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Fratini A, Izzetti R, Riccetti N, Gennai S, Graziani F, Marchetti E. Diagnostic Accuracy of Urinary Biomarkers in Periodontitis: A Systematic Review and Meta-Analysis. Int J Dent 2024; 2024:9769772. [PMID: 39105056 PMCID: PMC11300057 DOI: 10.1155/2024/9769772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/04/2024] [Accepted: 07/01/2024] [Indexed: 08/07/2024] Open
Abstract
Background Biomarkers can be measured in various biological samples. Urine is among the most useful biofluids for routine testing, and several experimental and clinical studies support its role as a tool for the diagnosis and prevention of various diseases. The present systematic review aimed to examine periodontitis-specific urine biomarkers that could have a diagnostic relevance and to provide a qualitative assessment of the current literature. Materials and Methods Relevant studies identified from PubMed, Embase, Cochrane Library, and Scopus databases were examined to answer the following PECO question: "Could the concentration of specific metabolites in the urine be related to periodontal health and what is their diagnostic accuracy?". Quality of included studies was rated using ROBINS-I tool. Meta-analysis was conducted on available quantitative data. Results After the screening of 768 titles, five studies were included in qualitative synthesis. The studies included referred to the evaluation of 8-hydroxy-2'-deoxyguanosine (8-OHdG) and neopterin. Meta-analysis was conducted for neopterin concentration on data available in four studies involving 129 participants. Higher concentrations of neopterin were found in periodontitis-affected patients compared to controls and patients treated for periodontitis. Conclusions The literature appears controversial in attributing a role to neopterin and 8-OHdG as periodontal biomarkers, highlighting the need for further clinical studies on this topic. While some studies report variations in 8-OHdG and neopterin levels in periodontally affected patients versus either controls or periodontally treated patients, the level of evidence appears still limited to draw firm conclusions (PROSPERO CRD42020222681).
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Affiliation(s)
- Adriano Fratini
- Department of Life, Health and Environmental SciencesUniversity of L'Aquila, L'Aquila 67100, Italy
| | - Rossana Izzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care MedicineUniversity of Pisa, Pisa 56126, Italy
| | - Nicola Riccetti
- Institute of Medical BiostatisticsEpidemiology and InformaticsUniversity Medical CentreJohannes Gutenberg University Mainz, Mainz, Germany
| | - Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology and Critical Care MedicineUniversity of Pisa, Pisa 56126, Italy
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care MedicineUniversity of Pisa, Pisa 56126, Italy
| | - Enrico Marchetti
- Department of Life, Health and Environmental SciencesUniversity of L'Aquila, L'Aquila 67100, Italy
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Li XY, Wen MZ, Xu YH, Shen YC, Yang XT. The association of healthy eating index with periodontitis in NHANES 2013-2014. Front Nutr 2022; 9:968073. [PMID: 36017231 PMCID: PMC9395606 DOI: 10.3389/fnut.2022.968073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Periodontal disease is very common worldwide and is one of the main causes of tooth loss in adults. Periodontal disease is characterized by chronic inflammation that can destroy adjacent alveolar bone and lead to a loss of periodontal ligaments. Although previous studies have found that a daily diet can influence the development of periodontal disease (e.g., a diet low in carbohydrates and rich in vitamins C and D and fiber can have a protective effect). Periodontal disease may present as gingivitis or periodontitis. However, studies on the role of healthy eating index in periodontitis are lacking. The purpose of this study was to assess the association between healthy eating index and periodontitis. Methods We analyzed data collected from participants in the National Health and Nutrition Examination Survey (NHANES), a nationally representative survey conducted in 2-year cycles from 2013 to 2014. As part of our analysis, we developed multivariate logistic regression models to examine the independent association between the healthy eating index and periodontitis. We evaluated the significance of association using odds ratios (OR) with 95% confidence intervals (95%CI). Results Individuals with a lower total healthy eating index had a higher prevalence of periodontitis. Adjusted multivariate regression models showed that a higher healthy diet index was associated with a lower prevalence of periodontitis (OR = 0.69, 95% CI: 0.55-0.86, P < 0.05). Conclusion The results of the study showed that dietary structure was associated with the prevalence of periodontitis. Patients with a higher healthy eating index had a lower prevalence of periodontitis. These findings will need to be confirmed by longitudinal, prospective studies in the future.
