Lifestyle and Psychosocial Factors Associated with Chronic Periodontitis in Taiwanese Adults

Duration and frequency of betel quid chewing affects periodontitis severity and life quality of people in Tanini Village, Kupang, Indonesia

BACKGROUND

Chewing betel nuts can increase the risk of periodontal disease severity and potentially become malignant in the oral cavity.

OBJECTIVE

This study aimed to investigate the effect of the duration and frequency of betel quid chewing behaviour on periodontitis severity and the life quality of people in Tanini Village, Kupang Regency, Indonesia.

METHODS

The type of this study was an analytic observational study with a cross-sectional design. We used a questionnaire to obtain sociodemographic data. Oral Health Survey Basic Methods were used to measure debris index, plaque index, bleeding on probing, loss of attachment, and pocket depth. Behaviour and quality of life were measured by questionnaire and WHOQOL-BREF method as well.

RESULTS

The largest number of respondents were male. Duration of chewing had a significant relationship with the frequency of chewing and periodontal status. Periodontitis was higher compared to all categories. The lifestyle of the community greatly influenced their behaviour in betel nut chewing and also affected the severity of their periodontitis and OHIs significantly.

CONCLUSION

The lifestyle of betel nut chewing of the people in Tanini Village, greatly influences their behaviour. Prolonged and excessive use of betel nut induced significant adverse effects on human health. The longer and more often chew betel or areca nut, the higher the incidence of periodontitis, which significantly affects the quality of life as there is a possibility of the development of carcinogenesis, particularly in the oral cavity.

Predictive data mining for diagnosing periodontal disease: the Korea National Health and Nutrition Examination Surveys (KNHANES V and VI) from 2010 to 2015

OBJECTIVES

This study aimed to identify patients with the highest risk of periodontal disease (PD), and to provide recommendations for the effective use and application of data mining (DM) techniques when establishing evidence-based dental-care policies for vulnerable groups at a high risk of PD.

METHODS

This study used the SEMMA (Sample, Explore, Modify, Model, and Assess) methodology to construct DM models based on data acquired from the fifth and sixth Korea National Health and Nutrition Examination Surveys (2000-2015). We analyzed the sociodemographic and comorbidity variables that influence PD by applying the popular DM techniques of decision-tree, neural-network, and regression models, and also attempted to improve the predictive power and reliability by comparing the results obtained by these three models.

RESULTS

Our comparisons of the three DM algorithms confirmed that the average squared error, misclassification rate, receiver operating characteristic index, Gini coefficient, and Kolmogorov-Smirnov test results were the most appropriate for the decision-tree model. The analysis of the decision-tree model revealed that age and smoking status exert major effects on the risk of PD, and that stress and education level exert effects in rural areas, whereas education level, sex, hyperlipidemia, and alcohol intake exert effects in urban areas.

CONCLUSIONS

We demonstrated that the decision-tree model is an effective DM technique for identifying the complex risk factors for PD. These results are expected to be helpful in improving the equality and efficacy of dental-care policies for vulnerable groups at a high risk of PD.

Relationship between -889 C/T polymorphism in interleukin-1A gene and risk of chronic periodontitis: Evidence from a meta-analysis with new published findings

Background

Periodontitis results from an inflammatory response caused by accumulative microorganisms in periodontal sites. Several factors are involved in pathogenesis of periodontitis, for example the -889 C/T polymorphism in interleukin-1A gene. This study aimed to evaluate the relationship between this polymorphism and risk of development of chronic periodontitis by a meta-analysis based in new published findings.

Material and Methods

Thereunto a review in literature was performed in the electronic biomedical and education databases (Cochrane Library, Google Scholar, MEDLINE and PubMed) to studies published before August 2, 2015, the abstracts were evaluated and the data extraction performed by two calibrated examiners. The calculations of the meta-analysis were obtained through statistical software Review Manager version 5.2 with calculation of Odds Ratio (OR), heterogeneity (I²) and Funnel plots with P <0.05.

Results

In overall, twenty-one case/control studies were selected with 2,174 patients with chronic periodontitis and 1, 756 controls. The meta-analysis showed T allele was associated with chronic periodontitis (OR = 1.22, 95% CI: 1.09, 1.36, P = 0.0004) with decreased value to heterogeneity (I² = 15%, P = 0.28). TT genotype was associated to patients with chronic periodontitis (OR = 1.40, 95% CI: 1.07, 1.83, P = 0.01). No publication bias was found in this meta-analysis by asymmetry in Funnel plots.

Conclusions

This meta-analysis with 2,174 patients with chronic periodontitis and 1, 756 controls evidenced the -889 C/T polymorphism is associated to risk of development of chronic periodontitis with no significant value to heterogeneity to allelic evaluation.

Key words:Alleles, odds ratio, periodontal disease, cytokines.

Periodontal disease status and associated risk factors in patients attending a Dental Teaching Hospital in Rawalpindi, Pakistan

BACKGROUND

Investigators have identified an association of socio-demographic and medical factors with periodontal risk. This study observed status and association of periodontal disease and associated risk factors/indictors.

