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Geurs NC, Jeffcoat MK, Tanna N, Geisinger ML, Parry S, Biggio JR, Doyle MJ, Grender JM, Gerlach RW, Reddy MS. A Randomized Controlled Clinical Trial of Prenatal Oral Hygiene Education in Pregnancy-Associated Gingivitis. J Midwifery Womens Health 2023; 68:507-516. [PMID: 37026567 DOI: 10.1111/jmwh.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/18/2023] [Accepted: 02/02/2023] [Indexed: 04/08/2023]
Abstract
INTRODUCTION Research shows there is a significant increase in gingival inflammation during pregnancy. This study was conducted to determine if an oral health intervention (OHI), including oral hygiene education delivered by nurse-led staff and an advanced over-the-counter (OTC) oral home care regimen, improved gingival inflammation in pregnant women with moderate-to-severe gingivitis compared with a standard oral hygiene control group. METHODS This was a multicenter, randomized, controlled, single-masked, parallel group clinical trial conducted in obstetrics clinics of 2 medical centers. A total of 750 pregnant women between 8 and 24 weeks of pregnancy with at least 20 natural teeth and moderate-to-severe gingivitis (>30 intraoral bleeding sites) were enrolled. Participants were randomized to either the OHI group, which included oral hygiene instructions supplemented with an educational video and advanced OTC antibacterial/mechanical oral hygiene products, or the control group receiving oral hygiene instructions and standard products. Both groups received oral hygiene instructions from nurse-led staff. Experienced, masked examiners measured whole mouth gingival index (GI) and periodontal probing depths (PDs) at baseline and months 1, 2, and 3. RESULTS Participants enrolled in this study presented with moderate-to-severe gingivitis at baseline. Both the OHI and control groups exhibited significant reductions in GI (P < .001) and PD (P < .03) from baseline that persisted throughout the study period. The OHI group exhibited modest, yet statistically greater, reductions in GI (P ≤ .044) compared with the control at all time points. The reduction in PD directionally favored the OHI group, but between-group differences were small (<0.03 mm) and not statistically significant (P > .18). DISCUSSION Significant gingivitis was prevalent among participants in this study and identifies an opportunity to improve gingival health during pregnancy by providing oral health education during the course of prenatal care when coupled with an advanced OTC oral hygiene regimen.
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Affiliation(s)
- Nicolaas C Geurs
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marjorie K Jeffcoat
- Department of Periodontics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nipul Tanna
- Department of Periodontics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maria L Geisinger
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph R Biggio
- Department of Obstetrics and Gynecology, Ochsner Baptist, New Orleans, Louisiana
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Matthew J Doyle
- Research & Development, The Procter & Gamble Company, Cincinnati, Ohio
| | - Julie M Grender
- Research & Development, The Procter & Gamble Company, Cincinnati, Ohio
| | - Robert W Gerlach
- Research & Development, The Procter & Gamble Company, Cincinnati, Ohio
| | - Michael S Reddy
- School of Dentistry, University of California San Francisco, San Francisco, California
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Lieske B, Makarova N, Jagemann B, Walther C, Ebinghaus M, Zyriax BC, Aarabi G. Inflammatory Response in Oral Biofilm during Pregnancy: A Systematic Review. Nutrients 2022; 14:nu14224894. [PMID: 36432584 PMCID: PMC9694722 DOI: 10.3390/nu14224894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/20/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Understanding the inflammatory response in oral biofilm during pregnancy and its association with oral and maternal health is essential for identifying biomarker patterns that may serve as markers of pregnancy-related complications. We aimed to conduct a systematic review of the available literature to assess: (1) inflammatory responses in oral biofilm during pregnancy, (2) the association between inflammatory responses in oral biofilm during pregnancy and maternal, oral or systemic conditions, (3) changes in the response of inflammatory biomarkers found in the oral biofilm during different pregnancy stages, and (4) the value of other risk factors such as nutrition and lifestyle. PubMed, Web of Science and Cochrane Library were systematically searched from inception until April 2022. From 5441 records, 39 studies were included for qualitative assessment. The oral biofilm in pregnant women was associated with increased inflammatory biomarkers when compared to non-pregnant women. Levels of inflammatory biomarkers in the oral biofilm were found to be highest in pregnant women with systemic conditions. Increased inflammatory biomarkers in the oral biofilm were also associated with worse oral health outcomes. Given the importance of nutrition and lifestyle for pregnancy and oral health outcomes and the fact that these factors were largely excluded in the included studies, future research should consider a holistic view of the mother during pregnancy to capture physiological, hormonal, immunologic, and metabolic changes in the context of inflammatory responses.
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Affiliation(s)
- Berit Lieske
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, O58, 20246 Hamburg, Germany
- Midwifery Science–Health Care Research and Prevention, Research Group Preventive Medicine and Nutrition, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Martinistraße 52, W38, 20246 Hamburg, Germany
- Correspondence:
| | - Nataliya Makarova
- Midwifery Science–Health Care Research and Prevention, Research Group Preventive Medicine and Nutrition, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Martinistraße 52, W38, 20246 Hamburg, Germany
| | - Bettina Jagemann
- Midwifery Science–Health Care Research and Prevention, Research Group Preventive Medicine and Nutrition, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Martinistraße 52, W38, 20246 Hamburg, Germany
| | - Carolin Walther
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, O58, 20246 Hamburg, Germany
| | - Merle Ebinghaus
- Midwifery Science–Health Care Research and Prevention, Research Group Preventive Medicine and Nutrition, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Martinistraße 52, W38, 20246 Hamburg, Germany
| | - Birgit-Christiane Zyriax
- Midwifery Science–Health Care Research and Prevention, Research Group Preventive Medicine and Nutrition, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Martinistraße 52, W38, 20246 Hamburg, Germany
| | - Ghazal Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, O58, 20246 Hamburg, Germany
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Liu Y, Qv W, Ma Y, Zhang Y, Ding C, Chu M, Chen F. The interplay between oral microbes and immune responses. Front Microbiol 2022. [DOI: 10.3389/fmicb.2022.1009018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Oral microbes play a critical role in maintaining oral homeostasis. Microbial dysbiosis promotes disease pathogenesis through several mechanisms. Recent studies have revealed that microbial imbalance and sustained inflammation are involved in disease progression. The adverse interaction triggered by a host immune response to microorganisms can lead to oral and systemic diseases. Here, we reviewed how oral microbes communicate with hosts during the development of local and distant inflammation. Elucidation of these processes may reveal future directions in this field and the potential targets of novel biological therapies for oral and systemic diseases.
