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Khoury RD, Minhoto GB, de Barros PP, Junqueira JC, Gagliardi CF, do Prado RF, Valera MC. Systemic administration of propranolol reduces bone resorption and inflammation in apical periodontitis of chronically stressed rats. Int Endod J 2024. [PMID: 39003599 DOI: 10.1111/iej.14118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/21/2024] [Accepted: 06/20/2024] [Indexed: 07/15/2024]
Abstract
AIM To evaluate the effect of systemic administration of propranolol on the severity of apical periodontitis (AP) in chronically stressed rats. METHODOLOGY Twenty-four 70-day-old male Wistar rats (Rattus norvegicus, albinus) were distributed into three groups (n = 8): rats with AP without stressful conditions (AP-Control), rats with AP and submitted to a chronic unpredictable stress (CUS) protocol (AP + S) and rats with AP and submitted to a CUS protocol treated with propranolol (AP + S + PRO). Stress procedures were applied daily until the end of the experiment. After 3 weeks of CUS, AP was induced in all groups by exposing the pulpal tissue of mandibular and maxillary first molars to the oral environment. Propranolol treatment was administered orally once a day for the entire period of the experiment. Rats were sacrificed at 42 days, and the blood was collected for stress biomarkers serum dosage by multiplex assay. Mandibles were removed and submitted to microtomography and histopathological analyses. Periapical tissue surrounding the upper first molar was homogenized and subjected to RT-PCR analysis to evaluate the mRNA expression of RANKL, TRAP and OPG. Parametric data were assessed using one-way ANOVA followed by Tukey's test while the nonparametric data were analysed by the Kruskal-Wallis followed by Dunn's test. Significance level was set at 5% (p < .05) for all assessed parameters. RESULTS Micro-CT revealed statistically significant differences in bone resorption which was greater in the AP + S group (p < .05), but no differences were observed between the Control and AP + S + PRO groups (p > .05). The AP + S + PRO group had a lower intensity and extent of inflammatory infiltrate compared to the AP + S group with smaller areas of bone loss (p < 0.05). The gene expression of RANKL and TRAP was significantly higher in the stressed group AP + S compared to the control group (p < .05), and a significantly higher OPG expression was observed in AP + S + PRO compared to the AP + S group (p < .05). CONCLUSIONS Oral administration of propranolol had a significant effect on the AP severity in stressed rats, suggesting an anti-inflammatory effect and a protective role on bone resorption of AP in stressed animals. Further research is necessary to fully comprehend the underlying mechanisms.
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Affiliation(s)
- Rayana Duarte Khoury
- Department of Restorative Dentistry, Endodontic Division, São Paulo State University - UNESP, Institute of Science and Technology, São Paulo, Brazil
| | - Giovanna Bignoto Minhoto
- Department of Restorative Dentistry, Endodontic Division, São Paulo State University - UNESP, Institute of Science and Technology, São Paulo, Brazil
| | | | - Juliana Campos Junqueira
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University - UNESP, Institute of Science and Technology, São Paulo, Brazil
| | - Carolina Fedel Gagliardi
- Department of Restorative Dentistry, Endodontic Division, São Paulo State University - UNESP, Institute of Science and Technology, São Paulo, Brazil
| | - Renata Falchete do Prado
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University - UNESP, Institute of Science and Technology, São Paulo, Brazil
| | - Marcia Carneiro Valera
- Department of Restorative Dentistry, Endodontic Division, São Paulo State University - UNESP, Institute of Science and Technology, São Paulo, Brazil
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Dibello V, Custodero C, Cavalcanti R, Lafornara D, Dibello A, Lozupone M, Daniele A, Pilotto A, Panza F, Solfrizzi V. Impact of periodontal disease on cognitive disorders, dementia, and depression: a systematic review and meta-analysis. GeroScience 2024:10.1007/s11357-024-01243-8. [PMID: 38943006 DOI: 10.1007/s11357-024-01243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/05/2024] [Indexed: 06/30/2024] Open
Abstract
A growing body of research suggested that there was a link between poor periodontal health and systemic diseases, particularly with the early development of cognitive disorders, dementia, and depression. This is especially true in cases of changes in diet, malnutrition, loss of muscular endurance, and abnormal systemic inflammatory response. Our study aimed to determine the extent of these associations to better target the multi-level healthy aging challenge investigating the impact of periodontal disease on cognitive disorders (cognitive impairment and cognitive decline), dementia, and depression. We conducted a comprehensive literature search up to November 2023 using six different electronic databases. Two independent researchers assessed the eligibility of 7363 records against the inclusion criteria and found only 46 records that met the requirements. The study is registered on PROSPERO (CRD42023485688). We generated random effects pooled estimates and 95% confidence intervals (CI) to evaluate whether periodontal disease increased the risk of the investigated outcomes. The quality assessment revealed moderate quality of evidence and risk of bias. Periodontal disease was found to be associated with both cognitive disorders (relative risk (RR) 1.25, 95% CI 1.11-1.40, in the analysis of cross-sectional studies); cognitive impairment (RR 3.01, 95% CI 1.52-5.95 for longitudinal studies, cognitive decline); and dementia (RR 1.22, 95% CI 1.10-1.36). However, no significant increased risk of depression among subjects with periodontal disease was found (RR 1.07, 95% CI 0.95-1.21). Despite the association with two of the three explored outcomes, the available evidence on periodontal diseases and dementia, cognitive disorders, and depression is controversial due to several limitations. Therefore, further investigations involving validated and standardized tools are required.
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Affiliation(s)
- Vittorio Dibello
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Carlo Custodero
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Raffaele Cavalcanti
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy
| | - Domenico Lafornara
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Antonio Dibello
- Stella Maris Nursing Home and Day Care Center, Monopoli, Bari, Italy
| | - Madia Lozupone
- Department of Translational Biomedicine & Neuroscience 'DiBraiN', University of Bari Aldo Moro, Bari, Italy
| | - Antonio Daniele
- Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy
- Neurology Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Alberto Pilotto
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Francesco Panza
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy.
| | - Vincenzo Solfrizzi
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
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Soysal F, Unsal B, Isler SC, Akca G, Bakirarar B, Ozcan M. Evaluation of salivary stress markers and inflammatory cytokine levels in peri-implantitis patients. Clin Oral Investig 2024; 28:290. [PMID: 38691206 PMCID: PMC11062951 DOI: 10.1007/s00784-024-05692-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND OBJECTIVE Psychological stress has been identified in some observational studies as a potential factor that may modify and affect periodontal diseases, but there are no similar data for peri-implantitis. The aim of this study was to determine the relationship between interleukin (IL)-1β, IL-6, IL-10, interferon (IFN)α inflammatory cytokines and the psychological stress-related markers, glucocorticoid receptor-α (GRα), and salivary α-amylase (sAA) gene expression levels in saliva samples obtained from healthy implants and peri-implantitis patients. MATERIALS AND METHODS The study included a total of 50 systemically healthy subjects. Peri-implant clinical parameters were recorded and psychological stress level was evaluated with the hospital anxiety and depression scale (HAD) and state-trait anxiety inventory (STAI) questionnaire forms. Following the evaluations, the patients were divided into 4 groups according their stress and clinical status (Ia, Ib, IIa, IIb). IL-1β, IL-6, IL-10, IFNα, GRα, sAA gene expression levels in the saliva samples were quantified by quantitative polymerase chain reaction (qPCR). RESULTS In the group of peri-implantitis who had a high score in stress level assessment scales, significantly higher IL-1β, IL-6, sAA expression levels were observed (p < 0.001). The IL-10 gene expression levels were lower in the groups with a high score in the stress level assessment scales (p < 0.001). GRα gene was expressed at lower levels in the group of peri-implantitis who had a high score in stress level assessment scales but the difference was not statistically significant (p = 0.065). CONCLUSION The study findings suggest that psychological stress may increase the inflammation associated with peri-implantitis by affecting cytokine expression levels. CLINICAL RELEVANCE To prevent peri-implantitis or reduce its prevalence, it could be beneficial to evaluate stress levels and identify individuals experiencing stress.
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Affiliation(s)
- Fatma Soysal
- Department of Periodontology, Faculty of Dentistry, Ankara Medipol University, Ankara, Turkey.
| | - Berrin Unsal
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Sila Cagri Isler
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Gulcin Akca
- Department of Medical Microbiology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Batuhan Bakirarar
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Mustafa Ozcan
- Department of Periodontology, Faculty of Dentistry, Cukurova University, Adana, Turkey
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Sanjar F, Silliman DT, Johnson IJ, Htut Z, Peacock TJ, Thompson SF, Dion GR, Nahid MA, Decker JF, Leung KP. Identification of temporal shifts of oral bacteria in bone regeneration following mandibular bone defect injury and therapeutic surgery in a porcine model. Mol Oral Microbiol 2024. [PMID: 38511906 DOI: 10.1111/omi.12460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 12/07/2023] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Considered the second largest and most diverse microbiome after the gut, the human oral ecosystem is complex with diverse and niche-specific microorganisms. Although evidence is growing for the importance of oral microbiome in supporting a healthy immune system and preventing local and systemic infections, the influence of craniomaxillofacial (CMF) trauma and routine reconstructive surgical treatments on community structure and function of oral resident microbes remains unknown. CMF injuries affect a large number of people, needing extensive rehabilitation with lasting morbidity and loss of human productivity. Treatment efficacy can be complicated by the overgrowth of opportunistic commensals or multidrug-resistant pathogens in the oral ecosystem due to weakened host immune function and reduced colonization resistance in a dysbiotic oral microbiome. AIMS To understand the dynamics of microbiota's community structure during CMF injury and subsequent treatments, we induced supra-alveolar mandibular defect in Hanford miniature swine (n = 3) and compared therapeutic approaches of immediate mandibullar reconstructive (IMR) versus delayed mandibullar reconstructive (DMR) surgeries. METHODS Using bacterial 16S ribosomal RNA gene marker sequencing, the composition and abundance of the bacterial community of the uninjured maxilla (control) and the injured left mandibula (lingual and buccal) treated by DMR were surveyed up to 70-day post-wounding. For the injured right mandibula receiving IMR treatment, the microbial composition and abundance were surveyed up to 14-day post-wounding. Moreover, we measured sera level of biochemical markers (e.g., osteocalcin) associated with bone regeneration and healing. Computed tomography was used to measure and compare mandibular bone characteristics such as trabecular thickness between sites receiving DMR and IMR therapeutic approaches until day 140, the end of study period. RESULTS Independent of IMR versus DMR therapy, we observed similar dysbiosis and shifts of the mucosal bacteria residents after CMF injury and/or following treatment. There was an enrichment of Fusobacterium, Porphyromonadaceae, and Bacteroidales accompanied by a decline in Pasteurellaceae, Moraxella, and Neisseria relative abundance in days allotted for healing. We also observed a decline in species richness and abundance driven by reduction in temporal instability and inter-animal heterogeneity on days 0 and 56, with day 0 corresponding to injury in DMR group and day 56 corresponding to delayed treatment for DMR or injury and immediate treatment for the IMR group. Analysis of bone healing features showed comparable bone-healing profiles for IMR vs. DMR therapeutic approach.