MATERIALS AND METHODS

All patients attending a dental teaching hospital were interviewed for socio-demographic and medical information through a structured questionnaire. Participants were examined for periodontal status using the community periodontal index (CPI), by a single examiner during September to November 2012. An association of age, gender, smoking habit, systemic conditions, and oral hygiene measures with periodontal status ([periodontitis CPI score ≥3]/nonperiodontitis [CPI score ≤2]) was analyzed by applying Chi-square test and forward selection stepwise regression analysis.

RESULTS

One thousand nine hundred and eighteen patients were examined during the study period. The findings revealed that 63.5% of the subjects had CPI score ≤2 (nonperiodontitis), while 34.5% were found with CPI score ≥3 (periodontitis). Age, gender, occupation, smoking, diabetes, arthritis, cardiovascular disease, kidney disease, stress, medications, and oral hygiene habits of using tooth powder or tooth brushing were significantly (P ≤ 0.037) associated with periodontal status. Regression analysis showed a significant association of age, occupation, and smoking with periodontitis.

CONCLUSION

This study observed prevalence of periodontitis in one-fourth of study sample. The study confirmed various socio-demographic risk factors/indictors associated with increased risk of periodontitis.

Association of periodontal and cardiovascular diseases: South-Asian studies 2001-2012

Large proportion of Asian populations have moderate to severe periodontal disease and a substantial number are anticipated to be at high risk of cardiovascular diseases (CVD). This study reviews epidemiology and association of periodontal and CVDs from the South-Asian region. Observational studies and clinical trials published during January 2001-December 2012 focusing association between periodontitis and CVDs in South-Asian countries were retrieved from various databases and studied. Current evidence suggests that both periodontal and CVDs are globally prevalent and show an increasing trend in developing countries. Global data on epidemiology and association of periodontal and CVDs are predominantly from the developed world; whereas Asia with 60% of the world's population lacks substantial scientific data on the link between periodontal and CVDs. During the search period, 14 studies (5 clinical trials, 9 case-controls) were reported in literature from South-Asia; 100% of clinical trials and 77% case-control studies have reported a significant association between the oral/periodontal parameters and CVD. Epidemiological and clinical studies from South-Asia validate the global evidence on association of periodontal disease with CVDs. However, there is a need for meticulous research for public health and scientific perspective of the Periodontal and CVDs from South-Asia.

Assessment and comparison of clinical dental status and its impact on oral health-related quality of life among rural and urban adults of Udaipur, India: A cross-sectional study

BACKGROUND

Dental diseases negatively influence people's oral health-related quality of life (OHRQoL) and thus their perceived need for dental care. QoL is increasingly acknowledged as a valid, appropriate and significant indicator of service need and intervention outcomes in contemporary public health research and practice.

OBJECTIVES

(1) To assess the psychometric properties of oral health impact profile-14 (OHIP-14) scale among rural and urban OHIP of Udaipur population. (2) To assess and compare clinical dental status (dental caries, periodontal disease and prosthetic status) and its impacts on OHRQoL rural and urban population of Udaipur.

MATERIALS AND METHODS

A cross-sectional descriptive survey was conducted among rural (600) and urban (600) population of Udaipur that have age ranges between 20 and 79 years, chosen from outpatient department of Pacific Dental College and Hospital. The OHIP-14 was tested for validity and reliability. Chi-square, Student's t-test, analysis of variance and multiple logistic regression analysis were employed for statistical analysis.

RESULTS

The Cronbach's alpha of the scale was found to be 0.85 among the rural population and 0.89 among the urban population. Prevalence of periodontal disease (community periodontal index and loss of attachment) was found greater among the rural population than the urban population. Urban population showed significantly greater proportion of subjects with prosthesis (including partial, fixed and total) as compared to the rural population. Among study population, OHIP-14 was significantly (P ≤ 0.05) associated with age, gender, presence of decayed teeth (DT), missing teeth (MT), and location. Significantly greater odds ratio (OR) (OHIP-14) were revealed among males (OR = 1.35, P = 0.02), urban residents (OR = 1.13, P = 0.002), those < 45 years of age (OR = 1.23, P = 0.01), those without DT (OR = 1.48, P = 0.002) and without MT (OR = 1.08, P = 0.03).

CONCLUSION

The rural and urban study subjects had a fair clinical status. The presence of dental caries had greatest impacts on OHRQoL. In addition, rural subjects faced greater impact than urban subjects.

Relationship between betel quid chewing and radiographic alveolar bone loss among Taiwanese aboriginals: a retrospective study

Background

Betel quid chewing is associated with the periodontal status; however, results of epidemiological studies are inconsistent. To the best of our knowledge, no study has reported radiographic alveolar bone loss (RABL) associated with betel quid chewing.

Methods

This survey was conducted in an aboriginal community in Taiwan because almost all betel quid chewers were city-dwelling cigarette smokers. In total, 114 subjects, aged 30–60 years, were included. Full-mouth intraoral RABL was retrospectively measured and adjusted for age, gender, and plaque index (PI). Multiple regression analysis was used to assess the relationship between RABL and potential risk factors.

