatory) diets in the total population (HRquartile4vs1  = 1.29; 95% CI: 1.13-1.48; ptrend <.001) and in both men (HRquartile4vs1  = 1.36; 95% CI: 1.07-1.73; ptrend  = 0.02) and women (HRquartile4vs1  = 1.27; 95% CI: 1.08-1.50; ptrend  = .002). The association remained significant even after excluding cases diagnosed early in the follow-up. In the cross-sectional analysis, a significant association was observed between the E-DII score and the prevalence of periodontitis among all study subjects (ORquartile4vs1  = 1.17; 95% CI: 1.03-1.34; ptrend  = 0.01) and men (ORquartile4vs1  = 1.28; 95%CI: 1.01-1.63; ptrend <.001); however, the association did not reach statistical significance in women (ORquartile4vs1  = 1.13; 95% CI: 0.96-1.33; ptrend <.001).

CONCLUSIONS

Findings from the current study support the hypothesis that diets with high pro-inflammatory potential increase the risk of periodontitis.

Differences in periodontal parameters between SPT patients who regularly and irregularly visited the dental clinic analyzed at tooth level: a 14-year retrospective cohort study

The purpose of this study was to evaluate the periodontal status of patients who routinely did SPT, when compared to patients that did not SPT. This retrospective cohort study was conducted at a general dental office from 2001 to 2019. Patients aged 18 to 81 years who visited the dental office over a 10-year period were assigned into two groups: an SPT group, which included patients who continually visited the dental office for SPT one or more times every year, and an irregular group, consisting of patients who did not visit the dental office at least once a year. A total of 7307 teeth (SPT group) and 4659 teeth (irregular group) were evaluated, and the periodontal conditions were compared between the first and latest visits. Multiple regression analysis was used to analyze the results. The mean follow-up time was 13.74 years. The risk factors for improvements in probing pocket depth included age, sex, smoking, diabetes mellitus, molar tooth, and irregular SPT group (p < 0.001), and that for a positive bleeding on probing site was the irregular group (odds ratio 2.94; 95% confidence interval 2.63-3.29). This study showed that lack of routine in attending the SPT program significantly decreased the periodontal parameters, thus highlighting the importance of continuing with the program to maintain the periodontal health.

Chronic oral diseases burden: The confluence of caries and periodontitis throughout life

AIM

To investigate the confluence of caries and periodontitis indicators from adolescence to elderhood among Americans.

MATERIALS AND METHODS

This cross-sectional study explored the grouping among a set of caries and periodontitis indicators (the proportion of sites with bleeding on probing, moderate probing pocket depth [PPD, 4-5 mm], severe PPD [≥6 mm], moderate clinical attachment level [CAL, 3-4 mm], severe CAL [≥5 mm], number of teeth with furcation involvement, number of decayed teeth, number of teeth with pulp involvement, and the number of missing teeth) in 14,421 Americans from the NHANES III study. Exploratory factorial analysis was used to determine the constructs between those indicators (factorial loading ≥0.3). These analyses were stratified by age and confirmed with a confirmatory factorial analysis. We also performed a sensitivity analysis using the NHANES 2011-2014.

RESULTS

Two constructs were extracted. The first, Chronic Oral Diseases Burden, grouped caries indicators with moderate PPD and moderate CAL for the youngest subjects (13-39 years old), while for the subjects over 50 years, the Chronic Oral Disease Burden grouped caries indicators with severe CAL and PPD and furcation involvement. The second construct, Periodontal Destruction, grouped only periodontitis indicators.

CONCLUSIONS

Caries and periodontitis indicators grouped consistently across the different age ranges in lapse times of 25 years.

[Multivariable analysis of tooth loss in subjects with severe periodontitis over 4-year natural progression]

OBJECTIVE

To evaluate the characteristics of severe periodontitis with various number of tooth loss during 4-year natural progression, and to analyze the factors related to higher rate of tooth loss.

METHODS

A total of 217 patients aged 15 to 44 years with severe periodontitis were included, who participated in a 4-year natural progression research. Data obtained from questionnaire survey, clinical examination and radiographic measurement. Tooth loss during 4-year natural progression was evaluated. The baseline periodontal disease related and caries related factors were calculated, including number of teeth with bone loss > 50%, number of missing molars, number of teeth with widened periodontal ligament space (WPDL), number of teeth with periapical lesions and etc. Characteristics of populations with various number of tooth loss and the related factors that affected higher rate of tooth loss were analyzed.

