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Yakar N, Bostanci N, Özdemir G, Atmaca H, Türedi A, Şahin Ç, Köse T, Emingil G. Salivary inflammatory burden in pre- and postmenopausal women: Associations with body mass index, patient-reported health, serum cytokines, and periodontal parameters. J Periodontol 2024; 95:209-218. [PMID: 37851637 DOI: 10.1002/jper.23-0124] [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: 02/24/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The decline of estrogen levels during menopause impacts weight, mood, and overall health, both orally and systemically. This study assessed salivary levels of tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), IL-10, and IL-7 in postmenopausal (PMW) and regularly menstruating premenopausal (RMPW) women, while considering serum cytokine levels, body mass index (BMI), periodontal health, and self-reported physical and emotional well-being. METHODS In this study, 75 PMW and 71 RMPW were included. Clinical and periodontal parameters were evaluated, and perceived health was assessed with the Women's Health Questionnaire (WHQ). Cytokine levels in both saliva and serum were quantified by enzyme-linked immunosorbent assay (ELISA). Covariate evaluations of salivary cytokines were conducted using hierarchical linear regression modeling. RESULTS Cytokines were detectable in saliva from 71 PMW and 67 RMPW. In the initial unadjusted model, IL-7, IL-10, and TNF-α exibited significant differences between RMPW and PMW. However, these differences became non-significant (p > 0.05) in the final model after adjusting for age, which implies a negligible effect of the investigated covariates on salivary cytokine levels when age was considered. Lower levels of IL-6 in PMW, which initially showed no significant difference, became borderline (p = 0.054) in the final model after adjusting for age. CONCLUSIONS After adjusting for multiple factors, no significant difference was found in the salivary levels of the investigated cytokines between RMPW and PMW. Factors such as BMI, perceived health, serum cytokine levels, and periodontal parameters seem to minimally influence these levels in PMW. However, age may be a stronger confounding factor.
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Affiliation(s)
- Nil Yakar
- Department of Periodontology, Faculty of Dentistry, Ege University, İzmir, Turkey
- Department of Biology, Basic and Industrial Microbiology Section, Faculty of Science, Ege University, Izmir, Turkey
| | - Nagihan Bostanci
- Section of Oral Health and Periodontology, Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Güven Özdemir
- Department of Biology, Basic and Industrial Microbiology Section, Faculty of Science, Ege University, Izmir, Turkey
| | - Harika Atmaca
- Department of Biology, School of Science, Celal Bayar University, Manisa, Turkey
| | - Asena Türedi
- Department of Periodontology, Faculty of Dentistry, Ege University, İzmir, Turkey
| | - Çağdaş Şahin
- Department of Gynecology and Obstetrics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Timur Köse
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Gülnur Emingil
- Department of Periodontology, Faculty of Dentistry, Ege University, İzmir, Turkey
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Meriç P, Silbereisen A, Emingil G, Öztürk VÖ, Bostanci N. Clinical, oral immunological and microbiological shifts during and after pregnancy. Clin Oral Investig 2023; 28:60. [PMID: 38157038 PMCID: PMC10756889 DOI: 10.1007/s00784-023-05408-1] [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: 07/03/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Physiological changes and shifts in the oral microbiota composition during pregnancy may affect the maternal immune system. Uncomplicated pregnancy is associated with a T-helper (Th) 2 predominant cytokine regulation (anti-inflammatory), while oral health deterioration during pregnancy is reflected by severe gingival inflammation, a primarily Th1 cytokine phenotype (pro-inflammatory), and oral microbiome alterations. This prospective observational study aimed to evaluate Th cytokine shifts and changes in the oral microbiota composition in saliva of women before and after birth. MATERIAL AND METHODS Saliva (n = 96) was collected before and 6 months after birth, and medical, oral health, and periodontal status were assessed. In a multiplex immunoassay, 10 cytokines were simultaneously analyzed and cumulative Th1 and Th2 cytokine levels and Th1/Th2 ratio were calculated for all groups. Putative periodontal pathogens (n = 6) were evaluated by quantitative real-time polymerase chain reaction. RESULTS Th2 cytokine levels were significantly lower (p = 0.014) while pro-inflammatory cytokine levels were significantly higher (p < 0.01) during pregnancy than postpartum. Similar Th1 levels were found between the groups (p = 0.143). Th1 and Th2 cytokines positively correlated with periodontal parameters (p < 0.001) and levels of studied bacteria during pregnancy (p < 0.05). CONCLUSIONS This study identified a significantly increased Th1/Th2 cytokine ratio during pregnancy and a positive association with putative periodontal pathogens. This immunological and microbiological deregulation in the oral milieu during pregnancy is suggestive of a destructive inflammatory periodontal profile. STUDY REGISTRATION Clinical Trials.gov (Record BAP-2015). CLINICAL RELEVANCE Understanding altered oral immunological and microbiological regulation patterns during pregnancy may help improve the inflammatory periodontal profile in pregnant women.
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Affiliation(s)
- Pınar Meriç
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
| | - Angelika Silbereisen
- Division of Oral Health and Periodontology, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, 14104, Stockholm, Sweden
| | - Gülnur Emingil
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
| | - Veli-Özgen Öztürk
- Department of Periodontology, School of Dentistry, Adnan Menderes University, Aydın, Turkey
| | - Nagihan Bostanci
- Division of Oral Health and Periodontology, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, 14104, Stockholm, Sweden.
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3
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Könönen E, Fteita D, Gursoy UK, Gursoy M. Prevotella species as oral residents and infectious agents with potential impact on systemic conditions. J Oral Microbiol 2022; 14:2079814. [DOI: 10.1080/20002297.2022.2079814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Eija Könönen
- Institute of Dentistry, University of Turku, Turku, Finland
| | - Dareen Fteita
- Institute of Dentistry, University of Turku, Turku, Finland
| | - Ulvi K. Gursoy
- Institute of Dentistry, University of Turku, Turku, Finland
| | - Mervi Gursoy
- Institute of Dentistry, University of Turku, Turku, Finland
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Iorio GG, Carbone L, Donadono V, Rovetto MY, Sarno L, Saccone G, Mazzarelli LL, Sirico A, Esposito G, Buonfantino C, DI Girolamo R, Arduino B, D'Alessandro P, Maruotti GM. Bleeding epulis gravidarum: what to evaluate? Minerva Obstet Gynecol 2022; 74:171-177. [PMID: 35421917 DOI: 10.23736/s2724-606x.21.04960-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Hormonal changes during pregnancy may induce modifications in oral mucosa. Epulis gravidarum (EG) is an oral disease arising during pregnancy, usually regressing after delivery. A case of EG managed at our department is described and those previously reported in literature are reviewed in order to define EG clinical features for stratifying the risk of complications and the need of surgery during pregnancy as well as which factors should be considered more relevant in EG management. EVIDENCE ACQUISITION Electronic databases (Medline, Embase, Web of Sciences, Scopus and Cochrane Library) were searched from inception of each databases until May 2021 to identify clinical studies on management of EG diagnosed during pregnancy. The aim of this review was to identify factors influencing the need and timing of surgical management. EVIDENCE SYNTHESIS A woman with a triplet pregnancy suffering from EG, complicated by profuse bleeding, required Caesarean section (CS) given the triplet pregnancy and the impending preterm labor. The surgical removal of EG was not performed because it spontaneously regressed without consequences 40 days after delivery. Review analysis indicated that EG clinical management is dependent on types of symptoms and their severity. Multilinear regression analysis showed that operative management strategy was associated with bone loss on X-ray (t=4.23, P=0.003), while EG surgical treatment during pregnancy was associated with pain (t=-2.91, P=0.03). No significant differences were found in management strategy, according to pain (P=0.12), interference with mastication (P=0.98) and speech (P=0.36). A poor oral hygiene was described in 71% of patients as hypothetical trigger. CONCLUSIONS EG management strategy depends on bleeding, pain and bone loss on X-ray. A multidisciplinary approach is useful to perform a rapid and appropriate diagnosis and to better evaluate pros and cons of surgery during pregnancy and following management.