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Affiliation(s)
- Fatemeh Sanjar
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - David T Silliman
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Ian J Johnson
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Zayer Htut
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Trent J Peacock
- Office of Research Compliance, Mississippi State University, Meridian, Mississippi, USA
| | - Samira F Thompson
- Carl R. Darnall Army Medical Center, Fort Hood Dental Activities-AEGD, Fort Hood, Texas, USA
| | - Gregory R Dion
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Md A Nahid
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - John F Decker
- Carl R. Darnall Army Medical Center, Fort Hood Dental Activities-AEGD, Fort Hood, Texas, USA
| | - Kai P Leung
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
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Ishimura K, Sakaniwa R, Shirai K, Aida J, Takeuchi K, Kondo K, Iso H. Frequency of Going Outdoors and Risk of Poor Oral Health Among Older Japanese Adults: A Longitudinal Cohort From the Japan Gerontological Evaluation Study. J Epidemiol 2024; 34:63-69. [PMID: 36967120 PMCID: PMC10751189 DOI: 10.2188/jea.je20220221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/09/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND The association between the frequency of going outdoors and the risk of poor oral health has been reported in several studies; however, the findings have been inconclusive. METHODS We conducted a 3-year longitudinal study of 19,972 Japanese adults aged ≥65 years who reported no poor oral condition at baseline in 2013. The respondents rated their frequency of going outdoors in three categories (≤1, 2-3, or ≥4 times/week), and the oral conditions reported in 2016 included tooth loss, chewing difficulty, swallowing difficulty, dry mouth, and composite outcomes. The associations between the frequency of going outdoors and the risk of poor oral health were examined as relative risk ratios (RRs) and 95% confidence intervals (CIs) using multivariable Poisson regression, while mediation analysis was performed to investigate indirect effects. RESULTS During the follow-up, 32.5% of participants developed poor oral health. In the mediation analysis, indirect effects were observed through low instrumental activities of daily living, depressive symptoms, little social network diversity, and underweight. Compared to going outdoors ≥4 times/week, the multivariable RRs of composite poor oral health conditions were 1.12 (95% CI, 1.05-1.20) for 2-3 times/week and 1.22 (95% CI, 1.07-1.39) for ≤1 time/week (P-trend < 0.001). Similar associations were observed for tooth loss, chewing difficulty, and swallowing difficulty; the corresponding RRs were 1.07 (95% CI, 0.97-1.19) and 1.36 (95% CI, 1.13-1.64) (P-trend = 0.002), 1.18 (95% CI, 1.06-1.32) and 1.30 (95% CI, 1.05-1.60) (P-trend < 0.001), and 1.15 (95% CI, 1.01-1.31) and 1.38 (95% CI, 1.08-1.77) (P-trend = 0.002), respectively. CONCLUSION The frequency of going outdoors was inversely associated with the risk of poor oral health through several modifiable risk factors in the older population.
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Affiliation(s)
- Keiko Ishimura
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryoto Sakaniwa
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kokoro Shirai
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Tokyo Medical and Dental University Graduate School of Medical and Dental Science, Tokyo, Japan
| | - Kenji Takeuchi
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
- Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hiroyasu Iso
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Healthcare Center Medicine, Tokyo, Japan
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Wright CD, Heaton B, Garcia RI, Leonard MM, Fasano A, McNeil DW. Gastrointestinal distress as a potential mediator between stress and periodontal inflammation. Community Dent Oral Epidemiol 2023; 51:1250-1257. [PMID: 37430381 PMCID: PMC10776810 DOI: 10.1111/cdoe.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/18/2023] [Accepted: 06/11/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVES Periodontal disease is multifactorial in its aetiology, which encompasses biopsychosocial contributors, including psychological stress. Gastrointestinal distress and dysbiosis have been associated with several chronic inflammatory diseases yet have rarely been investigated with respect to oral inflammation. Given the implications of gastrointestinal distress on extraintestinal inflammation, this study aimed to evaluate the potential role of such distress as a mediator between psychological stress and periodontal disease. METHODS Utilizing a cross-sectional, nationwide sample of 828 adults in the USA generated via Amazon Mechanical Turk, we evaluated data collected from a series of validated self-report psychosocial questionnaires on stress, gut-specific anxiety around current gastrointestinal distress and periodontal disease, including periodontal disease subscales targeted at physiological and functional factors. Structural equation modelling was used to determine total, direct and indirect effects, while controlling for covariates. RESULTS Psychological stress was associated with gastrointestinal distress (ß = .34) and self-reported periodontal disease (ß = .43). Gastrointestinal distress also was associated with self-reported periodontal disease (ß = .10). Gastrointestinal distress likewise mediated the relation between psychological stress and periodontal disease (ß = .03, p = .015). Given the multifactorial nature of periodontal disease(s), similar results were demonstrated using the subscales of the periodontal self-report measure. CONCLUSIONS Associations exist between psychological stress and overall reports of periodontal disease as well as more specific physiological and functional components. Additionally, this study provided preliminary data supporting the potential mechanistic role that gastrointestinal distress plays in connecting the gut-brain and the gut-gum pathways.
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Affiliation(s)
- Casey D. Wright
- Department of Developmental Sciences, School of Dentistry, Marquette University, Milwaukee, WI 53201, USA*
| | - Brenda Heaton
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA 02118, USA
| | - Raul I. Garcia
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA
| | - Maureen M. Leonard
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Alessio Fasano
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Daniel W. McNeil
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL 32610, USA*
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Baghaei S, Lavaee F, Roosta A, Amiri D. Evaluation of anxiety disorder in patients with trigeminal neuralgia. Surg Neurol Int 2023; 14:266. [PMID: 37560589 PMCID: PMC10408604 DOI: 10.25259/sni_394_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/11/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The aim of this cross-sectional study was to evaluate the relationship between anxiety levels and severity of trigeminal neuralgia (TN) disorder's chronic orofacial pain during 2019-2020 in Shiraz Dental Faculty. METHODS In this study, patients with TN disorder who were referred to the Oral Medicine Department of Shiraz Dental Faculty were evaluated. Individuals were selected based on convenience sampling. Finally, 47 patients with TN were recruited in this study. Satisfaction with treatment was recorded based on controlling the patient's pain, age, sex, and frequency of recurrence, and data were analyzed using SPSS18. The Chi-square test was used to compare the final results. A reliability of more than 95% was considered significant (P < 0.05). RESULTS According to the results, the mean ages of participants with TN and control groups were 56.89 ± 10.93 and 37.12 ± 9.55, respectively. The mean value of participants' age was significantly different between the two evaluated groups (P < 0.0001). The anxiety of patients with TN was significantly higher than the healthy control group (P < 0.0001). The mean level of anxiety in patients with TN and also in healthy controls was not significantly different among men and women (P > 0.05). The mean level of anxiety of men and women in TN group was significantly higher than the healthy control women (P = 0.001). The mean levels of anxiety between different age ranges in patients with TN and healthy controls were not different in both evaluated groups (P > 0.05). Patients with TN in different age ranges had higher level of anxiety than healthy controls (P < 0.05). CONCLUSION Patients with TN had significantly higher level of anxiety than healthy participants.
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Affiliation(s)
- Saman Baghaei
- Student Research Committee, Department of Oral and Maxillofacial Disease, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Lavaee
- Oral and Dental Disease Research Center, Department of Oral and Maxillofacial Disease, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azadeh Roosta
- Student Research Committee, Department of Oral and Maxillofacial Disease, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Delara Amiri
- Student Research Committee, Department of Oral and Maxillofacial Disease, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Klomp T, Jahr H, Abdelbary MMH, Conrads G. Evaluation of hydrocortisone as a strain-dependent growth-regulator of Porphyromonasgingivalis. Anaerobe 2023; 80:102698. [PMID: 36681234 DOI: 10.1016/j.anaerobe.2023.102698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Porphyromonas gingivalis is an oral key pathogen and known to be very diverse in geno- and phenotypes. It is a fastidious bacterium with low O2-tolerance and 3-7 days of incubation are necessary. With growing interest in the field of microbial endocrinology we explored the potential growth-stimulating effect of hydrocortisone (HC, synonym cortisol) on P. gingivalis cultures. MATERIAL AND METHODS Six different P. gingivalis strains were pre-incubated in supplemented Brain-Heart-Infusion broth under appropriate conditions for 24 h, diluted and transferred into microplates. A newly developed and semi-automated spectrophotometric measurement in triplicate, applying a SpectraMax i3x microplate reader at an optical density of 600 nm, was conducted to test growth differences between test group (exposed to a supplement of either 1.25, 2.5, 5, 10, or 20 μg/ml of hydrocortisone) and control group over 48 h of anaerobic incubation (O2 ≤ 1%). Furthermore, strains were also incubated on HC-supplemented blood agar to test for a possible growth-stimulating effect on solid media. RESULTS HC significantly stimulated the lag-phase growth of four out of six P. gingivalis strains. Our data suggest a concentration-dependent growth stimulatory effect of HC between 2.5 and 5 μg/ml, while below 1.25 μg/ml and above 10 μg/ml HC either did not stimulate or inhibited growth. CONCLUSIONS HC could reduce the incubation time when isolating P. gingivalis from clinical samples and could boost low biomass cultivations especially during their lag-phase. The growth-modulating effect might be via modulation of virulence factors/quorum sensing gene expression or by reactive oxygen species(ROS)-capturing during early stages of bacterial growth. Further experiments are necessary to explain the mechanism behind our observations.
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Affiliation(s)
- Tim Klomp
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany; Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany
| | - Holger Jahr
- Department of Anatomy and Cell Biology, Uniklinik RWTH Aachen and Institute of Structural Mechanics and Lightweight Design, RWTH Aachen University, Aachen, Germany
| | - Mohamed M H Abdelbary
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany
| | - Georg Conrads
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany.
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Minhas S, Qian Hui Lim R, Raindi D, Gokhale KM, Taylor J, Bradbury-Jones C, Bandyopadhyay S, Nirantharakumar K, Adderley NJ, Chandan JS. Exposure to domestic abuse and the subsequent risk of developing periodontal disease. Heliyon 2022; 8:e12631. [PMID: 36619466 PMCID: PMC9813698 DOI: 10.1016/j.heliyon.2022.e12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/18/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
Aims Periodontal disease and domestic abuse (DA) are significant public health problems. Previous cross-sectional evidence indicates an association between DA exposure and development of periodontal disease. There have been no large-scale cohort studies exploring this relationship in a UK-setting. Our aim was to conduct a population-based retrospective open cohort study to explore the association between DA exposure and the subsequent development of general practitioner (GP)-coded periodontal disease. Materials and methods We undertook a retrospective open-cohort study using the IQVIA Medical Research Database (IMRD) UK database between the 1st January 1995 to 31st January 2021. Women (aged 18 years and over) exposed to DA were matched by age, deprivation, and smoking status to up to 4 unexposed women, all of whom had no pre-existing record of periodontal disease. Cox regression analysis was used to calculate crude and adjusted hazard ratios (HRs) to describe the risk of developing periodontal disease in the exposed group. Results 23429 exposed patients were matched to 69815 unexposed patients. During the study period, 78 exposed patients had developed GP-recorded periodontal disease compared to 154 in the unexposed group, translating to an IR of 94.18 per 100,000 person years (py) and 54.67 per 100,000 py respectively. Following adjustment for key covariates, this translated to an aHR of 1.74 (95% CI 1.31-2.32), which was robust during our sensitivity analysis. Conclusions Our results provide further evidence that DA exposure is associated with increased risk of developing periodontal disease. There is a need for swift implementation of public health policies to improve surveillance, reporting, and prevention of DA.
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Affiliation(s)
- Sonica Minhas
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
| | - Rachel Qian Hui Lim
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, E1 2AD, United Kingdom
| | - Devan Raindi
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, University of Birmingham, B152TT, United Kingdom
| | - Krishna M. Gokhale
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
| | - Julie Taylor
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, B152TT, United Kingdom
| | - Caroline Bradbury-Jones
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, B152TT, United Kingdom
| | | | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
| | - Nicola J. Adderley
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
| | - Joht Singh Chandan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
- Corresponding author.
