Periodontitis As A Risk Factor For Stroke: A Systematic Review And Meta-Analysis

Oral Health in Patients Hospitalized Because of Ischemic Stroke

Background/Objectives: Maintenance of good oral health is relevant to overall health and quality of life. Results of many analyses showed that stroke patients had worse oral health than the control population. The aim of this study was a clinical assessment of oral condition in post-stroke patients and a healthy population. Methods: Oral health was assessed in stroke patients on the first day of ischemic stroke, and in a control group of healthy subjects. The number of teeth, the presence of active carious foci, fillings, and prosthetic restorations were evaluated. To assess oral hygiene, the Approximal Plaque Index (API) was used. In periodontal examinations, the presence of dental deposits, the depth of the existing periodontal pockets, tooth mobility, and the Sulcus Bleeding Index (SBI) during probing were assessed. Results: Significantly higher mean values of Decayed Teeth (DT), Missing Teeth (MT), and Decayed, Missing, and Filled Teeth (DMFT) indices were recorded in the study group. The incidence of dental caries, API, and SBI was also significantly higher in the study group. The study and control groups did not differ significantly in the average number of pockets 3 mm deep and deeper and in the frequency of having prosthetic restorations. Conclusions: Oral health and the level of oral hygiene in patients hospitalized because of ischemic stroke, in comparison with that in a healthy population, is not satisfactory. Active interdisciplinary collaboration between various medical specialists in the therapy of patients with general illnesses, including stroke, is strongly recommended.

The potential impact of periodontitis on cerebral small vessel disease

Cerebral small vessel disease (CSVD) is a term used to describe abnormalities in the intracranial microvasculature affecting small arteries, arterioles, capillaries, and venules. The etiology of these conditions is not fully understood but inflammation appears to play a significant role. Periodontal diseases have been associated with conditions such as stroke and dementia, which are clinical consequences of CSVD. Periodontitis is a highly prevalent chronic multifactorial inflammatory disease regulated by the host immune response against pathogenic bacterial colonization around the teeth. The inflammatory response and the microbial dysbiosis produce pro-inflammatory cytokines that can reach the brain and promote local changes. This review will explore the potential association between periodontitis and CSVD by assessing the impact of periodontitis-induced inflammation and periodontopathogenic bacteria on the underlying mechanisms leading to CSVD. Given the association of periodontitis with stroke and dementia, which are clinical features of CSVD, it may be possible to suggest a link with CSVD. Current evidence linking periodontitis with neuroimaging findings of CSVD enforces the possible link between these conditions.

Effectiveness of herbal oral care products in reducing dental plaque and gingivitis: an overview of systematic reviews

Introduction

Numerous clinical trials and systematic reviews have investigated the effectiveness of both herbal and conventional oral care approaches to reducing plaque and gingivitis. However, their findings vary and are inconsistent. Thus, the objective of this umbrella review is to compile data from systematic reviews and provide an overview of the effects of herbal oral care products on tooth plaque and gingivitis.

Methods

A comprehensive search of the literature was performed in 6 databases for systematic reviews with or without meta-analyses, published up to 30 May 2023, without any language restrictions. Only clinical trials comparing herbal oral care products (in the form of mouthrinse or toothpaste) against standard oral care products or placebo were considered.

Results

Some herbal oral care products, particularly in the form of mouthrinses, have a similar level of positive effect on plaque and gingivitis reduction and, thus, can be used as an adjunct to traditional dentifrices. However, the shorter duration of trials (<4 weeks) and reported publication bias in the clinical trials mean that these findings must be interpreted with caution.

Conclusion

To accurately determine the impact of various herbal extracts on periodontal health, well-designed, long-term, and controlled trials that adhere to standardized protocols must be carried out.

Stroke Caused by Vasculitis Induced by Periodontitis-Associated Oral Bacteria after Wisdom Teeth Extraction

Invasive dental procedures, such as wisdom teeth removal, have been identified as potential triggers for vascular events due to the entry of oral bacteria into the bloodstream, leading to acute vascular inflammation and endothelial dysfunction. This study presents the case of a 27-year-old healthy male who developed ischemic stroke resulting from bacteremia after undergoing wisdom teeth extraction. Initially, the patient experienced fever and malaise, which were followed by right-sided hemiplegia. Diagnostic imaging, including a CT scan, identified a subacute infarction in the posterior crus of the left internal capsule, and MRI findings indicated inflammatory changes in the masticatory muscles. Further investigations involving biopsies of the masticatory muscles, along with blood and cerebrospinal fluid samples, confirmed bacterial meningitis with associated vasculitis. Notably, oral bacteria linked to periodontitis, including Porphyromonas gingivalis, Fusobacterium nucleatum, Tannerella forsythia, and Parvimonas micra, were found in the biopsies and microbiological analyses. To the best of our knowledge, this is the first reported case showing that bacteremia following dental procedures can lead to such severe neurological outcomes. This case underscores the importance of recognizing bacteremia-induced vasculitis in patients presenting with neurological symptoms post-dental procedures, emphasizing the broader implications of oral infections in such pathologies.

Markers of periodontal disease and risk of stroke: INTERSTROKE case-control study

BACKGROUND

Periodontal disease may be an important modifiable risk factor for stroke.

AIMS

To determine the contribution of markers of periodontal disease to stroke risk globally, within subpopulations, and by stroke subtypes.

METHODS

INTERSTROKE is the largest international case-control study of risk factors for first acute stroke. All participants were asked a standardised set of questions about the presence or absence of painful teeth, painful gums or lost teeth, as markers of periodontal disease, within the previous year. The total number of reported variables was calculated per participant. Multivariable conditional logistic regression examined the association of these variables with acute stroke.

RESULTS

In 26901 participants, across 32 countries, there was a significant multivariable association between lost teeth and stroke (OR 1.11, 95 % CI 1.01 - 1.22), but not painful teeth (OR 1.00, 95 % CI 0.91-1.10) or painful gums (OR 1.01, 95 % CI 0.89 - 1.14). When these symptoms were considered together there was a graded increased odds of stroke, with the largest magnitude of association seen if a patient reported all three of painful teeth, painful gums and lost teeth (OR 1.34, 95 % CI 1.00 - 1.79).

CONCLUSIONS

Our findings suggest that features of severe periodontal disease are a risk factor for acute stroke. Periodontal disease should be considered as a potentially modifiable risk factor for stroke.

Periodontitis, Dental Procedures, and Young-Onset Cryptogenic Stroke

Periodontitis is associated with an increased risk of ischemic stroke, and the risk may be particularly high among young people with unexplained stroke etiology. Thus, we investigated in a case-control study whether periodontitis or recent invasive dental treatments are associated with young-onset cryptogenic ischemic stroke (CIS). We enrolled participants from a multicenter case-control SECRETO study including adults aged 18 to 49 y presenting with an imaging-positive first-ever CIS and stroke-free age- and sex-matched controls. Thorough clinical and radiographic oral examination was performed. Furthermore, we measured serum lipopolysaccharide (LPS) and lipotechoic acid (LTA) levels. Multivariate conditional regression models were adjusted for stroke risk factors, regular dentist visits, and patent foramen ovale (PFO) status. We enrolled 146 case-control pairs (median age 41.9 y; 58.2% males). Periodontitis was diagnosed in 27.5% of CIS patients and 20.1% of controls (P < 0.001). In the fully adjusted models, CIS was associated with high periodontal inflammation burden (odds ratio [OR], 95% confidence interval) with an OR of 10.48 (3.18-34.5) and severe periodontitis with an OR of 7.48 (1.24-44.9). Stroke severity increased with the severity of periodontitis, having an OR of 6.43 (1.87-23.0) in stage III to IV, grade C. Invasive dental treatments performed within 3 mo prestroke were associated with CIS, with an OR of 2.54 (1.01-6.39). Association between CIS and invasive dental treatments was especially strong among those with PFO showing an OR of 6.26 (1.72-40.2). LPS/LTA did not differ between CIS patients and controls but displayed an increasing trend with periodontitis severity. Periodontitis and recent invasive dental procedures were associated with CIS after controlling for multiple confounders. However, the role of bacteremia as a mediator of this risk was not confirmed.