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Affiliation(s)
- Giuseppe G Iorio
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy -
| | - Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Vera Donadono
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Marika Y Rovetto
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Laura Sarno
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Laura L Mazzarelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Angelo Sirico
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Giuseppina Esposito
- Department of Public Health, School of Medicine, Federico II University, Naples, Italy
| | - Cira Buonfantino
- Department of Public Health, School of Medicine, Federico II University, Naples, Italy
| | - Raffaella DI Girolamo
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Bruno Arduino
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Pietro D'Alessandro
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Giuseppe M Maruotti
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
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5
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Parhi L, Abed J, Shhadeh A, Alon-Maimon T, Udi S, Ben-Arye SL, Tam J, Parnas O, Padler-Karavani V, Goldman-Wohl D, Yagel S, Mandelboim O, Bachrach G. Placental colonization by Fusobacterium nucleatum is mediated by binding of the Fap2 lectin to placentally displayed Gal-GalNAc. Cell Rep 2022; 38:110537. [PMID: 35320712 DOI: 10.1016/j.celrep.2022.110537] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/20/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022] Open
Abstract
While the existence of an indigenous placental microbiota remains controversial, several pathogens are known to be involved in adverse pregnancy outcomes. Fusobacterium nucleatum is an oral bacterium that is one of several bacteria associated with preterm birth. Oral fusobacteria translocate to the placenta hematogenously; however, the mechanisms localizing them to the placenta remain unclear. Here, using peanut agglutinin, we demonstrate that the level of Gal-GalNAc (Galβ1-3GalNAc; Thomsen Friedenreich antigen) found on trophoblasts facing entering maternal blood rises during gestation and is recognized by the fusobacterial Fap2 Gal-GalNAc lectin. F. nucleatum binding to human and mouse placenta correlates with Gal-GalNAc levels and is reduced upon O-glycanase treatment or with soluble Gal-GalNAc. Fap2-inactivated F. nucleatum shows reduced binding to Gal-GalNAc-displaying placental sections. In a mouse model, intravenously injected Fap2-expressing F. nucleatum, but not a Fap2 mutant, reduces mouse fetal survival by 70%.
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Affiliation(s)
- Lishay Parhi
- The Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem 9112001, Israel
| | - Jawad Abed
- The Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem 9112001, Israel
| | - Amjad Shhadeh
- The Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem 9112001, Israel
| | - Tamar Alon-Maimon
- The Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem 9112001, Israel
| | - Shiran Udi
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Shani Leviatan Ben-Arye
- Department of Cell Research and Immunology, The Shmunis School of Biomedicine and Cancer Research, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Joseph Tam
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Oren Parnas
- Department of Immunology and Cancer Research, Institute for Medical Research Israel Canada (IMRIC), Hebrew University-Hadassah Medical School, Jerusalem 9112001, Israel
| | - Vered Padler-Karavani
- Department of Cell Research and Immunology, The Shmunis School of Biomedicine and Cancer Research, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Debra Goldman-Wohl
- Magda and Richard Hoffman Center for Human Placenta Research, Department of Obstetrics and Gynecology, Hebrew University Hadassah Medical Center, Jerusalem 91240, Israel
| | - Simcha Yagel
- Magda and Richard Hoffman Center for Human Placenta Research, Department of Obstetrics and Gynecology, Hebrew University Hadassah Medical Center, Jerusalem 91240, Israel
| | - Ofer Mandelboim
- Department of Immunology and Cancer Research, Institute for Medical Research Israel Canada (IMRIC), Hebrew University-Hadassah Medical School, Jerusalem 9112001, Israel.
| | - Gilad Bachrach
- The Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem 9112001, Israel.
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6
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Butera A, Maiorani C, Morandini A, Simonini M, Colnaghi A, Morittu S, Barbieri S, Ricci M, Guerrisi G, Piloni D, Cimarossa R, Fusaro B, Sinesi A, Bruni A, Scribante A. Assessment of Oral Microbiome Changes in Healthy and COVID-19-Affected Pregnant Women: A Narrative Review. Microorganisms 2021; 9:2385. [PMID: 34835510 PMCID: PMC8618476 DOI: 10.3390/microorganisms9112385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
During pregnancy, there are several metabolic changes and an alteration in the composition of microorganisms that inhabit the oral cavity, with an increase in pathogenic bacteria that promote the onset of gingival diseases. This review is based on research in reference to the PICO model (Problem/Intervention/Comparison/Outcome), related to changes in the oral microbiome of pregnant women and possible oral consequences in patients with COVID-19. The results showed a growth of some pathogenic bacteria in pregnant women, including Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum, and the selective growth of the Prevotella intermedia, Porphyromonas gingivalis and Tannerella species, probably due to the fact that these bacteria use progesterone as a source of nutrition. These same bacteria are implicated in the development of periodontal disease. Periodontal pockets have bidirectional interactions between the oral cavity and the systemic circulatory system through the peripheral gingival blood vessels. The affinity of the SARS-CoV-2 virus to specific membrane receptors is now clear, and could involve the internal and external epithelial lining or the fibroblasts of the periodontal ligament. According to the results of the present review, the control of oral microbiome changes during pregnancy would be welcomed. The use of probiotics could help clinicians manage pregnant patients, reducing inflammatory indexes. Future studies should focus not only on changes in the level of the oral microbiome in pregnancy or the correlation between periodontal disease and COVID-19, but also on oral changes induced by both clinical situations.
