Prevalence and predictors for periodontitis among adults in China, 2010

P2X7R and P2X4R expression of mice submandibular gland in high-fat diet/streptozotocin-induced type 2 diabetes

Type 2 diabetes mellitus (T2DM) is a chronic inflammatory disease that can compromise the functioning of various organs, including the salivary glands (SG). The purinergic system is one of the most important inflammatory pathways in T2DM condition, and P2X7R and P2X4R are the primary purinergic receptors in SG that regulate inflammatory homeostasis. This study aimed to evaluate P2X7R and P2X4R expression, and morphological changes in the submandibular gland (SMG) in T2DM. Twenty-four 5-week-old mice were randomly assigned to control (CON) and diabetes mellitus (DM) groups (n = 12 each). Body weight, diet, and blood glucose levels were monitored weekly. The histomorphology of the SMG and the expression of the P2X7R, and P2X7R was evaluated by immunohistochemistry (IHC) staining and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) at 11 and 13 weeks of age. Our findings indicate a significant increase in food consumption, body weight, and blood glucose levels in the DM group. Although a significant increase in P2X7R and P2X4R expression was observed in the DM groups, the receptor location remained unchanged. We also observed a significant increase in the acinar area in the DM13w group, and a significant decrease in the ductal area in the DM11w and DM13w groups. Targeting purinergic receptors may offer novel therapeutic methods for diabetic complications.

Injectable Thermosensitive Gel CH-BPNs-NBP for Effective Periodontitis Treatment through ROS-Scavenging and Jaw Vascular Unit Protection

Periodontitis, a prevalent inflammatory condition in the oral cavity, is closely associated with oxidative stress-induced tissue damage mediated by excessive reactive oxygen species (ROS) production. The jaw vascular unit (JVU), encompassing both vascular and lymphatic vessels, plays a crucial role in maintaining tissue fluid homeostasis and contributes to the pathological process in inflammatory diseases of the jaw. This study presents a novel approach for treating periodontitis through the development of an injectable thermosensitive gel (CH-BPNs-NBP). The gel formulation incorporates black phosphorus nanosheets (BPNs), which are notable for their ROS-scavenging properties, and dl-3-n-butylphthalide (NBP), a vasodilator that promotes lymphatic vessel function within the JVU. These results demonstrate that the designed thermosensitive gel serve as a controlled release system, delivering BPNs and NBP to the site of inflammation. CH-BPNs-NBP not only protects macrophages and human lymphatic endothelial cells from ROS attack but also promotes M2 polarization and lymphatic function. In in vivo studies, this work observes a significant reduction in inflammation and tissue damage, accompanied by a notable promotion of alveolar bone regeneration. This research introduces a promising therapeutic strategy for periodontitis, leveraging the unique properties of BPNs and NBP within an injectable thermosensitive gel.

Associated factors of periodontitis and predicted study among young man in China: a population-based cross-sectional study

BACKGROUND

Periodontitis represents the foremost oral condition in young men, strongly correlated with socioeconomic elements and oral health behaviors. This research aimed to assess the prevalence of periodontitis and associated associations with socio-demographics and oral health practices for subsequent Hazard Ratio (HR) estimation.

METHODS

A total of 46,476 young men were recruited to the study between August 2022 and October 2023. A questionnaire on socio-demographic factors and oral health-related behaviors related to periodontitis was completed. The standard procedure was used for oral examination. Logistic regression and hazard ratios were used to estimate the influencing factors, whereas the nomogram was used to predict the risk of periodontitis in young men.

RESULTS

A total of 46,476 young men were surveyed and completed the questionnaire. The overall prevalence of periodontitis among young men was 1.74%. Out of these, 1.7% had mild periodontitis and 0.6% had moderate periodontitis. Age and dental calculus were important factors in the periodontal health of young men. This nomogram, which includes 7 easily obtainable clinical characteristics routinely collected during periodontitis risk assessment, provides clinicians with a user-friendly tool to assess the risk of periodontal disease in young men.

CONCLUSIONS

Regular dental prophylaxis is crucial for young men to maintain their gingival health and prevent the onset of periodontitis. Dental calculus plays a prominent role in this matter, as it serves as a significant contributing factor.

Bioactive materials from berberine-treated human bone marrow mesenchymal stem cells promote alveolar bone regeneration by regulating macrophage polarization

Alveolar bone regeneration has been strongly linked to macrophage polarization. M1 macrophages aggravate alveolar bone loss, whereas M2 macrophages reverse this process. Berberine (BBR), a natural alkaloid isolated and refined from Chinese medicinal plants, has shown therapeutic effects in treating metabolic disorders. In this study, we first discovered that culture supernatant (CS) collected from BBR-treated human bone marrow mesenchymal stem cells (HBMSCs) ameliorated periodontal alveolar bone loss. CS from the BBR-treated HBMSCs contained bioactive materials that suppressed the M1 polarization and induced the M2 polarization of macrophages in vivo and in vitro. To clarify the underlying mechanism, the bioactive materials were applied to different animal models. We discovered macrophage colony-stimulating factor (M-CSF), which regulates macrophage polarization and promotes bone formation, a key macromolecule in the CS. Injection of pure M-CSF attenuated experimental periodontal alveolar bone loss in rats. Colony-stimulating factor 1 receptor (CSF1R) inhibitor or anti-human M-CSF (M-CSF neutralizing antibody, Nab) abolished the therapeutic effects of the CS of BBR-treated HBMSCs. Moreover, AKT phosphorylation in macrophages was activated by the CS, and the AKT activator reversed the negative effect of the CSF1R inhibitor or Nab. These results suggest that the CS of BBR-treated HBMSCs modulates macrophage polarization via the M-CSF/AKT axis. Further studies also showed that CS of BBR-treated HBMSCs accelerated bone formation and M2 polarization in rat teeth extraction sockets. Overall, our findings established an essential role of BBR-treated HBMSCs CS and this might be the first report to show that the products of BBR-treated HBMSCs have active effects on alveolar bone regeneration.

Circ_0099630 knockdown alleviates lipopolysaccharide-induced injuries of human periodontal ligament cells through the inhibition of TLR4 by releasing miR-409-3p

BACKGROUND

Periodontitis triggers tooth loss and affects the health of population worldwide. Emerging evidence hints that circular RNAs (circRNAs) are involved in various diseases, including periodontitis. This study aimed to investigate the role of circ_0099630 in the progression of periodontitis.

METHODS

Periodontitis cell model was constructed by treating human periodontal ligament cells (HPDLCs) with lipopolysaccharide (LPS). Quantitative real-time PCR was used to analyze the expression of circ_0099630, microRNA-409-3p (miR-409-3p) and toll-like receptor 4 (TLR4) mRNA. Western blot was used for detecting protein levels of TLR4, cleaved-caspase 3, Bcl-2, CyclinD1 and NF-κB signaling markers. For function analyses, cell proliferation was assessed by CCK-8 assay and EdU assay. The releases of pro-inflammation factors were monitored by ELISA kits. The potential relationship between miR-409-3p and circ_0099630 or TLR4 was verified by dual-luciferase reporter assay, RIP assay and pull-down assay.

RESULTS

The expression of circ_0099630 and TLR4 was elevated in periodontitis patients and LPS-treated HPDLCs. LPS induced HPDLC proliferation inhibition, apoptosis and inflammatory responses, while circ_0099630 knockdown or TLR4 knockdown alleviated these injuries. Besides, TLR4 overexpression reversed the inhibitory effect of circ_0099630 knockdown on LPS-induced HPDLC injuries. Mechanism analysis showed that circ_0099630 positively regulated TLR4 expression by acting as miR-409-3p sponge. MiR-409-3p restoration largely ameliorated LPS-induced HPDLC injuries by depleting TLR4. Moreover, LPS activated the NF-κB signaling pathway, while circ_0099630 knockdown inhibited the activity of NF-κB signaling via the miR-409-3p/TLR4 axis.

CONCLUSION

Circ_0099630 knockdown relieved LPS-induced HPDLC injury by miR-409-3p/TLR4 axis, suggesting that circ_0099630 might be a potential target for periodontitis treatment.

An injectable and thermosensitive hydrogel with nano-aided NIR-II phototherapeutic and chemical effects for periodontal antibacteria and bone regeneration

Periodontitis is a common public health problem worldwide and an inflammatory disease with irregular defect of alveolar bone caused by periodontal pathogens. Both antibacterial therapy and bone regeneration are of great importance in the treatment of periodontitis. In this study, injectable and thermosensitive hydrogels with 3D networks were used as carriers for controlled release of osteo-inductive agent (BMP-2) and Near Infrared Region-II (NIR-II) phototherapy agents (T8IC nano-particles). T8IC nano-particles were prepared by reprecipitation and acted as photosensitizer under 808 nm laser irradiation. Besides, we promoted photodynamic therapy (PDT) through adding H2O2 to facilitate the antibacterial effect instead of increasing the temperature of photothermal therapy (PTT). Hydrogel + T8IC + Laser + BMP-2 + H2O2 incorporated with mild PTT (45 °C), enhanced PDT and sustained release of BMP-2. It was present with excellent bactericidal effect, osteogenic induction and biosafety both in vitro and in vivo. Besides, immunohistochemistry staining and micro-CT analyses had confirmed that PTT and PDT could promote bone regeneration through alleviating inflammation state. Altogether, this novel approach with synergistic antibacterial effect, anti-inflammation and bone regeneration has a great potential for the treatment of periodontitis in the future.