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Bhuyan R, Bhuyan SK, Mohanty JN, Das S, Juliana N, Abu IF. Periodontitis and Its Inflammatory Changes Linked to Various Systemic Diseases: A Review of Its Underlying Mechanisms. Biomedicines 2022; 10:biomedicines10102659. [PMID: 36289921 PMCID: PMC9599402 DOI: 10.3390/biomedicines10102659] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/20/2022] Open
Abstract
Periodontitis is a chronic inflammatory disease of the gums. The incidence of periodontitis is increasing all over the world. In patients with periodontitis, there is gradual destruction of the periodontal ligament and the alveolar bone, and later, in advanced stages, there is tooth loss. Different microorganisms, the host’s immune response, and various environmental factors interact in the progression of this chronic inflammatory disease. In the present review, we discuss the epidemiology, clinical features, diagnosis, and complications of periodontitis. We also discuss the association of chronic inflammation found in periodontitis with various other systemic diseases, which include cardiovascular, respiratory, diabetes, Alzheimer’s, cancer, adverse pregnancy, and multiple myeloma, and also highlight microbial carcinogenesis and the microRNAs involved. The latest updates on the molecular mechanism, possible biomarkers, and treatment procedures may be beneficial for diagnostic and therapeutic purposes.
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Affiliation(s)
- Ruchi Bhuyan
- Department of Oral Pathology & Microbiology, IMS and SUM Hospital, Siksha ‘O’ Anusandhan University (Deemed to be), Bhubaneswar 751003, India
- Department of Medical Research, IMS and SUM Hospital, Siksha ‘O’ Anusandhan University (Deemed to be), Bhubaneswar 751003, India
| | - Sanat Kumar Bhuyan
- Institute of Dental Sciences, Siksha ‘O’ Anusandhan University (Deemed to be), Bhubaneswar 751003, India
| | - Jatindra Nath Mohanty
- Department of Medical Research, IMS and SUM Hospital, Siksha ‘O’ Anusandhan University (Deemed to be), Bhubaneswar 751003, India
| | - Srijit Das
- School of Applied Sciences, Centurion University of Technology and Management, Jatni, Bhubaneswar 752050, India
- Correspondence:
| | - Norsham Juliana
- Department of Human and Clinical Anatomy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman
| | - Izuddin Fahmy Abu
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
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Starzyńska A, Wychowański P, Nowak M, Sobocki BK, Jereczek-Fossa BA, Słupecka-Ziemilska M. Association between Maternal Periodontitis and Development of Systematic Diseases in Offspring. Int J Mol Sci 2022; 23:ijms23052473. [PMID: 35269617 PMCID: PMC8910384 DOI: 10.3390/ijms23052473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 12/24/2022] Open
Abstract
Periodontal disease (PD) is one of the most common oral conditions affecting both youths and adults. There are some research works suggesting a high incidence of PD in pregnant women. As an inflammatory disease of bacterial origin, PD may result in the activation of the pathways affecting the course and the pregnancy outcome. The authors, based on the literature review, try to answer the PICO question: Does maternal periodontitis (exposure) influence the incidence of complications rates in pregnancy and the development of systemic diseases in childhood and adult offspring (outcome) in the humans of any race (population) compared to the offspring of mothers with healthy periodontium (comparison)? The authors try to describe the molecular pathways and mechanisms of these interdependencies. There is some evidence that maternal periodontitis may affect the pregnancy course and outcome, resulting in preeclampsia, preterm delivery, vulvovaginitis and low birth weight. It can be suggested that maternal periodontitis may affect offspring epigenome and result in some health consequences in their adult life.
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Affiliation(s)
- Anna Starzyńska
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland;
- Correspondence:
| | - Piotr Wychowański
- Department of Oral Surgery, Medical University of Warsaw, 6 Binieckiego Street, 02-097 Warsaw, Poland;
- Specialized Private Implantology Clinic Wychowanski Stomatologia, 9/33 Rakowiecka Street, 02-517 Warsaw, Poland
| | - Maciej Nowak
- Department of Periodontology and Oral Diseases, Medical University of Warsaw, 6 Binieckiego Street, 02-097 Warsaw, Poland;
| | - Bartosz Kamil Sobocki
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland;
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, 7 Festa del Perdono Street, 20-112 Milan, Italy;
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, 435 Ripamonti Street, 20-141 Milan, Italy
| | - Monika Słupecka-Ziemilska
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5 Pawińskiego Street, 02-106 Warsaw, Poland;
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Porto ECL, Gomes Filho IS, Batista JET, Lyrio AO, Souza ES, Figueiredo ACMG, Pereira MG, Cruz SSD. [Maternal periodontitis and low birth weight: systematic review and meta-analysis]. CIENCIA & SAUDE COLETIVA 2021; 26:5383-5392. [PMID: 34787227 DOI: 10.1590/1413-812320212611.3.32362019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/20/2020] [Indexed: 11/22/2022] Open
Abstract
Recent evidence points to the influence of periodontal inflammatory processes on the occurrence of low birth weight. Although many studies employed robust investigation methods, there is still no general agreement on the relationship between maternal periodontitis and low birth weight. The search for studies was conducted until April 2019. The studies included cohort and case-control studies that estimated the association between periodontitis and low birth weight, with no restriction on language or date of publication. Analysis of the heterogeneity of studies, subgroup analyses and meta-analyses with a random effects model were performed. Summary association measurements were estimated using the crude and adjusted Odds Ratio, with respective 95% confidence intervals. Visual inspection of graphs was used to assess publication bias. A total of 21 articles were identified, all of which were selected for the meta-analysis. The final model indicates that periodontitis in pregnant women was associated with low birth weight (ORgross=2.13; CI95%=1.60-2.83; I2=80.0% and ORadjusted=2.64; CI95%=2.04-3.42; I2=17.4%). Pregnant women with periodontitis may be more than twice as likely to have low birth weight babies.