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Affiliation(s)
- Andrea Butera
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Carolina Maiorani
- Member Association: “Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (A.C.); (S.M.); (S.B.); (M.R.); (G.G.); (D.P.); (R.C.); (B.F.); (A.S.); (A.B.)
| | - Annalaura Morandini
- Member Association: “Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (A.C.); (S.M.); (S.B.); (M.R.); (G.G.); (D.P.); (R.C.); (B.F.); (A.S.); (A.B.)
| | - Manuela Simonini
- Member Association: “Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (A.C.); (S.M.); (S.B.); (M.R.); (G.G.); (D.P.); (R.C.); (B.F.); (A.S.); (A.B.)
| | - Arianna Colnaghi
- Member Association: “Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (A.C.); (S.M.); (S.B.); (M.R.); (G.G.); (D.P.); (R.C.); (B.F.); (A.S.); (A.B.)
| | - Stefania Morittu
- Member Association: “Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (A.C.); (S.M.); (S.B.); (M.R.); (G.G.); (D.P.); (R.C.); (B.F.); (A.S.); (A.B.)
| | - Stefania Barbieri
- Member Association: “Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (A.C.); (S.M.); (S.B.); (M.R.); (G.G.); (D.P.); (R.C.); (B.F.); (A.S.); (A.B.)
| | - Maria Ricci
- Member Association: “Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (A.C.); (S.M.); (S.B.); (M.R.); (G.G.); (D.P.); (R.C.); (B.F.); (A.S.); (A.B.)
| | - Gaetano Guerrisi
- Member Association: “Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (A.C.); (S.M.); (S.B.); (M.R.); (G.G.); (D.P.); (R.C.); (B.F.); (A.S.); (A.B.)
| | - Daniela Piloni
- Member Association: “Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (A.C.); (S.M.); (S.B.); (M.R.); (G.G.); (D.P.); (R.C.); (B.F.); (A.S.); (A.B.)
| | - Roberta Cimarossa
- Member Association: “Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (A.C.); (S.M.); (S.B.); (M.R.); (G.G.); (D.P.); (R.C.); (B.F.); (A.S.); (A.B.)
| | - Barbara Fusaro
- Member Association: “Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (A.C.); (S.M.); (S.B.); (M.R.); (G.G.); (D.P.); (R.C.); (B.F.); (A.S.); (A.B.)
| | - Antonia Sinesi
- Member Association: “Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (A.C.); (S.M.); (S.B.); (M.R.); (G.G.); (D.P.); (R.C.); (B.F.); (A.S.); (A.B.)
| | - Ambra Bruni
- Member Association: “Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (A.C.); (S.M.); (S.B.); (M.R.); (G.G.); (D.P.); (R.C.); (B.F.); (A.S.); (A.B.)
| | - Andrea Scribante
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
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7
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Balan P, Chong YS, Lin Q, Lim TK, Li H, Wong ML, Lopez V, He HG, Seneviratne CJ. Isobaric tags for relative and absolute quantification (iTRAQ)-based quantitative analysis of the salivary proteome during healthy pregnancy and pregnancy gingivitis. J Clin Periodontol 2021; 48:1559-1569. [PMID: 34605060 DOI: 10.1111/jcpe.13559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/25/2021] [Indexed: 02/06/2023]
Abstract
AIM The present study aimed to investigate the salivary proteome profiles of pregnant women with gingivitis (PG) or without gingivitis (HP) and non-pregnant healthy controls (HC) by employing iTRAQ-based proteomics. MATERIALS AND METHODS Saliva samples were collected from 30 Chinese women comprising 10 subjects in each of the three groups (PG, HP, and HC). The samples were subjected to iTRAQ-based proteomics analysis, and ELISA was performed to validate the results. The subsequent observations were validated in a cohort of 48 subjects. RESULTS Pathways associated with neutrophil-mediated immune response and antioxidant defence mechanism were significantly higher in PG than HC. The abundance of salivary cystatins (S, SA, and SN) and antimicrobials were significantly decreased in PG and HP, while cystatin C and D were additionally decreased in PG. Cystatin C was mapped to all the major catabolic pathways and was the most re-wired protein in pregnancy gingivitis. Further validation demonstrated cystatin C to be significantly lower in PG than HC. CONCLUSIONS While the decrease in levels of salivary cystatins and antimicrobial proteins may predispose healthy pregnant women to pregnancy gingivitis, it may cause persistence of inflammation in pregnant women with gingivitis.
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Affiliation(s)
- Preethi Balan
- Singapore Oral Microbiomics Initiative, National Dental Research Institute Singapore, National Dental Center, Singapore.,Oral Health Academic Clinical Program, Duke NUS Medical School, Singapore
| | - Yap S Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University Hospital, Singapore
| | - Qingsong Lin
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Teck Kwang Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Huihua Li
- Oral Health Academic Clinical Program, Duke NUS Medical School, Singapore
| | - Mun L Wong
- Discipline of Primary Dental Care and Population Oral Health, Faculty of Dentistry, National University of Singapore, Singapore
| | - Violeta Lopez
- School of Nursing, Hubei University of Medicine, Shiyan City, Hubei Province, China
| | - Hong Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chaminda Jayampath Seneviratne
- Singapore Oral Microbiomics Initiative, National Dental Research Institute Singapore, National Dental Center, Singapore.,Oral Health Academic Clinical Program, Duke NUS Medical School, Singapore
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8
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Regulation of matrix metalloproteinases-8, -9 and endogenous tissue inhibitor-1 in oral biofluids during pregnancy and postpartum. Arch Oral Biol 2021; 124:105065. [PMID: 33556788 DOI: 10.1016/j.archoralbio.2021.105065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 01/12/2021] [Accepted: 01/17/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE During pregnancy, mothers undergoe considerable physiological changes affecting the whole body including periodontal tissues. Susceptibility to gingival inflammation during pregnancy could be mediated by modulation of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). Therefore, the aim of this study was to investigate salivary and gingival crevicular fluid (GCF) levels of MMPs and TIMPs during the second and third trimester of pregnancy and postpartum. DESIGN Saliva and GCF samples were collected from 96 pregnant women (PW) before and after giving birth. The sixty matched non-pregnant women (N-PW) were recruited as a control group and full-mouth periodontal examination was performed. The levels of MMP-8, MMP-9 and TIMP-1 were determined by immunofluorometric and enzyme-linked immunosorbent assays. RESULTS The PW group exhibited significantly higher levels of MMP-8 and MMP-9 in their saliva than the N-PW group while corresponding salivary TIMP-1 levels were significantly lower in NPW compared to the postpartum stage. This resulted in significantly higher MMP-8/TIMP-1 and MMP-9/TIMP-1ratio in the saliva from PW before and after birth than in that from N-PW. MMP-8, MMP-9 and TIMP-1 levels were higher in GCF from PW and postpartum than in that from N-PW. CONCLUSIONS MMP-8 and MMP-9 levels in saliva and GCF reflect inflammatory burden during pregnancy. They could be used for monitoring the inflammatory state of gingival tissues during pregnancy.