Periodontal and Systemic Diseases: A Descriptive Analysis of Awareness Among the General Saudi Population

Background Taking into account the limited availability of research data, this study aimed to determine the general Saudi population's awareness of the link between periodontal diseases and systemic diseases. Methodology A structured online questionnaire with eight awareness items, apart from demographic variables, was distributed through email, WhatsApp, and Telegram to a sample of 500 individuals. The data were analyzed using a simple descriptive statistical approach and interpreted as ratios for comparison. The awareness regarding systemic diseases associated with periodontal diseases was classified into the following four categories based on the Bloom cutoff points: high (>80%), average (60-79%), low (40-59%), and extremely low (<40%). Results A response rate of 68% was reached with the participation of 340 Saudi citizens residing in the Al Qassim region. Overall, 61.22% of research participants had an average awareness of the link between periodontal and systemic diseases. Almost two-thirds (>60%) of participants were aware that periodontal diseases and systemic diseases have an association and that individuals with systemic diseases need a periodontal checkup. A majority (85%) of participants opined that periodontal treatment has the potential to enhance overall health. Nonetheless, only a few participants (60%) were aware of the association between diabetes mellitus and periodontal diseases, and they had a limited awareness of the association with other systemic diseases. Conclusions Although the Saudi general population possesses average awareness about the relationship between periodontal diseases and systemic diseases, their awareness about different systemic diseases and conditions is extremely low, particularly regarding infertility, stroke, and metabolic diseases. The present research indicates a deficiency in the efforts by healthcare professionals, community service providers, and community administrators to educate the general public regarding the association between periodontal diseases and systemic diseases. This awareness is crucial for individuals to control these intricate, interconnected diseases.

Association of Poor Oral Health With Neuroimaging Markers of White Matter Injury in Middle-Aged Participants in the UK Biobank

BACKGROUND AND OBJECTIVES

Poor oral health is a modifiable risk factor that is associated with clinically observed cardiovascular disease. However, the relationship between oral and brain health is not well understood. We tested the hypothesis that poor oral health is associated with worse neuroimaging brain health profiles in middle-aged persons without stroke or dementia.

METHODS

We performed a 2-stage cross-sectional neuroimaging study using UK Biobank data. First, we tested for association between self-reported poor oral health and MRI neuroimaging markers of brain health. Second, we used Mendelian randomization (MR) analyses to test for association between genetically determined poor oral health and the same neuroimaging markers. Poor oral health was defined as the presence of dentures or loose teeth. As instruments for the MR analysis, we used 116 independent DNA sequence variants linked to increased composite risk of dentures or teeth that are decayed, missing, or filled. Neuroimaging markers of brain health included white matter hyperintensity (WMH) volume and aggregate measures of fractional anisotropy (FA) and mean diffusivity (MD), 2 metrics indicative of white matter tract disintegrity obtained through diffusion tensor imaging across 48 brain regions.

RESULTS

We included 40,175 persons (mean age 55 years, female sex 53%) enrolled from 2006 to 2010, who underwent a dedicated research brain MRI between 2014 and 2016. Among participants, 5,470 (14%) had poor oral health. Poor oral health was associated with a 9% increase in WMH volume (β = 0.09, SD = 0.014, p < 0.001), 10% change in aggregate FA score (β = 0.10, SD = 0.013, p < 0.001), and 5% change in aggregate MD score (β = 0.05, SD = 0.013, p < 0.001). Genetically determined poor oral health was associated with a 30% increase in WMH volume (β = 0.30, SD = 0.06, p < 0.001), 43% change in aggregate FA score (β = 0.43, SD = 0.06, p < 0.001), and 10% change in aggregate MD score (β = 0.10, SD = 0.03, p < 0.01).

DISCUSSION

Among middle age Britons without stroke or dementia, poor oral health was associated with worse neuroimaging brain health profiles. Genetic analyses confirmed these associations, supporting a potentially causal association. Because the neuroimaging markers evaluated in this study precede and are established risk factors of stroke and dementia, our results suggest that oral health, an easily modifiable process, may be a promising target for very early interventions focused on improving brain health.

Periodontitis in ischemic stroke: impact of Porphyromonas gingivalis on thrombus composition and ischemic stroke outcomes

Background

Periodontitis is associated with an increased risk of ischemic stroke, but the mechanisms underlying this association remain unclear.

Objectives

Our objective was to determine whether Porphyromonas gingivalis (Pg), a periodontal bacterium, could be detected within thrombus aspirates, modify thrombus composition, and endovascular therapy responses.

Methods

The presence of Pg gingipain in 175 consecutive thrombi from patients with large vessel occlusion stroke enrolled in the multicenter research cohort compoCLOT was investigated by immunostaining. Thrombus blood cell composition according to gingipain status was analyzed in a subset of 63 patients.

Results

Pg gingipain immunostaining was positive in 33.7% of thrombi (95% CI, 26.7%-40.8%). The percentage of near to complete reperfusion (modified Thrombolysis in Cerebral Infarction Score 2c/3) at the end of the procedure was lower in the Pgpos group than the Pgneg group (39.0% vs 57.8% respectively; adjusted odds ratio, 0.38; 95% CI, 0.19-0.77). At 3 months, 35.7% of patients in the Pgpos group had a favorable neurological outcome vs 49.5% in the Pgneg group (odds ratio, 0.65; 95% CI, 0.30-1.40). Quantitative analysis of a subset of 63 thrombi showed that neutrophil elastase content was significantly (P < .05) higher in Pgpos thrombi than in Pgneg thrombi.

Conclusion

Our results indicate that intrathrombus Pg gingipain is associated with increased neutrophil content and resistance to endovascular therapy.

Oral microbiome and ischemic stroke risk among elderly Chinese women

Background

Stroke, a leading cause of disability worldwide, has been associated with periodontitis. However, whether stroke risk is related to oral microbiota remains unknown. This study aims to evaluate the associations between the oral microbiome and ischemic stroke risk.

Methods

In a case-control study of 134 case-control pairs nested within a prospective cohort study, we examined pre-diagnostic oral microbiome in association with stroke risk via shotgun metagenomic sequencing. The microbial sub-community and functional profiling were performed using Latent Dirichlet Allocation and HUMAnN2. Associations of microbial diversity, sub-community structure, and individual microbial features with ischemic stroke risk were evaluated via conditional logistic regression.

Results

Alpha and beta diversities differ significantly between cases and controls. One genus- and two species-level sub-communities were significantly associated with decreased ischemic stroke risk, with odds ratios (95% confidence intervals) of 0.52 (0.31-0.90), 0.51 (0.31-0.84), and 0.60 (0.36-0.99), respectively. These associations were potentially driven by the representative taxa in these sub-communities, i.e., genus Corynebacterium and Lautropia, and species Lautropia mirabilis and Neisseria elongate (p < 0.05). Additionally, 55 taxa, 1,237 gene families, and 90 metabolic pathways were associated with ischemic stroke risk at p < 0.05.

Conclusion

Our study highlights the role of oral microbiota in the etiology of ischemic stroke and calls for further research.

Factors associated with access to dental care among refugees: A systematic review of quantitative studies

OBJECTIVES

To identify, appraise and synthesize the published evidence from quantitative studies on the individual and contextual-level factors determining access to dental care among refugees worldwide.

METHODS

A systematic literature search was conducted until the last week of February 2022 in four electronic databases - MEDLINE, Embase, Web of Science (all databases) and APA PsycINFO - without any restrictions. Quantitative studies published in English language and meeting the a priori eligibility criteria were reviewed and data extracted. Quality assessment was conducted using the National Institutes of Health tool. The identified factors were stratified according to the framework of the Behavioural Model of Health Services Use, and the evidence related to each of these factors was summarized in tables. Narrative synthesis of the findings was conducted.

RESULTS

The search retrieved 6776 unique records, of which 69 were deemed eligible for full-text screening and nine studies were included in the final data analysis and synthesis. The studies were rated to be of 'fair' quality at best. Self-reported previous dental visits was the most commonly used measure of access. Associations between individual-level factors and dental care access were most frequently examined (predisposing [n = 6], need [n = 2] and enabling [n = 1]), while the contextual-level factors were rarely examined (predisposing and enabling [n = 1, each]).