Results

Age-, gender-, and PI-adjusted mean RABL was significantly higher in chewers with or without cigarette smoking than in controls. Multiple regression analysis showed that the RABL for consumption of 100,000 pieces betel quid for the chewer group was 0.40 mm. Full-mouth plotted curves for adjusted mean RABL in the maxilla were similar between the chewer and control groups, suggesting that chemical effects were not the main factors affecting the association between betel quid chewing and the periodontal status.

Conclusion

Betel quid chewing significantly increases RABL. The main contributory factors are age and oral hygiene; however, the major mechanism underlying this process may not be a chemical mechanism. Regular dental visits, maintenance of good oral hygiene, and reduction in the consumption of betel quid, additives, and cigarettes are highly recommended to improve the periodontal status.

Is frequency of tooth brushing a risk factor for periodontitis? A systematic review and meta-analysis

OBJECTIVES

The epidemiology of periodontitis regarding oral-hygiene practices particularly the frequency of tooth brushing has been the subject of relatively few dedicated studies. This paper provides a systematic review of available relevant epidemiological studies and a meta-analysis of the effect of tooth brushing frequency on periodontitis. To review and to quantify the risk for periodontitis associated with frequency of tooth brushing.

METHODS

Systematic literature search was conducted in nine online resources (PUBMED, ISI and 7 additional databases). Related and cross-referencing publications were reviewed. Papers published until end of March 2013 reporting associations between tooth brushing frequency and periodontitis were considered. A meta-analysis was performed to quantify this association.

RESULTS

Fourteen studies were identified. The test of heterogeneity for cross-sectional studies was not significant (P = 0.31). A fixed-effects model yielded a significant overall odds ratio estimate of 1.41 (95%CI: 1.25-1.58, P < 0.0001) for infrequent compared to frequent tooth brushing. For all fourteen studies, there was a slight indication for heterogeneity (I² = 48%, P = 0.02) and the corresponding result with a random-effects model was 1.44 (95%CI: 1.21-1.71, P < 0.0001).

CONCLUSIONS

There are relatively few studies evaluating the association between tooth brushing frequency and periodontitis. A clear effect was observed, indicating that infrequent tooth brushing was associated with severe forms of periodontal disease. Further epidemiological studies are needed to precisely estimate the effect of key risk factors for periodontitis and their interaction effects.

Inhibitory effects of areca nut extract on expression of complement receptors and fc receptors in human neutrophils

BACKGROUND

Chewing of areca quid increases the prevalence of periodontal diseases. Areca nut extract (ANE) inhibits the phagocytic activity of human neutrophils. This in vitro study investigates the effects of ANE on complement- and antibody-opsonized phagocytosis by neutrophils. Expression of complement receptors, Fc receptors, and F-actin in ANE-treated neutrophils is also analyzed.

METHODS

The viability of ANE-treated neutrophils was determined using the propidium iodide staining method. The possible effects of ANE on the expression of complement receptors and Fc receptors were examined using an immunofluorescence staining method followed by flow cytometry and confocal laser scanning microscopy. The phagocytic activity of neutrophils against complement or immunoglobulin (Ig)G-opsonized fluorescent beads was analyzed using flow cytometry. Expression of F-actin was determined using confocal laser scanning microscopy.

RESULTS

ANE significantly inhibited the production of complement receptors (CR1, CR3, and CR4) and Fc receptors (FcγRII and FcγRIII) in a concentration-dependent manner. Treatment of neutrophils with ANE significantly impaired their ability to phagocytose fluorescent beads. ANE also inhibited phagocytosis of fluorescent beads that were opsonized by complement or IgG. Moreover, expression of F-actin was inhibited after ANE treatment.

CONCLUSIONS

ANE inhibits the complement- and IgG-mediated neutrophil phagocytosis that may result from reduction of the expression of complement receptors, Fc receptors, and F-actin formation after ANE treatment. The findings suggest that areca nut chewing may jeopardize the defensive functions of neutrophils and affect periodontal health.

Prevalence and risk indicators of gingivitis and periodontitis in a multi-centre study in North Jordan: a cross sectional study

Background

There are limited data about the epidemiology and risk factors/indicators of gingivitis, aggressive periodontitis (AgP) and chronic periodontitis (CP) in Jordan. The aim of this study was to assess the prevalence and risk indicators of gingivitis, AgP and CP.

Methods

A sample of 595 subjects was randomly selected from subjects escorting out-patients attending a Medical Center, a Dental Teaching Hospital, and 2 private dental clinics. The socio-demographic variables, oral hygiene habits, income, smoking and Body Mass Index (BMI) were recorded. Full mouth periodontal examination was performed, and radiographs were taken for sites with probing depth > 3 mm.