RESULTS

In 4 years of natural progression, 103 teeth were lost, and annual tooth loss per person was 0.12±0.38. Nine patients lost 3 or more teeth. Thirty-four patients lost 1 or 2 teeth, and 174 patients were absent of tooth loss. Molars were mostly frequent to lose, and canines presented a minimum loss. The number of teeth with WPDL, with periapical lesions, with intrabony defects, with probing depth (PD)≥7 mm, with PD≥5 mm, with clinical attachment loss≥5 mm, with bone loss > 50% and with bone loss > 65% were positively correlated to number of tooth loss. Results from orderly multivariate Logistic regression showd that the number of teeth with bone loss > 50% OR=1.550), baseline number of molars lost (OR=1.774), number of teeth with WPDL (1 to 2: OR=1.415; ≥3: OR=13.105), number of teeth with periapical lesions (1 to 2: OR=4.393; ≥3: OR=9.526) and number of teeth with caries/residual roots (OR=3.028) were significant risk factors related to higher likelihood of tooth loss and multiple tooth loss.

CONCLUSION

In 4 years of natural progression, the number of teeth with bone loss > 50%, baseline number of missing molars, number of teeth with WPDL, baseline number of teeth with periapical lesions and number of teeth with caries/residual roots were significantly related to higher risk of tooth loss and multiple tooth loss among Chinese young and middle-aged patients with severe periodontitis in rural areas.

Oral Health Promotion under the 8020 Campaign in Japan-A Systematic Review

(1) Background: The aim of this study is to review the benefits of the 8020 Campaign since its inception. (2) Methods: We followed the PRISMA guideline and collected information regarding the 8020 Campaign through online database searches. (3) Results: Twenty-five studies met the inclusion criteria and were eligible for analysis. The main outcomes of the 25 included studies were reviewed. The quality evaluation demonstrated a range of studies showing a credible relationship between masticatory function, number of teeth, salivary secretion, frequent dental check-ups, and general health concerns. Due to the risk of bias, publication bias, and indirectness, 22 studies were considered that only had "fair" quality. (4) Conclusions: The 8020 Foundation funded several of the studies, and other research papers noted the 8020 Campaign in their papers, however there were no clear explanations for any direct relationship between their findings and the 8020 Campaign. As a result, evidence for the direct effectiveness and benefits assessment of the 8020 Campaign positive outcomes were compromised by confounding social and economic variables over the 30-year period. To fully elucidate how improvement in Japan's oral health was directly related to the 8020 Campaign, a more informed and systematic explanation of the campaign's structure and activities is required.

In vitro anti-inflammatory and antibiofilm activities of bacterial lysates from lactobacilli against oral pathogenic bacteria

Postbiotics are functional biological compounds, such as bacterial lysates (BLs) released from probiotic bacteria. Although postbiotics exert various bioactivities, the anti-inflammatory and antibiofilm activities of BLs against oral pathogenic bacteria have not been investigated. In the present study, pretreatment with BLs extracted from Lactobacillus plantarum and L. rhamnosus GG suppressed the mRNA and protein expression levels of inflammatory mediators induced by the lipopolysaccharide (LPS) of Porphyromonas gingivalis in RAW 264.7 cells. Both BLs attenuated P. gingivalis LPS-induced phosphorylation of mitogen-activated protein kinases (MAPKs) and activation of nuclear factor-κB (NF-κB), suggesting that BLs inhibit periodontal inflammatory responses by regulating the MAPK and NF-κB signaling pathways. Moreover, both BLs interfered with biofilm formation by Streptococcus mutans; however, they did not eradicate the established S. mutans biofilm. Furthermore, both BLs downregulated gtfB, gtfC, and gtfD responsible for biofilm formation by S. mutans, suggesting that BLs reduce the synthesis of extracellular polysaccharide and thereby reduce S. mutans biofilm. Taken together, these results suggest that BLs of L. plantarum and L. rhamnosus GG can attenuate periodontal inflammation and dental caries and thus contribute to the improvement of oral health.