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Affiliation(s)
- Xin-Yu Li
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ming-Zhe Wen
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Hua Xu
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Chen Shen
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xi-Tao Yang
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Ollikainen E, Saxlin T, Tervonen T, Suominen AL, Knuuttila M, Jula A, Ylöstalo P. Association between periodontal condition and blood pressure is confounded by smoking. Acta Odontol Scand 2022; 80:457-464. [PMID: 35120431 DOI: 10.1080/00016357.2022.2035430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To investigate the role of smoking as a confounding factor in the association between periodontal pocketing and blood pressure. MATERIAL AND METHODS After restriction to 45-64-year-old subjects without hypertension, diabetes, rheumatic diseases, obesity and with no history of cardiovascular diseases or ongoing lipid-lowering medications, the study population consisted of 307 subjects of the Health 2000 Survey in Finland. Systolic and diastolic blood pressure and pulse pressure (mmHg) were used as outcome variables. Periodontal condition was measured by the number of teeth with ≥4 mm periodontal pockets. β-estimates and 95% confidence intervals (CI) were obtained from linear regression models. Analyses were made in the whole study population and stratified according to smoking habits/history. RESULTS The number of teeth with ≥4 mm periodontal pockets associated statistically significantly with systolic blood pressure and pulse pressure in the whole study population. Among never-smokers or daily smokers, there were no consistent nor statistically significant associations between the number of teeth with ≥4 mm periodontal pockets and systolic/diastolic blood pressure or pulse pressure. CONCLUSIONS Smoking appeared to confound the association between periodontal condition and blood pressure. Thorough control for the effect of smoking was not obtained using multivariate models.
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Affiliation(s)
- Emilia Ollikainen
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tuomas Saxlin
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Department of Oral and Maxillofacial Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Tellervo Tervonen
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Department of Oral and Maxillofacial Surgery, Kuopio University Hospital, Kuopio, Finland
- Public Health Evaluation and Projection Unit, Finnish Institute for Health and Welfare (THL), Kuopio, Finland
| | - Matti Knuuttila
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Antti Jula
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Pekka Ylöstalo
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Mahendra J, Palathingal P, Mahendra L, Muralidharan J, Alzahrani KJ, Sayed M, Mugri MH, Almagbol M, Varadarajan S, Balaji TM, Bhandi S, Srinivasan S, Raj AT, Patil S. Isolated Systolic Blood Pressure and Red-Complex Bacteria-A Risk for Generalized Periodontitis and Chronic Kidney Disease. Microorganisms 2021; 10:50. [PMID: 35056499 PMCID: PMC8781149 DOI: 10.3390/microorganisms10010050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/13/2021] [Accepted: 12/24/2021] [Indexed: 12/29/2022] Open
Abstract
Hypertension is a risk factor for generalized periodontitis (GP) and chronic kidney diseases (CKD). However, the role of isolated systolic blood pressure as one of the major risks for these inflammatory diseases has not been explored. Very limited studies exist identifying the red-complex bacteria in association with the isolated systolic blood pressure. Hence, the main objective of this study was to assess the isolated systolic blood pressure and the red-complex bacteria along with the demographic variables, periodontal parameters, and renal parameters in patients with generalized periodontitis and chronic kidney disease. One hundred twenty participants (age 30-70 years) were divided into four groups-Group C: control (systemically and periodontally healthy subjects), Group GP: generalized periodontitis, Group CKD: subjects with CKD with good periodontal health, Group CKD + GP: subjects with both generalized periodontitis and CKD. Demographic variables and periodontal parameters were measured and recorded. Blood pressure measurements and a detailed history and renal parameters such as serum creatinine, eGFR, and fasting blood sugar were recorded. The red-complex bacteria (RCB) were assessed in the subgingival plaque samples of all four groups using RT-PCR. Older participants (above 50 years) showed worse periodontal scores in the CKD + GP group along with elevated isolated systolic blood pressure, higher serum creatinine, and fasting blood sugar. eGFR was significantly decreased compared to the other groups. Bacterial counts were higher in the GP + CKD group, suggesting that they may be at a higher risk for generalized periodontitis and chronic kidney disease. Isolated systolic blood pressure (ISBP) and RCB were significantly correlated with the renal and periodontal parameters. A log-linear relationship exists between periodontal disease, CKD, RCB, and isolated systolic hypertension levels.