Diagnostic potential of miR-200 family members in gingival crevicular fluid for chronic periodontitis: correlation with clinical parameters and therapeutic implications

OBJECTIVE

The purpose of this study was to evaluate the potential of miR-200 family members in gingival crevicular fluid (GCF) as diagnostic biomarkers for chronic periodontitis (CP), aiming to provide valuable insights for the early detection and management of the disease.

METHODS

GSE89081 dataset profiled miRNAs in GCF derived from 5 healthy and 5 periodontitis was analyzed by GEO2R. Quantitative real-time PCR was used to quantify the expression levels of miR-200 family members (miR-200a-3p, miR-200a-5p, miR-200b-3p, miR-200b-5p, miR-200c-3p, miR-200c-5p, miR-141-3p, miR-141-5p, and miR-429) in the GCF samples from 103 CP patients and 113 healthy controls. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic potential of miR-200 family members in differentiating CP patients from healthy controls.

RESULTS

By analyzing the GSE89081 dataset, miR-200a-5p, miR-200b-5p and miR-200c-5p were significantly upregulated in GCF of the CP patients compared to the healthy control. In this study, miR-200a-3p, miR-200a-5p, miR-200b-3p, miR-200b-5p, miR-200c-3p, miR-200c-5p were significantly increased in GCF of CP patients compared to the healthy control, while miR-141 and miR-429 did not show significant differences. MiR-200a, -200b and 200c had good diagnostic value, and when these miRNAs were combined, they demonstrated excellent diagnostic value for CP with an AUC of 0.997, sensitivity of 99.03%, and specificity of 98.23%. MiR-200a, -200b and 200c in GCF showed significant and positive correlation with plaque index (PI), gingival index (GI), bleeding on probing (BOP), clinical attachment level (CAL), and probing pocket depth (PPD).

CONCLUSION

MiR-200a, -200b and 200c in GCF may serve as potential biomarkers for the early diagnosis of CP, which was correlated with clinical parameters, being therapeutic targets for CP.

Associations of Attitudes and Practice Toward Oral Health, Socioeconomic Status, Self-Rated Oral Health, Subjective Oral Symptoms, and Oral Health-Related Quality of Life Among Residents in Eastern China: A Structural Equation Modeling Approach

Background and Purpose

The purpose of this study was to investigate the relationships among attitudes and practice about oral health, socioeconomic status, subjective oral symptoms, self-rated oral health, and oral health-related quality of life (OHRQoL) in a group of people from eastern China.

Methods

Between January 2021 to February 2022, 2502 (87.4%) of the 2863 participants completed an online questionnaire. OHRQoL, Socio-demographics characteristics, attitudes and practice toward oral health, self-rated oral health and subjective oral symptoms were all covered by the questionnaires. Based on the hypothetical model, structural equation modeling with the bootstrap method was used to examine the interactions and the strength of the correlations between the measured variables.

Results

The final model demonstrated acceptable data fit. Socioeconomic status (β = -0.051), attitudes (β = -0.100) and practice (β = -0.127) toward oral health, self-rated oral health (β = -0.493) and subjective oral symptoms (β = 0.294) were all significantly correlated with OHRQoL. Socioeconomic status was directly linked to attitudes (β = 0.046) and practice (β =0.070) about oral health, and attitudes play the role of intermediary between practice and socioeconomic status (β = 0.018). OHRQoL was indirectly linked with attitudes mediated by practice (β = -0.092), practice mediated by subjective oral symptoms (β = -0.107), subjective oral symptoms mediated by self-rated oral health (β = 0.031). OHRQoL was correlated with income, educational level, and socioeconomic status. Self-rated oral health was related to educational level and socioeconomic status.

Conclusion

In a sample of eastern China residents, OHRQoL was influenced by socioeconomic status, attitudes and practice toward oral health, subjective oral symptoms, and self-rated oral health.

Evidence from the Hamburg City Health Study - association between education and periodontitis

OBJECTIVE

Large-scale population-based studies regarding the role of education in periodontitis are lacking. Thus, the aim of the current study was to analyze the potential association between education and periodontitis with state of the art measured clinical phenotypes within a large population-based sample from northern Germany.

MATERIAL & METHODS

The Hamburg City Health Study (HCHS) is a population-based cohort study registered at ClinicalTrial.gov (NCT03934957). Oral health was assessed via plaque-index, probing depth, gingival recession and gingival bleeding. Periodontitis was classified according to Eke & Page. Education level was determined using the International Standard Classification of Education (ISCED-97) further categorized in "low, medium or high" education. Analyses for descriptive models were stratified by periodontitis severity. Ordinal logistic regression models were stepwise constructed to test for hypotheses.

RESULTS

Within the first cohort of 10,000 participants, we identified 1,453 with none/mild, 3,580 with moderate, and 1,176 with severe periodontitis. Ordinal regression analyses adjusted for co-variables (age, sex, smoking, diabetes, hypertension and migration) showed that the education level (low vs. high) was significantly associated with periodontitis (OR: 1.33, 95% CI: 1.18;1.47).

CONCLUSION

In conclusion, the current study revealed a significant association between the education level and periodontitis after adjustments for a set of confounders. Further research is needed to develop strategies to overcome education related deficits in oral and periodontal health.

Dietary magnesium intake is protective in patients with periodontitis

Background

Periodontitis is a chronic inflammatory disease of the oral cavity characterized by inflammation of the periodontal tissue and resorption of the alveolar bone, which has a high incidence and is the main cause of tooth loss in adults. In addition to its role in promoting osteogenesis, magnesium also has a role in regulating the inflammatory response, both systemically and locally. There is growing evidence that magnesium is an important factor in maintaining the normal functioning of the body's immune system. Hypomagnesaemia can lead to a variety of chronic inflammatory diseases throughout the body, including periodontitis. Two-thirds of the US population suffers from magnesium deficiency. The connection between dietary magnesium and periodontitis is unknown. As a result, we set out to investigate the link between dietary magnesium intake and periodontitis.

Methods

In this study, we collected data from the National Health and Nutrition Examination Survey (NHANES) database from 2013 to 2014. Through 24-h dietary recalls, information about food consumption was collected. We examined the association between the dietary magnesium and periodontitis using multivariable logistic regression model. Based on odds ratios (OR) and 95% confidence intervals (CIs), a strong association was detected.

Results

Multivariable logistic regression analysis showed that the OR for periodontitis comparing the highest to the lowest quintile of dietary magnesium intake was 0.69 (95% CIs = 0.52~0.92). The restricted cubic spline (RCS) analysis showed that the non-linear association between dietary magnesium and periodontitis was statistically significant and that dietary magnesium supplementation reduced the prevalence of periodontitis.

Conclusion

Dietary magnesium intake is associated with the prevalence of periodontitis. Dietary magnesium deficiency increases the prevalence of periodontitis.

Periodontitis prevalence and severity in an African population: A cross-sectional study in the Greater Accra Region of Ghana

BACKGROUND

Periodontitis is a major public health problem affecting many adults, with considerable variation in its prevalence and severity worldwide. There is little data on its prevalence or associated risk factors in Ghana making development of evidence based preventive programs challenging. This study assessed the prevalence, severity, extent and associated risk factors of periodontitis in an adult Ghanaian population.

METHODS

A population based cross-sectional study involving adults aged 25 years and above in the Greater Accra Region (GAR) of Ghana. A random stratified two-stage sampling method was used to select participants from rural and urban communities. Data on socio-demographic and risk factors was collected using a semi-structured questionnaire. A full mouth periodontal examination was carried out to diagnose and describe the severity of periodontitis following the CDC-AAP case definition.

RESULTS

A total of 729 participants were included in the study, with a mean age of 43.9 ±14.6 years and 61% being female. Majority (84.8%) presented with gingivitis, 46.7% had periodontitis with 41.8% having both, and 13.9% had severe periodontitis. The mean clinical attachment loss (CAL) was 1.36 ±0.67mm and 1.41 ±0.57mm for probing pocket depth (PPD). Factors associated with periodontitis included, increasing age, smoking and alcohol use, being Muslim provided lower odds of disease. Older people, former smoking, being underweight and not having health insurance was associated with severe periodontitis.