CONCLUSIONS

Individual-level predisposing factors, such as English language proficiency, education, health and dental literacy and acculturation and integration, were shown to be significantly associated with refugees' access. There is limited evidence to determine the effect of individual enabling and need and contextual factors.

Mouth-Heart Connection: A Systematic Review on the Impact of Periodontal Disease on Cardiovascular Health

Periodontal diseases (PDs) and cardiovascular diseases (CVDs) are highly prevalent global diseases with increasing percentages of morbidity and mortality. Both PD and CVDs independently have multifactorial causation, and emerging evidence shows an association between PD and CVDs. Periodontal diseases like gingivitis and periodontitis are chronic inflammatory conditions that eventually cause systemic inflammation, leading to many systemic diseases like rheumatoid arthritis, cardiovascular diseases, and others. In this study, we followed a systematic review approach to give an overview of the current evidence on the association between PD and CVDs. We used a relevant search strategy to retrieve articles from databases such as PubMed and Google Scholar from 2013 to July 2023. Upon applying filters and screening through titles and abstracts, we could narrow down articles to 21. On full-text screening, we selected 10 articles for in-depth analysis. This study showed a significant correlation between PD and CVDs. Poor oral hygiene, infection, and inflammation in the oral cavity lead to systemic inflammation, causing endothelial dysfunction. There are controversial views about PD acting as an independent risk factor for CVD development, as there are other risk factors such as age, gender, smoking, etc. acting as confounding factors while establishing the link between PD and CVDs. Knowledge about oral health, maintaining good oral hygiene, and proper treatment for PD could reduce the incidence of CVDs. Further research is needed to prove that PD is an independent risk factor for CVDs.

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Vitamin D levels and oral health in stroke patients during inpatient rehabilitation

BACKGROUND

Stroke is a severe that restricts the individual's functions, effects the oral health.

OBJECTIVES

The aim of this study was to investigate the relationship between oral health and vitamin D levels in stroke patients in rehabilitation units.

METHODS

Participants with stroke, and age- and sex-matched healthy controls were recruited for the study. Oral Health Impact Scale-14 (OHIP-14), Decayed, Missing, Filled Teeth (DMFT) Index, Community Periodontal Index of Treatment Needs (CPITN), Gingival Index (GI) and Plaque Index (PI) were assessed for all participants. Barthel Index (BI), Brunnstrom Recovery Scale (BRS) and Modified Ashworth Scale (MAS) assessed for the stroke patients. Vitamin D levels of each participant were recorded.

RESULTS

The stroke patients' DMFT index and OHIP-14 values were higher than those of the healthy controls (p < .05). However, no significant differences were observed in terms of CPTIN, PI, or GI scores (p > .05). No statistically significant difference was determined in the DMFT index, OHIP-14 scores, Community Periodontal Index of Treatment Needs (CPITN), PI (Plaque Index) and GI (Gingival Index) scores according to vitamin D levels among the stroke patients (p > .05). Stroke patients' functional scores (BRS, MAS and BI), vitamin D levels and oral health status (OHIP-14, DMFT, CPITN, PI and GI) were subjected to correlation analysis. This revealed significant negative correlation between BRS (arm, hand and leg), and BI and OHIP-14 scores (p < .05).

CONCLUSION

Although the DMFT index and oral health-related quality of life were adversely affected in stroke patients, no relationship was found between vitamin D and oral health status.

Poor Oral Health Is Associated with Worse Brain Imaging Profiles

Importance

Poor oral health is a modifiable risk factor that is associated with a variety of health outcomes. However, the relationship between oral and brain health is not well understood.

Objective

To test the hypothesis that poor oral health is associated with worse neuroimaging brain health profiles in persons without stroke or dementia.

Design

We conducted a 2-stage cross-sectional neuroimaging study using data from the UK Biobank (UKB). First, we tested for association between self-reported poor oral health and MRI neuroimaging markers of brain health. Second, we used Mendelian Randomization (MR) analyses to test for association between genetically-determined poor oral health and the same neuroimaging markers.

Setting

Ongoing population study in the United Kingdom. The UKB enrolled participants between 2006 and 2010. Data analysis was performed from September 1, 2022, to January 10, 2023.

Participants

40,175 persons aged 40 to 70 enrolled between 2006 to 2010 who underwent a dedicated research brain MRI between 2012 and 2013.

Exposures

During MRI assessment, poor oral health was defined as the presence of dentures or loose teeth. As instruments for the MR analysis, we used 116 independent DNA sequence variants known to significantly increase the composite risk of decayed, missing, or filled teeth and dentures.

Main Outcomes and Measures

As neuroimaging markers of brain health, we assessed the volume of white matter hyperintensities (WMH), as well as aggregate measures of fractional anisotropy (FA) and mean diffusivity (MD), two metrics indicative of white matter tract disintegrity obtained through diffusion tensor imaging. These measurements were evaluated across 48 distinct brain regions, with FA and MD values for each region also considered as individual outcomes for the MR method.

Results

Among study participants, 5,470 (14%) had poor oral health. We found that poor oral health was associated with a 9% increase in WMH volume (beta = 0.09, standard deviation (SD) = 0.014, p P< 0.001), a 10% change in the aggregate FA score (beta = 0.10, SD = 0.013, P < 0.001), and a 5% change in the aggregate MD score (beta = 0.05, SD = 0.013, P < 0.001). Genetically-determined poor oral health was associated with a 30% increase in WMH volume (beta = 0.30, SD = 0.06, P < 0.001), a 43% change in aggregate FA score (beta = 0.42, SD = 0.06, P < 0.001), and an 10% change in aggregate MD score (beta = 0.10, SD = 0.03, P = 0.01).

Conclusions and Relevance

Among middle age Britons without stroke or dementia enrolled in a large population study, poor oral health was associated with worse neuroimaging brain health profiles. Genetic analyses confirmed these associations, supporting a potential causal association. Because the neuroimaging markers evaluated in the current study are established risk factors for stroke and dementia, our results suggest that oral health may be a promising target for interventions focused on improving brain health.

The Relationship Between Periodontal Disease (PD) and Recurrent Vascular Events in Ischemic Stroke/Transient Ischemic Attack (TIA) Patients: A Hospital-Based Cohort Study

Background In this cohort study, the association between periodontal disease (PD) and recurrent vascular events was determined among the subjects with ischemic stroke/transient ischemic attack (TIA), and the extent and severity of periodontal disease were estimated among these subjects. Methods This prospective, longitudinal, hospital-based cohort study included 153 individuals who had a stroke or TIA. They were divided into two groups: high periodontal disease (HPD) (N=55, mean age: 59.40±12.21) and low periodontal disease (LPD) (N=98, mean age: 53.03±12.82). Clinical attachment loss (CAL) and probing pocket depth (PPD) were used to measure the severity of the periodontal disease. TOAST criteria were used to determine the ischemic stroke etiology, and the NIH Stroke Scale (NIHSS) was used to determine the ischemic stroke severity. A follow-up survey found that vascular incidents recurred. Results HPD individuals exhibited a higher median NIHSS (eight) than LPD patients (seven) in a subset of stroke population (N=23). Thirty-eight cardiovascular events occurred in the first three months after enrollment, including 23 strokes and seven TIAs, and five myocardial infarctions(MIs). There were three deaths from vascular causes. There was a non-significant association between PD and composite vascular events (HR 1.06, 95% CI, 1.03 to 1.09, p=0.71). Compound vascular events were not related to severe HPD (HR 1.31, 95 % CI 0.54 to 3.16, p=0.07). Conclusion In stroke/TIA patients, there is no link between high periodontal disease and recurrent vascular episodes. The proportions of stroke subtypes were not substantially different between HPD and LPD.