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Affiliation(s)
- Edla Carvalho Lima Porto
- Universidade Estadual de Feira de Santana. Av. Transnordestina s/n, Feira de Santana. 44036-900 Novo Horizonte BA Brasil.
| | - Isaac Suzart Gomes Filho
- Universidade Estadual de Feira de Santana. Av. Transnordestina s/n, Feira de Santana. 44036-900 Novo Horizonte BA Brasil.
| | - Josicélia Estrela Tuy Batista
- Universidade Estadual de Feira de Santana. Av. Transnordestina s/n, Feira de Santana. 44036-900 Novo Horizonte BA Brasil.
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7
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Antimicrobials from Medicinal Plants: An Emergent Strategy to Control Oral Biofilms. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11094020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Oral microbial biofilms, directly related to oral diseases, particularly caries and periodontitis, exhibit virulence factors that include acidification of the oral microenvironment and the formation of biofilm enriched with exopolysaccharides, characteristics and common mechanisms that, ultimately, justify the increase in antibiotics resistance. In this line, the search for natural products, mainly obtained through plants, and derived compounds with bioactive potential, endorse unique biological properties in the prevention of colonization, adhesion, and growth of oral bacteria. The present review aims to provide a critical and comprehensive view of the in vitro antibiofilm activity of various medicinal plants, revealing numerous species with antimicrobial properties, among which, twenty-four with biofilm inhibition/reduction percentages greater than 95%. In particular, the essential oils of Cymbopogon citratus (DC.) Stapf and Lippia alba (Mill.) seem to be the most promising in fighting microbial biofilm in Streptococcus mutans, given their high capacity to reduce biofilm at low concentrations.
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8
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Conceição SDS, Gomes-Filho IS, Coelho JMF, Brito SM, Silva RB, Batista JET, Figueiredo ACMG, Hintz AM, Lyrio AO, Souza ES, Pereira MG, Loomer PM, Cruz SSD. An accuracy study of the clinical diagnosis of periodontitis in pregnant women. J Periodontol 2020; 92:1243-1251. [PMID: 33252149 DOI: 10.1002/jper.20-0441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND There exists a diverse range of criteria used in epidemiological studies for the diagnosis of periodontitis. The results from these studies should be evaluated with consideration to the diagnostic criteria used, and this may account for differences between studies especially in some population groups such as pregnant females. The objective is to evaluate the diagnostic criteria used in a variety of epidemiologic studies of periodontitis in pregnant females. METHODS An accuracy study with cross-sectional design was performed out from a database of 671 pregnant females, using six different sets of criteria for the diagnosis of periodontitis. Women were classified for periodontitis, as follows: Center for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP, 2012 criterion), the gold standard, Gomes-Filho et al.(2018) criterion, Albandar et al.(2007) criterion, Bassani et al.(2007) criterion, López et al.(2002) criterion, and Nesse et al.(2008) criterion. For comparison amongst the gold standard and the other criteria, sensitivity, specificity, predictive values, and likelihood ratio were determined. RESULTS The frequency of periodontitis ranged from 25.0% to 90.2%. The Bassani et al. (2007) criterion was found to be more sensitive among the studies, and thus more suitable for diagnostic screening studies. Gomes-Filho et al.(2018), Albandar et al. (2007), López et al. (2002), and Nesse et al. (2008) criteria were considered more specific, which makes them more useful for studies of periodontitis with the aim of using diagnosis for confirmation of disease. CONCLUSIONS A variation in the occurrence of periodontitis was observed. The criterion must be chosen according to the research aims and population characteristics.
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Affiliation(s)
| | | | | | - Sheila Monteiro Brito
- Health Sciences Center, Federal University of Recôncavo of Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | - Roberta Borges Silva
- Faculty of Human Nutrition, University of Brasilia, Distrito Federal, Brasília, Brazil
| | | | | | | | - Amanda Oliveira Lyrio
- Faculty of Health Sciences, University of Brasilia, Distrito Federal, Brasília, Brazil
| | - Elivan Silva Souza
- Faculty of Medicine, University of Brasilia, Distrito Federal, Brasília, Brazil
| | | | - Peter Michael Loomer
- School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Simone Seixas da Cruz
- Department of Health, Feira de Santana State University, Bahia, Brazil.,Health Sciences Center, Federal University of Recôncavo of Bahia, Santo Antônio de Jesus, Bahia, Brazil
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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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Figuero E, Han YW, Furuichi Y. Periodontal diseases and adverse pregnancy outcomes: Mechanisms. Periodontol 2000 2020; 83:175-188. [PMID: 32385886 DOI: 10.1111/prd.12295] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Adverse pregnancy outcomes (APOs) have been defined as (a) pre-term birth, when there is a delivery before 37 completed weeks (<259 days); (b) pre-eclampsia, which is a multisystem disorder of pregnancy characterized by maternal hypertension and proteinuria after the 20th gestational week; (c) low and very low birthweight, depending on whether the weight of the baby is less of 2500 g or <1500 g and (d) the spontaneous death of the fetus with <20 weeks (miscarriage) or between 20 and 36 weeks (stillbirth). In 2012, during the Consensus Report from the Joint EFP/AAP workshop on periodontitis and systematic diseases the role of periodontal diseases on APOs was reviewed. Some years later, this evidence has grown, and an update on the literature regarding the mechanisms related to this potential association (APOs and periodontal diseases) needs to be presented. The two major pathways (direct and indirect) already accepted in 2012 are still valid nowadays. Most evidence published in the last 5 years deals with a strong and solid evidence coming from the direct pathway while there is as scarce new evidence regarding indirect pathway. In this direct pathway, the haematological dissemination of oral microorganisms and their products, would later induce an inflammatory/Immune response in the foetal-placental unit. The most plausible route for this direct pathway is the hematogenous transmission through dental bacteremia, although not many new studies dealing with bacteremia has been performed lately.