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Psychological stress: neuroimmune roles in periodontal disease. Odontology 2022:10.1007/s10266-022-00768-8. [DOI: 10.1007/s10266-022-00768-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/12/2022] [Indexed: 11/29/2022]
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11
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Seizer L, Schubert C. On the Role of Psychoneuroimmunology in Oral Medicine. Int Dent J 2022; 72:765-772. [DOI: 10.1016/j.identj.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/24/2022] [Accepted: 07/02/2022] [Indexed: 11/05/2022] Open
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Cortisol Promotes Surface Translocation of Porphyromonas gingivalis. Pathogens 2022; 11:pathogens11090982. [PMID: 36145414 PMCID: PMC9505793 DOI: 10.3390/pathogens11090982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Studies are showing that the stress hormone cortisol can reach high levels in the gingival sulcus and induce shifts in the metatranscriptome of the oral microbiome. Interestingly, it has also been shown that cortisol can influence expression levels of Type IX Secretion System (T9SS) genes involved in gliding motility in bacteria belonging to the phylum Bacteroidota. The objective of this study was to determine if cortisol impacts gene expression and surface translocation of Porphyromonas gingivalis strain W50. To conduct these experiments, P. gingivalis was stabbed to the bottom of soft agar plates containing varying cortisol concentrations (0 μM, 0.13 μM, 1.3 μM, and 13 μM), and surface translocation on the subsurface was observed after 48 h of incubation. The results show that when grown with certain nutrients, i.e., in rich medium with the addition of sheep blood, lactate, or pyruvate, cortisol promotes migration of P. gingivalis in a concentration-dependent manner. To begin to examine the underlying mechanisms, quantitative PCR was used to evaluate differential expression of genes when P. gingivalis was exposed to cortisol. In particular, we focused on differential expression of T9SS-associated genes, including mfa5, since it was previously shown that Mfa5 is required for cell movement and cell-to-cell interactions. The data show that mfa5 is significantly up-regulated in the presence of cortisol. Moreover, an mfa5 deletion mutant showed less surface translocation compared to the wild-type P. gingivalis in the presence of cortisol, and the defects of the mfa5 deletion mutant were restored by complementation. Overall, cortisol can stimulate P. gingivalis surface translocation and this coincides with higher expression levels of T9SS-associated genes, which are known to be essential to gliding motility. Our findings support a high possibility that the stress hormone cortisol from the host can promote surface translocation and potentially virulence of P. gingivalis.
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13
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Biomarkers common for inflammatory periodontal disease and depression: A systematic review. Brain Behav Immun Health 2022; 21:100450. [PMID: 35330865 PMCID: PMC8938251 DOI: 10.1016/j.bbih.2022.100450] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 12/12/2022] Open
Abstract
Background Dysregulated immune response arising in the periphery can induce depressive symptoms through neuroimmune interactions. Inflammatory oral pathology can be a potent inducer of chronic neuroimmune response relevant to depression. We aimed to synthesize available evidence for the association between inflammatory periodontal diseases (IPD) and major depression (MD) in relation to a broad range of biomarkers. Methods Medline, Embase, PsycInfo, Cochrane Library, Web of Science and Scopus databases were searched from inception until January 27, 2022. Search terms included subject headings and synonyms for inflammatory periodontal disease and depression. Studies that reported data on both depression and inflammatory periodontal disease as categories along with measurement of a biomarker were considered. Two reviewers independently selected the articles for inclusion, extracted data and assessed the quality of each study. The protocol for this study was registered with PROSPERO, CRD42021215524. Results Twenty-eight studies were included in the final review-eleven cross-sectional studies, seven case-control studies, and six prospective cohort studies conducted in humans; the remaining four were experimental animal studies. Eighteen studies including all animal studies reported a positive association between depression and periodontal disease; one study reported a negative association and another nine studies found no such associations. Twenty studies reported mixed associations between IPD and biomarkers (i.e, salivary, serum, urine or gingival crevicular fluid cortisol, C reactive protein, cytokines, etc.). Biomarkers related to depression were gingival crevicular fluid cortisol, interleukin 6 (IL-6), Il-1β, immunoglobulin G against Bacterioides forsythus; root canal lipopolysaccharides; blood IL-6, IL-1β, cortisol, advanced oxidation protein products, nitric oxide metabolites, lipid hydroperoxides and trapping antioxidant parameter; whereas five studies found no associations between depression and a biomarker. Although animal studies showed interaction of immune, inflammatory and neurotrophic biomarkers in the relationship between depression and periodontal disease, human studies showed mixed findings. In most studies, there were risks of bias due to the sample selection and assessment protocol. Study heterogeneity and limited number of comparable studies reporting on shared biomarkers precluded a meta-analysis. Conclusion Immune-inflammatory contribution to depression was evident in the context of inflammatory periodontal diseases, but whether biomarkers mediate the associations between IPD and MD needs to be tested through methodologically rigorous studies aiming specifically at this hypothesis.
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D’Ambrosio F, Caggiano M, Schiavo L, Savarese G, Carpinelli L, Amato A, Iandolo A. Chronic Stress and Depression in Periodontitis and Peri-Implantitis: A Narrative Review on Neurobiological, Neurobehavioral and Immune-Microbiome Interplays and Clinical Management Implications. Dent J (Basel) 2022; 10:49. [PMID: 35323251 PMCID: PMC8947556 DOI: 10.3390/dj10030049] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/06/2023] Open
Abstract
Besides the well-known systemic factors for periodontal and peri-implant diseases, additional co-factors, such as chronic stress and depression, may also affect disease onset and progression as well as treatment responsiveness. Neurobiological and neurobehavioral pathogenic links between chronic stress and depression, on the one side, and periodontitis and peri-implantitis, on the other side, which have been little investigated and principally related to necrotizing periodontal disease, have been reviewed, along with their putative interconnections with periodontal immune-microbiome balance. Rising evidence suggest that dysregulated neurobiological and neurobehavioral factors, as well as periodontal immune-microbiome unbalance, all related to chronic stress and depression, may crucially interact and thus represent contributing factors in the genesis and worsening not only of necrotizing periodontal lesions, but also of chronic periodontitis and peri-implantitis. Such potential interconnections may be even more relevant in recurrent and aggressive cases of periodontal and peri-implant disease, which are frequently refractory to therapy, and may, if corroborated, coherently pave the way for personalized prevention and treatment strategies, possibly targeting immune-microbiome unbalance and neurobehavioral factors and focusing on neurobiological ones, especially in chronically stressed and depressed subjects with periodontitis and peri-implantitis.
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Affiliation(s)
- Francesco D’Ambrosio
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (M.C.); (L.S.); (G.S.); (L.C.); (A.A.); (A.I.)
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15
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Agarwal M, Agarwal P, Bhattacharya H, Rastogi P, Agarwal A. Evaluation of association between potential stress markers and periodontal health in medical and dental students: A questionnaire-based study. Natl J Maxillofac Surg 2022; 13:90-94. [PMID: 35911810 PMCID: PMC9326195 DOI: 10.4103/njms.njms_101_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/13/2020] [Accepted: 03/12/2021] [Indexed: 11/11/2022] Open
Abstract
Aims and Objectives: Psychological conditions, particularly psychosocial stress, have been implicated as risk indicators for periodontal disease. The aim of the present study was to explore the role of psychosocial stress on periodontium through questionnaire and serum cortisol level. Subjects and Methods: Two hundred medical and dental undergraduates were recruited for the study. Case group included 82 examination going and control group had 79 nonexam going students. Their stress level was evaluated using a standard questionnaire (perceived stress scale). Gingival index, periodontal disease index, bleeding on probing index, serum cortisol level, and serum alpha-amylase level were also measured. Statistical Analysis Used: Bivariate correlations and multiple regression tests were done. Results: A positive correlation was found among stress scores, salivary cortisol, alpha-amylase, and periodontal disease measures. Conclusion: Periodontitis can be related to immunologic changes related to psychological states
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16
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Ali AR, Kapoor A, Chatterjee D, Gautam K, Choudhary A, Jain RL. Psychometric approach to evaluate periodontal disease using Revised Illness Perception Questionnaire. J Indian Soc Periodontol 2022; 26:69-74. [PMID: 35136320 PMCID: PMC8796782 DOI: 10.4103/jisp.jisp_831_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/08/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: Illness perception is the cognitive representation of an illness, which determines how a person responds to it. The Revised Illness Perception Questionnaire (IPQ-R) assesses seven components of illness representation in various chronic diseases, but queries prevail about its factor structure. The study assesses the components of illness representation in patients with chronic periodontitis. Materials and Methods: A total of 625 voluntary, consecutive dental patients with a clinical diagnosis of periodontitis were recruited into the study. The Hindi version of IPQ-R was used, consisting of three parts-identity scale, structured scale, and perceived causes of the patient's ailment. Results: Of the 625 participants, 44.0% reported cyclical disease pattern, 30.4% said their disease was a mystery. Only 1.6% predicted it to remain throughout their life. A total of 44.0% of participants reported the disease to impact their day-to-day life severely. A significant difference was observed between males and females across seven components of IPQ-R. While 21.6% of participants attributed stress to be a major cause for their diseased state, 20.8% reported workload to be a major cause, but 42.4% attributed poor medical care in the past to be a major cause for their state. Conclusions: A sensible approach to treating a disease is to measure the patient's illness perception and target specific interventions accordingly. It would be cost-effective and break misconceptions about diseases in patients, ultimately providing them with better overall health and satisfaction.
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Affiliation(s)
- A Rizwan Ali
- Department of Periodontics, RUHS College of Dental Sciences, Jaipur, Rajasthan, India
| | - Anjali Kapoor
- Department of Periodontics, RUHS College of Dental Sciences, Jaipur, Rajasthan, India
| | - Debopriya Chatterjee
- Department of Periodontics, RUHS College of Dental Sciences, Jaipur, Rajasthan, India
| | - Kompal Gautam
- Department of Dentistry, Siyaram Hospital, Jaipur, Rajasthan, India
| | | | - Rashi L Jain
- Department of Pedodontics and Preventive Dentistry, RUHS College of Dental Sciences, Jaipur, Rajasthan, India
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Goh V, Hassan FW, Baharin B, Rosli TI. Impact of psychological states on periodontitis severity and oral health-related quality of life. J Oral Sci 2021; 64:1-5. [PMID: 34690248 DOI: 10.2334/josnusd.21-0267] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE This cross-sectional study aimed to identify impacts of depression, anxiety and stress on periodontitis severity and oral health-related quality of life (OHRQoL). METHODS A total of 141 periodontitis patients were recruited. Psychological states were assessed using the Malay short-form Depression, Anxiety and Stress Scales (MDASS-21). Subjects were grouped as positive for depression, anxiety or stress (DAS) (positive-DAS), without DAS (non-DAS), stress-only and anxiety-only. OHRQoL was evaluated using the Malay short-form Oral Health Impact Profile (S-OHIP[M]). RESULTS OHRQoL was associated with MDASS-21, probing pocket depths, recession, clinical attachment levels, number of teeth present and number of teeth with mobility. S-OHIP(M) of positive-DAS subjects was associated with clinical attachment levels, number of teeth present and presence of anxiety. Anxiety-only subjects reported higher S-OHIP(M) scores compared to the non-DAS group. CONCLUSION OHRQoL of all subjects was negatively impacted by periodontitis severity and tooth loss. Combinations of depression, anxiety or stress led to worse periodontal status and OHRQoL. Subjects with anxiety-only experienced poorer OHRQoL compared to those without depression, anxiety and stress regardless of periodontitis severity. Possible impacts of psychological states on periodontitis and OHRQoL highlights the importance of assessing and improving psychological factors as part of periodontal therapy and to enhance OHRQoL.