Results

About 76% had gingivitis, 2.2% had AgP and 5.5% had CP. Periodontitis was more frequent among males than females with a M: F ratio of 1.6:1 and the prevalence increased with age. Subjects who reported not using a tooth brush, smokers and subjects with BMI > 30 kg/m² had significantly higher prevalence of periodontitis. The risk for periodontitis was greater among subjects who reported positive family history and subjects with ≤ 12 years of education.

Conclusions

This is the first study to report on the prevalence of gingivitis, CP and AgP in North Jordanian. Age, low education, low frequency of tooth brushing and family history were significantly associated with increased risk of periodontitis.

Inhibitory effects of safrole on phagocytosis, intracellular reactive oxygen species, and the activity of myeloperoxidase released by human polymorphonuclear leukocytes

BACKGROUND

Safrole, a component of Piper betle inflorescence, inhibits bactericidal activity and the release of superoxide anion (O(2)(-)) by polymorphonuclear leukocytes (PMNs). This in vitro study further investigated the effects of safrole on phagocytic activity, the intracellular production of reactive oxygen species (ROS), and the activity of the lysosomal enzyme myeloperoxidase (MPO), which is released by human PMNs.

METHODS

The possible effects of safrole on the phagocytic activity of PMNs against Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) were determined using flow cytometry. PMNs were treated with various concentrations of safrole, which was followed by treatment with Hanks balanced salt solution with or without cytochalasin B and fMet-Leu-Phe (CB/fMLP). Intracellular ROS was determined using 2',7'-dichlorofluorescein diacetate and a fluorometer, whereas MPO activity was determined using a substrate assay.

RESULTS

Safrole significantly inhibited the phagocytic activity of PMNs in a dose-dependent manner. Approximately 50% of the phagocytic activity of PMNs was affected when 10 mM safrole was used. Exposure of the PMNs to safrole (up to 5 mM) did not directly affect the intracellular levels of ROS and the extracellular activity of MPO. However, the ability of CB/fMLP to trigger production of intracellular ROS and the activity of MPO released by human PMNs was significantly suppressed by safrole.

CONCLUSIONS

Safrole reduced the uptake of A. actinomycetemcomitans by human PMNs. Safrole also impaired the normal activation activity of PMNs. Alterations in the defensive properties of PMNs by safrole might promote bacterial colonization, and this could result in periodontal infection.

Areca nut extract-treated gingival fibroblasts modulate the invasiveness of polymorphonuclear leukocytes via the production of MMP-2

BACKGROUND

Areca nut chewing is associated with an increase in the incidence of oral neoplastic or inflammatory diseases. Aberrations in matrix metalloprotease (MMP) expression are associated with the pathogenesis of oral diseases. This study investigated the potential effects of areca nut extract (ANE) on human gingival fibroblasts and the consequential impacts on inflammatory pathogenesis.

METHODS

Analyses of senescence marker, cell viability, changes of the cell cycle, and cell granularity in gingival fibroblasts together with an assessment of the invasiveness of polymorphonuclear (PMN) leukocytes after treatment with the supernatant of ANE-treated gingival fibroblasts were performed to characterize the phenotypic impacts. Western blotting and gelatin zymography were used to assay the expression and activity of MMP-2.

RESULTS

Chronic subtoxic (<10 microg/ml) ANE treatment resulted in premature growth arrest, appearance of senescence-associated beta-galactosidase activity and various other senescence-associated phenotypes in gingival fibroblasts. Gingival fibroblasts established from older individuals had a higher propensity to become ANE-induced senescent gingival fibroblasts. An activation of MMP-2 was identified in senescent cells. PMN leukocytes treated with the supernatant of ANE-induced senescent cells exhibited a significant increase in invasiveness, which was abrogated by both a MMP-2 blocker and a MMP-2 nullifying antibody.

CONCLUSIONS

This study provides evidence whereby MMP-2 secreted from ANE-induced senescent gingival fibroblasts would facilitate the invasiveness of PMN leukocytes, which could be associated with the oral inflammatory process in areca chewers.

Areca nut extract represses migration and differentiation while activating matrix metalloproteinase-9 of normal gingival epithelial cells

BACKGROUND AND OBJECTIVE

Areca (betel) chewing is associated with an increase in the incidence of periodontal diseases. Aberrations in matrix metalloproteinase (MMP) expression have been reported to be associated with periodontal disease. This study investigated the effects of areca nut extract on MMP activity and the phenotype of human gingival epithelial cells.

MATERIAL AND METHODS

Reverse transcription-polymerase chain reaction, western blotting and gelatin zymography were used to assay MMPs. Cell viability, mobility and detachment assays were performed to characterize the phenotypic impact. Confocal microscopy was employed to evaluate cell aggregation and the distribution of E-cadherin and F-actin.

RESULTS

Treatment of gingival epithelial cells with 10 microg/mL of areca nut extract reduced its cell viability. Treatment with 5 and 10 microg/mL of areca nut extract for 24 h activated MMP-9 but not MMP-2 in gingival epithelial cells. This activation could be nuclear factor-kappaB dependent and was abrogated by 10 microM curcumin. Areca nut extract also reduced the migration and detachment of gingival epithelial cells. The differentiated cell-cell contact of gingival epithelial cells was markedly impaired by areca nut extract. This was accompanied by a disruption of distribution of E-cadherin and F-actin.