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Affiliation(s)
- Elena Figuero
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Department of Dental Clinical Specialties, Faculty of Dentistry, University Complutense of Madrid (UCM), Madrid, Spain
| | - Yiping W Han
- Departments of Microbiology & Immunology, OB&GYN, Medical Sciences (Oncology), College of Dental Medicine, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Yasushi Furuichi
- Division of Periodontology & Endodontology, Department of Oral Rehabilitation, Health Sciences, University of Hokkaido, Hokkaido, Japan
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Levine JB, Goncalves J, Nguyen D, Nguyen O, Hasturk H. Efficacy of a novel post-foaming dental gel on gingival inflammation: A randomized controlled clinical trial. J Periodontol 2020; 91:1569-1583. [PMID: 32372407 DOI: 10.1002/jper.19-0594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/13/2020] [Accepted: 04/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND A pilot randomized controlled clinical trial was performed to evaluate the efficacy of a post-foaming dental gel containing cetylpridinium chloride (CPC), hydrogen peroxide (H2 O2 ), sodium bicarbonate, and antioxidants on periodontal/oral health. METHODS Individuals with gingivitis or mild-moderate periodontitis (n=36) were included and randomly assigned to Group 1 and 2 with foaming gel loaded on a mouthpiece with a light source and controlled warming heat built-in unit or on a toothbrush, respectively, in addition to regular twice-daily brushing. Group 3 served as control with twice daily brushing and further assigned split-mouth to Group 3a-un-flossed and Group 3b-flossed. Gingival index (GI) and bleeding on probing (BOP) were evaluated in addition to plaque index (PI), pocket depth, and clinical attachment level at days 14, 28, 42 (treatment), and 60 (maintenance). Subgingival plaque microbial profiles and gingival crevicular fluid (GCF) cytokine levels were determined by DNA-DNA hybridization and multiplexing assays, respectively. Exploratory analyses included esthetic outcomes: changes in tooth color and levels of volatile sulfur compounds in breath. Statistical analyses were conducted using ANOVA with a post hoc analysis of Fisher's LSD. RESULTS Use of post-foaming gel in both test groups resulted in significant changes in GI and BOP at Day 42 compared to control and un-flossed control (P<0.05). Device-enhanced foaming gel significantly reduced the PI in Group 1 at Day 42 compared to control and un-flossed control (P=0.02; P=0.007, respectively). GCF IL-6 and TNF-α levels were significantly reduced in Group 2 compared to control (PIL-6 =0.01, PTNF-α =0.02). Post-foaming gel resulted in greater reductions in periodontopathogens, whereas health-associated species remained stable. Despite cessation of adjunct treatments, Group 1 and 2 continued having reduced levels of GI, BOP, and PI at Day 60 (P<0.05). CONCLUSIONS The novel post-foaming dental gel improves oral health by reducing gingival inflammation at the local site in addition to better esthetic outcomes.
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Affiliation(s)
| | | | - Daniel Nguyen
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, Massachusetts, USA
| | - Olivia Nguyen
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, Massachusetts, USA
| | - Hatice Hasturk
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, Massachusetts, USA
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12
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Caneiro-Queija L, López-Carral J, Martin-Lancharro P, Limeres-Posse J, Diz-Dios P, Blanco-Carrion J. Non-Surgical Treatment of Periodontal Disease in a Pregnant Caucasian Women Population: Adverse Pregnancy Outcomes of a Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3638. [PMID: 31569780 PMCID: PMC6801449 DOI: 10.3390/ijerph16193638] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 02/04/2023]
Abstract
AIM To analyze if non-surgical treatment of periodontitis in a pregnant Caucasian women population can reduce adverse pregnancy outcomes. METHODS AND RESULTS A parallel randomized clinical trial was designed and approved by the Ethical Committee of Sanitary Area Santiago-Lugo, Spain (registration number: 2016/451). Forty patients with periodontitis stage II grade B were randomly allocated to receive either comprehensive non-surgical periodontal therapy (test group; n = 20) or professional tooth cleaning (control group; n = 20) before 24 gestational weeks. Randomization was computer-generated by the statistic program Epidat v.4.1 and allocation was performed using sealed opaque envelopes. Clinical measurements and peripheral blood samples for biochemical variables were collected at baseline, in the middle of second trimester before non-surgical treatment, and in the third trimester. Microbiological samples were collected in the second and third trimester. A statistically significant reduction was verified in all clinical and microbiological parameters after periodontal treatment in the test group. No significant differences were observed for the rest of the variables, including preterm birth and/or low birth weight. No adverse events related to periodontal treatment were reported. CONCLUSIONS Non-surgical periodontal treatment in Caucasian patients with periodontitis stage II grade B did not significantly reduce the risk of adverse pregnancy outcomes.
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Affiliation(s)
- Leticia Caneiro-Queija
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
| | - Jose López-Carral
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
- Department of Obstetrics and Gynecology, Clinic University Hospital of Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - Pablo Martin-Lancharro
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
- Department of Obstetrics and Gynecology, Clinic University Hospital of Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - Jacobo Limeres-Posse
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University, 15782 Santiago de Compostela, Spain.
| | - Pedro Diz-Dios
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University, 15782 Santiago de Compostela, Spain.
| | - Juan Blanco-Carrion
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
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Association between periodontal pathogens and systemic disease. Biomed J 2019; 42:27-35. [PMID: 30987702 PMCID: PMC6468093 DOI: 10.1016/j.bj.2018.12.001] [Citation(s) in RCA: 345] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 11/22/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022] Open
Abstract
A growing body of literature suggests that there is a link between periodontitis and systemic diseases. These diseases include cardiovascular disease, gastrointestinal and colorectal cancer, diabetes and insulin resistance, and Alzheimer's disease, as well as respiratory tract infection and adverse pregnancy outcomes. The presence of periodontal pathogens and their metabolic by-products in the mouth may in fact modulate the immune response beyond the oral cavity, thus promoting the development of systemic conditions. A cause-and-effect relationship has not been established yet for most of the diseases, and the mediators of the association are still being identified. A better understanding of the systemic effects of oral microorganisms will contribute to the goal of using the oral cavity to diagnose and possibly treat non-oral systemic disease.