The impact of smoking on periodontal status and dental caries

INTRODUCTION

Investigations to explore the relationship between smoking and its oral manifestations are important to clinicians. Among these oral manifestations, periodontal diseases and dental caries have still a controversial association. This study aims to analyze the effect of smoking on periodontal disease and caries and their relevance to each other.

METHODS

Data on demographic and clinical features were retrieved from 7028 patients. Smoking status was categorized as a smoker, non-smoker, former smoker and passive smoker. Each patient received a diagnosis according to the new classification system for periodontal disease, in which periodontal disease is divides into stages (PS). The carries status was diagnosed by evaluating the decayed, missing, and filled teeth (DMFT) index.

RESULTS

Of the patients, 66.6% were non-smoker women, whereas 53.7 % of passive smokers were women. Being a worker and having a Bachelor’s degree was associated with a higher likelihood of getting diagnosed with periodontal disease and caries in smokers. Smoking significantly influences periodontal disease severity and DMFT values (p<0.001). This becomes more evident in former smokers by showing the highest severe periodontal problems (PS3: 29.7% and PS4: 18.9%), and the highest DMFT mean (16.4 ± 7.4) Accordingly, persons having high DMFT had significantly the most severe periodontal disease, namely PS4 (p<0.05).

CONCLUSIONS

Smoking is associated with higher caries prevalence and more severe periodontal disease, and DMFT tend to increase with the severity of periodontitis in the same subjects.

Periodontal status of students living with disability in Amhara region, Ethiopia: a cross-sectional study

Background

Periodontal disease is the most common oral health problem among individuals living with disabilities. Any physical impairment and/or mental handicap can compromise the capability to perform oral health care. Individuals with poor oral hygiene practice were prone to dental caries, periodontal disease, and upper respiratory tract infections. Despite the high prevalence of disabled people in Ethiopia, data are scarce about their periodontal status. The aim of this study was to determine the prevalence and determinant factors of periodontal disease among students living with disability in the Amhara region.

Methods

A school-based cross-sectional study was done on eight special needs schools in Amhara regional state from November 30, 2020, to April 10, 2021. A simple random sampling technique using a computer random generator was employed to recruit the study participants. The participants were interviewed for sociodemographic characteristics, oral hygiene practice, type of disability, and medical condition through a pre-tested semi-structured questionnaire. The periodontal status of the participants was evaluated using the community periodontal index (CPI). Data entry was done using the Epi-data and analyzed using SPSS 26. Binary logistic regression analysis was used to identify the predictors of periodontal disease at a 5% level of significance.

Results

A total of 443 study participants were involved with a mean age of 15.84 ± 3.882. Among these, 27.5% (95%CI 23.4–32.0) had a periodontal pocket depth of ≥ 4 mm, and 56.7% had bleeding on probing. The prevalence of periodontal disease was higher in participants with poor oral health status (52.2%), dental caries (34.8%), class-2 malocclusion (46.1%), and low monthly income (30.4%), visually impaired (30%), and mentally disorder (29.9%). Age of above 18 years (AOR = 3.41, 95%CI 1.40, 8.28), low family monthly income (AOR = 2.21; 95%CI 1.22, 4.03), malocclusion (AOR = 1.59, 95%CI 1.01, 2.54), poor oral health status (AOR = 9.41; 95%CI 4.92, 17.98), and dental caries (AOR = 1.85, 95%CI 1.21, 2.82) were independent predictors of periodontal disease.

Conclusions

A substantial amount of disabled school students in the study area had periodontal disease. The study found that there was a statistically significant association between age, family monthly income, malocclusion, oral health status, and dental caries with periodontal disease. The implementation of school oral health programs has a great benefit for the oral health status of disabled school students.

