Chronic Kidney Disease and Periodontitis Interplay-A Narrative Review

Periodontitis and risk of mortality in patients with chronic kidney disease: A systematic review with meta-analysis

Studies examining the link between periodontitis and survival outcomes have yielded conflicting results in patients with chronic kidney disease (CKD). This systematic review with meta-analysis aims to assess the association between periodontitis and cardiovascular or all-cause mortality in CKD patients. A thorough search was conducted on the PubMed, Web of Science, and Embase databases for studies investigating the association between periodontitis and survival outcomes in CKD patients. Two authors independently scanned the titles or abstracts and then identified the eligible full-text article based on the PECOS criteria: Participants (CKD patients), Exposure (periodontitis), Comparison (mild/no periodontitis), Outcomes (cardiovascular or all-cause mortality), and Study design (retrospective or prospective cohort). Six cohort studies, including 7731 patients, were identified. The included studies had low-to-moderate risk of bias. The mean/median follow-up duration ranged from 18.1 months to 8.67 years. The all-cause mortality rate was 44.8% for patients with periodontitis and 28.0% for controls. Meta-analysis showed that periodontitis, defined through clinical attachment loss (CAL), was significantly associated with an increased risk of all-cause (adjusted hazard ratio [HR] 1.24; 95% confidence intervals [CI] 0.89-1.72; I2  = 80.9%) and cardiovascular mortality (HR 1.57; 95% CI 1.08-2.27; I2  = 34.0%). Additionally, a significant association between periodontitis and the risk of cardiovascular or all-cause mortality was observed in studies with a predominance of females, follow-up duration ≥5 years, all stages of CKD, and low risk of bias subgroups. Periodontitis is significantly associated with an increased risk of all-cause and cardiovascular mortality in CKD patients within low risk of bias subgroup or based on defining periodontitis through CAL. Registration number: PROSPERO CRD42018512391.

Association between Dental Scores and Saliva Uremic Toxins

Dental health is frequently altered in patients with chronic kidney disease. We conducted a prospective study on dental health in CKD patients with a specific interest in the association between dental health issues and the accumulation of uremic toxins in the saliva. A total of 88 patients were included in the study, with chronic kidney disease stage 2 to 5 (without kidney replacement). We analysed the total concentrations of eight uremic toxins (trimethylamine N-oxide -TMAO-, Indoxyl Sulfate, P-cresyl-sulfate, Indole 3-acetic acid, 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid -CMPF-, Kynurenine, Hippuric acid and Phenylacetylglutamine) and three precursors of uremic toxins (Tyrosine, Phenylalanine and Tryptophan) in the saliva using LC-MS/MS. We observed, for the first time, the association between various dental scores: DMFT, FST, CPITN, and OHIS, and saliva uremic toxins and precursors: TMAO, indoxyl sulfate, or hippuric acid. Further prospective interventional studies are required to confirm our results.

An Overview of Chronic Kidney Disease Pathophysiology: The Impact of Gut Dysbiosis and Oral Disease

Chronic kidney disease (CKD) is a severe condition and a significant public health issue worldwide, carrying the burden of an increased risk of cardiovascular events and mortality. The traditional factors that promote the onset and progression of CKD are cardiometabolic risk factors like hypertension and diabetes, but non-traditional contributors are escalating. Moreover, gut dysbiosis, inflammation, and an impaired immune response are emerging as crucial mechanisms in the disease pathology. The gut microbiome and kidney disease exert a reciprocal influence commonly referred to as "the gut-kidney axis" through the induction of metabolic, immunological, and endocrine alterations. Periodontal diseases are strictly involved in the gut-kidney axis for their impact on the gut microbiota composition and for the metabolic and immunological alterations occurring in and reciprocally affecting both conditions. This review aims to provide an overview of the dynamic biological interconnections between oral health status, gut, and renal pathophysiology, spotlighting the dynamic oral-gut-kidney axis and raising whether periodontal diseases and gut microbiota can be disease modifiers in CKD. By doing so, we try to offer new insights into therapeutic strategies that may enhance the clinical trajectory of CKD patients, ultimately advancing our quest for improved patient outcomes and well-being.