CONCLUSION

This study shows a high burden of periodontitis with comparatively more severe disease. Existing socio-demographic disparities in disease burden highlights the need of developing targeted population based preventive programs. This article is protected by copyright. All rights reserved.

Salivary gland proteins alterations in the diabetic milieu

Salivary glands are considered the chief exocrine glands of the mouth and physiologically contribute to the maintenance of the homeostasis of the oral cavity. They consist of the parotid, submandibular and sublingual glands, which come in pairs and are collectively called the major glands, and the minor glands, which are much smaller and are dispersed throughout the buccal cavity. Salivary glands are distinguished by their size, amount of saliva secretion and their location in the oral cavity. Salivary glands pathophysiology has been a subject of interest in various worldwide metabolic disorders, including diabetes mellitus. Diabetes mellitus (DM), a global health concern, with a pathological imprint involved in vasculature, promotes microvascular and macrovascular complications among which periodontitis ranks sixth. Indeed, DM has also been directly associated with oral health lesions. Specifically, salivary glands in the context of diabetes have been a focal point of study and emphasis in the research field. There is evidence that relates salivary secretion content and diabetes progression. In this review, we present all the reported evidence of the deregulation of specific salivary proteins associated with the progression of diabetes in parallel with changes in salivary gland morphology, cellular architecture, and salivary secretion and composition more generally.

COVID-19 and periodontitis: reflecting on a possible association

Recent studies have demonstrated a relationship between the severe clinical course of COVID-19 and other chronic diseases such as: cardiovascular disease, hypertension, diabetes mellitus, obesity and chronic renal disease. It may be possible to extend this association to a common and chronic oral disease in adults: periodontitis. Alternatively, the latter could be simply related to the systemic chronic diseases cited above, as already observed in the non-COVID-19 literature. In order to provide an overview and their opinion, the authors in this perspective article will report and discuss the most recent references of interest relating to COVID-19 and periodontitis pathophysiology. Within such a narrative review, the authors will hypothesize that the association between chronic periodontitis and COVID-19 could exist via two pathways: a direct link, through the ACEII and CD147 receptors used by the virus to infect the cells, which would occur in greater numbers in cases of periodontitis (thereby favoring a SARS-CoV-2 infection); and/or an indirect pathway involving the overexpression of inflammatory molecules, especially IL-6 and IL-17. An expression of the latter has been found to play a role in periodontitis, in addition to severe cases of COVID-19, although it is still unclear if it plays a direct role in the worsening of the clinical course.

Knockdown of TRIM52 alleviates LPS-induced inflammatory injury in human periodontal ligament cells through the TLR4/NF-κB pathway

Tripartite motif-containing (TRIM) 52 (TRIM52) is a vital regulator of inflammation. However, the function and mechanisms of TRIM52 in lipopolysaccharide (LPS)-induced inflammatory injury of human periodontal ligament cells (HPDLCs) in periodontitis remain undefined. In the present research, gene expression was determined using a quantitative polymerase chain reaction and Western blot. The effect of TRIM52 on LPS-induced inflammatory injury was evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, flow cytometry, and enyzme-linked immunosorbent assay (ELISA). We found that TRIM52 expression was up-regulated in LPS-treated HPDLCs. Knockdown of TRIM52 alleviated LPS-induced proliferative inhibition and apoptosis promotion in HPDLCs, as evidenced by a decrease in cleaved caspase-3 expression and caspase-3 activity. Silencing TRIM52 suppressed LPS-induced inflammatory response of HPDLCs, as indicated by the decrease in interleukin (IL)-6, IL-8, tumor necrosis factor-α (TNF-α) levels, and increase in IL-10 levels. TRIM52 knockdown inhibited LPS-induced activation of TLR4/nuclear factor-κ B (NF-κB) signaling pathway. Taken together, knockdown of TRIM52 mitigated LPS-induced inflammatory injury via the TLR4/NF-κB signaling pathway, providing an effective therapeutic target for periodontitis.

Periodontitis Prevalence, Severity, and Risk Factors: A Comparison of the AAP/CDC Case Definition and the EFP/AAP Classification

BACKGROUND

This cross-sectional study evaluated the utility of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classifications of epidemiological studies in terms of periodontitis severity, prevalence and associated risk factors and the 2012 American Academy of Periodontology/Centers for Disease Control and Prevention (AAP/CDC) case definitions.

METHODS

We included 488 participants aged 35-74 years. Measurements were recorded at six sites per tooth by two qualified examiners. The evaluated parameters included pocket depth (PD), clinical attachment loss (CAL) and bleeding on probing (BOP). Periodontitis prevalence and severity were reported using the 2018 EFP/AAP classification and the AAP/CDC case definitions. The data were stratified by recognized risk factors (age, diabetes and smoking status).

RESULTS

The 2018 EFP/AAP classification indicated that all patients suffered from periodontitis. When CAL served as the main criterion, the frequency of patients with severe (Stages III-IV) periodontitis was 54%. When the AAP/CDC case definitions were applied, the prevalence of periodontitis was 61.9% and that of severe periodontitis 16.8%. Age was the most significant risk factor, regardless of the chosen case definition.

CONCLUSION

It is essential to employ a globalized standard case definition when monitoring periodontitis and associated risk factors.

Downregulation of Macrophage-Specific Act-1 Intensifies Periodontitis and Alveolar Bone Loss Possibly via TNF/NF-κB Signaling

Periodontitis is a chronic inflammatory oral disease that affects almost half of the adult population. NF-κB activator 1 (Act1) is mainly expressed in immune cells, including macrophages, and modulates immune cells' function to regulate inflammation in inflammatory diseases. Macrophages play a vital role in the pathophysiology of periodontitis. However, the effect of macrophage-specific Act1 on periodontitis has not been investigated yet. This study aims to unravel the role of macrophage-specific Act1 on the pathophysiology of periodontitis. The expression of Act1 in healthy and periodontitis periodontal tissue was confirmed by immunohistochemistry. Macrophage-specific Act1 expression downregulated (anti-Act1) mice were developed by inserting anti-Act1 antisense oligonucleotides after the CD68 promoter of C57BL/6 mice. Ligature-induced periodontitis (LIP) was induced in anti-Act1 mice and wildtype mice. Micro-CT, histology, and TRAP staining analyzed the periodontal tissue status, alveolar bone loss, and osteoclast numbers. Immunohistochemistry, RT-qPCR, and ELISA analyzed the inflammatory cells infiltration, expression of inflammatory cytokines, and M1/M2 macrophage polarization. mRNA sequencing of in vitro bacterial lipopolysaccharide (LPS)-treated peritoneal macrophages analyzed the differentially expressed genes in anti-Act1 mice during inflammation. Anti-Act1 mice showed aggravated periodontitis and alveolar bone loss compared to wildtype. Periodontitis-affected periodontal tissue (PAPT) of anti-Act1 mice showed a higher degree of macrophage infiltration, and M1 macrophage polarization compared to wildtype. Levels of pro-inflammatory cytokines (IL-1β, IL-6, and TNFα), and macrophage activity-related factors (CCL2, CCL3, and CCL4) were robustly high in PAPT of anti-Act1 mice compared to wildtype. mRNA sequencing and KEGG analysis showed activated TNF/NF-κB signaling in LPS-treated macrophages from anti-Act1 mice. In vitro studies on LPS-treated peritoneal macrophages from anti-act1 mice showed a higher degree of cell migration and expression of inflammatory cytokines, macrophage activity-related factors, M1 macrophage-related factors, and TNF/NF-κB signaling related P-p65 protein. In conclusion, downregulation of macrophage-specific Act1 aggravated periodontitis, alveolar bone loss, macrophage infiltration, inflammation, and M1 macrophage polarization. Furthermore, LPS-treated macrophages from anti-Act1 mice activated TNF/NF-κB signaling. These results indicate the distinct role of macrophage-specific Act1 on the pathophysiology of periodontitis possibly via TNF/NF-κB signaling.

LncRNA DCST1-AS1 inhibits PDLCs' proliferation in periodontitis and may bind with miR-21 precursor to upregulate PLAP-1

OBJECTIVE

This study aimed to investigate the potential interactions among long noncoding RNA domain containing 1-antisense (lncRNA DCST1-AS1), miR-21, and periodontal ligament-associated protein-1 (PLAP-1) in periodontitis.

BACKGROUND DATA DISCUSSING THE PRESENT STATE OF THE FIELD

It has been verified that miR-21 can target PLAP-1 to regulate the osteogenic differentiation of periodontal ligament cells (PDLCs).

METHODS

Differential expression of DCST1-AS1 and miR-21 in PDLCs derived from periodontitis patients and healthy controls was determined by qPCR and unpaired t test. QPCR and Western blots were conducted to evaluate the effects of overexpression of DCST1-AS1 and miR-21 on the expression of PLAP-1. CCK-8 assay was applied to evaluate the effect of DCST1-ASI, miR-21, or PLAP-1 on PDLCs' proliferation. Western blotting was conducted to detect the expression levels of CKD family (CDK4, CDK6, and CCND1).