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Affiliation(s)
- Jaideep Mahendra
- Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai 600 095, Tamil Nadu, India; (J.M.); (S.S.)
| | - Plato Palathingal
- Department of Periodontics, Annoor Dental College, Ernakulam 686673, Kerala, India;
| | - Little Mahendra
- Research Department of Periodontics, Maktoum bin Hamdan Dental University, Dubai 213620, United Arab Emirates;
| | - Janani Muralidharan
- Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai 600 095, Tamil Nadu, India; (J.M.); (S.S.)
| | - Khalid J. Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia;
| | - Mohammed Sayed
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia;
| | - Maryam H. Mugri
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia;
| | - Mohammad Almagbol
- Department of Community and Periodontics, Faculty of Dentistry, King Khalid University, Abha 62529, Saudi Arabia;
| | - Saranya Varadarajan
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai 600130, Tamil Nandu, India; (S.V.); (A.T.R.)
| | | | - Shilpa Bhandi
- Department of Restorative Dental Science, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia;
| | - Sruthi Srinivasan
- Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai 600 095, Tamil Nadu, India; (J.M.); (S.S.)
| | - A. Thirumal Raj
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai 600130, Tamil Nandu, India; (S.V.); (A.T.R.)
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia
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Kılıç Akça N, Efe Arslan D, İn H. Examination of factors affecting oral health in patients receiving haemodialysis. J Ren Care 2021; 48:262-271. [PMID: 34346175 DOI: 10.1111/jorc.12396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/14/2021] [Accepted: 07/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients receiving haemodialysis suffer from oral problems, pain, deteriorated nutrition, and decreased self-confidence and quality of life. Nurses have a critical role in the evaluation and care of oral health. OBJECTIVES The aim was to investigate the associations between socio-demographic characteristics, medication use, and biochemical blood levels and oral health in adult patients receiving haemodialysis treatment. DESIGN This study was conducted as a descriptive study. PARTICIPANTS The sample study was made up of one hundred and fifty individuals treated with haemodialysis between March and June 2018. MEASUREMENTS Patient diagnosis and Bedside Oral Exam guide was the tool used to examine oral health. RESULTS It was seen that patients' oral health worsened as the number of dental caries increased. It was found that low level of education, those with nonregular oral care and brushing teeth, those using parathyroid hormone-lowering agents and who stated they complied with the drug and diet therapy had higher mean Bedside Oral Exam guide scores, meaning their oral health was statistically significantly worse (p < 0.05). Bedside Oral Exam guide scores were weakly negatively correlated with predialysis serum potassium levels (r = -0.213; p = 0.009), weakly positively correlated with the daily fluid amount consumed (r = -0.185; p = 0.024), and decayed teeth (r = -0.224; p = 0.006). CONCLUSIONS Use of parathyroid hormone-lowering agents, low level of education, insufficient oral care, decayed teeth, compliance with diet and medication, daily liquid consumption, and low potassium levels could lead to an increased severity of poor oral health in patients receiving haemodialysis. Oral and dental health protocols should be developed for all haemodialysis units.
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Affiliation(s)
- Nazan Kılıç Akça
- Department of Nursing, İnternal Medicine Nursing, Faculty of Health Science, Izmir Bakırcay University, İzmir, Turkey
| | - Dilek Efe Arslan
- Halil Bayraktar Health Services Vocational College, University of Erciyes, Kayseri, Turkey
| | - Harun İn
- Aksaray Gülağaç Hospital, Erzurum, Turkey
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Costa PD, Canaan JCR, Midori Castelo P, Campideli Fonseca D, Márcia Pereira-Dourado S, Mendonça Murata R, Pardi V, José Pereira L. Influence of Micronutrient Intake, Sociodemographic, and Behavioral Factors on Periodontal Status of Adults Assisted by a Public Health Care System in Brazil: A Cross-Sectional Multivariate Analysis. Nutrients 2021; 13:973. [PMID: 33802889 PMCID: PMC8002608 DOI: 10.3390/nu13030973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
The lack of access to a balanced diet, rich in vitamins and minerals, can predispose people to inflammatory diseases such as obesity, diabetes mellitus, and periodontitis. We aimed to evaluate the relationship between micronutrient intake, sociodemographic behavioral characteristics, and periodontal health in adults assisted by a public health care system. Participants (n = 450) answered a food frequency questionnaire and were submitted to anthropometric and oral clinical examinations. Principal component analysis was used to summarize the number of components emerging from 17-micronutrient intake. Subsequently, cluster analysis was employed. The prevalence of at least one periodontal pocket ≥ 4 mm was 67.4%. Three clusters were identified according to periodontal status. Cluster 1 "poor periodontal status" was characterized by older individuals (n = 202; 85% females) with poor periodontal status, lower education level, mainly smokers with non-transmissible chronic diseases (NTCD), with lower energy, omega-3, fiber, Zn, K, Cu, and vitamin C intake. Cluster 3 "healthy periodontal status" included younger individuals (n = 54) with the healthiest periodontal status, a higher education level, without NTCD, and with higher energy, omega-3, fiber, Zn, calcium, retinol, and riboflavin intake. Cluster 2 was labeled as "intermediate periodontal status". Micronutrient ingestion was associated with periodontal status and may be considered in health promotion actions for low-income populations.