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Hassan MN, Belibasakis GN, Gumus P, Öztürk VÖ, Emingil G, Bostanci N. Annexin-1 as a salivary biomarker for gingivitis during pregnancy. J Periodontol 2018; 89:875-882. [DOI: 10.1002/jper.17-0557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/02/2018] [Accepted: 01/02/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Manar N. Hassan
- Center of Dental Medicine; University of Zürich; Zürich Switzerland
| | - Georgios N. Belibasakis
- Center of Dental Medicine; University of Zürich; Zürich Switzerland
- Department of Dental Medicine; Karolinska Institute; Stockholm Sweden
| | - Pinar Gumus
- Department of Periodontology; School of Dentistry; Ege University; IZMIR Turkey
| | - Veli Özgen Öztürk
- Department of Periodontology; School of Dentistry; Adnan Menderes University; Aydın Turkey
| | - Gulnur Emingil
- Department of Periodontology; School of Dentistry; Ege University; IZMIR Turkey
| | - Nagihan Bostanci
- Center of Dental Medicine; University of Zürich; Zürich Switzerland
- Department of Dental Medicine; Karolinska Institute; Stockholm Sweden
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Wiener RC, Waters C. Personal Oral Infection Control, Low Birthweight, and Preterm Births in Appalachia West Virginia: A Cross-Sectional Study. Adv Prev Med 2018; 2018:9618507. [PMID: 30174960 PMCID: PMC6106793 DOI: 10.1155/2018/9618507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/11/2018] [Accepted: 07/29/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Appalachia West Virginia has a higher prevalence of preterm and low birthweight babies than the US national prevalence. Many factors have been studied which are known to influence preterm births and low birthweight babies. There are limited interventions that are available to decrease the likelihood of preterm and low birthweight babies; however oral health and personal oral infection control may be helpful. The purpose of this study was to evaluate the association of limited personal oral infection control among pregnant West Virginia Appalachian women and poor birth outcomes (preterm and low birthweight babies). METHODS A secondary data analysis of data from the West Virginia Healthy Start Helping Appalachian Parents and Infants (HAPI) Project from 2005 to 2016 was conducted. The researchers determined the odds ratio of personal oral infection control with a powered toothbrush (use of the brush fewer than 13 times per week versus use of the brush 13 or more times per week) on poor birth outcomes. RESULTS There were 845 women who completed the oral health program within the HAPI project. In unadjusted logistic regression, women who used the powered toothbrush and brushed less frequently had greater odds of poor birth outcomes than women who brushed more frequently (odds ratio of 2.07 [1.18, 3.62] P = 0.011 for low birthweight babies; and an odds ratio of 1.78 [1.04, 3.02] P = 0.034 for preterm birth). The results remained positive but were no longer significant in adjusted analysis. CONCLUSION There is a need to identify interventions that will benefit pregnant women so that their pregnancies result in healthy pregnancy outcomes.
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Affiliation(s)
- R. Constance Wiener
- Assistant Professor, Dental Practice and Rural Health, School of Dentistry, Department of Epidemiology, School of Public Health, West Virginia University, P.O. Box 9448 Robert C. Byrd Health Sciences Center Addition 104a, Morgantown, WV 26506, USA
| | - Christopher Waters
- Dental Research Labs Director, 106a Health Sciences Addition, P.O. Box 9448, Department of Dental Research, School of Dentistry, West Virginia University, Morgantown, WV 26506, USA
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Interaction between stress, cytokines, and salivary cortisol in pregnant and non-pregnant women with gingivitis. Clin Oral Investig 2018; 25:1677-1684. [PMID: 30066030 DOI: 10.1007/s00784-018-2569-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this study was to compare the effects of periodontal treatment on the inflammatory markers in gingival crevicular fluid and the concentration of salivary cortisol between non-pregnant and pregnant women with gingivitis. MATERIALS AND METHODS This study included 30 non-pregnant women (mean age 27.93 ± 6.61 years) and 30 pregnant women (mean age 28.93 ± 4.04 years). Each participant presented with the clinical symptoms of generalized, moderate-to-severe gingivitis. Saliva samples were collected by using the spitting method, and gingival crevicular fluid (GCF) samples were collected by using the intrasulcular method at baseline and after 3 weeks. Non-surgical periodontal treatment (NPT) comprising scaling and oral hygiene instruction was administered after sample collection. The interleukin-6 and interleukin-10 levels in GCF and salivary cortisol concentrations were determined with using enzyme-linked immunosorbent assay. RESULTS The pregnant women exhibited significantly deeper pockets (p < 0.05) and greater gingival inflammation (p < 0.05) than the non-pregnant women after periodontal therapy. Moreover, the levels of interleukin-6 in the GCF were significantly higher in the pregnant women compared to the non-pregnant women after periodontal therapy: 17.73 ± 9.82 pg per site and 8.08 ± 4.51 pg per site, respectively, p < 0.05. No differences in the levels of interleukin-10 were observed. The pregnant women also exhibited higher cortisol concentration in the saliva after periodontal therapy, compared to the non-pregnant women, while the levels of stress (as seen on the perceived stress scale-10) were similar in both groups. CONCLUSIONS Although non-surgical periodontal therapy may reduce the clinical parameters of gingivitis, increasing levels of stress in pregnancy may reduce the individual's response to it. However, further studies are necessary to substantiate these early findings. CLINICAL RELEVANCE Psychosocial stress may increase the risk of periodontal disease by altering the behavioral and immune responses of the individual. Therefore, the levels of stress should be taken into consideration in order to increase the efficacy of periodontal therapy in pregnant patients.