CONCLUSION

The areca nut extract-mediated activation of MMP-9 in gingival epithelial cells could signify a potential periodontal pathogenesis in areca chewers. The areca nut extract-mediated inhibition of cell viability and migration, together with the changed aggregation in gingival epithelial cells, suggests that impairment of the re-epithelization underlies the process and this, in turn, might exacerbate gingival inflammation.

Longitudinal Study of the Association Between Smoking as a Periodontitis Risk and Salivary Biomarkers Related to Periodontitis

BACKGROUND

Insufficient data exist regarding the long-term influence of lifestyle factors including smoking on periodontal health. The objective of this study was to examine the prospective association between smoking and periodontal disease progression and the effects of smoking on salivary biomarkers related to periodontitis.

METHODS

Probing depth (PD) was measured at health checkups of workers in 1999 and 2003; additionally, lifestyle information was obtained through a questionnaire. In 2003, 219 of 256 (86%) workers examined at baseline completed PD measurements; saliva samples were also collected. Change in PD was used for assessment of periodontitis progression when three or more sites displayed an increase of >or=2 mm over 4 years. Salivary biomarker levels were determined by real-time polymerase chain reaction and enzyme assay. Statistical methods included bivariate and multivariate regression analyses.

RESULTS

In the multiple logistic model, in which lifestyle-related factors served as independent variables, significant variables were current smoking and hours of sleep; respective odds ratios were 2.3 and 2.1. Additionally, 38.5% of periodontal disease progression was attributable to current smoking. Moreover, pack-years of smoking showed a dose-response relationship with disease progression. Levels of salivary markers including prostaglandin E(2), lactoferrin, albumin, aspartate aminotransferase, lactate dehydrogenase, and alkaline phosphatase were significantly lower in current smokers than in non-current smokers. However, no meaningful differences in the proportions of six periodontal pathogens were observed between current and non-current smokers.

CONCLUSIONS

Smoking exerted the greatest influence on periodontitis risk among lifestyle factors. Smoking may suppress the host-defense system, which may promote periodontal disease progression.

Areca nut extracts reduce the intracellular reactive oxygen species and release of myeloperoxidase by human polymorphonuclear leukocytes

BACKGROUND AND OBJECTIVE

Polymorphonuclear leukocytes (PMN) represent the first line of host defense. Areca nut extract inhibits the bactericidal activity of, and the release of superoxide anion (O2- ) by, PMN. This study investigated the effects of areca nut extract on the intracellular production of reactive oxygen species (ROS) and on the extracellular release of lysosomal enzyme, myeloperoxidase (MPO), by PMN. The effects of arecoline, a principal component of areca nut, were also examined.

MATERIAL AND METHODS

Human PMN were treated with various concentrations of areca nut extract or arecoline followed by treatment with Hanks' balanced salt solution, with or without cytochalasin B and fMet-Leu-Phe (CB/fMLP). The viability of PMN was determined using propidium iodide staining and flow cytometry. The presence of intracellular ROS was determined using 2',7'-dichlorofluorescin diacetate and fluorometry. MPO release was determined using a substrate assay.

RESULTS

Areca nut extract (25 and 50 microg/ml) significantly decreased the viability of PMN. The intracellular levels of ROS and the extracellular release of MPO were induced in PMN by CB/fMLP. Exposure of PMN to areca nut extract (up to 25 microg/ml) or to arecoline (up to 2 mg/ml) did not directly affect the levels of ROS and MPO activity. However, under conditions that did not affect the viability of PMN, the ability of CB/fMLP to trigger production of intracellular ROS and release of MPO in human PMN was significantly suppressed by areca nut extract and arecoline.

CONCLUSION

Areca nut impaired the activation of PMN by CB/fMLP that might decrease the effectiveness of PMN in the host defense. Alternatively, exposure of PMN to areca nut extract could decrease the capacity of PMN to damage tissues.

Enhancing Effects of Areca Nut Extracts on the Production of Interleukin-6 and Interleukin-8 by Peripheral Blood Mononuclear Cells

BACKGROUND

The habit of chewing areca quid (AQ) has been implicated in oral pathogenesis, including periodontal disease. Little is understood about the roles of AQ in the cytokine secretion by immune cells. The study examined the effects of areca nut, the major ingredient of AQ, on the production of interleukin (IL)-6 and IL-8 by peripheral blood mononuclear cells (PBMC), the immunocompetent cells. The possible role of oxidative stress of areca nut was also examined.

METHODS

Extracts of ripe areca nut (rANE) and tender areca nut (tANE) were examined for their cytotoxic effects on human PBMC using the trypan blue exclusion test. The production of IL-6 and IL-8 by ANE-treated PBMC was analyzed using enzyme-linked immunosorbent assay and reverse transcription-polymerase chain reaction. Effects of an antioxidant, pyrrolidine dithiocarbamate (PDTC), on ANE-induced cytokine secretion were also studied.