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Affiliation(s)
- Patrícia Daniela Costa
- Health Sciences Faculty, Universidade Federal de Lavras (UFLA), 37200-900 Lavras, Minas Gerais, Brazil; (P.D.C.); (J.C.R.C.); (S.M.P.-D.)
| | - Juliana Cristina Reis Canaan
- Health Sciences Faculty, Universidade Federal de Lavras (UFLA), 37200-900 Lavras, Minas Gerais, Brazil; (P.D.C.); (J.C.R.C.); (S.M.P.-D.)
| | - Paula Midori Castelo
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), 09913-030 Diadema, São Paulo, Brazil;
| | | | - Stela Márcia Pereira-Dourado
- Health Sciences Faculty, Universidade Federal de Lavras (UFLA), 37200-900 Lavras, Minas Gerais, Brazil; (P.D.C.); (J.C.R.C.); (S.M.P.-D.)
| | - Ramiro Mendonça Murata
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University (ECU), Greenville, NC 27834, USA;
| | - Vanessa Pardi
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University (ECU), Greenville, NC 27834, USA;
| | - Luciano José Pereira
- Health Sciences Faculty, Universidade Federal de Lavras (UFLA), 37200-900 Lavras, Minas Gerais, Brazil; (P.D.C.); (J.C.R.C.); (S.M.P.-D.)
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Kim EJ, Lee HJ. Association between low potassium intake and the number of teeth in Korean adults: based on the national data (2013-2015). Sci Rep 2021; 11:3058. [PMID: 33542374 PMCID: PMC7862401 DOI: 10.1038/s41598-021-82631-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/10/2020] [Indexed: 11/24/2022] Open
Abstract
General health and oral health are very closely related. This study aimed to analyze the nutritional factors associated with the number of present teeth in Korean elderly adults. A total of 6,356 individuals were surveyed from the sixth Korean National Health and Nutrition Examination Survey conducted from 2013-2015. The number of existing teeth was divided into three categories: 0-10, 11-20, and over 21, and the nutrition survey covers eating habits, food frequency and food intake using face-to-face interviews. Multiple logistic regression analysis was performed to evaluate the association between nutrient intake and the number of existing teeth after adjusting for socio-demographic factors and general and oral health behaviors and status. As age increases, the number of teeth decreases. Individuals with more teeth had a significantly higher mean daily intake of protein, calcium, phosphorus, potassium and riboflavin (p < 0.05). After adjusting for sociodemographic factors in model 1 and the lower number of teeth in model 2, the strength of the association between the number of teeth and daily calcium intake remained significant. Statistically significant associations were present for dietary potassium intake in models 1 and 2 and in the 11-20 teeth group in model 3 (p < 0.05). We demonstrated a significant association between calcium and potassium intake and the number of teeth.
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Affiliation(s)
- Eun-Jeong Kim
- Department of Dental Hygiene, Gangdong University, Chungcheong, Korea
- Dental Research Institute, Seoul National University, Seoul, Korea
| | - Hye-Ju Lee
- Dental Research Institute, Seoul National University, Seoul, Korea.
- Department of Dental Hygiene, College of Health Science, Sun Moon University, Asan, Korea.