Intra-Oral Photograph Analysis for Gingivitis Screening in Orthodontic Patients

This study aimed to confirm the presence of gingival inflammation through image analysis of the papillary gingiva using intra-oral photographs (IOPs) before and after orthodontic treatment and to confirm the possibility of using gingival image analysis for gingivitis screening. Five hundred and eighty-eight (n  =  588) gingival sites from the IOPs of 98 patients were included. Twenty-five participants who had completed their orthodontic treatments and were aged between 20 and 37 were included. Six points on the papillary gingiva were selected in the maxillary and mandibular anterior incisors. The red/green (R/G) ratio values were obtained for the selected gingival images and the modified gingival index (GI) was compared. The change in the R/G values during the orthodontic treatment period appeared in the order of before orthodontic treatment (BO), mid-point of orthodontic treatment (MO), three-quarters of the way through orthodontic treatment (TO), and immediately after debonding (IDO), confirming that it was similar to the change in the GI. The R/G value of the gingiva in the image correlated with the GI. Therefore, it could be used as a major index for gingivitis diagnosis using images.

The oral microbiome in the pathophysiology of cardiovascular disease

Despite advances in our understanding of the pathophysiology of many cardiovascular diseases (CVDs) and expansion of available therapies, the global burden of CVD-associated morbidity and mortality remains unacceptably high. Important gaps remain in our understanding of the mechanisms of CVD and determinants of disease progression. In the past decade, much research has been conducted on the human microbiome and its potential role in modulating CVD. With the advent of high-throughput technologies and multiomics analyses, the complex and dynamic relationship between the microbiota, their 'theatre of activity' and the host is gradually being elucidated. The relationship between the gut microbiome and CVD is well established. Much less is known about the role of disruption (dysbiosis) of the oral microbiome; however, interest in the field is growing, as is the body of literature from basic science and animal and human investigations. In this Review, we examine the link between the oral microbiome and CVD, specifically coronary artery disease, stroke, peripheral artery disease, heart failure, infective endocarditis and rheumatic heart disease. We discuss the various mechanisms by which oral dysbiosis contributes to CVD pathogenesis and potential strategies for prevention and treatment.

Combined Ferromagnetic Nanoparticles for Effective Periodontal Biofilm Eradication in Rat Model

Introduction

The critical challenge for periodontitis therapy is thoroughly eliminating the dental plaque biofilm, particularly penetrating the deep periodontal tissue. Regular therapeutic strategies are insufficient to penetrate the plaque without disturbing the commensal microflora of the oral cavity. Here, we constructed a Fe₃O₄ magnetic nanoparticle loading minocycline (FPM NPs) to penetrate the biofilm physically and effectively eliminate periodontal biofilm.

Methods

In order to penetrate and remove the biofilm effectively, Fe₃O₄ magnetic nanoparticles were modified with minocycline using a co-precipitation method. The particle size and dispersion of the nanoparticles were characterized by transmission electron microscopy, scanning electron microscopy, and dynamic light scattering. The antibacterial effects were examined to verify the magnetic targeting of FPM NPs. Confocal laser scanning microscopy was employed to check the effect of FPM + MF and develop the best FPM NPs treatment strategy. Additionally, the therapeutic effect of FPM NPs was investigated in periodontitis rat models. The expression of IL-1β, IL-6, and TNF-α in periodontal tissues was measured by qRT-PCR and Western blot.

Results

The multifunctional nanoparticles exhibited intense anti-biofilm activity and good biocompatibility. The magnetic forces could pull FMP NPs against the biofilm mass and kill bacteria deep in the biofilms both in vivo and in vitro. The integrity of the bacterial biofilm is disrupted under the motivation of the magnetic field, allowing for improved drug penetration and antibacterial performance. The periodontal inflammation recovered well after FPM NPs treatment in rat models. Furthermore, FPM NPs could be monitored in real-time and have magnetic targeting potentials.

Conclusion

FPM NPs exhibit good chemical stability and biocompatibility. The novel nanoparticle presents a new approach for treating periodontitis and provides experimental support for using magnetic-targeted nanoparticles in clinic applications.

Association between the interval of worksite dental check-ups and dental and medical expenditures: a single-site, 12-year follow-up study in Japan

OBJECTIVES

The purpose of this study was to identify the effective intervals of worksite dental check-ups to reduce cumulative dental expenditures (CDEs) and cumulative medical expenditures (CMEs), based on 12 years of follow-up dental check-ups.

SETTING, DESIGN AND PARTICIPANTS

A longitudinal study was conducted between 2002 and 2014 fiscal years. A total of 2691 full-time employees (2099 males and 592 females) aged 20-59 years in a manufacturing company in Japan were recruited.

PRIMARY AND SECONDARY OUTCOME MEASURES

Based on the follow-up of 12-year dental check-ups, the interval of dental check-ups visits was classified into the following categories: 'Once per year' as the regular group, 'At least once per 2 years' as the subregular group and others as the irregular group. CDEs and CMEs per capita were examined by the three groups of dental check-ups interval after adjustment for sex, age, occupation and total CMEs at baseline. For sensitivity analysis, decayed teeth, missing teeth and Community Periodontal Index were added as adjustment factors.

RESULTS

Compared with the irregular group, the pooled CDEs (including dental check-ups fee) per capita in the subregular group (OR 0.91, 95% CI 0.85 to 0.98) and regular group (OR 0.87, 95% CI 0.81 to 0.93) were significantly lower overall. The younger adults in the subregular group and younger-aged and middle-aged adults in the regular group had significantly lower CDEs. Sensitivity analysis confirmed these findings.

CONCLUSIONS

Our findings suggest that regular and subregular worksite dental check-ups were related to reduction of CDEs. It is important to promote a yearly interval between dental check-ups.

The Link between Stroke Risk and Orodental Status-A Comprehensive Review

One of the primary causes of disability and mortality in the adult population worldwide is stroke. A person's general health is significantly impacted by their oral and dental health. People who have poor oral health are more susceptible to conditions such as stroke. Stroke risk has long been linked to oral and dental conditions. The risk of stroke and its cost impact on the healthcare systems appear to be significantly reduced as a result of the decline in the incidence and prevalence of oral and dental illnesses. Hypothetically, better management of oral hygiene and dental health lead to reduced stroke risk. To the authors' best knowledge, for the first time, the potential link between dental health and stroke were cross-examined. The most typical stroke symptoms, oral and dental illnesses linked to stroke, and the role of oral healthcare professionals in stroke prevention are revealed. The potential mediating processes and subsequent long-term cognitive and functional neurological outcomes are based on the available literature. It must be noted that periodontal diseases and tooth loss are two common oral health measures. Lack of knowledge on the effects of poor oral health on systemic health together with limited access to primary medical or dental care are considered to be partially responsible for the elevated risk of stroke. Concrete evidence confirming the associations between oral inflammatory conditions and stroke in large cohort prospective studies, stratifying association between oral disease severity and stroke risk and disease effects on stroke survival will be desirable. In terms of clinical pathology, a predictive model of stroke as a function of oral health status, and biomarkers of systemic inflammation could be useful for both cardiologists and dentists.

Patients with periodontitis are at a higher risk of stroke: A Taiwanese cohort study

BACKGROUND

This study aimed to investigate the risk of stroke incidence in patients with periodontitis.

METHODS

Data on patients diagnosed with periodontitis were collected from Taiwan's National Health Insurance Research Database and were matched (1:1) with patients without periodontitis between 2001 and 2010. A multivariable Cox survival model was used to predict stroke between patients with and without periodontitis, and the possibility of confounders. Hazard ratios (HRs) with 95% confidence intervals (CIs) were used to explore the risk of stroke in the case and control groups. Diseases found during the follow-up period were analyzed to determine possible effects on the study. A total of 282 560 periodontitis and nonperiodontitis patients were enrolled, with most subjects aged 40 to 59 years.

RESULTS

The overall cumulative incidence of stroke was 2.14 times higher in periodontitis than in nonperiodontitis, and the highest HR was in the more than 80 years age group (HR = 9.30; 95% CI, 7.06-12.26). The multivariate Cox model indicated that the adjusted HR (aHR) between the case and control was 2.03 (95% CI, 1.99-2.08), and a higher aHR was associated with hypertension. Atherosclerosis, atrial fibrillation, obesity, kidney disease, anxiety, and gout discovered during follow-up also showed a potential risk of stroke in patients with periodontitis.