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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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18
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Lasisi TJ, Abdus-salam RA. Pregnancy-induced periodontal inflammation: Influence of salivary cytokines and antimicrobial proteins. Saudi Dent J 2018; 30:306-311. [PMID: 30202167 PMCID: PMC6128315 DOI: 10.1016/j.sdentj.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/02/2018] [Accepted: 07/01/2018] [Indexed: 01/03/2023] Open
Abstract
The aim of this study was to evaluate the association between pregnancy-induced periodontal inflammation and levels of some salivary cytokines and antimicrobial proteins (AMPs). The study was a cohort longitudinal study that included pregnant women attending a secondary health facility. Consented participants had oral examination and saliva sampling during pregnancy and post-partum (three months after pregnancy). Saliva samples were used for the analysis of cytokines (TNF-α, IFN-gamma and IL-1β) and AMPs (Lactoferin, Lysozyme, and β defensin-1) using ELISA. Data are presented as median with interquartile range and compared using related sample Wilcoxon signed rank test. Correlations between levels of the salivary factors and indices of periodontal inflammation were determined using Spearman’s correlation test. Salivary flow rate, pH, levels of salivary IL-1β and IFN-gamma were significantly lower; while gingival index, periodontal index and level of salivary TNF-α were significantly higher during pregnancy compared with postpartum period. However, salivary lactoferin, lysozyme and β defensin-1 did not show significant difference comparing during pregnancy and postpartum period. Level of salivary IFN-gamma showed negative correlation with gingival index while level of salivary TNF-α showed positive correlation with gingival and periodontal indices. Lower levels of salivary IL-1β and IFN-gamma along with higher TNF-α concentration during pregnancy suggest their contributions to the pathophysiology of pregnancy-induced periodontal inflammation.
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Affiliation(s)
- Taye J. Lasisi
- Department of Physiology, University of Ibadan, Nigeria
- Department of Oral Pathology, University of Ibadan and University College Hospital Ibadan, Nigeria
- Corresponding author at: Department of Physiology, College of Medicine, University of Ibadan, P.O. Box 22040, University of Ibadan Post Office, Ibadan, Nigeria.
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Punj A, Shenoy SB, Subramanyam K. Comparison of Endothelial Function in Healthy Patients and Patients With Chronic Periodontitis and Myocardial Infarction. J Periodontol 2017; 88:1234-1243. [DOI: 10.1902/jop.2017.160748] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Anahita Punj
- Department of Periodontology, A.B. Shetty Memorial Institute of Dental Sciences, NITTE University, Deralakatte, Mangalore, Karnataka, India
| | - Santhosh B. Shenoy
- Department of Periodontology, A.B. Shetty Memorial Institute of Dental Sciences, NITTE University, Deralakatte, Mangalore, Karnataka, India
| | - K. Subramanyam
- Department of Cardiology, K.S. Hegde Medical Academy, NITTE University, Deralakatte, Mangalore, Karnataka, India
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An Umbrella Review Exploring the Effect of Periodontal Treatment in Pregnant Women on the Frequency of Adverse Obstetric Outcomes. J Evid Based Dent Pract 2017; 18:218-239. [PMID: 30077375 DOI: 10.1016/j.jebdp.2017.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In the recent years, efforts have been made to reduce epidemiologic indicators of periodontal disease in pregnant women. This umbrella review aims to analyze the systematic reviews/meta-analyses investigating the effect of periodontal therapy in pregnant women on the frequency of obstetric complications (low birth weight, preterm delivery, and preeclampsia) and to identify the gaps in the scientific literature. METHODS A systematic review of systematic reviews with and without meta-analysis of intervention studies was conducted. Quality evaluation and qualitative analysis of the reviews were performed. RESULTS A total of 223 articles were obtained, and 18 of them were included in the analysis, 13 articles included meta-analysis, where 11 were of high quality and 7 of medium quality according to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guide. These systematic reviews/meta-analyses included a total of 19 studies (17 randomized clinical trials). Descriptive systematic reviews showed that periodontal therapy has positive effects on reducing the frequency of adverse pregnancy outcomes. In systematic reviews with meta-analysis, overall effect estimators were not significant, although a reduction in the incidence of obstetric complications was observed. Subgroup analysis resulted in significant effects, depending on sociodemographic conditions. CONCLUSIONS Differential findings are not enough to demonstrate that there is a significant reduction in the frequency of adverse pregnancy outcomes in pregnant women receiving periodontal therapy. Possible explanations are related to factors such as the type of studies analyzed, indicator of obstetric complication considered, and specific variables included in the analysis. Many systematic reviews did not address publication bias and did identify gaps in knowledge that require further clarification.
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Kornman KS, Giannobile WV, Duff GW. Quo vadis: what is the future of periodontics? How will we get there? Periodontol 2000 2017; 75:353-371. [DOI: 10.1111/prd.12217] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Garner EM, Hardy SL, Holmes CM, Arraj RA, Geurs NC, Geisinger ML. Decision Making in the Treatment of Patients With Rheumatoid Arthritis and Periodontitis: Scientific Evidence and Clinical Experience. Clin Adv Periodontics 2016; 6:208-214. [PMID: 31535475 DOI: 10.1902/cap.2016.160021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/24/2016] [Indexed: 01/01/2023]
Abstract
Focused Clinical Question: What are the key considerations for coordination of care for a patient with rheumatoid arthritis (RA) and chronic periodontitis (CP), and what are the clinical implications of RA on periodontal health? Summary: Both RA and CP involve hyper-immune response and osseous destruction. However, despite emerging evidence that RA and CP may have common etiologies and patients with RA have increased risk of CP, periodontal evaluation and treatment remain largely similar for patients with and without RA. More fully assessing inflammatory burden in patients with RA and CP may allow practitioners to more accurately assess the risk profile of a patient for RA and periodontal disease progression and to better evaluate adequate end points to periodontal therapy. Furthermore, coordination of care for patients with RA and CP with their rheumatologist or treating physician could allow for advanced screening and prophylactic care that may prevent disease development or progression. Conclusion: For patients with RA and CP, evaluation of their rheumatoid disease activity score and periodontal inflamed surface area score, rather than traditional periodontal clinical measurements, along with additional biologic sampling methods may be appropriate measures to more accurately assess inflammatory burden in these susceptible patients.