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Affiliation(s)
- Victor Goh
- Periodontology, Department of Restorative Dentistry, Faculty of Dentistry, The National University of Malaysia
| | | | - Badiah Baharin
- Periodontology, Department of Restorative Dentistry, Faculty of Dentistry, The National University of Malaysia
| | - Tanti I Rosli
- Dental Public Health, Department of Family Oral Health, Faculty of Dentistry, The National University of Malaysia
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18
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Funakubo N, Tsuboi A, Eguchi E, Hayashi F, Maeda M, Yabe H, Yasumura S, Kamiya K, Takashiba S, Ohira T. Association between Psychosocial Factors and Oral Symptoms among Residents in Fukushima after the Great East Japan Earthquake: A Cross-Sectional Study from the Fukushima Health Management Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116054. [PMID: 34199827 PMCID: PMC8200098 DOI: 10.3390/ijerph18116054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 12/02/2022]
Abstract
Oral health is closely related to subjective general health and systemic diseases. This cross-sectional study aimed to identify the factors related to oral symptoms and their worsening in relation to psychosocial factors after the Great East Japan Earthquake. In this study, 64,186 residents aged 15–101 years old, who experienced the earthquake on 11 March 2011, were surveyed regarding their oral symptoms; psychological factors, such as post-traumatic reactions and psychological distress; and social factors such as evacuation, work change, and loss of a close person; history of systemic diseases; and lifestyle. Binomial logistic regression analysis was used to calculate odds ratios, and 95% confidence intervals were established for each factor associated with prevalent and exacerbated oral symptoms. The proportions of participants with prevalent and exacerbated oral symptoms were 10.3% and 1.6%, respectively. The multivariate odds ratios and 95% CI of psychosocial factors associated with exacerbated oral symptoms were as follows: post-traumatic stress disorder symptoms, 2.24 (1.64–3.06); work changes, 1.88 (1.34–2.65); history of dyslipidemia, 1.74 (1.27–2.39); and subjective current poor health condition, 2.73 (2.00–3.75). Psychological factors, social factors, and physical factors were associated with both prevalent and exacerbated oral symptoms.
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Affiliation(s)
- Narumi Funakubo
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (N.F.); (F.H.); (T.O.)
| | - Ayaka Tsuboi
- Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (A.T.); (S.T.)
| | - Eri Eguchi
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (N.F.); (F.H.); (T.O.)
- Correspondence: ; Tel.: +81-(24)-5471-343
| | - Fumikazu Hayashi
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (N.F.); (F.H.); (T.O.)
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (H.Y.); (S.Y.); (K.K.)
| | - Masaharu Maeda
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (H.Y.); (S.Y.); (K.K.)
- Department of Disaster Psychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hirooki Yabe
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (H.Y.); (S.Y.); (K.K.)
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (H.Y.); (S.Y.); (K.K.)
- Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (H.Y.); (S.Y.); (K.K.)
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8553, Japan
| | - Shogo Takashiba
- Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (A.T.); (S.T.)
| | - Tetsuya Ohira
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (N.F.); (F.H.); (T.O.)
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (H.Y.); (S.Y.); (K.K.)
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Teles F, Wang Y, Hajishengallis G, Hasturk H, Marchesan JT. Impact of systemic factors in shaping the periodontal microbiome. Periodontol 2000 2020; 85:126-160. [PMID: 33226693 DOI: 10.1111/prd.12356] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since 2010, next-generation sequencing platforms have laid the foundation to an exciting phase of discovery in oral microbiology as it relates to oral and systemic health and disease. Next-generation sequencing has allowed large-scale oral microbial surveys, based on informative marker genes, such as 16S ribosomal RNA, community gene inventories (metagenomics), and functional analyses (metatranscriptomics), to be undertaken. More specifically, the availability of next-generation sequencing has also paved the way for studying, in greater depth and breadth, the effect of systemic factors on the periodontal microbiome. It was natural to investigate systemic diseases, such as diabetes, in such studies, along with systemic conditions or states, , pregnancy, menopause, stress, rheumatoid arthritis, and systemic lupus erythematosus. In addition, in recent years, the relevance of systemic "variables" (ie, factors that are not necessarily diseases or conditions, but may modulate the periodontal microbiome) has been explored in detail. These include ethnicity and genetics. In the present manuscript, we describe and elaborate on the new and confirmatory findings unveiled by next-generation sequencing as it pertains to systemic factors that may shape the periodontal microbiome. We also explore the systemic and mechanistic basis for such modulation and highlight the importance of those relationships in the management and treatment of patients.
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Affiliation(s)
- Flavia Teles
- Department of Basic and Translational Sciences, Center for Innovation & Precision Dentistry, School of Dental Medicine & School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Yu Wang
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - George Hajishengallis
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hatice Hasturk
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
| | - Julie T Marchesan
- Department of Comprehensive Oral Health, Periodontology, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
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Dubar M, Clerc-Urmès I, Baumann C, Clément C, Alauzet C, Bisson C. Relations of Psychosocial Factors and Cortisol with Periodontal and Bacterial Parameters: A Prospective Clinical Study in 30 Patients with Periodontitis Before and After Non-Surgical Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207651. [PMID: 33092182 PMCID: PMC7588876 DOI: 10.3390/ijerph17207651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/18/2022]
Abstract
(1) Background: The progression of periodontitis, induced by polymicrobial dysbiosis, can be modified by systemic or environmental factors such as stress or anxiety affecting host response. The purpose of this study is to evaluate the potential associations between psychosocial factors scores or salivary cortisol levels with clinical periodontal parameters and bacterial environment in patients with periodontitis; (2) Methods: Subgingival microbiota was collected in two pathological and one healthy sites from thirty diseased patients (before/after scaling and root planing (SRP)) and from one healthy site from thirty control patients. Usual clinical periodontal parameters were recorded, and a saliva sample was harvested. Patients completed stress and anxiety self-assessment questionnaires. Cortisol concentrations were determined by ELISA and bacteria were identified by PCR; (3) Results: No correlation between salivary cortisol and the stress-anxiety self-declared was found (p > 0.05), but high concentrations of this molecule were associated positively and linearly with periodontal pocket depth (p = 0.04). It appeared that certain psychosocial stressors are associated with a modulation of the bacterial colonization of pockets of diseased group (before/after SRP), notably concerning Tannerella forsythia (p = 0.02), Porphyromonas gingivalis (p = 0.03), Fusobacterium nucleatum (p = 0.049) and Campylobacter rectus (p = 0.01). (4) Conclusion: This study reveals associations between bacteria colonization and psychosocial parameters in periodontitis that needs to be further investigated.
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Affiliation(s)
- Marie Dubar
- Department of Periodontology, School of Dentistry, Lille University Hospital, 59000 Lille, France
- Stress Immunity Pathogens Unit (SIMPA), EA 7300, University of Lorraine, F-54000 Nancy, France; (C.A.); (C.B.)
- Correspondence:
| | - Isabelle Clerc-Urmès
- Department of Methodology, Promotion and Investigation, UMDS, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; (I.C.-U.); (C.B.)
| | - Cédric Baumann
- Department of Methodology, Promotion and Investigation, UMDS, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; (I.C.-U.); (C.B.)
| | - Céline Clément
- CHRU Nancy, Department of Public Health Dentistry, University Hospital, 54000 Nancy, France;
- “Interpsy” Laboratory, University of Lorraine, EA 4432, CEDEX 54015 Nancy, France
- «Health Systemic Process» Laboratory, University Lyon 1, EA 4129, 69008 Lyon, France
| | - Corentine Alauzet
- Stress Immunity Pathogens Unit (SIMPA), EA 7300, University of Lorraine, F-54000 Nancy, France; (C.A.); (C.B.)
- CHRU Nancy, Microbiology Department, University Hospital, F-54000 Nancy, France
| | - Catherine Bisson
- Stress Immunity Pathogens Unit (SIMPA), EA 7300, University of Lorraine, F-54000 Nancy, France; (C.A.); (C.B.)
- Department of Periodontology, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-lès-Nancy, France
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ÖZCAN M, ÖZCAN G. Stresin cerrahi olmayan periodontal tedavi üzerine etkisi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.745326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Blood Oxidative Stress Modulates Alveolar Bone Loss in Chronically Stressed Rats. Int J Mol Sci 2020; 21:ijms21103728. [PMID: 32466304 PMCID: PMC7279478 DOI: 10.3390/ijms21103728] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 01/29/2023] Open
Abstract
We aimed to investigate the effects of chronic stress (CS) on experimental periodontitis (EP) in rats. For this, 28 Wistar rats were divided into four groups: control, ligature-induced experimental periodontitis (EP), chronic stress (CS; by physical restraint model) and CS+EP (association of chronic stress and ligature-induced periodontitis). The experimental period lasted 30 days, including exposure to CS every day and ligature was performed on the 15th experimental day. After 30 days, the animals were submitted to the behavioral test of the elevated plus maze (EPM). Next, rats were euthanized for blood and mandible collection in order to evaluate the oxidative biochemistry (by nitric oxide (NO), reduced-glutathione activity (GSH), and thiobarbituric acid reactive substance levels (TBARS)) and alveolar bone characterization (by morphometric, micro-CT, and immunohistochemistry), respectively. The behavioral parameters evaluated in EPM indicated higher anxiogenic activity in the CS and CS+EP, groups, which is a behavioral reflex of CS. The results showed that CS was able to change the blood oxidative biochemistry in CS and CS+EP groups, decrease GSH activity in the blood, and increase the NO and TBARS concentrations. Thus, CS induces oxidative blood imbalance, which can potentialize or generate morphological, structural, and metabolic damages to the alveolar bone.
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Castro MML, Ferreira RDO, Fagundes NCF, Almeida APCPSC, Maia LC, Lima RR. Association between Psychological Stress and Periodontitis: A Systematic Review. Eur J Dent 2020; 14:171-179. [PMID: 32069501 PMCID: PMC7069755 DOI: 10.1055/s-0039-1693507] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This systematic review aims to investigate the association between psychological stress and periodontitis through analysis of cortisol levels and periodontal clinical parameters. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide and based on PECO (Participants, Exposure, Comparators, Outcomes) question and registered at PROSPERO under the code CRD42017076670. As eligibility criteria, observational studies performed in adult humans presenting periodontitis (P), which evaluated patients exposed (E) and nonexposed to psychological stress (C) and to verify the association between this type of stress and periodontitis (O) were included. The searches were performed until March 2018. The following databases were used: PubMed, Scopus, Web of Science, The Cochrane Library, LILACS, OpenGrey, and Google Scholar. After searches, the duplicate results were removed. The remaining citations were selected according to eligibility criteria in two phases. In the first phase, the title/abstract was evaluated. In the second phase, the articles were chosen previously were assessed by full text. After selection, the studies were submitted to data extraction and risk of bias evaluation by Fowkes and Fulton. A total of 1,386 citations were retrieved. After duplicates removal and selection process, three articles were selected by full text. Among them, two articles reported a positive association between psychological stress and periodontitis. All articles were classified as low risk of bias. Even though two articles highlighted an association between psychological stress and the presence of a possible modulatory pattern of cortisol levels in clinical parameters of periodontitis, more studies are necessary to elucidate this question.