RESULTS

DCST1-AS1 was downregulated in PDLCs derived from periodontitis patients, and its expression was inversely correlated with the expression of miR-2 but positively correlated with PLAP-1. Bioinformatics analysis showed that DCST1-AS1 might bind with miR-21 precursor but not mature miR-21. Transfection experiments showed that overexpression of DCST1-AS1 led to decreased expression levels of miR-21 and significantly increased the expression levels of PLAP-1 at both mRNA and protein levels, while overexpression of miR-21 resulted in a dramatic lower level of PLAP-1. CCK-8 assay indicated that overexpression of DCST1-AS1 or PLAP-1 prohibited PDLCs' proliferation. However, elevation of miR-21 had a contrary effect on the proliferation of PDLCs. And increased expression levels of DCST1-AS1 could significantly inhibit the expression of CDK4, CDK6, and CCND-1, while overexpression of miR-21 inversed the effects of DCST1-AS1.

CONCLUSION

Therefore, the expression levels of DCST1-AS1 are much lower in periodontitis patients compared to that in healthy controls, and overexpression of DCST1-AS1 can significantly elevate the expression of PLAP-1 by inhibiting miR-21 in PDLCs.

The correlation of altitude with gingival status among adolescents in western China: a cross-sectional study

Periodontal disease is common in Chinese adolescents. There is little information about the effect of different altitudes on gingival health. This study aimed to investigate the gingival status at different altitudes and to identify relative factors that affect adolescents' gingival status. A total of 1033 adolescents aged 12-14 years were included in this cross-sectional study in Ganzi (plateau, 1400 m, 2560 m, 3300 m) and Suining (plain, 300 m). Gingival status was assessed by the presence of gingival bleeding on probing (BOP) and dental calculus (DC). Demographic variables, socioeconomic status, dairy habits and oral health-related knowledge, attitudes and behaviors were obtained via questionnaire. Univariate and multivariate binary logistic regression analyses were performed to identify potential relative factors. A total of 64.09% and 77.15% of adolescents had BOP and DC, respectively. The prevalence rates of BOP and DC were higher in the plateau than the plain (P < 0.05). After adjusting for all other factors and interaction terms, residence altitudes of 2560 m [300 m as reference: P < 0.001, odds ratio (OR) = 4.072] and 3300 m (300 m as reference: P = 0.002, OR = 4.053) were significant relative factors of BOP, and an altitude of 2560 m (300 m as reference: P = 0.001, OR = 3.866, 1400 m as reference: P = 0.001, OR = 3.944) was an important relative factor of DC. Gingival bleeding and calculus deposits were common at different altitudes. High altitude was a significant relative factor of gingival bleeding and calculus deposits.

Natural progression of periodontal diseases in Chinese villagers based on the 2018 classification

BACKGROUND

Based on the 2018 classification, we aimed to determine the prevalence, distribution, and progression of periodontitis in the rural Chinese population without access to dental care.

METHODS

In all, 404 subjects (28.7 ± 8.9 years, M:F = 182:222) were randomly enrolled in 1992 and re-called in 1996. With the new classification, the prevalence and distribution of stage, grade, and extent were characterized. Stage progression was compared with the progression of clinical attachment loss (CAL) and radiographic bone loss (RBL).

RESULTS

At baseline, 94.1% villagers suffered from periodontitis, of whom 53.7% were in stage III/IV. The prevalence of stage III/IV increased from 18.2% in the age group of 15 to 24 years to 60.9% in 25 to 34-year-old group and 88.7% in the 35 to 44-year-old group. Significantly more stage III/IV, generalized, and grade C periodontitis were found in male villagers than female villagers. In 1996, the prevalence rate of periodontitis increased to 98.5%, with 80.0% in stage III/IV. Further, 84.2% villagers presented with grade C periodontitis based on longitudinal ΔCAL. The rate of progression (≥1 site with ΔCAL ≥3 mm) was 63.7%. Stage progression correlated significantly with CAL and RBL progression in stage I/II, but this association was not found in stage III/IV. Among subjects with disease progression in stage III/IV, 90.4% shifted from localized to generalized cases. Furthermore, ceiling effects were observed in stage III/IV.

CONCLUSIONS

In villagers without access to dental care, 94.1% suffered from periodontitis, with more than half having stage III/IV disease based on the 2018 classification. The majority cases presented with rapid periodontal progression. Although stage progression correlated significantly with CAL and RBL progression in stage I/II, ceiling effects existed in stage III/IV.

An epidemiological study to assess periodontal status among sugar factory workers of Karad taluka using community periodontal index

Objectives:

Oral health is an integral component of general health. Periodontal disease is one of the most prevalent dental diseases among the population. Researchers have identified an association of various risk factors with periodontal disease. The study aimed to assess the periodontal status among the sugar factory workers of Karad taluka.

Materials and Methods:

The study was conducted among 1200 subjects in the age group of 25-54 years. Personal and sociodemographic data were recorded in the proforma based on the WHO oral health survey form (1997). Periodontal status was assessed using community periodontal index (CPI). For statistical analyses, Chi-square test and Multiple Logistic Regression analyses was performed.

Results:

The sociodemographic characteristics (age, sex, and socioeconomic status) and deleterious habits like tobacco chewing and smoking were found to be significantly associated with the CPI and LoA scores for the population (P < 0.00001).

Conclusion:

The analysis of the results obtained in this epidemiological study evidenced that periodontitis is prevalent among the sugar factory workers of Karad taluka. There is a need for emphasis on the preventive care.

Can gingival crevicular blood effectively screen for diabetes in Chinese patients with moderate to severe periodontitis? A pilot study

Background/purpose

The early diagnosis of diabetes is essential for the prevention of complications. Periodontitis has been identified as the sixth complication of diabetes and chair-side screening may improve diagnosis of diabetes. This study evaluated whether gingival crevicular blood (GCB) available during routine periodontal examination can be used to screen for diabetes in Chinese patients with moderate to severe periodontitis.

Materials and methods

Finger-stick blood (FSB) and GCB were collected from patients (18 with diabetes and 42 without diabetes) during routine periodontal probing and analyzed for glucose and hemoglobin A1c (HbA1c) levels.

Results

In the diabetic group, the mean glucose levels in GCB and FSB were 12.21 ± 3.86 and 12.61 ± 4.19 mmol/L respectively, while those of the non-diabetic group were 6.14 ± 0.85 and 6.15 ± 0.87 mmol/L, respectively. The average HbA1c values of the diabetic group were 7.72% ± 1.71% and 7.89% ± 1.78% in GCB and FSB, respectively, while those of the non-diabetic group were 5.28% ± 0.31% and 5.23% ± 0.32%, respectively. Highly significant correlations were found between GCB and FSB glucose levels (r = 0.993 for the diabetic group, and r = 0.977 for the non-diabetic group) and between GCB and FSB HbA1c levels (r = 0.977 for the diabetic group, and r = 0.829 for the non-diabetic group).

Conclusion

Our study results indicate that GCB available during routine periodontal examination may be acceptable for the analyses of blood glucose and HbA1c levels. The approach is suitable for screening undiagnosed diabetes in a dental setting.

Massive data analyses show negative impact of type 1 and 2 diabetes on the outcome of periodontal treatment

Objectives

The aim was to evaluate the impact of diabetes on the outcome of periodontal treatment based on massive data analyses.

Materials and methods

Data originated from the database of a major German National Health Insurance. Patients who underwent periodontal treatment were allocated to four groups according to their medical condition: type 1 diabetes (D1), type 2 diabetes with the intake of oral anti-diabetics (D2M), type 2 diabetes without the intake of oral anti-diabetics (D2), and a control group without diabetes (ND). Four-year Kaplan-Meier survival analyses on the patient level and multivariate regression analyses were conducted for tooth extraction.

Results

Of 415,718 patients, 4139 matched the criteria for D1, 22,430 for D2M, and 23,576 for D2. At 4 years, the cumulative survival rate (no extraction) was 51.7% in the D1 group, 54.0% in the D2M group, and 57.7% in the D2 group. The ND control group had a significantly higher survival rate of 65.9% (P < 0.0001). In the multivariate analyses, both diabetes types were significantly associated with further tooth loss after periodontal treatment.

Conclusions

The diagnosis of diabetes type 1 or 2 seems to be associated with a higher risk of tooth loss after periodontal treatment.

Clinical relevance

The long-term prognosis of teeth in diabetes patients should be judged carefully.