Radiographic Bone Loss and Its Relation to Patient-Specific Risk Factors, LDL Cholesterol, and Vitamin D: A Cross-Sectional Study

The influence of patient-specific factors such as medical conditions, low-density lipoprotein cholesterol (LDL-C) or levels of 25-hydroxyvitamin D (25OHD) on periodontal diseases is frequently discussed in the literature. Therefore, the aim of this retrospective cross-sectional study was to evaluate potential associations between radiographic bone loss (RBL) and patient-specific risk factors, particularly LDL-C and 25OHD levels. Patients from a dental practice, who received full-mouth cone beam CTs (CBCTs) and blood-sampling in the course of implant treatment planning, were included in this study. RBL was determined at six sites per tooth from CBCT data. LDL-C and 25OHD levels were measured from venous blood samples. Other patient-specific risk factors were assessed based on anamnesis and dental charts. Statistical analysis was performed applying non-parametric procedures (Mann-Whitney U tests, error rates method). Data from 163 patients could be included in the analysis. RBL was significantly higher in male patients, older age groups, smokers, patients with high DMFT (decayed/missing/filled teeth) score, lower number of teeth, and high LDL-C levels (≥160 mg/dL). Furthermore, patients with high 25OHD levels (≥40 ng/mL) exhibited significantly less RBL. In summary, RBL was found to be associated with known patient-specific markers, particularly with age and high LDL-C levels.

Chemometrics analysis for the detection of dental caries via UV absorption spectroscopy

Caries is one of the non-communicable diseases that has a high prevalence trend. The current methods used to detect caries require sophisticated laboratory equipment, professional inspection, and expensive equipment such as X-ray imaging device. A non-invasive and economical method is required to substitute the conventional methods for the detection of caries. UV absorption spectroscopy coupled with chemometrics analysis has emerged as a good potential candidate for such an application. Data preprocessing methods such as mean centre, autoscale and Savitzky-Golay smoothing were implemented to enhance the signal-to-noise ratio of spectra data. Various classification algorithms namely K-nearest neighbours (KNN), logistic regression (LR) and linear discriminant analysis (LDA) were implemented to classify the severity of dental caries into International Caries Detection and Assessment System (ICDAS) scores. The performance of the prediction model was measured and comparatively analysed based on the accuracy, precision, sensitivity, and specificity. The LDA algorithm combined with the Savitzky-Golay preprocessing method had shown the best result with respect to the validation data accuracy, precision, sensitivity and specificity, where each had values of 0.90, 1.00, 0.86 and 1.00 respectively. The area under the curve of the ROC plot computed for the LDA algorithm was 0.95, which indicated that the prediction algorithm was capable of differentiating normal and caries teeth excellently.

Whey fermented by Enterococcus faecalis M157 exhibits antiinflammatory and antibiofilm activities against oral pathogenic bacteria

The aim of the present study was to investigate the antiinflammatory and antibiofilm effects of whey fermented by Enterococcus faecalis M157 (M157-W) against oral pathogenic bacteria. The M157-W significantly inhibited IL-1β, IL-6, and nitric oxide induced by the lipopolysaccharide of Porphyromonas gingivalis in RAW 264.7 cells. The M157-W also inhibited the production of IL-1β and IL-8 in human periodontal ligament cells. Treatment with M157-W suppressed the phosphorylation of mitogen-activated protein kinases as well as the activation of nuclear factor-κB in RAW 264.7 cells stimulated by P. gingivalis lipopolysaccharide. Furthermore, M157-W dose-dependently inhibited Streptococcus mutans biofilm, whereas unfermented whey did not inhibit the biofilm. Treatment with M157-W significantly suppressed gtfB, gtfC, and gtfD gene expression in S. mutans compared with the control (0 μg/mL), indicating that M157-W inhibits S. mutans biofilm formation by reducing the synthesis of extracellular polymeric substances. Collectively, these results suggest that M157-W has antiinflammatory and antibiofilm activities against oral pathogenic bacteria.

Application of Selected Biomaterials and Stem Cells in the Regeneration of Hard Dental Tissue in Paediatric Dentistry-Based on the Current Literature

Currently, the development of the use of biomaterials and their application in medicine is causing rapid changes in the fields of regenerative dentistry. Each year, new research studies allow for the discovery of additional possibilities of dental tissue restoration. The structure and functions of teeth are complex. They consist of several diverse tissues that need to act together to ensure the tooth’s function and durability. The integrity of a tooth’s enamel, dentin, cementum, and pulp tissue allows for successful mastication. Biomaterials that are needed in dentistry must withstand excessive loading forces, be biocompatible with the hosts’ tissues, and stable in the oral cavity environment. Moreover, each tooth’s tissue, as well as aesthetic qualities in most cases, should closely resemble the natural dental tissues. This is why tissue regeneration in dentistry is such a challenge. This scientific research focuses on paediatric dentistry, its classification of caries, and the use of biomaterials in rebuilding hard dental tissues. There are several methods described in the study, including classical conservative methods such as caries infiltration or stainless-steel crowns. Several clinical cases are present, allowing a reader to better understand the described methods. Although the biomaterials mentioned in this work are artificial, there is currently ongoing research regarding clinical stem cell applications, which have a high potential for becoming one of the most common techniques of lost dental-tissue regeneration in the near future. The current state of stem cell development is mentioned, as well as the various methods of its possible application in dentistry.