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Dommisch H, Kuzmanova D, Jönsson D, Grant M, Chapple I. Effect of micronutrient malnutrition on periodontal disease and periodontal therapy. Periodontol 2000 2019; 78:129-153. [PMID: 30198127 DOI: 10.1111/prd.12233] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Periodontitis is a complex chronic inflammatory noncommunicable disease, initiated by the development of a dysbiotic microbial plaque biofilm below the gingival margin. Whilst the pathogenic biofilm is a "necessary cause" of periodontitis, it is insufficient on its own to cause the disease, and a destructive immune-inflammatory response is a key to the translation of risk to destructive events. Other exposures or "component causes" include individual genetic predisposition, lifestyle (including smoking and nutrition), and environmental factors. Dietary nutrients are essential for life as they provide crucial energy sources in the form of macronutrients, as well as important cofactors in the form of micronutrients, which regulate the functionality of enzymes during the regulation of anabolic and catabolic processes in human cells. Moreover, micronutrients can regulate gene transcription factors, such as the proinflammatory nuclear factor kappa B and the anti-inflammatory nuclear factor (erythroid-derived 2)-like 2. This review focuses on the role of vitamins (vitamin A, carotenoids, the vitamin B complex, vitamins C, D, and E, and coenzyme Q10) and minerals (calcium, magnesium, iron, zinc, potassium, copper, manganese, and selenium) in human physiology and the impact of their deficiencies upon periodontal health and disease.
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Affiliation(s)
- Henrik Dommisch
- Department of Periodontology and Synoptic Dentistry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Denica Kuzmanova
- Department of Periodontology and Synoptic Dentistry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Jönsson
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Melissa Grant
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Iain Chapple
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.,Birminham Community Health Foundation Trust, Birmingham, UK
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Martin-Cabezas R, Seelam N, Petit C, Agossa K, Gaertner S, Tenenbaum H, Davideau JL, Huck O. Association between periodontitis and arterial hypertension: A systematic review and meta-analysis. Am Heart J 2016; 180:98-112. [PMID: 27659888 DOI: 10.1016/j.ahj.2016.07.018] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/22/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several studies have shown that periodontal diseases are associated with hypertension (HT). However, heterogeneity among populations, diagnosis criteria, and shared risk factors represent some difficulties in terms of interpretation. Therefore, the aim of this study was to determine the magnitude of the association between periodontal diseases and HT. METHODS AND RESULTS A systematic review and meta-analysis, including studies published up to June 2016, have been performed. Sixteen studies assessing the association between periodontal diseases and HT have been included. The meta-analysis considering all included studies (moderate to severe periodontitis) showed that the presence of HT was associated with the presence of periodontal diseases (OR, 1.50; 95% CI, 1.27-1.78). To reduce potential bias, a stratified analysis has been performed illustrating the impact of inclusion criteria and adjustments on the magnitude of the association. Interestingly, when only studies with secure diagnosis of severe periodontitis and HT were considered, an OR=1.64 (95% CI, 1.23-2.19) has been measured. CONCLUSIONS Periodontal diseases are associated with a higher risk of HT especially for severe periodontitis. However, no conclusions could be made regarding the causative involvement of periodontal diseases mainly due to the reduced number of available prospective studies and remaining questions regarding underlying biological mechanisms.
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Affiliation(s)
- Rodrigo Martin-Cabezas
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Department of Periodontology, Strasbourg, France
| | - Narendra Seelam
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Department of Periodontology, Strasbourg, France
| | - Catherine Petit
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Department of Periodontology, Strasbourg, France
| | - Kévimy Agossa
- University of Lille, Dental Faculty, Department of Periodontology
| | - Sébastien Gaertner
- Service Hypertension, maladies vasculaires et pharmacologie clinique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Henri Tenenbaum
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Department of Periodontology, Strasbourg, France; INSERM 1109 «Osteoarticular & Dental Regenerative Nanomedicine», Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Jean-Luc Davideau
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Department of Periodontology, Strasbourg, France; INSERM 1109 «Osteoarticular & Dental Regenerative Nanomedicine», Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Olivier Huck
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Department of Periodontology, Strasbourg, France; INSERM 1109 «Osteoarticular & Dental Regenerative Nanomedicine», Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.