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Bobetsis YA, Graziani F, Gürsoy M, Madianos PN. Periodontal disease and adverse pregnancy outcomes. Periodontol 2000 2020; 83:154-174. [PMID: 32385871 DOI: 10.1111/prd.12294] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Periodontal diseases are considered not only to affect tooth-supporting tissues but also to have a cause-and-effect relationship with various systemic diseases and conditions, such as adverse pregnancy outcomes. Mechanistic studies provide strong evidence that periodontal pathogens can translocate from infected periodontium to the feto-placental unit and initiate a metastatic infection. However, the extent and mechanisms by which metastatic inflammation and injury contribute to adverse pregnancy outcomes still remain unclear. The presence of oral bacteria in the placenta of women with term gestation further complicates our understanding of the biology behind the role of periodontal pathogens in pregnancy outcomes. Epidemiological studies demonstrate many methodological inconsistencies and flaws that render comparisons difficult and conclusions insecure. Therefore, despite the fact that a number of prospective studies show a positive association between periodontal diseases and various adverse pregnancy outcomes, the evidence behind it is still weak. Future well-designed explanatory studies are necessary to verify this relationship and, if present, determine its magnitude. The majority of high-quality randomized controlled trials reveal that nonsurgical periodontal therapy during the second trimester of gestation does not improve pregnancy outcomes. From a biological standpoint, this can be partially explained by the fact that therapy rendered at the fourth to sixth months of pregnancy is too late to prevent placental colonization by periodontal pathogens and consequently incapable of affecting pathogen-induced injury at the feto-placental unit. Thus, interventions during the preconception period may be more meaningful. With the increase in our understanding on the potential association between periodontal disease and adverse pregnancy outcomes, it is clear that dental practitioners should provide periodontal treatment to pregnant women that is safe for both the mother and the unborn child. Although there is not enough evidence that the anti-infective therapy alters pregnancy outcomes, it improves health-promoting behavior and periodontal condition, which in turn advance general health and risk factor control.
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Affiliation(s)
- Yiorgos A Bobetsis
- Department of Periodontology, National and Kapodistrian University of Athens, Athens, Greece
| | - Filippo Graziani
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Mervi Gürsoy
- Department of Periodontology, University of Turku, Turku, Finland
| | - Phoebus N Madianos
- Department of Periodontology, National and Kapodistrian University of Athens, Athens, Greece
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10
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Pedersen AML, Darwish M, Nicholson J, Edwards MI, Gupta AK, Belstrøm D. Gingival health status in individuals using different types of toothpaste. J Dent 2020; 80 Suppl 1:S13-S18. [PMID: 30696551 DOI: 10.1016/j.jdent.2018.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To examine the relationship between the medium term use (>1 year) of a toothpaste containing natural enzymes and proteins (Zendium™) upon gingival index, plaque index and bleeding index compared to medium term use of toothpastes without antimicrobial/antiinflammatory ingredients. METHODS A total of 305 participants eligible for inclusion were grouped according to their toothpaste use and matched with regard to gender and age (18-30, 31-55 and 56+ years of age). A total of 161 persons were using a toothpaste which contained enzymes and proteins (Zendium™, test group), and 144 persons were using a toothpaste without these ingredients (control group). The amount of dental plaque and the gingival condition were assessed at six sites of each tooth using the modified gingival index (MGI), plaque index (Modified Quigley and Hein plaque index, PI), and bleeding index (BI). Mean values of MGI, PI and BI were compared using analysis of covariance. RESULTS The test group had significantly less gingival inflammation than the control group (adjusted mean scores (SD); 1.80 (0.65) vs. 2.27 (0.63),p < 0.0001), as well as lower levels of plaque (2.03 (0.33) vs. 2.12 (0.33), p = 0.0168) and gingival bleeding (0.74 (0.45) vs. 1.08 (0.45), p < 0.0001). Females had significantly less gingival inflammation (p < 0.0001), plaque (p = 0.0005) and bleeding (p = 0.0118) than males. Participants aged 18-30 years had significantly higher levels of inflammation and bleeding than the older age groups (p < 0.001), and also higher plaque levels compared to participants aged 31-55 years (p = 0.0069). Potential confounding factors including oral hygiene practices and consistency of dental visits did not differ between groups. CONCLUSIONS Our findings indicate that medium term use of fluoride toothpaste containing enzymes and proteins (Zendium™) is associated with a better gingival health than the use of other types of fluoride toothpastes without antimicrobial active ingredients. CLINICAL SIGNIFICANCE Medium term (> 1 year) use of toothpaste containing naturally occurring enzymes and proteins (Zendium™) in an unsupervised home setting is associated with better gingival health compared to the unsupervised use of other commercially available toothpastes without antimicrobial/antiinflammatory active ingredients.
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Affiliation(s)
- A M L Pedersen
- Oral Medicine and Oral Pathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - M Darwish
- Periodontology and Oral Microbiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J Nicholson
- Unilever Oral Care, Quarry Road East, Bebington, Wirral, CH63 3JW, UK
| | - M I Edwards
- Unilever Oral Care, Unilever House, 100 Victoria Embankment, London, EC4Y 0DY, UK
| | - A K Gupta
- Hindustan Unilever Limited Research Centre, Main Road, Whitefield, Bangalore 560 066, India
| | - D Belstrøm
- Periodontology and Oral Microbiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Ayed MS, Alsharif AF, Divakar DD, Jhugroo C, Alosaimi B, Mustafa M. Evaluating the possible association between systemic osteoporosis and periodontal disease progression in postmenopausal women. Dis Mon 2018; 65:193-215. [PMID: 30502098 DOI: 10.1016/j.disamonth.2018.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To evaluate the association between systemic osteoporosis and periodontal diseases in postmenopausal women. A total of 300 women aged (50-70 years) were divided into an osteoporotic (OP) group (n = 150) and non-osteoporotic (NOP) group (n = 150) depending on BMD measured using (DXA) at the femoral neck and lumbar spine. Periodontal examination including PI, GI, PPD, and CAL was measured. A standard digital dental panoramic radiograph was taken for each patient and analyzed using specially developed software graphic program to assess the alveolar bone level and BMD. Elemental analysis of root surfaces of extracted teeth was done for detecting Ca, P, F, Mg, and K using (LIBS). Results showed the differences between both groups were not statistically significant in PI, GI, and PPD. A statistically significant difference was found between both groups in CAL, the distance between CEJ-AC and alveolar bone density. Elemental analysis of the root surfaces revealed that Ca was statistically significantly less in the OP group while the differences between both groups regarding F and P were not statistically significant. Mg and K found to be significantly more in the OP group than in the NOP group. To conclude osteoporosis is certainly a risk factor for periodontal disease and seems to plays a vital role in disease progression.
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Affiliation(s)
| | - Alaa Fuad Alsharif
- Department of Oral and Maxillofacial Surgery, Training Resident, Prince Mohammed bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia
| | - Darshan Devang Divakar
- Dental Health Department, Dental Biomaterials Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Chitra Jhugroo
- Indian Ocean Dental College and Hospital, Arsenal, Triolet, Mauritius
| | | | - Mohammed Mustafa
- Department of Conservative Dental Sciences, Division of Endodontics, College of Dentistry, Prince Sattam bin Abdulaziz University, P.O. Box:153, AlKharj 11942 Riyadh, Saudi Arabia
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12
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Yarkac FU, Gokturk O, Demir O. Effect of non-surgical periodontal therapy on the degree of gingival inflammation and stress markers related to pregnancy. J Appl Oral Sci 2018; 26:e20170630. [PMID: 30043934 PMCID: PMC6063465 DOI: 10.1590/1678-7757-2017-0630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/29/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The purpose of this study was to determine the impact of nonsurgical periodontal therapy considering the salivary stress-related hormone and cytokine levels in the gingival crevicular fluid (GCF) on pregnant and nonpregnant women. MATERIAL AND METHODS Thirty non-pregnant (control group) and 30 pregnant women (test group) that met the study inclusion criteria were chosen. Only participants with gingivitis were included. Clinical data and samples of GCF and saliva were collected at baseline and after periodontal therapy. The levels of interleukin-1 beta (Κ-1β) and IL-10, and concentration of salivary chromogranin A (CgA) hormone were analyzed by enzyme-linked immunosorbent assay (ELISA). The repeated measures analysis of variance was used for intragroup and intergroup analyses. RESULTS A major decrease in the gingival inflammation was observed in both groups after periodontal therapy (p<0.05). Periodontal treatment decreased the level of IL-1β in GCF (p<0.05) in control group, but no statistical difference was determined for GCF IL-1β in the test group. However, after periodontal therapy, the CgA hormone concentration was reduced in both groups (p<0.05). However, there was no difference in salivary CgA concentration, GCF IL-10 levels, and perceived stress scale (PSS)-10 between the groups (p>0.05). CONCLUSIONS Within the limitations of this study, periodontal therapy significantly improved the periodontal status and stress level. In addition, the severity of the gingival inflammation during pregnancy was related to stress. However, further studies will be needed to substantiate these early findings.