Performance of the 2017 AAP/EFP case definition compared to the CDC/AAP definition in population-based studies

BACKGROUND

Classification of the periodontal conditions is indispensable for epidemiological data in order to guide situational awareness and therapeutic strategies. The new classification of periodontal diseases and conditions introduced by the American Academy of Periodontology and the European Federation of Periodontology (AAP/EFP), however, has not yet been applied to population-based studies. The aim of the present study was to compare the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification system and to evaluate the accuracy of the new AAP/EFP classification system against the CDC/AAP case definition for population-based studies.

METHODS

Epidemiological data from two cross-sectional studies were obtained. One of them was a population-based study on Chilean adults (1.456 individuals; 35-44 years; 65-74 years) and the other one a sample of adolescents (1.070 individuals; 15-19 years) from 5 countries; Argentina, Chile, Colombia, Ecuador and Uruguay. All participants had undergone full-mouth periodontal examination by calibrated examiners. Epidemiological datasets were analyzed according to the AAP/EFP and the CDC/AAP case definitions. The accuracy of the AAP/EFP definition was examined by assessing the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating curve (ROC) using the CDC/AAP case definition as the reference standard.

RESULTS

According to the AAP/EFP, the prevalence of periodontitis in adolescents was 75.6%. The majority of the adolescents were classified either as stage I (39.2%) or stage II (28.2%). By using the CDC/AAP classification the prevalence of periodontitis in adolescents was 27.2%. The most common form of periodontitis with the CDC/AAP classification was moderate periodontitis (15.3%) followed by mild periodontitis (11.4%). The AAP/EFP revealed high sensitivity in moderate (95.7%) and severe periodontitis (100%) as well as a moderate (75%) to high specificity (92%) in moderate and severe periodontitis, respectively. The PPV was 41.6% in moderate and 5.7% in severe periodontitis while the NPV was high in both categories (moderate = 99%; severe = 100%). The AUC was 0.912 (95% CI = 0.89 - 0.93). In adults, the prevalence of periodontitis was 99% according to the AAP/EFP. The majority of adults were classified as stage IV (81.3%) whereas stage III amounted to 12.8%. By using the CDC/AAP classification, the prevalence of periodontitis in adults was 88.3% and the most common form of periodontitis was moderate periodontitis (57.2%) followed by severe periodontitis (29.7%). In adults, the AAP/EFP revealed high sensitivity in moderate (99.7%) and severe periodontitis (100%) but low specificity in both categories (moderate = 6.8%; severe = 8.3%). The PPV was 88.7% in moderate and 31.7% in severe periodontitis. The NPV was high in both categories (moderate = 76.5%; severe = 100%). The AUC was 0.573 (95% CI = 0.53 - 0.62).

CONCLUSIONS

This study revealed a clear discrepancy in the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification when using epidemiological data. The 2017 AAP/EFP classification system performs well compared to the CDC/AAP case definition in identifying adolescents with periodontitis. The AAP/EFP system seems less accurate in adults with high prevalence of periodontitis. This article is protected by copyright. All rights reserved.