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A Systematic Review on the Implication of Minerals in the Onset, Severity and Treatment of Periodontal Disease. Molecules 2016; 21:molecules21091183. [PMID: 27617985 PMCID: PMC6273540 DOI: 10.3390/molecules21091183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/25/2016] [Accepted: 08/31/2016] [Indexed: 12/16/2022] Open
Abstract
Periodontal disease is an inflammatory disease with high prevalence in adults that leads to destruction of the teeth-supporting tissues. Periodontal therapy has been traditionally directed at reduction of the bacterial load to a level that encourages health-promoting bacteria and maintenance of oral-hygiene. The role of nutrition in different chronic inflammatory diseases has been the subject of an increasing body of research in the last decades. In this sense, there has been an important increase in the volume of research on role of nutrition in periodontitis since the diet has known effects on the immune system and inflammatory cascades. Minerals play a key role in all these processes due to the multiple pathways where they participate. To clarify the role of the different minerals in the establishment, progression and/or treatment of this pathology, a systemically review of published literature cited in PubMed until May 2016 was conducted, which included research on the relationship of these elements with the onset and progression of periodontal disease. Among all the minerals, calcium dietary intake seems important to maintain alveolar bone. Likewise, dietary proportions of minerals that may influence its metabolism also can be relevant. Lastly, some observations suggest that all those minerals with roles in immune and/or antioxidant systems should be considered in future research.
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Ollikainen E, Saxlin T, Tervonen T, Suominen AL, Knuuttila M, Jula A, Ylöstalo P. Association between periodontal condition and hypertension in a non-smoking population aged 30-49 years: results of the Health 2000 Survey in Finland. J Clin Periodontol 2014; 41:1132-8. [PMID: 25256004 DOI: 10.1111/jcpe.12316] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2014] [Indexed: 11/27/2022]
Abstract
AIM The aim of this cross-sectional study was to investigate whether periodontal condition is associated with hypertension and systolic blood pressure. MATERIALS AND METHODS The study population consisted of dentate, non-diabetic, non-smoking individuals aged 30-49 years (n = 1296) in the national Health 2000 Survey in Finland. The number of teeth with deepened (≥4 mm) and deep (≥6 mm) periodontal pockets and the number of sextants with gingival bleeding were used as explanatory variables. Hypertension and systolic blood pressure were used as outcome variables. RESULTS There was no consistent association between the number of teeth with deepened (≥4 mm) (OR 0.98, 95% CI 0.95-1.01) or deep (≥6 mm) (OR 1.01, 95% CI 0.90-1.12) periodontal pockets and hypertension after adjusting for confounding factors. Nor was there any essential association between the number of bleeding sextants and hypertension. CONCLUSIONS Periodontal pocketing and gingival bleeding did not appear to be related to hypertension in non-diabetic, non-smoking individuals aged 30-49 years. Further studies using experimental study designs would be required to determine the role of infectious periodontal diseases in the development or progression of hypertension.
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Liu Z, Peng J, Lu F, Zhao Y, Wang S, Sun S, Zhang H, Diao Y. Salt loading and potassium supplementation: effects on ambulatory arterial stiffness index and endothelin-1 levels in normotensive and mild hypertensive patients. J Clin Hypertens (Greenwich) 2013; 15:485-96. [PMID: 23815537 PMCID: PMC8033958 DOI: 10.1111/jch.12109] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 02/27/2013] [Accepted: 03/06/2013] [Indexed: 12/25/2022]
Abstract
The authors investigated effects of excessive salt intake and potassium supplementation on ambulatory arterial stiffness index (AASI) and endothelin-1 (ET-1) in salt-sensitive and non-salt-sensitive individuals. AASI and symmetric AASI (s-AASI) were used as indicators of arterial stiffness. Plasma ET-1 levels were used as an index of endothelial function. Chronic salt-loading and potassium supplementation were studied in 155 normotensive to mild hypertensive patients from rural northern China. After 3 days of baseline investigation, participants were maintained sequentially for 7 days each on diets of low salt (51.3 mmol/d), high salt (307.7 mmol/d), and high salt+potassium (60 mmol/d). Ambulatory 24-hour blood pressure (BP) and plasma ET-1 were measured at baseline and on the last 2 days of each intervention. High-salt intervention significantly increased BP, AASI, s-AASI (all P<.001); potassium supplementation reversed increased plasma ET-1 levels. High-salt-induced changes in BP, s-AASI, and plasma ET-1 were greater in salt-sensitive individuals. Potassium supplementation decreased systolic BP and ET-1 to a significantly greater extent in salt-sensitive vs non-salt-sensitive individuals (P<.001). Significant correlations were identified between s-AASI and ET-1 change ratios in response to both high-salt intervention and potassium supplementation (P<.001). Reducing dietary salt and increasing daily potassium improves arterial compliance and ameliorates endothelial dysfunction.