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Affiliation(s)
- Micaele M L Castro
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, University Federal do Pará, Rua Augusto Corrêa 1, Guamá, Belém, PA, Brazil
| | - Railson de O Ferreira
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, University Federal do Pará, Rua Augusto Corrêa 1, Guamá, Belém, PA, Brazil
| | - Nathalia C F Fagundes
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta. 5528 Edmonton Clinic Health Academy, Edmonton, Canada
| | - Anna P C P S C Almeida
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, University Federal do Pará, Rua Augusto Corrêa 1, Guamá, Belém, PA, Brazil
| | - Lucianne C Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael R Lima
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, University Federal do Pará, Rua Augusto Corrêa 1, Guamá, Belém, PA, Brazil
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Ramlogan S, Raman V, Abraham K, Pierre K. Self-reported stress, coping ability, mental status, and periodontal diseases among police recruits. Clin Exp Dent Res 2020; 6:117-123. [PMID: 32067403 PMCID: PMC7025991 DOI: 10.1002/cre2.258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This cross-sectional study aimed to investigate self-reported stress level and coping ability as well as mental status (anxiety and depression) via the 12-item General Health Questionnaire (GHQ-12) questionnaire and periodontal status among police academy recruits during their 8 months of training. METHODS Eighty-five consenting police recruits were examined at baseline during the first month of training and again during the last month of training. Full mouth plaque score (FMPS), full mouth bleeding score, basic periodontal examination, self-reported stress level (scale of 1-10) and GHQ-12 questionnaire (mental status) were recorded at both visits. Ability to cope (yes/no) with stress was recorded at the final visit. Periodontal diagnosis was derived based on clinical examination. t test and regression analyses (p < .05) were performed. RESULTS High stress (odds ratio: 1.25) and inability to cope with stress (odds ratio: 1.31) were statistically significant (p < .05) predictors of high FMPS. Inability to cope with stress (odds ratio: 1.45) was also a statistically significant (p < .05) predictor for periodontitis compared to gingivitis. Mental status (anxiety and depression) may play a greater role in gingivitis (mean 1.75) as opposed to periodontitis (mean 1.00) as reflected by the higher mean GHQ-12 (t test, p = .04). CONCLUSIONS In this study, both self-reporting of stress level and ability to cope with stress were statistically significant predictors of higher plaque score (FMPS). Ability to cope with stress was also a statistically significant predictor of periodontitis compared to gingivitis. Recording of both self-reported stress level and ability to cope may be valuable variables to note in the management of plaque and periodontal diseases.
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Affiliation(s)
- Shaun Ramlogan
- Periodontology, Restorative Unit, School of Dentistry, University of the West Indies, Trinidad and Tobago
| | - Vidya Raman
- Periodontology, Restorative Unit, School of Dentistry, University of the West Indies, Trinidad and Tobago
| | - Kimberly Abraham
- Periodontology, Restorative Unit, School of Dentistry, University of the West Indies, Trinidad and Tobago
| | - Kereesa Pierre
- Periodontology, Restorative Unit, School of Dentistry, University of the West Indies, Trinidad and Tobago
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25
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Haririan H, Andrukhov O, Böttcher M, Pablik E, Wimmer G, Moritz A, Rausch-Fan X. Salivary neuropeptides, stress, and periodontitis. J Periodontol 2019; 89:9-18. [PMID: 28914594 DOI: 10.1902/jop.2017.170249] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/20/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Scientific evidence for psychologic stress as a risk factor for periodontitis is fragmentary and relies mostly on either questionnaire-based or biomarker studies. The aim of this study is to investigate brain-derived neurotrophic factor, substance P, vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), calcitonin gene-related peptide, and adrenomedullin as well as cortisol in saliva and serum in periodontal health and disease combined with different aspects of stress and possible associations with clinical parameters. METHODS In total, 56 patients with aggressive and chronic periodontitis and 44 healthy controls were screened by enzyme-linked immunosorbent assay and mass spectrometry for presence of neuropeptides and cortisol in saliva and serum. Psychologic stress was evaluated by validated questionnaires. All substances were explored for a possible relationship to periodontitis, clinical parameters, and stress. RESULTS VIP and NPY showed significantly higher levels in saliva but not in serum of patients with periodontitis. These neuropeptides correlated with the extent, severity, and bleeding on probing scores in patients with periodontitis. Females had significantly lower salivary VIP levels. There were no differences among participants regarding psychologic stress. CONCLUSION VIP and NPY in saliva could be potential sex-specific salivary biomarkers for periodontitis regardless of psychologic stress.
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Affiliation(s)
- Hady Haririan
- Division of Conservative Dentistry and Periodontology, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Oleh Andrukhov
- Competence Center for Periodontal Research, Division of Conservative Dentistry and Periodontology, Medical University of Vienna
| | | | - Eleonore Pablik
- Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna
| | - Gernot Wimmer
- Division of Prosthodontics, Restorative Dentistry, Periodontology, and Implantology, School of Dentistry, Medical University of Graz, Graz, Austria
| | - Andreas Moritz
- Division of Conservative Dentistry and Periodontology, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Xiaohui Rausch-Fan
- Division of Conservative Dentistry and Periodontology, School of Dentistry, Medical University of Vienna, Vienna, Austria.,Competence Center for Periodontal Research, Division of Conservative Dentistry and Periodontology, Medical University of Vienna
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Lee H. A life course approach to total tooth loss: Testing the sensitive period, accumulation, and social mobility models in the Health and Retirement Study. Community Dent Oral Epidemiol 2019; 47:333-339. [PMID: 31115080 DOI: 10.1111/cdoe.12463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/22/2019] [Accepted: 04/09/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Childhood socio-economic status (SES) has long been associated with later-life oral health, suggesting that childhood is a sensitive period for oral health. Far less attention has been given to the long-term impact of childhood trauma, abuse, and smoking on later-life oral health. This study fills the gap in the literature by examining how adverse childhood experiences-social, psychological, and behavioral-shape total tooth loss over the life course, with an assessment of the sensitive period, accumulation, and social mobility models from life course research. METHODS Data are drawn from the 2012 Health and Retirement Study (HRS) merged with multiple HRS data sources to obtain childhood information (N = 6,427; age > 50). Adverse childhood experiences include childhood financial hardship, trauma, abuse, and smoking. Total tooth loss is measured to assess poor oral health in later life. Educational attainment and poverty status (since age 51) are measured as adult adversity. Current health conditions and health behaviors are assessed to reflect the correlates of oral health in later life. RESULTS The sensitive period model indicates that childhood trauma such as parental death or divorce (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.04, 1.80), physical abuse (OR = 1.17, 95% CI = 1.03, 1.34), and low educational attainment (≤ high school; OR = 1.52, 95% CI = 1.04, 2.22) are associated with higher odds of total tooth loss in later life. Poverty status was not associated with the outcome. There was a clear graded relationship between accumulation of adverse experiences and oral health, which supports the accumulation model. In the social mobility model, older adults who occupied a stable disadvantageous position were more likely to be toothless (OR = 1.77, 95% CI = 1.08, 2.90) compared to those who did not face adversity in any case. Neither upward nor downward mobility mattered. CONCLUSIONS Failing oral health in older adults, especially total tooth loss, may have its roots in adverse experiences such as childhood trauma, abuse, and low educational attainment. Findings also suggest that oral health in later life may be more influenced by accumulation of adversity rather than changes in social and economic position over the life course.
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Affiliation(s)
- Haena Lee
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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27
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Brennan DS, Mittinty MM, Jamieson L. Psychosocial factors and self‐reported transitions in oral and general health. Eur J Oral Sci 2019; 127:241-247. [DOI: 10.1111/eos.12608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2018] [Indexed: 11/26/2022]
Affiliation(s)
- David S. Brennan
- Australian Research Centre for Population Oral Health Adelaide Dental School Adelaide SA Australia
| | - Manasi M. Mittinty
- Australian Research Centre for Population Oral Health Adelaide Dental School Adelaide SA Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health Adelaide Dental School Adelaide SA Australia
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28
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Karami E, Naghsh N, Mogharehabed A, Yaghini J. Comparative evaluation of the cortisol level of unstimulated saliva in patients with and without chronic periodontitis. Dent Res J (Isfahan) 2019. [DOI: 10.4103/1735-3327.270786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Makkar H, Reynolds MA, Wadhawan A, Dagdag A, Merchant AT, Postolache TT. Periodontal, metabolic, and cardiovascular disease: Exploring the role of inflammation and mental health. Pteridines 2018; 29:124-163. [PMID: 30705520 PMCID: PMC6350811 DOI: 10.1515/pteridines-2018-0013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Hina Makkar
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Mark A Reynolds
- Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Abhishek Wadhawan
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Aline Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Teodor T Postolache
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO 80220, USA; Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD 21201, USA,
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30
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The effect of the stress hormone cortisol on the metatranscriptome of the oral microbiome. NPJ Biofilms Microbiomes 2018; 4:25. [PMID: 30345066 PMCID: PMC6194028 DOI: 10.1038/s41522-018-0068-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/24/2018] [Accepted: 09/28/2018] [Indexed: 02/07/2023] Open
Abstract
Imbalances of the microbiome, also referred to as microbial dysbiosis, could lead to a series of different diseases. One factor that has been shown to lead to dysbiosis of the microbiome is exposure to psychological stressors. Throughout evolution microorganisms of the human microbiome have developed systems for sensing host-associated signals such as hormones associated with those stressors, enabling them to recognize essential changes in their environment, thus changing their expression gene profile to fit the needs of the new environment. The most widely accepted theory explaining the ability of hormones to affect the outcome of an infection involves the suppression of the immune system. Commensal microbiota is involved in stressor-induced immunomodulation, but other biological effects are not yet known. Here we present the impact that cortisol had on the community-wide transcriptome of the oral community. We used a metatranscriptomic approach to obtain first insights into the metabolic changes induced by this stress hormone as well as which members of the oral microbiome respond to the presence of cortisol in the environment. Our findings show that the stress hormone cortisol directly induces shifts in the gene expression profiles of the oral microbiome that reproduce results found in the profiles of expression of periodontal disease and its progression.
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31
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Cakmak O, Alkan BA, Saatci E, Tasdemir Z. The effect of nonsurgical periodontal treatment on gingival crevicular fluid stress hormone levels: A prospective study. Oral Dis 2018; 25:250-257. [PMID: 30187981 DOI: 10.1111/odi.12973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/02/2018] [Accepted: 09/02/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The purpose of this prospective study was to investigate the effect of nonsurgical periodontal treatment (PT) on anxiety/depression scale scores and on gingival crevicular fluid (GCF) cortisol (COR) and dehydroepiandrosterone (DHEA) levels. METHODS Fifty-five participants with generalized chronic periodontitis (GCP group, n: 21), with localized chronic periodontitis (LCP group, n: 19) and with gingivitis or healthy (control group, n: 15) subjects were treated and followed up for 6 months. Clinical periodontal parameters include plaque index, gingival index, bleeding on probing, probing depth and attachment level; psychosocial measurements include Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI 1-2) psychometric instruments; hormone levels in GCF including COR and DHEA were evaluated. RESULTS All clinical parameters were significantly decreased (except attachment loss) after PT (p < 0.05). No significant differences were observed between the two groups for STAI-1-2 and BDI scores, either at baseline or at 6 months (p > 0.05). COR levels were statistically lower following PT in GCP and LCP groups when compared to the baseline levels (p < 0.05). DHEA values at baseline and 6 months did not show significant differences. CONCLUSION Within the limits of the study, decreased GCF COR and unchanged GCF DHEA levels were determined in nonsurgically treated patients regardless of the extent and severity of periodontitis.