RESULTS

At the experimental conditions, 20 micro g/ml rANE decreased cell viability significantly, whereas no significant effect of tANE (< or =80 micro g/ml) was observed. Both rANE (< or =20 micro g/ml) and tANE (< or =160 micro g/ml) significantly increased the secretion of IL-6 and IL-8 by PBMC in a dose- and time-dependent manner. The altered mRNA expression of IL-6 by rANE and tANE was also observed. Moreover, the stimulating effects of rANE on cytokine expression in PBMC could be attenuated by PDTC, suggesting that the oxidative stress of rANE may play a role.

CONCLUSIONS

Markedly enhancing effects of ANE on PBMC-released inflammatory cytokines might cause a sustained cytokine-rich inflammatory milieu in oral cavity of AQ chewers. These excessive cytokines from ANE-treated immune cells may impair periodontal health.

A community study on the relationship between stress, coping, affective dispositions and periodontal attachment loss

BACKGROUND

Psychological factors may increase the risk for periodontal diseases. Contemporary conceptualization of the stress process supports the evaluation of stress at three levels: stressors, moderating and mediating factors, and stress reactions.

OBJECTIVE

This study was undertaken to investigate the relationship of periodontal disease in terms of clinical attachment level (CAL) to psychosocial stress, making reference to the major components of stress process.

METHODS

A cross-sectional study of 1000 subjects aged 25-64 years in Hong Kong was conducted. Subjects were asked to complete a set of questionnaires measuring stressors including changes, significant life event and daily strains, stress reactions including physiological and affective responses, and coping and affective dispositions. CAL was assessed.

RESULTS

Individuals with high mean CAL values had higher scores on the job and financial strain scales than periodontally healthy individuals (P < 0.05), after adjusting for age, gender, cigarette smoking and systemic disease. Depression, anxiety trait, depression trait, problem-focused coping, and emotion-focused coping were also related to CAL. Logistic regression analysis indicated that all these factors were significant risk indicators for periodontal attachment loss, except problem-focused coping, which reduced the odds of CAL. Individuals who were high emotion-focused copers, low problem-focused copers, trait anxious, or trait depressive had a higher odds of more severe CAL.

CONCLUSION

Chronic job and financial strains, depression, inadequate coping, and maladaptive trait dispositions are significant risk indicators for periodontal attachment loss. Adequate coping and adaptive trait dispositions, evidenced as high problem-focused coping and low anxiety/depression trait, may reduce the stress-associated odds.

Modulation of Phagocytosis, Chemotaxis, and Adhesion of Neutrophils by Areca Nut Extracts

BACKGROUND

A higher prevalence of periodontal diseases among areca chewers than non-areca chewers has been demonstrated. Neutrophils, representing the first line of the host defense mechanism against microbial infection, play important roles in maintaining periodontal health. This study determined the possible effects of areca nut on phagocytosis, chemotaxis, and adhesion of human neutrophils.

METHODS

Aqueous extracts of ripe areca nut without husk (rANE) and fresh and tender areca nut with husk (tANE) were examined for their effects on neutrophil phagocytosis using flow cytometry and confocal laser scanning microscopy. The effects of rANE and tANE on chemotaxis and adhesion of neutrophils to human aortic endothelial cells were examined using fluorescence-labeled neutrophils.

RESULTS

Both rANE and tANE inhibited the phagocytic activity of neutrophils in a dose-dependent manner. The levels of internalized fluorescent bacteria in neutrophils decreased after ANE treatment. However, exposure of neutrophils to rANE and tANE stimulated the chemotaxis activity of neutrophils to N-formyl-Met-Leu-Phe (fMLP) and enhanced adhesion of neutrophils to human aortic endothelial cells in a dose-dependent manner. Moreover, treatment of neutrophils with rANE was more effective than incubation with tANE.

CONCLUSIONS

Components of areca nut inhibited phagocytosis activity of neutrophils but enhanced chemotaxis and adhesion of neutrophils. Alterations in functions of neutrophils may lead to signs of clinical diseases associated with areca chewing. The components in ANEs that are responsible for these observations remain to be elucidated.

Risk factors and prevalence of periodontitis in community-dwelling elders in Mexico

AIM

The objective of this study was to determine whether an association existed between chronic systemic diseases/conditions, risk factors common in old age, and the extent and severity of chronic periodontal disease.

MATERIALS AND METHODS

Sociodemographic and lifestyle characteristics were examined by contrasting rural, urban-marginal, and urban social environments in Central Mexico. Data were analysed with Analysis of Variance, chi2 tests, and multivariable logistic regression.

RESULTS

A total of 473 adults 60 years old and over were interviewed; 315 were also examined and underwent laboratory assays (participation rate, 66%); women, 62%; mean age 73+/-8 years; 23% edentulous. The distribution of periodontitis by sociodemographic variables showed differences across locales (73% low-urban, 57% middle-urban, 29% rural). The regression model indicated that periodontitis was more frequently associated with low-urban locale, higher systolic blood pressure, higher body mass index, and worse calculus readings, with an interaction whereby being obese and having a high calculus index was associated with a high probability of having periodontitis.