Exposure to paraquat associated with periodontal disease causes motor damage and neurochemical changes in rats

Exposure to paraquat is possibly involved with the development of several conditions, including neurodegenerative diseases, such as Parkinson's disease (PD). This condition is mainly characterized by the loss of dopaminergic neurons in the nigrostriatal pathway and the development of classical motor symptoms. Etiology includes exposure to environmental factors, such as the paraquat exposure, and inflammatory diseases may exacerbate paraquat neurotoxicity. The aim of the study was to investigate whether the exposure to paraquat associated with the presence of periodontal disease is able to induce motor and biochemical changes in rats similar to that observed in PD. Adult male Wistar rats were sent to ligature. After 48 h, they were sent to daily treatment paraquat (1 mg/kg/day; 2 mL/kg; intragastric) or vehicle for 4 weeks. Twenty-four hours after the last administration, the open field test was performed. The rats were euthanized and the left hemimandibles and striatum were dissected for the analysis of dopaminergic and inflammatory markers. Only the combination of periodontal disease model plus paraquat exposure induced motor impairments. Remarkably, the paraquat exposure increased the ligature-induced alveolar bone loss in hemimandibles. Moreover, only the combination of periodontal disease and paraquat exposure induced the loss of dopaminergic neurons and astrocyte activation in the striatum.

Gingival bleeding and calculus among 12-year-old Chinese adolescents: a multilevel analysis

BACKGROUND

Gingivitis is a common oral health problem, and untreated gingivitis can progress to periodontitis. The objectives of this study were to (1) explore associated factors of gingival bleeding and calculus among 12-year-old adolescents; (2) find predictive models for gingivitis management.

METHODS

Four thousand five hundred twenty-five subjects aged 12 in Sichuan Province were investigated. The questionnaire and clinical examination were applied in schools, and two-level logistic regression models were constructed to interpret the effect of individual and contextual factors on Chinese adolescents' gingival bleeding and calculus.

RESULTS

46.63% (95%CI: 40.71, 51.60) and 66.94% (95%CI: 56.85, 67.45) of the subjects presented gingival bleeding and calculus, respectively. For the gingival bleeding cases, the model showed the significant associated indicators were hukou (OR = 0.61, 95% CI: 0.52-0.72), family size (OR = 1.41, 95% CI: 1.19-1.68), parental educational level (father: OR = 0.53, 95% CI: 0.45-0.63; mother: OR = 0.71, 95% CI: 0.59-0.86), tooth-brushing frequency (OR = 0.35, 95% CI: 0.26-0.48), dental floss use (OR = 0.58, 95% CI: 0.41-0.83), sugar-containing drink consumption (OR = 2.11, 95% CI: 1.80-2.49), and dental visit (OR = 1.44, 95% CI: 1.19-1.74). It also confirmed that gender (OR = 1.32, 95% CI: 1.13-1.54), hukou (OR = 0.69, 95% CI: 0.59-0.82), family size (OR = 1.34, 95% CI: 1.12-1.59), parental educational level (father: OR = 0.46, 95% CI: 0.39-0.54; mother: OR = 0.65, 95% CI: 0.59-0.82), tooth-brushing frequency (OR = 0.57, 95% CI: 0.42-0.78), dental floss use (OR = 0.66, 95% CI: 0.48-0.90) and sugar-containing drink consumption (OR = 1.30, 95% CI: 1.11-1.53) were associated factors for dental calculus.

CONCLUSIONS

Gingival bleeding and calculus were common in western Chinese adolescents. Socio-demographic factors including gender, hukou and family factors are strong determinants of gingival health in Chinese adolescents. In addition, health-related lifestyle behaviors such as healthy diet, good hygiene care and more dental visits are good predictors of better gingival status.

Upregulation of IL-10 expression inhibits the proliferation of human periodontal ligament stem cells

The abnormal increase in proliferation rate of human periodontal ligament stem cells (PDLSCs) is considered to be involved in the pathogenesis of periodontitis, a disease in which the IL-10-mediated anti-inflammatory pathway plays a critical role. This study aimed to investigate the involvement of microRNA-466l in periodontitis and to explore the possible interaction between IL-10 and microRNA-466l. PDLSCs were obtained from periodontitis-affected teeth and healthy control teeth. The expression of microRNA-466l and IL-10 mRNA was measured in PDLSCs using RT-qPCR. The proliferation ability of PDLSCs was analyzed using CCK-8 assays. Overexpression of microRNA-466l in a PDLSC cell line was established using two different types of PDLSCs, and the effect of microRNA-466l overexpression on IL-10 expression and cell proliferation were detected by western blot and CCK-8 assays, respectively. We found that expression levels of microRNA-466l and IL-10 mRNA were significantly lower (P < 0.05) in PDLSCs derived from periodontitis-affected teeth compared to those derived from healthy teeth. However, the cell proliferation ability was significantly higher in the PDLSCs derived from periodontitis-affected teeth. Meanwhile microRNA-466l overexpression decreased cell proliferation rates of both types of PDLSCs and upregulated IL-10 expression. Together, these data suggest that microRNA-466l can upregulate IL-10 and reduce the proliferation rate of PDLSCs.

Tooth Loss Predicts Myocardial Infarction, Heart Failure, Stroke, and Death

We investigated whether oral health, represented by missing teeth, was associated with an increased risk of cardiovascular disease, including myocardial infarction (MI), heart failure (HF), stroke, and all-cause mortality. Subjects who underwent routine dental examinations and health checkups provided by the Korean National Health Insurance from 2007 to 2008 ( n = 4,440,970) were followed up for incident MI, HF, stroke, and death until 2016. During follow-up of 7.56 y, 68,063 (1.5%) subjects died, and 31,868 (0.7%) were admitted for MI, 22,637 (0.5%) for HF, and 30,941 (0.7%) for stroke. Cardiovascular events and mortality increased in proportion to tooth loss. Tooth loss was an independent risk factor for cardiovascular events after multivariable analysis adjusted for cardiovascular risk, behavioral, and income factors. Each missing tooth was associated with an approximately 1% increase in MI (HR, 1.010; 95% CI, 1.007 to 1.014), 1.5% increase in HF (HR, 1.016; 95% CI, 1.013 to 1.019) and stroke (HR, 1.015; 95% CI, 1.012 to 1.018), and 2% increase in mortality (HR, 1.022; 95% CI, 1.020 to 1.023). Having ≥5 missing teeth substantially increased risk for cardiovascular outcomes, and even a small number of missing teeth (1 to 4) was associated with an increased risk for MI, stroke, and death. This association was consistent in subgroup analyses and especially strong among the younger subjects (age <65 y) and those with periodontitis. In this large Korean nationwide cohort study, we found that tooth loss showed a dose-dependent association with incident MI, HF, ischemic stroke, and all-cause death and was a good predictor of cardiovascular outcome. In clinical practice, the number of missing teeth can aid physicians in discriminating patients with a higher cardiovascular risk.

LncRNA AWPPH overexpression predicts the recurrence of periodontitis

Long non-coding RNA (LncRNA) AWPPH is a recently identified oncogenic lncRNA, while its role in other human diseases is still unknown. Blood samples from 80 periodontitis (periodontitis group) patients and 66 healthy controls (control group) who were admitted and treated by Peking University School and Hospital of Stomatology, expression levels of lncRNA AWPPH were detected by RT-PCR. In the present study, we showed that, before treatment, lncRNA AWPPH in plasma was up-regulated in periodontitis patients than in healthy controls. After treatment, expression levels of lncRNA AWPPH reduced significantly. Patients were followed up for 2 years to recorded recurrence. Compared with plasma levels of lncRNA AWPPH on the day of discharge, lncRNA AWPPH expression level increased significantly in patients with recurrence but not in patients without recurrence during follow-up. Based on Youden's index, patients were divided into high and low lncRNA AWPPH groups according to its expression level on the day of discharge. It was observed that the recurrence rate of periodontitis is significantly higher in high lncRNA AWPPH group than in low lncRNA AWPPH group. LncRNA AWPPH overexpression predicts the recurrence of periodontitis.

MALAT1 overexpression promotes the proliferation of human periodontal ligament stem cells by upregulating fibroblast growth factor 2

Fibroblast growth factor 2 (FGF2) has been revealed to promote human periodontal ligament stem cell (PDLSC) proliferation. The abnormal proliferation of PDLSCs has also been associated with the pathogenesis of periodontitis. The long non-coding RNA, metastasis-associated lung adenocarcinoma transcript 1 (MALAT1), has been demonstrated to regulate FGF2 secretion. Therefore, MALAT1 may also be associated with periodontitis. The aim of the present study was to investigate the effect of MALAT1 overexpression on the proliferation of PDLSCs. In the current study, PDLSCs derived from healthy and periodontitis-affected teeth were collected. MALAT1 and FGF2 mRNA expression in PDLSCs was detected using reverse transcription-quantitative PCR. PDLSCs overexpressing MALAT1 were subsequently generated. PDLSC proliferation was analyzed using a Cell Counting kit-8 assay. FGF2 protein expression was detected using western blot analysis. The results revealed that MALAT1 and FGF2 mRNA were significantly upregulated in PDLSCs derived from periodontitis-affected teeth when compared with PDLSCs derived from healthy teeth. PDLSCs derived from periodontitis-affected teeth also demonstrated a significantly higher proliferation rate than PDLSCs derived from healthy teeth. MALAT1 and FGF2 mRNA expression were positively correlated in both PDLSC groups. MALAT1 overexpression promoted the proliferation of healthy and periodontitis-affected PDLSC groups and upregulated FGF2 protein expression. The present study concluded that MALAT1 overexpression promoted the proliferation of human PDLSC potentially via upregulating FGF2.