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Affiliation(s)
- Omer Cakmak
- Department of Periodontology, Faculty of Dentistry, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Banu Arzu Alkan
- Department of Periodontology, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
| | - Ebru Saatci
- Department of Biology, Faculty of Science, Erciyes University, Kayseri, Turkey
| | - Zekeriya Tasdemir
- Department of Periodontology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
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Stress, salivary cortisol and periodontitis: A systematic review and meta-analysis of observational studies. Arch Oral Biol 2018; 96:58-65. [PMID: 30189327 DOI: 10.1016/j.archoralbio.2018.08.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/21/2018] [Accepted: 08/27/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This meta-analysis aims to systematically assess whether periodontitis has a meaningful effect on salivary cortisol, reflecting changes on free blood cortisol levels. DESIGN The Cochrane Handbook and the PRISMA statement were used as reporting guidelines. The MEDLINE-PubMed, Google Scholar, EMBASE, and CENTRAL databases were searched until September 2017 to identify eligible studies, screened by seven independent authors and verified by an eighth. Studies comparing salivary cortisol level of periodontitis cases to controls were included. Data were extracted using a predefined table and since all papers were non-randomized clinical trials they were appraised using Downs and Black tool. DerSimonian random effects meta-analysis was performed using OpenMetaAnalyst. RESULTS Six cross-sectional studies were included, with 258 participants with chronic periodontitis and 72 with aggressive periodontitis, in a total of 573 participants. Overall results showed that aggressive periodontitis patients have, on average, 53% higher salivary cortisol levels than healthy controls 1.53 (1.11-2.12). Meta-regression exploring the relationship among salivary cortisol levels and periodontal measures, i.e., periodontitis severity, showed a global neutral effect, although this result requires future confirmation due to the low power of the model. CONCLUSION Observational studies results suggest that subjects with aggressive periodontitis have higher salivary cortisol levels than healthy ones or patients with chronic periodontitis. Such salivary cortisol response difference may have a negative impact on the periodontium, contributing to worse the burden of aggressive periodontitis disease. In the future, wide and well-designed longitudinal studies should be carried out in order to extensively confirm this possible effect, considering the complex nature of periodontitis and its many confounders factors that may contribute to this outcome.
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Omori S, Uchida F, Oh S, So R, Tsujimoto T, Yanagawa T, Sakai S, Shoda J, Tanaka K, Bukawa H. Exercise habituation is effective for improvement of periodontal disease status: a prospective intervention study. Ther Clin Risk Manag 2018; 14:565-574. [PMID: 29593415 PMCID: PMC5865566 DOI: 10.2147/tcrm.s153397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background and purpose Periodontal disease is closely related to lifestyle-related diseases and obesity. It is widely known that moderate exercise habits lead to improvement in lifestyle-related diseases and obesity. However, little research has been undertaken into how exercise habits affect periodontal disease. The purpose of this study was to examine the effect of exercise habits on periodontal diseases and metabolic pathology. Methods We conducted a prospective intervention research for 12 weeks. The subjects were 71 obese men who participated in an exercise and/or dietary intervention program. Fifty subjects were assigned to exercise interventions (exercise intervention group) and 21 subjects were assigned to dietary interventions (dietary intervention group). This research was conducted before and after each intervention program. Results In the exercise intervention group, the number of teeth with a probing pocket depth (PPD) ≥4 mm significantly decreased from 14.4% to 5.6% (P<0.001), and the number of teeth with bleeding on probing (BOP) significantly decreased from 39.8% to 14.4% (P<0.001). The copy counts of Tannerella forsythia and Treponema denticola decreased significantly (P=0.001). A positive correlation was found between the change in the copy count of T. denticola and the number of teeth with PPD ≥4 mm (P=0.003) and the number of teeth with BOP (P=0.010). A positive correlation was also found between the change in the copy count of T. denticola and body weight (P=0.008), low-density lipoprotein cholesterol (P=0.049), and fasting insulin (P=0.041). However, in the dietary intervention group the copy count of T. denticola decreased significantly (P=0.007) and there was no correlation between the number of periodontal disease-causing bacteria and PPD and BOP. Conclusion Our results are the first to show that exercise might contribute to improvements in periodontal disease.
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Affiliation(s)
- Shoei Omori
- Oral and Maxillofacial Surgery, Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Dental Oral Surgery, Kitaibaraki City Hospital, Kitaibaraki, Ibaraki, Japan
| | - Fumihiko Uchida
- Department of Oral and Maxillofacial Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Sechang Oh
- Department of Medical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,The Center of Sports Medicine and Health Sciences, Tsukuba University Hospital, Tsukuba, Ibaraki, Japan
| | - Rina So
- Research Center for Overwork-Related Disorders, National Institute of Occupational Safety and Health, Kawasaki, Kanagawa, Japan
| | - Takehiko Tsujimoto
- Department of Sports Medicine, Faculty of Human Sciences, Shimane University, Matsue, Shimane, Japan
| | - Toru Yanagawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Satoshi Sakai
- Department of Medical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Junichi Shoda
- Department of Medical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,The Center of Sports Medicine and Health Sciences, Tsukuba University Hospital, Tsukuba, Ibaraki, Japan
| | - Kiyoji Tanaka
- Department of Sports Medicine, Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroki Bukawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Petersone-Gordina E, Roberts C, Millard AR, Montgomery J, Gerhards G. Dental disease and dietary isotopes of individuals from St Gertrude Church cemetery, Riga, Latvia. PLoS One 2018; 13:e0191757. [PMID: 29364968 PMCID: PMC5783410 DOI: 10.1371/journal.pone.0191757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/26/2017] [Indexed: 01/23/2023] Open
Abstract
This research explores oral health indicators and stable carbon and nitrogen isotope data to explore diet, and differences in diet, between people buried in the four different contexts of the St Gertrude Church cemetery (15th– 17th centuries AD): the general cemetery, two mass graves, and a collective mass burial pit within the general cemetery. The main aim is to assess whether people buried in the mass graves were rural immigrants, or if they were more likely to be the victims of plague (or another epidemic) who lived in Riga and its suburbs. The data produced (from dental disease assessments and isotope analyses) were compared within, as well as between, the contexts. Most differences emerged when comparing the prevalence rates of dental diseases and other oral health indicators in males and females between the contexts, while isotope analysis revealed more individual, rather than context-specific, differences. The data suggested that the populations buried in the mass graves were different from those buried in the general cemetery, and support the theory that rural immigrants were buried in both mass graves. Significant differences were observed in some aspects of the data between the mass graves, however, possibly indicating that the people buried in them do not represent the same community.
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Affiliation(s)
| | - Charlotte Roberts
- Department of Archaeology, Durham University, Durham, United Kingdom
| | - Andrew R. Millard
- Department of Archaeology, Durham University, Durham, United Kingdom
| | - Janet Montgomery
- Department of Archaeology, Durham University, Durham, United Kingdom
| | - Guntis Gerhards
- Institute of Latvian History, University of Latvia, Riga, Latvia
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Obulareddy VT, Chava VK, Nagarakanti S. Association of Stress, Salivary Cortisol, and Chronic Periodontitis: A Clinico-biochemical Study. Contemp Clin Dent 2018; 9:S299-S304. [PMID: 30294161 PMCID: PMC6169263 DOI: 10.4103/ccd.ccd_289_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Periodontitis and stress are among the areas of increasing interest over the past two decades. Early detection of these diseases plays a crucial role in successful therapy. Cortisol is a protein which was found to be consistently associated with both. Aim The present study was aimed to evaluate saliva cortisol levels (SCLs) in chronic periodontitis (CP) patients with and without stress. Materials and Methods In this cross-sectional study, saliva samples were collected and cortisol levels were determined using ELISA method in 92 participants. The participants were divided into four groups based on periodontal condition (number of teeth present, plaque index (PI), bleeding on probing (BOP), probing pocket depth, and clinical attachment level) and stress levels into Group 1 (no periodontitis and no stress), Group 2 (with periodontitis and no stress), Group 3 (without periodontitis and with stress), and Group 4 (with periodontitis and stress). Results Overall, 92 adult participants (41 males and 51 females) were included in the study. Participants with stress and periodontitis have high mean SCL when compared to other groups (Group 1: 15.01 ± 2.62, Group 2: 31.92 ± 6.80, Group 3: 34.47 ± 13.47, and Group 4: 60.13 ± 6.68). Group I shows a significant negative correlation of cortisol to BOP, stress to PI, and stress to cortisol level, whereas there is a positive correlation of SCL to PD in Group 4 which is not statistically significant. Conclusion SCL showed difference among the groups. SCL were associated with both CP and psychological stress. Increase in inflammation and stress levels enhances the SCL.
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Affiliation(s)
- Vishnu Teja Obulareddy
- Department of Periodontology, Narayana Dental College and Hospital, Andhra Pradesh, India
| | - Vijay Kumar Chava
- Department of Periodontology, Narayana Dental College and Hospital, Andhra Pradesh, India
| | - Sreenivas Nagarakanti
- Department of Periodontology, Narayana Dental College and Hospital, Andhra Pradesh, India
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Lee W, Lim SS, Kim B, Won JU, Roh J, Yoon JH. Relationship between long working hours and periodontitis among the Korean workers. Sci Rep 2017; 7:7967. [PMID: 28801658 PMCID: PMC5554150 DOI: 10.1038/s41598-017-08034-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/06/2017] [Indexed: 12/20/2022] Open
Abstract
We aimed to investigate the association between long working hours and periodontitis, and whether such an association constitutes an exposure-response relationship. Data for this study were collected from the Korea National Health and Nutrition Examination Surveys conducted from 2007 to 2014; 17,533 workers (9,483 of men and 8,050 of women) were included. The odds ratios (OR) and 95% confidence intervals (CI) for the analysis of periodontitis defined as positive of Community Periodontal Index in relation to working hours were calculated using multiple logistic regression models with various stratifications. Compared to participants who worked ≤40 hours per week, the prevalence ratio (95% CI) for the periodontitis was 1.19 (1.14–1.24) and full adjusted OR (95% CI) was 1.09 (1.02–1.18) in participants who worked over 40 hours per week. The OR (95% CI) for periodontitis were 1.09 (0.99–1.19) in working group of 40< and ≥52 and 1.10 (1.01–1.20) in working group of >52 hours per week with a significant trend (p = 0.0233) even after adjusting for age, socioeconomic status, healthy behaviour, chronic disease, and dental care status. Long working hours are associated with periodontitis among Korean workers in an exposure-response manner.
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Affiliation(s)
- Wanhyung Lee
- The Institute for Occupational Health, College of Medicine, Yonsei University, Seoul, Korea.,Graduate School of Public Health, College of Medicine, Yonsei University, Seoul, Korea.,Incheon Worker's Health Center, Incheon, Korea
| | - Sung-Shil Lim
- Severance Hospital, Health System, Yonsei University, Seoul, Korea
| | - Byurira Kim
- Severance Dental Hospital, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jong-Uk Won
- The Institute for Occupational Health, College of Medicine, Yonsei University, Seoul, Korea.,Graduate School of Public Health, College of Medicine, Yonsei University, Seoul, Korea.,Incheon Worker's Health Center, Incheon, Korea.,Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Jaehoon Roh
- The Institute for Occupational Health, College of Medicine, Yonsei University, Seoul, Korea.,Graduate School of Public Health, College of Medicine, Yonsei University, Seoul, Korea.,Incheon Worker's Health Center, Incheon, Korea.,Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Jin-Ha Yoon
- The Institute for Occupational Health, College of Medicine, Yonsei University, Seoul, Korea. .,Graduate School of Public Health, College of Medicine, Yonsei University, Seoul, Korea. .,Incheon Worker's Health Center, Incheon, Korea. .,Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea.