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Affiliation(s)
| | - Sonya L Hardy
- Department of Periodontology, University of Alabama at Birmingham
| | | | - Ramzi Abou Arraj
- Department of Periodontology, University of Alabama at Birmingham
| | - Nicolaas C Geurs
- Department of Periodontology, University of Alabama at Birmingham
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Schlagenhauf U, Jakob L, Eigenthaler M, Segerer S, Jockel-Schneider Y, Rehn M. Regular consumption of Lactobacillus reuteri-containing lozenges reduces pregnancy gingivitis: an RCT. J Clin Periodontol 2016; 43:948-954. [PMID: 27461133 PMCID: PMC6299356 DOI: 10.1111/jcpe.12606] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 12/30/2022]
Abstract
Aim This randomized controlled trial assessed the impact of Lactobacillus reuteri on pregnancy gingivitis in healthy women. Materials and Methods Forty‐five healthy women (24 test/21 placebo) with pregnancy gingivitis in the third trimester of pregnancy were enrolled. At baseline Gingival Index (GI) and Plaque Index (PlI) were assessed at the Ramfjord teeth and venous blood taken for TNF‐α analysis. Subsequently participants were randomly provided with lozenges to be consumed 2 × daily until birth (approx. 7 weeks) containing ≥108CFU L. reuteri ATCC PTA 5289 and ≥108CFU L. reuteri DSM 17938 (test) or being devoid of L. reuteri (placebo). Within 2 days after birth recording of GI, PlI and blood sampling were repeated. Results At baseline, mean GI and mean PlI did not differ significantly between both groups. In the test group mean TNF‐α serum level was significantly (p < 0.02) lower than in the placebo group. At reevaluation, mean GI and mean PlI of the test group were both significantly (p < 0.0001) lower than in the placebo group. Mean TNF‐α serum level did no longer differ significantly between the groups. Conclusions The consumption of L. reuteri lozenges may be a useful adjunct in the control of pregnancy gingivitis.
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Affiliation(s)
- Ulrich Schlagenhauf
- Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Lena Jakob
- Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Martin Eigenthaler
- Department of Orthodontics, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Sabine Segerer
- Department of Obstetrics and Gynaecology, University Hospital Wuerzburg, Wuerzburg, Germany
| | | | - Monika Rehn
- Department of Obstetrics and Gynaecology, University Hospital Wuerzburg, Wuerzburg, Germany
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Sex Hormones Enhance Gingival Inflammation without Affecting IL-1β and TNF-α in Periodontally Healthy Women during Pregnancy. Mediators Inflamm 2016; 2016:4897890. [PMID: 27034591 PMCID: PMC4791509 DOI: 10.1155/2016/4897890] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 01/31/2016] [Accepted: 02/08/2016] [Indexed: 01/24/2023] Open
Abstract
Hormones (progesterone and estradiol) change greatly during pregnancy; however, the mechanism of hormonal changes on gingival inflammation is still unclear. This study is to evaluate the effects of hormonal changes during pregnancy on gingival inflammation and interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in gingival crevicular fluid (GCF). 30 periodontally healthy pregnant women were evaluated in the first, second, and third trimesters. 20 periodontally healthy nonpregnant women were evaluated twice (once per subsequent month). Clinical parameters including probing pocket depth (PPD), bleeding index (BI), gingival index (GI), clinical attachment level (CAL), and plaque index (PLI) were recorded. GCF levels of IL-1β and TNF-α and serum levels of progesterone and estradiol were measured. From the data, despite low PLI, BI and GI increased significantly during pregnancy; however, no significant changes in PLI, CAL, IL-1β, or TNF-α GCF levels were observed. Although IL-1β, not TNF-α, was higher in pregnant group than in nonpregnant group, they showed no correlation with serum hormone levels during pregnancy. GI and BI showed significant positive correlation with serum hormone levels during pregnancy. This study suggests that sex hormone increase during pregnancy might have an effect on inflammatory status of gingiva, independent of IL-1β and TNF-α in GCF.
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Park HS, Nam HS, Seo HS, Hwang SJ. Change of periodontal inflammatory indicators through a 4-week weight control intervention including caloric restriction and exercise training in young Koreans: a pilot study. BMC Oral Health 2015; 15:109. [PMID: 26385382 PMCID: PMC4575481 DOI: 10.1186/s12903-015-0094-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 09/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent cross-sectional studies indicate that obesity is a risk factor for periodontal disease. Exercise training in high fat mice or rats can inhibit gingival inflammation effectively. The objective of this human intervention study was to investigate whether short-term weight control could affect periodontal indexes and serum and gingival crevicular fluid (GCF) biomarkers in young Koreans. METHODS Forty-one obese volunteers (body mass index (BMI) > 25.0) and 12 normal weight subjects (18.5 ≤ BMI ≤ 23.0) participated in a four-week weight control program to analyze the changes in anthropometric criteria, the concentrations of C-reactive protein (CRP), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides in serum, gingival index, bleeding on probing, periodontal biomarkers in GCF, and dental plaque index at the first and the 27th days. RESULTS The means of obesity measures decreased significantly more in the obese group (BMI 2.53 ± 0.96, waist-to-hip ratio (WHR) 4.88 ± 1.58 %, LDL 35.85 ± 21.74 mgdL(-1)) than in the normal weight group (BMI 0.78 ± 0.72, WHR 2.00 ± 0.95 %, LDL 15.58 ± 18.07 mgdL(-1)). While the obese group showed significant decreases in the biomarkers in GCF (IL-1β 58.38 ± 65.55 pgmL(-1), MMP-8 4.19 ± 5.61 ngmL(-1), MMP-9 3.36 ± 6.30 ngmL(-1)), the mean changes for the normal weight group (IL-1β 10.07 ± 21.08 pgmL(-1), MMP-8 1.49 ± 4.61 ngmL(-1), MMP-9 -1.52 ± 9.71 ngmL(-1)) were not statistically significant. Anthropometric measures and the amounts of GCF biomarkers had weak positive correlations (0.242 ≤ r ≤ 0.340), and LDL in serum correlated with MMP-8 (r = 0.332) and IL-1β (r = 0.342) in the obese group. Stepwise multiple linear regression analysis in the obese group showed that the relationship between the amount of IL-1β in GCF and predictor variables including LDL and BMI was highly significant and accounted for 19.1 % of the variance in IL-1β in GCF. CONCLUSIONS In periodontally healthy subjects, weight control could reduce the amounts of MMP-8, MMP-9, and IL-1β in GCF of the obese subjects. Further studies with periodontally unhealthy and obese people are needed to identify the mechanism of decreases in inflammation biomarkers in GCF through weight control. TRIAL REGISTRATION ISRCTN86753073 (2015.08.14).