Prevalence of Dental Caries and Periodontal Disease of High School Students Aged 15 to 18 Years in Taiwan

The purpose of this study was to assess the prevalence and distribution of dental caries and periodontal disease in Taiwanese high school students aged 15–18. A total of 1069 Taiwanese students participated in a cross-sectional nationwide dental survey. By using a stratified method based on the National Health Insurance administration regions, 24 high schools were randomly sampled in different areas of Taiwan. The participants were examined with dental mirrors and community periodontal index (CPI) probes without using radiographs, to measure dental caries and periodontal status. Demographic information and other relevant risk indicators for the two diseases were gathered via a self-report questionnaire. In this study population, the weighted mean decayed, missing and filled teeth (DMFT) scores for ages 15 to 18 were 5.2, 6.1, 6.1, and 5.7. The weighted mean decayed, missing and filled surfaces (DMFS) scores were 9.0, 12.0, 13.1, and 11.2 at ages 15, 16, 17, and 18, respectively. Additionally, 88.2% of the subjects had periodontal disease, with calculus as the most prevalent type. Moreover, 5.2% of these students showed loss of attachment. There was no significant association between dental caries and periodontal disease. Dental caries and periodontal disease were prevalent among Taiwanese high school students in this national dental survey.

Impact of COVID-19 Pandemic on Quality of Life of Type II Diabetes Patients With Periodontitis

Background: Confinement due to the COVID-19 pandemic has made dental treatments impossible in Chile and many other countries, including diabetic patients with periodontitis. The aim of the present study was to evaluate the impact of periodontal therapy in terms of oral health-related quality of life (OHRQoL) during the COVID-19 pandemic in a cohort of diabetic patients with periodontitis. Material and Methods: Thirty-eight diabetic patients with stage III-IV periodontitis, enrolled for periodontal therapy, were screened. Periodontal clinical parameters including clinical attachment loss (CAL), probing pocket depth (PPD) and bleeding on probing (BOP) as well as glycated hemoglobin (HbA1c) were evaluated at baseline and 3 months follow-up prior the pandemic. The OHRQoL changes by means of Oral Health Impact Profile (OHIP-14) and a self-reported oral health questionnaire were assessed at baseline (prior pandemic) and during the pandemic via telemonitoring. Results: Thirty-one patients received non-surgical periodontal therapy prior to the pandemic. Out of the 31 patients, four died due to COVID-19 resulting in 27 patients available for telemonitoring at the time of the pandemic. Periodontal therapy significantly improved CAL, PPD and BOP (p < 0.05) but not HbA1c (p > 0.05) between baseline and 3 months follow-up pior to the pandemic. Total OHIP-14 scores significantly improved between baseline and the middle of pandemic (intragroup comparison p = 0.00411). In particular, OHIP-14 scores related to the "Physical pain" (intragroup comparison p = 0.04) and "Psychological disability" (intragroup comparison p = 0.00) significantly improved between baseline and the middle of pandemic. Conclusions: In diabetic type II patients with periodontitis periodontal therapy tends to improve the oral health-related quality of life despite the COVID-19 pandemic.

The relationship between different types of caries and periodontal disease severity in middle-aged and elderly people: findings from the 4th National Oral Health Survey of China

BACKGROUND

The relationship between dental caries and periodontal disease is still controversial. The objective of this study was to explore the relationship between different types of caries and periodontal disease severity in middle-aged and elderly people in China.

METHODS

The study population consisted of 4407 middle-aged and 4117 elderly subjects. Caries were divided into the following three types: type A, crown caries; type B, lesions involving both the crown and root, representing mixed-type caries; and type C, root caries. These three types together represent the overall caries situation, which we call type ABC. Caries were quantitated by decayed and filled teeth (DFT index). Periodontitis was evaluated by clinical attachment loss.

RESULTS

Middle-aged people with periodontitis had a significant association with DFT type B (OR: 1.21, 95% CI 1.17-1.25) and type C (OR: 1.40, 95% CI 1.24-1.56). Elderly people with periodontitis had a significant association with DFT type C (OR: 1.28, 95% CI 1.21-1.35).

CONCLUSIONS

In China, caries types B/C were positively correlated with periodontitis in the middle-aged group, and only caries type C was positively correlated with periodontitis in the elderly group.

Risk factors for tooth loss with a mean follow-up period of 13.9 years in supportive periodontal therapy patients

Background

Clinical evidence indicates that there are various risk factors of tooth loss. However, the degree of this risk among other risk factors remains unclear. In this retrospective cohort study, the authors evaluated the hazard ratios of several risk factors for tooth loss.

Methods

Included patients had all been treated for dental disorders, were in the supportive phase of periodontal therapy by dental hygienists, and visited a Japanese dental office continually during a 10-year period. Periodontal parameters, tooth condition, and general status of all teeth (excluding third molars) at the initial visit and at least 10 years later were evaluated by using multiple classification analysis.