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Affiliation(s)
- Fatma Ucan Yarkac
- Gaziosmanpasa University, Faculty of Dentistry, Department of Periodontology, Tokat, Turkey
| | - Ozge Gokturk
- Abant Izzet Baysal University, Faculty of Dentistry, Department of Periodontology, Bolu, Turkey
| | - Osman Demir
- Gaziosmanpasa University, Faculty of Medicine, Department of Biostatistics, Tokat, Turkey
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13
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de Lima PO, Nani BD, Almeida B, Marcondes FK, Groppo FC, de Moraes ABA, Franz-Montan M, Cogo-Müller K. Stress-related salivary proteins affect the production of volatile sulfur compounds by oral bacteria. Oral Dis 2018; 24:1358-1366. [PMID: 29761905 DOI: 10.1111/odi.12890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine whether stress-related substances and sex hormones influence the growth and in vitro production of volatile sulfur compounds (VSCs) by Solobacterium moorei and Fusobacterium nucleatum. MATERIALS AND METHODS Bacteria growth and VSCs production were evaluated in the presence of alpha-amylase, beta-defensin-2, mucin, estradiol, and progesterone. Growth was evaluated by colony counting, and the production of the VSCs hydrogen sulfide (H2 S) and methyl mercaptan (CH3 SH) was measured using the Oral Chroma™ instrument. RESULTS Mucin induced the production of H2 S by both bacteria, but had a slight inhibitory effect on CH3 SH production by F. nucleatum. It also increased the viability of F. nucleatum. Alpha-amylase increased H2 S production by S. moorei and CH3 SH production by F. nucleatum, but had no effect on H2 S production by F. nucleatum. No substance altered the viability of S. moorei. No effects of beta-defensin-2, estradiol, or progesterone were observed. CONCLUSION The salivary stress-related proteins mucin and alpha-amylase altered VSCs production by F. nucleatum and S. moorei, favoring H2 S production. These findings are a step toward understanding the relation between stress and increased amounts of H2 S.
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Affiliation(s)
- Patricia Oliveira de Lima
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Bruno Dias Nani
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Barbara Almeida
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Fernanda Klein Marcondes
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Francisco Carlos Groppo
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Antonio Bento Alves de Moraes
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Michelle Franz-Montan
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Karina Cogo-Müller
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.,Faculty of Pharmaceutical Sciences, University of Campinas - UNICAMP, Campinas, SP, Brazil
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14
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Lin W, Jiang W, Hu X, Gao L, Ai D, Pan H, Niu C, Yuan K, Zhou X, Xu C, Huang Z. Ecological Shifts of Supragingival Microbiota in Association with Pregnancy. Front Cell Infect Microbiol 2018; 8:24. [PMID: 29497601 PMCID: PMC5819318 DOI: 10.3389/fcimb.2018.00024] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/18/2018] [Indexed: 02/05/2023] Open
Abstract
Pregnancy is a physiological process with pronounced hormonal fluctuations in females, and relatively little is known regarding how pregnancy influences the ecological shifts of supragingival microbiota. In this study, supragingival plaques and salivary hormones were collected from 11 pregnant women during pregnancy (P1, ≤14 weeks; P2, 20-25 weeks; P3, 33-37 weeks) and the postpartum period (P4, 6 weeks after childbirth). Seven non-pregnant volunteers were sampled at the same time intervals. The microbial genetic repertoire was obtained by 16S rDNA sequencing. Our results indicated that the Shannon diversity in P3 was significantly higher than in the non-pregnant group. The principal coordinates analysis showed distinct clustering according to gestational status, and the partial least squares discriminant analysis identified 33 genera that may contribute to this difference. There were differentially distributed genera, among which Neisseria, Porphyromonas, and Treponema were over-represented in the pregnant group, while Streptococcus and Veillonella were more abundant in the non-pregnant group. In addition, 53 operational taxonomic units were observed to have positive correlations with sex hormones in a redundancy analysis, with Prevotella spp. and Treponema spp. being most abundant. The ecological events suggest that pregnancy has a role in shaping an at-risk-for-harm microbiota and provide a basis for etiological studies of pregnancy-associated oral dysbiosis.
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Affiliation(s)
- Wenzhen Lin
- Department of Endodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Wenxin Jiang
- Department of Endodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Xuchen Hu
- Department of Endodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Li Gao
- Department of Endodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Dongmei Ai
- Department of Information and Computational Sciences, University of Science and Technology Beijing, Beijing, China
| | - Hongfei Pan
- Department of Information and Computational Sciences, University of Science and Technology Beijing, Beijing, China
| | - Chenguang Niu
- Department of Endodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Keyong Yuan
- Department of Endodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Changen Xu
- Obstetrics Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Zhengwei Huang
- Department of Endodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
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15
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Lasisi T, Abdus-Salam R. Pattern of Oral Health Among a Population of Pregnant Women in Southwestern Nigeria. ARCHIVES OF BASIC AND APPLIED MEDICINE 2018; 6:99-103. [PMID: 30035209 PMCID: PMC6052798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Oral health in pregnancy is important to the health of the pregnant woman; and good oral health plays a role in the outcome of pregnancy. However, many pregnant women and healthcare providers are either unaware of this or accord this less attention. The study was designed to describe pattern of oral health among a cohort of pregnant women. Seventy-seven pregnant women attending antenatal care at a secondary healthcare facility were evaluated in third trimester following written informed consent. Each participant had a structured data collection form administered and clinical examination conducted. Information on socio-demographic characteristics, dental and obstetric history and examination were obtained. Dental assessment involved the use of the oral hygiene, gingival, periodontal and caries indices. The data collected was entered and analysed using IBM SPSS Statistics version 20. The mean age of the participants was 29.90 (± 4.38) years and all women were in the third trimester of pregnancy. Only 6.5% of the participants had dental complaints, 26% indicated brushing twice a day and 96.1% never had dental health check in the past. A good oral hygiene score was found in 40% of participants; 6.5% and 10.4% had a healthy periodontal and gingival status respectively and only 8 (10.4%) had caries. Less than half of the pregnant women had good oral health status. The antenatal care period may be an opportunity to identify oral diseases; counsel and introduce positive oral health behaviours and enhance improved personal oral hygiene.