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Affiliation(s)
- Hoo-Seob Park
- Department of Preventive Medicine and Public Health, School of Medicine, Chungnam National University, Daejeon, South Korea.
| | - Hae-Sung Nam
- Department of Preventive Medicine and Public Health, School of Medicine, Chungnam National University, Daejeon, South Korea.
| | - Hyung-Seok Seo
- Department of Sports Medicine, College of Culture, Science & Technology, Konyang University, Nonsan, Chungcheongnamdo, South Korea.
| | - Soo-Jeong Hwang
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea. .,Department of Dental Hygiene, College of Medical Science, Konyang University, Daejeon, South Korea.
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Ao M, Miyauchi M, Furusho H, Inubushi T, Kitagawa M, Nagasaki A, Sakamoto S, Kozai K, Takata T. Dental Infection of Porphyromonas gingivalis Induces Preterm Birth in Mice. PLoS One 2015; 10:e0137249. [PMID: 26322971 PMCID: PMC4556457 DOI: 10.1371/journal.pone.0137249] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/13/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Epidemiological studies have revealed a link between dental infection and preterm birth or low birth weight (PTB/LBW), however, the underlying mechanisms remain unclear. Progress in understanding the associated mechanisms has been limited in part by lack of an animal model for chronic infection-induced PTB/LBW, mimicking pregnancy under conditions of periodontitis. We aimed to establish a mouse model of chronic periodontitis in order to investigate the link between periodontitis and PTB/LBW. METHODS To establish chronic inflammation beginning with dental infection, we surgically opened mouse (female, 8 weeks old) 1st molar pulp chambers and directly infected with w83 strain Porphyromonas gingivalis (P.g.), a keystone periodontal pathogen. Mating was initiated at 6 wks post-infection, by which time dental granuloma tissue had developed and live P.g. was cultured from extracted tooth root, which serves as a persistent source of P.g. The gestational day (gd) and birth weight were recorded during for P.g.-infected and control mice, and serum and placental tissues were collected at gd 15 to evaluate the systemic and local conditions during pregnancy. RESULTS Dental infection with P.g. significantly increased circulating TNF-α (2.5-fold), IL-17 (2-fold), IL-6 (2-fold) and IL-1β (2-fold). The P.g.-infected group delivered at gd 18.25 vs. gd 20.45 in the non-infected control (NC) group (p < 0.01), and pups exhibited LBW compared to controls (p < 0.01). P.g. was localized to placental tissues by immunohistochemistry and PCR, and defects in placental tissues of P.g. infected mice included premature rupture of membrane, placental detachment, degenerative changes in trophoblasts and endothelial cells, including necrotic areas. P.g. infection caused significantly increased numbers of polymorphonuclear leukocytes (PMNLs) and macrophages in placental tissues, associated with increased local expression of pro-inflammatory mediators including TNF-α and COX-2. Further placental tissue damage was indicated in P.g. infected mice by decreased CD-31 in endothelial cells, increased expression of 8OHdG, an indicator of oxidative DNA damage, and cleaved caspase-3, a marker of apoptosis. In vitro, P.g. lipopolysaccharide significantly increased expression of COX-2, IL-8 and TNF-α, in HTR-8 trophoblasts in an NF-κB-dependent fashion. CONCLUSIONS Our novel mouse model supports previous epidemiological studies signifying dental infection as predisposing factor for PTB/LBW. We demonstrate PTB and LBW in infected mice, translocation of P.g to placental tissues, increased circulating and local pro-inflammatory markers, and the capability of P.g. LPS to directly induce cytokine production in trophoblasts, in vitro. These findings further underscore the importance of local and systemic infections and inflammation during pregnancy and suggest that prevention and/or elimination of dental infections such as marginal or periapical periodontitis before pregnancy may have a beneficial effect on PTB/LBW.
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Affiliation(s)
- Min Ao
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
- Department of Pediatric Dentistry, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Hisako Furusho
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Toshihiro Inubushi
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Masae Kitagawa
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Atsuhiro Nagasaki
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Shinichi Sakamoto
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Katsuyuki Kozai
- Department of Pediatric Dentistry, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Takashi Takata
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
- * E-mail:
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Zi MYH, Longo PL, Bueno-Silva B, Mayer MPA. Mechanisms Involved in the Association between Periodontitis and Complications in Pregnancy. Front Public Health 2015; 2:290. [PMID: 25688342 PMCID: PMC4310218 DOI: 10.3389/fpubh.2014.00290] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 12/14/2014] [Indexed: 01/08/2023] Open
Abstract
The association between periodontitis and some of the problems with pregnancy such as premature delivery, low weight at birth, and preeclampsia (PE) has been suggested. Nevertheless, epidemiological data have shown contradictory data, mainly due to differences in clinical parameters of periodontitis assessment. Furthermore, differences in microbial composition and immune response between aggressive and chronic periodontitis are not addressed by these epidemiological studies. We aimed to review the current data on the association between some of these problems with pregnancy and periodontitis, and the mechanisms underlying this association. Shifts in the microbial composition of the subgingival biofilm may occur during pregnancy, leading to a potentially more hazardous microbial community. Pregnancy is characterized by physiological immune tolerance. However, the infection leads to a shift in maternal immune response to a pathogenic pro-inflammatory response, with production of inflammatory cytokines and toxic products. In women with periodontitis, the infected periodontal tissues may act as reservoirs of bacteria and their products that can disseminate to the fetus-placenta unit. In severe periodontitis patients, the infection agents and their products are able to activate inflammatory signaling pathways locally and in extra-oral sites, including the placenta-fetal unit, which may not only induce preterm labor but also lead to PE and restrict intrauterine growth. Despite these evidences, the effectiveness of periodontal treatment in preventing gestational complications was still not established since it may be influenced by several factors such as severity of disease, composition of microbial community, treatment strategy, and period of treatment throughout pregnancy. This lack of scientific evidence does not exclude the need to control infection and inflammation in periodontitis patients during pregnancy, and treatment protocols should be validated.
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Affiliation(s)
- Marcela Yang Hui Zi
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Priscila Larcher Longo
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Bruno Bueno-Silva
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Marcia Pinto Alves Mayer
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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