Results

The authors evaluated a total of 7584 teeth in 297 patients (average age: 45.3, mean follow-up time: 13.9 years) Non-vital pulp was the most significant predictor of tooth loss according to Cox hazards regression analysis (hazard ratio: 3.31). The 10-year survival rate was approximately 90% for teeth with non-vital pulp and 99% for teeth with vital pulp. Fracture was the most common reason for tooth loss.

Conclusions

Non-vital pulp had the most significant association with tooth loss among the parameters. Therefore, it is very important to minimize dental pulp extirpation.

Periodontal Treatment Protocol for Decompensated Diabetes Patients

Background: Decompensated diabetes is associated with a higher prevalence and severity of periodontitis and poorer response to periodontal therapy. It is conceivable that periodontal therapy may cause systemic and local complications in this type of patients. The aim of the present study was to identify and describe the best available evidence for the treatment of periodontitis in decompensated diabetics.

Material and methods: An expert committee including participants from different areas gathered to discuss and develop a treatment guideline under the guidance of the Cochrane Associate Center, Faculty of Dentistry, University of Chile. In total, four research questions were prepared. The questions prepared related to decompensated diabetic patients (glycated hemoglobin >8) were, (1) Does the exposure to periodontal treatment increase the risk of infectious or systemic complications? (2) Does the antibiotic treatment or prophylaxis, compared to not giving it, reduce infectious complications? (3) Does the exposure to periodontal treatment, compared to no treatment, reduce the glycated hemoglobin levels (HbA1c)? Last question was related to diabetic patients, (4) Does the exposure to a higher level of HbA1c, compared to stable levels, increase the risk of infectious complications? Based on these questions, a search strategy was developed using MEDLINE and EPISTEMONIKOS. Only systematic reviews were considered.

Results: For question 1, the search yielded 12 records in EPISTEMONIKOS and 23 in MEDLINE. None of these studies addressed the question. For question 2, the search yielded 58 records in EPISTEMONIKOS and 11 in MEDLINE. None of these studies addressed the question. For question 3, the search yielded 16 records in EPISTEMONIKOS and 11 in MEDLINE. Thirteen addressed the question. For question 4, the search yielded 7 records in EPISTEMONIKOS and 9 in MEDLINE. One addressed the question.

Conclusions: In decompensated diabetic patients, there is lack of scientific information about risk of infectious or systemic complications as a result of periodontal treatment and about the impact of antibiotic treatment or prophylaxis on reduction if infectious complications. A defined HbA1c threshold for dental and periodontal treatment in diabetic patients has yet to be determined. Finally, periodontal treatment does have an impact on HbA1c levels.

Exploring the relationship among dental caries, nutritional habits, and peri-implantitis

BACKGROUND

A study was made of the prevalence, co-occurrence and association among caries, nutritional habits, and peri-implant disease, with an analysis of the influence of other patient and implant factors upon peri-implant disease.

METHODS

The included subjects underwent a clinical examination and were asked to complete a questionnaire. Demographic data and potential lifestyle/behavioral variables were collected. Clinical and radiographic assessment allowed calculation of the decayed, missing and filled teeth (DMFT) index and peri-implant diagnosis. Uni- and multivariate multinomial logistic regression analyses were applied to identify predictors of peri-implant disease.

RESULTS

A total of 169 patients with 311 implants were studied. At patient level, 92.2% of the subjects presented at least one carious lesion, whereas 22.5% and 56.2% were diagnosed with peri-implantitis and mucositis, respectively. Those patients with more than two caries had a higher risk of mucositis (OR = 3.33). Statistically significant associations for peri-implantitis included full mouth periodontal indexes, sugar-rich diets, keratinized mucosa width, number of missing teeth and interproximal untreated caries or fillings adjacent to implants.

CONCLUSION

High caries risk profiles and mucositis/peri-implantitis tended to accumulate within subjects. A sugar-enriched diet and untreated caries or fillings adjacent to implant sites may be further considered as risk indicators of peri-implantitis.

Periodontal and caries status in unexplained female infertility: A case-control study

BACKGROUND

The aim of this study was to investigate the possible association between maternal periodontal disease and dental caries that affect oral health and unexplained infertility.