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Affiliation(s)
- T.J. Lasisi
- Department of Physiology, College of Medicine, University of Ibadan
- Department of Oral Pathology, University College Hospital. P.M.B. 5017, Ibadan, Nigeria
| | - R.A. Abdus-Salam
- Department of Obstetrics and Gynaecology, Adeoyo Maternity Teaching Hospital, Ibadan, Nigeria
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16
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Sandoval MJ, Zekeridou A, Spyropoulou V, Courvoisier D, Mombelli A, McLin V, Giannopoulou C. Oral health of pediatric liver transplant recipients. Pediatr Transplant 2017; 21. [PMID: 28670817 DOI: 10.1111/petr.13019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 01/25/2023]
Abstract
To evaluate oral health conditions in pediatric liver transplant recipients, with special focus on caries, green staining of the teeth, gingival bleeding, and gingival overgrowth. 40 patients (mean age 11.6 years) were examined at a routine follow-up visit, 6 months to 16 years after liver transplantation at the Swiss Center for Liver Disease in Children. After the medical examination, participants were further examined for the presence of dental caries, periodontal disease, GE, and GTC. The mean decay, missing, and filled teeth (dmft/DMFT) score was 3.8. 45% of the participants presented at least one carious lesion. Two-third of the participants had more than 20% of sites with the presence of plaque and gingival inflammation. Signs of GE were found in 18% and GTC in 30% of the participants. A positive correlation was identified between GTC and peak serum bilirubin (P<.001) and primary diagnosis of cholestatic disease (P=.04). Gingival inflammation was associated with plaque (P<.001), use of immunosuppressive medication (P=.04), and was more pronounced in children with cholestatic disease (P=.007). Children and young adults with liver transplants presented a rather poor oral health status. Liver transplant physicians should counsel patients for regular dental follow-up in order to avoid serious dental infections.
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Affiliation(s)
- Marίa José Sandoval
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Alkisti Zekeridou
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Vasiliki Spyropoulou
- Swiss Center for Liver Disease in Children, University Hospitals Geneva, Geneva, Switzerland
| | | | - Andrea Mombelli
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Valérie McLin
- Swiss Center for Liver Disease in Children, University Hospitals Geneva, Geneva, Switzerland
| | - Catherine Giannopoulou
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
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17
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Belstrøm D, Sembler-Møller ML, Grande MA, Kirkby N, Cotton SL, Paster BJ, Twetman S, Holmstrup P. Impact of Oral Hygiene Discontinuation on Supragingival and Salivary Microbiomes. JDR Clin Trans Res 2017; 3:57-64. [PMID: 29662960 PMCID: PMC5896869 DOI: 10.1177/2380084417723625] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of the present study was to characterize and compare supragingival and salivary microbiotas during a 10-d period of oral hygiene discontinuation. We tested the hypothesis that the composition of the salivary microbiota will reflect local microbial changes associated with accumulated biofilm formation and maturation. Pooled supragingival plaque (n = 145) and stimulated saliva (n = 145) samples were collected and plaque and gingival indices were recorded from 29 orally healthy individuals at baseline, during oral hygiene discontinuation (days 4, 7, and 10), and 14 d after resumption of oral hygiene. Supragingival and salivary microbiotas were processed by next-generation sequencing (Human Oral Microbe Identification using Next Generation Sequencing) and microbial community profiles were compared. Microbial composition of supragingival plaque samples collected after 4, 7, and 10 d of oral hygiene discontinuation, as well as 14 d after reuptake of oral hygiene, differed significantly from baseline samples, by a 3-fold increase in relative abundance Leptotrichia species and a 2-fold decrease in Streptococcus species (adjusted P < 0.01). In saliva samples, a significant increase in relative abundance of Leptotrichia species (adjusted P < 0.01) was evident at day 7 but completely reversed 14 d after resumption of oral hygiene. While the salivary microbiota was resistant to accumulated local biofilm formation, data from this study showed that compositional changes of supragingival microbiotas were not reversed 14 d after resumption of oral hygiene, despite the restoration of plaque to baseline levels. (ClinicalTrials.gov UCPH_OI_002, NCT02913235). Knowledge Transfer Statement: Data from this study showed compositional changes of supragingival microbiotas as a consequence of a 10-d period of oral hygiene discontinuation, that was not reversed 14 d after resumption of oral hygiene. Notably, oral hygiene discontinuation was associated with a significant increase in relative abundance of potential cariogenic Leptotrichia species and a decrease in Streptococcus species. Thus, findings from this study highlight the necessity of regular oral hygiene in the maintenance of oral homeostasis.
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Affiliation(s)
- D Belstrøm
- Section for Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - M L Sembler-Møller
- Section for Oral Medicine, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - M A Grande
- Section for Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - N Kirkby
- Department of Medical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - S L Cotton
- The Forsyth Institute, Cambridge, MA, USA
| | - B J Paster
- The Forsyth Institute, Cambridge, MA, USA.,Department of Oral Medicine, Infection & Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - S Twetman
- Section for Cariology, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - P Holmstrup
- Section for Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Denmark
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18
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Machado FC, Cesar DE, Apolônio ACM, Ribeiro LC, Ribeiro RA. Longitudinal study on clinical and microbial analysis of periodontal status in pregnancy. Braz Oral Res 2016; 30:e87. [PMID: 27556678 DOI: 10.1590/1807-3107bor-2016.vol30.0087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 05/24/2016] [Indexed: 11/22/2022] Open
Abstract
This study was aimed to provide a longitudinal overview of the subgingival bacterial microbiome using fluorescence in situ hybridization (FISH) technique, in women in the second trimester of pregnancy (between 14 and 24 weeks), and 48 h and 8 weeks postpartum. Of 31 women evaluated during pregnancy, 24 returned for the 48-h and 18 for their 8-week exams postpartum. Probing depth (PD), bleeding on probing, clinical attachment level, and presence of calculus were recorded. Subgingival plaque samples were collected, and FISH was used to identify the numbers of eight periodontal pathogens. Friedman test was used to compare differences between follow-up examinations, followed by a multiple comparison test for a post hoc pairwise comparison. Clinically, a significantly greater number of teeth with PD = 4-5 mm were found during pregnancy than on postpartum examinations. Microbial analysis showed a statistically significant decrease in cell count over the study period for Prevotella nigrescens. P. intermedia, Campylobacter rectus, and Porphyromonas gingivalis also decrease, although not significantly, and Aggregatibacter actinomycetemcomitans increased. No significant changes were found for Fusobacterium nucleatum, Treponema denticola, or Tannerella forsythia. Our data demonstrate a change in the subgingival microbiota during pregnancy, at least for P. nigrescens.