CONCLUSIONS

Overall periodontal conditions were fair. While we identified oral, systemic, and social variables that modulated the experience of periodontitis, it would appear that urban, low social class elders appeared to have worse periodontal conditions.

A socio-economic perspective on periodontal diseases: a systematic review

OBJECTIVE

The aim of this systematic review was to ascertain whether socio-economic conditions increase the risk of periodontal diseases.

METHODS

A MEDLINE search was conducted for the period 1965-April 2004. Only original articles were included; 47 studies remained for the final assessment. The studies were analysed regarding the outcome of the association between socio-economic variables and periodontal disease, depending on the study design (cross-sectional survey or longitudinal case-control) and whether smoking was included or not.

RESULTS

Twenty-nine out of 36 studies with a cross-sectional design were in favour of the association between socio-economic factors and periodontal diseases. In the studies with a longitudinal or case-control design, there were five in favour of the association, and also six against. When smoking was included in the analysis of cross-sectional studies, a significant association between socio-economic variables and periodontal disease was found in 11 studies and no significance in another five studies. The corresponding figures for case-control studies showed four studies being significant, but also four studies showing no significance.

CONCLUSION

Based on relevant study designs and including smoking in the analysis, the socio-economic variables associated with periodontal diseases appear to be of less importance than smoking.

Interleukin-12 and interleukin-16 in periodontal disease

The immune system plays an important role in the pathological process of periodontitis. Interleukin-12 (IL-12) is produced by monocytes, macrophages and neutrophils. These cells are proinflammatory infiltrates in periodontitis tissues. High IL-12 will contribute to the immune reaction to Th1 type. IL-12 is an inducer of INF-r production. IFN-gamma itself can also activate IL-12 production. Lipopolysaccharides (LPS) of periodontopathogens are also activators of IL-12. Interleukin-16 (IL-16) can cause the high affinity of IL-2 receptors on CD4+ cells and is chemotaxis to Th1 cells and CD4+ T cells. IL-16 can stimulate monocytes to produce proinflammatory cytokines and is highly associated with inflammation including arthritis, enteritis and allergic rhinitis. However, the information on IL-12 and IL-16 in periodontitis is not clear. In this study, 105 GCF samples were collected from 19 periodontal disease patients and 6 healthy ones. The clinical periodontal indices, the habits of cigarette smoking and alcohol drinking were recorded. ELISA was used to determine the levels of IL-12 and IL16 in the GCF. In the non-smoking/non-alcohol-drinking individuals: (1) the total amount of IL-12 (but not IL-16) was significantly higher in chronic periodontitis (CP) sites than gingivitis (G) or healthy (H) sites; (2) the diseased sites (CP + G) had a significantly higher total amount of IL-12 (but not IL-16) than the H sites. Among CP sites, both the concentration and total amount of IL-16 (but not IL-12) were significantly higher in alcohol drinkers/cigarette smokers as compared to the non-drinkers/non-smokers. CP sites of the drinkers/smokers also had significantly deeper probing pocket depth than sites of those without these two habits. IL-12 and IL-16 may be related to the pathogenesis of periodontal disease, but within the periodontitis sites, IL-16 may be related to disease severity in alcohol drinkers/smokers.

Smoking, a weak predictor of periodontitis in older adults

BACKGROUND

The impact of smoking habits on periodontal conditions in older subjects is poorly studied.

AIMS

To assess if a history of smoking is associated with chronic periodontitis and medical history in older subjects.

MATERIAL AND METHODS

The medical and dental history was collected from 1084 subjects 60-75 years of age. Smoking history information was obtained from self-reports. Periodontal variables [clinical probing depth (PD)>/=5.0 mm, clinical attachment levels (CALs) >/=4.0 mm], and radiographic evidence of alveolar bone loss were assessed.

RESULTS

60.5% had never smoked (NS), 32.0% were former smokers (FS) (mean smoke years: 26.1 years, SD+/-13.1), and 7.5% were current smokers (CS) (mean smoke years 38.0 years, (SD+/-12.1). The proportional distribution of CAL >/=4.0 mm differed significantly by smoking status (NS and CS groups) (mean difference: 12.1%, 95% confidence interval (CI): 1.5-22.6, p<0.02). The Mantel-Haenszel common odds ratio between smoking status (CS+FS) and periodontitis (>20% bone loss) was 1.3 (p<0.09, 95% CI: 0.9-2.0) and changed to 1.8 (p<0.02, 95% CI: 1.3-2.7) with 30 years of smoking as cutoff. A weak correlation between number of years of smoking and CAL>/=4.0 mm was demonstrated (r(2) values 0.05 and 0.07) for FS and CS, respectively. Binary logistic forward (Wald) regression analysis demonstrated that the evidence of carotid calcification, current smoking status, gender (male), and the number of remaining teeth were explanatory to alveolar bone loss.