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37
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Hilgert JB, Hugo FN, Bandeira DR, Bozzetti MC. Stress, Cortisol, and Periodontitis in a Population Aged 50 Years and Over. J Dent Res 2016; 85:324-8. [PMID: 16567552 DOI: 10.1177/154405910608500408] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Periodontitis and its relationship with psycho-neuro-immunological variables, such as psychological stress and cortisol, have been little explored. The objective of this study was to evaluate the extent and severity of chronic periodontitis and its association with the levels of salivary cortisol and the scores obtained with a stress questionnaire in a population aged 50 years and over. We studied 235 individuals in a cross-sectional study. They answered the Lipp’s Inventory of Stress Symptoms for Adults, were instructed to collect three saliva samples for cortisol analysis, and were examined for evaluation for periodontitis. Based on logistic regression, cortisol levels were positively associated with the following outcomes: means of clinical attachment level (CAL) > = 4 mm [OR = 5.1, 95%CI (1.2, 20.7)]; 30% of sites with CAL > = 5 mm [OR = 6.9, 95%CI (1.7, 27.1)]; and 26% of sites with probing depth > = 4 mm [OR = 10.7, 95%CI (1.9, 54.1)] after adjustment for confounding variables. The results suggest that cortisol levels were positively associated with the extent and severity of periodontitis.
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Affiliation(s)
- J B Hilgert
- Post-graduate Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, 2600/414 Porto Alegre, RS 90035-003, Brazil.
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Cakmak O, Tasdemir Z, Aral CA, Dundar S, Koca HB. Gingival crevicular fluid and saliva stress hormone levels in patients with chronic and aggressive periodontitis. J Clin Periodontol 2016; 43:1024-1031. [PMID: 27513682 DOI: 10.1111/jcpe.12614] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 12/28/2022]
Abstract
AIM This cross-sectional study aims to analyse cortisol and dehydroepiandrosterone (DHEA) levels in gingival crevicular fluid (GCF) and saliva in generalized aggressive periodontitis (GAP) and generalized chronic periodontitis (GCP) patients, as well as in periodontally healthy individuals (C). MATERIAL AND METHODS A total of 92 patients (31 C, 34 GCP and 27 GAP) were included in the study. Clinical parameters including plaque index, gingival index, bleeding on probing, probing depth and clinical attachment level; psychosocial measurements including Beck depression inventory and state-trait anxiety inventory; and hormone levels in GCF and saliva including cortisol and DHEA were evaluated. RESULTS Gingival crevicular fluid cortisol and GCF/saliva DHEA values were significantly higher in the GAP group when compared to the other two groups (p < 0.05). The lowest values were in the C group and the difference between the GCP and GAP groups was statistically significant (p < 0.05). Salivary cortisol levels were comparable for the GAP and GCP groups (p > 0.05), and the C group had the lowest values in comparison with the other two groups (p < 0.05). CONCLUSIONS Within the limits of this study, salivary/GCF cortisol and DHEA levels were suggested to be related with more severe and aggressive forms of periodontal disease.
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Affiliation(s)
- Omer Cakmak
- Department of Periodontology, Faculty of Dentistry, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Zekeriya Tasdemir
- Department of Periodontology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | | | - Serkan Dundar
- Department of Periodontology, Faculty of Dentistry, Firat University, Elazıg, Turkey
| | - Halit Bugra Koca
- Department of Medical Biochemistry, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
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Nakata T, Umeda M, Masuzaki H, Sawai H. The expression of 11β-hydroxysteroid dehydrogenase type 1 is increased in experimental periodontitis in rats. BMC Oral Health 2016; 16:108. [PMID: 27716163 PMCID: PMC5048409 DOI: 10.1186/s12903-016-0303-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background The involvement of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), which converts inactive glucocorticoids into active glucocorticoids intracellularly, in metabolic diseases and chronic inflammatory diseases has been elucidated. We recently reported that an increase in 11β-HSD1 expression was associated with chronic periodontitis in humans irrespective of obesity. To further clarify the role of 11β-HSD1 in chronic periodontitis, the expression of 11β-HSD1 was investigated in experimental periodontitis model in rats. Methods Experimental periodontitis was induced by silk ligature of left maxillary second molars of 7-week-old male Wistar rats, and periodontal tissues were collected at day 3. The expression of 11β-HSD1, 11β-HSD2, and TNFα mRNA was examined using real time reverse transcription-polymerase chain reaction. The expression of TNFα was used as an indicator of inflammation. Thus, the rats in which the levels of TNFα mRNA were increased in the ligature-induced periodontitis compared with the control were analysed. Results The findings demonstrated that the expression of 11β-HSD1 mRNA was significantly increased in experimental periodontitis compared with the control. The increase in the levels of 11β-HSD1 mRNA in the ligature-induced periodontitis compared with the control was positively correlated with that of TNFα mRNA. On the other hand, the expression of 11β-HSD2 mRNA, which inactivates glucocorticoids, was slightly decreased in experimental periodontitis. Therefore, the ratio of 11β-HSD1 versus 11β-HSD2 mRNA was significantly higher in experimental periodontitis than in the control. Conclusions These results suggest that the increased expression of 11β-HSD1, which would result in the increased levels of intracellular glucocorticoids, may play a role in the pathophysiology of experimental periodontitis.
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Affiliation(s)
- Takaya Nakata
- Department of Periodontology, Graduate School of Dentistry, Osaka Dental University, Hirakata, Osaka, Japan
| | - Makoto Umeda
- Department of Periodontology, Osaka Dental University, Hirakata, Osaka, Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Graduate School of Internal Medicine, University of the Ryukyus, Nakagami-gun, Okinawa, Japan
| | - Hirofumi Sawai
- Department of Internal Medicine, Osaka Dental University, Hirakata, Osaka, Japan.
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Brennan DS, Spencer AJ, Roberts-Thomson KF. Work-Family Conflict Modifies the Association of Smoking and Periodontal Disease. Int J Behav Med 2016; 24:77-82. [DOI: 10.1007/s12529-016-9581-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Lohana MH, Suragimath G, Patange RP, Varma S, Zope SA. A Prospective Cohort Study to Assess and Correlate the Maternal Periodontal Status with Their Pregnancy Outcome. J Obstet Gynaecol India 2016; 67:27-32. [PMID: 28242964 DOI: 10.1007/s13224-016-0920-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND There is an overwhelming body of evidence strongly suggesting that periodontal infection may have a significant negative impact on pregnancy outcome in some women. The aim of this study was to determine the association between periodontal disease and preterm low birth weight of babies. MATERIALS AND METHODS A total of 300 pregnant women, between 20 and 24 weeks of gestation i.e., second trimester, were considered for the study. The periodontal status was recorded using the following parameters: probing pocket depth, clinical attachment level, oral hygiene index and plaque index. After initial examination in the second trimester, the pregnant women were followed till delivery of the baby. Postpartum data i.e., weight of baby, gestational age of pregnancy and type of delivery, were recorded. RESULTS Out of 300 pregnant women, 248 women had full-term delivery (12 low birth weight and 236 normal birth weight) while 52 had preterm delivery (6 normal birth weight and 46 low birth weight). There was significant association between body mass index and level of periodontal disease severity of pregnant women with birth weight of babies, gestational age of pregnant women and mode of delivery, respectively. As the level of periodontal disease severity increased, the proportion of delivering preterm and low birth weight babies also increased. CONCLUSION The conclusions obtained revealed that Periodontal disease is a potential risk factor for preterm low birth weight babies of pregnant women.
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Affiliation(s)
- M H Lohana
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - G Suragimath
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - R P Patange
- Department of Obstetrics and Gynaecology, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - S Varma
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - S A Zope
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, India
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López Silva MC, Diz-Iglesias P, Seoane-Romero JM, Quintas V, Méndez-Brea F, Varela-Centelles P. [Update in family medicine: Periodontal disease]. Semergen 2016; 43:141-148. [PMID: 27068254 DOI: 10.1016/j.semerg.2016.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 01/18/2023]
Abstract
About 85-94% of the Spanish adults older than 35 experience gum problems, and about 15-30% suffer from periodontitis, being severe in up to 5-11% of them. Unlike other inflammatory conditions, periodontal disease rarely causes discomfort, or limits life or causes functional limitations until its advanced stages, when clinical signs and symptoms arise (gingival recession, pathological teeth migration, or mobility). Lack of knowledge about the disease, together with the idea that tooth loss is linked to ageing, frequently results in a late diagnosis, requiring extensive treatments with a worse prognosis. At Primary Care level, there is series of drugs have been related to periodontal disease (anticonvulsants, immunosuppressive drugs, and calcium channel blockers) as secondary effects, which vary as regards their frequency and severity depending of the amount of accumulated plaque. Stress and depression have also been reported to alter the immune response and to increase the inflammatory response as well as periodontal susceptibility. Certain systemic conditions, such as diabetes mellitus, cardiovascular disorders, respiratory diseases, as well as low-weight pre-term birth, have also been linked to periodontitis.
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Affiliation(s)
- M C López Silva
- Atención Primaria, CS Praza do Ferrol, EOXI Lugo, Cervo, e Monforte de Lemos, Servizo Galego de Saúde, Lugo, España
| | - P Diz-Iglesias
- Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - J M Seoane-Romero
- Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - V Quintas
- Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - F Méndez-Brea
- Pregrado de Odontología, Facultad de Medicina y Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - P Varela-Centelles
- Atención Primaria, CS Praza do Ferrol, EOXI Lugo, Cervo, e Monforte de Lemos, Servizo Galego de Saúde, Lugo, España; Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
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43
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Knight ET, Liu J, Seymour GJ, Faggion CM, Cullinan MP. Risk factors that may modify the innate and adaptive immune responses in periodontal diseases. Periodontol 2000 2016; 71:22-51. [DOI: 10.1111/prd.12110] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2015] [Indexed: 12/31/2022]
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Katuri KK, Dasari AB, Kurapati S, Vinnakota NR, Bollepalli AC, Dhulipalla R. Association of yoga practice and serum cortisol levels in chronic periodontitis patients with stress-related anxiety and depression. J Int Soc Prev Community Dent 2016; 6:7-14. [PMID: 27011926 PMCID: PMC4784068 DOI: 10.4103/2231-0762.175404] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM Reducing the psychosocial stress by various methods can improve overall health, and yoga is now considered as an easily available alternative method. The present cross-sectional pilot study was conducted mainly to find the association of yoga practice with periodontal disease by measuring serum cortisol levels. MATERIALS AND METHODS A total of 70 subjects with age range of 35-60 years suffering with chronic periodontitis were divided into group I (with stress), group II (without stress), and group III (practicing yoga). Psychological evaluation was carried out using Hamilton Anxiety Rating Scale (HAM-A) and Zung Self-rating Depression Scale (ZSDS). Periodontal parameters like plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) at 5-8 mm and >8 mm were recorded. Blood samples were collected and serum cortisol levels were measured. RESULTS Mean age, plaque scores, and number of teeth with PPD and CAL at 5-8 mm and >8 mm were similar in all the groups, except between group I and group III where a multiple comparison with Tukey's post-hoc test showed significant difference in plaque index (P < 0.038) and the number of teeth with CAL 5-8 mm (P < 0.016). Serum cortisol levels and HAM-A scale and ZSDS scores showed highly significant value (P < 0.001) in group I subjects when compared with group II and group III subjects. CONCLUSION Cross-sectional observation done among three groups showed that individuals practicing yoga regularly had low serum cortisol levels, HAM-A scale and ZSDS scores, and better periodontal health.