CONCLUSION

Therefore, this study suggests a high risk of stroke in patients with periodontitis.

Oral health knowledge, attitudes, and practices and oral health-related quality of life among stroke inpatients: a cross-sectional study

BACKGROUND

Stroke patients have poor oral hygiene, experience oral dysfunction due to disease factors, and have impaired oral health-related quality of life (OHRQoL). This study aimed to determine the oral health knowledge, attitudes, and practices of stroke inpatients, assess the OHRQoL of these patients, and identify their correlates.

METHODS

In this cross-sectional study, 281 stroke inpatients aged between 22 and 88 years (57.94 ± 10.94) were conveniently selected from three hospitals in Guangzhou, China. OHRQoL was measured among these stroke patients using a Chinese version of the Oral Health Impact Profile-14 (OHIP-14). SPSS 26.0 was used for statistical analysis. Mean scores, standard deviations, and frequency distributions were obtained. The Mann-Whitney U test, Kruskal‒Wallis H test, Spearman's correlation, and multiple linear regression were used in the analysis.

RESULTS

The mean score of the patients' OHRQoL was 8.37 ± 6.67, with the highest score in the pain or discomfort of the mouth dimension (3.11 ± 2.13) and pain being the most common negative effect (13.5%). In multiple linear regression analysis, significant differences were found between patients only in age (P = 0.008), toothache (P < 0.001), self-rated oral health (P < 0.001), time since last dentist visit (P = 0.037) and reason for not having visited a dentist in the past year (P < 0.001).

CONCLUSION

The OHRQoL of patients hospitalised with stroke was moderate, and oral conditions still need to be improved. Increasing age, toothache, a longer time since the last dental visit and the reason for not visiting a dentist in the past year had a negative effect on OHRQoL, and better self-rated oral health had a positive effect. Therefore, in clinical work, greater attention should be given to elderly stroke patients, patients with poor oral status and poor oral health behaviours, timely assessment of patients' swallowing function, nutritional function, and self-care ability, and early and targeted oral health interventions and guidance.

Prevalence, extent, and severity of periodontitis among Australian older adults: Comparison of two generations

BACKGROUND

Chronic periodontitis is highly prevalent among older adults. The study aimed to compare periodontal disease among Australian older adults in two generations. We hypothesized that the prevalence and severity of periodontitis would decrease from the previous generation to the recent generation.

METHODS

Data were obtained from the South Australian Dental Longitudinal Study (SADLS) in 1991 to 1992 (SADLS I) and 2013 to 2014 (SADLS II); population-based longitudinal surveys of Australian older adults aged ≥60 years. American Academy of Periodontology, the US Centers for Disease Control and Prevention (AAP/CDC), and the 2018 European Federation of Periodontology (EFP/AAP) classification case definitions were used to define and calculate prevalence of chronic periodontitis. Multivariable log-Poisson regression models were used to identify risk indicators for severe periodontitis after adjusting for other covariates.

RESULTS

There were a total of 801 and 355 participants that underwent a periodontal exam in SADLS I and II, respectively. The prevalence of severe periodontitis was higher in the recent generation (88% and 56%) than the previous generation (75% and 46.7%) under the CDC/AAP and EFP/AAP case definitions, respectively. The mean number of missing teeth was lower in the recent generation (6) than the previous generation (13). The prevalence ratio of severe periodontitis was around two times higher in the younger age group, men, those not born in Australia, and current smokers across both generations.

CONCLUSIONS

Our findings indicated that the recent generation of older adults has higher prevalence and severity of chronic periodontitis than the previous generation. Our findings indicated that aging, being male, born overseas, low household income, no dental insurance, and being a current smoker are significant risk factors associated with severe periodontitis among older Australians.

Association of periodontitis with tinnitus: A population-based cohort study in Taiwan

AIM

Tinnitus, ringing in the ears, is speculated to be driven by inflammation. This study examined whether periodontitis is a risk factor for tinnitus using Taiwan's National Health Insurance Research Database.

MATERIALS AND METHODS

Among the 79,456 patients who visited for dental concerns, 11,055 patients who were diagnosed with periodontitis and underwent periodontal treatment between 2000 and 2015 were enrolled in Group 1. After matching for sex, age, and index year, 11,055 patients with periodontitis who received no treatment were enrolled in Group 2. Similarly, 11,055 participants without periodontitis were included as controls.

RESULTS

At the end of the follow-up, 412 and 404 participants in the two periodontitis groups and 321 participants in the control group had tinnitus. Cumulative risk for tinnitus in Group 1 or 2 was significantly greater than in the control group. More periodontitis patients than controls developed tinnitus (adjusted hazard ratios were 1.71 (95% confidence interval [CI]: 1.49-1.97, p < .001) and 1.64 (95% CI: 1.37-1.86, p < .001) in Groups 1 and 2, respectively). The risks were not significantly different between Groups 1 and 2. Similar findings were obtained after excluding data for the first 1 or 5 years.

CONCLUSIONS

The study findings indicate that periodontitis is associated with tinnitus.

Cardiovascular Diseases and Periodontitis

Periodontitis is a chronic inflammatory disease of the tooth-supporting connective tissue and alveolar bone that is initiated by a bacterial biofilm in periodontal pockets. It affects about half of adults in the Western world, and is associated with a range of systemic comorbidities, e.g., cardiovascular disease (CVD), diabetes and rheumatoid arthritis, and these diseases share overlapping systemic and target tissue inflammatory mechanisms. Indeed, mounting evidence has indicated that their association is causal and built on the presence of systemic low-grade inflammation (LGI). Prior research linking periodontitis to CVD has mainly been derived from experimental studies, observational data, and small interventional trials with surrogate markers of CVD, e.g., endothelial dysfunction. However, recent data from randomised studies have demonstrated that intensive treatment of periodontitis can reduce blood pressure in patients with hypertension in conjunction with reduction of systemic inflammatory markers. Furthermore, targeted anti-inflammatory therapy has been shown to reduce recurrent events in patients with established CVD and LGI. Along this line, the concept of residual inflammatory risk has emerged as an independent new risk factor for atherothrombotic CVD. The present review summarizes translational evidence indicating that periodontitis is a risk factor for CVD dependent on LGI, and we conclude that treatment of periodontitis is likely to contribute importantly to reduction of residual inflammatory risk.

Oral Health-Related Quality of Life in Patients after Stroke-A Systematic Review

OBJECTIVES

Aim of this systematic review was to assess oral health-related quality of life (OHRQoL) of patients after stroke.

METHODS

The systematic literature search was performed on December 2021 based on PubMed, Medline, Web of Science, and Scopus, with the search terms: "oral health-related quality of life" AND stroke OR apoplexy OR ischemic stroke OR apoplectic insult. Articles exclusively examining patients after stroke and reporting a well-documented and valid OHRQoL measurement were included.

RESULTS

Out of 68 findings, 8 studies were included. The number of patients ranged between 31 and 549 individuals, mean age between 55.7 and 73.9 years, and 49-72% of individuals were male. Two studies included a healthy control group. Oral health parameters were rarely reported across studies. Five studies reported on the Oral Health Impact Profile (OHIP) 14 for OHRQoL, showing means between 2.87 and 33.0 in sum score. Three studies applied Geriatric Oral Assessment Index (GOHAI), with sum scores between 45.6 and 55.0. Only one study found worse OHRQoL in stroke patients compared to healthy controls. Two studies reported on an association between OHRQoL and general quality of life. Three studies found OHRQoL to be associated with different oral health parameters. Only one study found OHRQoL to be associated with stroke-related parameters.

CONCLUSIONS

Patients after stroke show a reduced OHRQoL. Medical staff and caregivers should support oral hygiene and dental visits, to foster patients' oral health and OHRQoL.