Effects of Periodontitis on Major Organ Systems

This review focuses on the fact that oral disorders are not merely localized to the mouth; in a broader sense, they also have a more significant impact on systemic health. In this review, we tried to bring to the notice various complications of periodontitis on the body's major organ systems. It has also been suggested that there is a potential connection between periodontitis and certain systemic disorders. Reviewing this fascinating topic is necessary. The objective is to create a thorough body of knowledge on the subject that is simple to access, alert medical professionals to the connection between dental health and systemic health, and highlight the necessity of a more thorough incorporation of medical and dental training. Periodontitis is a probable risk factor for various problems connected to the cardiovascular, pulmonary, endocrine, musculoskeletal, central nervous, and reproductive systems. It is a continual likely source of infection. Oral health affects overall health, and if extensive healthcare is ever accomplished, dental health should never be considered a distinct, remote, and lower significant part of health wholly disconnected from quality of life. One should never underestimate oral disorders as being acute and always curable. People should take utmost care and take the condition seriously to prevent significant complications.

Genomic Medicine in Canine Periodontal Disease: A Systematic Review

Genomic medicine has become a growing reality; however, it is still taking its first steps in veterinary medicine. Through this approach, it will be possible to trace the genetic profile of a given individual and thus know their susceptibility to certain diseases, namely periodontal disease. This condition is one of the most frequently diagnosed in companion animal clinics, especially in dogs. Due to the limited existing information and the lack of comprehensive studies, the objective of the present study was to systematically review the existing scientific literature regarding genomic medicine in canine periodontal disease and determine which genes have already been studied and their probable potential. This study followed the recommendations of the PRISMA 2020 methodology. Canine periodontal disease allied to genomic medicine were the subjects of this systematic review. Only six articles met all of the inclusion criteria, and these were analyzed in detail. These studies described genetic variations in the following genes: interleukin-6, interleukin-10, interleukin-1, lactotransferrin, toll-like receptor 9, and receptor activator of nuclear factor-kappa B. Only in two of them, namely interleukin-1 and toll-like receptor 9 genes, may the identified genetic variations explain the susceptibility that certain individuals have to the development of periodontal disease. It is necessary to expand the studies on the existing polymorphic variations in genes and their relationship with the development of periodontal disease. Only then will it be possible to fully understand the biological mechanisms that are involved in this disease and that determine the susceptibility to its development.

Association between Chronic Gingivitis and Cancer: A Retrospective Cohort Study of 19,782 Outpatients from the United Kingdom

Purpose: Recent data argue for the involvement of inflammatory and infectious diseases in cancer development. However, clinical data on the association between chronic gingivitis and cancer have been less conclusive. Here, we systematically evaluated the cancer incidence in a population-based cohort of outpatients with chronic gingivitis from the United Kingdom. Methods: 9891 patients with chronic gingivitis and an identical number of people without gingivitis matched by age, gender, index year, and the Charlson Comorbidity Index were identified from the Disease Analyzer database (IQVIA) between January 2000 and December 2016. Cox regression models were used to study the association between gingivitis and cancer. Results: The probability of cancer was significantly higher among patients with diagnosed chronic gingivitis compared to non-gingivitis individuals (HR = 1.36, 95% CI = 1.15–1.62). In cancer site-stratified analyses, we observed a trend towards higher rates of cancer in almost all cancers (breast cancer, lymphoid system cancer, digestive tract cancers, skin cancer); however, a significant association was only observed for prostate cancer (HR: 3.38; 95% CI: 1.57–7.27). Notably, the largest increase in cancer rates was observed in male patients (HR: 1.46, 95% CI: 1.13–1.89) between 41 and 60 years old (HR: 1.74, 95% CI: 1.30–2.32). Conclusions: Our data suggest that chronic gingivitis represents an important risk factor for the development of cancer. Therefore, in the context of patient dental care, awareness should be raised to refer gingivitis patients to existing screening programs, especially for prostate cancer. Moreover, the consistent treatment of gingivitis could potentially have a positive impact on the morbidity of certain cancers.