Long non-coding RNAs mortal obligate RNA transcript regulates the proliferation of human periodontal ligament stem cells and affects the recurrence of periodontitis

OBJECTIVE

The aim of this study is to investigate the role of long non-coding RNAs (lncRNA), mortal obligate RNA transcript (MORT), in human periodontal ligament stem cells.

DESIGN

Periodontal ligament tissues were collected from 48 periodontitis patients underwent tooth extraction and 38 people in similar age and gender distributions who experienced orthodontic treatment. After treatment, periodontitis patients were followed up for 2 years. MORT in periodontal ligament stem cells (PDLSCs) was detected by qRT-PCR. Proliferation of PDLSCs was detected by CCK-8 assay.

RESULTS

The proliferation rate of PDLSCs isolated from periodontitis-affected teeth was significantly higher than PDLSCs from healthy teeth. Overexpression of MORT inhibited the proliferation of both types of periodontal ligament stem cells. After treatment, periodontitis patients were followed up for 2 years and patients with high level of MORT expression showed relatively lower recurrence rate comparing to low expression group.

CONCLUSION

MORT is involved in the proliferation of human PDLSCs and affects the recurrence of periodontitis.

A novel in situ bone elevation method to achieve vertical periodontal augmentation in dogs: A pilot study

Objectives

The purpose of this study was to investigate whether a novel in situ interdental bone elevation method could achieve vertical bone augmentation around natural teeth.

Methods

Horizontal periodontal bone defects were created at nine quadrants of mandibles in five dogs. Six weeks later, one of the nine quadrants was randomly chosen as the model control. The remaining mandibles were allocated into two experimental groups: cortical bone removing (CBR) or interdental bone elevation (IBE). For the IBE group, four millimetres of interdental bone blocks were separated and elevated from the base of alveolar bone. Then bone xenografts were implanted beneath the elevated alveolar blocks. Animals were euthanised 12 weeks post‐operation. Cone beam computed tomography (CBCT) examination and histological analysis were performed to evaluate the surgical outcomes.

Results

Enhanced soft tissue profiles were observed in the two experimental groups as compared to the model control group. CBCT images showed that the height of alveolar bone was significantly higher in the IBE group with bone blocks seated near the cementoenamel junction. Significantly larger area of bone tissues with the highest coronal level of new bone was observed in the IBE group. New bone was observed around the elevated bone blocks with bone remodelling and neovascularisation inside the elevated blocks.

Conclusions

Vertical bone augmentation at interdental sites may be performed through in situ interdental bone elevation for patients with horizontal alveolar bone resorption.

Is there an association between asthma and periodontal disease among adults? Systematic review and meta-analysis

This systematic review and meta-analysis aimed to investigate a possible association between asthma and periodontal disease in adults. This study was conducted by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the searches were performed on the following databases: PubMed, Scopus, Web of Science, Cochrane, LILACS, OpenGrey e Google Scholar. In this systematic review, observational studies with adult humans, which evaluated patients with and without asthma, were selected to verify the association between both diseases. To qualitative analysis, Fowkes and Fulton guidelines was used and for the quantitative analysis, it was used the mean and standard deviation from each group (with and without asthma), using confidence interval (CI) 95% and heterogeneity were tested using I² index. Furthermore, a summary of the overall strength of evidence was presented using Grading of recommendations, assessment, development, and evaluation (GRADE). 3395 studies were identified, 11 were included on this systematic review to qualitative analysis and 6 of them to quantitative synthesis. Six meta-analyses were performed to the following clinical parameters: plaque index (PI), gingival index (GI), bleeding on probing (BOP), papillary bleeding index (PBI), calculus index (CI), clinical attachment loss (CAL). The meta-analysis results for CI was (p < 0.00001, I2 = 0%) PBI (p < 0.00001, I2 = 0%), CAL (p = 0,03, I² = 98%) showed higher means for the asthmatic group. For BOP (p = 0.20 I2 = 83%), GI (p = 0.14 I2 = 97%) and PI (p = 0.53 I2 = 95%) non-statistical difference was found. The level of evidence analysis (GRADE) presented a low level of evidence among the clinical parameters. This systematic review and meta-analysis observed that asthmatic individuals present more periodontal disease, especially gingivitis, when compared to healthy individuals, but further studies with similar methods are necessary to evaluate interactions between both diseases.

Berberine Ameliorates Periodontal Bone Loss by Regulating Gut Microbiota

Postmenopausal osteoporosis (PMO) is a risk factor for periodontitis, and current therapeutics against PMO prevent the aggravated alveolar bone loss of periodontitis in estrogen-deficient women. Gut microbiota is recognized as a promising therapeutic target for PMO. Berberine extracted from Chinese medicinal plants has shown its effectiveness in the treatment of metabolic diseases such as obesity and diabetes via regulating gut microbiota. Here, we hypothesize that berberine ameliorates periodontal bone loss by improving the intestinal barriers by regulating gut microbiota under an estrogen-deficient condition. Experimental periodontitis was established in ovariectomized (OVX) rats, and the OVX-periodontitis rats were treated with berberine for 7 wk before sacrifice for analyses. Micro–computed tomography and histologic analyses showed that berberine treatment significantly reduced alveolar bone loss and improved bone metabolism of OVX-periodontitis rats as compared with the vehicle-treated OVX-periodontitis rats. In parallel, berberine-treated OVX-periodontitis rats harbored a higher abundance of butyrate-producing gut microbiota with elevated butyrate generation, as demonstrated by 16S rRNA sequencing and high-performance liquid chromatography analysis. Berberine-treated OVX-periodontitis rats consistently showed improved intestinal barrier integrity and decreased intestinal paracellular permeability with a lower level of serum endotoxin. In parallel, IL-17A-related immune responses were attenuated in berberine-treated OVX-periodontitis rats with a lower serum level of proinflammatory cytokines and reduced IL-17A+ cells in alveolar bone as compared with vehicle-treated OVX-periodontitis rats. Our data indicate that gut microbiota is a potential target for the treatment of estrogen deficiency–aggravated periodontal bone loss, and berberine represents a promising adjuvant therapeutic by modulating gut microbiota.

Trends in the prevalence of periodontitis in Taiwan from 1997 to 2013: A nationwide population-based retrospective study

Periodontitis is one of the most prevalent oral diseases. In this study, we probed the nationwide registered database to assess the time trends of prevalence of periodontitis in Taiwan.A retrospective study was conducted to analyze the registered database compiled by the National Health Insurance provided by the Department of Health, Taiwan, from 1997 to December 2013.We found that the prevalence of periodontitis significantly increased from 11.5% in 1997 to 19.59% in 2013 (P for trend < .0001). The mean age ± standard deviation with periodontitis from 1997 to 2013 was 54.46 ± 14.47 and 45.51 ± 16.58 years old, respectively. The proportion of individuals with periodontitis in age group >65 years old decreased markedly. The proportion of individuals with periodontitis in age groups <25 and 26 to 35 years old demonstrated an increased pattern. Compared to the reference cohort of 1953 to 1957, the recent birth cohort of 1993 to 1997 revealed the highest relative risk (RR) of periodontitis (male: RR, 67.42, 95% confidence interval [CI], 17.04-266.76; female: RR, 65.85, 95% CI, 16.70-259.70). Both male and female groups showed the similar age-effect pattern in the cross-sectional age curve from age-period-cohort model. There was an upturn with advancing age up to 40 to 50 years old and then a downward trend in both genders. Population dwelling in suburban area (RR, 0.95; 95% CI, 0.94-0.97) and rural area (RR, 0.97; 95% CI, 0.95-0.99) had the lower risk of periodontitis than those who lived in urban area. The higher income group revealed the higher risk of periodontitis compared with lower income group (RR, 1.20; 95% CI, 1.18-1.23).The prevalence of periodontitis significantly increased in Taiwan over past 17 years. The mean age with periodontitis was shown in a decreased pattern. The use of a nationwide population-based database could provide sufficient sample size, generalizability, and statistical power to assess the periodontal status in Taiwan.