Periodontitis in Ischemic Stroke Patients: Case Definition Challenges of the New Classification Scheme (2018)

The identification of the associative relationships between ischemic stroke (IS) and risk factors such as advanced age and periodontitis is essential to design real screening protocols and to address them using primary and secondary preventive policies. This study primarily aimed to evaluate the diagnostic performance of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) case definition in detecting periodontitis against the 2012 Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) case definition in a group of IS patients. Secondarily, we report the periodontal status of IS patients and the associative relationship with respect to some risk factors. Patients with their first IS were assessed based on demographic data, medical, oral risk factors and periodontal parameters. The two case definitions were applied to identify the periodontitis burden. The agreement between the two case definition systems, as well as the misclassification ratio, were calculated. A total of 141 patients were included. According to the 2012 CDC/AAP and the 2018 EFP/AAP case definitions, a frequency of periodontitis of 98.5% and 97.8% based on two modalities of inclusion of cases in the severity groups, sensitivity values of 98.54% or 100%, and specificity values of 25% or 14.7% were calculated. Thus, the new case definition system has a higher capacity to detect periodontitis, especially the well-established forms.

Downregulation of lncRNA ANRIL Inhibits Osteogenic Differentiation of Periodontal Ligament Cells via Sponging miR-7 through NF-κB Pathway

BACKGROUND

Long noncoding RNAs (lncRNAs) are dysregulated in periodontitis development and involved in osteogenesis. The current study was aimed at investigating the function of lncRNA ANRIL in periodontal ligament cells (PDLCs) and potential molecular mechanisms.

METHODS

Firstly, the level of ANRIL was tested by qPCR. Then, PDLCs were treated with a mineralizing solution to induce osteogenic differentiation. ALP activity was measured, and protein levels of BMP2, Osterix, and OCN were measured by Western blot. A target of ANRIL was verified using dual-luciferase reporter assay. miR-7 level was measured by qPCR, and the signals of the NF-κB pathway were tested by Western blot.

RESULTS

ANRIL expression was downregulated in PDL tissues. Next, ALP activity and protein levels of BMP2, Osterix, and OCN were increased to show that PDLCs were differentiated. ANRIL level was increased in differential PDLCs, in which knockdown inhibited osteogenic differentiation. Then, miR-7 was found as a target of ANRIL. The miR-7 level was upregulated in PDL tissues and reduced in differential PDLCs. Inhibition of miR-7 suppressed ALP activity and BMP2, Osterix, and OCN expression. Moreover, inhibition of miR-7 reversed the effects on the osteogenic differentiation induced by knockdown of ANRIL. Besides, the levels of p-P65 and p-IκBα were elevated by ANRIL downregulation and were rescued by suppressing miR-7.

CONCLUSIONS

Knockdown of ANRIL inhibited osteogenic differentiation via sponging miR-7 through the NF-κB pathway, suggesting that ANRIL might be a therapeutic target for periodontitis.

Improved epithelial cell-cell adhesion using molecular mobility of supramolecular surfaces

Cells can sense the surrounding microenvironmental properties including contact with biomaterials. Although in vitro cell fates in response to the physical properties of cell-adhesive materials have been widely reported, their influence on cell-cell adhesion is unclear. Here, we investigated the role of molecular mobility on polyrotaxane surfaces in epithelial cell-cell adhesion. Polyrotaxane surfaces with high mobility induced cytoplasmic yes-associated protein (YAP) localization in epithelial cells, whereas those with low mobility induced nuclear YAP localization, suggesting that YAP localization is switched by the mobility of the polyrotaxane surface. The cytoplasmic YAP localization increased the expression of tight junction-associated genes. A scratch assay revealed that although the epithelial cells on the low mobile surface rapidly initiated their migration, the cells on the highly mobile surface delayed their migration. Thus, this finding suggests that polyrotaxane surfaces with higher mobility induce cytoplasmic YAP localization, leading to stronger cell-cell adhesion. The polyrotaxane biointerface is promising as a powerful tool to improve the physical immune system and repair biological tissues.

Association between dental diseases and history of stroke in the United States

OBJECTIVE

This study aimed to determine the potential association between the dental diseases and self-reported history of stroke in the United States based on data from the Third National Health and Nutrition Examination Survey (NHANES III).

METHODS

Data were extracted from NHANES III. Dental variables were carious tooth surfaces, number of missing teeth, gingival bleeding, and periodontal pockets. Multiple logistic regression modeling was used to estimate the effect of these dental diseases on the self-reported history of stroke with intent to adjust for the other potential determinants: age, sex, race, marital status, health insurance, education, exercise, body mass index, smoking, alcohol, hypertension, high serum cholesterol, and diabetes.

RESULTS

Number of missing teeth was found to be significantly associated with the self-reported history of stroke. Associations between the self-reported history of stroke and caries, gingival bleeding, or periodontal pockets were not statistically significant.

CONCLUSIONS

Number of missing teeth was an independent determinant of the self-reported history of stroke.

Periodontal disease and the risk of Alzheimer's disease and mild cognitive impairment: a systematic review and meta-analysis

BACKGROUND

Results of studies on the association between periodontal disease (PD) and Alzheimer's disease (AD) or mild cognitive impairment (MCI) are inconsistent, and a previous meta-analysis published in 2017 included inadequate studies and is thus outmoded. This study aims to systematically evaluate the correlation between PD and the risk of AD or MCI.

METHODS

The following electronic databases were screened by two investigators independently, without restriction of language: CENTRAL (Cochrane library), PubMed (MEDLINE), EMBASE, China National Knowledge Interne, China Science and Technology Journal Database, Wanfang Data, www.ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform. Meta-analysis was conducted using random-effects model or fixed-effects model according to the heterogeneity of included studies.

RESULTS

Thirteen eligible studies, of which eight reported AD (291 114 participants) and eight reported MCI (4805 participants), were included in this meta-analysis. The pooled results showed that compared with the non-PD population, the risk of AD and MCI in PD patients was significantly higher (for AD: odds ratio (OR) = 1.78, 95% CI 1.15-2.76; for MCI: OR = 1.60, 95% CI 1.24-2.06), and especially in those with severe PD (for AD: OR = 4.89, 95% CI 1.60-14.97; for MCI, OR = 2.32, 95% CI 1.24-4.36).

CONCLUSIONS

This meta-analysis indicated that PD was related to an elevated risk of AD and cognitive impairment, and that it should receive early intervention.

Evaluation of Oral Hygiene Status in Patients with Hemorrhagic and Ischemic Stroke

Background:

Stroke can broadly be categorized into ischemic or hemorrhagic. Ischemic stroke accounts for 85% of cerebrovascular accidents (CVAs), whereas hemorrhagic stroke accounts for 15% of CVAs. Stroke is broadly associated with loss of sensation or unilateral paralysis of orofacial structures.

Objectives:

The present study was conducted to evaluate the prevalence of various oral features in patients with ischemic and hemorrhagic stroke.

Materials and Methods:

One hundred patients diagnosed with stroke admitted in the intensive care unit were included in the study. The evaluation of oral manifestations and their prevalence was done by a well-experienced oral medicine expert deputed in the dental department of the hospital. A single examiner performed all oral evaluations.

Results:

The mean and median for the age were 60.8 and 59. Sixty of 100 patients were male, whereas 38 were female. Forty patients had hemorrhagic stroke, whereas 60 had ischemic stroke. Senenty-eight patients of 100 had features of periodontitis, 90 of 100 patients presented with halitosis, 79 presented with caries, 83 patients had positive signs of tongue hypermobility, and 75 patients had dysphagia.

Conclusion:

Oral hygiene is the most neglected aspect during rehabilitation in stroke patients. It is critical for stroke patients to receive thorough oral care, as it can prevent other systemic ailments and potentially life-threatening complications like aspiration pneumonia.

Vascular consequences of inflammation: a position statement from the ESH Working Group on Vascular Structure and Function and the ARTERY Society

: Inflammation is a physiological response to aggression of pathogenic agents aimed at eliminating the aggressor agent and promoting healing. Excessive inflammation, however, may contribute to tissue damage and an alteration of arterial structure and function. Increased arterial stiffness is a well recognized cardiovascular risk factor independent of blood pressure levels and an intermediate endpoint for cardiovascular events. In the present review, we discuss immune-mediated mechanisms by which inflammation can influence arterial physiology and lead to vascular dysfunction such as atherosclerosis and arterial stiffening. We also show that acute inflammation predisposes the vasculature to arterial dysfunction and stiffening, and alteration of endothelial function and that chronic inflammatory diseases such as rheumatoid arthritis, inflammatory bowel disease and psoriasis are accompanied by profound arterial dysfunction which is proportional to the severity of inflammation. Current findings suggest that treatment of inflammation by targeted drugs leads to regression of arterial dysfunction. There is hope that these treatments will improve outcomes for patients.