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Affiliation(s)
- Zhendong Liu
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
| | - Jie Peng
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education and Chinese Ministry of Public HealthShandong University Qilu HospitalJinanShandongChina
| | - Fanghong Lu
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
| | - Yingxin Zhao
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
| | - Shujian Wang
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
| | - Shangwen Sun
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
| | - Hua Zhang
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
| | - Yutao Diao
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
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Abstract
Potassium was identified as a shortfall nutrient by the Dietary Guidelines for Americans 2010 Advisory Committee. The committee concluded that there was a moderate body of evidence of the association between potassium intake and blood pressure reduction in adults, which in turn influences the risk of stroke and coronary heart disease. Evidence is also accumulating of the protective effect of adequate dietary potassium on age-related bone loss and reduction of kidney stones. These benefits depend on organic anions associated with potassium as occurs in foods such as fruits and vegetables, in contrast to similar blood pressure-lowering benefits of potassium chloride. Benefits to blood pressure and bone health may occur at levels below current recommendations for potassium intake, especially from diet, but dose-response trials are needed to confirm this. Nevertheless, intakes considerably above current levels are needed for optimal health, and studies evaluating small increases in fruit and vegetable intake on bone and heart outcomes for short periods have had disappointing results. In modern societies, Western diets have led to a decrease in potassium intake with reduced consumption of fruits and vegetables with a concomitant increase in sodium consumption through increased consumption of processed foods. Consumption of white vegetables is associated with decreased risk of stroke, possibly related to their high potassium content. Potatoes are the highest source of dietary potassium, but the addition of salt should be limited. Low potassium-to-sodium intake ratios are more strongly related to cardiovascular disease risk than either nutrient alone. This relationship deserves further attention for multiple target tissue endpoints.
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Shetty D, Dua M, Kumar K, Dhanapal R, Astekar M, Shetty DC. Oral hygiene status of individuals with cardiovascular diseases and associated risk factors. Clin Pract 2012; 2:e86. [PMID: 24765485 PMCID: PMC3981199 DOI: 10.4081/cp.2012.e86] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 07/30/2012] [Accepted: 08/30/2012] [Indexed: 12/21/2022] Open
Abstract
Dentist and oral health screening may be the latest weapon in identifying persons at risk of cardiovascular disease. Oral infections, specifically periodontitis, may confer independent risks for different systemic conditions. The risk factors associated with cardiovascular diseases also suggest that the relationship between periodontal disease and diabetes works in both ways. The aim of this study was to support and strengthen the association and relationship between oral hygiene status of individuals with cardiovascular diseases and its associated risk factors. A simple random sampling was carried out in 200 inhabitants of Western Utter Pradesh, India. An oral health visit and examination was made for an equal number of males and females of different age groups with cardiovascular diseases. Evaluation of the oral status was made by means of an oral hygiene index, community periodontal index of treatment needs and loss of attachment. Evaluation of oral status in patients with cardiovascular diseases and in the control group has shown a statistically significant low level of oral health in patients with cardiovascular diseases as compared to control. Prevalence of systemic diseases in different age groups significantly correlated with the prevalence of severe periodontal diseases. Treating gum disease may reduce the risk of heart disease and improve health outcomes for patients with periodontal disease and vascular heart problems.
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Affiliation(s)
- Divya Shetty
- Department of Orthodontics, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad (U.P)
| | - Mahima Dua
- Oral and Maxillofacial Pathology and Microbiology, Inderprastha Dental College, Sahibabad, Ghaziabad (U.P)
| | - Kiran Kumar
- Oral and Maxillofacial Pathology and Microbiology, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad (U.P)
| | - Raghu Dhanapal
- Oral and Maxillofacial Pathology and Microbiology, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad (U.P)
| | - Madhusudan Astekar
- Oral and Maxillofacial Pathology and Microbiology, Pacific Dental College and Hospital, Debari, Udaipur, Rajasthan, India
| | - Devi Charan Shetty
- Oral and Maxillofacial Pathology and Microbiology, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad (U.P)
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Kebapcilar L, Hakki SS. Letter to the editor: re: role of smoking and type 2 diabetes in the immunobalance of advanced chronic periodontitis. J Periodontol 2012; 83:1204-5. [PMID: 23016920 DOI: 10.1902/jop.2012.110678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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