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Affiliation(s)
- Kishore Kumar Katuri
- Department of Periodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Ankineedu Babu Dasari
- Department of Periodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Sruthi Kurapati
- Department of Periodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Narayana Rao Vinnakota
- Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | | | - Ravindranath Dhulipalla
- Department of Periodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
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Araújo MM, Martins CC, Costa LCM, Cota LOM, Faria RLAM, Cunha FA, Costa FO. Association between depression and periodontitis: a systematic review and meta-analysis. J Clin Periodontol 2016; 43:216-28. [DOI: 10.1111/jcpe.12510] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Milena Moreira Araújo
- Department of Dental Clinics, Oral Pathology, and Oral Surgery; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Carolina Castro Martins
- Department of Pediatric Dentistry and Orthodontics; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Lidiane Cristina Machado Costa
- Department of Dental Clinics, Oral Pathology, and Oral Surgery; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Luís Otávio Miranda Cota
- Department of Dental Clinics, Oral Pathology, and Oral Surgery; Federal University of Minas Gerais; Belo Horizonte Brazil
| | | | - Fabiano Araújo Cunha
- Department of Dental Clinics, Oral Pathology, and Oral Surgery; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Fernando Oliveira Costa
- Department of Dental Clinics, Oral Pathology, and Oral Surgery; Federal University of Minas Gerais; Belo Horizonte Brazil
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Nakata T, Fujita A, Umeda M, Yoshida H, Inami K, Masuzaki H, Sawai H. The increased ratio of 11β-hydroxysteroid dehydrogenase type 1 versus 11β-hydroxysteroid dehydrogenase type 2 in chronic periodontitis irrespective of obesity. SPRINGERPLUS 2016; 5:40. [PMID: 26835222 PMCID: PMC4715141 DOI: 10.1186/s40064-016-1679-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/06/2016] [Indexed: 01/19/2023]
Abstract
11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), which converts inactive cortisone to active cortisol, has been reported to play an important role in metabolic diseases as well as chronic inflammatory diseases. The involvement of 11β-HSD1 in chronic periodontitis was investigated in the present study. The relationship between the levels of 11β-HSD1, chronic periodontitis, and body mass index (BMI) was analyzed. The expression of 11β-HSD1 mRNA was significantly higher in the chronic periodontitis group than in the control group. Since the expression of 11β-HSD2, which converts active cortisol to inactive cortisone, was slightly lower in the chronic periodontitis group than in the controls, the ratio of 11β-HSD1 versus 11β-HSD2 was significantly higher in the chronic periodontitis group than in the controls. A correlation was not observed between BMI and the level of 11β-HSD1 or between BMI and the ratio of 11β-HSD1 versus 11β-HSD2. These results suggested that an increase in the ratio of 11β-HSD1 versus 11β-HSD2 was associated with chronic periodontitis irrespective of obesity.
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Affiliation(s)
- Takaya Nakata
- Department of Periodontology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121 Japan
| | - Atsuko Fujita
- Department of Periodontology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121 Japan
| | - Makoto Umeda
- Department of Periodontology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121 Japan
| | - Hiroaki Yoshida
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121 Japan
| | - Kaoru Inami
- Department of Orthodontics, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121 Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, 1 Senbaru, Nishiharacho, Nakagamigun, Okinawa 903-0213 Japan
| | - Hirofumi Sawai
- Department of Internal Medicine, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121 Japan
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Jaiswal R, Shenoy N, Thomas B. Evaluation of association between psychological stress and serum cortisol levels in patients with chronic periodontitis - Estimation of relationship between psychological stress and periodontal status. J Indian Soc Periodontol 2016; 20:381-385. [PMID: 28298818 PMCID: PMC5341311 DOI: 10.4103/0972-124x.193165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Stress classically describes a destructive notion that can have a bearing on one's physical and mental health. It may also add to an increased propensity to periodontal disease. Aim: To investigate the association between psychological stress and serum cortisol levels in patients with chronic periodontitis. Materials and Methods: Forty subjects were recruited from the outpatient department at the Department of Periodontics, from a college in Mangalore, divided into two groups, i.e., twenty as healthy controls and twenty were stressed subjects with chronic periodontitis. The clinical examination included the assessment of probing pocket depth, clinical attachment level and oral hygiene index-simplified. Serum cortisol levels were estimated biochemically using the enzyme-linked immunosorbent assay method and the estimation of psychological stress was done by a questionnaire. Results: Descriptive statistics such as mean and standard deviation was used to review the collected data. Independent sample t-test was used for comparison and correlation was evaluation using Pearson's correlation test. As per our observation, high serum cortisol levels and psychological stress are positively linked with chronic periodontitis establishing a risk profile showing a significant correlation (P < 0.05). Conclusion: Routine serum cortisol assessment may be a reasonable and a valuable investigative indicator to rule out stress in periodontitis patients as it should be considered as an imperative risk factor for periodontal disease.
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Affiliation(s)
- Roshni Jaiswal
- Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore, Karnataka, India
| | - Nina Shenoy
- Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore, Karnataka, India
| | - Biju Thomas
- Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore, Karnataka, India
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Rohini G, Kalaivani S, Kumar V, Rajasekar SA, Tuckaram J, Pandey V. Estimation and comparison of serum cortisol levels in periodontally diseased patients and periodontally healthy individuals: A clinical-biochemical study. J Pharm Bioallied Sci 2015; 7:S457-60. [PMID: 26538897 PMCID: PMC4606639 DOI: 10.4103/0975-7406.163501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Psychological conditions, particularly psychosocial stress have been implicated as risk indicators of periodontal disease. Stress increases cortisol production from the adrenal cortex by stimulating an increase in the release of ACTH from the pituitary gland. Increased cortisol production suppresses the immune response and increases the potential of periodontal tissue destruction. Aim: The aim of the present study was to estimate and compare the serum cortisol levels in periodontally diseased patients and periodontally healthy individuals. Materials and Methods: Total of 45 subjects were recruited for this study and were categorized into three groups. Group I - Comprised of aggressive periodontitis patients (n = 15), Group II - Chronic periodontitis patients (n = 15), and Group III - Healthy controls (n = 15). Serum samples were collected from each of the groups and cortisol levels were determined using cortisol immunoassay kit. Clinical examination covered probing depth, gingival index (GI), gingival recession, plaque index, and clinical attachment level. The statistical analysis was done using nonparameteric t-test and Spearman's rank correlation coefficient. Results: With respect to cortisol, the levels were higher in Group-I compared to the other groups. On comparison of mean cortisol levels among the groups, the values were statistically significant between Group-I and Group-III. Group-I showed a significant negative correlation between cortisol levels and GI. Conclusion: Within the limits of the study serum cortisol levels was higher in the chronic periodontitis group compared to the other groups. Positive correlation was found between the cortisol levels and other clinical parameters except for the GI.
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Affiliation(s)
- G Rohini
- Department of Periodontics, CSI College of Dental Sciences and Research, Madurai, India
| | - S Kalaivani
- Department of Periodontics, CSI College of Dental Sciences and Research, Madurai, India
| | - Vipin Kumar
- Consultant Periodontist and Implantologist, Delhi, India
| | - S A Rajasekar
- Consultant Oral and Maxillofacial surgeon, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Jaishree Tuckaram
- Department of Periodontics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Vinisha Pandey
- Department of Conservative Dentistry and Endodontics, Rama Dental College, Kanpur, Uttar Pradesh, India
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Warren KR, Postolache TT, Groer ME, Pinjari O, Kelly DL, Reynolds MA. Role of chronic stress and depression in periodontal diseases. Periodontol 2000 2015; 64:127-38. [PMID: 24320960 PMCID: PMC7167640 DOI: 10.1111/prd.12036] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2013] [Indexed: 12/15/2022]
Abstract
An extensive body of experimental and clinical evidence documents the negative impact of chronic psychological stress and depression on the immune system and health. Chronic stress and depression can result in general dysregulation of the immune system, of both cellular and humoral pathways, which may contribute to pathogenic infection and concomitant periodontal tissue destruction. In general, the evidence is consistent with the hypothesis that stress can modify the host defense and progression of periodontal infections in patients susceptible to periodontitis. However, substantial evidence also indicates that these conditions can mediate risk for disease, including periodontitis, through changes in health-related behaviors, such as oral hygiene, smoking and diet. The unequivocal interpretation of studies has also been hampered, in part, by issues related to conceptualization of stress and depression, as well as commonly associated comorbidities, such as diabetes, that can modify the onset and progression of periodontal disease. In addition, stress and depression appear to fall into a spectrum, ranging from mild to severe, involving a complex interaction of genetic background, coping strategies and environment. Differences in the conceptualization of stress and depression are probably important in assessing associations with other biologic and clinical measures. Future studies are necessary to clarify the complex interactions of chronic stress and depression in periodontal diseases.
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Sadetzki S, Chetrit A, Sgan-Cohen HD, Mann J, Amitai T, Even-Nir H, Vered Y. Long-Term Effects of Exposure to Ionizing Irradiation on Periodontal Health Status - The Tinea capitis Cohort Study. Front Public Health 2015; 3:226. [PMID: 26539423 PMCID: PMC4610133 DOI: 10.3389/fpubh.2015.00226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/22/2015] [Indexed: 12/19/2022] Open
Abstract
Studies among long-term survivors of childhood cancer who had received high-dose irradiation therapy of 4–60 Gy, demonstrated acute and chronic dental effects, including periodontal diseases. However, the possible effects of low to moderate doses of radiation on dental health are sparse. The aim of this study is to investigate the association between childhood exposure to low–moderate doses of ionizing radiation and periodontal health following 50 years since exposure. The study population included 253 irradiated subjects (treated for Tinea capitis in the 1950s) and, 162 non-irradiated subjects. The estimated dose to the teeth was 0.2–0.4 Gy. Dental examination was performed according to the community periodontal index (CPI). Socioeconomic and health behavior variables were obtained through a personal questionnaire. Periodontal disease was operationally defined as “deep periodontal pockets.” A multivariate logistic regression model was used for the association of irradiation status and other independent variables with periodontal status. The results showed that among the irradiated subjects, 23%, (95% CI 18–28%) demonstrated complete edentulousness or insufficient teeth for CPI scoring as compared to 13% (95% CI 8–19%) among the non-irradiated subjects (p = 0.01). Periodontal disease was detected among 54% of the irradiated subjects as compared to 40% of the non-irradiated (p = 0.008). Controlling for education and smoking, the ORs for the association between radiation and periodontal disease were 1.61 (95% CI 1.01–2.57) and 1.95 (95% CI 1.1–3.5) for ever never and per 1 Gy absorbed in the salivary gland, respectively. In line with other studies, a protective effect for periodontal diseases among those with high education and an increased risk for ever smokers were observed. In conclusion, childhood exposure to low-moderate doses of ionizing radiation might be associated with later outcomes of dental health. The results add valuable data on the long-term health effects of exposure to ionizing radiation and support the implementation of the ALARA principle in childhood exposure to diagnostic procedure involving radiation.
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Affiliation(s)
- Siegal Sadetzki
- Cancer and Radiation Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center , Tel Hashomer , Israel ; Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Angela Chetrit
- Cancer and Radiation Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Harold D Sgan-Cohen
- Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University Hadassah Medical School , Jerusalem , Israel
| | - Jonathan Mann
- Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University Hadassah Medical School , Jerusalem , Israel
| | - Tova Amitai
- Cancer and Radiation Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Hadas Even-Nir
- Cancer and Radiation Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Yuval Vered
- Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University Hadassah Medical School , Jerusalem , Israel
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