Serum High-Sensitive C-reactive Protein May Reflect Periodontitis in Patients With Stroke

BACKGROUND/AIM

Chronic infectious diseases are believed to increase the risk of stroke. We aimed to evaluate the prevalence of periodontal disease and its association with systemic inflammatory processes in patients suffering an acute stroke/transient ischemic attack (TIA).

PATIENTS AND METHODS

Altogether 36 acute stroke/TIA patients underwent clinical, laboratory and radiological examinations. The level of systemic inflammation was analyzed both with routine measurements of plasma C-reactive protein (p-CRP) and serum high-sensitivity CRP (s-hsCRP) to analyze their associations with periodontitis. The diagnostic criteria for periodontitis included increased probing depth (>4 mm) measured from four different sites, bleeding on probing, and horizontal (>1 mm), vertical (>1 mm) or apical bone loss observed on orthopantomography.

RESULTS

Twenty-six (72.2%) patients were diagnosed with periodontitis. Only five of the patients with periodontitis (19.2%) had elevated p-CRP values whereas the majority, (17/26; 65.4%) had elevated s-hsCRP values (p<0.01). Absolute s-hsCRP values in patients with periodontitis (8.9±12.5 mg/l) were significantly higher than in patients without periodontitis (2.3±3.0 mg/l; p<0.05). Absolute p-CRP concentrations did not differ (2.3±5.8 vs. 2.4±5.1 mg/l; p=not significant). The total number of periodontitis findings was significantly associated with s-hsCRP values (r=1.83) but not with p-CRP values. Conversely, seventeen of the nineteen patients with elevated s-hsCRP (89.5%) indicative of systemic inflammation had periodontitis.

CONCLUSION

Periodontitis is a common finding among patients with acute stroke/TIA as over 80% of patients with cryptogenic stroke/TIA had periodontitis. S-hsCRP is a useful tool for detecting subclinical systemic inflammation.

Severe periodontitis is associated with the serum levels of hypersensitive C reactive protein and lipoprotein-associated phospholipase A2 in the patients of acute ischemic stroke

BACKGROUND

Periodontitis is associated with the pathogenesis of atherosclerotic plaque, and hypersensitive C reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) are the serum biomarkers of the stability of atherosclerotic plaque. Whether periodontitis is associated with the serum level of hs-CRP and Lp-PLA2 of acute ischemic stroke remains unclear.

MATERIAL AND METHODS

We recruited 103 cases with acute ischemic stroke within 7 days after stroke onset. Pocket depth and clinical attachment loss were assessed by oral examination to define the severe periodontitis. Demographic information including gender, age and body weight index, income level, education level, past medical history include smoking history, drinking history, ischemic stroke history, coronary heart disease, hypertension, diabetes and hyperlipidemia were collected, and serum biomarkers including white blood cell (WBC), fibrinogen, total cholesterol (TC), triglyceride (TG), lower density lipoprotein (LDL-C), high density lipoprotein (HDL-C), hs-CRP, HemoglobinA1c (HbAlc), Homocysteine (HCY) and Lp-PLA2 were tested.

RESULTS

65 (63.1%) cases were diagnosed as severe periodontitis. Severe periodontitis group showed more male, age, drinking history, higher levels of hs-CRP and Lp-PLA2. Multivariate logistic regression showed that severe periodontitis was were significantly associated with hs-CRP (OR = 2.367, 95%CI: 1.182-4.738; P = .015) and Lp-PLA2 (OR = 2.577, 95% CI: 1.010-6.574; P = .048).

CONCLUSIONS

Severe periodontitis is independently associated with the serum Level of hs-CRP and Lp-PLA2 in patients with acute ischemic stroke. Whether the improvement of periodontitis could decrease the occurrence and re-occurrence of ischemic stroke by stablizating atherosclerotic plaque need be further studied in future.

Cardiovascular risks of periodontitis and oral hygiene indicators in patients with diabetes mellitus

AIM

Periodontitis is a common chronic inflammatory disease prevalent in diabetes. The aim of this study was to evaluate periodontitis and poor oral hygiene as independent risk factors for either cerebral or myocardial infarction in the diabetes population.

METHODS

This retrospective cohort study included 17,009 patients with diabetes who had participated in a nationwide health-screening programme, including oral health examination, during 2002-2003 in South Korea. Presence of periodontitis, tooth loss and carious teeth were assessed by professional dentists, and the number of tooth brushings per day was evaluated through self-reported questionnaires. The primary study outcome was the development of cerebral or myocardial infarction, based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes, up to 31 December 2015.

RESULTS

The study enrolled 17,009 patients with diabetes. Over the mean 11.64 years of follow-up, 1341 patients presented with either cerebral or myocardial infarction. On multivariable Cox proportional hazards regression analysis, presence of periodontitis was an independent risk factor for either cerebral or myocardial infarction [adjusted hazard ratio (HR): 1.17, 95% confidence interval (CI): 1.02-1.34; P = 0.030]. An increased number of carious teeth (≥5) was also associated with risk of cerebral or myocardial infarction (adjusted HR: 1.67, 95% CI: 1.20-2.32; P = 0.002), whereas frequent tooth brushing (≥2 times/day) was negatively associated with risk of cerebral or myocardial infarction (adjusted HR: 0.79, 95% CI: 0.70-0.90; P < 0.001) compared with tooth brushing ≤1 time/day.

CONCLUSION

Early identification and intervention of periodontal disease may be effective in reducing cardiovascular complications in the diabetes population, and improved oral hygiene would probably be associated with lower cardiovascular risk in diabetes.

Periodontitis and its higher levels of severity are associated with the triglyceride/high density lipoprotein cholesterol (TG/HDL-C) ratio

BACKGROUND

Periodontitis and the Triglyceride/High Density Lipoprotein Cholesterol (TG/HDL-C) ratio have both been associated with cardiovascular disease, metabolic syndrome, and obesity. Additionally, the ratio is a possible substitute for predicting insulin resistance. This study investigated the association between periodontitis, its severity levels (exposures), and the TG/HDL-C ratio (outcome).

METHODS

A cross-sectional study of public health service users in Brazil considered socioeconomic-demographic characteristics, lifestyle behavior, and general and oral health conditions. Anthropometric measurements and blood pressure were also measured. Systemic biomarker data were obtained, as well as assessment of periodontal diagnosis and its severity. The TG/HDL-C ratio was calculated using the serum triglyceride level over HDL cholesterol and the cut-off point, TG/HDL-C ≥2.3 serving as the cutoff indicting dyslipidemia. Logistic and linear regressions were used to statistically analyze the data.

RESULTS

A total of 1011 participants were included, with 84.17% having periodontitis and 49.85% having a TG/HDL-C ratio ≥2.3. For individuals with periodontitis, the odds of TG/HDL-C ratio ≥2.3 were 1.47 times greater than in those without periodontitis (OR_Adjusted  = 1.47, 95% CI: 1.02-2.14). Similar results were found for those with moderate and severe periodontitis, with a slight increase in the measurement magnitude with disease severity.

CONCLUSION

A positive relationship between periodontitis and the TG/HDL-C ratio ≥2.3 was found, suggesting a possible association with periodontal disease severity.

Is an Oral Health Status a Predictor of Functional Improvement in Ischemic Stroke Patients Undergoing Comprehensive Rehabilitation Treatment?