CONCLUSIONS

A clinically significant impact on periodontal conditions may require 30 years of smoking or more. Tooth loss, radiographic evidence of carotid calcification, current smoking status, and male gender can predictably be associated with alveolar bone loss in older subjects.

Areca nut extracts modulated expression of alkaline phosphatase and receptor activator of nuclear factor kappaB ligand in osteoblasts

OBJECTIVES

Areca chewers have a higher prevalence of periodontal diseases than non-chewers. This study was to determine the possible effects of ripe areca nut extracts (rANE) on viability and gene expression of alkaline phosphatase (ALP), receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) in human osteoblasts.

METHODS

The effects of rANE on cell viability of osteoblast-like MG63 cells were determined using 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyltetrazolium bromide (MTT) that measures metabolic activity. Gene expression of ALP, RANKL and OPG was examined using reverse transcription-polymerase chain reaction. ALP activity and RANKL protein were further examined using substrate assay and confocal laser scanning microscopy, respectively.

RESULTS

Relative viability was reduced to approximately 50% when 25 microg/ml of rANE was used. The expression of OPG mRNA in MG63 cells was not altered by rANE. However, decreased levels of mRNA and enzyme activity of ALP were observed. Moreover, the expressions of mRNA and protein of RANKL were stimulated by rANE in a dose-dependent manner.

CONCLUSIONS

The rANE affected morphology and viability of osteoblasts. We also present novel evidence demonstrating that areca nut may compromise the periodontal health of areca chewers by suppression of ALP gene expression and elevation of RANKL gene expression in osteoblasts.

Inhibitory Effects of Areca Nut Extracts on Phagocytosis ofActinobacillus actinomycetemcomitansATCC 33384 by Neutrophils

BACKGROUND

Areca quid chewers have a higher prevalence of periodontal disease than non-chewers. Little is known about the influence of areca quid on the immune system. This study was to determine the possible effects of the areca nut on phagocytic activity of human neutrophils.

METHODS

Aqueous extracts of ripe areca nut without husk (rANE), fresh and tender areca nut with husk (tANE), a major alkaloid (arecoline), and a phenolic component ([+]-catechin) of areca nut were examined for their effects on cellular viability using trypan blue exclusion assay. The possible effects on the phagocytic activity of neutrophils against a periodontal pathogen, Actinobacillus actinomycetemcomitans ATCC 33384, were determined using flow cytometry and confocal laser scanning microscopy.

RESULTS

At the concentrations tested, rANE, tANE, arecoline, and (+)-catechin did not significantly affect viability of neutrophils. However, rANE, tANE, arecoline, and (+)-catechin inhibited the phagocytic activity of neutrophils in a dose-dependent manner. Approximately 50% of the relative phagocytic activity of neutrophils was affected when 50 microg/ml of rANE, 400 microg/ml of tANE, 20,000 microg/ml of arecoline, or 2,500 microg/ml of (+)- catechin was used. Decreased levels of internalized fluorescent bacteria were also demonstrated. However, arecoline or (+)-catechin alone could not be used to explain the inhibitory effects observed for rANE and tANE.

CONCLUSIONS

Components of areca nut reduced the uptake of A. actinomycetemcomitans ATCC 33384 by human neutrophils. The inhibition of areca nut on phagocytosis of neutrophils may be one possible mechanism by which the areca nut compromises the periodontal health of areca quid chewers.

Periodontal attachment loss attributable to cigarette smoking in an urban Brazilian population

AIMS

The present study estimated the percentages of cases with severe periodontal attachment loss (PAL) attributable to cigarette smoking in a representative adult urban population in southern Brazil.

METHODS

A representative sample comprising 853 dentate individuals (age: 30-103 years) was selected by a multistage, probability sampling method. A full-mouth clinical examination of six sites per tooth was performed and an interview using a structured written questionnaire was undertaken. Cases were defined as individuals with > or =30% teeth with PAL > or =5 mm. A multivariate logistic regression analysis for complex surveys was performed, and adjusted for age, gender, race, socioeconomic status and dental calculus.

RESULTS

The prevalence of cases in this population was 49.7%, or 739,000 subjects. Overall, 50.9% of this adult population, or approximately 757,000 subjects have had a lifetime exposure to cigarette smoking. Multivariate analysis showed that heavy and moderate smokers had a significantly higher risk for PAL > or =5 mm than non-smokers (odds ratio=3.6, 2.0, respectively) after adjusting for the above covariates. We estimated that the number of moderate and heavy smokers with > or =30% teeth with PAL > or =5 mm might be reduced by approximately 28% and 48%, respectively, had they not smoked cigarettes. We project that a smoking cessation program could result in a reduction in the number of cases by up to 12% in this population, or approximately 90,000 potential cases.

CONCLUSION

Cigarette smoking was strongly associated with severe attachment loss in this population. A significant percentage of cases may have been prevented if smoking cessation interventions had been implemented. The results support the implementation of population-based smoking cessation programs to reduce the prevalence of severe attachment loss in populations with high level of smoking exposure.