Association between socio-economic status and dental caries in elderly people in Sichuan Province, China: a cross-sectional study

OBJECTIVES

As a vulnerable group, the elders' oral health gained less attention, particularly the relationship between socioeconomic status (SES) and dental caries. This study aimed to assess the associations and to explore the effects of confounders on the associations in elderly people.

DESIGN

Cross-sectional study.

SETTINGS

3 neighbourhood committees and 3 village committees in Sichuan Province, China.

PARTICIPANTS

744 people (362 men and 382 women) aged 65-74 years were included.

OUTCOME MEASURES

Oral health outcomes included the decayed, missing and filled teeth (DMFT) index and its components. SES was assigned by educational level, household income and type of household. The bivariate association between the participants' characteristics and DMFT was analysed using non-parametric tests. Four logistic regression models were used to analyse the associations between SES and dental caries by regulating confounders.

RESULTS

Poor oral health was observed in these participants. Bivariate analysis showed a significant association between SES and DMFT (p﹤0.05). Only adjusting gender, high educational level (adjusted (AOR)=0.34, 95% CI 0.17 to 0.66), high household income (AOR=0.47, 95% CI 0.41 to 0.77) were protective factors against dental caries, and living in agricultural families (AOR=1.86, 95% CI 1.32 to 2.63) was risk factor (p﹤0.05). After adjusting other confounders, SES was partly related to the dental caries. Moreover, an interaction existed among SES indicators.

CONCLUSIONS

SES is associated with dental caries, and older people with low SES have poor oral health. The associations were explained partly by diet, behaviour and awareness. Our results provide effective evidence in targeted policy-making and intervention measures and implicate that pertinence measures, economic assistance and medical insurance funds should be provided to older people of low SES. Furthermore, a follow-up design should attempt to confirm the causal relationship between SES and dental caries and evaluate the effect of intervention.

Risk factors for chronic periodontitis in Sri Lankan adults: a population based case-control study

OBJECTIVE

To determine risk factors for chronic periodontitis in 30-60 year olds in Sri Lanka. Cases and controls for this population based unmatched case-control study were identified from a broader cross-sectional study which was conducted to determine the prevalence of chronic periodontitis in 30-60 year old adults in Colombo district Sri Lanka. The study included 694 cases and 706 controls. Data were collected by means of a pre-tested interviewer administered questionnaire to obtain information about socio-demographic and behavioural factors, a physical examination to record anthropometric measurements and an oral examination.

RESULTS

Being a male, a Muslim, belonging to the 45-60 year old age group, having less than 12 years of education, using the finger to clean teeth, current smoking, current betel quid chewing, self-reported diabetes and hypertension emerged as risk factors for chronic periodontitis.

CONCLUSIONS

Several socio-demographic and behavioural factors as well as co-morbid conditions emerged as independent risk factors for chronic periodontits in this population. The findings could be used for planning programmes to reduce the burden of chronic periodontits in Colombo district Sri Lanka.

Development and validation of a condition-specific measure for chronic periodontitis: Oral health impact profile for chronic periodontitis

AIM

The aim of this study was to develop and validate the first condition-specific tool to assess oral health-related quality of life (OHRQoL) impairment in association with chronic periodontitis and to use it as an outcome measure in clinical trials.

METHODS

Twenty-three potential items were developed using a combined method consisting of a literature review, semi-structured patient interviews (n = 20) and expert panel 1. Subsequently, item selection was carried out by means of qualitative content analysis and quantitative classical test theory (CTT) with 110 patients and expert panel 2. Consequently, 18 items were selected and included in the final oral health impact profile for chronic periodontitis (OHIP-CP) instrument. The validity and reliability of the OHIP-CP were then examined.

RESULTS

A total of 238 patients participated in the validation phase of OHIP-CP. The final 18-item questionnaire was shown to have a three-domain structure. The three components "pain and functional limitation", "psychological discomfort" and "psychological disability and social handicap" explained 49.9%, 9.9%, and 6.2% of the variance, respectively, together accounting for 66.1% of the variance. In addition, the OHIP-CP was shown to be valid in distinguishing patients with varying severity of chronic periodontitis. For the convergent validity, the reported impact of chronic periodontitis based on the OHIP-CP significantly correlated with the global oral health rating. All of its three domains were found to have good levels of internal consistency with Cronbach's alpha >.7, and excellent test-retest reliability.

CONCLUSION

The OHIP-CP is the first condition-specific OHRQoL instrument for patients with chronic periodontitis. This short, reliable and valid questionnaire may serve as a valuable tool in future clinical trials.

Shammah (Smokeless Tobacco) and Public Health

Shammah is a preparation of smokeless tobacco (ST) that is frequently used in the Arabian Peninsula, especially in Saudi Arabia. A mixture of powdered tobacco, lime, ash, black pepper, oils and flavorings, shammah in is placed in the buccal cavity or lower labial vestibule of the mouth. The user (or dipper) spits out insoluble debris. ST is linked to a number of harmful effects such as dental disease, oral cancer, oesophagus cancer, and pancreas cancer. It also causes adverse reproductive effects including stillbirth, premature birth and low birth weight. The importation of ST products is prohibited in Saudi Arabia. Legislative action to combat the use of ST (moist snuff and chewing tobacco) in Saudi Arabia appeared in 1990. The actual percentage use may be higher than reported since shammah is illegal in Saudi Arabia and there may be some unwillingness to admit to its use. Data on ST use in the Arabian Peninsula are sparse. Most studies conducted there focused on the prevalence of shammah use among adolescents rather than among adults. This review paper aimed to understand the pattern of use of shammah and its adverse health effects. It also aimed to provide suitable epidemiological data for public health policy makers.

A comparison of DALYs for periodontal disease in China between 1990 and 2013: insights from the 2013 global burden of disease study

Background

China has undergone a rapid demographic and epidemiological transition with fast ecomonic development since the 1980s. Oral health is becoming a major public health problem as the prevalence of non-communicable diseases has greatly increased. Periodontal disease (PD) and caries are among the most prevalent oral diseases. PD accounts for the majority of tooth loss and increases with age. China’s third national epidemiological investigation on oral diseases (2005) revealed that periodontitis affected >50% of the adult population. The Global Burden of Disease Study 2013 (GBD2013) have been used to estimate DALYs for 301 acute and chronic diseases and injuries in 188 countries for 1990–2013. The estimation of burden of PD between 1990 and 2013 will provide a unique perspective for planning interventions and developing public health policies for PD even chronic diseases in China.

Methods

We used the GBD 2013 results for Years of Life Lost (YLLs) and Years Lived with Disability (YLDs) to calculate Disability Adjusted Life Years (DALYs) for PD in China. PD standardized DALYs rate (SDR) per 100,000 persons, the percentage of PD standardized DALYs rate (% PD SDR) in all diseases DALYs, and variance ratio of these two indexes between the years of 1990 and 2013 were compared by province, gender and age groups.

Results

Nationwide, compared to 1990, the SDR in 2013 increased slightly from 24.7 to 25.7, while the variance ratio of SDR for provinces in the middle, west and south of China showed a greater variation(4.8–6.2%). The % PD SDR in all disease DALYs increased from 0.06 to 0.11% for all groups. The four highest variance ratios % PD SDR in all diseases DALYs between 1990 and 2013 occurred in the west of China (97, 98.6, 108.4 and 112.8%). The PD SDR changed slightly in the women (20.3 to 21.7), meanwhile the variance ratio of PD SDR and % PD SDR in all diseases DALYs for the women (6.7 and 94.5%) was also higher than for men (2.1 and 60.6%). The highest variance ratio % PD SDR in all oral diseases DALYs occurred between 1990 and 2013 in ages 20 to 24 (50.7%) and 25 to 29 years (50.5%).

Conclusion

The PD standardized DALYs rate and % PD SDR in all diseases DALYs in China in 2013 has increased from 1990. Especially, the variance ratio of % PD SDR in all disease DALYs among Young population and women, in the west provinces of China have been becoming the highest in all age groups and national wide. Future intervention measurements should include young women of child-bearing age because women’s health impacts infant health. Periodontal disease has risk factors in common with a number of other non-communicable diseases (NCD) and conditions, and focusing on the common behavioral and environmental risk factors would be instrumental in the effective prevention of periodontal disease.

The mediating role of general self-efficacy in the association between perceived social support and oral health-related quality of life after initial periodontal therapy

BACKGROUND

Although initial periodontal therapy can ease some physical and psychological discomforts from periodontitis and improve patients' oral health-related quality of life (OHRQoL), it is also vital to find positive resources from psychological and social aspects to promote the overall OHRQoL. This study aims to explore the associations of perceived social support (PSS) and general self-efficacy with OHRQoL and the mediating role of general self-efficacy in PSS-OHRQoL association after initial periodontal therapy.