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Affiliation(s)
| | - Dionéia Evangelista Cesar
- Universidade Federal de Juiz de Fora - UFJF, Biological Sciences Institute, Department of Ecology, Juiz de Fora, MG, Brazil
| | - Ana Carolina Morais Apolônio
- Universidade Federal de Juiz de Fora - UFJF, Biological Sciences Institute, Department of Parasitology, Microbiology and Immunology, Juiz de Fora, MG, Brazil
| | - Luiz Claudio Ribeiro
- Universidade Federal de Juiz de Fora - UFJF, Department of Statistics, Juiz de Fora, MG, Brazil
| | - Rosangela Almeida Ribeiro
- Universidade Federal de Juiz de Fora - UFJF, School of Dentistry, Department of Social and Child Dentistry, Juiz de Fora, MG, Brazil
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19
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Gürsoy M, Gürsoy UK, Liukkonen A, Kauko T, Penkkala S, Könönen E. Salivary antimicrobial defensins in pregnancy. J Clin Periodontol 2016; 43:807-15. [PMID: 27191801 DOI: 10.1111/jcpe.12581] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 12/18/2022]
Abstract
AIM Susceptibility to and severity of gingival inflammation are enhanced during pregnancy; however, regulation of oral innate immune response, including antimicrobial peptides, during pregnancy is still unknown. We analysed salivary levels of human beta-defensin (hBD)-1, -2, -3, and human neutrophil peptide (HNP)-1 in pregnant women, and related those to their periodontal status. MATERIAL AND METHODS In this cohort study, 30 generally healthy, non-smoking Caucasian women without periodontitis were followed at three time points during pregnancy and twice post-partum. The non-pregnant group consisted of 24 women, who were examined three times at the following months. At each visit, periodontal status was recorded and stimulated saliva samples were collected. Salivary estradiol, progesterone, and defensin concentrations were measured by ELISA assays. RESULTS After adjusting for visible plaque and gingival bleeding, reduced salivary concentrations of hBD-1, hBD-2, and HNP-1 were found especially during the third trimester, whereas hBD-3 concentrations did not change during pregnancy and post-partum visits. Weak associations were observed between salivary defensin and hormone concentrations and clinical parameters. CONCLUSION There seems to be an independent regulation cascade for each antimicrobial defensin in the oral cavity during pregnancy, despite of the similarities between these antimicrobial peptides.
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Affiliation(s)
- Mervi Gürsoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland.
| | - Ulvi K Gürsoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Anna Liukkonen
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Tommi Kauko
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Saara Penkkala
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Eija Könönen
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland.,Oral Health Care, Welfare Division, City of Turku, Turku, Finland
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20
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Does estradiol have an impact on the dipeptidyl peptidase IV enzyme activity of the Prevotella intermedia group bacteria? Anaerobe 2015; 36:14-8. [DOI: 10.1016/j.anaerobe.2015.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 11/18/2022]
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21
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Jitprasertwong P, Charadram N, Kumphune S, Pongcharoen S, Sirisinha S. Female sex hormones modulate Porphyromonas gingivalis
lipopolysaccharide-induced Toll-like receptor signaling in primary human monocytes. J Periodontal Res 2015; 51:395-406. [DOI: 10.1111/jre.12320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 02/02/2023]
Affiliation(s)
- P. Jitprasertwong
- Department of Preventive Dentistry; Faculty of Dentistry; Naresuan University; Phitsanulok Thailand
| | - N. Charadram
- Department of Restorative Dentistry; Faculty of Dentistry; Naresuan University; Phitsanulok Thailand
| | - S. Kumphune
- Faculty of Allied Health Science; Biomedical Research Unit in Cardiovascular Sciences; Naresuan University; Phitsanulok Thailand
| | - S. Pongcharoen
- Department of Medicine; Faculty of Medicine; Naresuan University; Phitsanulok Thailand
- Centre of Excellence in Medical Biotechnology (CEMB); Faculty of Medical Science; Naresuan University; Phitsanulok Thailand
| | - S. Sirisinha
- Department of Microbiology; Faculty of Science; Mahidol University; Bangkok Thailand
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22
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Relationship between gingival inflammation and pregnancy. Mediators Inflamm 2015; 2015:623427. [PMID: 25873767 PMCID: PMC4385665 DOI: 10.1155/2015/623427] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/28/2014] [Indexed: 01/09/2023] Open
Abstract
An increase in the prevalence and severity of gingival inflammation during pregnancy has been reported since the 1960s. Though the etiology is not fully known, it is believed that increasing plasma sex steroid hormone levels during pregnancy have a dramatic effect on the periodontium. Current works of research have shown that estrogen and progesterone increasing during pregnancy are supposed to be responsible for gingivitis progression. This review is focused not only on epidemiological studies, but also on the effects of progesterone and estrogen on the change of subgingival microbiota and immunologic physiological mediators in periodontal tissue (gingiva and periodontal ligament), which provides current information about the effects of pregnancy on gingival inflammation.
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Köseoğlu S, Sağlam M, Pekbağrıyanık T, Savran L, Sütçü R. Level of Interleukin-35 in Gingival Crevicular Fluid, Saliva, and Plasma in Periodontal Disease and Health. J Periodontol 2015; 86:964-71. [PMID: 25786564 DOI: 10.1902/jop.2015.140666] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND A novel member of the interleukin (IL)-12 family, IL-35 is an important inhibitory cytokine released by regulatory T cells. The aim of this study is to evaluate gingival crevicular fluid (GCF), saliva, and plasma levels of IL-35 in periodontal disease and health. METHODS Samples of GCF, whole saliva, and plasma were obtained from systemically healthy, non-smoking individuals with gingivitis (n = 20) or chronic periodontitis (CP) (n = 20) and periodontally healthy individuals (n = 20). Full-mouth clinical periodontal measurements, including probing depth (PD), bleeding on probing, gingival index, and plaque index (PI), were also recorded. Enzyme-linked immunosorbent assay was used to determine IL-35 levels in the samples. Data were tested statistically by analysis of variance and Pearson rank correlation test. RESULTS All clinical parameters were significantly higher in the CP group than the healthy and gingivitis groups (P <0.001). The GCF total amount of IL-35 was significantly higher in the CP group than the other groups (P = 0.04), whereas the GCF concentration of IL-35 was significantly higher in the healthy group than the other groups (P = 0.002). There were significant differences among the study groups in terms of salivary IL-35 level (P <0.001), with the highest level observed in the healthy group and the lowest in the CP group. There was no statistical difference between groups in plasma levels of IL-35 (P >0.05). There was a positive correlation between GCF total amount of IL-35 and PD (r = 0.338, P = 0.03) and PI (r = 0.374, P = 0.005) parameters. CONCLUSIONS IL-35 could have an important role in suppressing periodontal inflammation and maintaining periodontal health. Additional studies are required to evaluate its role in periodontal diseases.