METHODS

This cross-sectional case-control study included 50 fertile women and 50 women with unexplained infertility aged 21 to 39 years. Dental and periodontal parameters were examined to evaluate the oral health of the participants. According to the new periodontal disease classification, periodontitis severity was determined.

RESULTS

In infertile women, the number of advanced caries lesions, the percentage of bleeding on probing (BOP), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were higher (P < 0.05). The DMFT and mean plaque index (PI) were not statistically different between the two groups. The PISA and PESA values were higher in women with unexplained infertility than in fertile women (P = 0.005 and P = 0.002, respectively). In multivariate analysis showed that association of DMFT and BOP variables with periodontitis was found to be significant for all women included in the study and for infertile women only (P = 0.000 and P = 0.012 for DMFT, respectively; P = 0.000 and P = 0.016 for BOP, respectively).

CONCLUSION

The chronic inflammatory environment caused by periodontitis and advanced carious lesions in women with unexplained infertility should be of great concern as it may have a role in the etiology of infertility.

Human neutrophils compromise the restoration-tooth interface

Neutrophils, cells of the innate immune system, enter the mouth and release factors that are hypothesized to contribute to the degradation of tooth dentin, methacrylate resin composites, and adhesives at the restoration-tooth-dentin interface. The objectives were to characterize neutrophils' degradation towards resin composite, self-etch (SE) and total-etch (TE) adhesives, SE and TE resin-dentin interfaces and to identify proteins that could contribute to the degradation process. Neutrophils' degradation of cured resin composite, and SE and TE adhesives, was quantified by measuring the specific resin degradation by-product, bishydroxy-propoxy-phenyl-propane (bisHPPP), released after 30 days incubation of the materials with the cells. Neutrophils' degradative effect on resin-dentin interfaces was examined by recording the interfacial fracture toughness (FT), and surface analysis of the fracture mode following incubation of SE and TE miniature short-rod (mini-SR) specimens with the cells. Neutrophils increased degradation of polymerized resin composite, and TE adhesive, but not SE adhesive over 30 days (p < 0.05). Incubation of SE and TE resin-dentin interfaces with neutrophils led to a reduction in FT over time (p < 0.05). The effect was more pronounced for TE interfaces. Neutrophils also affected the fracture mode of SE and TE resin-dentin interfaces. Several proteins that could contribute to the degradative activity of neutrophils, including Neutrophil collagenase (MMP-8), Matrix metalloproteinase- 9 (MMP-9), Cathepsin G, Neutrophil- gelatinase associated lipocalin (NGAL) and Myeloperoxidase, were isolated. The ability of neutrophils to degrade resin, tooth dentin, and reduce the bond strength of resin-dentin interfaces suggest neutrophils' potential role in primary and recurrent caries and dental restoration failure.

Relationship between periodontal parameters and non-vital pulp in dental clinic patients: a cross-sectional study

BACKGROUND

Endodontic diseases, such as apical periodontitis, communicate with periodontitis and mutually exacerbate them. However, it remains unclear whether pulp condition is a risk factor for periodontal disease. The purpose of this retrospective study was to examine relations between pulp condition and periodontal parameters in Japanese patients who visited a general dental clinic.

METHODS

Patients who visited a Japanese general dental clinic from 2016 to 2018 and aged 18 to 81 years were analyzed. Periodontal parameters, tooth condition, and general status of all teeth excluding third molars at the initial visit to the clinic were abstracted. A total of 7105 teeth were analyzed in this study by multiple classification analysis and the Mann-Whitney U test. We also performed a sub-analysis of non-vital teeth, which evaluated the presence or absence of unfavorable root canal obturation and apical periodontitis diagnosed by X-ray.

RESULTS

Significant relations between periodontal parameters and non-vital pulp were observed by multiple logistic regression analyses (odds ratio = 1.48; 95% CI = 1.03-2.14) and multiple linear regression analysis (p < 0.001). Significant relations between unfavorable root canal obturation tooth with periodontal pocket depth (p = 0.00837) and BOP (p = 0.0145) were also observed by the Mann-Whitney U test.

CONCLUSIONS

We demonstrated potential relations between periodontal disease and non-vital pulp.