METHODS

A prospective case series study was conducted among consecutive outpatients with chronic periodontitis during the period of July 2014-April 2015. A total of 145 eligible patients responded to OHRQoL questionnaire and periodontal examination at baseline. About 4 to 5 weeks after initial periodontal therapy, 120 patients completed the second OHRQoL measurement and periodontal examination, along with PSS and general self-efficacy measurement. The Wilcoxon matched-pairs signed-rank test was used to determine the difference between baseline and post-treatment OHRQoL scores and periodontal parameters. Hierarchical linear regression analysis was used to explore the associations of PSS and general self-efficacy with post-treatment OHRQoL after adjusting for some demographic and periodontal variables. Asymptotic and resampling strategies were performed to explore the mediating role of general self-efficacy.

RESULTS

Initial periodontal therapy resulted in a significant improvement in the mean total score and all domains of OHRQoL and all periodontal parameters measured. In hierarchical linear regression analysis, clinical attachment loss (CAL) was significantly and positively associated with post-treatment OHRQoL score (β = 0.265, p < 0.01), while PSS (β = -0.303, p < 0.01) and general self-efficacy (β = -0.221, p < 0.01) were significantly and negatively associated with post-treatment OHRQL score, respectively. A significant mediating role of general self-efficacy (a*b = -0.139, BCa 95 % CI: -0.298, -0.011) in the association between PSS and post-treatment OHRQoL was revealed, and the proportion of the mediating role of general self-efficacy was 31.4 %.

CONCLUSIONS

Initial periodontal therapy could significantly improve all aspects of OHRQoL. PSS and general self-efficacy could be the positive resources for improving OHRQoL after initial periodontal therapy among patients with periodontitis. General self-efficacy partly mediated the association between PSS and post-treatment OHRQoL.

The Prevalence and Associated Factors of Periodontitis According to Fasting Plasma Glucose in the Korean Adults: The 2012-2013 Korea National Health and Nutrition Examination Survey

Although the relationship between diabetes and periodontitis is well established, the association between periodontitis and prediabetes has been investigated less extensively. Furthermore, there has been little research on the prevalence of periodontitis among individuals with prediabetes and diabetes as well as in the overall population using nationally representative data.Among 12,406 adults (≥19 years' old) who participated in the 2012-2013 Korea National Health and Nutrition Examination Survey, a total of 9977 subjects completed oral and laboratory examinations and were included in this analysis. Periodontitis was defined as a community periodontal index score of ≥ 3 according to the World Health Organization criteria. The fasting plasma glucose level was categorized into the following 5 groups: normal fasting glucose (NFG) 1 (<90  mg/dL), NFG 2 (90-99  mg/dL), impaired fasting glucose (IFG) 1 (100-110  mg/dL), IFG 2 (111-125  mg/dL), and diabetes (≥126  mg/dL).Overall, the weighted prevalence of periodontitis among the Korean adult population was 24.8% (23.3-26.4%) (weight n = 8,455,952/34,086,014). The unadjusted weighted prevalences of periodontitis were 16.7%, 22.8%, 29.6%, 40.7%, and 46.7% in the NFG 1, NFG 2, IFG 1, IFG 2, and diabetes groups, respectively (P < 0.001). After adjusting for age, sex, smoking history, heavy alcohol drinking, college graduation, household income, waist circumference, serum triglyceride level, serum high-density lipoprotein cholesterol level, and the presence of hypertension, the adjusted weighted prevalence of periodontitis increased to 29.7% in the IFG 2 group (P = 0.045) and 32.5% in the diabetes group (P < 0.001), compared with the NFG 1 group (24%). The odds ratios for periodontitis with the above-mentioned variables as covariates were 1.42 (95% confidence interval [CI] 1.14-1.77, P = 0.002) in the diabetes group and 1.33 (95% CI 1.01-1.75, P = 0.044) in the IFG 2 group, respectively, compared with the NFG1 group.In conclusion, a higher range of IFG levels as well as diabetes, were positively associated with chronic periodontitis in a representative sample of Korean adults. This study suggests that individuals with a higher range of IFG levels before diabetes are at risk of periodontitis, and may benefit from dental screening.

GC Gene Polymorphisms and Vitamin D-Binding Protein Levels Are Related to the Risk of Generalized Aggressive Periodontitis

Objective. To explore whether GC (group-specific component) rs17467825, rs4588, and rs7041 polymorphisms are associated with generalized aggressive periodontitis. Methods. This case-control study recruited 372 patients with generalized aggressive periodontitis (group AgP) and 133 periodontal healthy subjects (group HP). GC rs17467825, rs4588, and rs7041 genotypes and plasmatic vitamin D-binding protein (DBP) were measured. Analysis of single SNP and multiple SNPs was performed and relevance between plasmatic DBP and haplotypes was analyzed. Results. GC rs17467825 GG genotype was statistically associated with lower risk for generalized aggressive periodontitis under the recessive model (OR = 0.52, 95% CI: 0.30-0.92, p = 0.028). GC rs17467825 and rs4588 had strong linkage disequilibrium with r² ≥ 0.8 and D' ≥ 0.8. Haplotype (GC rs17467825, rs4588) GC was associated with the less risk for generalized aggressive periodontitis (OR = 0.29, 95% CI: 0.09-0.96, p = 0.043). In group AgP, individuals with combined genotype (GC rs17467825, rs4588) AG+CA had significantly lower plasmatic DBP level than those with the other two combined genotypes (AG+CA versus AA+CC p = 0.007; AG+CA versus GG+AA p = 0.026). Conclusions. GC rs17467825 genotype GG and haplotype (GC rs17467825, rs4588) GC are associated with generalized aggressive periodontitis. The association may be acquired through regulating DBP levels. The functions of GC gene and DBP in inflammatory disease need to be further studied.

Prevalence and association of smokeless tobacco use with the development of periodontal pocket among adult males in Dawan Valley, Yemen: a cross-sectional study

BACKGROUND

The traditional type of smokeless tobacco used in the Arabian Peninsula, particularly common in Yemen, is called shammah. This study aims to determine the prevalence of shammah use and its association with the development of periodontal pockets. Other associated factors with the development of periodontal pocket were also determined.

METHODS

This cross-sectional study included 346 adult males aged 18 years old to 68 years old. Socio-demographic characteristics, oral hygiene practices, and shammah use history were surveyed by using a structured interview questionnaire. The clinical assessment for the presence or absence of periodontal pockets was assessed on the basis of community periodontal index. The chi-square test was used to assess significant differences in study groups in terms of the presence of periodontal pockets. Multivariable logistic regression was selected to assess potential associated factors with the development of periodontal pockets.

RESULTS

Among the 346 adult males, 248 (71.7 %), 30 (8.6 %), and 68 (19.7 %) males never used shammah, were former shammah users, and were current shammah users, respectively. The significant associated factors with the development of periodontal pocket were age group (30 years old and above) (Adjusted Odds Ratio (AOR) = 2.03, 95 % CI: 1.13, 3.65; P = 0.018), low family income category (AOR = 2.35, 95 % CI: 1.39, 3.99; P = 0.001), former shammah user (AOR = 2.66, 95 %: CI: 1.15, 6.15; P = 0.022), and current shammah user (AOR = 6.62, 95 %: CI: 3.59, 12.21; P = 0.001).

CONCLUSIONS

The results revealed that periodontal pockets were significantly associated with age group (30 years old and above), low family income category, former shammah use, and current shammah use. The findings of the current study highlighted the need to develop comprehensive shammah prevention programs and reduce periodontal disease and other shammah-associated diseases.

Knowledge, awareness, and behaviors of endocrinologists and dentists for the relationship between diabetes and periodontitis

AIMS

This study aimed to compare the opinions of dentists and endocrinologists regarding diabetes mellitus (DM) and periodontitis, and to investigate the possible effects on their practice.

METHODS

Cross-sectional data were collected from 297 endocrinologists and 134 dentists practicing in southern China using two separated questionnaires. Questions were close-ended or Likert-scaled. Statistical analyses were done by descriptive statistics, bivariate and binary logistic regression analysis.

RESULTS

Compared with endocrinologists, dentists presented more favorable attitudes for the relationship of DM and periodontitis (P<0.001). 61.2% of dentists reported they would frequently refer patients with severe periodontitis for DM evaluation, while only 26.6% of endocrinologists reported they would frequently advise patients with DM to visit a dentist. Nearly all of the respondents (94.4%) agreed that the interdisciplinary collaboration should be strengthened. The logistic regression analysis exhibited that respondents with more favorable attitudes were more likely to advise a dental visit (P=0.003) or to screen for DM (P=0.006).

CONCLUSIONS

Endocrinologists and dentists are not equally equipped with the knowledge about the relationship between DM and periodontitis, and there is a wide gap between their practice and the current evidence, especially for endocrinologists. It's urgent to take measures to develop the interdisciplinary education and collaboration among the health care providers.