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Affiliation(s)
- Serhat Köseoğlu
- Department of Periodontology, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Turkey
| | - Mehmet Sağlam
- Department of Periodontology, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Turkey
| | - Tuğba Pekbağrıyanık
- Department of Periodontology, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Turkey
| | - Levent Savran
- Department of Periodontology, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Turkey
| | - Recep Sütçü
- Department of Medical Biochemistry, School of Medicine, Izmir Katip Çelebi University
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24
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Sağlam M, Köseoğlu S, Savran L, Pekbağriyanik T, Sağlam G, Sütçü R. Levels of interleukin-37 in gingival crevicular fluid, saliva, or plasma in periodontal disease. J Periodontal Res 2014; 50:614-21. [PMID: 25399716 DOI: 10.1111/jre.12241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to compare the levels of levels of interleukin-37 (IL-37) in gingival crevicular fluid, saliva and plasma in patients with periodontal disease and patients with healthy periodontium and to correlate these levels with clinical parameters. MATERIAL AND METHODS Samples of gingival crevicular fluid, whole saliva and plasma were collected from systemically healthy, nonsmoker periodontally healthy controls (group 1, n = 20), gingivitis patients (group 2, n = 20) and chronic periodontitis patients (group 3, n = 20). Full-mouth clinical periodontal parameters, including probing depth, plaque index, gingival index and bleeding on probing, were also recorded. IL-37 levels in the biofluid samples were determined by ELISA. Data were tested statistically using the Kruskal-Wallis test followed by the Mann-Whitney U-test. RESULTS The concentration of IL-37 in gingival crevicular fluid was significantly lower in group 3 than in groups 1 and 2 (p = 0.001), whereas the total amounts in gingival crevicular fluid samples were similar (p > 0.05). The salivary and plasma concentrations of IL-37 were similar in the study groups (p > 0.05). There were negative correlations between gingival crevicular fluid IL-37 concentrations and gingival crevicular fluid volume in all groups (p < 0.05). There was also a negative correlation between the gingival crevicular fluid IL-37 concentration and gingival index in group 3 (p < 0.05). CONCLUSIONS IL-37 was expressed in all biofluids. According to our findings, the total amount of IL-37 in gingival crevicular fluid, or salivary or plasma concentrations of IL-37, may not be useful diagnostic markers to differentiate periodontal disease and the periodontally healthy condition. The difference in gingival crevicular fluid IL-37 concentration between the study groups may be a result of the variation in gingival crevicular fluid volume, as suggested by the negative correlation between gingival crevicular fluid volume and gingival crevicular fluid IL-37 concentration. In the light of our findings, it seems that IL-37 is not involved in periodontal disease. Further comprehensive studies may clarify this issue more clearly.
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Affiliation(s)
- M Sağlam
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - S Köseoğlu
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - L Savran
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - T Pekbağriyanik
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - G Sağlam
- Department of Medical Biochemistry, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - R Sütçü
- Department of Medical Biochemistry, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey
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25
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Pereira FMBG, Rodrigues VP, de Oliveira AEF, Brito LMO, Lopes FF. Association between periodontal changes and osteoporosis in postmenopausal women. Climacteric 2014; 18:311-5. [DOI: 10.3109/13697137.2014.966239] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Gürsoy M, Zeidán-Chuliá F, Könönen E, Moreira JCF, Liukkonen J, Sorsa T, Gürsoy UK. Pregnancy-induced gingivitis and OMICS in dentistry: in silico modeling and in vivo prospective validation of estradiol-modulated inflammatory biomarkers. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2014; 18:582-90. [PMID: 24983467 DOI: 10.1089/omi.2014.0020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pregnancy-associated gingivitis is a bacterial-induced inflammatory disease with a remarkably high prevalence ranging from 35% to 100% across studies. Yet little is known about the attendant mechanisms or diagnostic biomarkers that can help predict individual susceptibility for rational personalized medicine. We aimed to define inflammatory proteins in saliva, induced or inhibited by estradiol, as early diagnostic biomarkers or target proteins in relation to pregnancy-associated gingivitis. An in silico gene/protein interaction network model was developed by using the STITCH 3.1 with "experiments" and "databases" as input options and a confidence score of 0.700 (high confidence). Salivary estradiol, interleukin (IL)-1β and -8, myeloperoxidase (MPO), matrix metalloproteinase (MMP)-2, -8, and -9, and tissue inhibitor of matrix metalloproteinase (TIMP)-1 levels from 30 women were measured prospectively three times during pregnancy and twice during postpartum. In silico analysis revealed that estradiol interacts with IL-1β and -8 by an activation link when the "actions view" was consulted. In saliva, estradiol concentrations associated positively with TIMP-1 and negatively with MPO and MMP-8 concentrations. When the gingival bleeding on probing percentage (BOP%) was included in the model as an effect modifier, the only association, a negative one, was found between estradiol and MMP-8. Throughout gestation, estradiol modulates the inflammatory response by inhibiting neutrophilic enzymes, such as MMP-8. The interactions between salivary degradative enzymes and proinflammatory cytokines during pregnancy suggest promising ways to identify candidate biomarkers for pregnancy-associated gingivitis, and for personalized medicine in the field of dentistry. Finally, we call for greater investments in, and action for biomarker research in periodontology and dentistry that have surprisingly lagged behind in personalized medicine compared to other fields, such as cancer research.
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Affiliation(s)
- Mervi Gürsoy
- 1 Department of Periodontology, Institute of Dentistry, University of Turku , Turku, Finland
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27
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Fteita D, Könönen E, Söderling E, Gürsoy UK. Effect of estradiol on planktonic growth, coaggregation, and biofilm formation of the Prevotella intermedia group bacteria. Anaerobe 2014; 27:7-13. [DOI: 10.1016/j.anaerobe.2014.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/20/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022]
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28
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Jitprasertwong P, Chaisomboon N, Jamdee K. Progesterone, but not β-estradiol, enhances Porphyromonas gingivalis lipopolysaccharide-induced vascular endothelial growth factor-A expression in human THP-1 monocytes. J Dent Sci 2013. [DOI: 10.1016/j.jds.2013.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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29
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Pöllänen MT, Paino A, Ihalin R. Environmental stimuli shape biofilm formation and the virulence of periodontal pathogens. Int J Mol Sci 2013; 14:17221-37. [PMID: 23965982 PMCID: PMC3759961 DOI: 10.3390/ijms140817221] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/02/2013] [Accepted: 08/07/2013] [Indexed: 12/31/2022] Open
Abstract
Periodontitis is a common inflammatory disease affecting the tooth-supporting structures. It is initiated by bacteria growing as a biofilm at the gingival margin, and communication of the biofilms differs in health and disease. The bacterial composition of periodontitis-associated biofilms has been well documented and is under continual investigation. However, the roles of several host response and inflammation driven environmental stimuli on biofilm formation is not well understood. This review article addresses the effects of environmental factors such as pH, temperature, cytokines, hormones, and oxidative stress on periodontal biofilm formation and bacterial virulence.
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Affiliation(s)
- Marja T. Pöllänen
- Institute of Dentistry, University of Turku, FI-20014 Turku, Finland
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +358-40-723-58-18
| | - Annamari Paino
- Department of Biochemistry and Food Chemistry, University of Turku, FI-20014 Turku, Finland; E-Mails: (A.P.); (R.I.)
| | - Riikka Ihalin
- Department of Biochemistry and Food Chemistry, University of Turku, FI-20014 Turku, Finland; E-Mails: (A.P.); (R.I.)
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