The study's aim was a clinical observation concerning the influence of oral health on functional status in stroke patients undergoing neurorehabilitation. This pilot cross-sectional clinical study was performed in 60 subacute phase stroke patients during 12 weeks of treatment. The program was patient-specific and consisted of neurodevelopmental treatment by a comprehensive rehabilitation team. The functional assessment was performed using the Barthel index (BI), Berg balance scale (BBS), functional independence measure (FIM), and Addenbrooke's cognitive examination III (ACE III) scales. Oral health was assessed according to World Health Organization (WHO) criteria, and it was presented using DMFT, DMFS, gingival index (GI), and plaque index (PlI). Significant improvement in many functional scales was noticed. However, important differences in most dental parameters without relevant changes in GI and PlI after the study were not observed. Reverse interdependence (p < 0.05) was shown between physical functioning (BI, FIM, or BBS) with GI and PlI results, and most dental parameters correlated with ACE III. Using multivariate regression analysis, we showed that ACE III and BI are predictive variables for DMFT, just as FIM is for DS (p < 0.05). The present research revealed that poor oral health status in patients after stroke might be associated with inpatient rehabilitation results.

The role of CRISPR-Cas in advancing precision periodontics

The significant advancement of molecular biology has revolutionized medicine and provided important technologies to further clinical research development. Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) are DNA sequences derived from bacteriophages which have previously infected the bacterial species. The CRISPR-Cas system plays a key role in bacterial defense by detecting and destroying DNA fragments during subsequent bacteriophage invasions. The Cas9 enzyme recognizes and cleaves new invading CRISPR-complementary DNA sequences. Researchers have taken advantage of this biological device to manipulate microbes' genes and develop novel therapeutics to tackle systemic disease. In this review, we discuss the potential of utilizing CRISPR-Cas systems in the periodontal field to develop personalized periodontal care. We summarize promising attempts to bring this technology to the clinical setting. Finally, we provide insights regarding future developments to best utilize the CRISPR-Cas systems to advance precision periodontics. Although further research is imperative to evaluate the safety and potential of using CRISPR-Cas to develop precision periodontics approaches, few studies showed promising data to support the investment into this important technology in the dental sector. CRISPR-Cas9 can be a useful tool to create knockouts in vitro and in vivo as a screening tool to identify cellular pathways involved in the pathogenesis of periodontitis. Alternative CRISPR systems such as CRISPRa, CRISPRi, and Cas13 can be used to modify the transcriptome and gene expression of genes involved in periodontitis progression. CRISPR systems such as Cas3 can be used to target the periodontal biofilm and to develop new strategies to reduce or eliminate periodontal pathogens. Currently, the utility of CRISPR-Cas applications in clinical settings is limited. Through this review, we hope to foster further discussion in the periodontal research and clinical communities with respect to the potential clinical application of novel, CRISPR-Cas based, therapeutics for periodontitis.

Is periodontitis a risk factor for ischaemic stroke, coronary artery disease and subclinical atherosclerosis? A Mendelian randomization study

BACKGROUND AND AIMS

Observational studies have reported an association between periodontitis and cardiovascular disease but whether this association is causal is uncertain. We therefore used Mendelian randomization to test whether periodontitis is causally associated with stroke, coronary artery disease, or subclinical atherosclerosis.

METHODS

A two-sample Mendelian randomization analysis was carried out using five single nucleotide polymorphisms previously associated with periodontitis in genome-wide association studies. Summary data were drawn from MEGASTROKE and combined with de novo analyses of UK Biobank for stroke and its major subtypes (up to 44,221 cases, 739,957 controls) and CARDIoGRAMplusC4D and UK Biobank for coronary artery disease (122,733 cases, 424,528 controls). We used existing data on carotid intima-media thickness in UK Biobank as a marker of subclinical atherosclerosis (N = 22,179). Causal estimates were obtained using inverse-variance weighted Mendelian randomization. Sensitivity analyses were performed using weighted median and MR-Egger approaches.

RESULTS

No association was found between periodontitis and any stroke (odds ratio [OR] per doubling in the odds of periodontitis 0.99, 95% confidence interval [CI] 0.97 to 1.02), ischaemic stroke (OR 1.00, 95% CI 0.97 to 1.03) or its major subtypes (p > 0.4), or coronary artery disease (OR 1.01, 95% CI 0.99 to 1.03). Similarly, we found no association for periodontitis and subclinical atherosclerosis (β -0.002, 95% CI -0.004 to 0.001). These results were consistent across a series of sensitivity analyses.

CONCLUSIONS

These findings provide no robust evidence for a causal relationship between periodontitis and stroke or coronary artery disease. This suggests that associations reported in observational studies may represent confounding.

Periodontitis and circulating blood cell profiles: a systematic review and meta-analysis

Periodontitis is a chronic inflammatory disease with local and systemic implications. Evidence suggests consistent hematologic changes associated with periodontitis. Our aim was to critically appraise the available evidence on hemogram, leukogram, and thrombogram alterations in otherwise healthy patients suffering from periodontitis when compared with controls. For this systematic review (SR), we searched MEDLINE, Web of Science, EMBASE, and the Cochrane Library (CENTRAL) for studies published up to June 2020. Both observational and interventional studies with baseline standard hematologic levels were included. Outcomes of interest were baseline hemogram, leukogram, and thrombogram values and the impact of periodontitis treatment on these outcomes. Upon risk of bias assessment, data extraction and both qualitative and quantitative (standardized mean differences) analyses were performed. Random-effects meta-analyses were performed to provide pooled estimates. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed (PROSPERO Reg. No. CRD42020164531). A total of 45 studies, eight intervention and 37 case-control studies, were identified after the final search of 3,012 titles. Following quality assessment, 43 articles were deemed to have low risk of bias, and two articles moderate risk. Meta-analyses confirmed that periodontitis was associated with both white and red cell lineages. Severe chronic periodontitis was associated with greater white blood cell counts (mean difference [MD] = 0.53, 95% confidence interval [CI]: 0.26-0.79) when compared with controls. Periodontitis was associated with a larger number of neutrophils (MD = 7.16%, 95% CI: 5.96-8.37) and lower mean platelet volume (MD = 0.30 fL, 95% CI: 0.49 to -0.10) compared with healthy participants. Nonsurgical periodontal treatment was associated with a decrease in white blood cell (WBC) levels (MD = 0.28 10⁹/L, 95% CI: -0.47 to -0.08) in patients with chronic periodontitis. Periodontitis is associated with hematologic changes (Strength of Recommendation Taxonomy [SORT] A recommendation). Higher WBC levels, higher neutrophil levels, higher erythrocyte sedimentation rate, and lower mean platelet volumes are the most common blood count findings. The association between periodontitis and WBC could be causal in nature. Further assessment to determine whether periodontitis causes changes in circulating blood cells and to identify the molecular mechanisms underlying these associations is warranted.

Association of Tooth Loss with New-Onset Parkinson's Disease: A Nationwide Population-Based Cohort Study

Introduction

Tooth loss is associated with poor oral hygiene. During insufficient oral sanitation, focal infection and inflammation can occur and these reactions may induce systemic inflammation. Systemic inflammatory reaction may be related to the degeneration of dopamine neurons in the substantia nigra. We hypothesized that tooth loss is related to increased risk of new-onset Parkinson's disease.

Methods

Between 2003 and 2006, we included 153,165 participants from the national health insurance system-health screening cohort in Korea. The incidence of new-onset Parkinson's disease was defined as International Classification of Diseases-10 code “G20,” accompanying the prescription records for any anti-Parkinson's disease medication.

Results

Approximately 19.9% of the included participants had periodontal disease. After a median duration of 10.4 years, 1,227 (0.8%) cases of new-onset Parkinson's disease were noted. The number of tooth loss was positively related to an increased risk of new-onset Parkinson's disease. Contrastingly, the frequency of tooth brushings and dental clinic visits for any causes as well as competent dental care were negatively related to the development of new-onset Parkinson's disease. In multivariable analysis, the number of tooth loss (≥15) was positively related to new-onset Parkinson's disease development (hazard ratio: 1.38, 95% confidence interval (1.03–1.85), p=0.029, p for trend = 0.043) after adjusting variables.

Conclusion

Our study demonstrated that the number of tooth loss was positively correlated with a higher risk of new-onset Parkinson's disease development in a longitudinal study setting. Increased number of tooth loss may be an important risk indicator of new-onset Parkinson's disease.